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 coliform contamination of household drinking water (42% vs 88%) (Paper II). The odds of coliform contamination in water at community sources was 2.3 times lower in IWMV (95% CI 0.81-6.45, p=0.08). The number of severe diarrhoeal cases (18/663 vs. 42/639, p=0.001) was lower in IWMV compared to NWMV. E. coli isolates from water sources in NWMV were resistant to a wider range of antibiotics (Paper III). The professional stakeholders in rural healthcare and development administration perceived that integrated watershed management positively influences complex interlinked factors related to the health of tribal people (Paper IV).

Conclusions: This study suggests that in a hilly tribal setting, implementation of IWMP helps in efficient use and management of water for households, as well as for agriculture purposes, and contributes to enhance socio-economic development and public health. IWM appeared to influence public health through positive modification of complex interlinked factors that include hygiene, sanitation, and healthcare practices, agriculture, migration, education etc. Thus, it appears that an integrated water, health and agriculture management (iWHAM) approach will be useful in improving public health in hilly tribal areas with water scarcity.

List of scientific papers

I. Nerkar SS, Tamhankar AJ, Johansson E, Stålsby Lundborg C. (2013). Improvement in health and empowerment of families as a result of watershed management in a tribal area in India - a qualitative study. BMC Int Health Hum Rights, 13:42
https://doi.org/10.1186/1472-698X-13-42

II. Nerkar SS, Pathak A, Stålsby Lundborg C and Tamhankar AJ. Can integrated watershed management contribute to improve public health? A cross-sectional study from hilly tribal villages in India. [Submitted]

III. Nerkar SS, Tamhankar AJ, Khedkar SU, Stålsby Lundborg C. (2014). Quality of water and antibiotic resistance of Escherichia coli from water sources of hilly tribal villages with and without integrated watershed management - a one year prospective study. Int J Environ Res Public Health 11: 6156-6170.
https://doi.org/10.3390/ijerph110606156

IV. Nerkar SS, Tamhankar AJ, Johansson E, Stålsby Lundborg C. Impact of integrated watershed management on complex interlinked factors influencing public health- Perceptions of professional stakeholders from a hilly tribal area of India. [Manuscript]