The document describes the healthcare system of the Tibetan community in exile. It discusses the major health challenges faced by Tibetan refugees after fleeing to India in 1959. It outlines the development of the healthcare system from temporary medical camps in the early years, to establishing dispensaries and health centers in refugee settlements starting in the 1960s. The Department of Health of the Central Tibetan Administration was established in 1981 and now manages 54 health facilities across India and Nepal. The healthcare system relies heavily on community health workers to provide primary care in rural settlements due to the shortage of doctors.

1. HEALTHCARE SYSTEM OF THE TIBETAN
COMMUNITY IN EXILE
By:
Trinley Palmo (MPH)
Department of Health, CTA

2. INTRODUCTION
1959- His Holiness fled to India with about 80, 000 Tibetan
refugees
Major health challenges in the early resettlement era:
• Emotional trauma, grief and physical exhaustion
• Adjustment to new climate and diet
• Sickness and death due to illnesses like diarrhoea,
Tuberculosis, malaria and malnutrition
•Water and sanitation problems due to congested locations
in tent based temporary refugee camps in north India.

3. Major Health Challenges at present.
Tuberculosis
Hepatitis B
Chronic conditions like cancer and cardiovascular diseases.
Substance abuse in youth
Risk of HIV AIDS due to high mobility and low health
awareness.

4. Health system in the early resettlement era: 1960s and 1970s
Before formation of refugee settlements: (1959-1962)
Provision of medical care by Indian Government hospitals
to Tibetan refugees working as road laborers.
Few Tibetans, who knew Hindi and English, worked as
social workers and translators.
Tent based medical camps were set up by humanitarian
agencies and CRC at key focal points near the road
construction sites in Northern state of HP.

5. Early health system in the refugee settlements in 1960s
and 1970s
Relocation of refugees to different settlements in early 1960s.
A small dispensary was built in each settlement with one
community health worker (tents/buildings)
These dispensaries were managed by TIRS and supported by local
and international donors.
Health center at Bylakuppe Tibetan settlement, Karnataka was
established in 1961 by Walter Judd Function and MYRADA
The social workers/translators worked as community health
workers.

6. Department of Health, CTA
 Established in December, 1981.
 Registered as Tibetan Voluntary Health Association.
 The administration of health centers were formally
handed over to DOH in 1981.
 Aims to provide primary healthcare services to all Tibetan
refugees through a network of primary health centers with
a goal of “health for all”.
 Aims to create and expand public health programs for
health promotion and disease prevention.

7. Administrative structure of DOH
29 CTA staffs at the Head Office.
Health Minister and secretary are the administrative heads.
Organizational structure, DOH.pdf

8. Administration of DOH
Head office: 29 health staffs including health Kalon.
Organizational structure, DOH.pdf
MAP_Health centers..pdf

9. Network Health Centers of DOH
DOH manages 54 health facilities in India and Nepal.
7 hospitals (20-30 health staffs)
5 primary health centers (5-13 health staffs)
42 health clinics (1 health staff)
2 mobile clinics in Ladakh
Ngoenga school for children with special needs
 The hospitals and PHCS have a administrator and the
clinics are managed by the settlement officer.
 Hospitals and PHCs in India.pdf

10. Regionwise distribution of health centers
State No of health facilities
Himachal Pradesh ( HP) 16
Delhi 1
Uttranchal (UT) 6
Nepal 12
West Bengal 4
Sikkim 2
Arunachal Pradesh 4
Uttar Pradesh 1
Jammu and Kashmir 2
Maharashtra 1
Madhya Pradesh 1
Orissa 1
Karnataka 4
Total 54

11. Healthcare workforce under DOH
216 field health staffs ( medical and administrative)
Medical staffs:
92 community health workers
4 doctors
26 nurses
 The health staffs have multiple roles: social worker,
mental health counselor, health educator, data
collector besides providing treatment services.

12. Role of community health workers
Community health workers are the backbone of this well
functioning refugee healthcare system.
A community health worker’s training program was
implemented since 1981, through a collaboration between
Delek Hospital and DOH. Until now, about 256 CHWS
have been trained through a 3 month CHW training.
“Where there is no doctor” formed the main teaching and
practice manual. ( translated into Tibetan)
They have filled the gap of acute shortage of qualified health
care providers in our community.

13. Health Programs Carried by Department of Health
Infectious Disease
Control &
Treatment.
TB Control Program Malaria & Leprosy
program
Drinking Water and
Sanitation Program RH/MCH Program HIV/AIDS
Program
Mental Mental H Heeaaltlhth a anndd s sppeecciaial lp prorojejecctsts
MMeenntatal lh heeaaltlhth p proroggraramm
TTibibeetatann T Toortruturere S Suurvrvivivoor rp proroggraramm
HHeeppaatittiitsis B B p prorojejecctt
TTibibeetatann M Meeddicicaarere p prorojejecct t
TTeelelemmeeddicicininee p prorojejecctt
HHeeaaltlhth P Prorommootitoionn
Substance Abuse prevention & Rehab.
Substance Abuse prevention & Rehab.
Program
Program
HHeeaaltlhth I nInfoformrmaatitoionn s syysstetemm
HHeeaaltlhth E Edduuccaatitoionn a anndd T Trarainininingg
DDisisaabbiliiltiyty a anndd D Deesstittiututete s suuppppoortrt

14. Monitoring and Evaluation of Programs
The ground implementation is carried out by field staffs.
Monitoring and evaluation is done both at field and central
level in form of routine phone calls, site visits, quarterly and
annual reporting system.
The staffs of the project section of DOH works in planning
of annual projects/proposals based on needs of the
respective locations.

15. Some new health projects in 2013-2014
Cervical cancer prevention and screening project in Miao.
Gynecological visit program in 12 settlements
Reproductive Health awareness in 10 nunneries.
TB mobile project in 6 health centers
Infant disability project in 2 settlements
School health workshop and adolescent health booklet.
Strategic health communication workshop.
Stomach cancer screening project.

16. TELEMEDICINE PROJECT IN MAINPAT
Telemedicine is a rapidly developing application of the clinical
medicine where medical information is transferred through the
phone or the internet and sometimes other networks for the
purpose of consulting, telemedicine allows patients to visit with
physician live over video for immediate care. It captures
Video / still image and patient data are stored and sent to
physician for diagnosis and follow - up treatment at a later time.

17. Ngoenga School for children with special needs

18. Ngoenga School for children with special needs

19. A Health education talk by CHW

21. Providing TB
education to students
I Am Stopping TB Badge

22. Leprosy patients at Leprosy Home Palampur,
H.P

23. Talk on RH/MCH provided to settlers by nurses

24. HIV/AIDS
Awareness poster
HIV/AIDS Awareness
Talk

25. SA Rehabilitation Centre (Nishant & Astha) at
Delhi

26. Future implications
Using health data to make more evidence based health
policies and programs.
Improving the vaccination coverage among infants.
Promoting healthy behavioral change interventions to reduce
the incidence of chronic conditions.
Formulating sustainable financing solutions to address
funding shortages to manage health centers.
Finding ways to fill the gap of shortage of doctors.

27. Final thoughts:
This refugee healthcare system has evolved as a unique
community based healthcare model over a period of five
decades.
 Strives to provide compassionate and holistic health services
to all, both Tibetans and non Tibetans.
 Other displaced populations in humanitarian settings can
learn from our practical experience including well organized
healthcare settings, holistic care and realistic use of
manpower (stood and sustained difficult periods of
displacement and rehabilitation)

28. Questions?