Villages Forsaken on the Road to Progress
Independent journalist Anand Datta, through his poignant prose in
IndiaSpend, has compelled our attention towards the lamentable state of healthcare in Jharkhand. His report,
" Jharkhand: The health of the tribals depends on the crutches of the cot," holds a mirror to India, a nation vaunting its position as the world’s fifth-largest economy. It calls upon a nation, exulting in its status as the third-greatest power in Asia, to ameliorate the lives of those consigned to the margins. Through the intolerable suffering of Amarmuni Nagesia, this report exposes every index of progress to a bitter truth. Though three months have elapsed since its publication on IndiaSpend's portal on the 18th of December2024, the conditions have scarcely altered a jot. The sensitive photographs of Tej Bahadur and Vikas Aryan have endeavoured to stir the sympathies of the people, imbuing this report with a vibrant realism. This is not merely the narrative of Amarmuni, but the affliction of thousands of tribal families in Jharkhand for whom access to healthcare remains but a distant dream. It is with this purpose, that this curated version is republished with due acknowledgement, so that this irony may become widely known and understood....
The vermilion soil of Jharkhand, once clothed in verdant life, now stands as witness to the tribals’ anguish and destitution. Here, the rays of progress have yet to penetrate, and the indigenous communities, though bound to their ancestral roots for centuries untold, remain deprived of modern healthcare.
Here, healthcare is sustained by the crutch of the cot, and each day finds expectant mothers embarking on a precarious journey, gazing into the very maw of mortality, yet clinging to the hope of bringing forth their child.
On the morn of the seventeenth of October, in the year of Our Lord two thousand and twenty-four, such was the dawn for Amarmuni Nagesia, a woman eight months gravid with child. This morning was not merely the commencement of a day, but a dire decision to wager two lives. On one hand lay Amarmuni’s own mortal coil, and on the other, the nascent life within her womb, yearning for the light of the world it had yet to behold. Amarmuni tenderly fed her son, a mere two and a half years of age, unaware that his mother was about to undertake a journey from which there was no assurance of return. She steeled herself, this preparation not for revelry, but for a harrowing pilgrimage.
This preparation was to endure a four-hour passage, seated in a basket borne towards the hospital. This basket was no opulent palanquin, but a makeshift contraption of wood and rope, to be carried in turn upon the shoulders of four men. For Amarmuni, this was no novel circumstance; two and a half years prior, when her first child was nigh, she had faced like tribulation.
This is not merely Amarmuni’s tale, but the plight of thousands of tribal families in Jharkhand, for whom healthcare remains a chimera, more distant than any dream. This narrative embodies the bitter truth of Bharat, where every tenth child is brought forth without the aid of physician, nurse, midwife, or any other health practitioner, thus bereft of any form of medical succor at the time of birth.
When we speak of the indigenous peoples, the state of affairs is yet more dire. The figures from the National Family Health Survey of 2019-21 reveal that in the tribal community, nigh every sixth child is delivered sans the aid of any trained medical person. Jharkhand, where two and thirty tribes reside, among whom eight are categorized as Particularly Vulnerable Tribal Groups, sees the fifth highest number of such births in the whole of the nation.
According to a report of the Comptroller and Auditor General (CAG) of India in the year of Our Lord two thousand and seventeen, "Due to the absence of healthcare services and want of transportation, the vulnerable tribal communities are deprived of timely access to healthcare." According to the census of the year of Our Lord two thousand and eleven, the population of tribal peoples in the state numbers six and eighty lakhs, which constitutes six and twenty percent of the state’s population. This figure is three times greater than the national statistic of six and eighty percent.
Sukdev Nagesia, the father of Amarmuni Nagesia, together with two other villagers, fashioned a palanquin from a wooden basket and secured it to a bamboo pole with ropes. Amarmuni was to be conveyed to the Mahuadar Community Health Centre, some seven kilometers distant from her village, for antenatal examination. Amarmuni Nagesia, a woman of six and twenty years from the Kisan tribe, was soon to give birth to her second child.
Guwalkhar village lies ensconced amidst the forests of Mahuadar Block, in the Latehar district, approximately one hundred and seventy-eight kilometers from Ranchi, the capital of Jharkhand. The village numbers some fifteen hundred souls, the greater part being farmers, Korwa and Birjia tribals. For these communities, to journey to Mahuadar means to traverse perilous paths, where even a bicycle dare not tread. In inclement weather, and when the rains descend, this path becomes fraught with yet greater peril.
