1. Presenter – Dr. Vikas Bhatia Professor and HOD,
Department of Community and Family Medicine
All India Institute of Medical Sciences, Bhubaneswar

2. A study of tribal health in ODISHA, INDIA

3. Outline of presentation
Background
Key components of tribal health
Distribution of tribal population in Odisha
Key health indicators: Odisha and tribal population
Tribal health interventions and other welfare schemes

4. Introduction
The tribal population proportion in Odisha - increased from 22.1% to 22.8% in the last decade
Odisha ranks third and accounts for 9.1% of the tribal population in India
Highest in Mayurbhanj (58.7%) and lowest in Puri (0.7%)
44.70% of the State's geographical area - Scheduled Area
Extends over 119 out of 314 Blocks in 13 districts
*Census 2011 report. Available at
**Annual activity report Available at

5. Distribution of tribal blocks in Odisha

6. Key Components of Tribal Health
Accessible
Physical Access- Time Dimension
Social Access
Equity
Responsive & Dynamic
Match with real needs and felt needs of community
Tribal Health Care
Comprehensive Care with focus on local priorities
Promotive, prev-entive, curative and rehabilitative dimensions
ACCESS:
Physical access with ‘Time’ dimension,
- Access in emergencies within one to two hours, for acute care within a day, and for chronic illness within a week.
Social access by lack of exclusions. Every marginalized sections (tribal, homeless, street children, destitute) supported by additional efforts / affirmative action.
Equity by lack of difference between different social groups in terms of access to services and health outcomes.
COMPREHENSIVE CARE:
Diagnosis, treatment and care for the full range of illnesses covering:
RCH
Trauma
Disease Control Programs
Non Communicable Diseases
Disability
Should cover primary, secondary and tertiary.
Should have promotive, preventive, curative and rehabilitative dimensions
QUALITY:
The care provided is :
Effective in achieving outcomes desired:
Safe and satisfying
Provides comfort, dignity, privacy, confidentiality and “autonomy” of the use of services to the patients.
AFFORDABLE:
No out of pocket expenditure at the point of care
Minimum paperwork for availing the benefits
RESPONSIVE:
Health service delivery and health care action matching real needs and the felt needs of the communities.
This has implications for defining:
Set of services
Priorities &
Ability for appropriate resource allocation.
Affordable
No out of Pocket Expenditure
Quality of Care
Safety, Adherence to protocols, Patient Satisfaction

7. Health facility requirements – Tribal areas
Facility Type
General Area Population
norm per facility
Tribal Area Population
Sub-Centre
5000
3000
Primary Health Centre
30,000
20,000
Community Health Centre
1,20,000
80,000

8. Key Health Indicators (Odisha)
India Current Status
Odisha
Current status
IMR
42 (SRS- 2012)
53 (SRS-2012)
MMR
212 (SRS )
258 (SRS )
NMR
31 (SRS- 2011)
40 (SRS-2011)
Under 5 Mortality Rate
55 (SRS- 2011)
72 (SRS-2011)
Total Fertility Rate
2.7 NFHS-III ( )
2.2 SRS 2011
Child sex ratio (0-6 years)
914 (Census 2011)
934 (Census 2011)
Anemia among children ages (6-35 months)
79.2 (NFHS III )
API (Malaria)
5.84 (MIS-2012)
Success rate of TB
87% (MIS-2012)
Leprosy Prevalence Rate
0.99 (MIS-2012)

9. Key Health Indicators (Tribal Districts)
Source (AHS )
Sl. No.
District
IMR
NMR
U5MR
MMR
Odisha 59 39 79
237 1
Balasore 47 34 53
222 2
Gajapati 61 30 82
297 3
Kalahandi 56 75 4
Kandhamal 86 41
142 5
Keonjhar 57 43 81
212 6
Koraput 69 7
Malkangiri 52 33 77 8
Mayurbhanj 50 38 73 9
Nawrangapur 51 29 85 10
Rayagada
103 11
Sambalpur 32 67 12
Sundargarh 49 58 13
Debgarh 62 45 78

