RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 3994 [600959]

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

Journa l of Radix International Educational and Research Consortium
1 | P a g e www.rierc.org

TRIBAL HEALTH CULTURE AND PROBLEMS OF TRIBAL AREAS IN WARANGAL DISTRICT –AN
ANALYSIS
ENUMULA ANKOOS
Research Scholalar,
Dept. of. Public Administration &HRM,
Kakatiya University, Warangal,
(T.S.) -506009

DASARI NIVAS
Research Scholalar, Dept. of. Economics,
Kakatiya University, Warangal,
(T.S.) -506009

ABSTRACT
National Rural Health Mission (NRHM) launched in April 2005, now renamed as NATIONAL HEALTH
MISSION (NHM), and has strived to achieve progress in providing universal access to equitable, affordable
and quality health care, which is accountable as well as responsive to the needs of the people. Important
initiatives for reducing child and maternal mortality as well as stabilizing p opulation have been taken,
immunization has been accelerated, and human resources development and training of Doctors, Nurses
and Paramedics have begun in all earnest. All the States have operationalised the Mission and the Health
Delivery System is being rejuvenated through additional management, accountancy and planning support
at all levels. By placing Accredited Social Health Activists (ASHAs) in every village, basic health care has
been brought closer to the vulnerable groups by giving a boost to Healt h Education and Promotion. In
present study of the paper focus on tribal areas of Warangal district which have the health culture and
problems of tribal people. Any tribe must be encouraged to organize itself in order to take advantages of
the programs de signed for the development and health in the light of human genetics, prophylactic
immunization, socio -cultural traditions and eco -friendly environment.
Key words: tribal people, health culture and problems , National Rural Health Mission , Health Delivery
System , etc,. A Journal of Radix International Educational and
Research Consortium

RIJS
RADIX INTERNATIONAL JOURNAL OF
RESEARCH IN SOCIAL SCIENCE

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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INTRODUCTION

India is only second to Africa in terms of tribal mass. Approximately 635 tribal groups and subgroups
including 73 primitive tribes live in India Represent about 8.2% of India’s population who have been
designated as ‘primitive’ based on pre -agricultural level of technology, low level of literacy, stagnant or
diminishing population size, relative seclusion (isolation) from the main stream of population, economical
and educational backwardness, extreme poverty, dwelling in remote inaccessible hilly terrains,
maintenance of constant touch with the natural environment, and unaffected by the developmental
process undergoing in India. Maximum tribal population concentrated in North East India (highest in
Mizoram: 94%) followed by Centr al India (highest in Chattisgarh: 31%) and lowest proportion in South
India. Health and development indicators below national average. There is a consensus that these
scheduled tribes are the descendants of aboriginal population in India .

According to th e World Health Organization (WHO), the definition of health is a state of complete physical,
mental and social well -being and not merely the absence of disease or infirmity. The health status of any
community is influenced by the interplay of health consci ousness of the people, socio -cultural,
demographic, economic, educational and political factors. The common beliefs, traditional customs,
myths, practices related to health and disease in turn influence the health seeking behaviour of
autochthonous people (Balgir 2004a). Health is an essential component of the well -being of mankind and
is a prerequisite for human development. If general health of an average non -tribal Indian is inferior to the
Western and even many Asian counterparts, the health of an avera ge Indian tribal is found to be much
poorer compared to the non -tribal counterpart. The health status of tribal populations is very poor and
worst of primitive tribes because of the isolation, remoteness and being largely unaffected by the
developmental pr ocess going on in India.

The United Nations (UN) members met in 2000 and set themselves eight goals to be achieved by 2015. Of
these goals, reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and
other diseases related to the health segment were in cluded. The first goal ‘of eradicating extreme poverty
and hunger’ also contains a nutritional element which is health related. In the developing world, death
rates in children under five are dropping, but not fast enough. Eleven million children are still dying every
year, from preventable or treatable causes. More than half a million women die each year during
pregnancy or childbirth. AIDS has become the fourth largest killer worldwide, and in parts of Asia, HIV is
spreading at an alarming rate. The bligh t of malaria and tuberculosis continues. Clearly , the challenges for
India are multi -faceted. In rural areas, reducing child mortality and improving maternal health are major
challenges. HIV is spreading fast in urban and slum areas. Health care in India h as been neglected because
of insufficient spending by the government. The Central Government has vowed to increase spending on
health to 6% of Gross Domestic Product (GDP) by 2010 (as revealed recently by Union Health Minister that
India would be able to m eet the UN Millennium Development Goals, of which health is an important
segment), and has unveiled a National Rural Health Mission. If this dream comes true, villages would have
24-hour health care services provided by an army of paramedics.

