Study on assessing health system delivery in tribal areas

Sama is initiating a short-term study on assessing health system delivery in tribal areas in three Indian states having considerable proportion of tribal population – Chhattisgarh, Odisha and Jharkhand. Supported by National Human Rights Commission (NHRC), this study is thematically immersed within the broader framework of Sama’s understanding towards ‘health and its interlinkages with social determinants and social identities in the fulfillment of one’s right to health’. Right to health is incomplete without addressing the various social determinants of health including access to secure livelihoods, adequate food and nutrition, housing, safe water and sanitation, freedom from discrimination at all levels. The socio-cultural as well as well as the lived experience of everyday lives of people belonging to different social identities–tribal communities in this context, play a dominant factor in determining their access to health.

The study particularly aims to understand the current status of public health care delivery system in tribal dominated regions, status of public healthcare utilization among tribal communities and barriers faced in access to health care, differential access to public healthcare among tribal communities compared to non-tribal communities in the selected areas of study. Through this assessment study, specific answers will be sought towards the status of health infrastructure, drugs and diagnostic services and health personnel in the public healthcare system and its availability for tribal population; impact of geographical, socio-cultural, economic and other factors on access to public healthcare services for tribal communities; quality of public healthcare services that are available for tribal communities and barriers faced by them in access; and if there is a difference in access to public healthcare among tribals and other communities while exploring the reasons for such a differential in access.

Within Chhattisgarh this study will be done in Koriya and Jashpur districts, Nuapada and Rayagada districts in Odisha, and Gumla and Latehar districts in Jharkhand.

Preliminary Field visit in Chhattisgarh

With regard to this study, a team of Sama recently undertook a preliminary field visit in Chhattisgarh including a small visit to Koriya district. The objective of this visit was to hold interactions with key informants at state and district level who have been working in the area of tribal health, and to share the study plan with the community representatives in the selected area. Interactions were held with State Health Resource Centre (SHRC) in Raipur which provides additional technical support to the Department of Health and Family Welfare, Chhattisgarh for improving the access, quality and equity of public health system; and Jan Swasthya Sahyog in Ganiyari, Bilaspur which is a longstanding voluntary, non-profit health centre providing both preventive and curative services to people from the tribal and rural areas of Bilaspur, Chhattisgarh through a community health program and a rural health centre. These key informants discussions paved way to understand broadly both the historicity and contemporary state of health issues vis-à-vis tribal communities in Chhattisgarh-prevalence and types of diseases, existing health care system in the state etc. It further helped in understanding broadly the cultural context and social indicators related to tribal communities in the selected areas, including the heterogeneity amongst tribal communities inhabiting the selected region.

Further, following to these interactions a two days field visit was done in Koriya district which is one of the selected areas of the study wherein the objective was to hold community level discussions, and share with them about this study to be undertaken in their area while seeking their participation and support in the same. Group discussions with Mitanins (community health workers of the public health system), and visits to health sub-centres furthered this objective, and gave way to an affirmative response from the community regarding their participation in the study. The discussions at community level also brought forth briefly the health and health system access issues, its varied aspects which could be further explored in detail during the study.

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