According to the "Tribal Health in India" report, only eight and seventy percent of tribal women receive but a single antenatal examination, whereas a mere fifteen percent receive three such examinations. This is the lowest rate among any community in the nation.
Amarmuni ensconces herself in the basket, and two villagers take up the burden and set forth. Great stones, thorny thickets in places, to scale the mountain is no easy feat. After nigh two hours of unremitting progress, they pause to rest in a single place. Weary and exhausted, lines of anxiety are etched upon their faces.
Sukdev speaks: "Here the conditions are grievous. The rain which descended last night has rendered the path more treacherous. Should one slip, who knows what might befall mother and child?" In his voice are manifest both fear and resignation.
The local community health worker, Pyari Negesia, speaks: "This is commonplace in Jharkhand. Here, particularly for tribal communities living amidst the forests, the health center is far beyond reach." Pyari, herself issuing from this community, has witnessed these tribulations with her own eyes.
Recalling an incident of May in the year of Our Lord two thousand and twenty-three in Guwalkhar, the six and forty-year-old community health worker recounted that a woman had given birth at home. Suffering severe hemorrhaging, she was conveyed to the Mahuadar Primary Health Centre. Her condition being critical, she was referred to the Latehar District Hospital, some ninety kilometers distant from that place. But from grievous blood-loss, she perished in the hospital. Even now, in Pyari’s eyes, the pain of that day remains fresh.
Pyari related, 'Three years past, when yet another woman endured grievous pangs of parturition, she too was borne to the hospital in like manner, cradled in a basket. When her throes intensified, she was compelled, with the assistance of the women of the village, to deliver her babe in the midst of the forest.'
According to the 'Tribal Health in India' report, more than a fourth part, yea, some twenty-seven percent, of tribal women bring forth their children at home, a proportion higher than all population groups.
Pyari, who accompanied Amarmuni upon this four-hour pilgrimage along the perilous and slippery mountain path, stated that such a state of affairs is commonplace in districts such as Chaibasa, Gumla, Sahibganj, Pakur, Simdega, Khunti, and even the state capital of Ranchi. In these regions, the indigenous peoples are oft compelled to rely upon such arduous paths and the succor of fellow tribals in order to access medical facilities. Thus, a vicious circle is formed, wherein poverty and destitution, the remoteness of healthcare, and death are intertwined.
When asked how long this difficulty in accessing healthcare had persisted, Sukdev responded, 'This has continued for more than two or three generations. The absence of a road has ever been the source of woe. We have importuned for a road without surcease, yet the situation remains unchanged. For want of a road, people perish. Three or four children from our village have already fallen. In the year of Our Lord two thousand and twenty-one, my wife was stricken with paralysis. Lacking the resources to procure her treatment, she too passed. What can we do?' Sukdev’s query is a lamentation, calling into question the very claims of progress.
These tribulations are not confined to Jharkhand alone. On the twenty-seventh of September past, a pregnant woman in the village of Pinjarikonda in Andhra Pradesh was forced to cross a stream overflowing from a dam in order to be conveyed to a hospital. Each year, manifold such incidents come to light, exposing the lamentable condition of healthcare in the remoter regions of the nation.
In forest villages such as Guwalkhar, the absence of roads is a matter ensnared amidst bureaucracy and environmental regulations. It is a complex conflict between progress and preservation, wherein the indigenous communities are most gravely impacted.
A joint survey conducted in the year of Our Lord two thousand and twenty-one by the Jharkhand Forest Rights Forum (JVAM), an alliance of seventeen small and large voluntary organizations dedicated to the rights of forests and indigenous peoples, and the Indian School of Business, revealed that there exist in Jharkhand's forest regions some fourteen thousand eight hundred and fifty villages.
According to Sudhir Pal, the convener of the Jharkhand Forest Rights Forum, if one were to reckon but one hundred souls per village, this estimation still yields some fourteen and eight-tenths lakhs who reside in these distant regions, many of whom are compelled to rely upon makeshift conveyances such as cots in order to reach hospitals in times of emergency.
