Activities

Mainstreaming Tribal Project

Background - Tribal

TRIBAL ACTION PLAN
The Social Assessment study commissioned for the NACP – III found tribal’s especially vulnerable to HIV/AIDS because of their sexual networking patterns, migration both into and out of their habitats, poor penetration of media and low level of awareness and lack of availability of health services in general and HIV/AIDs related services in particular. Tribal world view is reflected in their health-seeking behavior. Like other societies, the care seeking was constrained by stigma & shame associated with it. Under NACP-II, there were no specific interventions among tribal’s except in NE States. There was also a dearth of IEC material in local dialects. ORG –MARG in its abovementioned study proposed a four-fold response. The NACP-III Tribal Action Plan included scaling up of activities in the NE states through a strong GO-NGO partnership. In other states with designated sub plan areas, it focused on increasing access to services especially preventive activities namely STD care, ICTC, condom promotion. It was to be underpinned by mapping of tribal communities at risk in collaboration with ITDP/TRI for focused response including those affected by migration. Behavior change is deemed central to these efforts and therefore activities to develop material in languages easily comprehendible by tribal communities. Orientation of community leaders is planned for preparing an enabling climate. Access is to be enhanced by collaboration with private providers, MoTA sponsored health units, unqualified providers and tribal healers. The role of last two set of providers is more of referral and behavior change. Guidelines are also proposed for reimbursement of travel & incidental expenses of the patient & companion so as to remove financial hardship as a hindrance to access of NACP services. The mainstreaming of HIV/AIDS in the tribal development programs and other areas of government in tribal areas is also an important plank of Tribal Action Plan. AEP for residential school/hostel inmates, preference in  admission to wards of dead or destitute AIDS patients, IEC through animators/programs of ITDP, monitoring of migrational patterns and mitigation of adverse impacts are some of examples, which this Guideline addresses. Capacity development is another crucial element of Tribal Action Plan(TAP). Accordingly, the Guidelines provide for sensitization of programme officials, facility heads & health workers to tribal situation so that they reach out and provide services more sensitively. The manpower constraints is sought to be overcome through contracting and training of private providers of all type including tribal healers. To enhance the capacity of tribal development and allied sectors for mainstreaming HIV/AIDS, orientation of their officials as well as those of NGOs engaged in the sector is proposed. The Tribal Research Institutes will be developed as Center of Excellence by induction of experts and training of their faculty. In order to take up TAP activities, Cells are planned in NACO, Ministry of Tribal Affairs (MoTA) and State Department. of Tribal Affairs (DTA). Proposals have also been formulated to have a Joint Steering Group of MoTA & NACO for providing technical advice and guidance. A Steering Group is planned for MoTA to steer the mainstreaming work. Similarly a Task Force is proposed for DTA. Crossrepresentation in the decision making bodies of the counterpart institutions is also proposed for better integration of the two sectors, including in Tribal Advisory Council. The evidence base of NACP –III activities for tribal population is inadequate. In order to enhance it, TRIs will also carry out an assessment of risk factors with the assistance of ITDPs. More evidence is proposed by inclusion of tribal attribute in behavioral surveys and biological surveillance and monitoring & reporting systems for the tribal majority states and ITDP areas. Since districts are the units for organization of data in most surveys and reports, it is proposed that surveys or surveillance or MIS will collect and report this for the entire district even though ITDP may cover only a part thereof. Reviews and documentation of the implementation of the NACP-III interventions in the tribal areas & for tribal people will be carried out including through TRIs. A set of indicators are proposed for measurement of progress made in implementation of TAP. Consolidated Annual Progress Reports of the TAP will be prepared at central/state/project level for both HIV/AIDS and Tribal sectors. The Guidelines are based on the premise that the TAP supplements regular action plan i.e. activities included on the basis of universal guidelines and those included in the TAP taken together constitute the complete set of activities taken up in tribal majority states of the NE and tribal sub-plan area in other states.The guidelines also describe briefly the channels of submission of plans, scrutiny thereof, fund-flow, timeline of activities. The organization of chapters in this Guideline follow the pattern of the document National AIDS Control Program, Phase-III: Strategy & Implementation Plan. This makes it easy to consolidate this action plan with that prepared on the basis of existing guidelines

