Bombay High Court
Dr. Rajendra Sadanand Burma And Anr. vs The State Of Maharashtra And Ors. on 26 March, 2026
Author: Ravindra V. Ghuge
Bench: Ravindra V. Ghuge
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IN THE HIGH COURT OF JUDICATURE AT BOMBAY
CIVIL APPELLATE JURISDICTION
PUBLIC INTEREST LITIGATION NO.133 OF 2007
WITH
CIVIL APPLICATION (ST.) NO.35428 OF 2013
WITH
CIVIL APPLICATION NO.57 OF 2018
WITH
CIVIL APPLICATION NO.87 OF 2009
WITH
CIVIL APPLICATION NO.56 OF 2018
WITH
VISHAL
CIVIL APPLICATION NO.175 OF 2014
SUBHASH WITH
PAREKAR
Digitally signed by
CIVIL APPLICATION NO.59 OF 2008
VISHAL SUBHASH
PAREKAR WITH
Date: 2026.04.01
10:54:06 +0530 WRIT PETITION NO.3589 OF 2011
WITH
WRIT PETITION NO.3561 OF 2013
Dr. Rajendra Sadanand Burma and Another ... Petitioners
Versus
The State of Maharashtra and Others ... Respondents
-------
Mr. Jugalkishore Gilda, Senior Advocate a/w. Mr. Ajinkya Jaibhave i/b.
Mr. Manmohan Jaju, for the Petitioners in PIL No. 133 of 2007.
Mr. Sumit Kale a/w. Mr. Utkarsh Pondkule i/b. Mr. Uday Warunjikar, for
the Petitioner in WP No. 3589 of 2011.
Mr. Bandu Sane, for the Applicant in CAI No. 87 of 2009 (through VC).
Mr. Bhushan Malgaonkar, for the Applicant in CAI No. 175 of 2014.
Mr. B.V. Samant, AGP a/w. Ms. Pooja Joshi-Deshpande, Ms. G.R.
Raghuwanshi and Mr. S.P. Kamble, AGPs for the State.
Mr. Y.R. Mishra a/w. Mr. D.A. Dube, Mr. N.R. Prajapati, Mr. Upendra
Lokegaonkar and Mr. Sachidanand Singh, for the Respondent.
Dr. K.B. Waghmare, Asstt. Director, Tribal Cell, Mumbai.
Mr. Aadinath Kolhe, Desk Officer, PWD present.
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Dr. Ashish Satav, present through VC.
Ms. Purnima Upadhyay, the Petitioner in person in WP. No. 3561 of 2013
through VC.
CORAM : RAVINDRA V. GHUGE &
ABHAY J. MANTRI, JJ.
DATE : 26th MARCH, 2026 P.C:
1. The fact that in 2026 issue of deaths of babies, young adults, pregnant women/lactating mothers is being discussed in this PIL after a passage of 25 years of continued passing of orders by various Benches of this Court, speaks louder than words. It is a tragedy that this Court has to hear submissions on deaths occurring due to malnutrition, lack of medication and nutrition and lack of appropriate medical support to malnourished patients, pregnant women and lactating mothers. The hearing in this matter commenced yesterday and due to paucity of time, we continued the hearing today in the second session. Mr. Warunjikar requested the Court to permit Dr. Ashish Satav, M.D. (Internal Medicine) who is a Medical Officer and President of Meditation, AIDS, Health, De-
Addiction, Nutrition ("MAHAN") Trust which is active in the remote parts and interiors of Melghat. Melghat has been in the discussions and the news more for the wrong reasons of deaths of babies on account of malnutrition, Vishal Parekar ...2 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt mothers and young adults who are referred to as economically productive age group youth considering high mortality rate.
2. We accepted the request made by Advocate Warunjikar and permitted Dr. Satav to address the Court. He has submitted, on broader lines, as under.
