How tribal infants are dying of malnutrition in Palghar

A number of tribal kids are dying of malnutrition in Palghar district, Maharashtra. Lack of basic facilities like roads, water, healthcare and employment is also not helping

geetanjali

Geetanjali Minhas | October 22, 2016 | Palghar


#Maharashtra   #Palghar   #Tribal issues   #Tribals   #Maharahtra   #Malnutrition   #Health  


On a cloudy afternoon in the last days of September, a five-watt bulb hangs inside a kuchha hut in Kalamwadi village, somewhere deep in a tribal area of Palghar district, Maharashtra. The flickering bulb fails to provide enough illumination to recognise a face at first sight.

At the entrance of the hut, Shiva Wagh stands aimlessly. Inside, his wife Sita sits with a baby girl in her arms. Till some time ago, there used to be a baby boy as well.

The hut is made of wood, bamboo, cow dung and mud, and among a few others, it stands in a densely forested area of Palghar. A thin wire strung inside, is loaded with drying clothes. There is also a tandoor and a few cooking vessels around.

In this hut lived Sagar, the baby boy. He could live only three more months after his second birthday; he died on August 30.

Sagar had become severely malnourished and was also suffering from tuberculosis (TB). Perhaps the only medical care he got was from Bal Sanjeevani Chhavni, a health camp run by NGO Shramjeevi Sanghatana, at the nearby Jawhar taluka. His 25-year-old father, Shiva, worked in its kitchen there.

Also read: “There is no check on quality of education and food provided at ashram schools”


But much before Sagar died, the local media had extensively reported the increasing instance of malnutrition in Palghar and Sagar’s deteriorating health. He was admitted in the health camp on January 1, 2016 but when the Maharashtra government announced restarting the village child development centres (VCDCs) in March, his mother left the camp and took him home. At VCDCs, a child is given nutritious meals six times a day for 30 days in anganwadis. The plan, which used to be funded by the central government, was cut short in August last year.


Sagar died of malnutrition on August 30. He was just a little over two years old

Things, however, did not turn out so well for Sagar at the anganwadi. By the time his mother reached the VCDC, the scheme had already shut down; it closed within 21 days after relaunch. As a result, the boy did not get enough food and his health worsened. His father was unable to get medical help in time as there was no telephone at his home. Poor road connectivity and an almost non-existent system of public transport made things all the more difficult. Sagar ultimately succumbed to his ailments. 

* * *
Zooming out on the map, Kalamwadi falls under Khoch gram panchayat which comes under Mokhada taluka of Palghar, a hilly region. Palghar district was formed on August 1, 2014 after bifurcation from Thane district for better administration and development. It has eight talukas – Palghar, Vada, Vikramgad, Jawhar, Mokhada, Dahanu, Talasari and Vasai-Virar – the northern end of Mumbai’s local train network. But according to Shramjeevi Sanghatana, which has been working in the area for 30 years, many senior government officers were moved away from the tribal areas. Thus, development – the intended purpose of bifurcation – has not been witnessed much.

Zooming in back on Kalamwadi, reaching there takes time. A diversion from the national highway 8 is led by a two-hour drive on kuchha and narrow roads and through a forest. It is hard to think of a regular occupation here. Shiva says he has no landholding or any permanent source of income. He prunes grass seasonally to earn Rs 160 per two quintals under a government scheme.

After much criticism from local NGOs and media, state health minister Deepak Sawant and state women and child welfare minister Pankaja Munde visited Sagar’s family in September. The family got an Antyodaya ration card and electricity connection in compensation. Electric poles had always been there but sans power. Munde also promised a cheque of Rs 51,000; though the family is waiting for it. And the others – Shiva’s neighbours – would be receiving power after completion of formalities. But more is required than such knee-jerk ‘giveaways’. The hamlet has no toilet and gets an erratic water supply through tankers. Many educated youth are jobless, and there are no pucca houses in the village. 

A few kilometres away, in Khoch village, two-year-old Ishwar Savra was taken to a hospital in Mokhada  on August 30 when he fell ill. The doctors referred him to nearby Jawhar or Nashik as they did not have the necessary facilities for treatment. His poverty-struck family had no wherewithal to go there. So they brought him back home. “The hamlet has two anganwadis with a total of four workers. But they never visited the boy’s house. On September 4, he died,” says former village sarpanch Eknath Pawar.

