Anjaneya CHLP 2015-4-FR 53.pdf

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CHC-P-ZO^'-A/FR |S3

2015-16
Community Health Learning Programme
A Report on the Community Health Learning

Experience

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School of Public Health Equity and Action
(SOPHEA)

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building community health

Society for Community Health Awareness Research and Action

My community Journey

REPORT
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ANJANEYA.fi
COMMUNITY HEALTH LEARNING PROGRAMME
APRIL 2015 TO APRIL 2016

MENTOR
Mr.PRAHLAD IM
Society for Community Health Awarness, Research and Action (SOCHARA)

csochanv
building community health

Society for Comniiinitry Health Awareness Research and Action

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A cknowledgemen ts

The month of April 2015 to April 2016 I never forget in my life because it wondrfull and
learning time in my professional life.

SOCHARA is wonderful place with beautiful people with beautiful hearts. Friendly smiling
faces always welcome people here.
It may be cliched to mention that words are not enough to show my gratitude to MYRADA, but
it still does not make it false.

Initially my sincere thank go to Dr.Thlelma the director of Sochara for conducting CHLP and
encouraging young fellows like me to get plunged into community health and Dr.Ravi Narayan
has been an inspiration to my life
I special thank to my mentors Mr.Prasanna soligram and prahalad IM team members of
SOCHARA provided valuable mentorship to me and supporting to my research and reporting.

Adithya’s climate change sessions were eye openers, Rahul’s google head was always
welcoming us to discuss, Kumar.s recap,Prasanna’s proverbs and polyglot skills were much
appreciated, Janelie’s friendly and caring attitude, Krishna’s communication techniques,
Chandran’s virtual skills and Prahlad’s santitation sensitivity techniques were not just inspiring
but moving. The smooth functioning of SOCHARA wouldn’t have been possible without Hari
Bhaiya, Tulsi Bhaiya, Joseph, Vijayamma, Kamalamma, Maria, Mathew, Vinay and Victor.
They manage logistics efficiently. Special thanks to the librarian, Swamy who has well
maintained this treasure trove. All these made the learning, a fun filled experience and I want to
thank everyone.
My heartfelt thanks to at Bilagiri Rangana hills VGKK, Dr.Deepak and Dr.Thanya. At
MYRADA Mr.Kumar, Mr.Rajachary and other MYRADA team were very supporting, caring
and good mentoring. I wish to thank the Adivasi Soliga community for their love and support
specially Mendare and Medaganaane villages Adivasi community.

This journey wouldn’t have been a pleasant one without my co fellows. Finally, I want to thank
my ever supportive family and friends.

Anjaney B

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2015-16 CHLP fellow

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47

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66.1%

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Adolescent girls____________
Children below 5 years_______
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70.4%
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1970

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2013

Baseline2010

End
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Baseline- End
2010
2013

1

Heard of anemia

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96.50%

12.63%

97.40%

12.87%

94.73%

2

Dewormed
last 6 months

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69.04%

11.10%

93.83%

10.66%

88.55%

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87.92%

14.00%

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13.11%

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Health resource mapping

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m)3dd e’d^d^otoJ&.^d/ae^ 3eod,d 2014- 15^e ddrd ddd ddodoso^^.
Total villages_____
36___
Total population
15319
34___
Anganwadies
ASHAs
12___
ANM___________
3____
Sub-center
3____
Gram panchayaths________
3
en)d ^eod d^d dcroSo^

59

Sub-center wise population
SC population

Population

others population

ST population

Sub-center

Male

female

Male

Female

Male

female

Male

female

Addagal-a

2366

2236

690

657

463

293

1213

1186

650

332

260

1190

1200

628

560

574

2088

1938

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2110

700

Kondamari

3303

3153

673

eJda 2014-15

esdjaert

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Dog bits

No of delivery

adults

Children

&

ORD
cases

RNTCP

Male

Female

Male

Female

April

379

0

0

0

0

0

0

10

10

19

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381

0

0

0

0

0

0

6

7

25

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392

0

0

1

0

0

0

6

8

20

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274

0

4

0

0

0

1

3

3

24

August

356

1

2

1

0

0

0

5

9

13

September

330

0

0

0

2

0

0

2

3

28

October

468

0

0

1

2

0

0

1

5

25

November

362

0

2

0

0

0

0

2

5

31

Month
year

IMR*

Day

night

ANC

December

346

1

1

0

0

0

0

6

6

17

January

351

2

1

2

1

0

0

0

5

23

February

310

0

0

1

0

0

0

0

3

22

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320

1

0

0

0

0

0

6

6

16

April

244

0

0

0

0

0

0

4

8

25

2

1

0

7

6

14

may

326

2

June

446

0

0

0

0

0

0

1

5

21

July

42

0

0

0

0

0

0

10

9

22

august

407

0

0

1

0

0

0

5

2

15

September

652

0

2

0

0

0

0

5

7

20

October

514

1

4

0

0

0

0

3

4

November

430

1

0

1

0

0

0

6

2

♦

*

88

113

0

0

December

309

4

2

0

0

0

0

January

355

1

1

1

0

0

0

7994
14
21
10
5
0
1*
low birth wight female baby delivery in hospital 59.th
tn day

