Children in Madhya Pradesh

Survival Challenged Again

A fact finding report on Deaths of Children caused by Malnutrition

and aligned Diseases
(Village-Nahargarha, District-Shivpuri, Madhya Pradesh, India)

October 2010

Right to Food Campaign Madhya Pradesh Support Group

E-7/226, Ist Floor, Opp. Dhanvantri Complex, Arera Colony, Shahpura, Bhopal
mprighttofood@gmail.com
 Sections

1. Background
2. Registered Verbal Autopsies of Malnourished children
3. Case Studies of SAM Children admitted in NRCs
4. Annotations

5. Plight of Health Systems of Nahargarha village

6. Health Examination and Analysis

7. Plight of essential state services

8. Summary
9. Recommendations
10. Affidavits
11. Press Clippings

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 1. Background
It is the high time when India which was shining in economic growth, improved its record in
areas like literacy rate, declining maternal and infant mortality rate etc. Malnutrition
comprises of both protein energy malnutrition and micronutrient malnutrition, accounts
for children mortality. It is well established fact accepted by the govt., policy and
programme managers at national, state, district and blocks level. Malnutrition is commonly
seen in children aged between 6 months to 2 yrs.

NHFS III data (2007) shows that in less than 3 yrs age group 40% of Indian children were
underweight, of these 23 % are wasted and 45% were stunted. This means every second child
is undernourished. Protein energy malnutrition (PEM) accounts for death in 7 % of cases.

NHFS III also reports 60% underweight children in Madhya Pradesh out of these 33% were
wasted and 40% were stunted which is higher than National average. Prevalence of
underweight in MP as per NHFS data is less than 50%, underweight children is 60.3%, were
urban is 52.8% and Rural is 63.6 %. Prevalence of poverty In Madhya Pradesh (BPL families)
was 37.4%. As per Tendulkar committee estimates, poverty in Madhya Pradesh is 48.6%.

Table No 1: Showing Malnutrition status of children

in Gwalior-Chambal Division
Sr. Name of District No. of Malnourished
No children
1 Shivpuri 9500
2 Sheopur 206397
3 Morena 130045
5 Datia 66402
6 Bhind 9450

Shivpuri is a district which is mainly predominates by Sahariya Tribe. Sahariyas or the tribals
who call themselves Sehera or Sair, it is claimed are the first of all tribes in the country. For
generations they depended on the forest for survival, living a subsistence life with limited
needs. Agriculture, gathering forest products and hunting is their traditional means of
earning a livelihood. Life has not been easy for the Sahariyas after their eviction from the
forests.

Sahariya Children are the worst affected due to poverty, lack of livelihood resources and
indifferent government policy. According to the regional medical research centre for tribals
in Jabalpur, the Infant Mortality Rate of Sahariya is 88 (per 1000 lives births) and 93.5 percent
of Sahariya children are severely malnourished. According to the same sources the average
life span of a Sahariya is only 45 years, 74.3 percent of Sahariya children are underweight and
75.4 percent stunted. Nearly 86.5% Sahariya are anaemic because of non-availability of any

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proper and nutritious food. These indicators show that Sahariyas are one of the poorest and
most deprived communities in the entire country.

Table No 2: Showing malnutrition status of children in Shivpuri District

Sr Name of village Registered Mild Severe
No. children malnutrition malnutrition
1 Shivpuri city 14067 4527 383
2 Khaniadhana 27950 9823 1296
3 Pohri 28617 9404 1383
4 Karara 17888 5745 676
5 Kolaras 18828 6407 1382
6 Pichoor 26735 11267 1250
7 Narwar 2418 6871 544
8 Badarwas 25965 6683 1210
9 Shivpuri rural 21622 5675 1326

Situation is really grave in the Shivpuri, in every village of the district, malnutrition is
predominant underlying recent survey data done by Women and Child Development
Department, Shivpuri tells the story.

In Shivpuri District malnutrition amounts to 41.9 % of total children population, and severe
acute malnutrition (SAM) is 20.7%. Nutritional status of children is worse in Shivpuri and
kolaras sector. 65% malnutrition means nearly 76000 malnourished children and 9000
severely acute malnutrition children in the Shivpuri district. This status is being seen in a
district which has intensive programs for women and child survival, where all health
professional, health worker (ANM) and ICDS Anganwadi workers have completed their
IMNCI training to handle malnutrition and child mortality challenges almost 2 year before.

In these situations, deaths of 3 children because of malnutrition in the Nahargarha village in

shivpuri district really put a question to policy makers and govt. officials. It was time to
understand that the grounds of malnutrition were beyond Hunger and poverty.

