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 Table of Contents  
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 380-381  

Addressing health needs of the highest settlements in the world

1 Professor and Head, Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Assistant Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Hamirpur, Himachal Pradesh, India
3 Assistant Professor, Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
4 Assistant Professor, Department of Community Medicine, Radhakrishnan Government Medical College, Hamirpur, Himachal Pradesh, India
5 Coordinator, The Institute of Studies in Buddhist Philosophy and Tribal Cultural Society, Lahaul & Spiti, Himachal Pradesh, India

Date of Submission15-Mar-2022
Date of Decision12-Jul-2022
Date of Acceptance22-Jul-2022
Date of Web Publication22-Sep-2022

Correspondence Address:
Harshvardhan Singh
Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_392_22

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How to cite this article:
Gupta A, Singh H, Sachdeva A, Kumar S, Barall D, Tamba S. Addressing health needs of the highest settlements in the world. Indian J Public Health 2022;66:380-1

How to cite this URL:
Gupta A, Singh H, Sachdeva A, Kumar S, Barall D, Tamba S. Addressing health needs of the highest settlements in the world. Indian J Public Health [serial online] 2022 [cited 2023 Mar 26];66:380-1. Available from:

Dear Editor,

A study was carried out to assess the health-care needs of the inhabitants of the Spiti subdivision of Lahaul and Spiti, which is one of the two fully tribal districts of Himachal Pradesh. The region hosts the highest settlements in the world connected by motorable roads lying at an altitude ranging from 9680 to 13,450 feet as compared to the state's altitude range of 1148–22,293 feet and remains cutoff from the rest of the country for about 6 months a year due to harsh climatic conditions.[1] Both communicable and noncommunicable disease trends are quite different from the country averages. The prevalence of mild hypertension in women and men has been noted to be 8.5% and 12.2%, respectively, in the district which is higher than the national average of 6.5% and 9.8%, respectively.[2] A study conducted in the same region reported the high prevalence of hypertension to be influenced by the presence of certain dietary factors such as ingestion of “salted tea,” lifestyle-related risk factors, age, and possibly altitude of residence.[3]

Recently, two studies have found the prevalence of hepatitis B to be remarkably high in the Spiti subdivision than in the rest of India and the world. The seroprevalence in two different studies has been noted to be 21.9% and 17.2%, respectively, which is remarkably high as compared to the national average of 4%–7%.[4],[5] The possible causes for higher prevalence could be explained by the unsafe treatment practices by local faith healers, unsafe sexual practices, and the absence of vaccination for the now-older group which has a higher prevalence.[4]

A cross-sectional study design was employed to survey 194 households housing 649 members. Seventy-one villages were selected using probability proportional to size sampling and households were selected through simple random sampling. Trained volunteers undertook home visits to collect data using a pretested interview schedule. The study envisaged to identify and analyze the community health needs and suggest strategies to address them. It was observed that 67% of respondents preferred the local government health services for minor and major ailments, maternal health, and other preventive services. The rest preferred going out of the region to avail health services. About 34.5% fell ill during the preceding year. The top three illnesses were gastrointestinal, respiratory, and musculoskeletal in nature. About 62.8% of respondents reported that health services were not available in all areas of the subdivision and 41.2% of the respondents were not satisfied with the available government health services. About 4.4% and 3.1% had knowledge about the presence of adolescent and geriatric health clinics, respectively. About 42.8% reported to have undergone regular health check-ups and 31.4% reported to have undergone diagnostic/screening medical tests ever. About 11.3% had good knowledge of the various health schemes/programs being run by the government. Substance/drug abuse was prevalent in 29.9% of the households. Smoking tobacco (25.2%), alcohol (15.9%), and opium products (9.3%) were the three most common substances abused. Only 16% of the respondents were aware of the presence of a deaddiction/rehabilitation facility in their area.