total

information not available

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With out Community
Service, we would not have
A strong quality of life. It's
Important to the person
Who serves as well as the
recipient. It's the way in
which we ourslevs grow
and development
62

-Dr.Dorothy Height

Research
1. Title
A STUDY ON AVAILABILITY AND ACCESSIBILITY OF HEALTH SERVICES FOR SOLIGA
COMMUNITY IN MENJARE AND INDIGANATHA VILLAGES", CHAMARAJANAGARA
DISTRICT, KARNATAKA.'
2. Introduction
A tribe is a social group in which there are many clans, nomadic bands, and sub-groups
having a definite geographical area, a separate language, a distinct culture and a common
political organization or a feeling of common determination against Social and Political
Organization strangers. Scholars have described tribes as aborigines or aboriginals or
Adivasis. The tribal groups generally live away from civilized world in the inaccessible
parts lying in the forests and hills. They speak the same tribal dialect. Traditionally they
profess primitive religion known as 'Animism' in which they worship of ghosts and spirits.
This is the most important element. Now most of the tribals profess Hinduism. They follow
primitive occupations such as gleaning, hunting, and gathering of forest produce. They are
largely flesh or meat eaters. They have nomadic habits and love to drink and dance. Some
of them are bond-slaves or agrestic serfs of moneylenders, zamindars, contractors, slave
laborers in plantations, mines, railway constructions and other enterprises. Now the tribes
are generally being converted into castes by changing one's lineage and by joining Hindu
religion. The Government of Karnataka has launched various projects and schemes for the
welfare of tribes. (Public health resource network. Book 15 Tribal health.New delhi: Public Health
Resource Network ;2010)

I
I

Literacy is very poor in tribal community in 2001 only47.10% of the adivasi population
was found to be literates in India and also students and teachers ratio is very high.There
are a large number of single teacher schools where one teacher has to teach from class 1 to
5th standard. In most tribal families, the current generation is thelst orat the most 2nd
generation of literates. As a result, the students are not able to get any help with their
studies from their parents and poverty prevents them from looking for alternative help.
(Public health resource network. Book 15 Tribal health.New delhi: Public Health Resource
Network ;2010))

The soliga are a scheduled tribe who lives in the hilly area forest areas of Bilagiri
Rangana Hill and Male Mahadeshwara hill of Chamarajanagara district, Karnataka. The
soligas were also referred as 'sholiga,' 'soliga,' and 'soligaru' by early authors. Soliga speak
an old dialect of kannada called 'Soliga nudi.’ The prominent settlement of soligas iscalled
haadi'. The settlement in hilly slope or forest with lesser number of families is called
'podu.' They are leaving in hunt
Most of the tribal community follow-only traditional health care system while they
use the common beliefs, customs, traditions, values and practices connected with health
63

and disease have been 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 tribal communities may have positive impact,
which could provide the model for appropriate health and sanitary practices in a given eco­
system.
(Tribal health. Annals of Community Health(internet).(place unknown)[cited2015 Sep
26];Available
fromhttp://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhe
alth)

According to the NFHS-3, 54.5% of STchildren under under weight, 27.6% are wasted
53.9% are stunted, and 24.9% are severely malnourished. (Tribal health. Annals of
Community Health (internet) .(place unknown) [cited2015 Sep 26];Available
fromhttp://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhe
alth)
After the NRHM implementation health services should reach tribal communities who are
living in forest area and most of the interior villages in India. Howeer most of the soligas
| living in forest area in Chamarajanagara district^ especially those who are living in Male
Mahadeshwara Hill are totally neglected from most of the government facilities, including
health services.
Tribal health status
•

