Nearly four years ago the Maharashtra government had announced what it considered a great achievement: the reduction in malnutrition deaths among tribal children in the state by 10%. That claim was endorsed by the UNICEF.
But Dr Abhay Bang, an award-winning health care professional who has been working among tribals in the heavily forested Gadchiroli district for years, was highly sceptical. An alumni of the Johns Hopkins University in the US, Dr Bang had chaired a state committee on child mortality evaluation and told the government in 2013 , “That has to be a miracle.” For it was much more than 10 per cent.
Dr Bang runs an NGO called SEARCH (Society for Education, Action and Research in Community Health) which also keeps a watch on such data.
“They had brought down the deaths from 39 per cent to 22 per cent. No one achieves that kind of success in such a short period of time.’’
That achievement began to be known as the ‘Maharashtra Model’ of child development and was held up as a template for those who wanted to achieve similar targets. But three years on, that model seems to be in tatters with nearly 600 malnutrition deaths reported among tribal children from Palghar district alone this year, barely 100 kms from Mumbai. The National Human Rights Commission, taking suo moto notice of the reports, has asked the Maharashtra chief secretary for a detailed explanation within four weeks.
So what went wrong in such a short while? “Nothing,” says Dr Bang.
What the government had achieved was a mere reduction in child mortality which at 45 deaths per thousand children is commendable figure. But infant mortality is vastly different from malnutrition though the two are interlinked and have a bearing upon each other.
“The mistake that the media and government agencies often make is to confuse mortality with malnutrition deaths. No one quite dies of malnutrition. They die of other causes because of that malnutrition. Stunting is often the better measure of malnutrition and even today 51% of children and adults among tribal populations in the state are undernourished and stunted. That is huge. And here has been little improvement in those figures.’’
Many years ago Dr Bang authored a report on child mortality and malnutrition related deaths of children below five titled ``Kowali Panejar’’ in Marathi (Shedding of Tender Leaves). So when Vivek Pandit founder of the Shramjeevi Sangathana, a NGO working among these tribals, saw a two-year old child he had rushed to a hospital in Nashik, die of high fever, and asked in anguish, “How many more sacrifices of children does the government want before they stop dying?”’ the answer to it could be, “Scores.”
Dr Bang says the government figures are often under reported because the reporting agency and the sustaining agency are one and the same – that means the officials who have to compute the deaths are the very same health officials responsible for preventing malnutrition and infant mortality.
“No one is a personal villain but it is human nature not to want to carry the blame. So often many deaths will not be reported and the actual numbers are tens of times that the government gives out each year.”
According to Dr Bang nearly 50% of infant mortalities happen in the neo-natal stages – that is within one month of birth because the children are born to highly undernourished mothers. If they do make it past 30 days, diarrhea and pneumonia often prove fatal as also malaria (if they survive the first two calamities) within six months to one year of their lives. By two they are so weak and ‘wasted’, even an ordinary fever can be fatal.
Tribals have the additional burden of their superstitions. “It is a larger South Asian problem but Indian tribals particularly will not feed the child for the first three days of his or her life. The child may sometimes be given sweetened water but not mother’s milk in this time. Breast feeding begins only from the fourth day. You can imagine what that does to the child,” says Dr Bang.
However, except for the superstation and faith in witch doctors that keeps them from taking modern medicines, which is a major cultural issue, much of the battle against malnutrition is easy to win with a few changes in government policies and outlook, Dr Bang told the Hindustan Times.
“The Integrated Child Development Services needs a shift in emphasis. Now the child has to go to the centre to collect nutrition. Which means only children over three who can walk to the centres, get access to nutrition. On the other hand, it is often children below two who are more in need of such supplements. So food must be reached to them.’’
The Maharashtra cabinet did formulate a policy for this shift in emphasis some years ago but it was defeated by its own officials who resisted the change. And so, children continue to be malnourished and the deaths prevail.
According to Varsha Gaikwad, former minister for women and child welfare who, during her tenure worked hard to reduce child mortality, the nodal agency (which is the women and child welfare department) has to go the extra mile in co-ordinating between various other agencies – health officials, tribal welfare department, forest department (as tribals mostly live in or around forests) and even the public works department (to ensure road access to tribals in remote places remain open).
“It has to be a combined effort, just one person or agency cannot do it,” she says.
Her oblique reference is to the unilateral manner in which both tribal welfare minister Vishnu Savara and women and child welfare minister Pankaja Munde have handled the recent malnutrition deaths in Palghar.
Savara’s visit to Kalambwadi village in Mokhada tehsil of the newly formed and tribal dominated Palghar district earlier this month after a child’s death drew a hostile response from the tribals. Badly rattled after activists grilled him about the mounting deaths and the government’s alleged scant attention, he snapped carelessly, “So be it!” That video went viral and when Munde visited the district on September 21 after the death of yet another two-year old from Ruighar village in Jawhar taluka, police had to invoke preventive measures to stop people from heckling her.
“But that is not how you do it,” says Gaikwad who faced similar flak several times during her tenure, “You have to be heckled by the people and they have to point out to you what is going wrong. That is how you will know what corrective measures to take. You cannot govern or solve this issue in isolation.’’
Munde did meet members of the NGO Shramjeevi Sangathana working among these tribals for years. Vivek Pandit pointed out that nearly 20% of posts for health officials in the district were lying vacant and that the Jawhar rural hospital needed to be upgraded to a district hospital at the least to save more lives.
That’s why Gaikwad’s emphasis on integrated co-ordination between the various ministers and departments, because funding for tribal welfare has not been an issue. The tribal population of Maharashtra is 9% and an equivalent percentage of the budget automatically gets allocated to the tribal welfare department each year.
Dr Bang is pained by the fact that despite ample funds (upwards of Rs 5000 crore) these are not utilised or at times they are diverted to non-tribal uses. “One year I found that a previous tribal minister had paid tolls worth several crores through these funds in Nandurbar district (another tribal dominated area). Those truck drivers bringing supplies to tribal villages who benefitted were not tribals. Such things are avoidable.”
Bang says the best thing the government can do, after tackling health, educational, economic and cultural issues, is to empower tribals to take charge of their own lives. This has already happened in a way with amendments to the Forests Act wherein, barring teak and timber, tribals have been allowed to make use of all other forest produce (like fruits and tendu leaves) and sell them directly in the market with private operators forbidden to step in.
“The first few years many gram panchayats made at least a hundred crore rupees from such sales and judiciously distributed the profits among various villages. Cut off the middlemen and let there be no shortfall in health and nutritional facilities. It will still take a long time but it will happen one day.’’
Only then, tender leaves then will no longer be swept away by a breeze.