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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MEDICAL AND PUBLIC HEALTH

The Plan outlay for 2014 -15 of the Department of Health and Family Welfare is `30,645.00 crore (CSS –
`24,490.88 crore and CS – `6,154.12 crore) inclusive of `3,064.50 crore for the benefit of the Schemes/
Projects in the NER and Sikkim. The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), aimed at
strengthening the tertiary sector, envisages setting up of new AIIMS -like institutions and upgradation of
existing Government Medical College Institutions. A provision of `1,956.00 crore has been ea rmarked for
the scheme during 2014 -15. Additional needs of human resources and medical education has been
articulated and the outlay for the scheme has been kept at `2,578.88 crore. Certain other Schemes such as
Oversight Committee, Health Care of Elderly and also New Schemes like, Strengthening of Existing
Branches and Establishment of 27 Branches of NCDC, Strengthening of Inter sartorial Coordination of
Prevention and Control of Zoonotic Diseases, Health Insurance, Viral Hepatitis, etc. are also part of Plan
Outlay.

HEALTH RESEARCH

The Plan outlay of the Department of Health Research is `726.00 crore inclusive of `72.60 crore for the
benefit of the schemes/projects in the NER and Sikkim. The Indian Council of Medical Research, an apex
body mandated to pr omote, co -ordinate and formulate biomedical & Health Research, receives
maintenance Grants from the Central Government for Research in health, nutrition, non -communicable
diseases and basic research. The Council is also engaged in research on tribal health , traditional medicines
and publication and dissemination of information.

DEPARTMENT OF AIDS CONTROL

The Department of AIDS Control implements National AIDS Control Programme (NACP), a 100% Centrally
Sponsored Programme, which in Twelfth Five Year Plan ha s phased out to National AIDS Control
Programme Phase -IV (NACP -IV) with a goal to accelerate reversal of HIV epidemic in the country by
integrating programmes for prevention, care, support and treatment. The Approved Outlay for 2014 -15 is
`1,785.00 crore.

Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH): The objective of
Department of AYUSH is to develop and promote the Indian systems of medicines in an organised and
scientific manner. Towards achievement of this objective, the Departme nt implemented a number of
Centrally Sponsored Schemes and Central Sector Schemes. The involvement/integration of AYUSH systems
in National Health Care Delivery by making them part of National Rural Health Mission (NRHM) is also
being given a thrust. The P lan outlay for Department of AYUSH for 2014 -15 is `1069.00 crore.

Women and Child Development: The Plan outlay of the Ministry in 2014 -15 is `21,100.00 crore including
`2,110.00 crore for the benefit of North Eastern Region. The Integrated Child Development Services

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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Scheme (ICDS) is the flagship scheme of the Ministry for which the allocation is `18,195.00 crore in the
Expenditure Budget Vol.I, 2014 -2015 40 current year. The scheme seeks to provide an integrated package
of health, supplementary nutrition and education services to children up to six years of age, pregnant
women and nursing mothers, and includes supplementary nutrition, immunization, health check -up,
referral services, nutrition and health education and non -formal pre -school education. In order to
universalize the scheme, the Government has approved a cumulative number of 7076 Projects and 14 lakh
Anganwadi Centres/Mini Anganwadi Centres, including 20,000 Anganwadis on demand. The ICDS Scheme
has now been merged with National Nutrition Mission ( NNM) and World Bank assisted ICDS Systems
Strengthening and Nutrition Improvement Project (ISSNIP) with a total allocation of `18,691.00 crore
during 2014 -15 (`300.00 crore for NNM and `196.00 crore for ISSNIP). Under National Nutrition Mission,
the nation wide IEC campaign against malnutrition has been launched on 19th November, 2012 and roll out
of the four stages campaign disseminated through multi -channel mode since 28th December, 2012. The
framework for multi -sectoral programme to address the maternal a nd child malnutrition in selected 200
high -burden districts has been prepared. This programme proposes to bring together various national
programmes through strong institutional and programmatic convergence at the State, District, Block and
Village levels. The ISSNIP has been designed to supplement and provide value addition on the existing ICDS
programme, through systems strengthening for better service delivery, as well as to allow the select
States/Districts to experiment, innovate and conduct pilots of potentially more effective approaches for
ICDS, to achieve early childhood education and nutrition outcomes. The Ministry launched a Centrally
Sponsored Scheme “Integrated Child Protection Scheme (ICPS)” from 2009 -10. The objectives of the
scheme is to cre ate a safe and secure environment for comprehensive development of children who are in
need of care and protection, including children in conflict with law and other vulnerable children. Another
Centrally Sponsored Scheme namely, Rajiv Gandhi Scheme for Em powerment of Adolescent Girls (SABLA)
is under implementation since 2010 -11, formulated to address the multidimensional problems of
adolescent girls (11 -18 years). The scheme is being implemented in 205 districts across the country on pilot
basis. The allo cation of SABLA for the year 2014 -15 is `700.00 crore.

