The Hindu : Opinion / Leader Page Articles : Life on the fringes

Online edition of India's National Newspaper
Sunday, Aug 01, 2004

Opinion

Opinion - Leader Page Articles

Life on the fringes

Maharashtra's poor public healthcare and highly skewed distribution of wealth lies at the root of the current crisis highlighted by malnutrition deaths among Adivasis, writes Kalpana Sharma.

— Photo: Vivek Bendre

Malnourished children at the Dhadgaon rural hospital in Maharashtra's Nandurbar district.

THE MAHARASHTRA Chief Minister, Sushilkumar Shinde, could rue the day he decided to dismiss recent reports of infant deaths due to malnutrition in the State's tribal districts as "highly exaggerated." Public memory is short but not that short.

People cannot forget that last year, and the year before that, and even further back in time, there have been regular, apparently "exaggerated," reports about tribal infants dying because they have no food in their stomachs. Neither do their mothers have food. Nor their brothers and sisters.

Death finally comes from catching a chill because the mother has no covering for the child or from malaria or from diarrhoea. And the Government goes to great lengths to explain that such deaths are not caused by malnutrition.

Mr. Shinde should glance again at the Human Development Report 2002 prepared by his own Government. It might help him understand why every year this story repeats itself.

The bad news

The report states that despite its status as an advanced State, "compared to other developed states, the overall health sector in Maharashtra is weaker, not having kept pace with its general economic attainments."

The bad news does not end there. The report also states that 57.5 per cent of households in rural areas in the State are nutritionally deficient with inadequate calorie intake. "Nearly half the ever-married women, between 15 and 49 suffer from anaemia."

Worse still "of the children under three years, 76 per cent were also suffering from anaemia, the levels being comparatively higher in rural areas." The data in the report have not been disaggregated to present separate data on the tribal districts. If they had, the picture would have been grim.

Maharashtra's per capita income is one-and-a-half times that of the average for India. Yet according to a World Bank assessment, while the poverty rate in India has declined to 28 per cent (1999-2000), "when compared to other Indian states with comparable per capita income, Maharashtra continues to have a disproportionately higher poverty rate. Despite having the second highest per capita income amongst the 14 major Indian States, Maharashtra has the fifth highest poverty rate."

According to this assessment, Maharashtra also has "high levels of inequality."

It is this combination of Maharashtra's low status in the health sector, its high poverty rate, and the highly skewed distribution of wealth that is the real cause of worry. It lies at the root of the current crisis highlighted by the reports on malnutrition deaths.

These child deaths have taken place in the poorest districts of the State that are also badly served under every developmental parameter — roads, electricity, education, and health infrastructure.

Furthermore these districts — Thane, Amravati, Nandurbar, Gadchiroli and Nasik — are largely inhabited by Adivasis who form almost 10 per cent of the population of the State, an estimated 7.4 million people divided into 17 major tribal groups.

The contrast

These communities pay the price each year for this pattern of unequal development that appears to be set in stone, a pattern that creates some areas of light while leaving others in chronic darkness. Successive governments have failed to break this pattern.

The contrast between social indicators for the rest of the State and for the tribal pockets in Maharashtra is nothing short of scandalous.

For instance, according to data from the Public Health Department, while the infant mortality rate is 48 per 1000 live births in the State, it is 110 among the tribals.

If 28 per cent of babies are of low birth weight in the general population, the figure is 40 per cent among tribal babies. If 86 per cent of women deliver their babies with the aid of a trained birth attendant in the rest of the population, only 12 per cent of tribal women do.

According to the Pune-based Tribal Research and Training Institute, 92 per cent of the children in some tribal districts are malnourished.

The Government, of course, refuses to accept this and continues to blame infant deaths on a variety of factors including illiteracy and early marriage.

Can anything be done? Is it impossible to ensure that the benefits of development actually reach the people most in need of them?

No livelihood choices

There are several aspects to the current crisis that need to be addressed. Principally, the crisis is one of absence of livelihood choices.

Adivasi communities in all these districts live in forested areas. They have cultivated forestland and lived off forest produce. But these forests are either being denuded or diverted for "other purposes."

What remains of the forests has been reserved and protected by Government decree. The forests are important for humankind as a whole and not just for those who live in forests goes the argument. These people can be resettled elsewhere in the interests of preserving forests. It is this basic premise that has resulted in the dislocation of the lives of millions of tribal communities throughout India. In Maharashtra, the situation has been acute.

Displaced

In Melghat, for instance, subject of the recent reports in this paper of malnutrition deaths, 22 tribal villages have been displaced for the tiger sanctuary. In Nandurbar in north Maharashtra, the tribal areas fall in the submergence zone of the Sardar Sarovar Project.

Displacement has forced Adivasis to leave their villages in search of work. Usually only the men migrate. The women and children are left behind to fend for themselves. The Government's response is new programmes.

Thus, children are supposed to get cooked food in the anganwadi, there are mobile units and wireless sets to bring speedy medical aid and there is an effort to improve the supply of medicines and medical personnel. Some of this has been done in Maharashtra.

Money no motivation

Yet money alone has not worked in motivating doctors to work in remote tribal areas. Here even if the Government provides primary health centres and rural hospitals, there are no doctors.

A recent study on the status of health care in three Maharashtra districts by the Centre for Enquiry into Health and Allied Themes (CEHAT) found that almost half the PHCs had no doctor, 75 per cent did not have medicines and only 18 per cent had ambulances.

Even if the PHCs had ambulances, 40 per cent had no driver. In rural hospitals, one step up from the PHC, which are supposed to provide specialist care, only 20 per cent had paediatricians and just one third had anaesthetists. Only two out of the 19 rural hospitals surveyed could perform an operation.

However, even if the public health system were adequate, it would not be enough. It is a medical solution for an economic problem. If you remove people from their source of sustenance, you must provide them with an alternative.

Doles and medical intervention can save lives but they cannot deal with generational nutritional deficiencies, where low birth weight babies grow into emaciated and underfed mothers who then produce low birth weight babies. It is a cycle that cannot be broken by medicines alone.

Printer friendly page
Send this article to Friends by E-Mail

Opinion

News Update

Stories in this Section

Life on the fringes

Hardly hospitals

The wages of neglect

Encroachers in their own land

Degeneration of politics