In Nahargarha village of Toda in Shivpuri district, death of Parianth s/o Ramlal age 6yrs
male, Gudia d/o of Kailash age 3 yrs female and kallu s/o Puran Adivasi age 3yrs male were
reported by media but name of sunny deol s/o of kasha ram 2months/male was missed in
the same village. Many of such deaths in the district were also not reported.

Issues of acute malnutrition death of children in rural villages have always been raised by
media personnel.

This news alerted the local administration and health department. As a one time activity they
acted swiftly and camped for a day in the village to manage present situation by identifying
other five children of severely acute malnutrition (SAM). Malti 5 yrs female, Pradeep 7 yrs
male, Pawan 8yrs male and Ashiq 3 yrs male. These children were referred to NRC Pohari.
Other identified children were given counseling and symptomatic treatment. As a cover up
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collector announced suspension of Anganwadi Worker and endorsed by project officer ICDS,
Pohari wide order no sno/ICDS/Est/2010/533 Pohari dt 7/10/10.

In population of 200 Saharia tribal families 10 SAM children and 5 deaths were reported in
Nehargarha village. There were 9450 SAM children in district and other 66402 were in their
way to become SAM, as they were underweight. The number of underweight and
malnutrition is increasing day by day. Question is who holds the responsibility?

1. Poverty which causes hunger starvation result in malnutrition but study shows that
person from higher socioeconomic background also suffers from malnutrition.

2. Lack of political commitment

3. Caste based hierarchal structure

4. Administration, Health, ICDS and other associated department but they lack co-
ordination and are very slow to respond and with a denial attitude.

5. Public Health Services where utilization is poor by common people

6. Women and Child Development Department where Anganwadi Workers dont care
for low caste communities. Lack of coordination with ANM suffers immunization and
ANC care services.

7. Illiterate mothers were ignorant about child feeding and care practices

8. Safe drinking water and sanitation of villages

9. Status of women in community.

10. Local Economic issues on which their livelihood depends and

11. Cultural and caste issues specially marginal and primitive tribal group.

But as usual it will end in the fashion highlighted in news paper like this, Dainik Bhaskar
Gwalior Friday 8-10-10.vapy ds 8 ftyks esa 80 gtkj cPps dqiksf"kr& Xokfy;j vkSj pacy vapy esa 3 djksM dh foks"k
dk;Z;kstuk cuh] 1 uoEcj ls feyus yXksxk foks"k HkkstuA tks vVy cky vkjksX; feku ds rgr ckWVk tk;sx kA foks"k FkSjIs ;wfVd
QwM& rjy QwMA Question is wheather this multi-Corer scheme is going to provide ultimate solution?

The above mentioned lists various causes associated

directly or indirectly, immediate and underlying
with malnutrition in the state. To solve the mystery
of malnutrition, this had to be look beyond hunger
and poverty and cannot be addressed on single
solution of just providing supplementary nutrition
or implementing any other nutrition programme.

To analyze the malnutrition death in the

Nehargarha village a multidisciplinary fact finding

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team which consisted of activist, advocate, social worker, nutritionist and public health
expert from Bhopal, Khandwa, Satna and Shivpuri visited the Nehargarha village on
7/10/10 and on 8/10/10. Team has a clear view to find the truth behind these deaths and
facilitate the understanding of complexity of malnutrition problem.

Members of the Fact Finding Team

Sr. Name Profession Organization Place
No
1 Mr Prakash Michael Social Spandan Khandwa
Activist
2 Ms Rolly Shivhare Social Right to Food Campaign Madhya Bhopal
Activist Pradesh Support Group
3 Mr Madhukar Social Madhya Pradesh Lok Sangarsh Bhopal
Activist Saajha Manch
4 Ms Apara Nutritionist Social Worker associated with Right Bhopal
Vijaywargiya to Food Campaign Madhya Pradesh
Support Group
5 Mr Mohsin Ali khan Advocate Human Rights Law Network Bhopal
6 Dr Shailendra Patne Public Madhya Pradesh Vigyan Sabha Bhopal
Health
expert
7 Mr Prateek Social Adivasi Adhikar Manch Satna
activist

Objectives
1 To present an analysis of interventions and systems that exists in village Nahargarha in
context to morbidity and mortality due to malnutrition.

