Thread by @prashanthns

#TRIBECON begins #Pravara; felicitations to #AbhayBang @SearchGad & #sudarshan #VGKK for their inspiring work on #TribalHealth; @DrLahariya @whoindia among others felicitated

#abhayBang #healthsystem design for tribal communities need to be relooked for #UHC; strategies & schemes must adapt with local social & cultural context; recollects #Brainstorming with @DesirajuKeshav at @SearchGad leading to #ExpertCommittee #tribalhealth @TribalHealthIND

#TRIBECON #AbhayBang notes with happiness increasing interest in #tribalhealth research, yet this continues to be “off the beaten path”; congratulations to #pravara medical college in bringing this together; the proposed #Bandardhara declaration to improve #tribalhealth research

#TRIBECON meaaage from #anhaybang to #earlycareer reaearchers; be the #pathfinders and find relevant solutions to #tribalhealth problems; go off the beaten track and go beyond grant opportunities and papers and work with communities and people; don’t start with “influence policy”

#tribecon message from #NitinPatil Of #Maharashtra #tribal development corporations to young people: go to rural and tribal areas to find a fulfilling life of service; celebrates role of #CivilSociety in responding to #tribal cause

#TRIBECON calls for “jugadoo solutions” in tribal areas; very well meant but we need to provide culturally and technically competent care for all; perhaps we don’t need to only depend on the #modernmedicine doctor but still, solutions can’t be bandages, patchwork or #jugaad IMO

#TRIBECON being held in rural medical college at #pravara is an idea reality check on where such conferences ought to be held rather than in metros far away from the realities often discussed at such conferences #tribalhealth

#TRIBECON #AbhayBang begins #keynote acknowledging
@SearchGad team, hundreds of community health workers, people of #Gadchiroli in driving his work;
11:47 AM · Sep 19, 2019·Twitter Web App

#AbhayBang: Thanks to @TribalAffairsIn for constituting #ExpertCommittee #TribalHealth @Lancet
#GlobalCommissiononTribalHealth, @TribalHealthIND: to diagnose problems & recommend policy framework on #TribalHealth

@TribalAffairsIn @lancet @TribalHealthIND #AbhayBang: 104 million #Tribal communities in India mainly in 10 "mainland" states & the 7 #Northeast states covering 705 major tribes with uniqueness & #diversity despite a common term "scheduled tribe"; @TribalHealthIND #TRIBECON

#AbhayBang at #TRIBECON: abysmal lack of data on #TribalHealth; quotes a rather pure positivist position on a socially constructued problem (#NeilsBohr "nothing exists until it's measured" perhaps only symbolic/metaphorical value in this context IMO)

#AbhayBang at #TRIBECON: @TribalHealthIND analysed original data on 4 #NFHS surveys; u-5 mortality decreased from 135 per 1000 live births reduced to 57 but much slower than all other population groups in India; 48% higher u-5 mortality among ST children

#AbhayBang at #TRIBECON: the high triple burden of disease among #tribal popl'n; increasing burden of #MentalHealth; evidence of early #epidemiologicalTransition with appearance of #NCDs (work of @yogesh_kalkonde @SearchGad with @India_Alliance already begins to address this)

@yogesh_kalkonde @SearchGad @India_Alliance #AbhayBang at #TRIBECON: quantum of people with healthcare needs at #primarycare level such as #Fever, #respiratoryinfections, #backache, #diarrhoea, #scabies, #worminfestation high; (IMO appear minor but huge contribution of #SDOH here; lead to morbidities)

@yogesh_kalkonde @SearchGad @India_Alliance #AbhayBang at #TRIBECON: huge shortfall of #healthcare infrastructure in #TribalHealth; 27% shortfall of subcentres, 40% deficit in #PHCs & 31% deficit in CHCs in tribal areas; worse still quality and nature of care at most facilities poor (IMO #culturalcompetence lacking)

