5) Description of health product/service offering: The primary health issue that Prakriti Health Center addresses is the general health of adivasis in the western side of the tribal belt. The Prakriti healthcare programme was initiated in 2001 with a view to address the sickle cell anaemia prevalent among tribal communities. This work took us into villages and brought to our knowledge the blatant gaps in the present outreach of government health infrastructure that is largely non functional and insensitive or ignorant of tribal healthcare needs. To meet those healthcare needs, the Prakriti Healthcare Clinic was set up in December 2003. The method to achieve improvement of general health for tribal communities consists of three main parts. The first one consists of the clinics that are held every Saturday and Sunday in the village of Tejgadh, in the eastern part of Gujarat. In those clinics, 350 patients from over 300 surrounding villages are treated each week. Secondly, we offer health camps in different surrounding villages twice a month. In these health camps, general check-ups and check-ups regarding specific, differentiating diseases, such as sickle cell anaemia, various nutritional problems including pellagra and facio-maxillary malformations, and cataract are carried out. The third main part of our work is education of community health workers through a Certificate Course. In this course, presently 21 adivasi- students from the area are trained to be health-workers in their villages. This means, for example, that they are trained to raise awareness about matters like TB, hygiene and family-planning. The primary beneficiaries of our work are the people in the Chhotaudepur, Kanwant and Pavi Jetpur talukas in Vadodara district. These adivasi- communities directly benefit from our initiative because their general health has improved through the check-ups and treatments in the clinics and health-camps. Furthermore, their health-prospects have been and are still improved through the training of the health workers.

6) Description of innovation: The Prakriti Healthcare Clinic is set up on the campus of the Adivasi Academy at Tejgadh. The Adivasi Academy is established by Bhasha Research and Publication Centre, a voluntary organization set up in 1996 to voice and address issues of cultural identity, empowerment, human rights and social justice of tribal and nomadic communities. The Adivasi Academy is the only autonomous institute in India that is engaged in research and training in areas of tribal imagination and culture, healthcare, education, micro finance and sustainable livelihood, which makes it unique. The Prakriti programme is a significant component of the Academy’s larger initiative to establish an integrated model for tribal development. The unique feature of Prakriti and its endeavour is to combine traditional knowledge practices of tribal communities with modern healthcare delivery systems. While the Prakriti Programme provides modern medical care in rural areas, it has also included traditional healers. The Prakriti Programme is also linked with other programmes and activities that Bhasha undertakes. For example, Dhol, one of the Academy’s most significant publications, is brought out in ten major tribal languages of western India and documents the traditional knowledge systems of tribal communities. Also, the Prakriti Programme is linked to larger economic and social issues of indebtedness and food security. The Academy’s activities on these topics directly lead to improved income levels that contributes to better health and productivity of the community. Furthermore, our approach differs from existing programs in the field in the sense that the Prakriti Programme is not only run for adivasis, but also to a great extent by adivasis. Especially the Certificate Course in tribal healthcare management, which will attract more adivasi- students over the following years, is set up in such a way that the adivasis are made self-reliant and independent regarding the matters the course deals with.

7) Operational model: The Adivasi Academy has established a tribal model of sustainable development and empowerment. The model has been evolved by students of the Tribal Studies Programme of the Adivasi Academy during their residential traineeship. The model addresses core issues of indebtedness, food insecurity, healthcare, outward migration and illiteracy. The model is based on building self reliance through social equity, people’s participation and gender injustice. The trainees of the Academy have established Gram Vikas Kendras or Development Services Centres (DSC) in tribal villages as a nucleus for village development. Each DSC undertakes development work in 40-50 surrounding villages. Presently there are 15 DSCs in Vadodara District, Panchmahals District, Sabarkantha District, Narmada District, Surat District and in Madhya Pradesh. The DSCs cover 780 villages and jointly run 950 micro credit groups, 94 food grain banks, 54 non formal centres, organic agriculture for 190 women and 60 gobar banks. The development work reaches 50,000 tribal households. The social responsibility of the DSCs includes: -address issues of hunger, indebtedness, migration, unemployment, illiteracy, illness, child labour and exploitation -Build social equality and respect for women -Build linkages between urban and rural areas -Promote communal harmony and protecting human rights The Prakriti Programme reaches out to 375 villages in Vadodara district. The Clinic is fully equipped with health equipment to address primary health issues along with facilities for minor surgeries and short procedures. Basic laboratory infrastructure for testing facilities and physiotherapy clinic have been set up at the clinic. The clinic offers medical treatment, counseling and paramedical education. The paramedical trainees work in the villages, carrying out health studies, assessing health needs, referring cases, attending to emergencies and carrying out health sensitization under the guidance of doctors.

8) Human resources: The Prakriti Programme is run by : -Dr Kiran N Shinglot, (MBBS, DCH) Chief Medical Officer at the M S University Health Centre, has 24 yrs of work experience -Dr Jaishree Rao, MBBS, DGO, presently with Sun Pharmceuticals, has 24 years of experience -Dr Arvind Kumar Pratap , MBBS, with six years experience as private practitioner and six months with Child and Family Welfare, Gaya, Bihar -Smt Rajni Arda has retired after 17 years of working in Paedriatic Ward at SSG Hospital, Vadodara -Shri Rajendra Varia, Health Co-ordinator, B.SC.(Agr) and PG Diploma in Tribal Studies -21 community health workers Besides, the Prakriti programme has built a network of voluntary doctors and health service organizations.

