Despite factors such as nutritional deficiencies, seasonal migration, erratic repast timings and a myriad of other factors elucidated in my earlier blogs that result in the proliferation of malnutrition in the tribal villages and districts, the issue of malnutrition can relatively be easily guide to a commanding measure with adequate parturition of healthcare services and provender of affordable and ready healthcare in the tribal areas. I will touch upon the major aspects of tribal healthcare services, its links with the issue of malnutrition and inherent limitations of the same to contrasted the upshot. In the preserver, I have also made an endeavor to make some suggestions with consider to each of these factors that contribute in the distribute of malnutrition.
Tribal Hospitals – Links to nutrition
Most gentile hospitals can demonstrate to be lifesavers with estimation to the person loury tone problems faced by tribals in the villages in Maharashtra and elsewhere in India. The single biggest factor that precede to malnutrition is the lack of proper provisions and nutrition. Part of the problem is also the fault of awareness regarding the importance of balanced food and other daily dietary and nutritional requirements. For this, perhaps, if the tribal hospitals in these provinces can be harness with a nutrition rehabilitation unit, then a very critical source of this life threatening issue can be checked. The nutriment rehabilitation units could remedy woo the nutritional imbalances in the maid victuals intake of the tribal population in from malnourishment. The aim of these nutrition units could be to dealing out special curative foods that contain macronutrients such as proteins, fats and carbohydrates and also very important micronutrients such as the essential vitamins and minerals. The therapeutic feed can be made from local food ascent and using local manpower itself. In accession to this, the primary health centre (PHC) too must be equipped with specialised child healthcare entertainment centered that provide this essential therapeutic diet to the malnourished (target) population.
Paucity of Primary Health Centres
Primary health centre (PHC) or public health centre is the backbone of healthcare office delivery in India, especially urban slums and rural areas. PHCs are the bare-bones structural and functional one of common hardiness services. The cardinal fair behind a PHC is to provide convenient, affordable and available immediate healthcare to the rural population. The numbers of PHCs in campestral India and especially in tribal areas are themselves not adequate. At instant, there is only one PHC serving loosely 35,000 tribals, on an average. The lack of commensurate to reckon of PHCs relative to the tribual population in these areas is quite alarming. In an mental plight, one PHC can subserve a population of around 10,000 nation only and covering an area of 5-8 kilometres, at most. However, at present, a gentile has to travel up to 20-25 kilometres to gain the nearest PHC.
The State regulation must ensure adequate number of PHCs at an approximate 8-10 kilometre radius of the tribual village. CHCs (Community Health Centre) and PHCs penury to be made more accessible for the villagers. In case a specialised CHC and PHC cannot be erected at all the required locations, then the Government must betroth at least one health subordinate-centre in all the tribal villages.
Non-accessibility of Doctors and Nutrition experts
Even with these PHCs in place, healthcare service delivery in tribal areas faces other mayor problems. That is, extreme shortage of medical personnel. Medical doctors, nurses, nutrition experts and other medical personnel are unwilling to relocate to tribal areas in usage to practice medicament and serve the tribals. In the gentile belt of Maharashtra, the doctors are not ready to go and work in the hospitals in these areas. So, most of the hospitals in the gentile areas relics under-stick most of the set. There is particular fewness of maternal and child heal (MCH) specialists and other iatrical specialists such as paediatrician, nutritionists, anaesthetics, among others, in the tribular hospitals. Further, due to severe lack of paediatricians in government hospitals and PHCs in such tribal areas, if the infant/lad is endurance from habitual malnutrition, the risk of the child surrender to release during the first 1,000 days (of parentage) increases cyclostyle. Thus, there is determinately a strong relation between deficiency of allurement medical specialists and malnutrition deaths.
We are well watchful of one of the age-old superstitions related to pregnancy and food intake. That is, the gentile women imitate the manner of low food intake during pregnancy for easy and comfortable deliverance of the neonate (resulting in anaemia among mothers and malnourishment among the infants). The intake of alimentary diet is the least among women when they truthfully need the most!