Sidenote #TRIBECON: @iphindia work using participatory methods with #Soliga people to build healhtcare navigation could be useful solution; hopefully work by #healthequity cluster may contribute to this; need to improve #dignity #quality #culturalCompetence of care #TribalHealth

@iphindia #AbhayBang at #TRIBECON: Bring #TribalHealth into #UHC urgently; BEGIN your efforts of #UHC #AyushmanBharat in tribal areas #Antyoday; goal of @TribalHealthIND to bring #HealthEquity to #TribalHealth; communitize #healthcare, engage & empower and broaden services being offered

@iphindia @TribalHealthIND #AbhayBang at #TRIBECON: Current population norms for PHCs and sub-centres not adequte for #Tribal areas; focus on improving #HealthLiteracy (IMO disproportionately high reliance on "modern science" as an emancipator); integrate traditional healers; #ASHA needed for each hamlet

@iphindia @TribalHealthIND #AbhayBang at #TRIBECON: #Governance in #healthcare for tribal areas needs to be turned around; often schemes and strategies designed in #Delhi #Mumbai; cede power to communities; dont leave decision & design to #experts #bureaucrats; create participatory platforms #GramSabhas

#AbhayBang at #TRIBECON: Calls for a District health action plan in tribal districts; improve #healthfinancing of #TribalHealth; Tribal Health itself requires 2.5% of GDP on per-capita basis; estimates (2015) 2500 per capita per year for ST communities;

#AbhayBang at #TRIBECON: in reality the #TribalSubPlan is supposed to organise specific #financing for #Tribal areas, but the monitoring, effectiveness of this funding stream is poor;

#AbhayBang at #TRIBECON: limited data available on its expenditure even at #Ministry level; #data (or lack of) is related to #SocialJustice; @TribalHealthIND is doing the rounds between ministries; waiting for action on the report; widespread #welcome from @NITIAayog & ministries

@TribalHealthIND @NITIAayog #AbhayBang at #TRIBECON: a participatory session seeking #ResearchQuestions on #TribalHealth; (IMO: this question-driven approach rooted in explicitly stated values ought to drive #science #HPSR #PolicyEngagement; curiousity guides the quest and methods)

@TribalHealthIND @NITIAayog #AbhayBang at #TRIBECON: case of 8-year old ill #tribal girl with #SickleCellDisease in the 1980s and @SearchGad quest for responding to SCA; 15% population prevalence of #SickleCell mutation; shared quickly with policymakers then; led to awards & publications, but...

#AbhayBang at #TRIBECON: ...little action happened on ground; a research centre proposed then was located in far-away Pune; led to frustration locally; wonders aloud: in the lack of solution, does research-based descriptions of health problems matter?

#AbhayBang at #TRIBECON: Way we conceive, conduct and use research as important as the research itself; reserach often conceived in libraries, universities or intellectual groups far away from where it is supposed to act, transform or emancipate;

#AbhayBang at #TRIBECON: If intended outcome is social change or trasnformation, #research ought to do more than conceive an intellectually challenging problem (he refers to his early research on #SickleCell anaemia as a blunder); research has to transform; lead to change

#AbhayBang at #TRIBECON: his thoughts recall #decolonise research in #TribalHealth; research with and for the people and not ON the people; refers to Manson's quote on "think like a mosquito, if you want to do research on mosquito" (IMO: need better metaphor for #decolonise)

#AbhayBang at #TRIBECON: Who are "tribal"? #ScheduledTribe (a colonial hangover and poor term for diverse communities and not dignified); Census/NFHS (self-declaration!), #LokurCommittee 5-criteria (rather outdated/1950s), Vanwasi/Adivasi (contentious and differing viewpoints)

#AbhayBang at #TRIBECON: #Revolutionary studies of genetic studies by #DavidReich #DNA analysis on genetic origins (refers to @tjoseph0010 book #EarlyIndians); our multi-ethnic origins and conclusive proof of "colonisation" of this land 60000 years ago;

#AbhayBang at #TRIBECON: some communities/population groups continue to preserve #DNA patterns of first-arriving populations #OutOfAfrica; (IMO: our multi-ethnic origins reinforces need for embracing unity within diversity)

