THE architects of the Indian Constitution (1950) prescribed several affirmative actions for the protection, development and welfare of adivasis. Moreover, state and central acts, policies and programmes with similar objectives have also been in existence for almost six decades. Despite this, the never ending narrative of nutrition deprivation in adivasi children – from hunger induced deaths, poverty, and food insecurity to poor access to entitlements, basic civic services and self-employment opportunities – makes it clear that children have least benefited from these actions.

In 2005-06, 54% of India’s adivasi children under five were chronically undernourished (stunted – too short for their age). Studies carried out between 2006-13 in different states of rural India reveal that the percentage of stunted adivasi children remains stubbornly high at between 50% and 60%. Unsurprisingly, accessing basic civic amenities remains a challenge as evident from the 2011 Indian census. Less than 20% adivasi households have a safe drinking water source or a toilet facility on their premises. Forty seven per cent adivasis in rural areas still live below the poverty line, even by the minimalist nature of the poverty line definition. Why has the Indian government failed to translate affirmative action legislations, policies and programmes into positive nutrition outcomes for adivasi children? Is there a deficiency of nutrition actions for adivasi children in the first place? This essay examines affirmative nutrition actions – legislations, plans, policies, structures, government and non-government programmes – for adivasi children, identifies their pitfalls and suggests some ways forward.

The Indian Constitution protects the rights of adivasis to good nutrition, both directly and by addressing its determinants such as food, land and livelihood security through Articles 11, 21, 39, 46, 47, 243(d), 275(1), 330 to 342 and 366 (25). Article 244(1) of the Fifth Schedule guarantees special privileges to tribal dominated administrative blocks in nine states,¹ even though the adivasis may be a minority in that state. Article 244(2) of the Sixth Schedule protects the administrative autonomy of adivasis in the tribal majority states of Assam, Meghalaya, Tripura and Mizoram. Legislations such as Panchayats Extension to the Scheduled Areas Act (PESA) 1996, and Scheduled Tribes and Other Traditional Forest Dwellers Act, 2006 grant to adivasi communities the power to protect, manage and control sale of their land, forest and natural resources. The Land Acquisition Act, 2013 promises fair compensation for land taken by the state for development purposes. The excise policy 1975 prevents any commercial vending of liquor in an adivasi area and the draft Tribal Policy 2006 improves accountability to adivasis via a set of declarations, commitments and programming principles.

Nevertheless, land grabbing continues to take place – through market valorization and mercantilism of non-timber minor forest produce which keep the adivasi share of profits abysmally low. Fraudulent marriages, manipulation of transfer paperwork and blatant violation of safeguard mechanisms like informed consent before land acquisition, have now become the norm. Commercial vending of liquor in the adivasi areas persists in many states (in spite of being declared illegal). Ironically, it is the state as protector, which is the biggest violator. The fact that out of 76 strife affected districts in the country 32 are PESA districts, highlights poor legislative enforcement as one of the core reasons for fuelling mistrust and civil strife, which results in massive administrative logjams.

 

Finally, there has been a tendency to design nutrition schemes as reflecting state benevolence and patronage rather than as a right, thereby ignoring the core existentialist issues that affect all aspects of the adivasi existence, i.e. poverty, indebtedness and household food security and the trust between the state and its citizen for effective nutrition action.

Budgets are not a major constraint in nutrition programmes for adivasis. The chapters on ‘Social Sectors’, ‘Women’s Agency and Child Rights’ and ‘Health’ in the 12th five year plan 2012-17 flag special programmes with commensurate budgets to be in place to improve nutrition of adivasi children. Starting from the fifth five year plan (1974-75), a separate tribal sub-plan (TSP) within the umbrella of the overall state plan is drawn up providing need-based funds for welfare and development in tribal dominated administrative blocks. The annual budget for every state plan and for 28 central ministries has to apportion funds to TSP, which is at least equal to the proportion of the scheduled tribe population. The TSP funds are earmarked to be spent by sectoral departments in tribal dominated administrative blocks/project areas. The Ministry of Tribal Affairs under the special area programmes of Special Central Assistance (SCA) to TSP and Grant under Article 275 (1) of the Constitution also provides top-up funds to states under the TSP.

