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Department of Health
Mrs Yangkyi Samkhar Dashee (Minister)
Mr Tsering Dorjee (Secretary)
Department of Health
Central Tibetan Administration
Gangchen Kyishong
Dharamsala - 176 215
INDIA
Introducation
After the forceful occupation of Tibet in 1959 by the Chinese, some 85,000 Tibetan refugees sought asylum in India, Nepal and Bhutan. His Holiness the Dalai Lama, the spiritual and temporal head of Tibet, established the Central Tibetan Administration (CTA), the Tibetan Government- in- exile.
Tibetans have a unique traditional system of medicine practiced for over 2000 years. In 1961, Menstikhang, the present day Tibetan Medical and Astro Institute (TMAI) was established to preserve the traditional Tibetan medical system and serve the ever expanding refugee community.
While rehabilitating the refugees in the newly developing settlements, some health care centers were set up, funded by various non government organizations. In 1971, Delek Hospital was built in Dharamsala as a referral hospital for the scattered Tibetan communities in Himachal Pradesh.
Department of Health (DoH)
In December 1981, the Doll was established as an apex body within the infrastructure of the Central Tibetan Administration to finance and manage the health care centers as well as to plan a comprehensive health care system for the Tibetans in exile.
The Department has been organizing and maintaining health care Programmes, health educational campaigns as well as providing facilities for the basic health care of the Tibetan people.
In its basic health care policy, the Department of Health has followed the WHO's guidelines for Primary Health Care (PHC) and has adopted the Alma Ata Declaration of 1978; "Health for all by the year 2000
Doll has integrated the traditional system of Tibetan medicine with the allopathic PHC system. So, the two systems of medicines run in parallel to each other to have maximum benefit to the public.
Organizational Structure
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Kashag | |||
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The Department of Health | |||
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Achievements
In the span of almost fifteen years since its inception the Doll has been able to establish PHC centers in almost every Tibetan Refugee Settlements in India & Nepal with one to four Community Health Workers (CHW) to look after the preventive, promotive and curative health care needs of each community.
There are Sixty one (61) PHC centers and eight (8) referral hospitals under the DoH with a fleet of 225 medical staff. TMAI has at present thirty seven (37) branch clinics in different parts of India & Nepal.
Aims
To provide adequate and holistic health care service to all Tibetans living in India & Nepal through PHC with integration of indigenous Tibetan system of medicine.
To create health awareness in the community for prevention of disease & a healthier lifestyle and environment.
CURRENT ProgrammeS AND PROJECTS
The following Programmes are being undertaken by the department:
Immunization Programme
The immunization Programme is designed to immunize all under fives against the main communicable diseases. All the new born children are given DPT, Polio and BCG vaccinations. Tetanus vaccine is administered to pregnant mothers through the existing hospitals & PHC centers. The new refugees coming from Tibet are also being vaccinated with tetanus, BCG and measles. Currently 95% of Children have been immunized where as it's coverage in 1991 was only 40%.
Mother and Child Health Programme
The infant mortality rate in the major Tibetan Settlements in South India is 34.8 out of 1000 of which many are preventable. The Programme aims to reduce current infant mortality rate by 75% by the next five years by providing appropriate ante natal care and immunization for mothers and children. Through health education many mothers are now aware of the need for providing immunizations and proper health care for their children especially during pregnancy.
Birth & Death rates: (1988-91)
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Particulars |
Health Data Survey |
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Crude Birth Rate (per 1000) Crude Death Rate (per 1000) Natural Growth Rate (%) Infant Mortality Rate (per 1000) |
18.6 5.0 0.7 34.8 |
TB Control Programme
Tuberculosis (TB) has been a major health problem for the Tibetan Community. In fact, the incidence of TB in the Tibetan population is among the highest in the world estimated to be at least 20 per 1000.
The number of TB patients are increasing. This is due to more efficient case finding and increasing coverage of our Programme and therefore more cases being identified. We are trying to bring down the TB prevalence rate to 10 per 1000 people by year 2000 A.D.
Drinking Water and Sanitation Programme
The Drinking Water and Sanitation Programme is being given priority because gastro enteric and diarrhoeal diseases together accounted for a large proportion of the disease incidence in the Settlements and the scattered communities. This is understandable because on average the settlements are able to get only 64% of their drinking & washing water requirements. In view of these conditions, the DoH in close coordination with the Department of Home, has taken up the Programme.
For all drinking water and sanitation' projects, community contributes either free labor and 10% of the cost of the project in cash or simply 25% of the total cost of project.
