Alternative Service Providers: Traditional Healers fostering positive social change in tribal communities of Odisha

Summary:

The study deals with the role of traditional healers in addressing primary health and nutrition care through communication strategies piloted by UNICEF and then taken to scale introduced by government as central to health-seeking behaviour. Traditional beliefs and health-seeking behaviours are inseparable domains of the culture among tribal communities. The complex system of knowledge, beliefs, techniques, attitudes, customs, rituals, and symbols still occupy an important part of the everyday life of the tribal communities. Traditional healers form an integral part of these communities and seeking their advice affects/determines the health status of many tribal people in remote districts in Odisha state. With social development indicators focusing on an underlying need of changing behaviours, social norms and cultural practices for improved health, nutrition and child survival indicators; development strategies need to be inclusive and understand the prevalent social practices that impact demand and utilisation of health and nutrition services. This study bases itself on the premise that systematic engagement and mobilising traditional healers as key community influencers will lead to improved health and nutrition outcomes but also foster change in negative social norms and cultural practices that negatively impact health and nutrition outcomes in children.

Background/Objectives:

Development has not been unfolding equally across India and Odisha is no exception. Having the third highest tribal population in India; tribal and marginalised communities especially in remote geographical areas remain partially insulated from processes of social development. Multiple deprivations such as low levels of education, poverty and poor access to services make tribal communities even more vulnerable. Strategic interventions to improve access and demand for services also require an enabling environment that would foster positive actions; both individual and community for social change, and demand and utilisation of services. This kind of sustained change requires a kind of 'social movement'.

Description of Intervention and/or Methods/Design:

Bringing about a change in health seeking behaviours of communities require strategic interventions that focus on internal mobilisation and external information sharing. In most cases what is required to systematically engage communities around their own behaviours and show them the benefits of adopting a particular behaviour through evidence generated from within. Strategic interventions to improve access and demand for services also require an enabling environment that would foster positive actions; both individual and community for social change, and demand and utilisation of services. This kind of sustained change requires a kind of 'social movement' at community level driven by influencers. In remote, insulated and vulnerable tribal communities; these influencers are 'traditional/faith healers' who enjoy immense acceptability and trust amongst community members. Perceived as god-men in communities; the traditional and faith healers in these communities are informal-service providers by government institutions.

Results/Lessons Learned:

The engagement with traditional healers as key informants and influencers to improve health seeking behaviours amongst tribal communities has yielded great results. The design of the intervention had identified key indicators to measure outputs of planned interventions. Simple but telling indicators gave very clear indications about the benefits of systematically engaging traditional faith healers in a development programme that focused on child survival. A third party evaluation of the pilot showed strong evidence that uptake of services were much higher where the involvement of the healers was higher and stronger. Villages in which faith healers worked closely with frontline functionaries have reported high number of children with illnesses referred to medical institutions or nutritional rehabilitation centres; increased number of pregnant women have gone to hospitals for institutional deliveries thereby reduced child morbidity, deaths and maternal deaths. They have been instrumental in reviving, inculcating trust amongst communities for government services

Discussion/Implications for the Field:

Advocacy with government counterparts has resulted in a phased replication of the intervention in the state of Odisha through a government order. A provincial district has also begun a campaign called Jyoti - meaning 'light' to call for partnerships with faith forums for improved child survival and reduction in normative practices like branding children with hot iron rods for example. Apart from the government there is great acceptance of the model amongst civils society partners who work with the remote indigenous communities.

Abstract submitted by:

Lopamudra Tripathy - UNICEF
Siddartha Shrestha - UNICEF
Monika  Nielsen - UNICEF