2 To analyze health and nutritional status of under 5 yrs children and burden of disease in
village.

3. To analyze the extent of outreach of various food and employment scheme in compliance
of the Supreme Court orders.

4. Based on above study report recommend measures to resolve the issues of malnutrition
and if possible file a public litigation

Methodology
FGD with residents of Nehargarha and one to one discussion with family members of
children who died, Anganwadi Helper and others, close examination of populace

The participants were the people of Nahargarha village including children less than 5 yrs of
age present at the time of visit. Door to door survey of all 45 houses was done. All were
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examined clinically and probable diagnoses were made. Children were weighed and MUAC
was measured by shakirs tape. Parents of dead children and children admitted in NRC
bairad, Anganwadi Worker, Sahayika and ICDS supervisor, CDPO, PHC Medical Officer,
Private Practitioner (Quack) who reported to treat the deceased were interviewed. Sarpanch,
people of village were involved in focus group discussion to investigate the causes and effect
of malnutrition and sickness burden on tribal community and legal matter if any. Data were
collected from the sick individual, from village tribal families, ICDS office Pohari and from
Anganwadi and analyzed.

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 2. Registered Verbal Autopsies of Malnourished
children
Demonstrative cases of factors behind malnutrition and deaths of Saharia
tribal children
Verbal Autopsy Case 1
Deceased Parant was born at Primary Health Centre, Name of child: Parant
Berad. Before his death once he suffered from Name of Father: Ramlal
diarrhea and vomiting and itching problem. Name of Mother: Ratia
Date of Birth: November 2007
For treatment of itching problem his parents (Age at time of
consulted at Vijaypur spent Rs. 1,100/-. After that he Death 35 months)
was quite healthy and ate well. He did not receive Sex: Male
any vaccination. Para of child: 5
Died on: 5.10.10, Morning
This time when he fell sick they consulted two 4.00 AM
private doctors of Berad, since they didnt trusted Weight: 10.800 Kg.
Govt. doctors. Initially he had fever and after 5-6 (Border of normal
days of fever he developed ulcers in mouth, and and mild
died on 5.10.10 malnutrition;
August 2010)
For his treatment Ramlal had taken a loan Rs. 5,000 Symptoms: Fever for 3-4 days
from Pancham Yadav of the same village @ of Rs. 3 and ulcers in
per hundred per month. Parents of Parant have 5-6 mouth
beegha land of which 2 beegha is irrigated land. In
case of non-repayment of loan, or some how not in position to repay the loan, his family will
have to work without any wages on Pancham Yadavs field.

Every day family used to eat chutney (Onion, Garlic and chilli) Roti and they eat dal once in
8 days whereas occasionally they take vegetable like bottle guard, brinjal and other economic
vegetable available at Berad.

Family has job card which is kept with Sarpanch and a bank passbook where one time entry
of Rs. 2719/- was made. This passbook is on the name of eldest brother of Parant who is
married.

Family has Antyodaya Ration card which entitles them fo 32 kg grain per month at
subsidized rate.

Parents reported that Parant never got any service from Anganwadi Centre but by checking
attendance register at AWC, Parant was registered there from the month of August 2010. In
July 2010 on S. No. 19 another child Jitendra/Misri was written while in August this name
was painted with white fluid and name of Parant is being written over it. Before July 2010

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Parant was not registered in AWC. On this query AWW was unable to give any satisfactory
answer.

Late Parant father had 4 children who were never vaccinated by any health worker and they
were not registered in Anganwadi and not received any ration from Anganwadi.

Verbal Autopsy Case 2

Deceased Rajveer had same complaints, suffering from diarrhea and mouth ulcers and fever
for about a week before he died. Since birth he did not responded to anything, did not drink
sufficient milk and was lean and thin (malnourished). He had fever for two days. The family
consulted quack practitioner Mr. Shivkumar Pathak Name of child: Rajveer
Shivpuriwale at Berad. Dr. gave them a bottle of Name of Father: Puran
some syrup which they buried along with Rajveer. Name of Mother: Natia
He charged Rs 200/-. When the fact finding team Date of Birth: November 2009
(Age at the time
met so called Dr shivkumar at Berad he out rightly of death 10
denied having treated the child. They are months)
unregistered practitioner and use unsafe practices of Sex: Male
treatment without writing any prescription. This Para of child: 1
Died in: 21 Sept 2010
made it impossible to ascertain the fact.
Symptoms: Fever for 3-4 days
Maternal grand parents and parents of Rajveer did and ulcers in
mouth
not have any agriculture land and only rely on
wages they spent around Rs. 500/- on Rajveers treatment.

Together Bhallas family has 10 members to be fed and cared. They have an Antyodaya
Anna Yojana ration card but both Bhalla and Purans family are listed in the same card.
Puran is adult, married and lives in another hut and has separate kitchen so ideally he is
qualified to have a separate ration card. Many a times they approached the Panchayat
secretary who wants a hefty bribe which the family can ill afford. The family gets 33
kilograms of wheat a month. The stipulated 2 kilogram of wheat has been discontinued for
many months now. The present ration received under PDS by the family hardly lasts for a
week. Rest of the days the family buys grains from open market. They usually buy wheat
flour that costs 14 rupee a kilogram.