(i) He has been in the Melghat region for the last more than 26 years and he is also one of the Petitioners before us. He refers to the Tribal Health Mission implementation framed in 2016 by the Government of Maharashtra, UNICEF, Acadamitions and NGO's. He points out that the parents are not able to admit their under nourished babies who are actually patients of malnutrition, because of loss of confidence that the medical facilities available at Melghat would rescue the babies. He has also informed us though in the world market there are therapeutic foods of high nutritional value, in Melghat, we have to manage with local therapeutic food in order to rescue malnutrition babies, both severally and acutely affected.
(ii) On the aspect of the economically productive age youth who are the future of the next generation, between the age group of 16 to 24 years are all from the tribal parts of Melghat, actually being tribal.
There is a high mortality rate on account of Anemia and lack of nourished Vishal Parekar ...3 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt even amongst such age group. He had suggested that the nearest Government Medical College in areas where tribal population or villages inhabited by tribal should be attached with the tribal hospitals in such areas. He has tendered a compilation in the form of key recommendations under various heads which include, improvement of health status of the tribals, rigorous and regular implementation of existing good Government policies, Tribal mission for Targeted Interventions for Improved Maternal and Child Survival Outcomes in Tribal Areas, Tribal Health and nutrition policy, Community Based Management of severely malnourished children (SMC), Severely Acute Malnutrition children (SAM) and Severely Under Weight children (SUW) with locally prepared therapeutic food (LTF) and micronutrient (MN).
3. The compilation also includes recommendations from the World Health Organization in the form of guidelines for proteins, calories and micronutrient supplements and duration of nutrition therapy, mortality control program for economically productive age group (16 to 60 years), Importance of Home based child care, Intensive behavior changed communication, Treatment of infections of children, Antenatal care, Newborn care. These 23 pages compilation is taken on record and marked as 'X-2' for identification. Out of this compilation, the first 13 pages are Vishal Parekar ...4 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt being made a part of this order which would be uploaded along with this order as its 'Annexure'.
4. Dr. Satav has further informed us there are patients who are being admitted on account of infections, anemia and malnutrition, on daily basis. Yesterday, a young patient was admitted with a HB count of 3.0%. Dr. Satav finds that such a patient is a high risk patient and immediate treatment includes administering him with blood transfusion.
Presently, the Doctors have collected funds and purchased a bag of blood which was available. If proper assistance and blood transfusion is not carried out, the improvement of the health of the patient would be circumspect.
5. We find that the vexed question which is being dealt with by this Court for the last 20 years and more, is as regards extending proper medical facilities in the Melghat region. A 300 bedded hospital has already been declared in Dharni. According to learned Senior Advocate Shri Gilda, such a declaration made decades ago. He contends that there has been no progress thereafter, save and except the statement of the evidence defending the State Government that files are being moved from one table to another table, approvals are being sought one Department to Vishal Parekar ...5 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt another Department, lack of funds is a major issue with the Government which prompted Shri Gilda to vehemently submit that funds are being spent on the people who do not work. A schemes which are being talked about under the title of 'Ladki Bahin Yojna'. Shri Gilda submits that if funds are spend on the most crucial issues of rescuing babies, mothers and adults from death owing to malnutrition, infection and various other typical medical problems suffered by tribals in tribal areas, at least the debate on the tribal deaths would stop and people would discuss the schemes of the Government end at rescuing such needy persons.
6. The learned Additional Government Pleader has supplied us copies of the orders passed by this Court running into 480 pages from 2006 to 2025. The index and copies of the said orders (480 pages) is taken on record and marked as 'X-3' for identification.
7. The learned Senior Advocate Shri Gilda submits that the learned AGP is not tendering copies of orders of this Court which have been passed since 1993 in Writ Petition No. 2528 of 1993. He revised us that the issue with regard to the problems of the tribals in Melghat regions as well as other tribal parts with the State of Maharashtra which includes the District Nandurbar which is declared to be a Tribal District, need to be Vishal Parekar ...6 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt re-visited by this Court since it is only time that has passed by and little having been done.
