Maternal health status in tribal India: A 5-year intervention program and its outcome

Abstract

Introduction: There is poor penetration of evidence-based maternal health care provided under national health programs in resource-poor underserved regions. A well-planned locally acceptable community-driven comprehensive health promotion strategy and quality health care delivery mechanism is necessary to improve the situation. Objective: The main objective was to find the gaps in the existing system and promote health literacy and health-seeking behavior. Methodology: 80,000 tribal population living in isolated conflict zone of Bastar district was covered for 5 years between 2012 and 2017. An integrated health-care plan was developed with community leaders, panchayat, and the local government to promote and provide quality evidence-based maternal health care. Available resources were mobilized and health technologies introduced. Results: Regular home visits, point of care diagnostics, identification of high-risk mothers and their timely referral, and behavioral change communication increased the trust of the community. It resulted in higher demand for evidence-based health interventions. The adolescent pregnancy rate (<19 years) reduced to 6.8% (2016) from 13.5% (2012). Hemoglobin level >9 g% (third trimester) improved. Supervised births and high-risk referrals increased from 19.5% (2014) to 58% (2017) and 8.5% (2014) to 13.1% (2017), respectively. Although significant improvement was noted, key indicators continued to remain below rural Bastar (National Family Health Survey-4). Conclusion: Promotion of existing good practices, behavior change, health technologies, and evidence-based emergency care improved the maternal health status of the secluded and underserved tribal community, but persistent effort is needed to enable women access the quality maternal health services provided under National Health Mission.

Community engagement in health systems interventions and research in conflict-affected countries: a scoping review of approaches

“…Only two documents explicitly described the use of elements of community co-design in research or program development, implementation, or assessment, while one described challenges of the absence of any co-creation approach [ 20 , 25 , 33 ]. Ager et al ’s examination of health service resilience in Yobe state, Nigeria, in the context of the Boko Haram insurgency, involved community and local government representatives in study design and data interpretation using participatory group model building for systems dynamics analysis [ 20 ].…”

“…Sengupta et al ’s five-year maternal health intervention in tribal areas of India included community-nominated volunteers through group discussions, household surveys, and participatory appraisal to design maternal health services and promotion activities [ 33 ]. Intervention staff trained volunteers to implement healthcare protocols, survey methods, advocacy and social mobilisation (e.g.…”

“…Intervention staff trained volunteers to implement healthcare protocols, survey methods, advocacy and social mobilisation (e.g. contextual enquiry, persuasive method, participatory rural appraisal, brainstorming), and ethics in their communities [ 33 ].…”

Understanding health care seeking behavior in a tribal setting in West Bengal

“…[ 5 ] Similar findings were demonstrated in several recent studies. [ 11 12 13 ] Delving into the determinants of health care seeking behavior will benefit all stakeholders, but especially those who are the first point of contact, i.e., primary care physicians.…”

Community based sensitization to address maternal and child health problems in tribal population of India

“…In addition to TBAs, tribal girls in same communities were found to be the potential trainers for educating community members about MCH. [8][9][10][11][12] Majority of the tribes in India reside in hilly terrain where health care services are difficult to reach and consequently it becomes challenging for health care system and providers to reach there. 2 Therefore, selecting, training and deploying local volunteers to serve in own communities as a primary health provider may be highly recommended.…”