 

The problem is that most TSP items are focused on infrastructure with negligible attention to nutrition specific activities. Most state and central ministry plans do not even apportion funds for TSP as per the schedule tribe proportion. Importantly, even when it is done, the apportioning often lacks prioritization, purpose or even a system of tracking the allocation usage. In 2012-13, this proportion for the TSP was as low as 3.3% for Assam, 4.9% for Karnataka and 6.4% for Maharashtra. In the same year, in 17 out of 28 ministries, earmarked funds for TSP accounted for only 5.5% of plan funds.

In many states, instead of ensuring additional resources as top-up, the practice is to switch the state allocation with the central allocation, and hence keep the overall quantum of funds almost unchanged. Further, the TSP is drawn up on a naive assumption that spending money will automatically lead to the development of adivasis. Such a view ignores the structural constraints and violations that the government turns a blind eye, if not being a party to. As things stand, there is no publicly available data that allows one to reliably track budgetary allocation and expenditure on programmes for adivasis.

Is the Ministry of Tribal Affairs, the nodal ministry for adivasis, doing enough to improve the nutrition situation of adivasi children? Sadly not, since both its structures and coordinating bodies are not designed for the purpose and have thus remained untapped for serving nutrition concerns. In all fairness, while the primary responsibility for implementing nutrition programming for adivasis rests with the respective sectoral ministries, the Ministry of Tribal Affairs (MoTA) does have the mandate to coordinate inter-sectoral efforts for adivasis and financially supplement the efforts of sectoral ministries. Its 17 tribal research institutes can support training and research.

Further, its state tribal advisory councils, national and state commissions, and councils that focus on monitoring legislative safeguards can all play a role in monitoring nutrition safeguards. Unfortunately, not many of the constituted bodies have even met. For example, the National Council for Tribal Welfare has yet to be convened. The absence of a dedicated vertical cadre and a forum in which all sectoral ministries can periodically decide on coordinated action for adivasis is non-existent or under-prioritized.

 

There is a clear case for coordinated action between concerned ministries, given that chronic undernutrition in adivasi children is influenced by multiple factors: poverty, household food insecurity, maternal undernutrition before and during pregnancy, frequent infections or disease, poor care and feeding practices especially in the first two years of life, inadequate health services and unsafe water and sanitation. At least six ministries directly play a role in this – Tribal Affairs, Health and Family Welfare, Women and Child Development, Consumer Affairs, Food and Public Distribution, Rural Development and Drinking Water and Sanitation. Have these ministries and their respective state departments made a special effort to reach out to adivasis?

Partly yes, because all line ministries have flexible population norms for outreach services and staff recruitment in adivasi pockets in various nutrition, health, water, sanitation, food security and poverty alleviation schemes. Tested and creative solutions like mobile outreach, health services and free on-call referral transport services attempt to reach out to underserved adivasi areas and monetary and non-monetary incentives are provided to health personnel serving in remote tribal areas. Adivasi children are also to benefit from the National Food Security Act, 2013 (as also other poor populations) which legitimize food, feeding and maternity entitlements to approximately two thirds of India’s populace. Andhra Pradesh was the first state to legalize the system of earmarking funds by each line department for TSP through the Scheduled Castes Sub-Plan and Tribal Sub-Plan Act. The state’s Department of Health and Family Welfare was also one of the first to set up a separate state tribal programme management unit with adequate staffing.

 

Other states have also shown some initiative and introduced innovations that are worth adapting. Chhattisgarh not only ensures hot cooked meals and nutrition promotion for adivasi children though self-help groups, it has a programme for tag-tracking underweight adivasi children and following them through extra home visits. It also partners with non-government organizations to ensure service delivery in conflict areas. Maharashtra and Chhattisgarh have crèches for children between 6-36 months, and Maharashtra has a cash transfer provision for adivasi populations to help them avail primary health services. Andhra Pradesh and Odisha have worked towards social mobilization and community demand generation while Jharkhand has set up nutrition rehabilitation centres in hospitals set up by the tribal department. Andhra Pradesh also provides hot cooked noon meals to adivasi pregnant women through women collectives. Efforts have also been made in Maharashtra to improve inter-sectoral coordination and accountability for nutrition action with a focus on adivasis, through an autonomous State Nutrition Mission.

