Health care through community participation: a policy initiative in reference to tribal areas of India

Abstract

Report released by Tribal Department illustrates that when it comes to tribal areas, health infrastructure and human resources shows the yawning gap between what is available and what is required thus leaving the entire tribal communities more vulnerable. There are nine states which are severely affected by the menace of left wing extremism; six of them lie in scheduled areas. And in these states 42 districts are affected by extremism. Out of various causes for the same it was found that the lack of health services is also one of the reasons for LWE. Since 1946 various committees, which were constituted to look into the health sector has advocated for the involvement of community in local health programmes. Also the health policies of 1983, 2002 and 2015 (proposed) have also found community participation as a sine-qua-non for health programme implementation in the country. Various community models in the country and abroad have shown their effectiveness in the implementation of health programmes and they have scalability potential also. What is needed from the framework of the policy is the realization to this effect. Owing to the special characteristics of the tribals to live as a community , such models have been highly successful in tribal areas like Ghadchiroli and Jamkhed. In Ghadchiroli model, in the 39 tribal villages it was found that the IMR due to pneumonia reduced from 120 to 30 with the help of community participation, CSO s and the workers who came from the community and were responsible to the community. Framers of our Constitution have given enough safeguards to the tribals and their culture, recognizes their special needs hence the special governance structure in the form of 5th and 6th Schedule of the Constitution. In addition to this acts like PESA 1996 and the FRA are an excellent opportunity to provide good governance in tribal areas. These laws are only skeletons and require operational rules and guidelines which will be the sinews and flesh, removal of incongruencies which are legal in nature to ensure a tribal life which is dignified and campaigns of awareness on self-governance and control of community control over resources which are natural. It s high time that all the concerned states formulate the rules for the implementation of PESA in letter and spirit. If the mandated governance structure, as promised by the Constitution is followed, it will ultimately have beneficial implication for the tribal community in including them in mainstream rather than excluding them and also will be undoing the historical injustices . Participation and participatory research has its origin in non-formal adult education, where the people who were involved in the research realized that there is a need to work with people in order to impart knowledge and stimulate action, rather than treat people merely as material for study. This approach is based on the conviction that people have important knowledge about their own lives and problems. Hence it is necessary that field level health workers should be from the community and responsible to the community itself. Governments are to provide necessary funds to the VHC s (village health communities) without any bureaucratic hindrance and handholding to the community either in the form of awareness or training is to be provided through Civil Society Organisations who know the need of the communities better as they are more nearer to the community hence the problem of information asymmetry and principal agent problem is least. It is only through community empowering and participation can Govt. fill the yawning gap in the tribal areas as far as health services are concerned.