Ishwar’s father Namdev, an unskilled labourer, and mother Sunder, who too is malnourished, tend to jobs at brick kilns and fields, or break stones or cut woods. Here too, electricity is rare; water is in short supply. After the local bawri (water reserve) dries up, villagers dig holes in the ground to search for water or walk for four-five miles to find drinking water from other wells, says Pawar.



Health camp organised by Shramjeevi Sanghatana in Mokhada Taluka ​

“When the state health minister [Sawant] was in the opposition, he would come, cry hoarse and rant about the high rate of malnourishment here. He would click pictures and say the government is doing nothing. Now when he has become the health minister he says deaths are occurring due to TB and not because of malnourishment. In fact, TB is caused due to malnourishment. So does that mean when he was not a minister children were dying of malnourishment and now that he is in power they are dying of TB?” asks Vivek Pandit, a former MLA from Vasai taluka and president of Shramjeevi Sanghatana.

* * *

The Katkaria tribe is one of the economically weakest and smallest tribes in Palghar. The families of both Sagar and Ishwar belong to this tribe that comes under the particularly vulnerable tribal group (PVTG), for which the government has special schemes but often the allocated money lies idle. The tribal sub-plan budget of Palghar in 2016-17 is Rs 447 crore. Besides, it gets additional funds under the tribal sub-plan innovative scheme – for 2016-17, its budget is Rs 8.07 crore. According to the district collectorate, most of this money is utilised on health, education and nutrition.

But some figures tell a different story. According to an ongoing public interest litigation (PIL) in the Bombay high court, over 17,000 women and children below six years have died in Maharashtra in 2015-16 due to malnutrition related illnesses. As per the state women and child welfare department, in the same year there were a total of 1,64,553 moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) children in the state. And according to RTI data collected by Shramjeevi Sanghatana and NGO Samarthan, an advocacy group working in Maharashtra, there have been 208 child deaths in Palghar district this year till August. In 2015-16, there had been 457 child deaths, in 2014-15 the number was 485, while in 2013-14, 512 children had died of malnutrition. In Palghar district alone, there are 5,864 SAM children and 1,456 MAM children.

The problems naturally are many. The tribals grow their staple food – ragi (finger millet) and rice – but have no oil or sugar to cook. Most have small or no landholdings. Other than lack of basic infrastructure, there is no telephone or internet connectivity, leaving theses tribals isolated from the rest of the state. Villagers are thus compelled to migrate to surrounding areas for work. Most women are malnourished, yet they have to go out and work for food. Unemployment leads to migration, which in turn, affects children’s education and takes them away from the anganwadi network. Water is scarce and there is hardly any irrigation or drinking water available. Blind faith and superstitions, alcohol addiction, teenage pregnancies and unhygienic habits add to the miseries.


* * *

To tackle malnutrition, authorities have launched several schemes in the past. Some were wound up, some were forgotten while some were poorly implemented. The most popular of the schemes was the VCDC. Healthcare workers in the area say that its closure led to an increase in the death rate. However, Palghar district collector Abhijit Bhangar says that after the centre stopped funding VCDC in August last year, at the district level they have funded the scheme using Rs 1.2 crore from the tribal sub-plan budget. Though Bhangar admits that there are serious issues in Jawhar, Mokhada and Vikramgad talukas, he denies any abrupt increase in child deaths. “Malnutrition is an old issue; in the early 1990s two child deaths were reported in Jawhar taluka. But malnutrition is not happening due to nutritional aspects only. Others aspects such as livelihood are also to be taken in account.”

Now the Maharashtra government, in September again, announced to restart VCDCs in the wake of rising incidents of child deaths.
When Sagar was taken to the Chhavni in Jawhar, his 20-year-old mother Sita was pregnant with her second child. The health workers there were able to provide her with a nutritious diet. But now her nine-month-old daughter, Nandini, has also become an MAM child and is quickly reducing weight, says Asha Lilavanti Govind Chaudhari, coordinator, youth wing, Shramjeevi Sanghatana. “After Sagar’s death, VCDC was again started but has not fully spread out and not all children are being provided with the required diet. Also, the necessary food – khichdi, lapsi and usal – is given twice a week but is not cooked properly. Though the government rule provides for eggs and bananas four days a week, these are provided only for two days. Even the salaries of anganwadi sevikas and ASHAs [accredited social health activists] are delayed by three to six months,” says Chaudhari.

