Broken promises

Published : Sep 24, 2004 00:00 IST

The tribal people of the Agency areas in Visakhapatnam district are caught in a vicious circle of illiteracy, disease and poverty despite constitutional guarantees relating to their welfare.

THE Constitution makes it incumbent on the government to "take care" of the country's tribal population. Articles 15 and 16, which refer to fundamental rights of citizens, seek to ensure that the provisions for the tribal people are implemented. For example, though equality of opportunity is a state policy, an exception is made to ensure reservations in all seats/ports for the tribal people. Article 244 allows the state to make special arrangements for their development. Article 275-1 enables the state (in particular, the Central government) to make financial provisions for tribal development. Also, if the Centre approves of a State government scheme for tribal development, the former is obliged to finance it as well. Thus, vis--vis tribal development, the state cannot give the excuse that it is not empowered enough.

The Fifth Schedule of the Constitution is unique in that it empowers the Governor of a State to suspend any Act of Parliament or the State legislature if he/she thinks it is not in the interest of the tribal people. This can be done even with retrospective effect. The Sixth Schedule allows the formation of an autonomous district-level body wherever the tribal population is substantial. This Act was formulated especially with the northeastern region in mind.

But despite all these guarantees, the tribal people of the Visakhapatnam Integrated Tribal Development Agency (ITDA) areas are caught in a vicious cycle of illiteracy, disease and poverty. Adding to their woes are increasing landlessness, rise in the prices of most essential commodities - kerosene, oil, salt, matchboxes, and so on - and the inability to benefit from the high market prices for their produce.

According to a recent study, "Nutritional Status of Khond, Gadaba and Porja Tribes of Andhra Pradesh" (U. Kupputhai and N. Mallika, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore) the tribal people of Andhra Pradesh's Paderu mandal are desperately poor, backward, and generally uneducated and lead hard and miserable lives. The women are particularly disadvantaged and their diets are nutritionally deficient.

While the tribal families engage in farming primarily for subsistence, they sell their agricultural surplus and minor forest produce in the shandies (local markets) or to traders who come to the village to buy cheap. Many of the traders exploit the tribal people as they give them small loans for emergency needs. The tribal people collect and sell minor forest produce throughout the year. They engage in farming for nine months. February, March and April are the lean months. The family's monthly monetary income ranges from Rs.150 to Rs.300.

The interior villages do not have power, safe water supply, primary health centres (PHCs), schools, balwadis, or means of transportation. Wherever there are schools, they are manned by one teacher.

Following the outbreak of naxalite violence in the tribal belt of Srikakulam district in 1972, major initiatives for the development of the tribal people were introduced. The policies focussed largely on the education and economic development to shelter them from exploitation and increase their incomes.

Since the First Five-Year Plan, some Rs.100 crores have been spent on these scheduled areas by the Tribal Welfare Department, with another Rs.100 crores being mobilised from other departments. While no data are available to assess the extent to which these efforts have helped in poverty alleviation among the tribal people, it is believed that some have benefited from the expansion of irrigation facilities, introduction of cash cropping, higher procurement price of minor forest produce, and the extension of agriculture credit facilities.

The health conditions are abysmal owing to poor access to health care and the quality of the health care infrastructure. Persistent morbidity and early death prevail in some villages. There is also a very high incidence of diseases caused by nutritional deficiency such as anaemia, diarrhoea, night blindness and goitre. The average lifespan of the Primitive Tribal Groups in the Agency areas of Visakhapatnam is only 40 years. Tribal maternal mortality is eight per 1,000, (it goes up to 25 among some tribal groups) as against four per 1,000 for the whole of Andhra Pradesh; the infant mortality rate is 120-150 per 1,000 (72 being the State average); and the crude death rate is nine per 1,000, though among some major tribal groups such as Savaras, Gadabas and Jatapus, it is as high as 15-20 per 1000, with over 50 per cent of deaths occurring among children under five.

There is evidence of a rapid decline in the sex ratio during the period 1981-91 and a high level - 75 per cent - of stunting and wastage among children. Tuberculosis is rampant, the rate of incidence being double that of the normal population. The incidence of malaria is over 18 per 1,000, and accounts for 75 per cent of the State's total deaths on account of the disease.

According to K. Sujata Rao ("Health Care Services in Tribal Areas of Andhra Pradesh: A Public Policy Perspective", Economic and Political Weekly, 33(9), February 28-March 6, 1998), the budget allocation for health care in the tribal areas is negligible. For example, the budget allocated for the purchase of medicines to the G'Madugula PHC, which caters for about 363 tribal hamlets, is just Rs.26,000 (or 79 paise per capita).

The situation of women and children is particularly bad. For instance, pregnant women have to walk, or be carried, to the nearest PHC, which is about 20 km away, for delivery. The tribal areas of Andhra Pradesh have 111 PHCs, 823 subcentres, 29 mobile medical units (MMUs), 21 hospitals and 18 dispensaries. There are an estimated 277 doctors, 1,720 health workers and 260 health supervisors working in the tribal areas.

This infrastructure seems hardly enough given the highly dispersed nature of the tribal population. The PHCs and the subcentres are so located that the distances to be covered - on foot - average about 272 km and 37 km respectively, going up to a high of 465 km and 50 km respectively. Every PHC covers an average of 73 villages (the highest being 1,461 villages) and every subcentre 10 villages (the highest being 379 villages).

