Tribal Healthcare – Malnutrition Links

Despite factors such as malnutrition, seasonal migrations, irregular meal timings, and the myriad of other factors that have contributed to the prevalence of malnutrition in tribal villages and townships, which have been described in my previous blogs, the problem of malnutrition can be relatively easily controlled. limited to adequate provision of health services and the provision of affordable and accessible health services in tribal areas. I will touch upon the main aspects of tribal health care, its links to the problem of malnutrition, and the inherent limitations of the same to address the problem. In the process, I have tried to make some suggestions regarding each of these factors that contribute to the spread of malnutrition.

Tribal Hospitals – Nutrition related links

Most tribal hospitals can prove to be a lifesaver regarding the life-threatening health problems faced by tribes in villages in Maharashtra and elsewhere in India. The biggest factor leading to malnutrition is the lack of proper food and nutrition. Part of the problem is a lack of awareness of the importance of a balanced diet and other daily nutritional and nutritional requirements. For this reason, if the tribal hospitals in these regions can be equipped with a nutrition rehabilitation unit, a very critical source of this life-threatening issue can be prevented. Nutrition rehabilitation units can help correct nutritional imbalances in the daily food intake of the undernourished tribal population. The purpose of these nutritional units may be to expel special therapeutic foods containing macronutrients such as proteins, fats and carbohydrates as well as very important micronutrients such as essential vitamins and minerals. Therapeutic food can be made from local food sources and using local manpower. In addition, the primary care center (PHC) should be equipped with specialized pediatric treatment centers that provide this essential therapeutic diet to the malnourished (target) population.

Scarcity of Primary Health Centers

The primary health center (PHC) or public health center is the backbone of healthcare delivery in India, particularly in urban slums and rural areas. BSMs are the basic structural and functional unit of public health services. The primary purpose behind a PHC is to provide accessible, affordable and available primary health care to the rural population. The number of PHCs in rural areas of India and especially in tribal areas is not sufficient. Currently, there is only one PHC serving an average of about 35,000 tribes. The lack of sufficient numbers of PHCs relative to the tribal population in these areas is highly worrying. In an ideal situation, a PHC can only serve a population of around 10,000 people and cover a maximum area of ​​5-8 kilometers. But currently a tribe has to travel 20-25 kilometers to reach the nearest PHC.

The state government should provide enough PHC within a radius of about 8-10 kilometers of the tribal village. TSMs (Public Health Center) and PHCs should be made more accessible to villagers. In case a specialist PRC and PHC cannot be established in all necessary places, the Government should provide at least one health sub-center in all tribal villages.

Absence of Doctors and Nutritionists

Even with these PHCs in place, healthcare delivery in tribal areas faces other major challenges. Namely, the extreme shortage of medical personnel. Medical doctors, nurses, nutritionists, and other medical personnel do not want to move to tribal areas to practice medicine and serve the tribes. In Maharashtra’s tribal belt, doctors are not ready to study and work in hospitals in these areas. This is why most hospitals in tribal areas are often understaffed. Maternal and child health (MCH) specialists and other medical professionals such as pediatricians, nutritionists, anesthetics are particularly scarce in tribal hospitals. Also, due to the severe shortage of pediatricians in government hospitals and PHCs in such tribal areas, if the infant/child suffers from chronic malnutrition, the child’s risk of succumbing to death during the first 1000 days (after birth) increases exponentially. Thus, there is certainly a strong correlation between a lack of trained medical professionals and malnutrition deaths.

We are aware of one of the old superstitions about pregnancy and food intake. That is, tribal women follow the practice of low food intake during pregnancy (resulting in anemia in mothers and malnutrition in infants) for easy and comfortable delivery of the newborn. Nutritious dietary intake is the least among women when they really need it most!

Another critical obstacle facing healthcare services is that local people often do not want to admit their children into hospitals due to superstitions, cultural barriers and various other socio-economic factors. Children die at home because these tribes often do not admit their malnourished children to hospital.

State governments could perhaps initiate a home-based ‘Child Health Programme’. For example, the Delhi government Mohalla clinics. This is a very clear sign of why primary health care should be provided as close to home as possible.

In these programs, related malnutrition cases can be treated by a trained female health worker in the comfort of their homes and villages. This female health worker can focus on the specific health needs of a pregnant woman; helps provide prenatal care (ANC), postnatal care (PNC), provides guidance and assistance to young mothers, newborns and infants. Perhaps the Maharashtra Government can initiate such a program where basic maternal and child health care facilities are provided to all underserved rural areas, especially tribal areas. Here, government health officials and staff such as Accredited Social Health Activist (ASHA) employees, Integrated Child Development Service (ICDS) program employees, Assistant Nurse Midwives (ANM), among others, can be tethered to provide this type of specialized and specialized care. to focus groups.

In addition, healthcare consultants can be engaged to advocate and promote the provision of institutional deliveries. Counselors can provide round-the-clock care and advisory services, particularly in the least-served tribal areas. State governments, local NGOs etc. can invest in and develop such ‘Health Counseling Programs’ with its support. This will further ensure affordable, accessible and equitable healthcare delivery among rural and tribal people.

Government Failures – Underreporting of malnutrition cases

Reporting of malnutrition and child mortality is a huge problem. The average Infant Mortality Rate (IMR), ie the number of child deaths per thousand live births, is close to about 60 in all tribal areas. However, it is reported to be below 40. The same is true for reporting cases of severe acute malnutrition (SAM). The prevalence of SAM is about 20% of the total malnourished children, which is very high. But according to government figures, less than 10% is regularly reported! In essence, suppose there are 1,000 severely malnourished children, but only half of them are reported as SAM cases. Children who remain (an estimated 50 percent) suffering from SAM are excluded from special care and treatment, if any. These are essentially ‘missing SAM’ cases. These excluded/missing/neglected children are therefore more prone to succumb to death in the absence of much-needed care.

Therefore, accurate statistics, accurate recording of facts and figures, and accurate reporting can go a long way in at least moving in the right direction and thereby solving the serious malnutrition problem prevalent in these tribal areas. This will ensure that targeted treatment and care for both severe and moderate acute malnutrition cases in tribal villages are properly planned, implemented and carried out.

As a result, I would like to place more emphasis on the existing health systems at the center, state, village, district and block levels working together rather than independently. There is a serious need to strengthen the connections and synergies of all major health care stakeholders in India, particularly in the most underserved rural and tribal areas of our country. The state government needs to invest more in the tribal health ecosystem. Tribal hospitals need to be equipped with state-of-the-art facilities that focus specifically on the most vulnerable segments of society such as young mothers, pregnant and lactating women (PLW) and newborns and infants and children under 5 years old. There is also an urgent and persistent need to develop formal behavior change communication (BCC) and community mobilization (CM) strategies by the CHC, PHC and health sub-centres to comprehensively address the cultural barriers prevalent among the tribal population.

Finally, the relationships between tribal cultures, behavior, government interventions (such as subsidies), health systems and policies, and malnutrition should be examined in detail. The solution to solving such a big problem as malnutrition cannot be generalized. This is because the demographics of the tribal community are very dynamic and vary by region. For this reason, special, focused and ingenious interventions should be made at the micro level, for that district, that block, that village or hamlet.

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