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FACTORS INFLUENCING MATERNAL
HEALTH INDICATORS AMONG TRIBAL
POPULATION IN MAHARASHTRA WITH
SPECIAL FOCUS ON FIVE HIGH
PRIO...
INTRODUCTION
 Health - a state of complete physical, mental, and social well-being and not
merely the absence of disease ...
Conceptual Framework – WHO 2008
http://whqlibdoc.who.int/publications/2010/9789241500852_eng.pdf
KEY SOCIAL SECTOR EXPENDITURE: MAHARASHTRA
 Much of the tribal budget goes towards infrastructure development, but there is
barely enough budget for the maintenance...
 Early age marriages. (SS Nerkar et al. 2016)
 Dependency of tribal people upon spiritual security they receive from the...
 Poor spending on health.
 Trend towards self-treating themselves through herbal medicines or allopathic
medicines bough...
PROFILE OF 5 HPD DISTRICTS
 Dhule, Gadchiroli, Jalgaon,
Nanded, and Nadurbar
 Issues related with equitable health
care ...
The Major ST groups in the 5 HPDs (Census 2011)
District Major tribal groups in rural area (>1000 population)
Nandurbar Bh...
THE SOCIO ECONOMIC PROFILE OF THE THE TRIBAL
POPULATION – SECC 2011
GENDER (CENSUS 2011 & SECC 2011)
Gender specific indicators Maha
rashtr
a
Rural
Women owning a house and/or
land (alone or...
Education status of Women (7-80+) in five HPDs
(Census 2011)
MIGRATION
 Chief Minister of Maharashtra: Lack of nourishment coupled
with sustained earning that often lead to migration...
FOOD AND FOOD SECURITY
A report of enquiry based on the Starvation, Malnutrition and Malnutrition
Related Deaths of Childr...
GENETICS
 The prevalence of sickle cell hemoglobin (HbS), beta-thalassemia trait and G6PD
among some important Gond relat...
Sr. No Tribal Group District Sickle Cell Carriers (%)
1 Otkar Gadchiroli 35
2 Pardhan Nanded 33.7
3 Pawara Dhule, Jalgaon ...
AVAILABILITY OF HEALTH FACILITIES
*Tiers of Health Care Infrastructure and the Applicable Population Norms
Centre Hilly/Tr...
Building Position for Sub Centres, PHCs, and CHCs in Tribal Areas (as on 31st March 2015)Maharashtra
Maharashtra
Total Num...
CHANGES IN THE STATUS OF HDI
HMIS COMPOSITE INDEX OF 5 HPDS DURING 2012-15
(NRHM)
Districts
Composite Index
Overall Index Pregnancy care
Postnatal
mate...
CONCLUSION AND RECOMMENDATIONS
 Necessity of tailored programmes with a focus on the social determinants of
health influe...
Factors influencing maternal health indicators among tribal population in maharashtra with special focus on five high prio...
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Factors influencing maternal health indicators among tribal population in maharashtra with special focus on five high priority districts

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Introduction: Despite the implementation of National Rural Health Mission (NRHM), five high priority districts (HPDs) which are tribal in nature in Maharashtra show poor composite index in terms of maternal health indicators.
Objective: To find out the determinants influencing maternal health indicators among tribal population in five HPDs.
Methods: Various secondary data sources on the five HPDs in Maharashtra were reviewed.
Results: The available data suggests that five levels of determinants such as individual characteristics, family structure, community profile, cultural practises, availability, and accessibility of health infrastructure and facilities, district profile, and the governance issues, are influencing the maternal health Indicators.
Conclusion: Coordinated efforts are required for developing resources and agencies for the empowerment of this population in the long run. Tailor-made programmes to influence the health seeking behaviour of tribal mothers would play an important role and would bring about improvement in the maternal health indicators in these districts.

