Nissy Solomon was a part of the group that visited Melghat, Maharashtra in the month of October, 2017 to work with KHOJ in pursuance of the field work component of the Master of Public Policy programme. She highlights the issue of malnutrition and its impact in the region based on her interactions with the local community and other stakeholders.
In the southern offshoot of Satpura hills, nestled amidst forested mountains is situated the region of Melghat. While it is known for its pristine mountains, it has also been infamous for a high number of deaths due to malnutrition. The severity of it has been under the scanner since 1993, following a Public Interest Litigation filed by activist Sheela Barse in the Bombay High Court. Despite steps undertaken by the government and initiatives by voluntary organisations, the problem of malnutrition continues to persist.
The sustainable development goals that aim to end poverty by 2030 highlight the element of nutrition being central to holistic development. Concerns of nutrition arise not just from sufficient dietary intake but from a host of interconnected processes like education, health care, employment, sanitation, connectivity, and more. In other words, there exists a complex interplay of factors which is poorly understood. In the context of Melghat, a detailed study exhibits that malnutrition is multifaceted and it is both a cause and an outcome of other problems plaguing the region.
According to official government figures, child mortality in two blocks of Melghat – Chikhaldara and Dharni – was 206 in 2016 and maternal mortality was 7 in the year 2016 which shot up to 15 in 2017. On an average, every year 400-500 children between age 0-6 die in this region. The reasons are multi-causal and intricately connected. Eighty-four per cent of women in this region suffer from anaemia, the cause of which is nutritional deficiency. Lower haemoglobin weakens women’s ability to survive child birth. Surviving a high risk pregnancy causes greater risk to child’s health.
Maternal mortality and child deaths due to malnutrition are a result of systemic failures. Factors like limited Public Health Centres (PHCs), dearth of paediatricians and gynaecologists, high unemployment, poor infrastructure and connectivity, reliance on traditional medicines, and lack of awareness among the tribal population contribute to this failure. For instance, at Chunkadi village, a remote village in Chikhaldara, there was no PHC functioning. Absenteeism of medical practitioners is common to most villages in Melghat. Complicated cases do not get due attention as a result of which maternal and child health deteriorates. This appalling situation is representative of what confronts the region.
In response to the humanitarian crisis in Melghat, many civil society organisations emerged to maintain and build strong capacities aimed at assuaging the plight of the people. Advocate Bandu Sane, director of one such organisation KHOJ, asserts that there has been a long term presence of government and civil society organisations, each working in their own capacity to improve and mobilise resources for action. However, lack of coordination among the institutional actors has been impeding the desired progress in the region.
When considerable attention was drawn to this region, the state government appointed committees and initiated schemes to fight the issue of malnutrition. Several non-governmental organisations (NGOs) were set up, each with their strategies for the region’s development. Currently, there are over 300 registered NGOs operational in 320 villages. Despite their presence, the problem of malnutrition continues to grip Melghat. This is reflective of a lack of synthesis among the institutional actors.
Understanding the importance of collaborative efforts, KHOJ organised a convergence workshop on October 28, 2017 where prominent stakeholders took part to collectively envision a better future for the tribal population in Melghat.
Given the interrelationships among the range of causal factors underlying malnutrition, efforts to address these problems from individual capacities have resulted in limited success. In order to achieve these strategies of development, a coordinated action that encourages dialogue among institutional actors is imperative to avoid policy discrepancies. Part of the solution in managing complex problems includes successfully partnering across permeable boundaries and engaging citizens and stakeholders in policy making.
At a point when considerable effort has been invested in this area, the time has come to examine whether convergence could be an effective means of governance, since the future demands a collective rethinking of common issues.
(Nissy Solomon is a 2017-19 participant of the Master Public Policy programme at National Law School of India University. She can be reached at nissysolomon@nls.ac.in)