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Introduction The Tribes people constitute 8.14% of the total population of the country, numbering 84.51 million (2001 Census). Out of total population in the state of Tripura, tribal population constitutes 31.1 % having literacy rate of 56.5% (State average 73.7%) which is higher than the national average of 47.1%. Tribal male literacy rate is 68.0%(State average 81.5%) and female literacy rate is 44.6% (State average 65.4%). Child bearing imposes additional health needs and problems on women -physically, psychologically and socially. Maternal mortality was reported to be high among various tribal groups. The chief causes of maternal mortality were found to be unhygienic and primitive practices for parturition. From the inception of pregnancy to its termination, no specific nutritious diet is consumed by women. On the other hand, some pregnant tribal women reduced their food intake because of simple fear of recurrent vomiting and also to ensure that the baby may remain small and the delivery may be easier. The consumption of iron, calcium and vitamins during pregnancy is poor. The habit of taking alcohol during pregnancy has been found to be usual in tribal women and almost all of them are observed to continue their regular activities including hard labour during advanced pregnancy. More than 90 per cent of deliveries are conducted at home attended by elderly ladies of the household. No specific precautions are observed at the time of conducting deliveries which resulted in an increased susceptibility to various infections. Services of paramedical staff are secured only in difficult labour cases. As far as child care is concerned, both rural and tribal illiterate mothers are observed to breast-feed their babies. But, most of them adopt harmful practices like discarding of colostrum, giving prelacteal feeds, delayed initiation of breast-feeding and delayed introduction of complementary feeds. Vaccination and immunization of Infants and children have been inadequate among tribal groups. In addition, extremes of magico-religious beliefs and taboos tend to aggravate the problems. Maternal and child health care practices among tribes Tripura has made remarkable progress in Routine Immunization by increasing coverage throughout the State. As per the National Immunization schedule of Govt. of India, Routine Immunization is carried out in the State including ADC area to cover all children in the age group of up to 1 year. Overwhelming response has been shown in connection with Immunization of DPT. 120.6% children throughout the State has been immunized through DPT whereas the performance of all India level is 94.7 % as per record of Govt of India Ministry of Health & Family Welfare ( Monitoring & Evaluation Division ) during the year 2006-2007. The success is same for the period of 2006-2007 in connection with OPV also (94.6 VS 120.8%). In connection with B.C.G vaccination our performance (140.9%) is much better than that of all India performance which is 100.1%. During the year 2006-07 B.C.G vaccine was given to 679251 children which is much better for the period of 2005-2006 where the total was 64775 children. Measles Vaccine is also being given to children in an effective manner. The achievement of proposed need assessment is 122.2% in the State which is higher than the percentage of all India level (90.4 %) for the period of 2006-2007. In connection with Tetanus immunization (except Mothers) state performance (81.9% achievement of proposed need assessed) for the period of 2006-2007 is better than all India level performance which is 79 %. 37 Point Tribal Development Package was announced by the Hon'ble Chief Minister on 15th September 2003. The Package has one of the components on Immunization for all Children and pregnant women in ADC area for implementation by Health & FW Department. There are vast differences in the health status of mothers and children between tribal and non-tribal populations. Compared to the NFHS 2 survey, the infant mortality, under-five mortality, and neonatal mortality have decreased, the proportion of home deliveries is at a standstill. There was a fall in the median months of exclusive breastfeeding, while it had shown improvement among others from 1.3 months to 1.9 months. 9,10 The total fertility rate had shown a slight increase compared to the NFHS 2 survey. Health care initiatives in Tripura Rural health schemes benefits of tribals in Tripura under National Rural Health Mission (NRHM) The implementation of various schemes in Tripura under the National Rural Health Scheme has given a reason to smile to the locals. Various health schemes under the National Rural Health Mission (NRHM) are being implemented with an aim to bring down the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). “NRHM can play a very important role in tribal areas where it is still difficult to reach medical services due to inaccessibility,” said L Darlong, Mission Director of NRHM, Tripura. The schemes are not only trying to create increased health awareness among the poor, but also to increase the manpower of the health department in the state. New well equipped hospitals and health centers are also being constructed in the remote of the regions to provide instant aid to the people. Further, to spread awareness, tribals are being educated through puppet shows, road shows and folk songs. “After implementation of these schemes, there has been rapid awareness among the remote villagers about the health facilities. Similarly there has been also infrastructure development and the latest medical equipments have also been introduced,” said Uttam Choudhury, a resident. NRHM was launched by the Central Government in April 2005 to provide effective healthcare to rural