Piramal Swasthya Management and Research Institute

SARTHI: Sustainable Action to Redefine Tribal Health in India Highly Ranked

Lead Organization

Piramal Swasthya Management and Research Institute

Hyderabad, Telangana, India


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Project Summary

Availability of affordable, quality healthcare is a distant dream for the tribal people of India, a large proportion of whom are geographically isolated, residing in hard-to-reach terrains and are untouched by the public health system. The situation is worsened by limited awareness and poor health seeking behavior. As a result, millions of lives are lost due to causes which are preventable. The proposed solution is designed to reach out to this section of the society, the most vulnerable in terms of health outcomes, roughly estimated to be 40 million. The solution addresses the constraints on both the demand and the supply side of the public health ecosystem. It strengthens supply of services by ensuring last mile delivery of primary healthcare. Simultaneously, it includes interventions to generate demand for services among the target population, improving health-seeking behaviour. The solution will transform the way tribal people seek and receive healthcare in India

Problem Statement

Tribal people in India have poorer health outcomes compared to other groups. On an average, they die 10 years earlier than non-tribal people in the country. Mothers and children are even more vulnerable and as per estimates, a tribal woman is twice as likely to die during pregnancy and childbirth as compared to the rest of the population. Similarly, a tribal child is 1.5 times more likely to die before his/her fifth birthday compared to a non-tribal child. Tribal communities in India are geographically isolated and face barriers in terms of awareness of, access to and quality of healthcare. They are unreached by the public health system as there is 20% - 30% shortfall of government hospitals along with 82% shortfall of specialists in the tribal areas of the country. Additionally, myths, misconceptions, malpractices and limited access to health information act as barriers to health-seeking behavior. Strengthening health systems along with ensuring demand for services from the community is the most influential way to address the issue. India is home to one-third of the world’s tribal population. Approximately 40% of the Indian tribal population, around 40 million, live in 72 districts of India spread across the states of Madhya Pradesh, Jharkhand, Chhattisgarh, Assam, Odisha, Gujarat and Maharashtra. The proposed solution will be implemented in these 72 districts. The solution will strengthen the existing public health system and result in an enhanced demand-for and access-to services.

Solution Overview

The proposed solution presents a comprehensive approach to transform the health ecosystem in the tribal districts of India addressing both supply-side and demand-side constraints. The core elements of this approach includes setting up ‘community centers’ in remote areas to provide health and nutrition services, community outreach for last mile service delivery and simultaneous public health system strengthening. The community centers will be a hub of activities which plug-in existing service delivery gaps. Specialist services through telemedicine centers, one-on-one health and nutrition counselling, demonstration of food preservation techniques during agriculturally lean periods, nutrition based livelihood models for women groups, cultivation of kitchen gardens, capacity building of self-help groups for health and nutrition reviews are just a few examples of the activities which will be conducted in the Centers. In extremely remote and hard-to-reach areas, nurse-led community outreach teams will provide last-mile primary healthcare to those currently untouched by the public health system. These community level activities will complement a series of parallel activities to address supply side challenges that include strengthening existing health facilities, optimal resource utilization and capacity building support to the healthcare system. ICT will be leveraged to track programmatic progress; complemented by third party evaluation across the project period. The program will have both macro level and micro level impact, with a special focus on the 40% of tribal Indian population currently residing in these areas. Ending preventable maternal, neonatal and under five child deaths will be the primary objective of the program.

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