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=Healthcare=
[http://www.thehindu.com/opinion/op-ed/prafulla-das-on-the-lost-tribe-of-odisha-due-to-acute-malnutritionrelated-diseases/article8949433.ece ''The Hindu''], August 6, 2016

Prafulla Das

''' ''The lost tribe of Odisha'' '''

'''Nineteen Juang tribal children dies during May-August 2016, due to acute malnutrition-related diseases in inaccessible hamlets atop the Nagada hills, in Odisha’s Jajpur district. A public outcry has forced the State government to finally sit up and take notice, finds Prafulla Das'''

==Administrative mechanisms==

There is one permanent Anganwadi in the foothills of Nagada, under the charge of Satyabhama Dehuri. Her job is confined to supplying packets of nutritional chhatua, a mix of Bengal gram, wheat, peanut and sugar, to the villagers whenever they come down. The Anganwadi worker is not only required to weigh children but also administer nutritional food to them and ideally should have been located at the top of the Nagada hills.

Deaths on account of malnutrition are not an admission health officials like to make on record. The exact reasons for the young children’s deaths will never be known as the parents quickly buried their little ones. The two deaths registered in the Tata Steel hospital have been put down to “malaria and protein-energy malnutrition”, says Chief District Medical Officer of Jajpur Phanindra Kumar Panigrahi.

The government responded by setting a field-level task force and a State-level monitoring committee to keep a close watch.

Although officials remain tight-lipped about the prevalence of acute malnutrition among children under five years of age, an official survey by the State Women and Child Development Department found that 44 children in the age group of six months to five years were suffering from malnutrition in the seven hamlets atop the hills, and nine more such children had been identified in Ashokjhar, another Juang hamlet situated in the foothills. As many as 24 of these 53 children are suffering from severe acute malnutrition (SAM) and the remaining are suffering from moderate acute malnutrition (MAM). The SAM and MAM status of children are known by measurement of upper arm muscles along with body weight. These undernourished children are now being provided nutritious food and treatment at their homes by the doctors camping there and being monitored.

==A history of tribal neglect==

Odisha has 62 tribes, the highest number among all States and Union Territories in the country, accounting for 22.85 per cent of the total population as per 2011 census. As many as 13 of these tribes have been identified as Particularly Vulnerable Tribal Groups (PVTGs), living in over 500 habitations of the State but mostly in hamlets inside the forested hills across Odisha. The Juang tribe is one of the PVTGs that belong to the Munda ethnic group and live in Keonjhar, Dhenkanal, Angul and Jajpur districts of Odisha and speak the Juang language, which is accepted as a branch of the greater Austroasiatic language family. Those who come down the hills at regular intervals have picked up Odia.

It was to bring the Juangs into the mainstream that the Juang Development Agency (JDA) was established in 1975, with its headquarters in Gonasika Hills in Keonjhar district. Even after four decades have elapsed, the agency has not been able to go beyond the Juangs of Keonjhar, operating in 35 villages in six gram panchayats of Banspal block of Keonjhar. In fact, around 20 more villages in that block are yet to be covered. Many other Juang-dominated villages in Harichandanpur block of Keonjhar, Kankadahad block of Dhenkanal have remained outside the purview of the JDA all these decades. As do the hamlets on the Nagada hills. They are inaccessible by road — there is only one way to get there, and that is by foot.

The tragedy at Nagada involving the Juang tribe exposes the government’s apathy towards the PVTGs, but this is not for the first time that malnutrition-related deaths have stalked the tribal children. In 2013, several malnourished Paudi Bhuyan tribal children had allegedly died of diseases caused by acute malnutrition in Lahunipara block of Sundargarh district, over 200 km away from Nagada. Though the exact number of deaths is not available in the official records, a food rights activist claims that about 15 deaths were reported from different villages in Lahunipara. Many deaths of undernourished children in hilltop tribal hamlets in the interiors go unreported as they remain inaccessible. Following media reports about acute malnutrition among Paudi Bhuyan children, the State Women and Child Development Department, in consultation with Scheduled Caste and Scheduled Tribes, health and family welfare, rural development and panchayati raj departments, had prepared a guideline for a convergent health and nutrition plan to address the health and nutritional needs of PVTGs in the State. An official survey that time detected that as many as 195 children belonging to Paudi Bhuyan tribe were suffering from severe malnutrition in Lahunipara.