population throughout the country with special focus on 18 states. (ANI) Health Dept of Tripura : A brief appraisal The Tripura government is trying its best to make the medical treatment accessible to all. In this direction, Health and family welfare department in the state should be geared up to fulfill the aspiration of common people. In case of preventive treatment, the department is so far successful in reducing death rate due to deadly meningitis. Last year, more than 60 forest dwellers and rural people died of meningo caccual meningitis. The department launched massive vaccination program and the death rate is considerably low in this year. The government has also taken several steps to strengthen the Public Health Care system in the state. No doubt, both the central and state government is sincerely trying to ensure treatment facility for all. Lack of proper infrastructure and shortage of specialists are only few of the hurdles that the government is encountering. Some of the doctors in rural areas are working hard. Without bothering much about infrastructure, they are sincerely trying to provide treatment to helpless poor people. Despite good efforts from government, performance of the health and family welfare department has raised several eyebrows. Comptroller and Auditor General (CAG) conducted routine audit and found gross misappropriation of public money by the health and family welfare department. Tripura government published CAG report and gross financial irregularities are obvious. In case of health and family welfare department, the report said, “Non-compliance with financial rules relating to maintenance of Cash Book, handling cash and drawal of money coupled with absence of supervision and internal control led to suspected fraud of Rs. 3.49 crore, out of which, Rs 1.96 crore was suspected to have been misappropriated.” (Ref: CAG Report for 2009, The Government of Tripura, Page 47) The report also revealed that concerned department did not properly maintain cashbook. There were no surprise checks and department did not conducted any bank reconciliation. Huge difference between ‘amount passed to withdraw’ and actual amount withdrawn is really a matter of concern. Statistical data published in CAG report shows that Rs 11,26,850 was withdrawn whereas only Rs 59,800 was passed for withdrawal resulting an excess withdrawal of Rs 10,67,050. Withdrawal of Rs. 3,66,050 was not recorded at all. (Ref. CAG Report for 2009, The Government of Tripura, Appendix 2.1A) Further the report unveiled that the Draw and Disbursement Officer (DDO) deposited Rs. 15,74,000 in two installments in cash in SBI. However, no records regarding source of revenue and purpose of cash deposits remain unanswered. CAG team observes that health and family welfare department did not enforce provisions of financial rules in managing cash, drew money without sanction orders and lack of supervision and internal control resulted in suspected fraud of huge amount of public money. It is interesting to note that the cashier was absconding from Jan 13, 2009 and a case was registered on Feb 7, 2009. CID is now investigating the case. Sources said that the cashier, the DDO and head of the office were placed under suspension. The state government stated that proper action would be taken against the erring officials. To prevent such misappropriation, the government will take few measures to ensure systematic and error free maintenance of accounts. On condition of anonymity, a senior official said that benefits of government welfare policies could not reach to common people due to corrupt officials of the department. He further argued that corruption among the officials could be tracked and controlled. However, malpractices by a section of medical staffs including Doctors also need to be investigated. Services in state hospital are not satisfactory due to commission system and private practice by a section of Doctors. One should stick to one’s professional ethics. Only then, corruption can be tackled and services can be improved, he suggested. State Population Policy The Government of Tripura announced the “State Population Policy-2000”in August-2001 with three following objectives. 1) Immediate objective: To address the unmet needs for contraception, health care infrastructure and health personnel and to provide integrated service delivery for basic reproductive and child health care. 2) Mid-term objective: To bring total fertility rate (TFR) to replacement levels through rigorous implementation of inter-sectoral operational strategies. 3) Long-term objective: To achieve a stable population by 2045 at a level consistent with the requirement of sustainable economic growth, social development and environment protection. Main endeavour will be on elimination of poverty and illiteracy and socio-economic upliftment of the people. Conclusion One of the important features of backwardness of the tribes is low literacy rate. But it is heartening to note that the tribal people in Tripura have made significant progress in literacy during the last few decades. The literacy rate of the tribal people as a whole increased from 10.01 percent in 1961 to 15.03 percent in 1971 and 23.09 percent in 1981. During the same period, the female literacy rate rose from2.31 to 6.04 and then to 12.27 percent. Even then the difference between the tribal and non-tribal in respect of literacy persists to be substantial. If these differences can be overcome then in near future the state will establish a remarkable landmark in the overall status of maternal and child health care scenario in the country.
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Tribes, Maternal health, Child health, Health indices, Immunization,
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