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Factors influencing maternal health indicators among tribal population in maharashtra with special focus on five high priority districts

  1. 1. FACTORS INFLUENCING MATERNAL HEALTH INDICATORS AMONG TRIBAL POPULATION IN MAHARASHTRA WITH SPECIAL FOCUS ON FIVE HIGH PRIORITY DISTRICTS Ajeesh Sebastian & Shahina Begum Dept. of Biostatistics National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra
  2. 2. INTRODUCTION  Health - a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. (WHO. 1948)  Main determinants of health include The social and economic environment,  the physical environment, and, The person's individual characteristics and behaviors. (WHO, 2008)  The inequities in how society is organized mean that the freedom to lead a flourishing life and to enjoy good health is unequally distributed between and within societies. (WHO commission on social Determinants of Health, 2008)
  3. 3. Conceptual Framework – WHO 2008 http://whqlibdoc.who.int/publications/2010/9789241500852_eng.pdf
  4. 4. KEY SOCIAL SECTOR EXPENDITURE: MAHARASHTRA
  5. 5.  Much of the tribal budget goes towards infrastructure development, but there is barely enough budget for the maintenance of those assets, or for human development. (Krishna, S. 2016)  Poor planning and implementation Eg: The Dr APJ Abdul Kalam Amrut Ahar Yojna. (DNA report,2016)  Poor utilization by the target population. Eg: JSY evaluation(PP Doke, UH Gawande, SR Deshpande. 2015) SCHEMES FOR SCHEDULED TRIBE
  6. 6.  Early age marriages. (SS Nerkar et al. 2016)  Dependency of tribal people upon spiritual security they receive from their traditional healers.  Practises for normal delivery by making changes in food consumption (CJ Sonowal. 2010, Jungari and B Paswan.2016, Dilnaz Boga. 2015)  Child feeding practises. (Neonatal Disease Surveillance Study - 2006-07)  Spacing between deliveries. (Niswade A et al. 2011)  All the household level hard work continues even during pregnancy. (SS Nerkar et al. 2016) CULTURE
  7. 7.  Poor spending on health.  Trend towards self-treating themselves through herbal medicines or allopathic medicines bought from a pharmacy also reported.  Embarrassment to discuss reproductive problems (A Shukla. 2012). HEALTH SEEKING BEHAVIOUR
  8. 8. PROFILE OF 5 HPD DISTRICTS  Dhule, Gadchiroli, Jalgaon, Nanded, and Nadurbar  Issues related with equitable health care and poor performance in health outcomes. (PIB. 2015)  listed in the Backward Regions Grant Fund Programme under Ministry of Panchayati Raj (PIB.2012)  These districts are characterized by agrarian economy and majority of its population lives in rural areas. (Census. 2011; NRHM PIPs. 2008- 14)
  9. 9. The Major ST groups in the 5 HPDs (Census 2011) District Major tribal groups in rural area (>1000 population) Nandurbar Bhil, Kokna, Gamit, Koli Mahadev, Dhanka, Koli Dhor Dhule Bhil, Kokna, Koli Dhor, Gamit, Pardhi, Koli Mahadev, Thakur Jalgaon Bhil, Koli Dhor, Koli Mahadev, Pardhi, Dhanka, Thakur, Naikda, Koli Malhar, Korku Gadchiroli Gond, Pardhan, Halba, Kawar, Oraon Nanded Andh, Koli Mahadev, Kolam, Gond, Bhil, Pardhan, Naikda, Pardhi, Thakur Growth rate of tribal population in five HPD districts between 2001 and 2011 Dhule -4.59%, Gadchiroli - 1.17%, Jalgaon - 3.86%, Nanded - 1.1%, Nandurbar - 3.28%
  10. 10. THE SOCIO ECONOMIC PROFILE OF THE THE TRIBAL POPULATION – SECC 2011
  11. 11. GENDER (CENSUS 2011 & SECC 2011) Gender specific indicators Maha rashtr a Rural Women owning a house and/or land (alone or jointly with others) (%) 33.3 Women having a bank or savings account that they themselves use (%) 38.7 The tribal land holdings are characterized by men ownership. The share of women who hold land is critically low. (Alkira S. et al. 2012)
  12. 12. Education status of Women (7-80+) in five HPDs (Census 2011)
  13. 13. MIGRATION  Chief Minister of Maharashtra: Lack of nourishment coupled with sustained earning that often lead to migration was a cause of serious concern in tribal areas of Maharashtra. (Khapre. 2014)  Migration to other parts of the state as well as to neighbouring states in search of seasonal jobs under contractors. (CJ Sonowal. 2010)  Tough to track pregnant women. (D Kulkarni. 2015)
  14. 14. FOOD AND FOOD SECURITY A report of enquiry based on the Starvation, Malnutrition and Malnutrition Related Deaths of Children in 15 Tribal Districts of Maharashtra points out:  Unstable cereal production  20 to 50 percent landless labour households who consume less than 2300 calorie value of food  Production of jawar & bajra is coming down and is substituted by the production of cash crops.  huge deficit between the recommended norm and what is available for consumption in respect of cereals, sugar, pulses, vegetables, fruits, oil/fat, milk, meat and fish.  The existing PDS does not distribute coarse cereals such as jawar, bajra and ragi for which members of tribal households have a preference.  PDS caters to only 50 percent of the requirements of a family .