Puran and Bhalla are already indebted to the tune of nearly 4000 rupees that they had
borrowed chiefly to buy grains. It was during rainy season just passed by when the family
runs out of the food and work gets hard to come by. They are supposed to repay the loan by
Deepawali or they will have to compensate the money lender (big farmer of the village) by
providing voluntary, unpaid physical labor whenever demanded by him.

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The ration shop of Nehargarha village is situated at Toda village 3 kilometers away which is
also the Panchayat of the village. The ration shop is managed by the sarpanch and opens
once in a month. The families are not allowed grain purchase in installments.

Puran is a daily wage earner. He works as agricultural labor in the fields of big farmers
usually, Yadavs who have big landholdings. Sometimes when work is hard to be found he
also grazes the cattle.

The familys job card has been with the Sarpanch for more than 2 years now. It was stated by
Bhalla that they have just one job card wherein even Purans name is entered. However the
family has the Post office pass book numbered 800011. This account was opened at the Post
office at Berad on 30th July 2009. The pass book showed just one payment debited on 11th
August 2009 worth 455 rupees. 450 rupees were withdrawn on 25 th August 2009. Bhalla was
not sure as to what was the wage payment rate. He could just inform that he had worked on
some plantation work months ago. He did not know how to withdraw the money from the
post office. The Sarpanch and Secretary withdraw the money on his behalf. He was reluctant
(may be afraid) to disclose the amount taken as bribe by the Panchayat officials. However he
did not deny the fact.

Parents of Rajveer came to live with his mother's parents (grand parents). His grand father
Bhalla provided the information as puran has gone to his in laws home to bring back his
wife, so AWW reported that she did not register him in AWC.

Verbal Autopsy Case 3

Parents of deceased Rampuri reported that Name of child: Rampuri
she was an active girl and she did not have Name of Father: Kailash
any complaints earlier. She was never Name of Mother: Phulwati
Age of child: 2 yrs. 4 months
weighed before and not received any Sex: Female
vaccine. She was 5th child and had 4 elder Para of child: 5
brothers. At first parents reported that Death: 10 days before the visit
Rampuri was born at Govt. PHC Berad but Symptoms: Fever for 2-3 days and
ulcers in mouth
after they turned and told that her birth was
carried out at home. She consulted Mr.
Shivkumar Pathak, Shivpuri wale, a Private unregistered quack practicing at Berad. Parents
also reported that every time they have to pay around Rs. 100/- and they consulted the
shivkumar 3-4 times for ailment. They do not have faith on govt doctors.

Kailash and Phulwati, parents of Rampuri, has 4 beegha land which is non irrigated and for
treatment of Rampuri they have to take debt of Rs. 3,000/- from Siddham Yadav of the
village @ of Rs. 2.00 per hundred per month.

Parents also reported that AWW, ASHA and ANM never visited them. When inquired from
AWW about why she was not registered in the AWC, she said that mother of Rampuri got

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married to Kailsh recently and came to village and her children are from her first husband so
AWW did not registered her. At the time of Rampuris death Kailash went for wages with
contractor to Mumbai, where contractor did not gave him any money. In village Nehargada
he did not have any job card under MNREGA.

This is not the end of verbal autopsy statistics say we lost 8956 children as a result of
malnutrition and consequences of disease in last one year in the district.

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 3. Case Studies of SAM Children admitted in
NRCs
On the day of visit of fact finding team Collector and CMHO along with other officers of the
district visited the same village and to cover up all the matter he admitted 4 children to NRC
Pohri. Fact finding team also visited NRC and met mothers of these children and observed
children also. At the time of visit to NRC there was no electricity and in absence of cool air
children were feeling uncomfortable.

Case No 1 Ashik s/o Vijay singh and his mother is Ganeshi. Ashik born in
October 2008 (Wt. 8 Kg. SAM MUAC 11 cms.) and suffering from Pneumonia
since last 2 months he is second child in the family and has one younger
brother whose weight is below normal. Her mother thinks that he is a sick
child appears to her healthy and he always recovers by own. He was under
treatment of Pneumonia from a private quack (so called doctor) at Berad.

Case No 2 Kuldeep s/o Gangaram and his mother is Angoori is almost a

year old (DOB 9.10.2009) (Wt. 6.6 Kg. SAM MUAC 11.5 cms.) He was born at
home and did not receive any vaccine. He was breastfed within an hour and
also given water after two days. He is second child but his elder brother died
due to swallowing a nail (keel). He is a healthy child with all developmental
milestones at time. His father has 2 beegha irrigated agriculture land on
which they take wheat crop. They did not have any ration card.

