A Fact-finding and an Introspective Visit
04-11-2011

The verdant forested hills hide a forlorn story. They are home to some of the most isolated people in the country, including the Korku Adivasis. This region, comprising Chikhaldhara and Dharni talukas, has seen the death of 400 to 500 children below six years of age, every year consistently in spite of being in the news.

Accompanied by the Hon Minister of State for Health, Officers from the Local Administration, Medical Experts, NGOs and a team form Yashwantrao Chavan Pratishthan, Mumbai, we visited Melghat on 04-11-2011 to study the reasons for this dismal statistic of 2005.

During our visit to these small hamlets scattered across hundreds of miles, the same recurring stories came to be narrated:

1. A dismal lack of infrastructure is the common thread running through this myriad of maladies. Due to lack of proper and motorable roads and very poor frequency in fact near absence, of public transport, it becomes difficult for these residents to commute and communicate regarding the daily and basic necessities of life. It is not possible for parents to take the sick children to a Public Health Center, or for a pregnant woman in labour with complications to get a specialized medical unit with facilities in time.
2. We saw a plea for better Education at pre primary and primary levels by strengthening the ‘Anganwadis’ and Primary school in close vicinity of the villages
3. Immediate appointment of doctors for the posts those are vacant for long. They need appropriate gynecologists/obstetricians and pediatricians. A large number of maternal deaths occur due to lack of Trained Obstetricians. Similarly, Neonatal, Infant and Under-Five deaths related to complications from malnutrition need to be prevented by having regular trained Pediatricians. Changes in the post graduate admission procedures, non application of Sixth pay Commission recommendations and pathetic basic living facilities have forced a large number of doctors to shun this region.
4. There was a demand to have effective implementation of the ‘EMPLYMENT GUARANTEE SCHEME (ROJGAR HAMI YOJANA)’ in the region, and continuation of the ‘NREGA’ – National Rural Employment Guarantee Act, to maintain the economic well-being of the villagers.
5. Due to implementation of The Forest Act, people complained about the authorities of the Forest Department who do not allow them to use certain roads after evening hours which hinders them while going for labor work and returning home after work.
6. A serious and detailed discussion over establishing the Community Rights over forest rather than Individual Rights (as is being done now) is important to restore a sense of responsibility in people over safeguarding the environment and using the same sensibly rather than exploiting it for individual benefit.

The day-long deliberation with the accompanying members of NGOs was very insightful.
Some of the key issues raised by the NGOs were as follows:

1) With respect to Administrative issues, it appears that the Administration in Melghat

• Does not show consistency in execution of programs and schemes, in the area of health, education and infrastructure.
• The authorities lack Standard Operating Procedures.
• Administration and Management (both Productive and in response to Emergencies and Contingencies) is not system driven but rather individual authority centric.
• Administrative Appointments in Melghat are taken as punishment postings (in terms of actual transfers to, living and other conditions of the officers and the uncertain and often prolonged tenure) and that leads to lack of motivation to do substantial and quality work. A case in point is the one illustrated by NGO representatives – Mr. Praveensingh Pardesh (I.A.S) who took keen interest and brought about remarkable transformation in the situation, but unfortunately his successors did not sustain the improvement, in fact it has further deteriorated.

2) Implementation of Bachat Gats are in fact leading to a divide within the rural female population causing them to form smaller groups. This threatens the objectives to keep the population united.

3) Effective implementation of NREGA, as it will be financially beneficial for the local population and help reduce the rate of migration, which is one of the causes of consistently high mortality due to malnutrition and maternal deaths.

During our visit we saw few moderately acute malnourished children (MAM) and one severely acute malnourished child (SAM).

On interviewing their mothers it showed that they need to go to the farms for their livelihood abandoning their children, sometimes as early as a month after delivery. They lacked counseling from a properly trained person from Primary Health Unite (PHU) to guide them about breast feeding and weaning, nutrition and care of children with malnutrition and follow-up of those cases till recovery.