The Indira Gandhi Matritva Sahyog Yojana (IGMSY) and ‘Umbrella Scheme for Protection and Development
of Women’ have been merged into new scheme called National Mission for Empowerment of Women
(NMEW). NMEW was launched on 8th March, 2010, with a view to empowering women socially,
economically and educationally. The Mission aims to achieve empowerment of women on all these fronts
by securing convergence of schemes/programmes of different Ministries/ Depa rtments of Government of
India as well as State Governments. Alongside, the Mission shall monitor and review gender budgeting by
Ministries/Departments. The allocation of NMEW for the year 2014 -15 is `90.00 crore. IGMSY – a
Conditional Maternity Benefit (C MB) scheme is a pilot intervention in selected 53 districts of the country
using the framework of the existing ICDS programme. It is a mitigative measure in the form of conditional
cash transfer to provide part compensation of wage loss as maternity benefi t to women during pregnancy
and lactation period. The allocation for IGMSY for the year 2014 -15 is `400.00 crore. Other important
women empowerment schemes of the Ministry include Support to Training and Employment Programme
(STEP); Priyadarshini Scheme, R ehabilitation and Support schemes like Swadhar, Micro -Credit Scheme of

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

Journa l of Radix International Educational and Research Consortium
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Rashtriya Mahila Kosh (RMK), etc. The Ministry is implementing ‘Ujjawala’ scheme, which provides
support for rescue, rehabilitation, reintegration and repatriation of victims of traffic king for commercial
sexual exploitation. A new scheme namely, ‘Beti Bachao Beti Padhao Campaign’ has been introduced in
the regular budget, 2014 -15, which is a Central Sector Scheme under Child Development. A provision of
`100.00 crore has been made for th e scheme during 2014 -15.

WATER SUPPLY AND SANITATION

The National Rural Drinking Water Programme (NRDWP) is a flagship programme of the Ministry of
Drinking Water and Sanitation, and a component of the ‘Bharat Nirman’. The objective of programme is to
ensure provision of safe and adequate drinking water supply through hand pumps, piped water supply
schemes etc. to all rural areas and household. Under the programme, financial assistance is provided to
States/UTs for provision of drinking water supply to rur al areas of the country under the components of, (i)
coverage of partially covered rural habitations with water supply, (ii) coverage of quality affected rural
habitations with water supply, (iii) taking up source and system sustainability measures, (iv) s upporting
operation and maintenance of existing water supply schemes, (v) water quality monitoring and
surveillance and, (vi) support activities like IEC, training, MIS, computerisation, R&D, etc. Assistance is
provided in the ratio of 50:50 between Centre and States for the components of coverage, water quality
and O&M except for North Eastern States and Jammu & Kashmir, to whom assistance is provided in the
ratio of 90:10. Sustainability, Water Quality Monitoring & Surveillance, and support components are
funded on a 100% basis by the Central Government. Out of 16.92 lakh rural habitations in the country as
on 01.04.2013, 11.61 lakh habitations are fully covered with safe and adequate drinking water supply. For
2014 -15, a provision of `11,000.00 crore has been made for NRDWP and the rural water supply sector,
including `1,100.00 crore for North Eastern Region and Sikkim. Further, 22% and 10% of the total allocation
are earmarked for meeting expenditure on Scheduled Caste Sub -Plan and Tribal Sub -Plan respect ively.
During 2014 – 15, the thrust will be on coverage of rural population with piped water supply schemes,
completion of on -going schemes, prioritising coverage of quality affected habitations, focusing on
convergence of water supply with rural sanitation , planning for the optimum use of the sustainability
component especially in water stressed blocks and effectively using incentive funds to promote
decentralisation of Management of Water Supply Schemes.

