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The verdant forested hills hide a forlorn story. They are home to some of the mostisolated people in the country, including the Korku Adivasis. This region, comprisingChikhaldhara and Dharni talukas, has seen the death of 400 to 500 children elo! si"years of age, every year consistently in spite of eing in the ne!s. Accompanied y the #on $inister of %tate for #ealth, &fficers from the 'ocal

 Administration, $edical ("perts, )*&s and a team form +ash!antrao Chavanratishthan, $umai, !e visited $elghat on 04--/0 to study the reasons for thisdismal statistic of /005.

During our visit to these small hamlets scattered across hundreds of miles, the samerecurring stories came to e narrated

A dismal lack of infrastructure is the common thread running through this myriad ofmaladies. Due to lack of proper and motorale roads and very poor fre1uency in factnear asence, of pulic transport, it ecomes difficult for these residents to commuteand communicate regarding the daily and asic necessities of life. 2t is not possilefor parents to take the sick children to a ulic #ealth Center, or for a pregnant

!oman in laour !ith complications to get a speciali3ed medical unit !ith facilities intime.

/ e sa! a plea for etter (ducation at pre primary and primary levels ystrengthening the Angan!adis6 and rimary school in close vicinity of the villages

7 2mmediate appointment of doctors for the posts those are vacant for long. They needappropriate gynecologists8ostetricians and pediatricians. A large numer of maternaldeaths occur due to lack of Trained &stetricians. %imilarly, )eonatal, 2nfant and9nder-:ive deaths related to complications from malnutrition need to e prevented yhaving regular trained ediatricians. Changes in the post graduate admissionprocedures, non application of %i"th pay Commission recommendations and patheticasic living facilities have forced a large numer of doctors to shun this region.

4 There !as a demand to have effective implementation of the ($'+$()T*9A;A)T(( %C#($( 6 in the region, and continuation of the );(*A6 ? )ational ;ural (mployment *uarantee Act, to maintain the economic!ell-eing of the villagers.

5 Due to implementation of The :orest Act, people complained aout the authorities ofthe :orest Department !ho do not allo! them to use certain roads after eveninghours !hich hinders them !hile going for laor !ork and returning home after !ork.

@ A serious and detailed discussion over estalishing the Community ;ights over forestrather than 2ndividual ;ights is important to restore a sense ofresponsiility in people over safeguarding the environment and using the same

sensily rather than e"ploiting it for individual enefit.The day-long delieration !ith the accompanying memers of )*&s !as veryinsightful.%ome of the key issues raised y the )*&s !ere as follo!s> ith respect to Administrative issues, it appears that the Administration in $elghat

a Does not sho! consistency in e"ecution of programs and schemes, in the area ofhealth, education and infrastructure.

The authorities lack %tandard &perating rocedures.c Administration and $anagement is not system driven ut rather individual authority centric.d Administrative Appointments in $elghat are taken as punishment postings and that leads to lack of motivation to do sustantial and

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1uality !ork. A case in point is the one illustrated y )*& representatives ? $r.raveensingh ardesh !ho took keen interest and rought aout remarkaletransformation in the situation, ut unfortunately his successors did not sustain theimprovement, in fact it has further deteriorated./> 2mplementation of achat *ats are in fact leading to a divide !ithin the rural female

population causing them to form smaller groups. This threatens the oBectives to keepthe population united.7> (ffective implementation of );(*A, as it !ill e financially eneficial for the localpopulation and help reduce the rate of migration, !hich is one of the causes ofconsistently high mortality due to malnutrition and maternal deaths.During our visit !e sa! fe! moderately acute malnourished children and oneseverely acute malnourished child .&n intervie!ing their mothers it sho!ed that they need to go to the farms for theirlivelihood aandoning their children, sometimes as early as a month after delivery.They lacked counseling from a properly trained person from rimary #ealth 9nite to guide them aout reast feeding and !eaning, nutrition and care of children

!ith malnutrition and follo!-up of those cases till recovery.&n visiting a school in a village of $elghat, it !as shocking to note the poorconditions for storage of food grains and poor attendance, including the teacher. &nthe other hand in the same premises, the cooked food !as readyto serve aout 00 to /5 children, pregnant !omen and lactating !omen. e tastedthis and found it satisfactory and pretty hygienic. 2n fact the remarkale cleanliness inthe kitchens and houses of the villagers had us completely impressed.&n a surprise visit to an Adivasi school in a remote hamlet called ;eta Kheda6, !efound the condition of the road to e e"tremely poor and it took us 50 minutes tocover a distance of @ km. The school had attendance of fe! students ut the teacher!as asent The local people seemed reluctant to divulge details.&n interaction !ith the *overnment Authorities like roBect &fficers District &fficers,it revealed that they have not started the !ork of (*%- ;o3gar #aami +oBana6 utassured us that they !ould start the !ork as soon as possile.The Doctors seemed to e doing their est amidst all these difficulties. A ediatrician!ho has een !orking there for one year !as !orried, as he has not received anyletter of continuation.2n the past, 1ualified $% doctors used to come and !ork in $elghat as they had anassurance of ost *raduation opportunity aftercompleting their tenure in this region. )o!, as the government has stopped thisprogram, so the $% doctors have no motivation in !orking in the $elghat region.

 After visiting these remote villages in $elghat and having a heart to heart interaction!ith the local Adivasi community, )*& representatives, #ealth and other Administrative &fficers, !e !ould like to put the follo!ing suggestions to reducemalnutrition and malnutrition related deaths• Health and Malnutrition: - A. %ystematic lanning , training of stakeholders and 2mplementation ofthe *overnment %chemes and proBects.. There should e trained people to reach and track every Adivasihouse for the follo!ing

a $aintaining the #ealth card of each family. $onitoring concerns related to health !ith special attention to adolescent girls,

pregnant !omen, lactating mothers and children up to the age of 5 years.c  Arogya Doot  needs to give scientific advice and training on simple household food

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made !ith local produce !ith due demonstrations.d  Arogya Doot  to supervise the effective implementation of providing and consuming

packets of Take #ome ;ation under oservation for children !ith %A$. T#;are micro nutrient food packets, !hich has to e ready to use mi" nutrient made asper the guidelines of the orld #ealth &rgani3ation .

e The monitoring of the same has to be done every day with every child; this is Bust like giving D&T treatment in case of Tuerculosis that has een proved to e veryeffective in treating Tuerculosis.

• Administrative:- A. There is a need to facilitate a common and regular dialogue et!een senioradministrative officers, roBect officers ? #ealth, (ducation, and the :orestDepartment together to formulate a strong government policy !ith

a %hort term lanning $idterm lanning

c 'ong term lanningto ring aout a systematic and sustained change in the conditions of $elghat Adivasis.To summarize here are some of the basic needs of the !eo!le in Melghat

a "ro!er #cientific Nutrition including Micronutrients$b "reventive Healthc Mother and %hild %ared &eactivating %om!rehensive 'ducation systeme Trans!ortation ( &oadsf Availability of !ermanent 'm!loyment )uarantee during the non-agricultural

season$Considering these facts, !e are of the opinion that the *overnment has to takeimmediate and effective steps to reach remote, interior regions. $alnutrition in$elghat has gone on for too longE ho!ever it is not an insurmountale arrier as ithas een made to appear. 2t is the sincere and considered opinion of all of us that!hat !e need is a concentrated, unified, systems ased operational approach !ith asingle or unified chain of command !ith accountaility. Considering the chronic natureof the prolem, !e recommend that this command directly report to the #onouraleChief $inister of $aharashtra.