Tailored Healthcare Solutions for Tribal Women

Tailored Healthcare Solutions for Tribal Women

16-year old Nirmala weighed 43 kgs and had a haemoglobin level of 5.8 when she was eight months pregnant. Hers was a “high-risk pregnancy”, and after much coaxing over multiple visits by the on-ground health worker she agreed to travel 4 kilometres (2.5 miles) on foot and 11 kilometres (6.8 miles) in a bullock-cart to the nearest hospital for her delivery. She is now the mother of a healthy six-month old boy.

She was lucky; more than half of the maternal deaths in India are among the 8.6% tribal population . Less than 15% of tribal women meet the recommended protocol of ante-natal care . Across the continuum of care, tribal women have poorer access to adequate maternal and child health services than their counterparts elsewhere in India. By increasing access to quality maternal health services and emphasising on two important social determinants of maternal health – literacy and age of marriage – India has succeeded reducing maternal mortality by 77% in the last 19 years.

However, the last leg is the toughest. How do we reach the most marginalised women in remote villages to ensure safe deliveries for them?

Sattva_Insights_TribalHealthcare

There is no data on health, healthcare and finances specific to the 104 million strong tribal population in India, and the budgetary plans and allocations for the tribal population remain buried under “rural healthcare”. Alarmingly, there are no existing institutional mechanisms to even gather or generate such data!

The challenges and needs of the tribal population are unique and need to be addressed differently. Tribal populations suffer from the “triple disease burden”: infections and communicable diseases, non-communicable diseases such as cancer and diabetes, and mental illnesses . The nutritional parameters are poorer: anaemia among tribal women is 38% higher than it is in the non-SC-ST population in India4 and the Infant Mortality Rate (IMR) among tribal children is 20% higher than the national average.

Continued disproportionate health outcomes indicate the need for a different approach to address the maternal health challenges in these communities. To paraphrase American writer and activist Audre Lorde, “it is not our differences that separate us, but our inability to accept and acknowledge them”.

Maternal health services for tribal women need to be tailored to their needs, instead of being replicated naively from modern health practices or relying on monetary incentives to motivate health-seeking behaviour. To improve maternal health outcomes, we need to adopt a three-pronged strategy: provide last-mile access to care, leverage technology to provide better quality care, and increase utilisation of services provided by being more culturally sensitive and building trust in the community.

Solutions to combat poor maternal healthcare Last mile access can be improved through effective community-based care, adequate ante-natal counselling, and provision of emergency transportation services. The Government of Madhya Pradesh, along with UNICEF, piloted a 24×7 Free Referral Transport system for pregnant women (home to facility, inter-facility and drop back) which contributed to the increase in institutional delivery from 47% to 83% in Madhya Pradesh over a five-year period.

We also need to preserve and build beneficial traditional practices by integrating last-mile health workers into the system and focus on safer deliveries – at home or in a health centre.

There is tremendous scope to leverage technology to improve health outcomes. Mobile applications can help identify and track high-risk pregnancies, increase on-ground reach by incentivising field workers, and strengthen the referral chain to make patient data accessible. Tech solutions can conduct point-of-care diagnostic tests, improve the performance of field workers by providing training support and work as job-aids to guide them through complex tasks. Telemedicine centres and electronic medical records also hold great promise.

Through our research, we learnt that tribal communities view pregnancy and childbirth as a natural phenomenon that does not warrant external interventions. Doctors in white coats and sterile, whitewashed, multi-storeyed hospital buildings are viewed as intimidating. Respecting tribal culture and community beliefs, the Society for Education, Action and Research in Community Health (SEARCH) has built a tribal-friendly hospital in Gadchiroli . The clinics are modelled on a typical tribal home with mud flooring and thatched roofs. Outpatient departments feature large, tree-lined open spaces for patients to wait and mingle. To overcome access barriers, the state of Jharkhand established Sahiyya Help Desks in District Hospitals and Community Health Centres to help patients navigate complex, often culturally alien and unfriendly health facilities. Anecdotal evidence suggests that these desks significantly reduce the fear of being misunderstood on account of language and socio-cultural differences and improve awareness of entitlements and services, grievance redressal, and feedback regarding services.

To drive community behaviour change, we need to go beyond acknowledging the distinctiveness of the tribal population and learn to understand their culture and beliefs. We must eschew the cookie-cutter approach that seems to characterise many proposed solutions to this challenge. Tailoring interventions to the needs of tribal people will promote health-seeking attitudes, improve the overall nutritional status and enable better integration. This will facilitate better outcomes for mothers and children.

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This article was originally published in Impact Magazine and can be accessed here.

You can find more Insights from Sattva here.

To talk to us for collaborations or partnerships, you can write to us: impact@sattva.co.in

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i.Name changed to protect identity
ii.India’s maternal mortality rate is 167 per 100,000 live births- Census 2011 data
iii.Tribal Health Expert Committee Report
iv.NHFS-3 data
v.SEARCH website: http://searchforhealth.ngo/tribal-friendly-hospital/

Parvathy Ramanathan

Parvathy leads the Transformation Advisory Services portfolio at Sattva, where we focus on enabling ambitious organisations achieve their highest impact. In addition, she also leads Sattva’s technology CSR Programme Management product – SHIFT.

Parvathy has worked extensively in both the US and India at the intersection of systemic transformation and technology, in sectors including Government, Healthcare and Education.