Case No 3 Pawan, s/o Bageti and Moti is also a year old (DOB September
2009) (Wt. 5.560 Kg. SAM MUAC 10.5 cms.). He got chicken pox around a
month ago and did not receive any treatment till then he got fever repeatedly
but now since 15 days he is quite well. He is healthy and active also.

Case No 4 Manti (Malti), d/o Ramwati and Ramet is 5 years old (Wt. 11.4
Kg. SAM MUAC 11.4 cms.). She also got chicken pox since 15 days and got
treatment from private quack at Berad where they take her around 5 times
and every time doctor taken 20-20 Rs. from them. After getting chicken pox
she did not walk and complaint for being tired. In hospital records her age is
being noted as 1 year to prove her not malnourished and if she is of 1 year
age how her mother told that after illness she is unable to walk is it possible
for a child of 1 year to walk. Her mother described that she was born at the
time of panchayat elections before this time elections.

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Parents of all these children are working as labor and facing problems in getting treatment of
their children.

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 4. Annotations
1. Demography

Geographical location: Shivpuri is the district of Madhya Pradesh, located on National

High 3 (AB road). Pohri block is situated at a distance of about 30 kms on west of Shivpuri. In
Pohri Block there are 234 villages. Nehargarha village is one among these village situated 30
kms away from Pohri tehsil in Toda gram panchayat with a very difficult accessibility
especially during rains. It is almost 6 kms interior from approach road. Only connectivity to
village is kaccha and bumpy road on which people travel by walking or by bull cart or by
personal or hired two or four vehicle, which get cut off during rainy season and it becomes
very difficult to move on.

Total number of houses in Nehargarha is 79, habituated by Yadav and Sahariya, a primitive
tribal group. In Yadav community no. of houses was 35 and in saharian no of houses were 44.
Population of village is 450. Saharia tribes contribute around 43% (195) of population of
village.

Socio Demographic characteristics:

Sex ratio 925/10001

Literacy tribal adults (both male and female) were illiterate and children having either poor
attendance in school or they are not registered in school.

1
Health bulletin (August 2010) http://www.health.mp.gov.in/bulletin.htm

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Occupation and income Majority were agricultural laborers working in the fields of Yadav
community. Women assisted their husband in working in the field either on wages.
Sometimes they were forced to work in the field without wages because of their inability to
pay their loans. The whole income depends on the Yadav community. Saharia per capita
incomes is very low and were BPL families. Hardly one or two Sahariya tribal families
possess a piece of land. Few were migrant laborer.

Major crops were wheat, bajra, Moongfali (groundnut), Maize and Jowar,

Family Size - Saharia tribal having a large family size with number of children more than 3
were noticed in the households during visit. Average family size is 5.6

2. Housing

The whole Sahariya community bounded in semi round outer boundary of layered stone
and then again subdivided in to group of 3 to 4 houses of their sons and parent. Houses were
clean, street were kaccha road. All 45 houses were kaccha, ill-ventilated and ill- lighted made
up of stones with no provision of windows. Roofs were tied up with leafy shoots and plastic
sheets tied on top to prevent rains. Over crowding were evident in almost in all houses.

3. Water and Sanitation

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The only drinking water source available is open well constructed almost 1 km away from
village, never cleaned. 15 hand pumps were digged in Nehargarha village, all of them were
non functional on the day of visit of fact finding team. One large big pound is situated in
southeast direction of village seems to be the only source of irrigation of 100 acres field where
landholding is with Yadav

Personal hygine among children was very poor. Adults & Children used mud to clean their
hairs and body. No soap was used.

No latrines and bathroom: in or out of houses were constructed. Open field defecation. No
drainage system exists in village.

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 5. Plight of Health Systems of Nahargarha village
Sub Health Center - The nearest subcenter to nehargada is located at jorari village.

Primary Health Center - The PHC is situated in Berad, 9 kms away from
village. PHC berad serves a population of 48000 through 12 sub centers. Staff in the hospital
is adequate but they were deprived of basic facilities in the hospital. Peripheral field visit
were generally avoided by the hospital staff because of lack of vehicle. A female health work
said that if we improved the facilities, it would be a killing blow to private hospitals.

Outreach to cater population and monitoring of immunization services and other health
programme is not done. User fees and private consultation fee by govt. doctor again hesitate
them to utilize public health services. Thus suffer the poor tribe.

Community Health Center - 30 km away at Pohri beyond their approachable limits.

District hospital - 60 km away in Shivpuri, Never thought of going there due to lack of
proper transportation. A visit to the district hospital may cause more than a day for people
leaving in some of the far off villages.

