UNDERSTANDING SPECIFIC BARRIERS TO UTILIZATION OF TB CONTROL SERVICES BY TRIBAL PEOPLE TO HELP IN DESIGNING INCENTIVE PLAN

Open Access
Author:
Botla, Krishna Chaitanya
Graduate Program:
Industrial Engineering
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
None
Committee Members:
  • Dr Paul Griffin, Thesis Advisor
Keywords:
  • Barriers for Tribal People
  • Incentive plan
Abstract:
The objective of the study is to uncover barriers to utilization of TB Control services by Tribal people living in Visakha Agency area of Andhra Pradesh, India. The selection of this region was done after considering the fact that this region is covered under the government TB Control program for the past one year and availability of health worker resources from the District Tuberculosis Officer to conduct the survey. A mix of quantitative and qualitative survey questionnaire was designed to understand the relationship between accessibility and various factors such as socioeconomic status, educational level and working status. Sample of 1000 Tribal people spread across 10 villages of the Agency area were pre-selected from the Census data available using multi-stage sampling. The sample quota for each village was allocated based on the higher proportion of tribal population within the village to ensure a cost-effective way of achieving a better representation of core Tribal areas. The villages were then visited by a health worker after getting briefed on the details of the survey objectives and procedures to conduct interviews using the provided survey questionnaire. A response rate of 63.1% was achieved as in some instances, the census data was outdated and/or the person pre-selected was not accessible. Detailed accounts of all the 631 persons interviewed were recorded and analyzed in the study to identify key factors that influence utilization and accessibility of TB control services. The results from the survey showed that the occurrence of TB symptoms increased with age up to 50 years and people living in tribal areas of Visakha agency region in between 25-50 years of age are found at a higher risk of being infected by TB than their younger counterparts. Possible indication of higher levels of transmission risk was observed among unskilled/daily wage labor workers as primary occupation of over half of symptomatic persons surveyed was unskilled/daily wage labor compared to only 28% of non-symptomatic population. In-spite of the free treatment services and travel reimbursement provided by the government, symptomatic persons, who were advised to seek diagnosis/treatment but did not seek any treatment, was overwhelmingly high (37%). The primary reason for not seeking treatment reported was under par financial situation of the population in this region. Recommendations are provided taking into account various significant observations made from the study to improve the treatment seeking behavior of the Tribal persons in this region.