In the recent assembly elections in Jharkhand, many elected to abstain from voting in protest against the government’s failure to provide basic infrastructure. As an example, consider the villages of Bamanabad in the Tundi constituency of Bokaro district and Taratand in the Bengabad block of Giridih district. The denizens of these places abstained from voting, being excluded from the classification of forest villages. This abstention was emblematic of their outrage toward the system and their longing for transformation.
The Ministry of Environment informed Parliament in December of the year of Our Lord two thousand and twenty-three that there are approximately six hundred and fifty thousand villages in Bharat, among which one hundred and seventy thousand lie proximate to forests. Some thirty crore souls depend upon the forests for their livelihood. The want of coordination between the forest and environment ministries constitutes a grave impediment to the path of progress in these villages.
A response given in Parliament in the year of Our Lord two thousand and twenty-one stated that one hundred and forty-two posts for physicians remained vacant in the primary health centers of Jharkhand’s tribal areas. In the central budget for the years two thousand and twenty-three and two thousand and twenty-four, some one lakh seventeen thousand nine hundred and forty-four crore rupees were allocated from the total planned budgetary allocation of forty and two ministries and departments as the Development Action Plan for Scheduled Tribes (DAPST) fund. The allotment of budgets doth occur, but their implementation upon the ground proves a grave challenge.
In the recent assembly elections of the year two thousand and twenty-four, political promises were made in the manifestos of both the Jharkhand Mukti Morcha (JMM) and the Bharatiya Janata Party (BJP). These included an ambulance for every five thousand families, a health sub-center in each panchayat, a fifty percent increase in the emoluments of healthcare workers, and the allocation of sufficient funds to improve healthcare. The promises made during elections oft become mere rhetoric, and the tribal community finds itself deceived, buoyed each time by fresh hopes.
Concerning these pronouncements of the parties, Sudhir Pal says, 'These promises are fair to behold upon paper, but they fail to address the fundamental problems. The greater query lies in how, in sooth, one may reach these distant villages. Without clear plans for the construction of roads or the improvement of basic infrastructure, these promises remain but empty declamations.'
The health secretary of Jharkhand, Ajay Kumar Singh, in offering the government’s defense of this entire situation, stated that mobile medical units are in operation to convey healthcare in the state. Singh averred, 'In a manner of speaking, these units furnish OPD services, but in those regions or villages where roads are lacking, these units are likewise unable to function. In such areas, the Rural Development Department must needs act.' More than one hundred units are in operation throughout the state. Mobile medical units provide a temporary remedy, but the development of basic infrastructure is requisite for any enduring solution.
Reshma, the Jharkhand State Trainer for Dhwani Foundation, which has been working for women’s rights for the past fifteen years, avers that the health concerns of women and children living in forest regions have been consistently disregarded."
She affirmed, 'In this election, these matters were scarcely broached. This time, the women who have profited from the Chief Minister Maiya Samman Yojana have cast their ballots overwhelmingly in favor of the present government. It behooves the government now to demonstrate its gratitude to the people by furnishing them with improved roads and healthcare facilities.'
Chief Minister of Jharkhand, Hemant Soren, declared, 'The principal aim of our government is to serve every Jharkhandi and ensure their well-being, especially those who dwell in the most distant regions. Whether they reside in the villages amidst the forests or in other inaccessible areas, the provision of healthcare facilities for them remains our foremost priority.
We are formulating a comprehensive plan to ameliorate healthcare services, which includes the construction of motorable roads through the coordination of the departments of health, rural development, and forests. Our purpose is to ensure that every citizen, however remote, may have access to necessary medical facilities without hindrance,' he averred.
Speaking of the Maiya Samman Yojana, Soren said, 'This ambitious social welfare scheme is centered upon the economic empowerment of women and their families. With monthly financial assistance of ₹2,500, more than 50 lakhs of women are profiting from this program. It is not merely financial aid—it is a significant step toward the empowerment of women.'
George Monopally, convener of the Jharkhand Forest Rights Forum, stated that there is a grievous flaw in the Forest Rights Act of 2006. It permits the construction of dwellings upon one hectare of land in forest villages, but allows the felling of only 75 trees. This renders the construction of roads to the innermost villages of the forest difficult, for these villages lie often several kilometers distant from the main thoroughfare.