Sub center/PHC and CHC are situated far away and problem of transportation and distance
make useless for them. ANM did not visit the village regularly, she was based in Bairad, and
Attendance of ANM was poor. Once in a while when she visited the village
proper attention and care was not given to tribal women and children. She would sit
at Anganwadi in yadavs house and would operate from there. Recent news was she is on
maternity leave.

Immunization -Immunization status of the children was very poor in the village as per
physical examination and available evidence from their immunization card only 4 out of 40
that is only 10% children were immunized that too partially. This fact was accepted and
ascertained by health official at CHC Bairad. The immunization status of village, as appeared
first hand was dubious, most of the families informed that immunization was not happening
and no record was available with the families.

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 6. Health Examination and Analysis
40 Children were examined clinically, out of which 20 (50%) shows clincaly evident potbelly,
muscle wasting, were under weight, MUAC is less than 115 mm, and sick suffering from
fever, abdominal ache and boils on skin . Out of 20, 9 were SAM , very low weight and
severly ill, One case of dirrohea with severe dehydration, two cases of falciparum malaria
and 4 were admitted in NRC barriad and One case of TB.

Table No 3 Showing examination of sick children

Age Male female total Disease diagnosed
Less than 1 3 2 5 Boils on head
yr
1 to 5 yrs 19 16 35 Diarrohea-severe (3), fever(9) with falciparum
malaria (2), Abdominal pain(1), weakness (2),
conjuctivitis (1)
Total 22 18 40 No of sick 20

Poverty is the major contributing factor, as mothers of malnourished children were out of
village for 8 to 12 hrs and had no time to care there under nutritent sick children. Care and
feeding of children was on elder sister or brother and grand parents. In case of non-avialiblity
of any such person mothers often take children with them to their workplace, where they is
no arrangment for taking care. Seriously ill children are also accompnaied with their mothers
instead of going to hospital.

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Utiliziation of public health Table No 4 Showing treatment taken for ailment in under 5
facility by tribal people was very children
poor. As per the information Sr. No Medical Treatment Practitioner
avilable from the villagers there Ailment
was 3 Govt. and 11 private so 1 Diarrohea Private Quak
called doctors. Only 10%(approx.) 2 Fever private Quak
of them visited government 3 weakness No treatment Quak
hospital on pretext of gross 4 URI PVT. OR NO RX Quak
negligence by staff, charging of 5 measles Pvt. Quak
fees. Around 30% would remain 5 Conjuntivitis No Rx
at home without any treatment 6 Skin boils No treatment
and rest would go to private
practitioners.

Out of 22 sick people examined 14 (63.6%) Table No 5 Showing sick above 5 yrs of age
suffer from fever and 2 were positive for Sr. Age Male Female Total
falciparum malaria. 6 (27.7%)were suspected for No
TB as suffering from cough and fever.1 (4.5%) 1 5- 15 4 2 6
case of leprosy suffering from numbness and 2 15 4 12 16
loss of sensation of Rt hand and Pain in chest or above
weakness and abdominal ache complaints by total 8 13 22
majority of adults in village.

Jhola Chap Doctors - in any case the

observation at Bairad made it obivous that
many unregistered quacks runs their OPD in
rented houses or main 0 banner shop just like
a pan dukhan. The modus of openadi of these
private practioner was their cordial
relationship with the patient and treatment
were provided on credits one can later pay
their convinence. But saharian were looted by
the quacks by wrong diagnosis, unethical
unskilled high risk malpractice and low cost
nakli drugs.

JOHLACHHAAP DOCTORs SHOP

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 7. Plight of essential state services

PLIGHT OF AGANWADI OF NEHARGARHA VILLAGE

Aganwadi was sanctioned 2 yrs before, but has no building of its own and runs from a
yadavs house sited in yadav mohalla of village, tribals are either not allowed or hesitate to
visit. Aganwadi worke is from Guna 100 km from the village and barely comes for visits. Her
services to tribal community is zero.

Saika manage the aganwadi and she is based in nearby village. Some villagers testified that
as a result of wide reporting of malnutritional deaths and visit of collector, 10 bags of
supplementary nutrition were distributed in the village, else it was nearly non-functional for
past 2 years. Supplements and other items provided by anganwadi were sold to local shops
which were latter sold as food for animals.

After the visit of collector anganwadi was shifted to Sahariya mohalla, in house of Pappu
Sahariya whose family is already living there.The room was pitch dark and ill- ventilated and
at about 120 clock noon we were unable to see anything
without help of light.

Record keeping at aganwadi center was not updated and

the Anganwadi Worker living at other village kept it with
her.Records of the register were tempered before the
examination by fact finding team, and many of them
looked freshly prepared, details of decesed children.
Weight and growth record of children was not
maintained properly, needs to more accurate and
unquestionable. When the fact finding team were looking to available attendance register it
seems to be freshly prepared.and there were tampering regardings name and entries of
decesed children As weight or growth record were not maintained properly.

