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In India, only 20% people with minor illness, and only 50% people with serious illness come to Government hospitals. Thus, there is a need to understand the reasons influencing health care seeking practices to generate demand for health programmes. Amongst rural and tribal communities in Madhya Pradesh, it has been generally noticed that the first point of contact for any illness is a private provider, many-a-times an untrained practitioner, since they are easily accessible. Literacy level is quite low in the state, particularly in rural and tribal communities, resulting in being unaware of the basic symptoms of Tuberculosis (TB) and availability of free treatment and diagnostics at Government health facilities. Some TB patients also discontinue treatment, due to lack of awareness. At times these people also get required medications from a local pharmacist, since they have low faith in Government health system and when condition worsens (both in terms of health as well as finances), they visit a Government health facility. Also these communities are generally dependent on daily labour, leading to delayed TB diagnosis and treatment, in fear of loss of wages. Alcoholism & tobacco use of all forms is predominant in these communities, thus affecting the treatment adherence.

Barriers & constrainMoumita's photots

With reference to the programme delivery, a number of barriers play a role in influencing health care seeking behaviour of rural and tribal communities of Madhya Pradesh, such as unavailability of health staff, poor accessibility due to distance, unavailability of medicines and other requirements, to name a few. A major proportion of rural and tribal communities are residing far off from the Government health facilities, and thus even if the PHC is open and there are health staff providing services round the clock, it is difficult for a sick person to reach the PHC.

Beliefs influencing TB health seeking behaviour

Rural people in India and tribal populations in particular, have their own beliefs and practices regarding health. Some tribal groups still believe that a disease is always caused by hostile spirits or by the breach of some taboo. They therefore seek remedies through magic and religious practices.

Amongst tribals in Madhya Pradesh, evil spirits are attributed to be the cause of TB. The belief that TB occurs due to supernatural powers lead to the concept of seeking relief through magic, keeping the allopathic medical practitioner as a last resort. There are also beliefs that they cannot get TB, hence leading to delayed treatment seeking.

Lessons learnt and way forward

To summarize, there are many reasons for people to go to a particular health provider. Most important reasons include awareness, money, distance and availability of staff. These factors play a role in creating demand for any health programme, particularly the Revised National TB Control Programme (RNTCP). Hence, there is a need to address the issues that influence TB health seeking behavior such as improving the availability of trained staff at health facilities, enhance level of awareness amongst the community about TB – IEC activities to be increased, regular patient provider meetings to ensure treatment adherence as well as improved faith in Government health system. Also in RNTCP, there is a scope for involvement of NGOs in the programme – since most of the rural and tribal habitations are quite interior, Sputum collection centres can be established through NGOs nearer to these communities.

Moumita Biswas was a  student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.

Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.

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