NIRMAL BHARAT ABHIYAN (NBA)

To accelerate the progr ess of sanitation in rural areas, Government of India has designed a paradigm shift
in Total Sanitation Campaign (TSC), which is now called the Nirmal Bharat Abhiyan (NBA), in the XIIth Five
Year Plan. The new strategy is to transform rural India into ‘Nir mal Bharat’ by adopting community
saturation approach. The provision of incentive for individual household latrine units has been widened to
cover all APL households who belong to SCs,
STs, small and marginal farmers, landless labourers with homesteads, physically challenged and women
headed households along -with all BPL households. NBA goal is to achieve 100% access to sanitation for all

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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rural households by 2022. NBA Projects have been launched in the entire rural India covering 607 districts
in 30 State s/UTs for which a provision of `4,260 crore has been made for the year 2014 -15, including `426
crore for North -Eastern Region and Sikkim. Further, 22% and 10% of the total allocation are earmarked for
meeting expenditure on Schedule Caste Sub -Plan and Trib al Sub -Plan respectively.

TRIBAL AFFAIRS

The allocation of `4479.00 crore includes provisions for Grants -in-Aid to Voluntary Organisations for
Scheduled Tribes (ST) including Coaching and Allied Schemes and Award for Exemplary Services (`36.50
crore), Vo cational Training in Tribal Areas (`3.00 crore), Strengthening of Education among ST girls in low
literacy districts (`40.00 crore), Market Development of Tribal Products/Produce (`35.00 crore), Grantsin –
Aid to State Tribal Development Cooperative Corpora tion for Minor Forest Produce (`15.00 crore),
Development of Particularly Vulnerable Tribal Groups (PTG) (`207.00 crore), Support to National/State
Scheduled Tribes Finance and Development Corporations (`70.00 crore), Rajiv Gandhi National Fellowship
for S T students (`50.00 crore), National Overseas Scholarship Scheme (`1.00 crore), Mechanism for
Marketing of Minor Forest Produce (MFP) through Minimum Support Price (MSP) and Development of
Value Chain for MFP (`317.00 crore), World Bank Project – Improving Development Programmes in the
Tribal Areas (`3.86 crore), Research Information and Mass Education, Tribal Festivals and Others (`25.64
crore), Umbrella Scheme for Education of ST Children (`1058.00 crore), Scheme under Tribal Sub -Plan
(`1200.00 crore) and Scheme under Proviso to Article 275(1) of the Constitution (`1317.00 crore). An
amount of `100 crore has been provided for a new scheme – Van Bandhu Kalyan Yojana.

Tribal communities in general and primitive tribal groups in particular are highly disease p rone. Also they
do not have required access to basic health facilities. They are most exploited, neglected, and highly
vulnerable to diseases with high degree of malnutrition, morbidity and mortality. Their misery is
compounded by poverty, illiteracy, igno rance of causes of diseases, hostile environment, poor sanitation,
lack of safe drinking water and blind beliefs, etc. The chief causes of high maternal mortality rate are found
to be poor nutritional status, low hemoglobin (anemia), unhygienic and primiti ve practices for parturition.
Average calorie as well as protein consumption is found is below the recommended level for the pregnant
as well as lactating women. Some of the preventable diseases such as tuberculosis, malaria,
gastroenteritis, filariasis, m easles, tetanus, whooping cough, skin diseases (scabies), etc. are also high
among the tribals. Some of the diseases of genetic origin reported to be occurring in the Indian tribal
population are sickle cell anemia, alpha – and beta -thalassemia, glucose -6-phosphate dehydrogenase
(G6PD) deficiency, etc. (Balgir, 2004b). Night blindness, sexually transmitted diseases are well known
public health problems of tribals in India.

OBJECTIVES OF TRIBAL HEALTH IN WARANGAL DISTRICT
To implement an integrated and sustai nable system for primary health care services delivery in the nine
ITDA areas.