9) Key operational partnerships: Being a non-profit health initiative, partnerships play a significant role in the Prakriti healthcare programme. The partnerships focus on sharing of knowledge, experiences and expertise. These include: -Organisational and Individual Partnerships for financial support: -Terre des Hommes and Pharmacists sans Frontiers have been funding the health and non formal education programmes since 2001 -Individual donors, local corporate houses and foundations who contribute for medicines and infrastructure -Partnerships with Vadodara based NGO professing in production of low cost, generic, rational drugs namely, LOW COST STANDARD THERAPEUTICS which supplies medicines at subsidized rates -Technological and Expert support includes experts such as Dr Kenneth Bridges, Harvard University and Dr Paul Komasaroff, Australia -Reliance Lifesciences Division that conducted a massive survey of sickle cell anaemia -Technical inputs by DA-IICT, Gandhinagar students for preparing health softwares -Health organizations such as Jaipur Foot and medical hospitals

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: We charge Rs 10 from new patients and Rs 5 from old patients. The fees is kept low so that it is affordable to the community members. Tribal families in the area have an annual income of Rs 1200-Rs 1500. Patients are also referred to the government hospitals where services are subsidized or free of cost. Members are also encouraged to avail of health insurance facilities.

          • Earned incomes as a percentage of operating costs: 4.5

          • Other funding sources: Fees from members availing services contributes 4.5% (Rs 25,000 fees of the expenses of Rs 550000). The operating costs include medicines and medical equipment, fees/honorarium to the doctors and nurse, stipend to healthcare workers, training and health studies. The Prakriti Programme is a non profit initiative. It is run with a view that it improves the health of the community, directly increasing their productivity, improving their quality of life and reducing their expenditure on health. The funding sources include: -Terre des Hommes – Pharmacists sans Frontiers support (Rs 5,133,190 (for health and non-formal education for 2004- 2007) -Individual Donors -In kind services -Accessing government medical services and facilities

          • Strategy for long-term sustainability: The members of Bhasha’s microcredit and foodsecurity will be covered under the health-insurance scheme, which will supposedly address to the health-needs of 2500 families linked to foodgrain-banks and 3000 families linked to the microcredit network. Once the infrastructure is in place, it would be necessary to meet the running costs of medicines and doctors. We also envisage to send the health-workers who are trained at the Adivasi Academy into their villages as community health workers, who will be supported financially by the communities in which they will be working.

11) Current and Future Impact

          • Total number of clients: 35000

          • Clients in the past year: 12000

          • Percentage of low-income clients: 95%

          • Impact: The Prakriti Programme has reached healthcare to interior tribal areas where no medical units exist. People in the focus villages now have access to hospitals and other medical aid and are able to receive timely treatment, due to greater awareness about major illnesses and minor ailments, diet and nutrition, childcare and women’s health. Besides modern medicine, the Prakriti Programme also encourages use of traditional medicinal systems. The efficacy of the treatment provided has built faith in modern medical intervention and has brought to light more serious health problems and traditional practices and health beliefs. The health programme has improved the livelihood status in the area by reducing vulnerability to casual and temporary illness that had been causing loss of daily wages.

          • Overall "market": The Prakriti health project has a philosophical approach and is based on modern medicine, as well as supporting the indigenous healthcare systems and traditional healing knowledge of the tribals. It is basically not started with the idea of forcing a highly technologically advanced medical center, which would not be practical for such poor and marginalized populations. The idea is to make them self-reliant in their own healthcare with minimum aid from modern medicine. This way, the Prakriti clinic annually attends to the healthcare needs of about 25,000 persons in remote rural areas. Also, in the clinic, rather than offering a cure to each and every tribal health problem, we also try to learn the tribal man’s concepts of health, healing, disease, pain, misery and death. Therefore, this work is not going to be a medical establishment, having vested interest from the suffering of a common man. This model extends to daily healthcare, short and long term illness and emergency aid. It is a model that would be replicable in all third world countries, without requiring big financial investments.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: We plan to reach out the Prakriti Programme to 800 tribal villages and set up a Healthcare Research Centre at Tegadh Adivasi Academy that would study and document traditional healthcare knowledge systems, ecology and healthcare, migration patterns, gender, institutions of family and marriage, tribal attitude to body and medicines, death and life.

13) Policy change: We are presently negotiating with the Department of Health, Government of Gujarat for handing over their Community Health Centre in Zoz village. Partnership of Bhasha with the Government and other NGO’s would be the needed policy change to effect an upward shift in the health status of tribals.

14) Origin of the initiative: While Bhasha started addressing the various issues of the tribal population, such as poverty, migration, indebtedness, illiteracy and so on from 1996, it was realized that health is invariably connected with all such problems. It was also thought that healthcare can be instrumental in reaching out to the tribal population because it is a very felt need. During our initial work, we also realized that certain inherited and cultural health problems of these people, such as sickle cell disease and pellagra, were not effectively addressed by the existing health infrastructure. The relationship between their lifestyle and culture with their disease, suffering and dying, was curious and unstudied. So we thought of venturing into tribal healthcare-management.

Contact Information:
Kiran  Shinglot
Chief Medical Officer, The M S University of Baroda, Vadodara and Honorary Secretary, Bhasha Research and Publication Centre, in charge of Prakriti Health Project at Bhasha
Bhasha Research and Publication Centre
(NGO)
India
Website: NIL