The Tribal Health Initiative model for healthcare delivery: a clinical and epidemiological approach
Prabhakar, H.; Manoharan, R.
National Medical Journal of India 18(4): 197-204
2005
ISSN/ISBN: 0970-258X PMID: 16252551 Document Number: 588263
Objective: To evaluate the current healthcare delivery model, the Tribal Health Initiative model, offered to Malayali and Lambadi tribal populations in Dharmapuri District, Tamil Nadu, India; and to explore the model in combination with the health status of the target population, placing emphasis on the long term sustainability and cross-implementation of the model. Methods: The health system was examined during 2000-03 from the perspective of the base hospital, considering mortality patterns, inpatient incidence of selected infectious and non-infectious illnesses, and preventive and curative services administered by the hospital to the community. Results: 12 947 patients in 2000, 12 796 patients in 2001, 14 124 patients in 2002, and 17 033 patients in 2003 were included in the study. Gender susceptibility patterns revealed disparities in anaemia and tuberculosis besides fluctuations in gastrointestinal disorders and typhoid. A combination of gender- and age-susceptibility patterns revealed specific age intervals for mental health-related disorders. Mortality patterns indicated an increase in youth deaths and suicide, with an overall reduction in infant mortality due to different infectious and non-infectious diseases. However, an increased tribal confidence in allopathic medicine was noted after implementation of the health system. Conclusion: The base tribal hospital is important in administering primary and secondary healthcare, health education, disease surveillance, community outreach and for continued confidence in allopathic medicine. Diet-based morbidities may be controlled by organic farming and banning local alcohol production, while anaemia may be controlled through continued iron, salt and folic acid supplementation to women. The formulation of mental health programmes and long term educational initiatives at the village level are critical to reduce suicide and infant mortality. Further epidemiological studies are required to gain a complete picture of the health of the population, and successful implementation of the model elsewhere must consider sociocultural disparities among tribes.