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To provide, food & stay facility and compensation of loss of daily wages for the tribal pregnant women to
encourage institutional deliveries by strengthening birth waiting homes.

Strengthening of primary health centers by providing with necessary equipment in addition to those
provided regularly to make 24 x 7 services effective.

BCC & IEC in local tribal languages in to wean them from superstitious health seeking behavior.

Inter department coordination, functional convergence with tribal welfare department, and WDCD
depar tments and establishment of special Tribal health project monitoring units at The State and ITDA
level.

To encourage the MPHA (F) for conduction of deliveries in remote and unreached sub center areas.

Provision of mobility to the PHC medical officers.

SITUATION ANALYSIS AND CURRENT STATUS: GAPS IDENTIFIED

Total No of Sub Centers functioning in Tribal Area 108, out of which 14 Sub Centers have own buildings, 17
new Sub -cente r buildings were sanctioned vide Go.Ms.No.345 and 10 Sub Center buildings were
sanctioned vide Go.Ms.No.260 i.e. 67 Sub Centers requires buildings required @ Rs.9 Lakhs i.e. Rs. 6.03
Crores, this is to have one additional room for ANMs stayal in the Sub Center.

New PHC Building is required for Royyur .

For the 24 x7 MCH Cetners functio ning in Tribal Area requires Pediatric and Gynocologist consultations for
overall improvement of Maternal & Child health services requires honororuim of Rs.1000/ – per visit plus
Rs.750 towards hire charges for each Pedicatircian and Gynoclogist for 52 Week s of the year amount
required Rs.14,56,000 for the service rended by the Gynocologist and Pediatrcian.

It is requested to have atleast two specialists in all Tribal CHCs i.e. 1.Mulug, 2.Eturnagaram and 3. Gudur
i.e. Rs.65,000 for each specialist for month for above three CHCs requires amount Rs.70,20,000/ – for
additional Pediatrics, Gynocologist and Anestiastist.

For mobility of the Medical Officers as the area is requires frequent conduction of Health Camps and to
contain the measures for epadamics and Ve ctor born deseases requires hire vehicles i.e. Rs.22,000 per
month, for 12 Months Rs.2,64,000/ – for each PHC and for 17 PHC i.e. Rs.44,88,000 for annual requirement.

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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As the Tribal people will have low immunity and prone for deseases as their usual residenc y Malaria
endomic area and also suffering from Maul Nutrition requires additional One Lakh rupees required for 17
PHCs i.e. Rs.17Lakhs.

All Tribal PHCs should have atleast 2 Medical Officers and 3 Staff Nurses, in Warangal 6 Medical Officers
may be appoin ted as Second Medical Officer on Contract Basis as per the norms with minimum
qualification of MBBS, Remunaration is payable Rs.30,000 per month like other doctors working in the
PHCs and amounting Rs.21,60,000 per annuam.

All the equipments and infrastru cture should be provided to all 108 Sub Centers as per the IPHS.

All Tribal PHCs should be equipped with Ambulances

It is propsed to increase the incentives of the Medical Officers emergency visit to hostels in Tribal Area by
Rs.1000/ – per visit (17*4*100 0*12=8,16,000)

HEALTH SCENARIO IN WARANGAL DISTRICT

The Health Strategy of Warangal District in 2014 has advocated the improvement in health status of tribal
population by reducing the morbidity and mortality in them. Tribal people suffer from special health
problems disproportionately such as malaria, sexually transmitted diseases, tuberculosis, nutritional
deficiency diseases, genetic disorders like glucose -6- phosphate dehydrogenase (G6PD) deficiency, sickle
cell anemia, etc. The situation analysis o f health indices of the tribal population in Warangal District is
worse than the national average: infant mortality rate 84.2, under five mortality rates 126.6, children
underweight 55.9, anemia in children 79.8, children with acute respiratory infection 22.4, children with
recent diarrohea 21.1, and women with anemia 64.9 per 1000. A high incidence of malnutrition has also
been documented in tribal dominated districts of Warangal District . This scenario presents a very grim
picture about the general healt h and quality of life of the tribal people in Warangal District . There is an
urgent need to combat the health problems and take the rehabilitative measures to alleviate the sufferings
of the dwindling masses in the state of Warangal District .