8. The learned AGP submits on instruction that from November, 2024 until today, the health department of the State Government has supplied 121 blood bags to an NGO mainly "Meditation, AIDS, Health, De-Addiction, Nutrition" (MAHAN) and Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tah. Dharni, Dist. Amaravati. He further submits that Government does not charge for supply of bloods in the Government Hospitals. He submits that whole blood cross matching testing charges are Rs. 1,100/- as per the Government policy in the private Hospitals and the State Government's shoulders the burden of such expenditure.
9. Dr. Ashish Satav has informed us that the 121 bags of blood which the Government claims to have supplied has not been free of cost. For every blood bag, the payments have been made by NGO's and only thereafter the blood bags have been delivered. No free of cost blood bags have been supplied by the Government.
10. We would appreciate if the State Government takes a Vishal Parekar ...7 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt decision for commencing a construction of 300 bedded hospital at Dharni.
The learned AGP submits that the Government has upgraded a 30 bedded hospital to a 50 bedded hospital from rural to sub-District hospital. Shri Gilda submits that the need is of no less than 300 bedded hospital considering the expanse of the Melghat region. Mr. Gilda submits that little is being done and prays that more will have to be done before it is too late.
11. Shri Gilda further raises an issue of Grampanchayats having not being funded by the Rural Development Department and as a consequence of which the electricity charges for consumption of electricity to pump portable water in the tribal region is likely to be discontinued since the electricity charges are not being paid by the Grampanchayat. The arrears have mounted to Rs.148 Crores in whole District of Amaravati and around Rs. 30 Crores in so far as Melghat is concerned. He therefore submits that if the State Government funds the payment of the arrears of Rs. 30 Crores of electricity charges, the electricity supply to the pumps operating for pumping of portable water in Melghat region would get an uninterrupted electricity supply and pumping of portable water would not be disconnected.
12. Ms. Purnima Upadhyay, the Petitioner in person brings Vishal Parekar ...8 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt to our notice that there are thousands of Tribals in Melghat who have secured employment for survival through the MGNREGA Scheme. Their daily wages have not been paid. Arrears are mountain. She further submits that MGNREGA Scheme is now to be concluded and to be replaced by 'Vikasit Bharat Gramin Rojgar Yojna'. If the funds are not generated for payment of wages of the daily wagers, there would be migration of such labourers and the problem in Melghat would be further escalated.
13. We are informed that the District Collector Nandurbar has prepared a Research Report on the Tribals which would greatly assist the State Government as well as this Court while considering this PIL. It is requested that the District Collector's office at Amaravati be directed to produce the report authored by the then District Collector Ms. Mitali Sethi.
We accordingly call upon the learned AGP to ensure that the said report shall be produced before the Court and copies be shared with the colleague Advocate in advance to enable them to study.
14. In the light of the above, we expect that the State Government would take note of the above facts and initiate urgent steps to ensure that the electricity supply is not discontinued which apprehension is voiced by Shri Gilda.
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15. The learned AGP submits that the material tendered to the Court, 'X-2' by Dr. Satav would be received as suggestions to the State Government since this is non adversarial litigation. The Government would study the said material and would come back to the Court with certain positive statements after a period of two weeks.
16. Stand over to 15th April, 2026 at 3.00 pm. (ABHAY MANTRI, J.) (RAVINDRA V. GHUGE, J.) Vishal Parekar ...10 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt ANNEXURE -
The health & nutrition problems of tribal India, & recommendations for improvement The health problems of Tribal in Maharashtra, India and recommendations for improvement.:
Dr. Ashish Satav (MD) Dr. Vibhawari Dani (MD)
President, MAHAN trust, Ex. Dean & Prof. of Paediatrics,
Govt. Medical College, Maharashtra),
Key recommendations to improve health status of tribal of
Maharashtra, India:
1. Tribal Mission implementation (framed in 2016 by Govt. of Maharashtra, UNICEF, academicians and NGOs).
2. Community Based Management of Severe Malnutrition by Local Therapeutic food & Micronutrients. (LTF-MN: WHO-UNICEF protocol:
SAM, SUW-SMC, severe stunting)-VCDC-CTC.)
