Melghat, a predominantly Adivasi region, has the highest number of malnourished children in Maharashtra’s Amravati district. Interestingly, it’s also known for having more NGOs than it has villages.

Why, then, are Melghat’s Adivasi children malnourished and still dying?

Melghat, comprising the talukas of Dharni and Chikhaldhara, stretches across a vast expanse of forest and a tiger reserve. It first made news for malnutrition in the 1990s when over 5,700 children died, according to data from the health department and a response to an RTI request. In the following decade, Melghat drew a lot of attention from the media as well as NGOs, activists, researchers, medical practitioners, and committees set up by courts to tackle malnutrition and child deaths in this region.

Innumerable reports, surveys, and papers have been written by medical practitioners, including Dr Abhay Bang and Dr Ashish Satav, detailing the high prevalence of severe stunting and severe acute malnutrition among Adivasi children under five in Melghat. They all suggested effective measures to control child deaths.

Yet, three decades, several government and non-governmental interventions, and multiple recommendations later, Melghat still has the highest number of child deaths in Amravati. The situation has improved since the 1990s but between 400 and 500 children still die every year. In 2019, about 409 children under six died, according to an RTI response as well as the Amravati Zilla Parishad.

A few bad eggs

First, the “more NGOs than villages” claim isn’t quite what it seems.

Mitali Sethi, project officer with the government’s Integrated Tribal Development Programme in Dharni taluka, said she was told there are 400 NGOs but only 350 villages in Melghat.

“When we actually began investigating, we realised there are only 20 functional NGOs,” Sethi said. “The rest of the registered NGOs are either religious organisations like Ganesh Mandals, self-help groups, or similar local organisations. There are registered organisations that accept funds but don’t work.”

Sethi added that a handful of NGOs in Melghat had shown results, like Mahan Trust, Khoj, Akshar Kshetu, Melghat Mitra, Plan India, and Action Against Hunger.

Yet, some NGOs seemed to be working for themselves instead of for the people. For example, Sethi said, during a meeting in December 2019, representations from a few NGOs discussed how accessibility was a main criterion for selecting villages.

“How is this any different from what the government is doing? An NGO should supplement our effort. They should fill a void left by the government,” Sethi said. “They receive huge funds under corporate social responsibility programmes and several resources are pumped into such initiatives. Then why is it not helping? Is this just for employees of the organisation to take out their salaries and add to their CSR record?”

Sethi said the NGO representatives were asked if regular meetings were conducted with the villagers or if health maps were drawn out for them. “We found that there was hardly any involvement with the villagers, the very people these organisations are working for,” she said. “How do we expect the situation to change?”

Ground reality

Chaurakund village in Dharni is nestled in the buffer zone of the Melghat Tiger Reserve, about 35 km of bumpy roads away from the state government’s Dharni project office. Chaurakund’s gram panchayat administers three other villages — Chopan, Tangda and Malur — with a total population of 3,001, according to the 2011 census. Of this, 2,833 are Adivasis, mostly Korkus.

Madhavi Agarkar, an anganwadi worker from Chaurakund, said NGOs work mostly on health and nutrition. They collect data, and conduct check-ups and free medical camps. Villagers are charged half the usual fees for further treatment, but people here are so poor they can’t afford it.

“Instead, they prefer visiting government medical facilities that provide free services,” Agarkar said. “However, to reach such government medical facilities when roads are bad is a task in itself.”

Agarkar pointed to another issue. “These health workers from the NGOs meet us [the anganwadi workers] and not the families. They write down the data on the number of malnourished children and pregnant women and head out of the village, filling up their paperwork. We cooperate with them but don’t see any concrete results.”

But it’s not all bad.

Since 1997, Dr Ashish Satav’s Mahan Trust has been lauded for its home-based childcare programmes and community-based management for severely malnourished children. The initiatives aim to reduce deaths in children under five across 30 villages in Melghat.

Between 2015 and 2018, Mahan Trust helped to provide cooked meals under the village child development centre scheme, organised at anganwadi centres to treat severely acute malnourished, or SAM, children..