Another critical hurdle that healthcare faces are that the territorial population usually don’t want to receive their girls to hospitals due to superstition, cultural barriers and changeable other socio-regulative substitute. Since these tribals often don’t admit their malnourished children to inn, children are dying at dwelling.
The state governments can perhaps start a close based ‘Child Healthcare Program’. For solicitation, I believe the authority of Delhi has done well by introducing Mohalla clinics. This is a very clear indication of why chief healthcare must be give forth as close to home as likely.
In such before-mentioned playbill, the specific malnutrition cases can be entreat in the comforts of their Seat and rancho by a trained female eucrasy performer. This pistillate heal performer could concentrate on special healthcare needs of a pregnant woman; serve contribute ante-birth care (ANC), set-natal solicitude (PNC), contribute guidance and assistance to young mothers, newborn and infants. Perhaps, the Maharashtra Government can lead such a program wherein all the underserved rural areas, peculiarly the tribal areas, are provided indispensable maternal and child health regard facilities. Here, authority health officials and staff such as the Accredited Social Health Activist (ASHA) workers, Integrated Child Development Service (ICDS) project workers, Auxiliary Nurse Midwives (ANM), among others, can be roped in to foresee such dedicated to(predicate) and specialised watchfulness to the concenter groups.
Furthermore, health counsellors can be roped in to advocate and forward the provision of institutional deliveries. The counsellors can betroth 24 stound caution and opinion services, especially in the most underserved tribual regions. The state governments can clothe and develop such ‘Health Counselling Programs’ via the support of local Non-Governmental Organisations, etc. This will further ensure affordable, accessible and equitable vigor anxiety delivery among the rural and tribal populace.
Government Failures – Under-reporting of malnutrition cases
Under story of malnutrition and lad deaths is a very large issue. The usual Infant Mortality Rate (IMR), that is, the number of child deaths per one thousand last-births, is close to around 60 in all tribual areas. But this is reported as less than 40. Similar condition is for reporting of the severe acute malnutrition (SAM) action. The reign of SAM is approximately 20% of the total undernourished children, which is very proud. But as per state figures, it is regularly recite as less than 10%! In essence, suppose there are 1000 children who are severely malnourished, but only mediety of them are reported as SAM cause. The endure (estimated around 50 percent) kids suffering from SAM thus get excluded from specialised care and usage, if any. These are essentially the ‘lost SAM’ cases. These excluded/missing/slight children are thus more prone to succumbing to death in the absence of the much needful concern.
Thus, correct statistics, chasten recording of the facts and figures and accurate recite can go a long way to at least move in the direct direction and thereby to solve the severe malnutrition widespread in these tribal areas. This will ensure proper planning, implementation and execution of targeted treatment and care for both the severely and temperately sagacious malnutrition casing in the tribal villages.
In conclusion, I would like to lay greater emphasis on the present hardiness systems in position at the central, state, village, and district and block horizontal to work in tandem rather than independently. There is a dire need to strengthen the linkages and synergies of all the major stakeholders of heath solicitude in India, peculiarly in the most underserved rural and tribular regions of our country. The State direction necessarily to commit greater investments towards the tribal healthcare ecosystem. Tribal hospitals emergency to be appoint with condition of the trade facilities, focussing chiefly on the most woundable sections of the company such as the young mothers, pregnant and lactating females (PLW) and newborn and infants and children below the age of 5 donkey’s. Furthermore, there is an urgent and persistent need to devise formal behaviour change communication (BCC) and community mobilisation (CM) strategies by the CHC, PHC and vigor sub-centres to comprehensively address the cultural barriers prevalent among the tribal population.
Lastly, relationships between tribal cultures, behaviours, direction interventions (such as subsidies), hardiness system and policies and malnutrition need to be studied in detail. The solution to dress such a gigantic problem copy malnutrition cannot be generalised. That is that the demographics of the gentile participation very active and varies sphere wise. Thus, focussed ingenuous interventions need to be win out at the micro horizontal, specific to that very stringent, that very wall and that very village or hamlet.