Tribal Hospitals – Links to nutrition
Most tribal hospitals can prove to be lifesavers with respect to the life threatening health problems faced by tribals in the villages in Maharashtra and elsewhere in India. The single biggest factor that leads to malnutrition is the lack of proper food and nutrition. Part of the problem is also the lack of awareness regarding the importance of balanced diet and other daily dietary and nutritional requirements. For this, perhaps, if the tribal hospitals in these regions can be equipped with a nutrition rehabilitation unit, then a very critical source of this life threatening issue can be curbed. The nutrition rehabilitation units could help address the nutritional imbalances in the daily food intake of the tribal population suffering from malnourishment. The purpose of these nutrition units could be to dole out special therapeutic foods that contain macronutrients such as proteins, fats and carbohydrates and also very important micronutrients such as the essential vitamins and minerals. The therapeutic food can be made from local food sources and using local manpower itself. In addition to this, the primary health centre (PHC) too must be equipped with specialised child healthcare treatment centres that provide this essential therapeutic diet to the malnourished (target) population.
Paucity of Primary Health Centres
Primary health centre (PHC) or public health centre is the backbone of healthcare service delivery in India, especially urban slums and rural areas. PHCs are the basic structural and functional unit of public health services. The main objective behind a PHC is to provide accessible, affordable and available primary healthcare to the rural population. The numbers of PHCs in rural India and especially in tribal areas are themselves not adequate. At present, there is only one PHC serving approximately 35,000 tribals, on an average. The lack of adequate number of PHCs relative to the tribal population in these areas is quite alarming. In an ideal situation, one PHC can serve a population of around 10,000 people only and covering an area of 5-8 kilometres, at most. However, at present, a tribal has to travel up to 20-25 kilometres to reach the nearest PHC.
The State government must ensure adequate number of PHCs at an approximate 8-10 kilometre radius of the tribal village. CHCs (Community Health Centre) and PHCs need to be made more accessible for the villagers. In case a specialised CHC and PHC cannot be erected at all the required locations, then the Government must ensure at least one health sub-centre in all the tribal villages.
Non-availability of Doctors and Nutrition experts
Even with these PHCs in place, healthcare service delivery in tribal areas faces other major problems. That is, extreme shortage of medical personnel. Medical doctors, nurses, nutrition experts and other medical personnel are unwilling to relocate to tribal areas in order to practice medicine and serve the tribals. In the tribal belt of Maharashtra, the doctors are not ready to go and work in the hospitals in these areas. So, most of the hospitals in the tribal areas remain under-staffed most of the times. There is particular scarcity of maternal and child health (MCH) specialists and other medical specialists such as paediatrician, nutritionists, anaesthetics, among others, in the tribal hospitals. Further, due to severe lack of paediatricians in government hospitals and PHCs in such tribal areas, if the infant/child is suffering from chronic malnutrition, the risk of the child succumbing to death during the first 1,000 days (of birth) increases manifold. Thus, there is definitely a strong correlation between lack of trained medical specialists and malnutrition deaths.
We are well aware of one of the age-old superstitions related to pregnancy and food intake. That is, the tribal women follow the practice of low food intake during pregnancy for easy and comfortable delivery of the newborn (resulting in anaemia among mothers and malnourishment among the infants). The intake of nutritious diet is the least among women when they actually need the most!
Another critical hurdle that healthcare faces are that the local population usually don’t want to admit their children to hospitals due to superstition, cultural barriers and various other socio-economic factors. Since these tribals often don’t admit their malnourished children to hospital, children are dying at home.