Tribals suffer as NRHM flops in KBK districts Basant Rath | Nabarangpur The Pioneer, Bhubaneswar. Date:1.09.2009 Recognising the importance of health in the process of economic and social development and improving the quality of life of our citizens, the Government of India launched the National Rural Health Mission (NRHM) in 2005 to carry out necessary architectural correction in the healthcare delivery system. The NRHM seeks to provide effective healthcare to rural population throughout the country with special focus on 18 States, including Orissa, which have weak public health indicators and/or weak infrastructure. The NRHM seeks to revitalise local health traditions and mainstream AYUSH into the public health system and to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare. It also aims to provide an umbrella scheme to the existing health and family welfare programmes including reducing IMR and MMR. The national programmes cover malaria, blindness, iodine deficiency, filaria, kala azar, tuberculosis, leprosy and include integrated disease surveillance. The plan of action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, pooling resources, integration of organisational structures, optimisation of health manpower, decentralisation and district management of health programmes, community participation and ownership of assets, induction of management and financial personnel into district health system and operationalising community health centres into functional hospitals meeting the Indian Public Health Standards in each block of the country. But the undivided KBK districts of Orissa have got the dubious distinction of having one of the highest maternal mortality rate (MMR) in the country despite the massive launching of NRHM. So, there is a lot more to be done in direct and indirect health care practices to minimise the death rate so that we can have more healthy babies for a healthy generation in future. Lack of commitment of medical officials, who are working in the KBK districts, lack of communication facilities, shortage of staff and non-development of existing Primary Health Centres (PHCs) force poor tribals to die as they fail to get medical treatment on time. A visit to remote tribal villages under KBK districts has exposed the miserable condition of the tribals living in the villages. All the PHCs are functioning without MBBS doctors and some centres are functioning only with mere pharmacists. Unnatural deaths of tribals occur mostly among children who are below five years. Junior doctors after completion of their MBBS are posted in Government service to serve for a period of three years in the district mandatorily but they leave immediately after obtaining service certificate from the authorities for higher education or better-paying hospitals in corporate places. Lack of community ownership of public health programmes impacts levels of efficiency, accountability and effectiveness. This also leads to lack of integration of sanitation, hygiene and nutrition and results in drinking water issues. There are striking regional inequalities. Population stabilisation is still a challenge, especially in the KBK region of the State with weak demographic indicators. More than 70 per cent of hospitalised patients belonging to the KBK region fall below poverty line. Unnatural deaths of tribals occur mostly among children who are below five years of age. According to official sources, for every 1,000 live births, 251 die within five years. More than 60 per cent of the villages in KBK districts do not have drinking water facilities. The Government health inspector says that it took years to create awareness among the tribals. Over the last two decades 15 lakh tribals in undivided KBK districts alone died. The chief medical officers of districts have returned crores of unspent money meant for health service in undivided KBK district. Due to lack of commitment by the scheme implementing agencies, the money meant for construction of new health sub-centres and repair of existing PHCs are partly spent and the rest of the money is kept locked in the bank. The situation is worse in the rural areas in spite of recommendations by various organisations, including the district administration have not been able to do enough for these tribal-dominated tracts that report a large number of deaths due to under-nutrition, endemic malaria, diarrhea and other diseases. Reduction in IMR and MMR, universal access to public health services such as women’s health, child health, water, sanitation, personal hygiene, immunisation and nutrition, prevention and control of communicable and non-communicable diseases, including locally endemic diseases, revitalising local health traditions and mainstream AYUSH and promotion of healthy lifestyles is a distant dream for the tribals of KBK region. Due to the non-availability of health services, the tribals in the remote areas of KBK districts mainly depend on quacks and those who sell indigenous medicines. Some people, who do turn up at the nearest health centre, are more often treated by nurses and health workers. The NGOs who are engaged for resources organisations are the torrent ones as local NGOs are not involved in the improved programme management. Immunisation coverage is the poorest in the case of tribal population compared to other social groups and the aggregate population. Only 26 per cent of tribal children are completely immunised against all vaccine-preventable diseases and 18 per cent have not received any vaccine at all. Thus 56 per cent of children are only partially immunised. Children having three common childhood diseases, namely respiratory infection, diarrhoea and fever, during a reference period of two weeks among the tribal population is surprisingly lower than for the population as a whole as well as for other social groups such as SC/ST and other backward population. The nutritional status of tribal children is apparently worse as compared to that of other social groups and the population as a whole. The incidence of anaemia among children is much higher among tribal population. As in the case of tribal children, the nutritional status of tribal women is also worse than that in the case of the general population or that of women belonging to other disadvantaged social groups such as SC/ST or OBC. However, the incidence of anaemia amongst tribal women is significantly higher than that for other social groups. Till today 40 per cent or more of the population still have to travel more than 5 km to reach the nearest health facility. The problem of physical access is compounded by two other factors, poor roads and poor transport connectivity. The so-called coastal NGOs who were selected for this purpose do not know the name of the villages or any data about the KBK districts. The NGOs are claiming creating awareness, workshops to streamline the existing policies and programmes and also establishing synergy among stakeholders but all these are in pen and paper only. The NGOs have neither visited the villages of KBK region nor interacted with the villagers, alleged former MP, Parshuram Majhi. He further alleged that in the KBK region there are several local NGOs who are working for the tribals but the mission dawdles to select the local NGOs for the smooth running of the programme. Due to the lackadaisical attitude of the State Mission and the district mission authorities, the programme failed to achieve any goal in the KBK region. Lack of motivation and awareness among the people is said to be the main reason for failing to bring an improvement in quality of health among the rural people. The inter-district disparity comes down in the case of safe deliveries as still about two-thirds of deliveries are unsafe being not attended by any trained professionals. Access to post-natal care seems to be poor in KBK. Immunisation coverage in the State cannot be said to be satisfactory. With only about 60 per cent of children completely immunised in the districts, the immunisation coverage is between 40 to 60 per cent. Frequent cases of severe diarrhoea, malaria, measles, tuberculosis, gastroenteritis, diphtheria, whooping cough and poliomyelitis also remain a major public health problem in the undivided KBK districts.