Despite the existing government spending on tribal health, there is an immense scope for the upgradation of clinical infrastructure and improvement in preventive health-care services. As per the latest rural health statistics 2020–21, the number of sanctioned Primary Health Centres (PHC) (51) is more than the required (45) in the tribal areas of Himachal Pradesh. However, 09 posts of doctors are still vacant at the PHC level. At the sanctioned Community Health Centres in the tribal areas (08), out of the total sanctioned posts of specialists (32), all the posts of surgeons, obstetricians, gynecologists, physicians, and pediatricians are lying vacant.[6]

The major areas for improvement include water, sanitation, hygiene, reproductive, maternal and child health, adolescent and geriatric services, drug addiction, and prevention of communicable and noncommunicable diseases. There is a minimal shortfall of required MBBS doctors at the tribal PHCs unlike in the past. This can be explained by the incentive scheme of the government which mandates extra marks in the PG entrance examination in relation to the level of difficulty of the area served. However, all the posts of specialists at the secondary care institutions are lying vacant. This can be explained by the requirement of 1-year mandatory field service post-PG as an eligibility criterion for senior residency irrespective of the difficulty of the area served. Due to the preference for absorption in the ever-increasing number of medical colleges in the state, serving in a tribal area does not seem to be an attractive option. Therefore, a model is being proposed through which the perennial shortage of specialists in the tribal areas can be addressed by the adoption of the respective tribal areas by medical colleges of the region concerned. This will offer opportunities for the medical college specialists in tribal health and will provide uninterrupted specialist services to the inhabitants, thereby improving the overall health-care delivery in the tribal areas in a robust manner. A system of adoption of tribal areas by medical colleges as their outreach centers can be set after upgrading the existing health infrastructure and evolving a system of rotation of medical college faculty and residents all year round [Figure 1].
Figure 1: Amplification of eae gene (796bp) of EPEC. Lane 1: Ladder, Lane 2: Positive control, Lane 4: Negative control, Lane 11, 12, 13, 15, 16: PCR products showing amplified eae gene at 796bp.

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A system based on incentives can also be looked into. This would ultimately reduce the out-of-pocket expenditure on health and improve the overall health and socioeconomic status of the tribal region. We acknowledge the support of The Institute of Studies in Buddhist Philosophy and Tribal Cultural Society, Tabo (Lahaul and Spiti), in conducting this study.

Financial support and sponsorship

The study was conceptualised by MADAD-Global and supported by The Institute of Studies in Buddhist Philosophy and Tribal Cultural Society, Tabo (Lahaul and Spiti).H.P.

Conflicts of interest

There are no conflicts of interest.

   References Top

Government of Himachal Pradesh. Department of Tourism and Civil Aviation. District Lahaul and Spiti. Available from: [Last accessed on 2021 Jul 14].  Back to cited text no. 1
National Family Health Survey, India-4. India Fact Sheet. Available from: [Last accessed on 2021 Apr 21].  Back to cited text no. 2
Negi PC, Bhardwaj R, Kandoria A, Asotra S, Ganju N, Marwaha R, et al. Epidemiological study of hypertension in natives of Spiti valley in himalayas and impact of hypobaric hypoxemia; a cross-sectional study. J Assoc Physicians India 2012;60:21-5.  Back to cited text no. 3
Barall D, Gupta A, Sharma B, Mazta SR, Singh S. Prevalence of chronic hepatitis B infection among residents of hilly tribal district in northern India. Int J Community Med Public Health 2018;5:2989-96.  Back to cited text no. 4
Sharma RK, Shukla MK, Minhas N, Barde PV. Seroprevalence and risk factors of hepatitis B virus infection in tribal population of Himalayan district Lahaul and Spiti, India. Pathog Glob Health 2019;113:263-7.  Back to cited text no. 5
Government of India. Ministry of Health and Family Welfare. Rural Health Statistics. 2020-21. P202-09. Available from: [Last accessed on 2022 Jun 17].  Back to cited text no. 6


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