iWHAM-integrated water, health and agriculture management : public health implications of integrated watershed management in a tribal area

Background: Water scarcity remains a major hurdle in the overall development of tribal people living on hilly terrain, and it is one of the major reasons for their various health problems. Integrated watershed management (IWM) aims to increase water availability and to enhance socio-economic development in such areas. There is a lack of information on the implications of IWM on various aspects of public health, especially in hilly tribal areas. Aim: The overall aim of this thesis was to explore the public health implications of integrated watershed management in a hilly tribal area in India. Methods: This study was conducted in six tribal villages of Maharashtra, India. In Paper I, six focus group discussions (FGDs) were conducted with men and women from tribal community, who lived in three different villages with different levels of implementation of the integrated watershed management programme (IWMP). Paper II was a cross-sectional survey involving face-to-face interviews with heads of households in the six study villages. There were 142 households from three integrated watershed management villages (IWMV) and 144 households from three non-watershed management villages (NWMV) participated in study. Paper III was a one year prospective study that investigated physico-chemical and faecal coliform contamination of seven water sources (wells) from six villages. Antibiotic resistance of Escherichia coli isolated from the water sources was investigated. The incidence of diarrhoea was recorded at regular intervals. For Paper IV, 17 individual interviews and four FGDs were conducted with professional stakeholders involved in rural healthcare and development administration in the same tribal area. Findings: Tribal people living in hilly terrain perceived that water scarcity was the main reason for their health problems, and that implementation of IWMP was helpful in improving their health and also empowering their families by improving their socio-economic status through development of agriculture (Paper I). The questionnaire-based cross sectional study revealed positive influence of IWM on many aspects of public health including shorter periods of water scarcity (OR=0.02, 95% Confidence Interval (CI) 0.01-0.04), increased use of toilets (OR=6.95, 95% CI 4.07-11.85), increased cultivation of fruit and vegetables (OR=2.61, 95% CI 1.60-4.27), reduction in migration (OR=0.59, 95% CI 0.36-0.97), increased utilization of healthcare facilities and reduced faecal colif