According to a survey by the Department of Family Welfare, in 1994-95 none of the 29 MMUs was functioning; 66 per cent of the PHCs needed repairs; 30 per cent had no electricity (affecting vaccine potency); 62 per cent had no labour rooms or water supply (making institutional deliveries impossible); and 19 per cent were housed in thatched, one-room sheds. While 80 per cent of the PHCs had no blood pressure monitoring apparatus, virtually none had a weighing scale or blood testing equipment, making antenatal check-up a notional exercise. Fifty-three per cent of the PHCs had no operating theatre and of the remaining PHCs, 22 per cent had no equipment and therefore remained unutilised.

In the case of subcentres, which are wholly funded by the Centre, 87 per cent are housed in rented accommodation, which in tribal areas would mean a portion of a thatched hut. Of the remaining, while 50 per cent require major repairs and are unoccupied, 8 per cent have some facilities such as an examination table, 1 per cent have water facility and 6 per cent electricity. Obviously, the sub-centres are not functioning, save for a few in roadside villages.

Vacancies in the posts of doctors average 26 per cent, the highest being 60 per cent in Adilabad; male health workers 20 per cent and female health workers 26 per cent. Given the distances, such vacancies mean non-coverage of a large segment of the population. As against 824 male health workers who ought to be available, the sanctioned posts are 690. As male health workers are the key to malaria control programmes, their non-availability in 40 per cent of the subcentres (on account of vacancies and non-sanctioning of posts) has resulted in the virtual non-implementation of this most important programme in most tribal areas.

The 30-bed hospital at Paderu (the ITDA headquarters of Visakhapatnam district is also here) which has had no patients since its construction five years ago, typifies the state of health care services in the tribal areas. According to the tribal people, the treatment at the PHCs is unsympathetic and casual, if not hostile and exploitative; moreover, regardless of the illness or complaint, all patients are administered the same medicines. Worse is the uncertainty about their working hours; often after a 10-km walk, a tribal person would find the PHC "closed".

Private health care in the tribal areas consists of a few qualified practitioners and government health workers concentrated in the relatively better developed areas. Most of the unqualified practitioners resort to aggressive medication, prescribing a range of antibiotics or placebos. Prescriptions are normally not issued. For any minor surgical operation, the patients have to travel 60 to 100 km.

Given the frequency of illnesses in the tribal areas, the annual average spending by a family on health care may be Rs.1,000-2,000. This amounts to over 20 per cent of the income, going by a study on the expenditure patterns of tribal people conducted by the Tribal Cultural, Research and Training Institute for the International Fund for Agricultural Development (IFAD), Rome, which put the average annual expenditure per family at Rs.4,327.

The money required for health care is raised by taking loans at usurious rates - say, at 5 to 10 per cent a month or/and on condition of preferential sale of agricultural produce at 70 per cent of the prevailing market rates. If these indirect costs, including the opportunity costs of wages lost on account of the absence from work or reduced productivity are computed, the amounts spent on basic health care are significantly higher.

Recently, a tribal health project (THP) was prepared by the Department of Tribal Welfare (funded by the World Bank and the IFAD, which was to be implemented in the districts of East Godavari, Srikakulam, Visakhapatnam and Vizianagaram, covering some eight lakh people. Under the project, a community health worker (CHW) is selected from every village and after a two-month training she is expected to monitor and treat the sick and the infirm.

But a Frontline investigation found that the CHWs, who are paid an honorarium of Rs. 200 a month (from community contribution), hardly know even the names of medicines; they seem to qualify for the post if they can identify colours.

Primary education in the tribal areas is abysmal, to say the least. The literacy rates among the tribal people in Andhra Pradesh are pathetic. While according to the 1991 Census 25 per cent of the men and 8 per cent of the women are literate (but they can hardly write or read their names), in most interior villages the literacy rate is less than 2 per cent. The drop-out rate at the primary level is close to 70 per cent; in the case of girls it is 90 per cent. Over a third of the tribal hamlets in the State have no primary school within a radius of 5 km. Most schools have one teacher each, and no pucca roof. When Frontline visited the tribal areas in July, the schools had not reopened after the summer vacation. On inquiry, it was found that the government had decided to close all schools and start bridge schools (usually set up to train child workers before they are put into regular schools).

Some of the reasons cited by the tribal people for not sending children to school include the difficulty to find schools within a radius of 1.6 km and to travel long distances to reach schools.

The teachers here are not tribal people and hence do not understand their problems. Most teachers come to the schools only at the beginning of the month to collect their pay, they complain. The school management is not familiar with the tribal people and their cultures. The books are not in the tribal language and the syllabi are not appropriate to their environment.

According to Samata's Ravi, between 1979 and 2000 there were hardly any new schools started in the tribal areas of Andhra Pradesh. In tune with its overall policy of "encouraging active private sector participation for providing quality education", the State government's allocation for education fell and is almost solely based on loans from `development aid institutions' such as the IFAD and the World Bank.

With such funds, the government started in the tribal areas `peoples' schools' such as `community' schools, `ashram' schools and `Maa Badis'. These schools are closed down when the programme period ends or funds dry up and then the children go back to tending cattle.

Thus, as Samata's Ravi wonders, how can the tribal people, with poor health care and practically non-existent primary education, ever develop? The government appears to be doing little to change the situation.

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