TRIBAL HEALTH CULTURE

Tribal communities are mostly forest dwellers. Their health system and medical knowledge over ages
known as ‘Traditional Health Care System’ depend both on the herbal and the psychosomatic lines of
treatment. While plants, flowers, seeds, animals and other naturally available substances formed the
major basis of treatment . Faith healing has always been a part of the traditional treatment in the Tribal
Health Care System, which can be equated with rapport or confidence – building in the modern treatme nt
procedure. Health problems and health practices of tribal communities have been profoundly influenced
by the interplay of complex social, cultural, educational, economic and political practices. The study of

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

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health culture of tribal communities belongin g to the poorest strata of society is highly desirable and
essential to determine their access to different health services available in a social set up. The common
beliefs, customs, traditions, values and practices connected with health and disease have b een closely
associated with the treatment of diseases. In most of tribal communities, there is a wealth of folklore
associated with health beliefs. Knowledge of folklore of different socio -cultural systems of tribals may have
positive impact, which could p rovide the model for appropriate health and sanitary practices in a
Proceeding of National Symposium on Tribal Health given eco -system. The health culture of a community
does not change so easily with changes in the access to various health services. Hence , it is required to
change the health services to conform to health culture of tribal communities for optimal utilization of
health services. Health is a universally cherished goal. Health cannot be forced upon the people. The
organization of health servic es to all people is considered to be t he key step towards development. It is an
important input for the development of man and, thereby, to social and economic development of the
country. Health is widely linked with development. A rapid and equitable econ omic development is a good
health input and an adequate and equitable health care system stimulates development with improving
human productivity. This is the reason; why the investment in health is, sometimes, called an investment
in human capital. Health care is one of the most important of all human endeavours to improve the quality
of life especially of the tribal people. There is a need to scientifically study the traditional tribal medicine
and healing systems and combine them with modern allopathic s ystem so as to make it available and
affordable for the poor tribal population.

HEALTH STATUS

 High level of consanguineous marriages leading to defects in the race and hereditary diseases
 High prevalence of sickle cell anemia and other genetic diseases
 High fertility rates, low institutional delivery rates
 Higher maternal mortality and infant mortality compared to national average
 Inadequate immunization status
 High prevalence on malnutrition – stunting and underweight – especially among preschool children
 Communicable and Tropical diseases like malaria, and parasitic diseases widespread
 Increasing burden of non communicable diseases like diabetes mellitus
 Health care facilities absent or lacking in terms of infrastructure, personnel, finance, accessibility
and availability
 Poor hygiene and sanitation
 Lack of emphasis on mainstreaming their traditional systems of medicine
 Poor health seeking behaviour

Health must meet the need of the people, as they perceive them. Health cannot be imposed from outside
against people’s will. It cannot be dispensed to the tribal people. They must want and be prepared to do
their share and to cooperate fully in whatever the healt h programs a community develops. The problems
of shortage of food, poverty, population expansion, m alnutrition, health, hygiene and disease burden still

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persist in 60% rural population in India. Proper health and balanced nutrition are, therefore, considered as
some of the prime requirements for application of biotechnology in improving the quality of l ife of rural
poor. It implies sufficient knowledge about the culture, environment, natural and human resources, skill
endowments and the belief systems of a set of people. This approach is best suited to study the behaviour
of the people in health and dise ase, encompassing the biocultural and eco -environmental aspects of the
concerned tribal population.

TRIBAL HEALTH PROBLEMS

The primary health care infrastructure provides the first level of contact between the population and
health care providers and forms the common pathway for implementation of all the health and family
welfare programs. It provides integrated promotive, preventive, curative and rehabilitative services to the
population close to their hearth and home. A majority of the health care ne eds of the tribal population are
taken care of either by the trained health personnel at the primary health care level or by their own
traditional indigenous health practitioners at village level. Those requiring specialized care are referred to
secondary and tertiary sector. The tribal population is not a homogeneous one. There are wide variations
with regard to education and health status, access and utilization of health services among the tribal
populations.