3. Mortality Control Program for Economically Productive Age Group (16-60 years). (MCPEPAG) -CD, NCD, Mental health (24800 deaths per year_16-60 years in Maharasthra)
4. Home based newborn and child care (HBNC, HBCC).
5. To know the factual status and correct reporting of mortality of children & adults (16-60 years) including community deaths and severe undernutrition of tribal.
6. External vigilance and expert committee for monitoring and quality control of health and nutrition services.
7. Counsellor program for strengthening of Public Health Institutions (PHC and above).
8. Policy for doctors' availability like affiliation of tribal regions with medical colleges-every district has medical colleges.
9. Behavior change communication (BCC) for health & nutrition like MAHAN did. Exact method-actual implementation- (intensive and proper).
10. Task shifting and empowering grass root workers-ASHA, ANM, GNM, BAMS, MBBS. (76) (For grass root workers-Intensive residential training- fresh and refresher, and monitoring.
11. Public Private partnership in health and nutrition sector.
12. Minimal Invasive Tissue Sampling (MITS) for determining causes of death.
13. Tribal health budget should be 5%(77)-7 % of state expenditure.
14. RSV maternal immunization.
15. Vigorous & regular implementation of existing good government policies:
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Up-gradation of Govt. hospitals: Indian Public Health Standards (IPHS) 2022.
PHCs should also provide secondary care treatment of patients. Nutrition Rehabilitation Unit/Center (NRU/NRC) in tahsil. Child treatment centers (CTC) in PHCs for severe malnutrition management.
Village child development centers (VCDC) for severe malnutrition management.
Verbal autopsies for determining causes of community deaths esp. adults.
Kitchen garden and nutrition farming. Poultry, Fishery Various social and health policies for tribal-details written below. (78) Incorporated suggestions from:
*Tribal mission of Maharashtra Govt. draft, * Rajmata Jijau Mission, *Govt. Health and ICDS department, *Divisional Commissioner Amaravati, *Tribal Development Department, *UNICEF, and KHOJ, * 'MAHAN', *World Vision,* ' Apekshya H.S'.,* ' PREM', * 'Melghat Mitra', *'CARD', * 'Save the children', * 'Caritas India',* 'JeevanVikas', * 'MCWC', *Adivasi Samaj Vikas Sanghatana,* Rationing Kriti Samiti, *Dr. Kuthe(obstetrician), *Dr. Tiwari (Prof. of Paediatrics), * 'Nidhi', other voluntary organizations (VOs) & Technical experts.
Address for correspondence:
Dr. Ashish Satav (M.B.B.S., M.D.) 'MAHAN' (Meditation, Addiction, Health, AIDS, Nutrition)-Mahatma Gandhi Tribal Hospital. Karmgram, Utavali, Tahsil: Dharni. Melghat.
District: Amaravati (Pin: 444 702) Phone: 9423118877 Email: [email protected] Conclusion:
There is very high mortality and malnutrition in tribal areas in spite of efforts and money put by government. Hence it is necessary to revisit the programs. It is possible to reduce deaths & malnutrition in tribal regions & improve health status to achieve SDGs. The interventions are tribal friendly, accessible, achievable, affordable, safe and hence replicable.
As per WHO, child death rate can be reduced through community based management of childhood illnesses and malnutrition by community health workers(79) Details of recommendations.
To increase impact and coverage of health care delivery system: Task shifting and empowering grass root workers for community-based treatment in rural health-care is important because of scarcity of doctors and low health seeking behaviour. They should be intensively trained Vishal Parekar ...12 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt (initial and regular refreshers) for abbreviated, focused work and it should be ensured that they should do that specific work, along with establishment of efficient health facilities as referral offering quality care. Community participation is essential in the form of selection of community health workers like ASHA empowered for treatment of infections, trained birth attendants for clean and safe deliveries, and traditional healers for BCC and referral of patients to health facilities. It will deliver quality healthcare to tribal population. (76) Health and Wellness Centres (HWCs) are catering to 3000-5000 population and is expected to offer health care services within 30mins. However one HWC exists for 3 to 5 tribal villages and therefore cannot offer expected health care delivery within 30 minutes.