“The severely and moderate acute malnourished children in my anganwadi gained weight during that period,” Agarkar said. “However, Mahan’s momentum slowed down when their health worker went to work at an ashram school. Their new health worker is learning the ropes, but isn’t as effective as the previous one.”

However, Agarkar was told Mahan would be launching a peanut jaggery bar for the children.

Then there was an initiative by Plan India, the India chapter of UK-based NGO Plan International. Plan India’s community health worker gave Agarkar a packet of seeds to start a kitchen garden. The packet contained a few seeds (tomato, cowpea, ladies finger, fenugreek, bitter gourd, spinach, eggplant, chilli, cluster beans, and courgette) and Agarkar was asked to distribute it amongst five beneficiaries (pregnant women) as a part of the NGO’s Nutrition India programme.

“Ideally, they should have given five seed kits for each beneficiary,” Agarkar said. “How am I supposed to distribute one packet among five women?”

Involving village administration

NGOs should involve the village administration in their planning stage, said Avinash Hatwate, a fellow with the Chief Minister's Fellowship Programme. Hatwate has been working in Chaurakund for two years.

“Most of the time, beneficiaries [of NGO schemes] are themselves not aware of the organisations working for their welfare,” Hatwate told Newslaundry. “And few NGOs reach villages that are as remote as Chaurakund or Chopan or Malur.”

What does Hatwate recommend? “By meeting villagers during a gram sabha, listening to their grievances, consulting with them on agendas and indicators, involving villagers in planning their interventions, these organisations can gain their trust,” he said. “NGOs should also share their progress reports, monthly or annually, at village meetings or gram sabhas. The results would certainly show.”

However, Hatwate noted, this has never happened. “Several NGOs have worked for decades in Melghat on malnutrition and a lot of money has been invested,” he added. “But no one is aware of how the funds are utilised. There needs to be transparency.”

The sarpanch of Chaurakund, Shankar Kasdekar, told Newslaundry he prefers working with the government over NGOs.

“Many organisations are only here to pocket money in the name of welfare. They take information from us but do not visit the very people they are supposedly working for,” he said. “Most of them are around for a few years and then shut shop. Only a few NGOs, like Mahan and Khoj, stick around.”

So, he added, “I would rather work with the government, which is there throughout. Though it’s another story that they take ages to address and resolve our complaints.”

Overlapping resources

Plan India has worked to address issues of nutrition in Chaurakund for the past few months. Its target group is severely and moderately acute malnourished children, severely underweight children, and high-risk pregnant women. It provides seed kits to grow kitchen gardens, and uses games and audio-visual tools to educate pregnant women on hygiene, nutrition and health.

Nityanand Haldar is the Amravati district lead of Plan India’s Nutrition India programme. The organisation works in 104 villages in Melghat, he said.

“The district administration provided us with a list of villages that are hard to reach,” he explained. “We have our workers in about 40 percent of these villages that are remote. Even Integrated Child Development Services officers are unable to reach.”

This is Nutrition India’s “pilot year” in Melghat. “We’re here for a limited period; about four years more because of the memorandum of understanding we signed with the Maharashtra government,” Haldar said. “Our aim is also to strengthen government mechanisms during this period by working with the Integrated Child Development Services and in health, drinking water, and sanitation.”

Nutrition India also wants to work to “strengthen” village health nutrition day — a monthly initiative proposed under the National Health Mission, where “malnourished children are diagnosed, treated and even counselled”, Halder said.

Another NGO that works in the region is Action Against Hunger. For two years, its team of 13 community mobilisers has worked in 39 villages that fall under the Sadrabadi primary health centre in Dharni.

“It’s an integrated project that includes community-based management of acute malnutrition,” said Rajesh Patidar, the project manager of its Dharni chapter. Some of their programmes include: regular health screening and monitoring; cooking demonstrations in anganwadi; providing training and capacity building to anganwadi workers; and educating pregnant women on the “first 1,000 days” programme which is a preventive measure for malnutrition. Villagers are also trained through home visits.

Action Against Hunger works in coordination with the Integrated Child Development Services, Patidar said. “Most NGOs here work for three-four years depending on the project. We try to deliver the best in that period.”