The Need for Tribal Action Plan

The Social Assessment study commissioned for the NACP – III found tribals especially vulnerable to HIV/AIDS because of their sexual networking patterns, migration both into and out of their habitats, poor penetration of media and low level of awareness and lack of availability of health services in general and HIV/AIDs related services in particular. The study also found out that tourism, mining, displacement and other external influences increasing lured tribal women/girls into commercial sex work /trafficking. Except in Manipur, by and large, the tribal communities were unaware of STIs and HIV/AIDS. Awareness was lower among women. In all states except Manipur, the awareness regarding services for prevention, diagnosis, treatment and care for STIs and HIV/AIDS were low amongst tribal people. Condoms were generally not used, as these were disliked. Treatment seeking behavior for most health problems including STIs, revealed initial resort to home remedies or self medication by buying medicines over the counter
from grocery or petty shops (in Manipur), followed by visits to the traditional healers. Health facilities like the CHC/PHC were reported to be visited only when the problem became unbearable. Private health facilities were used, particularly when the location of public sector facilities was not convenient. Studies have also indicated that tribal world view of close linkage between man, nature and spirits also was an important factor influencing their health seeking behavior and the interventions need to be worked out around this fact although the contact with outside world also influenced it. Some studies have also indicated that some groups of diseases were believed to be caused by spirits and therefore treatment by spirit healers or traditional healers. Other studies have also reported that due to stigma and shame associated with RTIs/STDs women suffering from RTI / STIs did not consult any physician unless the problem became very acute. Non-availability and/or lack of access to health care facilities were the main factors inhibiting modern health seeking on the part of tribals. Under NACP-II, there were no specific interventions among tribals except in NE States. Wherever the interventions designed for the high-risk (CSW and migrants) and other groups overlapped the tribal people, these populations were covered under the interventions. Very few NGOs were reported to have been working specifically with tribal population on HIV/AIDS. Except in places where TI programmes for tribals were being undertaken, there was a dearth of IEC material communicating in local dialect of tribal communities 1.3. India’s Tribal Population, Institutions The tribal population of the country, as per the 2001 census, is 8.43 crore, constituting 8.2% of the total population. Barring the states of Haryana, Punjab, Delhi & UT of Chandigarh, all other states have tribal population. Indian Constitution has provided for certain safeguards and protection mechanisms. To them, new instruments have been added over time. The net result is a dense & complex network of Institutions, mechanisms and structures. Of these, the ones that are relevant to the prevention & mitigation of HIV/AIDS are given below. 1.3.1. Tribal Population and its distribution The tribal population of the country, as per the 2001 census, is 8.43 crore, constituting 8.2% of the total population. Barring the states of Haryana, Punjab, Delhi & UT of Chandigarh, all other states have tribal population. Majority population in some states in the North-East viz. ArunachalPradesh, Mizoram, Meghalaya, Nagaland and UTs of Dadra & Nagar Haveli & Lakshdweep are tribals. In the States of Madhya Pradesh, Chhattisgarh,Maharashtra, Orissa, Rajasthan, Jharkhand and Gujarat, the tribals do not constitute the majority, yet their population is substantial. In fact, about three-fourth of the India's Scheduled Tribe population is concentrated in these States. Even in these states/UTs, in pockets, which have been declared as Scheduled Area or MADA area (cluster of more than 10000 tribal population with tribal being majority of the population) or clusters (similar to MADA but tribal population being more than 5000), the tribal population constitutes a majority. The distribution of the tribal population.

The Approach of Tribal Action Plan
The Tribal Action Plan is a sub-set of the NACP overall strategic plan. The response of the NACP is calibrated according to the epidemiological situation, availability of hot spots, vulnerabilities & risk factors of population/area & availability of other infrastructure and services. Accordingly it classifies different districts of the country based on HIV/AIDS incidence among attendees of ANC clinics or ICTC clinics or presence of hot spots in the 4 classes namely A, B, C and D. The schemes under the Programme are accordingly offered.

