Issues, challenges and opportunities in accessing primary health services in tribal-rural setting in India: a decadal view

Abstract

Even after 75 years of independence, the country's most underprivileged tribal population is still far from getting health benefits. Tribals in India have poor health and present a bleak picture in terms of social development metrics, especially health. From this perspective, this paper is intended to identify the problems and existing challenges faced by tribal communities in accessing health care from primary health care settings. Exploring the observations based on reviewed scholarly articles published between 2012 and 2022 from databases like PubMed and Google Scholar and in addition to several government reports and articles. These articles were selected and subsequently analyzed to extract specific outcomes. By applying the principle of the 'five A' approach, the analysis revealed a significant shortfall in the service delivery of health wellness centers. It was implicit that despite the introduction of affirmative policies by the government, gaps still existed in the healthcare system at grass root level. Major gaps are lack of human resources, staff stereotyping indigenous population, and inadequate infrastructure; and high health costs due to out of pocket expenditure and informal payments were evident. The paper recommended both individual and community-level strategies to overcome the barriers of rural health services. More decentralized planning and cultural competency training are immediate measures for the inclusion of tribal-rural people in healthcare services. Further, we proposed developing a "Mangal Health Team' which will coordinate between Health and wellness centre and villagers.

Effect of family linked factors on sibling’s oral health

“…As per Kuppuswamy [ 8 ] socio-economic status scale 2022 , 50.9%, 31.9%, 10.3%, and 6.9% belongs to upper lower, lower middle, upper and upper middle class respectively. In family size, 74.1% belong to nuclear family and rest 25.9 % had family members of five and above.…”

“…The parents' socioeconomic status was assessed by composite Kuppuswamy [ 8 ] SES scale which is based on parents' education, occupation of the head of the family, and total monthly family income. Parents' education level has been associated with the caries experience in their children [ 26 ].…”

“…Almost all parents were occupied in some form of occupation, from elementary work to Skilled Professionals. In Kuppuswamy socio-economic status [SES] scale 2022 -almost 50.9% belonged to upper lower class which actually falls in low SES according to the Government of India in the National Family Health Survey [NFHS -II] using the Standard of Living Index [SLI] scale [8]. This can be attributed to the study being carried out in a government hospital [GCMCH].…”

“…The questions were explained in the patient's native language for those who were illiterate, and their answers were recorded. A questionnaire was given, to gather information on the parents' socioeconomic status (as measured by the Kuppuswamy socioeconomic scale [ 8 ]), age and family size. For Dental caries assessment, the numbers of decayed, filled and missing teeth (deft and DMFT) were noted for children with caries.…”

Nutrition status and associated factors among tribal preschool children of 2-5 years in five districts: a cross-sectional study from three states of India

“…39 In tribal regions major gaps such as lack of human resources, infrastructure, out of pocket expenditure, etc., exist, so there is a need to develop individuals and community level plans to overcome the barriers of rural health services. 40 The major strength of the study is large scale coverage of tribal children from different states of the country to analyse the factors answerable for nutritional status. We could not cover the food supplement and pattern from Anganwadi centre.…”