10. Maternal and child health indicators: Odisha vs Tribals
Sl No
Indicator
Odisha (1)
Tribal population (2) 1
Infant mortality rate
40 (per 1000)
78.7 (per 1000) 2
Under 5 mortality rate
49(per 1000)
136.3(per 1000) 3
Anemia in children
(6-59 months)
44.6%
80.1% 6
Institutional delivery
85.4%
11.7%
National Family Health Survey , State Fact Sheet. Available at
An analysis of health status of Orissa in specific reference to health equity. Available at

11. Other key indicators of Tribal Health
State Average ( %)
Tribal Population(%)
Registered pregnancy
90.3
81.2
Women who received 3or more ANCs
75.3
61.7
Consumed 100 or more IFA tablets/syrups during pregnancy
28.9
19.9
Visited at least once during pregnancy by ANM
9.2
6.8
Institutional Delivery
81.3
60.1
Percentage of children months fully immunized 62
61.9
Percentage of children months received no vaccination 8
14.1
Children 0-59 months with diarrhea given ORS including Home available fluids
70.9
45.7

12. Communicable diseases – Tribal population
Prevalence of diarrhoea is higher among tribal population (12.2%) against others (11.1%)
More than 60% population of the State is living in the malaria high risk areas, particularly in the tribal districts
Although state contributes to 9.2% of the total tribal population of the country, it accounts for 25% of the total malaria cases
*An analysis of health status of Orissa in specific reference to health equity. Available at *

13. Tribal health interventions…1
Maternity Waiting Home (Maa Gruha):
Temporary home for expectant mothers - can wait for safe delivery
Shifted to nearby health facility having BeMOC facilities on onset of labour
No post-partum cases will be allowed to stay
Located nearer to the hospital
Objectives of Maa Gruha:
To establish alternative support infrastructure for addressing communication problems in difficult tribal pockets for ensuring institutional delivery
To increase institutional delivery in the difficult tribal pockets
* Tribal Health. Available at

14. Tribal health interventions…2
Tribal health camps:
Pivotal step to meet the prime diseases during the high prone months in tribal hard to reach areas
Bi-annual health camp to be organized in this areas in the hard to reach areas
Treatment of various common health diseases like - Malaria, Tuberculosis, Diarrhoea, Jaundice and Child malnutrition etc
Objectives:
a)In order to provide primary Health care services to the tribal’s living in the remote and hard to reach tribal settlements
b) The awareness regarding prevention, services regarding diagnosis, treatment and  referral services towards tribal people
* Tribal Health. Available at

15. Tribal health interventions…3
Vulnerable Group Project:
Underserved population due to problems of geographical access
Primitive Tribes, Scheduled Castes/Scheduled Tribes (SCs/STs) - suffer social and economic disadvantages
RCH indicators of vulnerable population are very low than the District/ State average
Objectives:
This concept of RCH - to provide to the beneficiaries need based, client centred, demand driven, high quality and integrated RCH services
To promote and make available contraceptive/ terminal methods for desirous couples
* Tribal Health. Available at

16. Tribal health interventions…4
Urban Education Program - ANWESHA
Scheme for providing quality education to ST/SC students (Private/ Government English Medium schools) across 17 districts from
Admission of ST/SC children (70% ST & 30% SC) with maximum ceiling of Rs. 25,000/- per student
Approximately 2600 ST/SC students already admitted in Class-I during and 4572 during
Target - 25,000 ST/SC students in next 5 years
About 154 public schools participating in the programme
* Annual activity report Available at

17. Other Tribal specific schemes
Odisha Tribal Empowerment And Livelihood Program (OTELP & OTELP Plus)- Enables tribals to enhance food security, increase incomes & improve quality of life through natural resource management.
Integrated Conservation cum development Plan- Focuses on PVTGs in and ensures holistic development, with focus on livelihood, education & infrastructure development
Focused Area Development Programme (FADP)- Sustainable livelihoods of through land and non-land based activities, providing basic infrastructure & develop backward and forward linkage
Odisha Girls Incentive Programme (OGIP)- Scholarships for tribal & dalit girls studying in class nine & ten to bring them into schools
Odisha PVTG Empowerment & Livelihoods improvement Program-An integrated approach towards livelihood improvement in PVTG areas
*Annual activity report Available at

18. Thank you…..