Disease incidence In 30 Settlements and 47 Scattered Communities
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Disease |
Percent |
Percent |
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Settlements |
Scattered Communities |
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Skin Diseases Gastro-enteric & Diarrhoea Respiratory Tuberculosis Malaria Blood Pressure Others not specified |
22.20 35.00 10.50 6.50 3.00 0.30 22.50 |
20.20 22.70 31.70 7.70 0.00 1.70 15.90 |
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Total |
100.00 |
100.00 |
Health Education and Media Project
Health awareness within the Tibetan Community including schools, monasteries and nunneries has been very poor. Our Health Education and Media Unit, has been conducting health education Programmes in all the Tibetan settlements. It has -published posters, Tibetan & English Biannual bulletins, pamphlets on dental health in Tibetan & English, and produced video cassette on TB. These are distributed to all Community Health Centers for public education.
An important part of the Programme is to continue to develop appropriate media through which to provide health education. Materials are also being translated from the WHO and other publications, as well as various pamphlets, books, comics, posters and video cassettes, into Tibetan.
Primary Health Care Programme
The Tibetan Settlements are located in remote areas where medical facilities are not available. Thus the DoH adopted PHC system to cover all the Tibetans in India and Nepal through setting up of PHC Centers.
Although the DoH currently has sponsors for all the PHC centers and hospitals, the DoH is trying tomove towards self sufficiency in order to make the health care system more sustainable. We have made a policy to charge for medicine that is prescribed and instructed the PHC centers and referral hospitals in south India to bear 25% of annual cost of running while 25% of the running cost should be borne by the community and the remaining 50% is being covered by the Doll. This Programme will be extended to Central and Northern Tibetan Settlements in India and Nepal.
Disabled & Handicapped Project
In 1989, the Department initiated a special unit for treatment and rehabilitation of Disabled and Handicapped. The aim is to help them to become self-supporting and lead as normal life as possible. At present there are 1006 cases of disability within the Tibetan refugee community.
The Disabled in 42 Settlements and 64 Scattered Communities (with a population of 85,843)
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Disability |
No. affected |
Per 1000 of population |
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Deaf/Mute Blind Hands/Ann Leg Paralysis Leprosy related Polio Retarded Other |
144 163 81 215 102 76 79 74 72 |
1.7 1.9 0.9 2.5 1.2 0.9 0.9 0.9 0.8 |
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Total |
1006 |
11.7 |
Eye & Dental Care Programme
Education on prevention of dental diseases are being given to the public in settlements and scattered communities. Dental therapy courses are given to Tibetans to train them in treating dental diseases. We have conducted 3 batches of dental therapy training for 13 trainees. Eye care and dental clinic camps are organized in the settlements & other communities from time to time.
Tortured Victims Survival Project
An important reason for many Tibetans to flee Tibet is that they have suffered from torture under the Chinese rule. While not all of them require medical treatment, a sufficient number need medical support. They need medical and counselling treatment to adapt to the new environment and earn their livelihood.
Health Data and Research Fund
In 1990 a project on Health Data Collection of Tibetans in India & Nepal was started. After couple of years of doing partial coverage and training of our staff, a full scale data collection was started in 1994. We are soon expecting the results of the analysis. This will greatly help to better plan our Programmes in the future.
Training of Health Personnel
Although the Department has made consider able progress in the last 14 years, we continue to face shortage of key medical and paramedical personnel in its health care centers and hospitals.
The main objective of the training Programme is to train and recruit health personnel and to provide in-service training to the existing health personnel both in the field and in the Department.
The Programme also provide refresher courses for Community Health Workers, lab technicians and XRay technicians to acquaint them with new technologies. Doctors & nurses are also given refresher courses from time to time.
Essential Drugs Supply Fund
A large portion of Tibetan refugees covered by our health care centers are destitute and poor patients. These patients get free drugs and medical services.
Thus, we still rely on gift drugs.
Recently the Department has updated the booklet on essential drugs requirement based on WHO's guidelines and has distributed to all health workers in the settlements.
Integration of Allopathic and Traditional system of medicine
Number of seminars and conferences are being organized for the practitioners of the two systems of medicine to promote integration of the two systems. It is planned to do clinical tests and research to find the beneficial effects on certain diseases.
Emergency Medical Fund (EMF)
The fund is created to provide financial support to poor Tibetan refugees who cannot afford medical treatment they require. All the unspecified funds donated to the Department are kept in EMF.
Many of tortured victims needing medical treatment are funded from EMF. In addition the fund is used to provide nutrition to pregnant mothers, expenses for medical camps, for drinking water & toilets at schools and for extension of PHC centers.