#AbhayBang at #TRIBECON: Most tribal population in 169 districcts in India's 640 districts; (our #colonial(?) notions of "primitive ways of life" has to change); 55% of ST population live outside the #tribal majority blocks; many of them migrant, mobile, urban-living

#AbhayBang at #TRIBECON: Measuring health status of STs in India a challenge; for long ST-specific IMR was unknown/unavailable; @TribalHealthIND worked with #CensusCommissioner and committee made indirect estimates with help from IIPH; published @TheLancet Anderson et. al. 2016

@TribalHealthIND @TheLancet #AbhayBang at #TRIBECON: 74 per 1000 live births among #TribalPopulation in India only marginally better than tribal communities in Pakistan (86) which had worst-off outcomes among countries for which global estimates done in #TheLancet Anderson et. al. study

#AbhayBang at #TRIBECON: Census and NFHS IMR for #TribalPopulation do not agree; wide differences between the two; what is the "true" estimate? Unknown; variation between tribes unknown.

#AbhayBang at #TRIBECON: 8.6% of our tribal population shoulder over half of India's #Malaria burden; #ForestMalaria requires particular #DiseaseControl strategies;

#AbhayBang at #TRIBECON: Very little evidence that mounting a #SickleCellDisease programme in #Tribal areas focusing on disclosing sicklecell status and marriage counselling will help; different approach needed

#AbhayBang at #TRIBECON: Several challenges related to #TraditionalMedicine practices in #Tribal communities; poor attitudes especially among #Research communities; (IMO: how can we integrate scientific rigour with a respectful approach respecting intellectual rights and dignity)

#AbhayBang at #TRIBECON: How should we implement #Asha progrmame in #tribal areas with small population and incentive-based payments? (some of the work in @iphindia #healthequity cluster with @devaki_nambiar @georgeinstitute on ASHAs in #tribal areas may hold some answers)

@iphindia @devaki_nambiar @georgeinstitute #AbhayBang at #TRIBECON: Anecdotal but striking absence of #Neonatal #tetanus in tribal areas; among many things that we dont know; Bailey&Love possibly mistook #NeonatalSepsis deaths for tetanus in their early editions; limited research on many of these

@iphindia @devaki_nambiar @georgeinstitute #AbhayBang at #TRIBECON: the F-series data in census data has lot of #Tribal data but unavailable; SRS system too has quite some data with millions of records, but poorly analysed also some #StudyDesign issues; but will to #opendata on #tribal populations lacking

#AbhayBang at #TRIBECON: calls for #TribalHealth Index; @iphindia THETA project is in process of piloting such an index at a very fine-scale in select forest areas in #Karnataka, #Kerala, #MadhyaPradesh, #ArunachalPradesh (with support from @India_Alliance)

@iphindia @India_Alliance #AbhayBang at #TRIBECON: Asks @ICMRDELHI to spend at least 10% of their budget on #TribalHealth research; shares autographed copy of @TribalAffairsIn from #amartyasen; ends hoping @TribalAffairsIn @MoHFW_INDIA will do justice to @TribalHealthIND

@iphindia @India_Alliance @ICMRDELHI @TribalAffairsIn @MoHFW_INDIA @TribalHealthIND #VGKK #Sudarshan at #TRIBECON gives his keynote; his lifetime dedication to the #Soliga and other #tribal communities in southern Karnataka mentioned; opening slide is the "biligiri" (white cliff) of #brhills

@iphindia @India_Alliance @ICMRDELHI @TribalAffairsIn @MoHFW_INDIA @TribalHealthIND #VGKK #Sudarshan at #TRIBECON: highlights 10-90 divide in #healthresearchmatters; very limited funding for operational/action research especially; "my life and my work are not too different" early days in the area of #Veerappan; high-association of #tribal areas iwth #conflict

