Editor—We note that the aboriginal groups living in India were not included in Durie's editorial on providing health services to indigenous peoples.1 We share here an experiment with a group of "primitive tribes" (as classified by the government of India) in improving their health status.
In 1987, when a non-governmental organisation, ACCORD (Action for Community Organisation, Rehabilitation and Development), initiated its health programme, infant mortality among these hunter-gatherers was more than 125 deaths per 1000 live births.2 Over the years we developed a health system specifically targeted at tribal people, and this reduced infant and maternal mortality remarkably. This health service had four main characteristics.
Firstly, it was nested within larger development services such as agriculture, education, and housing.
Secondly, it was owned by the people: from the beginning the tribal community patricipated in planning and implementing the scheme. Most of the staff, including hospital nurses, administrators, and field workers, were from the tribal community and had been provided with the necessary vocational skills.
Thirdly, the entire health system was developed with the world view of the tribal community in mind. So initially the hospital did not have any beds as patients found it more comfortable to sleep on mats on the floor. Nurses spoke only the tribal language. Patients could interrupt allopathic treatment to return to their villages to "call the spirits." Monthly meetings were held with community leaders to discuss the feedback from the patients, community, and staff about the performance of the health services.
Figure 1.
Fourthly, over 10-15 years immunisation coverage (which was 2% to start with) crossed the 75% mark. Antenatal coverage was more than 90%.3 Use of hospital services was more than three times the national average in a population that initially refused to go to hospitals, as "only dead spirits circulate there."
Some of the lessons from this experiment might easily be incorporated into similar projects elsewhere.
Competing interests: None declared.
References
- 1.Durie M. Providing health services to indigenous peoples. BMJ 2003;327: 408-9. (23 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Devadasan N, Devadasan R. ACCORD—baseline survey. Bangalore: Actionaid, 1987.
- 3.Thekaekara M. ACCORD—experiences in health and community development. New Delhi: Voluntary Health Association of India, 1994.