1. Problem: At present, there is no specific Tribal policy.
Recommendations: Tribal Policy: Tribal mission for Targeted Interventions for Improved Maternal and Child Survival Outcomes in Tribal Areas (59 PESA blocks) have been drafted in detail by Govt. of Maharashtra: Tribal development department and Health department, UNICEF, and 64 voluntary organizations working in tribal areas of Maharashtra in May 2015. (Annexure 7) The existing rural-urban gap in U5MR suggests the need of Tribal Mission to reach rural-tribal children from poor families and uneducated mothers.(78) .
Tribal healthi and nutrition policy should be immediately implemented.(104)
2. Community Based Management of severely malnourished children (SMC):
SAM and SUW with locally prepared therapeutic food (LTF).
Problem: Prevalence of severe malnutrition is very high (SAM 10-22.2%,(31, 32) SUW: 15.5 to 36.1%(32-37) and severe stunting: 34.4 to 36.2%(32-34)) in tribal India. Malnutrition is underlying cause of deaths in >60% of all U5MR (UNICEF), (82),(83). There is lack of specific program for management of severe malnutrition in India. WHO protocol is not followed for management of malnutrition. Severely malnourished children are not given therapeutic food as per WHO- UNICEF protocols in NRU, CTC and VCDC. Hence many critically ill severely malnourished babies are mismanaged leading to deaths.
Recommendation: Community Based Management of SAM, SUW with locally prepared therapeutic food (LTF) and micronutrients (MN).
Community based management of SAM is well accepted globally (84) Community-based management of SAM, SUW by locally prepared therapeutic food and micronutrients (MN) has shown recovery rate of 79.4%(85) of SAM.
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Recovery of SUW was 36.8% at 90 days of LTF therapy. After stopping LTF therapy but with timely treatment of infections and BCC, the recovery rate increased to 78.2% at 60 months of age. (86) SUW catch-up with the normal growth velocity curves of the age matched controls by 60 months of age. This underlines the importance of timely and appropriate community-based treatment of common infections and behavior change communication until 60 months of age, implemented by VHWs. The case fatality rate has been reduced to less than 1% and it also could significantly reduce prevalence of SAM, SUW, (p<0.005).(85, 86) The results of LTF-MN model by "MAHAN" are comparable with WHO & International Sphere Standard. (87) VCDC (Village child development centers)(88) program run by Govt. for management of SAM, does not follow WHO/UNICEF recommended therapeutic food and protocol. VCDC should be regularly functioning and follow WHO protocol with local therapeutic food (LTF) and micronutrients for SAM and SUW.
Recommendation- WHO guidelines for proteins, calories and micronutrient supplements and duration of nutrition therapy should be strictly followed.
WHO -UNICEF protocol for therapeutic food containing the amount of proteins (15 gms), calories (500), fats (30 gms) and 40 micronutrients per 100 gms should be strictly adhered. This should be in the form of locally prepared therapeutic food, prepared in socio-culturally acceptable ways, minimum for 90 days as sole food and to be fed under direct supervision.
Only one NRUs in tahsil place is grossly inadequate considering high burden of severe malnutrition as per NFHS 5.(31) Government should establish regularly functioning NRUs, CTCs and VCDCs at all SDH, RHs and PHCs with local therapeutic food and micronutrients.
3. Mortality Control Program for Economically Productive Age Group (16 to 60 years) Problem:
Sixty two percent of population is in economically productive age group.
Premature deaths in age group of 16-60 years are very high in tribal areas, (Table 2), which has devastating effects on the families, communities and nation. Children of such families are the most neglected and more prone for malnutrition and mortality.(91) Main causes of deaths (16-60 years) are TB, jaundice, diarrheal diseases, CNS infections, cardiovascular diseases, suicide, etc. (20) (Annexure 6) Infections and addiction of tobacco and alcohol are important underlying causes of deaths.
