Impact of a Short Term Intervention on Health Care Outreach to a Marginal Population in Rural North India

摘要

Introduction: Government health care coverage in marginal population is usually low. They are not adequately covered by routine health care services e.g. slums in urban areas and brick kiln population, and migrant/floating populations in rural areas. These often provide a potent pocket of breeding ground for communicable diseases outbreaks because of poor hygienic conditions.Objectives: To ascertain the socio-demographic and health profile and lifestyle of the study population To ascertain the impact of short term interventions viz. regular visits, focus group discussions and immunization/ health checkup camps on health care coverage of the study population. Material and Methods: Study design - Short-term operational research (before and after study) Study Area- Three snake charmers community (Sapera basti), a marginal population of Naraingarh BlockStudy Period- Six months (July- December 2004) Study Methods- Baseline Survey of Community, Six Focus Group Discussions, Five health check-up camps, Five immunization Camps and Field Trips. Profile of the study area was also compared with another marginal community (brick kiln workers) and the native urban population of Naraingarh. Results: Average family size in Sapera bastis was 4.6. Acute morbidity incidence (morbidity within 15 days) at Ward-1, 7 and Shazadpur were 1.3%, 3.8% and 8.3% respectively. Barring 5 children, none of the children below 5 years (n=48) and pregnant women (n=6) in Sapera basti of Ward -1 and Shazadpur were immunized for any disease except polio (given during pulse polio campaigns).Impact of Intervention: There was no objections or hostile reactions either from the Sapera basti inmates or brick kiln population and they happily brought their children to our camps. We immunized all children (n=33 at Shazadpur, 19 at Ward-1) for various vaccine preventable diseases. Follow up visits of the residents of Sapera basti increased (from an average of five patient visits to 23 visits per month) in our clinic for medical consultations. Conclusion: There is a need for regular contacts by health care staff with marginal un-reached population to establish a rapport with them. Introduction Health care planners have often highlighted the problem of poor accessibility of health services to the temporary population settlements i.e. marginal population. These people usually belong to low socioeconomic strata of the society. Government health care coverage in this population is usually low. They are not adequately covered by routine health care services e.g. slums in urban areas and brick kiln population, banjaras in rural areas. Such migrant/floating populations often provide a potent pocket of breeding ground for communicable diseases outbreaks because of poor hygienic conditions. Banjaras are a nomadic group in India. They do not have a fixed abode. Banjaras literally means ‘wanderers'. They usually make temporary thatched huts near villages or cities. They earn their liveihood by making iron implements of daily use in kitchen or in agriculture eg. Cauldron, tongs, tawa (a thick round iron saucer like sheet for baking chapattis- the Indian bread), spades, axes, hammer, sickle etc. After satying at a placefew weeks they move to a new location.Similar feelings were expressed during a routine monthly meeting between faculty, senior resident (SR) of dept. of Community medicine and senior health officials of the district, when health care coverage of Naraingarh town was discussed. In the meeting, it was decided to lay more emphasis on provision of comprehensive health care to three Sapera bastis (sapera = snake charmer; basti= settlement or locality; sapera basti= snake charners locality/ settlement), two of which are located within two km. of the 50-bedded hospital at Naraingarh, where resident doctors of departments of Community Medicine, Pediatrics and Obstetric & Gynecology of the Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh regularly conduct