Major limitation to National Programme when implementing through peripheral field

workers of health and ICDS Dept is that they were not sincere for the duties and involved in
corruption of other type like storing the stock for personel consumption or selling it to local
shopkeeper.

SCHOOL OF NAHAGADA VILLAGE

Nehargada village has one primary school on the outskirt of village. Which has one two
teachers one of whom was a guest teacher. On the time of visit of the team they were
distributing uniform, which was for the first time in the history of the school. On inquiring
about MDM students and teacher responded that SHG of the village is preparing MDM and
supplied to school but their was no utensils available in the school for eating meals some of
the students reported that they used to go at the place of SHG and take their MDM at that
place.
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STATUS OF NREGA and PDS OF NEHARGARHA VILLAGE

NREGA There hasnt been any work under NREGA in the village for past 2 to 3 yrs. Many of
the villages have job cards. Sarpanch of village belongs to yadav community and took the job
cards from them on the pretext of updating it and withdrawing money and has not returned
it. After the panchayat election, the then sarpanch lost elections and new sarpanch was
elected, now he is in possession of job cards.

It was reported by many of the villagers that children who grew adult, got married and
moved out to their own house did not got separate job cards.

PDS shop of the village was 2-3 kms away from village. No fixed time of opening of PDS
shop may be once a week. Antyodaya Anna Yojana card (AAY card) was their and every
saharia were entitled for AAY card which allow them to buy 35 kg food grains from the shop
at subside rate of Rs 2 per kg, kerosine 4 liters @ cost of 13.50/- Rs per liter. Sugar and rice is
always out of stock

No new AAY cards were issused to newly married couples and they were still very much
part of the parents family.

It was told that while the ration from PDS last only for 5-6 days for a family of 5-6 adult
members, so for rest of days of months they were buying flour from local market at Rs
14/per kg to meet their need. There were 5-10 days on average when the family would have
nothing to eat and they slept empty stomach.

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 8. Summary
1. Deaths of 3 children reported because of malnutrition in the Nahargarha village in
shivpuri district which really put a question to policy makers and govt. officials.

2. Communicable diseases as well as water borne diseases were widely spread among
the villagers of Nehargarha, which in itself ascertained the poor socio-economic status
of villagers. As spread of communicable disease and socio-economic conditions are
directly co-related to each other. Epidemiology of Nehargarha village shows typical
communicable diseases trend which reflects the poor socioeconomic status
of Sahariya community. Sahariya are a primitive tribal group and almost all the
development indicator they fare very badly in comparison to other communities

3. Water born disease was widely spread in the village. The source of drinking water to
the villager was an uncovered and unhygienic well.

4. Poverty is the major contributing factor in malnutrition and maturational deaths of

children. All the Sahariyas were very poor and majority of them did not have MPL
cards thus living in extremely unhygienic conditions; their soul source of water was a
well whose water was unsafe for drinking. These things in it self showed the kind of
denial of entitlements they have faced from state administration. Due to lack of source
of livelihood and food security they were forced to use various unhygienic practices

5. Majority of the population do not have access to public health services being provided
by state. Either they are too far, ill maintained or the staff there is charging illegal fees.
Also tribal do not have faith in government doctors and health officials, as
they believe that, there is gross negligence on their part. Often due to lack of resources
or of other reasons, in around 30% cases people tend to remain at home even
if they're suffering from a disease or other, without treatment. Rest of them prefers to
go to local Quacks, who have mushroomed out in local market. These quacks do not
have registration neither they have the required expertise, to treat, methods of
treatment which they use are extremely unhygienic and harmful, the fact finding team
has gone on to establish this claim by physical verification of the place

6. Poor utilization of public health services and hard to reach govt. welfare schemes,
immunization and nutritional programmes is some of the major reasons behind the
present situation. Limitations in implementation of schemes are largely due
to irresponsible behaviour of peripheral field workers of health and ICDS dept. There
hasnt been proper immunization of children in the area, ICDS is limited only to
providing supplementary nutrition and is not catering to rest of its components.

7. Anganwadi Centre was remained close as AWW was coming from Guna. Thus
services of ICDS were not provided to children.

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 8. Record keeping at aganwadi center was not updated and the Anganwadi Worker
living at other village kept it with her. Records of the register were tempered
regardings name and entries of decesed children before the examination by fact
finding team, and many of them looked freshly prepared. Weight and growth record
of children was not maintained properly.

