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Traditional Healers Promote Healthcare in Tribal Pockets, Chhattisgarh.
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Subject Area="Behavioural Change Communication." Objective="Improve outreach services"
Details for Reform Option "Traditional Healers Promote Healthcare in Tribal Pockets, Chhattisgarh."
Summary

Background: Bastar is a predominantly tribal district located in the south of Chhattisgarh state. The rugged topography, dense forest cover, scattered settlement pattern, traditional beliefs and over-dependence on traditional healers makes it difficult for the public healthcare service to reach out to the tribal population. Following the formation of Chhattisgarh state in November 2000, the government is adopting many strategies; including roping in traditional healers as agents of behaviour change, as the tribal population largely relies on them for cure. Besides, traditional healers, known as Sirha-Gunia- Baiga, also create obstacles to delivery of as well as access to health services. Action: The district Collector and Chief Medical Health Officer (CMHO), Bastar requested Medical Officers (MOs) to evolve a suitable strategy whereby Sirha-Gunia- Baigas could be made partners in promotion of modern health care services among the tribal population. Initially, a meeting was organised by block level MOs to befriend them and understand their reasons of obstructing delivery of health services to the tribal population. The strategy worked; some of the Sirha-Gunia- Baigas volunteered to be the government’s partners in the promotion of health services. The district administration was thus able to win over Sirha-Gunia- Baigas by removing their fear that the public health system would jeopardise their livelihood and diminish their status in the village. Subsequently, in April 2005, the district administration started a movement to educate the Sirha-Gunia- Baigas in modern medicine and take their assistance in provision of health services. The district administration also urged them to refer villagers to the nearest government health centre in case of complications they were not confident to handle. Fourteen block level workshops were organised to educate Sirha-Gunia-Baigas and to motivate them to participate in the delivery of public health care services. Many of these workshops were inaugurated by the district Collector and state ministers. Sirha-Gunia- Baigas were welcomed in traditional ceremonial manner at these meetings; they were also given a badge. The workshops mainly tried to dispel the myths and misconceptions surrounding modern medicine and focused on ways to treat common ailments of villagers. Besides, they were also motivated to become depot holders of over-the-counter drugs for common ailments and contraception. The willing Sirha-Gunia- Baigas were identified and were made depot holders at the meeting; they were given medicine supplies, for which they could charge minimal amounts from the patients. The supplies included drugs such as anti-diarrhea, paracetomol, Oral Rehydration Salt (ORS) packets and contraceptives. Thereafter, a list of Sirha-Gunias was prepared at every Primary Health Centre (PHCs) and Community Health Centres (CHC) and records were maintained to see the number of patients referred by them to the PHC and CHC. On August 15, 2005, the Sirha-Gunias who had been sending a sizeable number of patients to PHCs/CHC were felicitated by the district administration as part of the Independence Day official ceremony. The next large-scale block level Sirha-Gunia workshop was organised on June 9-10, 2006. At the end of the workshop drug kits were distributed to Sirha-Gunia-Baiga, containing medicines on seasonal diseases. The district administration is also issuing identity cards to Sirha-Gunia-Baigas. Results: Currently, Bastar district has 1500 Sirha-Gunias-Baigas as depot holders. This initiative has helped service providers in their work. According to the CMHO of Dantewada, the initiative has led to fewer causalities and deaths in the district.

Cost CARE, Madhya Pradesh gave one-time support to the district administration of INR. 50,000 for organising workshops and thereafter the district administration is using its own funds to do the same.
Place All blocks of Bastar and Dantewada districts.
Time Frame Few weeks.
Advantages

Mainstreaming: Sirha-Gunia-Baigas have starting motivating villagers to go to PHCs for treatment as the initiative nurtured their transition from traditional to modern medicine. Enabling environment: The health workers can work more effectively with support from Sirha-Gunia-Baigas in the villages.

Challanges

Funds: It is difficult for the district to manage funds as requirement of medicines has gone up as medicines are provided to various levels of functionaries. Management: Continuous effort has to be made by the district administration so that all Sirha-Gunia-Baigas refer patients to the nearest government health centre. Services: Unavailability of doctors and services at PHCs rolls back all that is achieved by the initiative as the community loses faith in the health delivery system.

Prerequisites

District administration’s will to improve health care services. Funds to organise workshops for traditional healers. Availability of health centres to manage cases.

Who needs to be consulted

District Collector. Chief Medical Health Officers. Block level Medical Officers. Sirha-Gunia-Baigas. Tribal community.

Risks

Sustainability

Sustainable, but it depends largely on how efficiently the system delivers health services.

Chances of Replication

Can be replicated in all tribal pockets.

Comments

In November 2000 there was an onslaught of malaria in the tribal belt causing a large number of deaths. The district CMHO believes the epidemic spread further mainly due impediments caused by Sirha-Gunias-Baiga. This initiative has improved the overall health situation in the district as there has been no untoward incident or epidemic in the last two years in Bastar district.

Contact

Submitted By

Dr. Nandini Roy, HS-PROD Research Consultant, NIMS. May 2006.

Status Active
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