Monopally believes that the solution lies concealed within a clear and effective plan. He stated, 'The state government must needs compile a list of those regions requiring roads, measure their distances, and contact the central Ministry of Forests for permission.'
According to Lal Ratnakar Singh, the former Principal Chief Conservator of Forests (PCCF) of Jharkhand, 'It is true that the felling of 75 trees per hectare is permitted under the Forest Rights Act of 2006. Nevertheless, roads have been constructed in those regions of the forest where few dwell.'
Singh avers, 'If the government and the forest department so will it, all-weather roads may be constructed anywhere in the forest. Forasmuch as villages are scattered in such places, and few reside there, the government pays them little heed. Those who dwell there are unable even to convey their troubles to them properly.'
After nigh four hours of walking, Sukdev, the villagers, and the healthcare worker arrived at the nearest road, where an ambulance awaited Amarmuni. In Amarmuni’s eyes were mingled expressions of weariness and relief.
Tyagrajan Sundararaman, the Global Coordinator of the Jan Swasthya Abhiyan, states that it is a grievous failing if the people are compelled to walk for four hours to reach a hospital. Both the central and state governments must ensure that there be a road within one kilometer of every person's village, which remains open throughout the year. In the years two thousand and eleven and two thousand and twelve, a map of the remoter regions of Jharkhand was drawn, so that hospitals might be within reach of pregnant women within one hour. But owing to want of funds and the government’s negligence, the work upon this has been delayed.
Dr. Irfan Ansari, the Minister of Health of Jharkhand, has lately assumed his office. He declared, 'See, none perishes from a journey of eight or ten kilometers. If one perishes, it is because they suffered some grave illness before.' This statement of the Minister of Health is the very height of callousness.
He continues, 'I have determined that the physicians shall be posted in that district wherein they dwell. Thus, no physician shall refuse to go to these areas. And, moreover, deliberations are underway to increase the wages. The condition of the Mahuadar hospital has just now come to my knowledge, and I promise to ameliorate it.'
The community health worker, Pyari Negesia, has also related the tribulations of pregnant women in those regions, who are contending with anemia, nutritional deficiencies, and the want of adequate medical counsel.
UNICEF avers that pregnant women must needs partake of good and home-cooked meals three times each day. Also, they must needs partake of light snacks and fruits and vegetables three to five times as well. A diet rich in whole grains, proteins, and green leafy vegetables is requisite. Moreover, advice is given to ingest supplements of iron, folic acid, and calcium, as well as to drink copiously of pure water for hydration.
According to the directives of the National Health Mission (NHM), pregnant women are counselled to receive tetanus injections, to ingest 100 tablets of folic acid, and to consume milk products and green vegetables. Owing to a want of these requisite things, manifold complications arise in pregnancy, leading oft to protracted labor. Thus, to deliver at home may prove hazardous.
Pyari avers, 'Even to reach health facilities to undergo necessary examinations is beyond possibility. When the rains descend heavily, even drugs such as folic acid find it hard to reach the village. This may have its effect upon the child gestating in the womb.'
According to NFHS-5, in rural Jharkhand, 42% of children below the age of 5 are stunted (short for their age), 22.3% are wasted (thin for their height), 8.8% are severely wasted, while 41.14% of children below the age of 5 are underweight. Malnutrition hangs as a dark shadow upon the lives of tribal children.
According to the World Health Organization (WHO), pregnant women must needs undergo ultrasound scans between the 8th and 14th weeks (dating scan) and then between the 18th and 22nd weeks (anomaly scan). In addition, tests are advised during pregnancy for hormones (HCG), thyroid function, sugar level, hemoglobin, and oral glucose tolerance test (OGTT).
Pyari averred, 'In villages amidst the forests, none of these things are readily attainable.' The want of modern medical examinations places the health of pregnant women and their children in grave peril.
In Bharat, twenty-three percent of tribal children are born at home. According to NFHS-5, in rural Jharkhand, the infant mortality rate is 41.4, while the neonatal mortality rate is 30.4, and the mortality rate of children under the age of five is 49.2 per 1,000 live births. Here it is of import to note that the maternal health services proffered by the government are often ill-suited to the health beliefs and practices of the indigenous peoples. Thus, the distribution of healthcare services is in need of cultural sensitivity.