  15. 15. GENETICS  The prevalence of sickle cell hemoglobin (HbS), beta-thalassemia trait and G6PD among some important Gond related endogamous tribes in Maharashtra, India. The HbS gene frequency varies from 0.0530 to 0.1805, the beta-thal gene from 0 to 0.0283 and Gd- gene from 0.0189 to 0.1120. (Rao VR and Gorakshakar AC. 1990)  Glucose-6-phosphate-dehydrogenase (G6PD) deficiency was observed in the Gamits (31.4%), and Bhils (16.3%) in Maharashtra. Deficiency of this enzyme is highly polymorphic in those areas where malaria is/has been endemic. (Mukherjee MB et al. 2015)
  16. 16. Sr. No Tribal Group District Sickle Cell Carriers (%) 1 Otkar Gadchiroli 35 2 Pardhan Nanded 33.7 3 Pawara Dhule, Jalgaon 25.18 4 Madia, Gond Gadchiroli 20.8 5 Bhil Nandurbar 20.6 6 Halbi Gadchiroli 13.93 8 Rajgond Gadchiroli 10.88 10 Tandvi Jalgaon 8.33 14 Kokana Dhule 3.50 15 Andha Nanded 1.97 % of sickle cell carriers in different tribal groups in five HPD districts
  17. 17. AVAILABILITY OF HEALTH FACILITIES *Tiers of Health Care Infrastructure and the Applicable Population Norms Centre Hilly/Tribal/Difficult Area (as per norms) Situation in Tribal Areas of Maharashtra including 5 HPDs (in reality) Sub-Centre 3000 4378.258 Primary Health Centre 20000 28590.72 Community Health Centre 80000 134419.1 *Ministry of Tribal Affairs, Statistical Profile of Scheduled Tribes in India 2013 Number of Sub Centres, PHCs & CHCs in Tribal Areas (as on 31st March 2015) State/ UT Tribal Population Sub Centres PHCs CHCs Required Shortfall Required Shortfall Required Shortfall Maharashtra 9006077 3002 945 450 135 112 45
  18. 18. Building Position for Sub Centres, PHCs, and CHCs in Tribal Areas (as on 31st March 2015)Maharashtra Maharashtra Total Number of Sub Centres functioning Buildings required to be constructed Total Number of PHCs functioning Buildings required to be constructed Total Number of CHCs functioning Buildings required to be constructed 2057 220 315 26 67 7 Human Resource Required In position Shortfall Health Worker [F] / ANM at Sub Centre & PHC 2372 6833 0 Health Worker [M] at Sub Centre 2057 1375 682 Health Assistants [Male] at PHCs 315 700 0 Health Assistants [Female] / LHV at PHCs 315 739 0 Total Specialist at Community Health Centres 268 83 185 Obstetricians & Gynaecologists at CHC 67 29 38 Surgeon at CHCs 67 16 51 Physicians at CHCs 67 15 52 Nursing Staff at PHCs & CHCs 784 646 138 Lab Technicians at PHCs & CHCs 382 400 0
  19. 19. CHANGES IN THE STATUS OF HDI
  20. 20. HMIS COMPOSITE INDEX OF 5 HPDS DURING 2012-15 (NRHM) Districts Composite Index Overall Index Pregnancy care Postnatal maternal & new born care Reproductive age group 2014- 15 2013- 14 2012- 13 2014- 15 2013- 14 2012- 13 2014- 15 2013- 14 2012- 13 2014- 15 2013- 14 2012- 13 Dhule 0.4058 0.3599 0.3545 0.3157 0.3204 0.341 0.5713 0.336 0.3985 0.2909 0.395 0.2755 Gadchiroli 0.532 0.6119 0.5766 0.6579 0.7675 0.7612 0.5199 0.5666 0.5354 0.4391 0.58 0.4831 Jalgaon 0.4821 0.5309 0.4985 0.5063 0.5275 0.4408 0.5172 0.591 0.6388 0.2717 0.3833 0.2926 Nanded 0.4889 0.5298 0.5246 0.5901 0.6327 0.6175 0.6229 0.6592 0.6056 0.0596 0.0461 0.0828 Nandurbar 0.3843 0.4576 0.3909 0.4524 0.5686 0.5083 0.4945 0.5397 0.5365 0.2242 0.2832 0.1609
  21. 21. CONCLUSION AND RECOMMENDATIONS  Necessity of tailored programmes with a focus on the social determinants of health influencing the maternal health indicators.  Need to encourage context-specific and culturally and socially acceptable provisioning of care.  Addressing the social determinants of health through health system strengthening and inter-sectoral convergence.  Improved community participation. ----------------------------------------------------------------------------------------------- Thank you

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