Pathways to Enable Primary Healthcare Nurses in Providing Comprehensive Primary Healthcare to Rural, Tribal Communities in Rajasthan, India.

Background: Emerging health needs and uneven distribution of human resources of health have led to poor access to quality healthcare in rural areas. Rural pathways provide an approach to plan and evaluate strategies for ensuring availability, retention, motivation, and performance of human resources for health in rural areas. While effectiveness of primary healthcare (PHC) nurses to deliver primary health care is established, there is not enough evidence on ways to ensure their availability, retention, motivation, and performance. The paper draws on the program experience and evidence from a primary healthcare network (AMRIT Clinics), in which nurses play a central role in delivering primary healthcare in rural tribal areas of Rajasthan, India, to bridge this gap. Methods: Rural, tribal areas of Rajasthan have limited access to functional healthcare facilities, despite having a high burden of diseases. We used the rural pathway approach to describe factors that contributed to the performance of the nurses in AMRIT Clinics. We analyzed information from the human resource information system and health management information system; and supplemented it with semi-structured interviews with nurses, conducted by an independent organization. Results: Most nurses were sourced from rural and tribal communities that the clinics serve; nurses from these communities were likely to have a higher retention than those from urban areas. Sourcing from rural and tribal communities, on-going training in clinical and social skills, a non-hierarchical work environment, and individualized mentoring appear to be responsible for high motivation of the primary healthcare nurses in AMRIT Clinics. Task redistribution with due credentialing, intensive and on-going training, and access to tele-consultation helped in sustaining high performance. However, family expectations to perform gendered roles and pull of government jobs affect their retention. Conclusion: Rural and remote areas with healthcare needs and scarcity of health provisions need to optimize the health workforce by adopting a multi-pronged pathway in its design and implementation. At the same time, there is a need to focus on structural factors that affect retention of workforce within the pathway. Our experience highlights a pathway of up-skilling PHC nurses in providing comprehensive primary healthcare in rural and remote communities in Low and Middle-Income Countries (LMICs).

Food Insecurity in Tribal High Migration Communities in Rajasthan, India.

BACKGROUND: The COVID pandemic and subsequent lockdown has disrupted food supplies across large parts of India, where even prior to the pandemic, food insecurity and malnutrition were widely prevalent. Tribal populations in southern Rajasthan, India, live in extreme scarcity, rely mainly on outward migration for sustenance, and have been significantly affected by the pandemic. In this study, we assess the availability of foodstuffs at the household level and community experiences about satiety and hunger during lockdown. METHODOLOGY: We conducted a rapid assessment of food security in rural southern Rajasthan, India, using a structured questionnaire. Trained interviewers conducted telephonic interviews using KoBoToolbox, an open-source tool. A total of 211 respondents including community volunteers, family members of tuberculosis patients and malnourished children, pregnant women, and influential members in the villages participated in the study. RESULTS: A cereal was reported to be present by 97% of the respondents, two-thirds had pulses, and nearly half had milk. The amount of cereals available was adequate for about 5 months and that of pulses, oil/ ghee, and sugar for about 1 to 2 weeks. Two-thirds of the respondents reported that food in their households was sometimes not sufficient for the amount they wanted to eat, and 97% of these mentioned not having money to buy food as the reason for not having sufficient food. CONCLUSION: This study highlights widespread food insecurity among tribal communities in southern Rajasthan, and the scenario is likely to be similar in other tribal migration dependent areas of the country.