Jasinta Korwain, another community health worker in Guwalkhar, recounted that the instruments for measuring blood pressure, sugar, and conducting blood tests in the health center have remained broken for four years. Jasinta stated, 'The state government sanctioned funds in October of the year of Our Lord two thousand and twenty-four for the purchase of new instruments, but owing to a want of KYC, these have not yet been obtained.' Red tape and corruption are a grave impediment to the path of progress.
Antenatal examinations must needs be conducted at least three times during pregnancy, which, owing to a want of instruments and facilities, occurs but once or twice. Jasinta avers that, lacking adequate resources, the healthcare workers too find it hard to perform their duties aright.
Avadhesh Singh, the Civil Surgeon of Latehar, declares, 'The instruments are not retained by the healthcare workers (Sahiyas). They are retained in the Anganwadi centers, and the healthcare workers make use of them from there. There is no fixed timeframe for replacing broken instruments.' The absence of accountability and responsibility has its effect upon the quality of healthcare services.
Jasinta further relates, 'Even pure water is denied us. We drink from the chuaan (water collected in the hollows of mountain streams). The want of pure water gives rise to many diseases as well.' The absence of pure water is yet another factor of import affecting the health of the tribal communities.
Such is approximately the state of affairs in Jharkhand and in other tribal regions throughout Bharat, where water quality is poor and healthcare services are scarce.
Sudhir Pal of the Jharkhand Forest Rights Forum speaks of potential legal remedies. He avers that under Section 3-2 of the Community Forest Rights (CFR) agreement, if the Gram Sabha doth consent, up to 1 hectare of forest land may be allocated for community development, where land may be used for roads, health centers, and water, as well as telecommunications facilities. Under this act, 75 trees per hectare may be felled.
Monopally believes that the solution lies concealed within a clear and effective plan. He stated, 'The state government must needs compile a list of those regions requiring roads, measure their distances, and contact the central Ministry of Forests for permission.'
According to Lal Ratnakar Singh, the former Principal Chief Conservator of Forests (PCCF) of Jharkhand, 'It is true that the felling of 75 trees per hectare is permitted under the Forest Rights Act of 2006. Nevertheless, roads have been constructed in those regions of the forest where few dwell.'
Singh avers, 'If the government and the forest department so will it, all-weather roads may be constructed anywhere in the forest. Forasmuch as villages are scattered in such places, and few reside there, the government pays them little heed. Those who dwell there are unable even to convey their troubles to them properly.'
After nigh four hours of walking, Sukdev, the villagers, and the healthcare worker arrived at the nearest road, where an ambulance awaited Amarmuni.
Tyagrajan Sundararaman, the Global Coordinator of the Jan Swasthya Abhiyan, states that it is a grievous failing if the people are compelled to walk for four hours to reach a hospital. Both the central and state governments must ensure that there be a road within one kilometer of every person's village, which remains open throughout the year. In the years two thousand and eleven and two thousand and twelve, a map of the remoter regions of Jharkhand was drawn, so that hospitals might be within reach of pregnant women within one hour. But owing to want of funds and the government’s negligence, the work upon this has been delayed.
The tribal community continues to face manifold challenges. Poverty, illiteracy, malnutrition, a want of healthcare services, and governmental indifference render their lives difficult.
The plight of the tribal community in Jharkhand is a tale that compels us to call into question the claims of progress. It is a tale that reminds us that progress is not merely the name for lofty buildings and gleaming thoroughfares, but the raising of the standard of living for every citizen.
Amarmuni Nagesia, though she did reach the hospital on that day, yet her story doth not end there. Like her, thousands of tribal women continue to live in the hope of a brighter tomorrow. To realize their hopes, we must needs labor together. We must needs become their voices and compel the government to resolve their troubles.
Today, when we speak of new dimensions of progress, we must not forget that a great part of our society remains bereft of basic amenities. We must recall that true progress is that which carries every citizen along with it, that which leaves none behind.
Shall we be able to construct a better future for the tribal community? Shall we be able to remove the crutch of the cot and enable them to profit from modern healthcare? This query rests today upon every one who dreams of a just and inclusive society.
Like Amarmuni, thousands of tribal women live still in the hope of a better tomorrow. To realize their hopes, we must needs labor together. We must needs become their voices, and compel the government to resolve their troubles. Only then shall we construct in truth a developed and equitable society.