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  2. 2. CONTENTS <ul><li>Definition </li></ul><ul><li>Part Of Indian Constitution </li></ul><ul><li>Map </li></ul><ul><li>Population Distribution </li></ul><ul><li>Different Types Of Tribes </li></ul><ul><li>Tribal Education </li></ul><ul><li>Tribal Health </li></ul><ul><li>Improper Nutrition </li></ul><ul><li>Communicable Diseases </li></ul><ul><li>Genetic Disorders </li></ul><ul><li>Health Infrastructure </li></ul><ul><li>Social And Cultural Issues </li></ul><ul><li>Example Of Maharashtra </li></ul><ul><li>High Disease Burden </li></ul><ul><li>Factors Contributing To Increased Disease Burden </li></ul><ul><li>Older Govt Initiatives </li></ul><ul><li>Additions After 9 th Five Year Plan </li></ul><ul><li>Obstacles In Set Up </li></ul><ul><li>Strategies To Improve Health Care In Tribal Areas </li></ul><ul><li>Some Suggestions </li></ul><ul><li>Tribal Health Development Organization </li></ul><ul><li>Conclusion </li></ul><ul><li>Acknowledgement </li></ul><ul><li>References </li></ul>
  3. 3. DEFINITION <ul><li>Ādivāsīs (Devanagri: आदिवासी , literally: old inhabitants) is a term used for all the heterogeneous set of ethnic and tribal groups believed to be the aboriginal population of India. </li></ul>
  4. 4. PART OF INDIAN CONSTITUTION <ul><li>Officially recognized by the Indian government as &quot;Scheduled Tribes&quot; in the Fifth Schedule of the Constitution of India, they are often grouped together with scheduled castes in the category &quot;Scheduled Castes and Tribes&quot;, which is eligible for certain affirmative action measures. </li></ul><ul><li>Scheduled Castes 16.2% </li></ul><ul><li>Scheduled Tribes 8.02% </li></ul><ul><li>(As per 2001 census) </li></ul>
  5. 6. POPULATION DISTRIBUTION <ul><li>Tribal peoples constitute 8.2% of the nation's total population. </li></ul>
  6. 7. <ul><li>In the Northeastern states of Arunachal Pradesh, Meghalaya, Mizoram, and Nagaland - 90% Tribal population. </li></ul><ul><li>In the remaining Northeast states of Assam, Manipur, Sikkim, and Tripura -Tribal population between 20% and 30% </li></ul>POPULATION DISTRIBUTION
  7. 8. <ul><li>Central Indian states have the country's largest tribes, and, taken as a whole, roughly 75% of the total tribal population live there. </li></ul>POPULATION DISTRIBUTION
  8. 9. <ul><li>One concentration lives in a belt along the Himalayas stretching through Jammu and Kashmir, Himachal Pradesh, and Uttarakhand in the West, to the Northeast. </li></ul>POPULATION DISTRIBUTION
  9. 10. <ul><li>Another concentration lives in the hilly areas of central India (Chhattisgarh, Madhya Pradesh, Orissa and, to a lesser extent, Andhra Pradesh) </li></ul>POPULATION DISTRIBUTION
  10. 11. <ul><li>Small numbers of tribal people in Karnataka, Tamil Nadu, and Kerala in South India. </li></ul><ul><li>In Western India in Gujarat and Rajasthan. </li></ul><ul><li>In the Union Territories of Lakshadweep and the Andaman and Nicobar Islands. </li></ul>POPULATION DISTRIBUTION
  12. 13. TRIBAL EDUCATION <ul><li>Efforts to improve a tribe's educational status have had mixed results. </li></ul><ul><li>Recruitment of qualified teachers and determination of the appropriate language of instruction also remain troublesome. </li></ul><ul><li>Many tribal schools are plagued by high dropout rates. </li></ul>
  13. 14. TRIBAL HEALTH <ul><li>Tribes usually remain isolated. </li></ul><ul><li>Majority of them have poor health status. </li></ul><ul><li>Inadequate health infrastructure. </li></ul>
  14. 15. IMPROPER NUTRITION <ul><li>Deficiency of essential components in diet leading to malnutrition, protein calorie malnutrition and micronutrient deficiencies. </li></ul><ul><li>Goitre of various grades is also endemic in some of the tribal areas. </li></ul>