 

However, these efforts are marked by problems of scale and quality. Remote adivasi hamlets, with poor road and transport connectivity, makes outreach and field monitoring a challenge, and this worsens during the rains and in areas of civil strife. Shortage of skilled human resource, high staff turnover and absenteeism is a major problem in adivasi areas, particularly in zones of conflict. Assignments in adivasi areas are generally perceived as ‘punishment postings’. The fact that only one line ministry (Ministry of Health and Family Welfare) has a dedicated chapter for tribals in its annual plans, and annual reports of line ministries only mention the percentage of budgetary allocation to TSP without reference to any coverage, special schemes, allocations and expenditure for adivasis, makes it clear that differential affirmative programming for adivasis is not a common practice.

Most schemes targeting poor households assume that tribal concerns too are addressed, even if tangentially. Historically, however, the poor nutrition situation of adivasis grabs political, media and bureaucratic attention only when starvation and hunger deaths create public outrage and litigation by social activists. Thus, while it is well recognized and even accepted that efforts to prevent chronic undernutrition in children require a multi-sectoral approach, there is little progress on how best to implement such an integrated approach.

What about the contribution of non-government organizations (NGOs) to improving reach and coverage of nutrition services in adivasi domains? First, both the numbers and geographical coverage of such organizations working on nutrition issues of adivasis is limited, which reduces further in conflict zones. Nevertheless, the few NGOs reviewed (see Table) show that many have set up secondary level hospitals, outreach health service outposts, and free referral transport in remote forested pockets. In partnership with government, they also run anganwadis, nutrition rehabilitation centres for treatment of children with acute malnutrition, and primary health centres, often in the remotest of locations. To respond to food insecurity and livelihood concerns among the tribal poor, many NGOs have organized communities into thrift and credit self-help groups and linked them with livelihood options and community grain banks.

 

A few organizations have started crèches, as most adivasi women work for long hours outside the home. Tapping key influencers, traditional headmen and the panchayat leaders to both generate demand for and increase participation so as to improve access to services, is an integral component of NGO programmes. There is a focus on training and working with community workers, federations/cooperatives and to organize home visits and group meetings, so as to stimulate communities to identify problems and craft and implement their own solutions. While this can improve maternal and child health outcomes, the problem remains that the linkage with the government block and district machinery to bridge the community-service provider gap or planning gap remains weak.

Distance from facilities and opportunity cost of lost wages, cost of travel time to the facility and medicines are some of the main reasons why a reliance on traditional medicine and spiritual healers remains high and delayed care-seeking a norm. The programmes for creating an awareness of facilities and services the adivasis are entitled to are usually in the local official state language. This is a severe handicap given that each tribe has a language of its own. Moreover, many groups are not literate and unfortunately nor is the literature visually attractive. Finally, since child stunting is not viewed as an abnormality, raising awareness among adivasis to address it is not easy.

 

While some work has been done to enhance awareness of adivasis about their entitlements, their inherent shyness, language barriers and an absence of collective voice implies that these never reach a critical level to create positive pressure on the government. The federations working for tribals, unlike for other social groups, have rarely been strong. Most efforts in tribal areas are led by non-tribal leaders, signalling an absence of tribal leadership. Many adivasi thinkers feel that schemes, programmes and forums where SCs and STs are represented together unintentionally favour scheduled castes, given their greater numbers and superior organization.

Another big problem is the absence of nutrition data regarding tribals. The National Nutrition Monitoring Bureau (NNMB) reports on tribal population provide information on select nutrition indicators for only nine states. Evidence on the nutrition of STs is available only at the aggregated level, failing to account for the diversity among ST groups, Schedule V and Schedule VI states and ST blocks. Also, a lack of governance and other failures of implementation and delivery, both in quantity and quality, are significant even across flagship programmes. Though difficult, it is nevertheless essential to distinguish the effects of various factors that negatively influence service delivery in adivasi areas. Monitoring and evaluation systems are not designed to provide data disaggregated by tribal blocks so as to assess the real and effective delivery of inputs as well as their quality.