#VGKK #Sudarshan at #TRIBECON: personal experience with father's loss due to lack of medical aid in village; took off a year due to not meeting eligibility for #meded at #BangaloreMedicalCollege; earned 2.5 rupees fees at flour mill which was used to pay #mededfees

#VGKK #Sudarshan at #TRIBECON: Early experience with #tribal communities in #Ooty; initiated #VGKK in 1980; found #Megalithic burial sites around the area; idea of #SacredGroves inspiring and helps us understand their wellness paradigms

#VGKK #Sudarshan at #TRIBECON: In the 80s, there was huge difference between #tribal communities at edge of forest and those relocated away from forests; core areas communities were better-off with #healthcare (IMO: perhaps changing a lot these days?)

#VGKK #Sudarshan at #TRIBECON: Early "arrogance" at calling squatting position delivery as a superstition was soon reversed; we adopted it and learnt; delivery cot is more comfortable for healthcare professionals; #Soliga people still prefer #squatting posture;

#VGKK #Sudarshan at #TRIBECON: We need to be open, humble and receptive to various #TraditionalHealth practices; various primarycare ailments are dealt with at household level; (IMO: health systems begin at homes)

#VGKK #Sudarshan at #TRIBECON: Early exchange with developing #Electrophoresis machine with #appropriatetechnology locally with a 400 rupee machine (mentions R L Kirk from #Australia who helped)

#VGKK #Sudarshan at #TRIBECON: With respect to #AbhayBang on #SickleCell status, agree that genetic counselling may have limited impact but need to establish #SickleCell status and use it in our #healthcare nonetheless

#VGKK #Sudarshan at #TRIBECON: Lot of #primarycare ailments can be taken care of at household level; lets not over-medicalise and kill #localtraditions; lets build self-reliance rather than medical dependence in our #healthsystem;

#VGKK #Sudarshan at #TRIBECON: evolution from #curative services to preventive health (immunisation) to #CommunityHealth to #ForestRights and #SustainableDevelopment ("there are no pills for poverty"); "I found quantum leap in health and well-being due to #ForestRights"

#VGKK #Sudarshan at #TRIBECON: understanding #tribal culture and building a culturally competent #HealthSystem is important to address #TribalHealth; humility to learn from the people; "I dont beleive in national mainstream; lets respect diversity"

#VGKK #Sudarshan at #TRIBECON: Started a school with 6-children in #tribal areas; one of them is today the President of VGKK; recalls visit by #APJAbdulKalam in 2006 to VGKK to celebrate his birthday;

#VGKK #Sudarshan at #TRIBECON: Megalithic burial sites in #BRHills dating possibly between 4000 to 800 BC; the calls by some conservationists for displacement and relocation of #tribal communities for conservation is dangerous and ought to be fought back #ForestRightsAct

#VGKK #Sudarshan at #TRIBECON: Huge responsibility to care for so-called vanishing tribes; lets also ensure ALL of the different communities under the #tribal banner have equitable access to rights, health, education etc

#VGKK #Sudarshan at #TRIBECON: Huge contribution of #SDOH in driving health inequities among #tribal communities; need to address #forestrights in order to achieve #healthforall in #tribal communities

#VGKK #Sudarshan at #TRIBECON: Was born in a #Cowshed; ensuring #SafeDelivery for women is of utmost importance and became my passion

#VGKK #Sudarshan at #TRIBECON: we need to #decentralise data as well; data generated by PHCs and #healthsystem should be locally useful; over-reliance on NFHS, SRS etc for health planning needs to stop; they only give a broader picture

#VGKK #Sudarshan at #TRIBECON: the NHM's blunder of not having a #TribalHealth as a special component is slowly changing; focus is improving; we also need greater leadership by @TribalAffairsIn in putting the #TribalHealth agenda high

@TribalAffairsIn #VGKK #Sudarshan at #TRIBECON: We need #HelpDesk #CommunityMonitoring and strengthening of health and sanitation committees at village levels; plans need to be made at village level