Keeping in view that most of the tribal habitation is concentrated in far flung areas, forestland, hills and
remote villages, and in order to remove the imbalances and provide better health care and family welfare
services to scheduled tribes, the populati on coverage norms of establishment of rural infrastructure have
been relaxed. The primitive tribes in India have distinct health problems, mainly governed by
multidimensional factors such as habitat, difficult terrains, varied ecological niches, illiteracy , poverty,
isolation, superstitions and deforestation. The tribal people in India have their own life styles, food habits,
beliefs, traditions and socio -cultural activities. The health and nutritional problems of the vast tribal
populations are varied beca use of bewildering diversity in their socio -economic, cultural and ecological
settings in Warangal District that the tribal communities are vulnerable as well as have major threat of the
following major health problems:

The people in their daily life con sciously or subconsciously modify the environment and ecological aspects
of their habitat, which in turn increase the risk for communicable diseases. The communication of diseases
is dependent either on the direct contact or on the indirect agents like bre athing, sputum, stool, saliva,
urine, etc. The venereal diseases are communicated through direct contact and tuberculosis is
communicated through indirect contact such as breathing. Thus, the communicable diseases are those
diseases, which pass from infect ed person to a healthy person by direct or indirect contacts through
infectious agents. Sometimes, viral or bacterial infections cause death in a large numbers (in epidemic
form) and threaten the survival of mankind. There are several communicable diseases prevalent among
the tribals of Warangal District. These are: Tuberculosis, Hepatitis, Sexually Transmitted Diseases (STDs),
Malaria, Filariasis, Diarrhoea and Dysentry, Jaundice, Parasitic infestation, Viral and Fungal infections,

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Conjunctivitis, Yaws, Scab ies, Measles, Leprosy, Cough and Cold, HIV/AIDS, which is spreading like wild
fire, etc. due to lack of sanitation and unhygienic living .

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) recommends that all those who live in
endemic communiti es be treated once in a year with a single dose of appropriateantifilarial drug like
diethylcarbamazine (DEC). Though this drug has limited effect on adult filarial worm, it clears microfilariae
from infected humans and deprives mosquitoes for opportunity to pick up infection from affected host to
healthy individual. Elimination of LF by 2015 is the goal prescribed in National Health Policy of India.

THE HEALTH CARE SERVICES AND CHALLENGES IN RURAL AND TRIBAL AREAS ARE A COMPLICATED
PHENOMENON SUCH AS

Concept of health and disease is rather traditional which results in their not seeking treatment at an early
stage of physical maladjustment and frequent refusal of preventive measures in rural areas and their idea
of medical care is some treatment not eas ily accessible and available. Lack of motivation of people for
availing medical care at the initial stage of the disease.

Limited paying capacity or habit of getting treatment always free of cost.

Comparative inaccessibility of medical care services due to under -developed communication and transport
facilities.

Non availability of qualified medical practitioner in the village.

Qualified health workers and professional medical and paramedical staff do not want to work in rural and
tribal areas because of p rofessional, personal and social reasons.

Nonavailability of private or governmental doctor as and when need arises.

A look into the pattern of rural health services shows that the scarcity of trained manpower for health is a
major problem and obstacle to the extension of health services to rural and tribal areas. Moreover, the
qualified health workers do not want to work in rural and tribal areas because of professional, personal
and social reasons.

CONCLUSION

The health problems of rural and tribal pop ulations cannot automatically be overcome by establishing
more primary health centres and sub -centres and also imparting training to more health personnel or
providing integrated health services by a single authority or by a number of agencies. An integrat ed health
services would be operated on a teamwork basis by division of labour so that the greatest possible use of

RIJS Volume 4, Issue 4 (April , 2015 ) ISSN: 2250 – 3994

Journa l of Radix International Educational and Research Consortium
12 | P a g e www.rierc.org
professional skills could be made. Proceeding of National Symposium on Tribal Health personnel consisting
of nurses, various categories of p aramedical (Laboratory Technician, Pharmacist, Multipurpose Health
Worker, Genetic/Marriage Counselor, Anganwadi worker, etc.) and auxiliary staff. Managerial skills and
controlling power of the doctor to coordinate various activities and maintenance of in frastructures
including vehicles and procurement of equipments, medicines, vaccines, etc. on regular basis are highly
desirable. There is a complete lack of managerial training, financial empowerment and facilities available
to the doctor to efficiently an d effectively monitor and carry out public health duties in the rural setting
and tribal areas . Frequent transfers and absenteeism of the staff, favouritism and corrupt practices hinder
the smooth functioning of the Primary Health Centre (PHC), which have a dverse health effects on the tribal
population.

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