 

Sufficient evidence exists to show that the best window of opportunity to prevent chronic undernutrition in children, including adivasi children, is the period from conception to the first two years of life. The damage caused in this period is largely irreversible. Unfortunately, the child feeding and care practices, particularly after the child turns six months of age, are abysmally poor. A 2013 Unicef study in rural areas of the top eleven tribal populated states shows that the proportion of chronically undernourished adivasi children increased with increasing age – one-fourth in the age group 0-5 months, which doubled in 6-11 months period and at 18 months, 75% adivasi children were already chronically undernourished. With only 2% adivasi children between 6-11 months fed complementary foods in recommended quality and frequency, such levels of undernutrition should not trigger surprise. But the fact that this is considered the norm should cause outrage!

The study also revealed that if the mother herself was chronically stunted, the likelihood that the child being chronically undernourished increased twofold. The reasons for high maternal undernutrition in adivasis were obvious – 68% mothers under 20 years and 48% mothers overall were themselves undernourished, inter-pregnancy intervals were narrow and birth orders ranged from 1-12. We need to remember three things – first, 50% of the growth failure that accrues by two years of age actually occurs in the womb; second, foetal stunting is largely because of problems in the first trimester and pre-pregnancy; and third, pre-pregnancy weight and weight gain during pregnancy have independent and additive effects on foetal stunting. This compounds the problem for India since the focus of nutrition interventions for Indian children have largely been interventions after birth. Clearly, we are missing the critical time period in which stunting takes place.

 

So what needs to be done? First, improving the ‘nutrition of adivasis’ should become a priority to stir policy dialogue and enhance coordinated action for nutrition. A designated officer for tribals in line ministries will help inter-department communication and mandated line ministries should have a separate chapter for tribals in their annual plans. Instituting vigilance mechanisms and encouraging public scrutiny of plans and expenditures will add seriousness to this effort. Activating the dormant tribal council and/or formation of a tribal nutrition task force within existing task forces will help bring together all stakeholders (including the media), cross-fertilization of ideas including replication-worthy practices, especially for linking poverty alleviation with nutrition programming and focusing on the critical time periods.

Second, scope for experimentation, contractual staff, hardship allowances, partnerships, rotational postings in adivasi locales with dual professional credits and flexi pools should be an inherent part of adivasi programming. The host of innovations being undertaken in states demonstrates that with political and bureaucratic will, differential programming for adivasis is possible. However, the publicity material should be both visually attractive, as also respect and tap into local culture and beliefs. Care should be taken that all this is communicated through community leaders, particular traditional healers as they have a better chance of influencing change.

 

Third, civil society and faith-based organizations with established grassroots presence and credibility can expand outreach, generate community demand and create a cadre of trained foot soldiers to reach out to mothers with timely information, counselling and support on a periodic basis, including in inaccessible hilly and rugged terrain. There is a need for creating platforms to simplify the process of applying for funds, and make it more transparent. Better incentives should be given to encourage more NGOs to work in adivasi areas.

 

Fourth, countrywide tribal nutrition data is needed and this requires expanding the geographic scope of NNMB. Monitoring of few actionable indicators can provide real time data on inputs vs. outcomes. Undoubtedly, the need for evaluating what works and why in adivasi settings and initiating work on inter-sectorality of action for adivasis is an absolute must.

Last but not the least, nearly all promising state innovations with visible impact have a core component of formal engagement with adivasi women communities in a rights based framework. Investing in strengthening the leadership of adivasi women networks over a staggered period to support service delivery, voicing their needs for behaviour promotion and vigilance is thus critical.

 

To conclude, the unending saga of nutrition deprivation amongst adivasis must end. This calls for a rethinking on differential programming strategies, budget and government accountability mechanisms and new rules, new optics and new frameworks need to be co-designed where adivasis communities are not just informants, but partners and influencers of change.

1. Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Himachal Pradesh, Madhya Pradesh, Maharashtra, Odisha and Rajasthan.