Components of Tribal Action Plan

On the basis of above discussion above, following approach will be followed in the formulation of Tribal Action Plan:-
 i. Assessment of data on epidemiology of HIV/AIDS & associated factors such as STI, KAP, risk factors and vulnerabilities, availability of services (prevention, Care, Support and treatment), shortcomings and their impact.
ii. Based on aforesaid epidemiological and program assessment, formulation of Action Plan and identification of NACP – III norms/guidelines needing relaxation for more appropriate response.
iii. Implementing new services or activities hitherto not included in NACP – III, designed to address specific needs of tribal areas/communities
iv. Mainstream HIV/AIDS activities in the schemes/programs/structures targeted at the tribals & build their capacities to do so on a sustainable basis
v. Strengthening linkages among the Tribal, Health & HIV/AIDS sectors for a more forceful response to HIV/AIDS For ease of planning and processing of the proposals, different activities
constituting them have been categorized in manner similar to that of NACP III Strategy and Implementation Plan document.

Issues covered under proposed Tribal Action Plan

Mainstreaming Tribal Trainings

Sr.No	Category	Target (2011-12)
1	Induction training for project coordinators	1
2	State Level workshop	1
3	TOT of TRI	1
4	ITDP - District Level Workshop	5
5	Orientation of Community leader	5
6	Orientation  Of NGOs	5
7	Trg. of Ashram school Heads	8

Lat year completed training - Mainstreaming Tribal (2010-2011)

Sr. No.	Training Name	Training Date	Training Place (ITDP area)  & District	Participants
1	Grampanchyat  Sarpanch and community leaders Training	20/1/2011	Chimur Chandrapur	38
2	Non Governmental Organization Members Training	22/1/2011	Chandrapur	39
3	Grampanchyat  Sarpanch community leaders Training	24/1/2011	Rajura, Chandrapur	49
4	Grampanchyat  Sarpanch community leaders Training	24/1/2011	Pandharkavada Yavatmal	36
5	Grampanchyat  Sarpanch community leaders Training	31/1/2011	Kinwat Nanded	38
6	Non Governmental Organization Members Training	4/2/2011	Nandurbar	43
7	ITDP Staff Training	5/2/2011	Nandurbar	31
8	ITDP Staff Training	11/2/2011	Chimur, Chandrapur	44
9	ITDP Staff Training	22/2/2011	Pandharkavada, Yavatmal	35
10	Grampanchyat  Sarpanch community leaders Training	24/2/2011	Kinwat Nanded	49
11	Grampanchyat  Sarpanch community leaders Training	25/2/2011	Kinwat Nanded	32
12	Non Governmental Organization Members Training	27/2/2011	Pandharkavada, Yavatmal	33
13	Grampanchyat  Sarpanch community leaders Training	28/2/2011	Pandharkavada Yavatmal	41
14	Non Governmental Organization Members Training	5/3/2011	Chandrapur	49
15	Grampanchyat  Sarpanch community leaders Training	9/3/2011	Kinwat Nanded	37
16	Ashram School Staff Training	14/3/2011	Nandurbar	44
17	Grampanchyat  Sarpanch community leaders Training	15/3/2011	Nandurbar	50
18	ITDP Staff Training	16/3/2011	Taloda, Nandurbar	47
19	Ashram School Staff Training	28/3/2011	Pandharkavada, Yavatmal	28
20	Grampanchyat  Sarpanch community leaders Training	28/2/2011	Pandharkavada, Yavatmal	23






Gram Panchayat Sarpanch Training at Kinwat, Nanded



Ashram Shool Heads Training at Pandharakvada, Yavatmal



Non Governmanetal Organizations representatives training at Chandrapur



Non Governmental Organizations representatives training at
Chandrapur



Gram Panchayat Sarpanch and Community Leaders training at chandrapur



Gram Panchayat Sarpanch and Community leaders training at Chandrapur



Gram Panchayat Sarpanch and Community Leaders training at Chandrapur



Gram Panchayat Sarpanch and Community Leaders Trainig at Chandrapur



Ashram School Heads training at Pandharkavada, Yavatmal



Gram Panchayat Sarpanch and Community Leaders Training at chandrapur ( Panchayat Samiti Sabhapati, Health Education Officer was chief guest for training).