@TribalAffairsIn #VGKK #Sudarshan at #TRIBECON: Shares experience with demand for bribes in #health sector; need for high integrity among NGOs to just say NO; focus on #GoodGovernance; shares inspiring story of a doctor in Jeying PHC in Arunachal who stayed in a thatched hut temporarily (2 years)

#VGKK #Sudarshan at #TRIBECON: Huge logistic and geographic challenges in #ArunachalPradesh; inspiring stories of ASHAs and ANMs who achieve immunisation through dedication and commitment;

#VGKK #Sudarshan at #TRIBECON: Huge bias for #ModernMedicine in our #HealthSystem, but #AYUSH too is not properly integrated; in addition, we must document, learn and engage with #TraditionalHealers respectfully; they offer culture-specific and person-centred care

#VGKK #Sudarshan at #TRIBECON: cant evaluate #TraditionalMedicalPractices with reductionist/narrow scientific frameworks; mentions work of @TDU_CABHN @TDUFRLHT in advancing mainstreaming of #TraditionalMedicine

@TDU_CABHN @TDUFRLHT #VGKK #Sudarshan at #TRIBECON: #AYUSH has become #curative services only despite origins in #Ayurveda with holistic view of wellness (except #Yoga which has an identity of its own)

@TDU_CABHN @TDUFRLHT #VGKK #Sudarshan at #TRIBECON: experience with #Karnataka #TaskForce on health and family welfare; identified #corruption as the top issue facing #healthsector; need to focus on #GoodGovernance;

#VGKK #Sudarshan at #TRIBECON: experience with the #Karnataka #Lokayukta as a #Vigilance director; the need for #Ombudsman #Oversight over #healthsystem is important; we need to reinstate a strong health #Ombudsman

#VGKK #Sudarshan at #TRIBECON: Several instances of #kickbacks #corruption in health sector #PrivatesectorinHealth; they are as bad if not worse than #PublicSector in health; #goodgoverance can give quantum leaps in #TribalHealth; often punishment transfers to tribal areas

#VGKK #Sudarshan at #TRIBECON: Leadership in tribal health: (a) concern and empathy, (b) ability to find solutions, (3) will and passion to put solutions into practice: #TransformationalLeadership needed

#VGKK #Sudarshan at #TRIBECON: Quotes #Gandhi "My life is my message" & #VIvekananda "They alone live who live for otheres" as inspirational quotes that drive his life

#VGKK #Sudarshan at #TRIBECON: My own education came from public money; such is the case for many of you; we all need to recognise societal inputs in our achievement and learn to give back to society

#TRIBECON discussion: Why not a National #TribalHealth Mission; this is one among several of our inconvenient truths; "Delhi"/powers-that-be do not recognize this as a sufficiently high priority; if not earlier, now at least, we need to have a #TribalHealth Mission

#TRIBECON how do we achieve a happy and satisfied #workforce in #tribal areas; how do we ensure that transfer to these places are NOT seen as #punishment postings; often postings here result in corruption for transferring out; can we think of regional cadres?

#TRIBECON need for a #TribalHealth officer in blocks with high tribal population; #AbhayBang "need for mission, policy and action plan for tribal health" hopefully #TRIBECON can help move #politicalwill towards this

#TRIBECON need for intense and effective implementation of #ForestRightsAct in #tribal areas and this will certainly have an impact of #TribalHealth; need to have greater convergence across departments to achieve this

#Sudarshan at #TRIBECON do not overgeneralise problems with some specific #Ayurveda #herbal medicines to the entire system of medicine; need to integrate #AYUSH practitioners into preventive and health promotion activities as well in #TribalHealth

#TRIBECON vulnerability to #addiction among #tribal people could be higher due to social/cultural as well as limited access to #HealthLiteracy #cessation; in #Australia #indigenous communities recognise #alcohol dependence as a planned arm of colonialnialism;

#TRIBECON experience of multi-stage randomly selected district sample survey being done in #Gadchiroli by @SearchGad gives glimpses of robust epidemiological data for action #alcohol #tobacco #addiction #TribalHealth