He admitted that there’s some overlapping of resources between NGOs.

“In any given village in Melghat, there may be more than two NGOs,” he said. “It would certainly peeve a beneficiary if he or she has to hear a particular suggestion or measure from us, another NGO representative, and also an anganwadi worker.”

Haldar agreed that resources are sometimes “duplicated”.

“There are some NGOs that provide food or tablets or protein powder. When the government is providing one-time meals to pregnant women, there’s no need to duplicate,” he said. “Besides, who monitors the quality of the food that’s given? How reliable is the act of providing medicines? You can give them for two years but once your project is over — you don’t.”

But do the villagers find these interventions effective?

Shobharam Metkar is a resident of Mandu, a small village in Dharni taluka with a population of 1,144.

“People from some organisations visited my family and gave my pregnant daughter-in-law some powder and tablets,” Metkar said. “But she never ate them out of fear of losing her child. The NGO representative never visited again to check on her.”

Later, Metkar said, a representative from another NGO visited along with an anganwadi worker. “They told us how to take care of our pregnant daughter-in-law. As if we don’t know how to take care of her.”

As Haldar said, there’s a need for “sustainable change”. “That happens when the government mechanism is strengthened. That’s what we do. A government stays, but an NGO might not.”

Resources for pregnant women

Chilati village in Chikhaldhara taluka is about 30 km from Chaurakund, near the Hathru primary health centre. The road connecting the two has been battered by the rain. Visitors to Chilati now need to take another route via Semadoh village — a detour of 133 km.

Chilati belongs to a cluster of 25 villages. All its residents are Korkus. The “nearest” bank is a State Bank of India branch about 40 km away in Semadoh.

In this remote village, Melghat Mitra, a body of 13 volunteers, has been working on nutrition and livelihood issues for the last 20 years. It’s not the only NGO in the area; an organisation called Jeevan Vikas also covers Chilati along with 33 other villages.

Melghat Mitra, which covers 15 other villages along with Chilati, focuses on counselling pregnant mothers and educating them on vaccinations, the first 1,000 days after birth, and eating right while pregnant. Jeevan Vikas provides these mothers with protein powders, and works with anganwadis to promote kitchen gardens.

Rameshwar Phad, Melghat Mitra’s main coordinator, said his organisation also trains local village women. These women are then called “arogya maitrin”: arogya means health and maitrin means friend in Marathi.

“We teach them how to take care of a pregnant woman from the first trimester till the baby turns one year old,” Phad said. “Our focus is on behavioural change, rather than providing materialistic help. Our field workers are so well-trained that we can say that we were able to reduce child deaths from 126 in 1998-99 to 48 in 2018-2019. We also have punchnamas of child deaths for the last 20 years.”

Parvati Mawaskar, an anganwadi worker in Chilati, said everyone in the village relies on Melghat Mitra.

“Since their health worker, Balika, is from our community, she helps us a lot in explaining and bringing out positive changes in our behaviour,” Mawaskar said. “The representatives from Jeevan Vikas provide protein powder. That helps but not in the long run, because they should also make sure the women consume it.”

A local doctor in Melghat said, on the condition of anonymity, that local NGOs in the region aren’t interested in resolving an issue “from its core”.

“They are more focused on secondary prevention,” the doctor said.

Persisting challenges

Some of the NGOs receive generous international and individual donations. They include Plan India, which publishes its audit reports on its website. Some allegedly swindle the donors in the name of charity. For others, scrounging for funds has always been a challenge.

“Most of my time is spent in writing proposals seeking funds,” said Dr Ashish Satav of Mahan Trust. “At present, I’m awaiting a grant of Rs 80 lakh from the government for my 30 villages. I should have ideally got it months ago.”

Varsha Parchure, an activist working with the Adivasi community in Maharashtra, said “behavioural change” is also a major challenge.

“We’re not really helping the Adivasis by providing them with so many options; we’re only making them more dependent,” she said. “It’s important that we [the NGOs] look at sustainable and customised solutions that will help them in the long run.”

It takes a village to raise a child, but it takes an effective system to rescue a malnourished one.

This report is sponsored by the Thakur Foundation.