  15. 16. COMMUNICABLE DISEASES <ul><li>Water borne and communicable diseases: Gastrointestinal disorders are very common, leading to marked morbidity and malnutrition. </li></ul><ul><li>Malaria and tuberculosis. </li></ul><ul><li>Spectrum of viral and venereal diseases. </li></ul>
  16. 17. GENETIC DISORDERS <ul><li>High prevalence of genetic disorders mostly involving red blood cells: Genetically transmitted disorders like sickle cell anaemia, </li></ul><ul><li>Glucose 6 phosphate dehydrogenase deficiency and different forms of thalassaemia are also common. </li></ul>
  17. 18. HEALTH INFRASTRUCTURE <ul><li>The inadequate health infrastructure for these peculiar health needs of the tribes is also a major factor. </li></ul><ul><li>Lack of maternal and child health services among the hilly tribal areas. </li></ul><ul><li>The tribal demographic scenario is one of high fertility, high maternal and infant mortality rates. </li></ul>
  18. 19. SOCIAL AND CULTURAL ISSUES <ul><li>Superstitions particularly related to health problems. </li></ul><ul><li>Extreme poverty. </li></ul><ul><li>Excess consumption of alcohol. </li></ul>
  19. 20. EXAMPLE OF MAHARASHTRA 12% 86% Delivery by TBA 4.2 3.8 Family Size 40% 28% LBW babies Not available 2 Maternal mortality rate 13 7.9 Crude death rate 110 59 Infant mortality rate Tribal Situation Situation in Maharashtra Indicators
  20. 21. HIGH DISEASE BURDEN <ul><li>Poverty and under nutrition </li></ul><ul><li>Poor sanitation, lack of safe drinking water </li></ul><ul><li>Diseases which are more prevalent in tribals </li></ul><ul><li>Lack of awareness about and access to health care </li></ul><ul><li>Social and economic barriers to utilisation </li></ul>
  21. 22. FACTORS CONTRIBUTING TO INCREASED DISEASE BURDEN <ul><li>Poverty and consequent undernutrition; </li></ul><ul><li>Poor environmental sanitation, poor hygiene and lack of safe drinking water. </li></ul><ul><li>Lack of access to health care facilities resulting in increased severity and/or duration of illness; </li></ul><ul><li>Social barriers preventing utilization of available health care services. </li></ul><ul><li>Specific diseases they are prone to such as genetic diseases (G-6 PD deficiency), infections (Yaws) etc. </li></ul>
  22. 23. <ul><li>Till June 30, 1996 there were 20097 sub-centres functioning against a requirement of 28383 sub-centres for tribal areas. </li></ul><ul><li>The number of functioning PHCs were 3260 against a requirement of 4180 and functioning CHCs were 446 against a requirement of 492. </li></ul><ul><li>There are also 1122 Dispensaries and 120 Hospitals and 78 Mobile Clinics in Modern Medicine . </li></ul><ul><li>1106 Dispensaries and 24 Hospitals in Ayurveda. </li></ul><ul><li>251 Dispensaries and 28 Hospitals in Homeopathy. </li></ul>OLDER GOVERNMENT INITIATIVES
  23. 24. ADDITIONS AFTER 9 TH FIVE YEAR PLAN <ul><li>16,845 Sub Centres, 5987 PHCs and 373 CHCs have been established in Scheduled Caste Basties/Villages - 20% or more Scheduled Caste population. </li></ul><ul><li>In addition 980 Dispensaries in Modern Medicine, 1042 Ayurvedic Dispensaries, 480 Homeopathic Dispensaries, 68 Unani/Siddha. </li></ul><ul><li>Mobile dispensaries and camps were organised to provide health facilities wherever feasible. </li></ul>
  24. 25. OBSTACLES IN SET UP <ul><li>Lack of both professional and paraprofessional manpower. </li></ul><ul><li>The State Governments are trying to minimize vacancies . </li></ul><ul><li>A Central Planning Committee has been set up to review the health care activities in 39 districts of 12 States . </li></ul>
