UG presentation for tribal health, Depicts their problems.

1. Tribal Health In India
Dr Shreyash Mehta
Professor
Dept. of Community Medicine
GAIMS

2. Introduction
• Schedule tribe- 1st Constitution of India
• 104 million tribal people live, 705 tribes and 8.6% population
• Remained marginal geographically, socio-economically, politically so
health and health care in tribal area remains unsolved

3. Demographic profile
• Concentrated in 10 states and 8 North Eastern States
• 90% in rural India
• Madhya Pradesh- largest- 15 million
• Maharashtra- 10 million
• Odisha- 9 million
• Rajasthan- 9 million
• Concentration highest in North Eastern states- hilly and forested areas
• Males- 52.5 million, Females- 52

4. Demographic profile
• Fertility rate- 2.48, reasonable
• Sex ratio in 2011, 990 >943 (national)
• Child sex ratio (0-6 yr) declined from 972 to 957 (>914-general
population)
• Literacy rate- 2001: 47.1 % to 2011: 59%
• Life expectancy- 63.9 years< 67 years (general population)
• MMR- no recent estimate available
• But risk factors are there- early marriage, early child birth, low BMI
and high incidence of anaemia

6. Demographic profile
• 68%- institutional delivery< 78.9 (national average)
• 71.5% of delivery are conducted by skilled health personnel
• PNC coverage poor
• 37% receiving PNC care with 48 hours
• After NFHS 5, estimated IMR was 41.6
• 1-4 year child mortality rate- 9.0
• Neonatal mortality rate- 28.8/1000
• Immunization coverage lower
• Stunting, wasting, under weight –reduced
• Malnutriton- still higher

8. Burden of Diseases in Tribal Community
• Epidemiological transition
• Health care needs –more than RMNCH+A
• Triple burden of disease-
• Malnutrition &
• Communicable Disease (malaria,TB)- rampant,urbanization
• Non Communicable Diseases- cancer,HT,DM- env. Distress lifestyle
changes
• Mental illness- Addictions

9. Communicable Diseases
• Disproportionate burden- TB,malaria, leprosy, STD, AIDS/HIV, skin
infections, ADD, hepatitis
• A. TB- estimated prevalence higher- tribal 703- general 256/ 1,00,000
• NTEP free diagnosis and treatment to all.
• Newer interventions
• 40,000 diagnosed since 2015
• To improve access, provision for:
• 1. additional TB unit and DMC
• 2. Compensational for transport & attendant
• 3. Higher salary- contractual staff
• 4. Enhanced vehicle maintenance and TA
• 5. Provision TBHV- urban areas

10. Communicable Disease- TB
• Initiative will intensify case findings
• Door to door case finding- Phase-1- Jan 2017, Phase-2- July Aug- 2017
• Screened 72,000 tribal population- 27 additional TB cases
• Most significant aspect- Mobile TB Diagnostic Van ( MTDV) equipped with X
ray, sputum microscopy facility and other diagnostic services at doorstep
• Initially 5 states- MP, GJ, CHHG, RAJ, JH- 17 districts, 35 MTDV- deployed
• Project covers- 17.65 million
• Result- Improve STD of Care
• Efforts- Improve early care seeking, reduction out of pocket expenditure

11. Communicable Diseases- Leprosy
• Data collected on monthly basis
• 2016-17- 25,474(18.90%)-ST & 25,449 (18.78%) SC out of 1,35,485
cases
• Facilities uniformly available
• Funds provided NGO- work in tribal area- do IEC- prevention of
deformity- follow up of cases

12. Communicable Diseases- Malaria and VBDS
• Tribal community- 8% of population but account 30% of all malaria
cases,60% of which are P.falciparum- 50% of mortality associated with
malaria
• Under NVBDCP services are available uniformly
• VBDs prevalent in low socio economic class, attention given to tribal
areas of NE states, Andhra Pradesh, Chhatisgarh, Gujarat, Jharkhand,
Karnataka, MP, Maharashtra, Odisha.
• Provision of additional funds from World Bank/Global funds/projects
for Malaria in NE states
• Also for Kala Azar elimination in Bihar, Jharkhand, WB

13. Non Communicable Diseases
• A. Hypertension- 1 out of 4 tribal suffers
• Prevalence significantly increases with age, tobacco consumption, alcohol, and
sedentary lifestyle
• 2 out of 3 don’t know sign and symptoms
• B. Blindness and visual impairment-
• NPCB centrally sponsored (90:10 –NE states, other states 60:40)
• Initiatives taken-
• Assistance for construction of dedicated eye units in NE states
• Appointment of contractual ophthalmic manpower
• Assistance for setting up multipurpose district mobile ophthalmic units for
diagnosis and medical management of eye disease for coverage in difficult
areas

14. Genetic Diseases
• Prevalence of Sickle cell disease and thalassaemia
• Varies 1-40% in different tribal populations
• Most of the prevalence is due to heterozygous form of disease
• Sickle cell anaemia more serious form: 1in 86 births
• G6PD deficiency- among 14 primitive tribal populations; from 4
different states show high frequency of sickle gene, the prevalence of
G6PD deficiency varied - 0.7 to 15.6%

15. Mental Health and addictions
• 72% of tribal men in 15-54 year age group use tobacco – 56% non
tribal
• 50%- tribal consume alcohol
• Tobacco and alcohol risk factors for NCD
• Decrease productivity, disrupt family harmony and generate lawand
order problems

16. Animal attacks and violence in conflict areas
• Surrounded by forests so more cases of animal bites, snake bites and
scorpion bites

17. Health Infrastructure and Tribal development
• Tribal development a challenge- planners and policymakers
• Due to traditional lifestyle, remoteness of habitation, dispersed
population,displacement
• Tribal Sub Plan – Scheduled Tribe Component- adopted in 5th five year
plan
• Ministry of Tribal Affairs and Ministry of Health and Family Welfare
are making efforts through tailored educational, infrastructural,
livelihood schemes for improvement of various indicators like literacy,
health, socio economic status
• But significant gap as compared to general population

18. Facilities for scheduled tribes under NHM
• One Sub center/HWC- 2000 population
• One PHC- 20,000 population
• Data of required vs short fall was generated
• Subcentre- 7 states no shortfall, 11 shortfall; 4996; 27%
• PHC- 11 states no shortfall, 7 states short fall- 1,023 short; 40%
• CHCs- 8 states no shortfall,10 states short fall- 209- 31%
• UT- 8% shortfall in SC and 1 CHC

19. Human Health Resource
• Huge gap in HR in HC
• Limited scope of social interaction, social and professional isolation, weak HR policies, poor
working conditions
• Efforts made to overcome shortage of doctors
• Compulsory bond of rural service
• Expert committee formed in Oct 2013, following measures to improve HR for tribal health:
• 1. local tribal preferred
• 2. training of local tribal and deployment
• 3. doctors and specialists- closer to community
• ASHA- expanded role
• Midlevel- bridge course
• MO-salary increased
• Dedicated Medical College

20. • Thank you