Centre for Training, Research, and Innovation in Tribal Health (CTRITH)

Duration of project
(2021 to 2026)

Centres for public health research and training embedded within tribal health centres and hospitals are scarce. Such an effort could help address important gaps in our knowledge (and action) on tribal health especially given the trend of increasing non-communicable diseases among tribal communities (including diabetes, hypertension, stroke, and COPD). Tobacco and alcohol addictions are among the most crucial risk-factors driving mortality and morbidity among tribal populations, yet efforts to design community-based interventions adapted to tribal populations to address these are limited.

In September 2021, DBT/Wellcome Trust India Alliance has awarded Institute of Public Health BengaluruIndian Institute of Public Health, Hyderabad and JSS Medical College, Mysuru with a grant titled Centre for Training, Research and Innovation in Tribal Health (CTRITH), under their Clinical/Public Health Research Centres (CRC) grant. Under this project a team of researchers from two public health research organizations – Institute of Public Health Bengaluru and Indian Institute of Public Health, Hyderabad and two medical colleges – JSS Medical College, Mysuru and Mysore medical College shall partner with a local non-governmental organization, community-based organizations and government health departments to

  • Use state-of-the-art implementation research and theory-driven approaches to design, implement and evaluate innovative community health interventions for neglected health problems including hemoglobinopathies and substance (tobacco and alcohol) use among tribal populations
  • Set up a birth cohort (including family members) among tribal populations in and around forested areas to characterize individual, household and population-level effects of tobacco and alcohol use.
  • Create a field-practice area for physician-researcher and community medicine training in southern Karnataka.

 

Project Geographical area:

Chamarajanagar district of Karnataka and neighbouring districts.

 

The Centre’s overall strategy involves setting up a multi-institutional centre in Chamarajanagar district, where the PI shall be based along with a field team. This will allow field-level mentorship, oversight, and coordination across a wide range of stakeholders. In order to ensure smooth coordination across a variety of activities proposed in this grant, the activities are divided into specific Work-Packages (WP 1-8), each with a well-defined plan and milestones . The list of collaborators identified for each WP is provided with their roles in the Additional Information section.

WP No. Title Main activities with corresponding cross-cutting (CC) /vertical (V) theme Lead institute (co-lead)
WP1 Realist and Implementation research Action Lab (RIAL) Co-production of interventions using participatory approach with an in-built theory-driven design and implementation research to assess effectiveness in differing contexts (CC1) IPH (MMCRI*)
WP 2 Inter-disciplinary tribal population cohort Establish a family cohort of 2000 tribal households studying parental tobacco and alcohol use (exposure) with child health and development (outcome) (CC2) IIPHH/PHFI Bengaluru
WP 3 Population-based Hemoglobinopathy Registry (PHR) Study the genetic profile, clinical characteristics and establish a population-based registry for haemoglobinopathies (V1) JSSMC
WP 4 Socio-behavioural aspects of substance use among tribal populations

Explore sociocultural and historical pathways of interaction of substance use among tribal populations

Identify and design health services and community-based approaches for treatment and support for harmful substance use among tribal populations

IPH
WP 5 Capacity-building and mentorship Prepare a plan, curriculum and administer programmes. WP5 covers the training and mentorship plan and will be led by the Programme Head for 7 CRTP fellowships, 3 PhD and 2 postdoctoral fellows. An Assistant Professor-level support staff will assist her. They will work with Coordinators in other institutions. IPH
WP 6 Public and policy engagement

Identify pathways to impact the district and state-level programmes and policies affecting tribal health with respect to neglected health problems

Translation of research findings into knowledge outputs for different actors (decision-makers, communities, civil society)

IPH
WP 7 Research management (including collaborations, quality, and sustainability) Setting up MoUs/collaborations, permissions, ethics approval, material transport logistics, recruitment, performance appraisals, documentation and reporting and coordinating external engagements including social media/print/electronic media IPH
WP 8 Monitoring and evaluation Monthly and annual meetings, collaborator workshops for discussion and dissemination, and independent mid-term and end-line evaluations

IPH

 

The establishment of such a research and training centre embedded within a tribal hospital setting and landscape will be a pioneering effort in southern India. The Centre will provide a unique platform for incubating research and action on tribal health in the field. Various collaborations with leading institutions will be established via the creation of such a centre in a remote tribal setting. The Centre will have the following outcomes over the next five years:

Research:

  1. Tribal people birth cohort: Possibly the first of its kind, an interdisciplinary cohort of tribal households in and around forest areas in India shall be established enabling long-term research on tobacco and alcohol use and other related aspects like NCDs and associated morbidity and mortality profile.
  2. Population-based haemoglobinopathy registry for a district.
  3. Community-based interventions to address harmful substance use along with a model for studying socio-behavioural aspects of substance abuse among tribal populations.

Training:

  1. PhD, CRTPs and PDs sensitised to working in limited-resource settings with communities
  2. Certificate courses for physician-researchers and social scientists looking to work with communities
  3. Multiskilling the existing health workforce in a limited resource tribal setting to address health inequities.

Within the framework of Work Package 1, known as the Realist Implementation Research Action Lab, we have formulated four distinct intervention components. The first of these components, titled the ‘Hosa Jeevana Tobacco Cessation Clinic,’ was initiated with the primary goal of establishing a community-based tobacco cessation clinic, anchored at the Taluka Hospital with direct connections to primary health centers. We have successfully formalized a Memorandum of Understanding (MoU) with the Taluka Hospital, which enables the operation of this clinic.

The clinic has been operational for half a day every Tuesday, from morning until mid-day, up until December 2022. Individuals struggling with tobacco dependency have been referred to this clinic from primary health centers, ensuring a comprehensive approach to addressing this critical issue.

The second component, ‘Hosa Jeevana Alcohol De-Addiction Centre,’ was developed in response to our previous engagement with the Soliga tribal community, which highlighted a distressingly high prevalence of harmful alcohol consumption within the community. Recognizing that institutionalized de-addiction services were not readily accessible to these community members, we embarked on the initiative to provide outpatient counseling services and community-based support groups to those affected by harmful alcohol use.

The third component of our intervention is a sports-based mental health program known as ‘OneAll,’ which is currently being implemented through our collaboration with ASHWINI, a community-based organization in Gudallur. This intervention has proven effective in enhancing the mental well-being of tribal youth and preventing the initiation of alcohol and tobacco use. We have established a partnership with ASHWINI and assembled a dedicated six-member design team to oversee the implementation of this program.

In June 2022, the design team embarked on an exposure visit to Gudallur to gain a deeper understanding of the intervention’s modalities and cultural sensitivity when applied to tribal communities. In August 2022, an MoU was signed with the Oneall Trust to provide technical training to our team. Subsequently, a comprehensive protocol outlining the intervention-specific action plan was developed, and ethical clearance for the proposal was obtained in February 2023. In November 2022, we identified and trained two facilitator trainers, and they successfully completed their training in March 2023.

The project’s scope has been expanded to include Kollegala, and from November 2023, two new facilitators will undergo training to facilitate the program in this region. The implementation of the project has already commenced, targeting participants from VGKK on specific days of the week. Additionally, sessions are conducted in various communities at different podus on Saturdays and Sundays, with a focus on the age group of 14-24 years.

During these sessions, a life skills curriculum is followed, allowing participants to develop essential skills in self-management, relationship-building, self-awareness, and social awareness. At the end of each session, facilitators facilitate a ‘spirit circle,’ providing participants with a platform to express their opinions, thoughts, and views on specific topics. These sessions aim to empower participants with the necessary tools to lead healthier, more fulfilling lives.

 

OUR TEAM