Parvathy is an entrepreneurial leader, now focused on solving urgent problems in the development sector, leveraging over 18 years of global experiences in strategy, marketing, product innovation, services delivery and business development. She has launched, generated and managed global revenue streams across products and services. Her leadership roles range from Accel-Partners funded Big Data Analytics start- up to Fortune-500 firms like Amazon, IQVIA and McGraw-Hill. Her experience spans sectors including Government, Healthcare, Financial Services, Education and Retail.

Parvathy has an MBA from the Kellogg School of Management and a Bachelors in Engineering from RAIT, Mumbai University.

Shaivi Chandavarkar

Shaivi is a Senior Consultant based in our Mumbai office. She works in CSR Advisory and is currently focused on a project to build the paediatric liver transplants ecosystem in India and the tribal maternal health space. She brings with her a diversity of experience in strategy consulting, project management, business development and marketing communications in healthcare projects.

Prior to Sattva, Shaivi worked in healthcare consulting with IQVIA in Singapore, was the Medical Project Lead for a multi-specialty hospital in Mumbai – Namaha Healthcare (voted #1 Emerging Hospital in India by TOI in 2017) and worked in healthcare communication with DDB Remedy. She is also the founder of a non-profit Swasyah, to conduct camps to identify undiagnosed patients and direct them to appropriate health care.

Shaivi is a physical therapist by training from Seth GS Medical College and KEM Hospital, Mumbai. She also has an MA in Economics from SNDT University and an MBA from INSEAD.

Bobbymon George

Bobbymon heads Assessments in Sattva and is based in our Bangalore office.

He has delivered evaluation assignments across sectors and with key CSR accounts such as ABG, JPMorgan, ACC, Philips, L&T Infotech, L&T Financial Services, Dell and Fidelity. He comes with over 13 years of experience in the development sector, across programme design, implementation and Monitoring and Evaluation. He has led Programme Delivery, Curriculum Development, setting up Monitoring & Evaluation frame works and tools in non-profits.

He is also a master facilitator/trainer in Life Skills.

Garima Goel

Garima is part of the Transformative Advisory team in Delhi, working with Kaivalya Education Foundation (KEF) on the District Transformation Product for 25 districts.

Before Sattva she co-founded a sanitation enterprise called “Project Raahat” which is working in the field of urban sanitation in partnership with the government and is currently operational in 3 states. She represented India and Raahat in London and become ‘Enactus World Champion 2017’, chosen among 36 countries. She has also worked with MPs under the MPLAD programme and ran projects in their adopted villages regarding menstrual hygiene and community development. At Sattva she has worked with Central Square Foundation in landscaping the EdTech industry on a programme to drive efficacy and advocacy for country wide implementation by the government. She is committed to inculcating a bottom up method in development solutions to make them community driven.

Garima did her Bachelors of Management Studies from Shaheed Sukhdev College of Business Studies, with a major in Finance.

Atul Sukumar

Atul helps design, build and implement consulting projects as part of the Consulting Services team in Delhi.

Previously, his experience includes extensive research and analysis on problems of economic policy, education, healthcare, and energy. He has worked as a Data Analyst with the McKinsey Center for Government, a global hub for research, collaboration and innovation in government productivity and performance. He has also worked in consulting organisations, publishing companies, law firms and election campaigns. He is committed to bringing best practices from the private sector to impact public efficiency and effectiveness.

Atul is a liberal arts graduate of the University of Miami.

Mohana Rajan

Mohana Rajan is part of the Consulting Services team in Mumbai.

Prior to Sattva she has worked in the corporate as well as development sectors and as a Legislative Assistant to Mr. Jyotiraditya Scindia. She has worked with Foundations, Philanthropists, Corporate CSR and Non-profits in the areas of skill development, healthcare and children with special needs. She is passionate about gender equality and is keen to look into innovative models that can emulate corporate success in the development sector.

Mohana is a mechanical engineer from NITK Surathkal and a graduate of IIM Bangalore.

Sonam Angmo

Sonam is currently part of the Consulting Services team at Sattva.

Her experience in the development sector has spanned a wide range of themes such as Maternal Healthcare, Adolescent girls’ Hygiene & Sanitation, Malnutrition in Children, Farm based livelihood project for SHG women, assessments, social audits and sustainable livelihoods. She is passionate about optimal use of natural resources, and about waste management and water saving methods.

Sonam is a graduate from Delhi University and has a Post Graduation in Rural Management from Institute of Rural Management (IRMA), Anand.

Lakshmi Sethuraman

Lakshmi currently leads the sales function at Sattva. She has been with Sattva since 2010 and has led a diverse set of projects during this time working extensively with leaders of social organisations in building and scaling their operations sustainably. She has also worked with key CSR clients of Sattva in designing, implementing impactful programmes.

Prior to Sattva, Lakshmi has worked with the Manipal Group, Jubilant Retail and ITC Hotels across sales, business development and strategy functions. She holds a PGDM from T.A.Pai Management Institute.

Anita Kumar

Anita Kumar leads the Strategic Initiatives group at Sattva. She has over a decade of experience in both the private sector and the development sector and has worn various hats – employee in a large corporate, freelancer, and entrepreneur. She was with Procter & Gamble for five years in Sales & then Go-to-market Strategy for All-India. In 2009 she shifted to the development sector to use her skills to solve more complex social issues, and was consulting with different social organisations through her firm InsightsApplied including the Tamil Nadu Government, and various Foundations. For about 1.5 years, she consulted full-time with one of the large skill training organisations in the country helping them across a range of activities including mission alignment, impact measurement, sales strategy and partnerships.

Last year she co-founded a social enterprise which used technology to bridge information gaps about learning and livelihoods for disadvantaged youth. Anita is a graduate of IIM Calcutta (2004) and has an MSc in Development Management from LSE.