FINANCIAL RESOURCES
Income in the Refugee Community are low and sometimes the cooperatives are without funds. The Refugee community does not have enough income generating Programmes to be self reliant in looking after its needs. Thus, it is very difficult to produce self reliant Health Care Centers. We request individuals and organizations to donate funds to look after the health care needs of our community. But we are trying to meet the running expenses of the PHC facilities. The system of local contribution and charging fees for medical treatment will be extended to all areas of our community by the year 2000 A.D. The Department needs to raise Rs. 107.9 million over the period of five years (1996 - 2000 A.D), of which Rs. 25.7 million(23.8%) have already been raised and Rs. 19.5 million( 18%) will be raised through fees and contribution.
Fund Utilisation 1994-95
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Programmemes and Projects |
Fund usage |
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Health Education & Media Handicapped & Disabled Health Data Collection Water & Sanitation TB Control Training & Personnel Essential drugs Immunization Emergency Medical Fund Tortured Victims Mother & Child Health |
4.78% 1.14% 7.12% 7.76% 43.29% 7.24% 9.04% 3.72% 12.02% 0.79%/g 3 - 19% |
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Total |
100 |
IMPLEMENTATION
The community involvement in health care Programmes is very important and we have therefore formed a "Health Committee" in each settlements to evaluate the health care Programmes. The committee meets at least three times a year to discuss and improve health care in the settlements. Senior staff from the Department when visiting the settlements also request the committee to meet to discuss health care progress & problems.
MONITORING & EVALUATION
The mode of monitoring & evaluation is through feedback from health care centers in the form of monthly reports as well as during periodic field trips taken by the Department staff to the settlements.
If required directions are sent to procure updated information. The Department submits timely progress or completion reports with audited statement of accounts to donors.
FUTURE PROJECTS & ProgrammeS
The Department of health plans to implement the following three major Programmes over the next two years with their sub-Programme or projects, besides running our current Programmes.
Preventive Health Care Programme
Curative health Care Programme
Strengthening Organizational Capability
ACKNOWLEDGMENT
We would like to extend our deep appreciation and thank all the donors and volunteers who have helped us to serve our people. We still have a long way to achieve our goals and we request for your continued support.
ProgrammeS AND PROJECTS FOR 1996-1997
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Strengthening Organizational Capabilities |
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The Epidemiology Data Analysis and training Unit, Dharamsala. |
755,000.00 |
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Health Training Center, D/sala Guest House as income generating project, New Delhi Purchase of 486 computer for Health Data section |
4,844,500.00 |
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Health Training Center, Dharamsala |
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Guest House as income generating project, New Delhi |
7,491,319.00 |
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Purchase of 486 computer for Health Data section |
188,968.00 |
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Medical Staff Training |
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Doctors
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290,000.00 |
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Nurses:
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295,000.00 |
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Pharmacist
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96,000.00 |
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Laboratory Technician
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90,000.00
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CHWs Training (10)
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93,800.00
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Refresher Course for CHWs (20) |
99,500.00 |
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Medical Equipment
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1,450,000.00 |
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Ambulance for Tenzingang Settlement, Bomdila |
520,000.00 |
HOW YOU CAN HELP
Our health care projects help over 1,19,686 Tibetan refugees in India and Nepal, and we also serve the local Indian and Nepalese communities. This booklet gives you some idea of the scope of our work, what we are doing, and what we would like to do with our human and monetary resources. If you would like to contribute, please use the form.
We/I would like to help with the Primary Health Care Programme through a contribution to the:
Tuberculosis Control Programme
Training of Health Personnel
Health Education and Media Project
Emergency Medical Relief Fund
Essential Drug Supply Fund
Disabled and Handicapped Project
Immunization Programme
Health Data and Research Fund
Torture Victims Survival Project
Mother and Child Health Programme
Drinking Water and Sanitation Programme
Health Education materials for general public in
Tibetan Language
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A Guide to daily Health Care Nutrition Better Dental Care Rabies First Aid at Home AIDS Prevention Tuberculosis Prevention Tuberculosis Prevention Gastro-enteritis Dental care Personal Hygiene Breast Feeding Tibetan Health \Neighing Under Five TB Control |
Booklet Booklet Pamphlet Pamphlet Pamphlet Pamphlet Posters Pamphlet Pamphlets Manual Posters Posters Periodical Posters Video |
English Language
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Particulars |
Type |
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Better Dental care Tibetan Health Doctors Tuberculosis Maternal & Child Health Essential Drug & Equipment List |
Poster Periodical Manual Manual Manual |
Forth-coming Publications
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Particulars |
Type |
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Tobacco or Health General Health Guide (Tibetan) Cancer General Hygiene (Nima) Health Career Guidance Menpa Mey-Pay Kap Book (Tibetan version of the book Where There is No Doctor) |
Pamphlet Manual Pamphlet Comic Booklet Book
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Last updated: 30-Sept-96