•

•

•
•

•

•

Marriages below 18 years for girls is high(60%).
(http://www.annaIsofcommunityhealth.in/ois/index.php/AoCH/pages/view/tribalhealth.
)
43% of tribal women do not receive any antenatal checkups.
(http://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhealth .
)
38% do not receive any Tetanus toxoid (TT) injections and 51% do not receive I FC (Iron
and Folic acid tablets
(http://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhealth .
)
54.5% of children under weight, (NFHS-3)
81% tribal pregnant women deliver at home, 44% of all deliveries are attended by TEA
and 32% by other untrained persons. Only 5% are attended by health care professionals.
http://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhealth .)
42% of married women have reproductive health problem(Public health resource network
byNRHM)
Only 26% of children receive all vaccines.(NFHS-3)

| Generally most of the tribal villages not getting proper health servicesx especially those
who are the staying in forest area. There are public and private health services and also
64

immunization of most of the tribal people depend on traditional health services. According
to the NFHS 3, more than 11% of tribal children did not get any vaccines. Therefore the aim
of my study is to find out the gap between the health services and tribal community access
and also to find out the barriers of the health services availability and accessibility in the
two villages.
Objectives

1. To identify the health services available in the vicinity of soliga tribes habitation.
2. To document experiences of utilization of the health services available from those places.
3. To Identifying the barrier in accessing the health services.
4. Methodology

•

Study Design -

Qualitative methods were used for the study. The following table provides the details
regarding the methods to used in the study.
Sl.No
1

Objective___________________________
To identify the health services available in
the vicinity of soliga tribes habitation.

Methods_____________
Key Informant interview
and Govt records

2

To document experiences of utilization of
the health services available from those
places.______________________________
Identifying the barrier in accessing the
health services

FGD(Focus
groupDiscussion)- and In
depth interview________
FGDfFocus
groupDiscussion)- and In
depth interview

3

• | Study Area. The study will be conducted in Menjare and Indiganatha
taluk, Chamarajanagaar district, Karnataka

-villages, Kollegal

Study Population.
Soligas tribal community in Menjare and Indiganatha, villages, Kollegal taluk,
Chamarajanagaar district, Karnataka.
Source of data collection
The table below shows the sources of data collection for each of the objectives and the
design methods.

65

Sampling
Sampling was by means of a maximum variation sample (sometimes called a maximum
diversity sample or a maximum heterogeneity sample). Thus is a special kind of purposive
sample. Normally, a purposive sample is not representative, and does not claim to be.
However, a maximum variation sample, if carefully drawn, can be as representative as a
random sample. Despite what many people believe, a random sample is not necessarily the
most representative, especially when the sample size is small. In my study we selected on
two tribal villages in Kollegal taluk Karnataka.
•

Topic guide

o

FGD(Focus groupDiscussion)- Focus groupDiscussion with Myrada's two Self help
groups and also one water shed management group members.

Key Informant interviews - The study Involved key informant interviews of the health
department officials to get health system's view of the schemes and programs in the tribal
areas.
o In depth interview. In depth interview conducted with 6 members identified during the
FGD based on maximum variability method.
o

• | Data Analysis- FGD and interview data was recorded hand written notes, The data
collected was translated and transcribed. Data was corrected for errors. Themes that
emerged from the interviews ware written up manually and was analyzed using both
deductive and inductive methods.
5. Results
Health problems- Community peoples face some common health problems like
cold fever, headaches, Infection, joint pain, cough and other health problems also
like diarrhoea, TB, malaria, anaemia, snake bite and animal attack.
5.1. Available health services
In tribal area health services area very poor, even government, and private health services.

> Government Health Services- Near the villages there is no government health services.
| They are staying in the forest area so no-_health workers visit to the village^ and thePHC
available in Male Mahaddeshwar hill is 10 Km away from the village and sub centre also 5
to 6 Km away from the village. CHC in kollegal is 90 km away from the village.

I

According the PHC medical officer (Male mahadeshwara hill PHC), the health department
recently announced a new programme for who living in the forest area they provid the
travel allowance to those who are going for immunization and also pregnant women will
| get five days of food, shelter and carebefore delivery.
66

| Private Health services- Private health services also available in Male Mahadeshwara hill.
There were 2private medical shops, one RMP Doctor and one private clinic. Majority of the
Adivasi people go to.private clinics in Kolaturu and Metturu in Tamilnaddu.
Traditional Health Services- Adivasi people use. home remedies for common health
problems like fever cold joint pain and if there is a village traditional dayi available she
does home deliveries and some of the traditional health workers give treatment for bone
setting, snake bites and dog bites.

Health resource mapping
Health resource mapping conducted in two different villages in that 35 community
| members participated including men, women and children
First we observed the full village with community then selected place For health resource
| mapping we discussed about the village -total households population, School. Anganwadi,
sub centre, PHC, Private clinic medical shops, CHC and district hospital and also other
| health related resources.in the village.
Mendare Village -

I

i

.