Another scheme called APJ Abdul Kalam Amrut Yojana for pregnant and lactating mothers was started in 2015 but that too didn’t cover all the villages. “Money under the Amrut Yojana does not come on time and the amount that comes is not enough for requirements,” adds Chaudhari, who is also a member of Vedhegaon gram panchayat, Bhiwandi taluka.

With required nutrition already being far from reach, the child further suffers at the hospital or clinic. This is because – leave alone availability of necessary medical facilities – there is severe shortage of staff. As per claims of Shramjeevi Sanghatana, the entire Palghar district has only one pediatrician. Moreover, all 13 posts of child development project officers (CDPOs) are vacant. The law requires one CDPO for 200 anganwadis who is responsible for monitoring and running of anganwadis along with the medical officers. The NGO adds that at the district headquarters, six of the total seven grade-3 posts are vacant, and so are the posts of three of 14 extension officers, eight chief anganwadi workers, 91 anganwadi workers, 135 anganwadi assistants and as many as 111 mini anganwadi workers. It further claims that the district civil surgeon has no office and staff. The post of the resident medical officer at the headquarters is also lying vacant since the creation of the new district. Of the total 12 posts of medical superintendents, eight are vacant. Of the 59 posts of medical officers, 12 are vacant. At Palghar zilla parishad headquarters, 28 of the 54 posts are also lying vacant. In the employee guarantee scheme (EGS) department, 11 of the 18 posts are vacant, and only one of the total 38 posts is filled in the district supply office while 13 out of 18 posts are not filled in the planning department. There has been no deputy collector (EGS) since the district split from Thane.

“Posts are inadequately filled up and that too without qualified and committed personnel. What is written on paper is quite different from the ground reality. Often, required medicines are not available and if present, they are of substandard quality,” says a health specialist working in the area. She adds that anganwadi workers are overloaded with paper work and have to maintain nearly 20-21 registers of different types. The work of preparing food is generally given to local self-help groups who also have to take care of accounts pertaining to ration and other payments. “Though money and policies exist, they do not reach the people. Even when they reach, there is pilferage. Vote bank politics is also responsible. People must question all this,” adds this expert.

A doctor who has been working in the villages of Vikramgad taluka for more than two decades also gives a similar description. “Due to lack of accommodation facilities, doctors are unwilling to come to this area. Public health centres (PHCs) too lack workforce. Only where anganwadi workers are sincere do they make efforts to prepare the food properly,” he says. 

While the district reels under staff crunch, there are many who are working on temporary basis. A total of 791 medical officers have been working on temporary rolls in tribal regions of the state for the past 12 years, claims Shramjeevi Sanghatana. A bachelor of ayurvedic medicine and surgery (BAMS) medical officer in the belt, who has been serving on the same post for last nine years without promotion or transfer, says on condition of anonymity that salaries are low and not given on time in government hospitals, apart from the long working hours. There is only one doctor at Mokhada rural hospital and medical officers have no executive powers, say health activists.

In 2013, the Maharashtra Association of Gazetted Medical Officers (MAGMO) had gone on a strike as the then chief minister Prithviraj Chavan assured them permanent jobs but things remained the same even three years later. “The government is saying there are no vacant posts, then on which posts are we working?” asks the BAMS medical officer.

* * *

According to Shramjeevi Sanghatana, in the last five years employment in the state has come down by 20 percent. “Setting up of industries in tribal areas, computerisation and internet connectivity could generate employment for these locals and slowly bring about a social change,” says Pandit. He adds that work can also be created through schemes like MGNREGS, EGS. Departments of forest, public works, agriculture, and gram panchayat can also chip in to help the unemployed youth. “People can be given work such as planting of seeds, tree saplings, conserving soil and water, laying of roads, etc. to ensure minimum wages,” says Pandit.

As for the measures taken by the administration, district collector Bhangar says, “Every year more than Rs 80 crore under Thakkar Bapa scheme is being spent on infrastructure and more than 90 percent of this money is used on roads.” Talking about the development work and employment opportunities, Bhangar says, “We are coming up with a garment apparel park in Dahanu as the land is owned by the government. Non-polluting industries can be set up here as this is an eco-sensitive zone. Labour can be provided from tribal areas. A memorandum of understanding for skills development has been signed with a few industries and training is going on in batches. A batch of 176 candidates has been guaranteed placement, and a new batch of 3,000 will start on October 10. At our recent skill development camp held at Jawhar, Vada and Boisar, 9,000 school dropouts, educated and unemployed youth came for registration.” 

