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Workshop held to Discuss Delivery of Health Services to Tribal People

A one day national workshop aimed at identifying issues concerning delivery of health services to tribal people, disease burden on tribal people and augmenting capacity of Institutions involved in tribal welfare was held recently in New Delhi. Dr. Hrusikesh Panda, Secretary, Ministry of Tribal Affairs and Dr. VM Katoch, DG, Indian Council of Medical Research ( ICMR) jointly chaired the consultation cum workshop organized by ICMR and Ministry of Tribal Affairs.

Speaking on the occasion, Dr. Panda said that his Ministry has been offering untied funds to the States in its Project Appraisal Committee meetings for addressing tribal health issues. He highlighted on the importance of malaria control whose burden was higher for the tribal people as compared to non-tribal areas. He said, with only 8.6% of the population share, tribals account for 30% of Malaria cases, 70% of Falciparum cases and 50% of deaths due to Malaria. In many tribal areas, the incidence of Falciparum is 90% or more. Furthermore, Sickle Cell Anemia was another enormous health problem. The secretary was of the opinion that the Ministry’s intervention in writing to the State Welfare Departments to screen tribal students for sickle cell trait and disease has not reaped sufficient response due to lack of awareness of diagnosis and treatment amongst medical officers in the tribal areas.

Sharing his observation of his field visits, Dr. Panda said many young tribal girls were deprived of education as they were involved in new born children care due to absence of Anganwadi Centres in many of the areas. He said Malnutrition among tribal population was yet another issue that requires action. The issue of malnutrition is aggravated due to shift in food basket. The traditional crops which were rich in minerals, proteins and vitamins have disappeared and substituted by high carbohydrate cereals. Dr Panda said knowledge in traditional vegetables and tubers, particularly, those gathered from the forests has also disappeared. He informed the gathering that his Ministry has been supporting revival of these crops. At the same time, cultivation and consumption of green leafy vegetables is also being emphasized to address malnutrition issues. He said activities like dairy, poultry and fisheries are also encouraged because, in addition to livelihood support, this will make available nutritious food to the tribal households.

The workshop focused on specific themes of Maternal & Child health, Nutrition, Malaria, Sickle Cell Anemia and TB. It was realized that ICMR has a vast body of knowledge with regard to tribal health and issues concerned therein. A better co-ordination and collaboration between the ICMR and Tribal Welfare Departments, Tribal Research Institutes (TRIs) and Integrated Tribal Development Agencies/ Integrated Tribal Development programmes not only in resources but also in knowledge and design interventions based on best practices can help in improving health status of tribal people.

It was felt that high incidence of Sickle Cell Anemia amongst tribal poeple needs to be addressed by screening of all school going children on the status of Sickle Cell Disease and they have to be provided with health card indicating status. This would help in counseling of parents availing services and disease management through health facility. Each State/UT would ensure 100 % screening of school children for Sickle Cell Disease. It was also decided to draw up a training plan in collaboration with ICMR for Medical Officers and Technicians of tribal areas on Sickle Cell screening and disease management. A user manual on disease management would also be prepared.

Experts attending the workshop were of the view that to contain Malaria, in tribal areas, services of traditional healers can be used by training them on Malaria medicines, who can also distribute medicine to the patients. Similarly to contain mosquito to population, composite fish culture in ponds was recommended. This would also provide protein in the form of fish to the tribal people.

Participants were of the view that malnutrition and Anemia issues were to be addressed by bringing back traditional food of minor millets, green leafy vegetables and effective implementation of ongoing folic acid supplements and de worming programmes in these areas. Training Manual prepared by ICMR for paramedic would be shared with State Tribal Welfare Departments/TRIs for capacity building of local educated persons.

It was also suggested that use of Cassia tora (chakoda Bhaji) in meals of schools in tribal areas would ensure Calcium and B- complex supplement in the food in cost effective manner. This can also help in improving conditions of Fluorosis. Ministry of Tribal Affairs should issue advisory to the State/UT for inclusion of the Cassia tora in the menu of the meals in the schools.

Issue of adolescence pregnancy including bringing every pregnant mother under heath cum nutrition support system was emphasized using best practices. Hiring local girls/women for paramedical service by appropriate training can deepen the service in tribal areas was another important suggestion.

Referring to the high incidence of TB amongst Saharia in Madhya Pradesh it was felt that it can be addressed through better ventilated houses. A special effort by the State should be undertaken towards this.

samir/jk

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