"

Forest forest area in this village 24 household don’t have any available health
services they have local dayi conducting home deliveries even health worker wont visit to
the village. PHC 8km away from the village, sub centre, private clinics available and CHC
very far from the village so most of the people going to Metturu pravite clinic that is 80km
from the village.

67

Medagana Aane Village

..

I
I

|

I

This village also 6km from the Malemahadeshwara hill here also not available any health
services only dayi is conducting deliveries totally 23 household and 83 populations is there
his village also facing same problems like Mendare village.
5.2.
Knowledge about tribal health service- State and central government provid
special health services like mobile health unit, tribal health hospital but in that community
people were not aware about the programmes and schemes

Chamarajanagar district health department recently announced a new program for those
living in the forest area. They provide the travel allowance for thous going immunization
and also before delivery five days food, shelter and care but this information not aware to
community.
Barriers of utilizing government health services- Government health services
5.3.
peoples not utilizing properly because following reasons.

> Bribing/corruption- In government hospital they are not providing health services and
they collecting money from the every patients 20 rupees each and everything they
prescribing to private medical shops and they are not giving proper treatment.
> Geographical barrier- They are staying between the forest so they don't have any road
and transport connection if they have any health problem they go by walk that is very
difficult for patients so they not able to they giving preference to home remedial treatment
the final stage only they going to hospital and government health workers also not going to
villages for immunization and tribal mobile health unit also not visit to that area.
68

> Economic barrier - In the that villages people are very poor and there is no good source of
income only rainy season only they getting work with less wages in agricultural work in
that men 60 women 50 rupees for day so they not able to purchase medicines.

6.

Discussion an Tribal Health servicesThe soliga is a schedules tribe who lives in the hilly area forest areas of Bilagiri rangana hill
and male Mahadeshwara hill of Chamarajanagara district. Karnataka.
In Male
Mahadeshwara hill they are totally neglected from most of the government facilities
including health services.

According to the my research protocol planed data collection by 2FGD 6 in-deft interviews
and 2 Key Informant interview as for the plan I was conducted 2 FGD and 6 in-deft
interviews but Key Informant interview plan with PHC medical officer and taluk health
officer but taluk health officer not supported to my study so I was canceled and with
medical officer collected more information.

One barrier linked with other barriers example because of geographical problem link all
barrier and one of the important reason is poverty its link everything.

Health
problem

Poverty

No Food
7.

Conclusion
In this paper shows what are health problems facing in tribal area and what are the health
services available and what services adivasi community people accessing. Through health
resource mapping find out the health services in the tribal villages.
Each factor seemed why Adivasi community not utilizing properly available health
services what are the barriers and how to linked one barrier to other barriers. For the Adivasi
community health problems can solved through Skilled training of Dais to help communities not
able to reach the health facilities, health education and promotion through Anganwadi workers
and ANMs, Strengthening of the Sub-health Center through people’s mobilization, promoting to

69

income generation actives and mobilize the community to demand better road connections and
transport facilities

Acknowledgements
I am grateful to Prahlad IM for editing and technical review of this paper. I am thankful to Dr.
Thelma Narayana (SOCHARA), Dr. Ravi Narayan (SOCHARA) and Mr. Prasanna saligram for
wonderful supporting in study period. I acknowledge the MYRADA team specially Mr Kumar
My field mentor and Mr Rajachary Program officer Kollegal hilly area development project and
other team members of MYRADA kollegal team for supporting to my study, Mr Manjunatha
Jenugudu Community management resource center (CMRC) manager and other team members
for supporting in field, and Community Health Learning Program (CHLP), SOCHARA family .

Reference
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2.

3.
4.
5.

6.

Public health resource network. Book 15 Tribal health.New delhi: Public Health Resource
Network ;2010.
Tribal health. Annals of Community Health(internet).(place unknown)[cited2015 Sep
26];Available
fromhttp://www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhe
alth
Basu S. Dimensions of tribal health in India. Health Popul Perspect Issues. 2000;23(2):6170. Available
NFHS-3
from:www.annalsofcommunityhealth.in/ojs/index.php/AoCH/pages/view/tribalhealth
Bose A. Empowering Soliga tribes:'Sudarshan model'of Karnataka. Econ Polit Wkly.
2006;564-6.

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1

1

School of Public Health, Equity and Action (SOPHEA}~
SOCHARA
# 359, 1st Main,
1st Block, Koramangala,
Bengaluru - 560034
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