On visiting a school in a village of Melghat, it was shocking to note the poor conditions for storage of food grains and poor attendance, including the teacher. On the other hand in the same premises, the cooked food (Khichadi and Usal) was ready to serve about 100 to 125 children, pregnant women and lactating women. We tasted this and found it satisfactory and pretty hygienic. In fact the remarkable cleanliness in the kitchens and houses of the villagers had us completely impressed.

On a surprise visit to an Adivasi school in a remote hamlet called ‘Reta Kheda’, we found the condition of the road to be extremely poor and it took us 50 minutes to cover a distance of 6 km. The school had attendance of few students but the teacher was absent! The local people seemed reluctant to divulge details.

On interaction with the Government Authorities like Project Officers & District Officers, it revealed that they have not started the work of ‘EGS- Rozgar Haami Yojana’ but assured us that they would start the work as soon as possible.

The Doctors seemed to be doing their best amidst all these difficulties. A Pediatrician who has been working there for one year was worried, as he has not received any letter of continuation.

In the past, qualified MBBS doctors used to come and work in Melghat as they had an assurance of Post Graduation opportunity (in-service candidates program) after completing their tenure in this region. Now, as the government has stopped this program, so the MBBS doctors have no motivation in working in the Melghat region.

After visiting these remote villages in Melghat and having a heart to heart interaction with the local Adivasi community, NGO representatives, Health and other Administrative Officers, we would like to put the following suggestions to reduce malnutrition and malnutrition related deaths:

• Health and Malnutrition: -

A. Systematic Planning (SOP based), training of stakeholders and Implementation of the Government Schemes and projects.

B. There should be trained people (Arogya Doots) to reach and track every Adivasi house for the following:

• Maintaining the Health card of each family.
• Monitoring concerns related to health with special attention to adolescent girls, pregnant women, lactating mothers and children up to the age of 5 years.
• Arogya Doot needs to give scientific advice and training on simple household food made with local produce with due demonstrations.
• Arogya Doot to supervise the effective implementation of providing and consuming packets of Take Home Ration (THR) under observation for children with SAM. THR are micro nutrient food packets, which has to be ready to use mix nutrient made as per the guidelines of the World Health Organization (WHO).
• The monitoring of the same has to be done every day with every child; this is just like giving DOT treatment in case of Tuberculosis that has been proved to be very effective in treating Tuberculosis.

(Note: The distribution of THR packets to children was stopped suddenly due to the problems in storage and administration.)

• Administrative:-

A. There is a need to facilitate a common and regular dialogue between senior administrative officers, Project officers – Health, Education, and the Forest Department togetherto formulate a strong government policy with

• Short term Planning
• Midterm Planning
• Long term Planning

to bring about a systematic and sustained change in the conditions of Melghat Adivasis.

To summarize, here are some of the basic needs of the people in Melghat

• Proper Scientific Nutrition, including Micronutrients.
• Preventive Health
• Mother and Child Care
• Reactivating Comprehensive Education system
• Transportation & Roads
• Availability of permanent Employment Guarantee during the non-agricultural season.

Considering these facts, we are of the opinion that the Government has to take immediate and effective steps to reach remote, interior regions. Malnutrition in Melghat has gone on for too long; however it is not an insurmountable barrier as it has been made to appear. It is the sincere and considered opinion of all of us that what we need is a concentrated, unified, systems based operational approach with a single or unified chain of command with accountability. Considering the chronic nature of the problem, we recommend that this command directly report to the Honourable Chief Minister of Maharashtra.

Writing Committee:
Supriya Sule, M.P.
Datta Balsaraf
Dr Samir Dalwai
Dr. Sachin Jadhav
Dr. Suresh Bahte
Ameya Jagtap
Amruta More
Nilesh Puradkar

On Behalf of
Yashwantrao Chavan Pratishthan, Mumbai.