  25. 26. STRATEGIES TO IMPROVE HEALTH CARE IN TRIBAL AREAS <ul><li>Ensuring availability of adequate infrastructure and personnel. </li></ul><ul><li>Area specific RCH programmes. </li></ul><ul><li>100% central Plan funds for NMEP. </li></ul><ul><li>Effective implementation of the Health & Family Welfare programmes. </li></ul><ul><li>Close monitoring, early detection of problems in implementation and midcourse correction. </li></ul>
  26. 27. SOME SUGGESTIONS <ul><li>Improvement of healthcare infrastructure. </li></ul><ul><li>Developing a flawless referral system. </li></ul><ul><li>Provide diagnostic facilities for genetic defects. </li></ul><ul><li>Follow up of anemic and other severe patients. </li></ul><ul><li>Carry out population genetic survey programs. </li></ul><ul><li>Health education. </li></ul><ul><li>Genetic counseling. </li></ul><ul><li>Marriage counseling. </li></ul><ul><li>Provide prenatal diagnosis. </li></ul>
  27. 28. TRIBAL HEALTH DEVELOPMENT ORGANIZATION <ul><li>Tribal Health Initiative is a public registered charitable trust established in the small village of Sittilingi in Dharmapuri District, Tamil Nadu. </li></ul><ul><li>Fifteen years ago, in Sittilingi, one out of five babies died before they became a year old and many mothers died in childbirth.  </li></ul><ul><li>The nearest hospital was 48 kilometers away and to find one with surgical facilities meant a journey of over 100 kilometers.  </li></ul><ul><li>Today, Tribal Health Initiative runs a full-fledged 24 bed primary care hospital. </li></ul>
  28. 29. AIMS <ul><li>Bring all woman and children through childbirth alive and well. </li></ul><ul><li>Ensure children grow up well nourished. </li></ul><ul><li>Give easy, low cost access to good health care </li></ul><ul><li>Share their knowledge of health care with tribal communities so it becomes part of their wisdom and day to day experience. </li></ul><ul><li>To attain the highest possible level of physical, mental and social health . </li></ul><ul><li>To create an atmosphere highly conducive for the growth and development of local cultures and customs </li></ul>
  29. 30. WAY’S <ul><li>Regular clinics in all villages to see all pregnant mothers and children less than five years. </li></ul><ul><li>Refreshing and sharing knowledge with tribal women. </li></ul><ul><li>Tribal girls working as Health Workers. </li></ul><ul><li>Postnatal checkups in all villages once a week . </li></ul><ul><li>Health education and discussion of social problems. </li></ul><ul><li>Dramas and cultural shows to spread information. </li></ul><ul><li>Outpatients & Inpatients seen at the Tribal Hospital. </li></ul>
  30. 31. ACHIVEMENTS <ul><li>95% of pregnant mothers undergo checkups. </li></ul><ul><li>7 out of every 100 children still die during the first year. </li></ul><ul><li>Underweight children are only 30% compared to 50% earlier. </li></ul><ul><li>No mothers died in childbirth last 3 years. </li></ul>
  31. 32. CONCLUSION <ul><li>It is necessary to continue with primary health care educational activities, National health and tribal health programmes and other measures of providing proper nutrition and counseling and with the help from experts from multi-disciplinary fields, the health status of the tribal population can be improved. </li></ul>
  32. 33. ACKNOWLEDGEMENT <ul><li>Dr.Jayanti Roy Dutta </li></ul><ul><li>Dr.Manoj Kumar Sharma </li></ul><ul><li>Dr. Swaran Singh </li></ul><ul><li>Balakrishan </li></ul>
  33. 34. REFERENCES <ul><li>Health Problems of Tribal Population Groups from the State of Maharashtra, S. L. Kate </li></ul><ul><li>www.census of india 2001 </li></ul><ul><li> </li></ul><ul><li> </li></ul>
  34. 35. THANK YOU