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Sir,
While commending you for bringing out an issue on the health of indigenous
people, we were pained to note that the aboriginal groups living in India
were not included in the list of indigenous people.
We share here an experiment with a group of 'primitive tribes' (as
classified by the Government of India) in improving their health status.
In 1987, when ACCORD's health programme was initiated, the IMR among these
hunter gatherers was more than 125 infant deaths per 1000 live births.
Over the years we developed a health system specifically targeted for the
tribals and this has reduced the IMR and MMR remarkably. The main
characteristics of this health system were
1) It was nested within larger development services like agriculture,
education, housing
2) It was owned by the people - from the beginning the tribal community
was involved in the planning and implementing of the scheme. Most of the
staff, including hospital nurses, administrators and field workers, are
from the tribal community and have been provided with the necessary
vocational skills
3) The entire health system has been developed keeping in mind the world
view of the tribal community. So initially the hospital did not have any
beds, as the patients found it more comfortable to sleep on mats on the
floor. The nurses only spoke the tribal language. The patients could
interrupt allopathic treatment to return to their villages to 'call the
spirits'. Monthly meetings were held with the community leaders to discuss
the feedback from the patients, from the community and from the staff
about the performance of the health services.
4) Over a period of 10 - 15 years, immunisation rates (which were 2% to
start with) has reached more than 75% coverage. Antenatal coverage is more
than 90%. The utilization of hospital services is more than 3 times the
national average - this in a population which initially refused to go to
hospitals, as 'only dead spirits circulate there'.
We trust that some of the learnings from this would be incorporated
into similar projects elsewhere.
Yours sincerely
Dr N Devadasan.
Competing interests:
None declared
Competing interests:
No competing interests
25 August 2003
N Devadasan
PhD student ITM, Antwerp
Shyla Menon, Nandakumar Menon, Roopa Devadasan
ACCORD, Gudalur, Nilgiris, Tamil Nadu, India - 632002
Improving health service utilization by the indigenous
Sir,
While commending you for bringing out an issue on the health of indigenous
people, we were pained to note that the aboriginal groups living in India
were not included in the list of indigenous people.
We share here an experiment with a group of 'primitive tribes' (as
classified by the Government of India) in improving their health status.
In 1987, when ACCORD's health programme was initiated, the IMR among these
hunter gatherers was more than 125 infant deaths per 1000 live births.
Over the years we developed a health system specifically targeted for the
tribals and this has reduced the IMR and MMR remarkably. The main
characteristics of this health system were
1) It was nested within larger development services like agriculture,
education, housing
2) It was owned by the people - from the beginning the tribal community
was involved in the planning and implementing of the scheme. Most of the
staff, including hospital nurses, administrators and field workers, are
from the tribal community and have been provided with the necessary
vocational skills
3) The entire health system has been developed keeping in mind the world
view of the tribal community. So initially the hospital did not have any
beds, as the patients found it more comfortable to sleep on mats on the
floor. The nurses only spoke the tribal language. The patients could
interrupt allopathic treatment to return to their villages to 'call the
spirits'. Monthly meetings were held with the community leaders to discuss
the feedback from the patients, from the community and from the staff
about the performance of the health services.
4) Over a period of 10 - 15 years, immunisation rates (which were 2% to
start with) has reached more than 75% coverage. Antenatal coverage is more
than 90%. The utilization of hospital services is more than 3 times the
national average - this in a population which initially refused to go to
hospitals, as 'only dead spirits circulate there'.
We trust that some of the learnings from this would be incorporated
into similar projects elsewhere.
Yours sincerely
Dr N Devadasan.
Competing interests:
None declared
Competing interests: No competing interests