The doctor working in Vikramgad taluka says there is a need to create awareness on consumption of locally grown food. “Tribals are primarily dependent on forests for all their needs,” he says, adding that with gradual deforestation, they are neither fully here nor there.
Bhangar agrees that though agriculture is a major activity, people of Palghar have not gained much from it. “About 1,10,000 hectares of area is under kharif [monsoon crop] cultivation while that under rabi [winter crop] is less than 10,000 hectares. So, less than 10 percent area is cultivated for the second time during the year. For that reason double or multiple cropping does not happen. During kharif season, people go only for paddy and ragi and these two do not fetch adequate money to them. After the season ends, they have no option but to migrate. So far we have no record on where they migrate but we are trying to address this problem. Half the battle will be won if migration stops and for that availability of employment at the local level is very important.”

He adds, “We have built 334 farm ponds by May which are now full of water. We are now converging farmers with schemes like the tribal sub-plan under the agriculture department where seeds and fertilisers will be provided to them for cultivating vegetables or jasmine flowers in Jawhar, Mokhada, Vikramgad, Vada and pockets of Dahanu and Talasari. For next year we are planning 2,000 more farm ponds.”
But Pandit alleges that while the government sprouts several schemes, they often get tarnished by corruption. In the EGS, he says that though the public works department generates employment but it usually leans towards contractors. “Funds under the Thakkar Bapa scheme provided at the gram panchayat level are transferred to irrigation projects,” says Pandit.

He adds that schemes like MGNREGS, where one member of a family is entitled to 100 work-days a year, are non-productive. “In Maharashtra, people get only 40-45 work-days and that too irregularly. While MGNREGA calls for online transactions and registrations of workers, required infrastructure and staff is not available. People are not correctly registered and have no online records and therefore do not have job cards,” he says. According to data from the office of Palghar district collector, in 2015-16 a total of 16,54,305 man-days were created – up to two times man-days compared to the previous year – at the cost of Rs 29.26 crore. In 2014-15, 7,64,071 man-days were created at the cost of '13.55 crore and in 2016 (till September), 7,04,593 man-days had been created with the expenditure of Rs 13.86 crore.
Last month, Shramjeevi Sanghatana wrote a letter to Maharashtra governor C Vidyasagar Rao highlighting the plight of the tribals and the district. The letter stated that a total of 42,693 claims were lodged under the Forest Rights Act in Palghar district. Taking advantage of the illiteracy of the tribals it was shown that as many as 19,711 claims were rejected by the gram sabha, the NGO alleged. At the sub-divisional officer level, a total of 18,226 claims had been sanctioned and 3,218 claims were rejected. At the district level, a total of 17,598 individual claims were sanctioned and 638 were kept pending in 2015-16. Unjust means were adopted while rejecting claims, the organisation says. To this, Bhangar counters, “So far, as of August 2016, 31,172 claims have been approved. Thus, more than 30,000 individual plots were allocated under the Forest Rights Act and names were recorded.

Out of these, more than 25,000 plots have been measured. In terms of community plots, as compared to 1-2 acre plots (till 2014-15) for a community the average area has now gone up to more than 150 acres. More than 350 community claims in Palghar have been sanctioned so far.”

Bhangar adds, “The government is now setting up satellite communication where telephone towers do not exist. In a CSR project along with IIT-Bombay we are implementing wireless internet connectivity in 30 villages of Jawhar, Mokhada, Vikramgad and Vada. The departments of health and women and child development are doing marvellous work at these places. Despite many adversaries, absence of a significant change does not mean that these departments are not doing their jobs properly. Yet, a fallout of media reports is that the machinery is getting demotivated.” 

But Pandit laments, “While there is no dearth of funds, even after 70 years of independence there is no political will. While earlier at least a five-year plan existed on paper, now there is none and we are working on ad-hocism. Wealth creation and not poverty eradication is our priority now.”

geetanjali@governancenow.com

(The story appears in the October 16-31, 2016 issue)

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