9. Lack of political commitment on the part of political leadership at every level be it at

the local level, state level or central leadership, Sahariyas are some of the most
excluded and marginalized communities in the country and they have been facing this
discrimination, denial or marginalization

10. Lack of education among Sahariyas is another reason. Literary rate among Sahariyas Is
very low as compared to other communities, and female literary is extremely
bad. Illiteracy of tribal women consequence in unhygienic child rearing practices

11. The caste pattern of the area has only contributed more in creating gaps, and more
denial of communities who are placed lower in the existing feudal caste system. Lower
caste communities and tribal do not have access to any resources. They are landless
laborers often dependent on the upper caste landlord for work and source of
livelihood. These landlords double up as money lenders when these poor tribals are in
need of the same. They charge heavy interest on the money which is often in the tune
of 3 to 5 %, in case of non- payment of money tribals have to work for free in the fields
of the landlord, which virtually makes him a bonded labor. Ownership on any other
resource is rarely seen to have with the tribal. The Anganwadi functions from yadavs
house, the sitting sarpanch and the former one have been yadavs, and the helper is
from yadav community. So the Sahariyas are denied of every opportunity they could
have got to break this glutinous circle of poverty, illiteracy and malnutrition deaths.

12. SHG of the village was preparing MDM and supplied to school but there was no
utensils available in the school for eating meals.

13. No work under NREGA was carried out in the village.

14. Many of the villagers have job cards but kept with Sarpanch

15. It was reported by many of the villagers that children who grew adult, got married
and moved out to their own house did not got separate job cards.

16. PDS shop of the village was 2-3 kms away from village and there is no fixed time of
opening of PDS shop.

17. Majority of families did not have BPL cards.

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 18. All the children did not received any vaccination and hence prone to several disease
which leads to malnutrition

19. Sub center/PHC and CHC are situated far away and problem of transportation and
distance makes them useless. ANM does not visits the village regularly, she was based
in Bairad, and Attendance of ANM was poor. Once in a while when she visited the
village proper attention and care was not given to tribal women and children. She
would sit at Anganwadi in yadavs house and would operate from there.

20. No coordination has been found between the schemes run by health department and
women and child development departement.

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 9. Recommendations
A survey on the status of malnutrition and health related problem among children
under the age of 6 years through Health Department in the village should be carried
out it will help in identifying those in immediate need of care.

This survey should come out with the specific details of

(a) Malnutrition and Anemia among children and women with grades and levels,

(b) What children eat in general (nutritional status of children): How many meals, what
kind of food, nutritional values of their intakes, deficiency of protein or iron or vitamin or
any other micronutrient deficiency?

(c) Source of safe drinking water in families and in institutions like Anganwadi and
Schools

(d) Major health related problems, Children suffering from in these villages along with
the causes.

All malnourished children should be identified and registered in AWC, SAM children
should be referred to NRCs for more intensive care. Intake capacity of NRCs should be
increased and they should be provided with all basic necessary facilities.

Fully functional Anganwadi center should be established under the process of

universalization of ICDS. Also, Anganwadi should not be restricted to providing
supplementary nutrition; instead they should be providing all the necessary services
in order to prevent malnutrition among children and mothers.

Access to health facilities for utilization of preventive, promotive, curative and

rehabilitative services and regular monitoring of these services by Public Health
Department for better health of children, pregnant women, women and elders.

All the Sahariya families should be provided yellow card on a priority basis. Many of
children who have grown adult are married and have moved out in different houses
still they did not have separate cards.

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 Immediate action must be taken to ensure (a) they get their Job Cards (b) Action
against those, who are in illegal possession of villagers job cards (c) Provide
employment to those, who need it.

PDS shop of the village is at TODA which is about 3 km from the village and is
controlled by yadavs. A separate PDS shop for the village should be allotted and a
Sahariya should be given the chance to operate it.

Cases of debt, non-payment of loans and become a non-paid laborer should be probed
by social justice department. Government should provide financial loan on 0 %
interest so that Sahariyas should come out of viscous circle of debt, interest, bonded
labor or servitude.

There must be a door-to-door campaign held along with the members of the vigilance
committees to find out the people who are devoid from the ration card.

It is suggested that these tribal families should get the entitlement of 35 Kgs per month
per family as per the Supreme Court order dated 28/11/2001 & 10/01/2008.

And it is also requested to investigate that why distressed poor people do not prefer to
take their children to the government health institutions & seeks for expensive
treatment in spite of scarcities. There is immediate need to go for corrective actions &
perk up pro poor services in the public health institutions. Public health system of the
area needs a revival in order to be more effective and user friendly.

Regular visit of ANM to the village should be ensured so that proper services should
be delivered to women and children of the village.

Coordination should be built up between all the department working for the health
and nutrition of children in village.

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