Baseline Needs Assessment Repor

Introduction:

KEM Hospital Research Centre, Pune has been working in tribal areas for over 15 years addressing holistic development of tribal villages due to lack of infrastructure, health care and general amenities of daily living. This is coupled with malnutrition, illiteracy and poverty. Literature reviewed shows poor access and lack of basic health care in tribal areas. The need for increasing access and providing basic health care in a sustainable model has been documented as a need in this community. Factors linked to poor health status include lack of knowledge, inaccessibility to health facilities, customs and taboos, climatic behavior, poverty and so on. Through the institutes work and the previous project it has emerged that health-related issues are a major concern in tribal areas.

A baseline health care needs assessment was carried out by using qualitative technique of data collection in selected 6 tribal villages for intervention.

Methodology:

Total 15 Key Informant interviews and 7 Focus Group discussions were conducted in order to collect the data on current health care facilities, needs of villages, difficulties and so on.

Target population-

  1. Government health care workers (ANMs, Medical officers of PHC, ASHAs).
  2. At village level- Gramsevak, Sarpanch, Anganwadi workers.
  3. Community level- Pregnant women (ANC), Lactating women (PNC), Adolescents, Adult males, adult females and geriatric population.

Key findings:

  • They don't have healthcare centers nearby villages so they requested that the mobile health clinics to be continued. Mobile van works as complimentary health care service provider along with Aarogya kuti facility which is run by ASHAs who are Bare Foot Doctors (BFDs) trained in the project.
  • They had to travel far to access primary medicines.
  • Girls requested Sanitary Pads because it is not easily available in the village or nearby village.
  • No transportation facility so they walk 10 to 15 km to get health facility.
  • Some villages have sub-centers but the staff does not come regularly. They come once in a while.
  • Lack of awareness regarding non communicable diseases (NCDs) and treatment was not available for the same in the government health system.

Result of analysis

Awareness on pubertal changes: A lot of probing was required to make participants talk about changes during puberty.

According to boys, adolescence is a growing age. The changes during adolescence reported by the boys are:

 

Physical changes:

  1. Body growth (tabyet vadhte)
  2. Height increases
  3. Changes in voice

Psychological and mental changes:

  1. Attraction towards girls
  2. Changes in nature – some of them become angry
  3. The changes during adolescence are reported by girls are:
  4. Chest increase
  5. Menstruation starts
  6. Hair growth on private parts

Psychological and mental changes:

  1. Attraction towards boys
  2. Girls become more shy

  • There was no response on questions on reproductive system. They cannot talk openly on changes during puberty. It was revealed from the discussion that they have some information on menstruation however, there is still some confusion and misunderstanding. When girls were asked in detail about menstruation, they said menstruation is the body waste blood that is released (ashuddha rakta)
  • Girls mentioned that a female school teacher conducted a lecture on girls. Or sometimes from the hospital ladies like KEMHRC (you) came and gave the information.
  • Boys shared that other adolescent boys have addictions like alcohol, cigarette, and gutkha (Vimal) and these are available in village shops. Girl participants felt that alcohol or substances should be banned.
  • Anganwadi workers distribute the nutrition packages they receive but they do not deliver any information regarding that to pregnant women. (ANC/PNC FGD)
  • It was observed that large number of elderly persons were living in the houses alone as younger generation have gone to cities for earning livelihood.
  • It was observed that respondents diagnosed with hypertension and/or diabetes had limited information on the high-risk factors, treatment to be taken and long term complications.

Quotes
  1. "We live in a very remote area where we don't have proper transport. We had to travel 10-15 km for small diseases. We didn't have primary healthcare in our village.
  2. "We requested to KEMHRC start some vocational courses like tailoring, so we can learn about various stitching techniques. Because we didn't have a proper tailor in the village., so we can start earning some money for ourselves."
  3. "We never got any information on issues like sexual health, reproductive health, and interpersonal relation. It would be very useful if we get information on it." (17,18 years old Boyes FGD).
  4. "We live in a hamlet which is situated in the hills and when we are ill, we have go to the PHC which is very far from our village. Also, the sub-center that we have is 10 km away from our hamlet and we have no transport facilities. We have to walk all the way to go there. Also, it is closed sometimes." (a 35 years old male told in FGD)
  5. "In women most common diseases are found like knee pain, back pain, because our villages are situated in a hilly area and we have to go up and down to fetch water from 2/3 km on our head that's why we face these problems a lot." (आमच्याकडे भागच असा आहे, कि वरती चढायचा आणि खाली उतरायचा.) (Womens FGD)
  6. "Earlier we used to eat many vegetables (बांधाची कुर्डूची भाजी, अळूची भाजी ) there were less diseases. Now many diseases are caused by chemical fertilizers "(55+ elderly people FGD)
  7. "If you people give us such facilities in our village it would be great and beneficial for us. If you come once in a week to give medicines, will be good for us. Aarogya kuti will be useful to give the medicines in Bhorgiri,Bhivegaon,Bhimashankar,Phansewadi population... It's an interior part. If a person falls ill, they have to be carried in a bag (zoli karun aanaave lagte). Instead, there is no other option. Previously rural peoples use it. If in case of delivery we do the same thing with that women (जर डिलेव्हरी असेल तर त्या बाईला सुद्धा आम्हाला झोळी/डोली करून आणावे लागते.)

I already had a kidney stone. It wasn't because of the covid vaccine, but by some coincidence I had a lot of trouble. Then I called an ambulance. And I was taken to Dhene PHC. That time my BP was at 200. They told me to go to my family doctor. I told them we didn't have a family doctor. I said that if we had a family doctor, we would not have come here. Then they applied saline to me. But while coming home they did not help us with the ambulance, they said this ambulance is only for delivery patients. Me and my mother came home from his bike at 10pm. They didn't give an ambulance. So are these ambulances used only for delivery patients, Asha workers or leaders. This is my experience.

Need Expressed of intervention:

1. At Village level:

  1. Need of ambulance in case of emergency.
  2. Making clean and safe drinking water available.
  3. In the health facilities good quality staff and medicines is not available. Medicine essential for the geographical areas i.e., medicines on snake bite etc. should be made available in PHC.

2. Awareness of General Community

  1. Information about personal hygiene, and the importance of early diagnosis and treatment. Government schemes for each section of the community.
  2. Nutrition and anemia, care during pregnancy, signs and symptoms of high-risk pregnancy, and contraception for pregnant women.
  3. Changes during puberty, menstruation and menstrual hygiene, nutrition, contraception, responsible sex behavior, addiction etc. for adolescents
  4. High risk factors of hypertension and diabetes, long term complications, prevention and treatment are the need of the hour.