==Infrastructure, neglected==
'''Last-mile connectivity issues'''

The Nagada deaths raise questions on the efficiency of plans and schemes launched for the welfare of tribals living in inaccessible areas, including the Nutrition Operational Plan that was drawn up in 2009 to accelerate the pace of underweight reduction in Odisha. About 38 per cent of children in the State are stunted, its prevalence highest at about 46 per cent among tribal children.

As nutrition needs of the PVTGs remain unaddressed with the failure to ensure road connectivity to their habitations, the government has also failed to bring them under the ambit of the National Food Security Act. Though ration cards had been issued to a majority of these tribals, Antyodaya Anna Yojana (AAY) cards elude many of them despite a standing order of the Supreme Court that “ that all households belonging to six priority groups, one of them PVTGs, would be entitled to AAY cards”.

“It is not geographical isolation alone, but exclusion of the tribals from many government programmes that has made hundreds of children suffer from acute undernourishment in Odisha. A coordinated approach by different government departments is the need of the hour to bring all PVTGs living atop forested hills in the State under the welfare programmes,” says Rajkishor Mishra, State Adviser to the Commissioners of the Supreme Court.

It has taken 19 deaths for officials to now admit that the Juang people in the hamlets atop Nagada hills — Tala Nagada, Majhi Nagada, Upara Nagada, Tumuni, Naliadaba, Guhiasala and Taladiha — were deprived of basic facilities such as drinking water, primary health care, electricity, and primary education available under various Central and State schemes due to lack of road connectivity. There is not a single well in these hamlets and they depend on forest streams for water throughout the year.

Tala Nagada hamlet, the biggest of the seven hamlets with a population of 162, alone reported as many as 15 child deaths. Many residents in these hamlets do not have even voter IDs and job cards under the Mahatma Gandhi National Rural Employment Guarantee Scheme. None of the families have been given land rights under the Forest Rights Act.

The able men and women of these hamlets climb down the hills and walk down 20 km at least once a month to buy ration rice from the gram panchayat office at Chingudipal or anything from the weekly haat (market) near Kaliapani. Rice and salt is their staple. Since the quantum of ration rice is never sufficient for their families, they eat boiled wild tuber that they collect from the forest as dinner.

The only initiative to provide informal education to children had begun in Nagada in November last year when Aspire, a non-governmental organisation, started a non-residential bridge course for 100 children, with financial support from Tata Steel Rural Development Society.

CSR funds from the mining companies operating in nearby areas in the district since long, however, had not been utilised for the benefit of people of Nagada who live just few miles away. Some of these companies are supporting the Aahar outlets being run by the State government in district headquarters, towns and cities.

The last time a block development officer (BDO) of Sukinda visited Nagada to convince the tribals to leave the hills to be rehabilitated on the plains was in 2013, says Dharmendra Kumar Sahoo, the local gram panchayat extension officer camping at Nagada. Mr. Sahoo, who claims that he accompanied the then BDO that time, says that the residents were in no mood to leave their habitat.

==Future prospects==

'''On the road to hope'''

After Odisha Women and Child Development Minister Usha Devi’s comment that the Juangs lack awareness attracted criticism from the public and the Opposition, the State administration is working overtime to build roads to Nagada using Integrated Action Plan funds by involving the Forest and Rural Development departments. Senior bureaucrats are drawing up plans to build roads from the Jajpur as well as Dhenkanal sides.

In the meanwhile, officers and employees of almost all departments of the government have reached Nagada by climbing with great difficulty. Efforts are on to provide health care and sanitation facilities, and supply free food to children at four newly-set-up mini Anganwadis. Officials have even created two WhatsApp groups among themselves to monitor the delivery of services at Nagada on a regular basis.

Further, an initiative has been taken to identify all inaccessible tribal hamlets across the State by assimilating information being collected from the district administrations and using remote sensing data from Odisha Space Applications Centre.

Virtually admitting to the lapses on the part of his government after opposition parties sharpened their attack and sought Governor S.C. Jamir’s intervention in the matter, Chief Minister Naveen Patnaik has assured that such tragic incidents would not recur in future. That responsibility has been entrusted with Development Commissioner R. Balakrishnan, who first visited the Nagada hills as Sub-Collector of the then Jajpur subdivision way back in November 1986. As a young officer then, Balakrishnan had walked up the hills and distributed clothes to the Juang tribals. The situation has not changed even today. “The crux of the matter is connectivity. The topography poses a big challenge. But efforts are being made on a war footing to overcome the difficulties and ensure service delivery,” he says.