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Policy framing to reduce the age specific mortality rate(ASMR) (16-60 years age group) in tribal areas should be done on priority basis by Government.
Causes of deaths in community should be identified by verbal autopsy. (20, 92, 93) (Ref. WHO and MAHAN method).
Community based management of people in economically productive age group through ASHA should be implemented. Successful MAHAN model with statistically significant reduction in ASMR should be replicated.(94, 95) TB contributes to 19% of adult mortality (16-60 years) (20) Revision of national TB control program should be done in the form of better community-based tracking, early diagnosis and complete follow up of treatment of TB though ASHA workers.
Community based management of hypertension leading to cardiovascular mortality of 10% of ASMR, should be done through ASHA workers.(94-97) De-addiction centers for tobacco and alcohol should be established. Reduction in deaths of people in economically productive age group will ultimately reduce malnutrition and child deaths.
4. HBCC for reduction of U5MR, IMR, NMR, and malnutrition.
Why home-based child care?
Problem - very high U5MR, IMR and NMR: (Refer to Table No.1) One PHC is for 30 villages, having MBBS doctor, and is around 20 kms from the villages. Many children die due to lack of basic medical help at proper time & lack of timely transport and communication. Poor socio- economic conditions, ignorance and superstitions, lead to low health seeking behaviour of tribal especially for hospitalization of children and hospital delivery. This leads to very high U5MR, IMR & NMR in tribal areas as compared to rest of India.
HBCC - implementation sequence by grassroot ASHA workers in the community to achieve success without complications in Home Based Child care.
1) Intensive Behavior Change Communication (BCC)
2) Treatment of infections of children: 1 to 59 months.
3) Antenatal care (ANC).
4) Newborn care: Normal and high-risk newborn care, . including management of sepsis and birth asphyxia.
BCC topics: health, hygiene, infant and young child feeding, malnutrition, antenatal and newborn care, breast feeding, diarrhea, malaria, pneumonia and growth.
BCC Methods: counselling, lecture, discussion, hand washing, nail cutting and nutrition demonstrations, community growth chart, pictorial flipchart and audiovisual shows in local dialect-local pictures, and street plays. (Annexure-1).
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Treatment of infections of children (1 to 59 months): Community-based management of pneumonia, diarrhoeal illness and malaria, using standard WHO guidelines. (Annexure-2) Antenatal care: Community-based ANC is very important along with prevalent hospital-based ANC. (Annexure-3) Newborn care: Grassroot workers (ASHA) should visit 7 times to home of normal newborn for normal care, 13 home visits for high-risk newborn care, breast feeding problems, hypothermia, premature and low birth weight babies, and provide management of neonatal sepsis and birth asphyxia. (Annexure-4):
Home-based management of illnesses of newborn and U5children, by trained ASHA/ village health workers should be done. Based on the research study by "MAHAN", Melghat in 74 villages during 2004 to 2023, reveals that HBCC can reduce U5MR by over 65.78%, (35, 80) NMR by 55.34% and IMR by 69.28%. (35) It was validated externally by government medical colleges Nagpur, Mumbai and Aurangabad.
Hence, complete models: 1)Home-based neonatal care (HBNC) of SEARCH (81) and 2) HBCC of "MAHAN" should be implemented in all tribal area of India. ANC components of these models have reduced MMR also.
5. Counsellor program for strengthening of government hospitals:
Problem: Low health seeking behaviour of (89)Tribal. Recommendation: Counsellor program: Public private partnership (PPP) by Govt. & VOs at Govt. hospitals (PHC/ RH/SDH/District level Hospitals). Developed by the local voluntary organizations in partnership with district administration, the programme was designed to strengthen public hospitals and change health-seeking behavior among tribal populations of Melghat. Counsellors were 10th to 12th standard educated tribal men and women, who were trained and posted in 17 government hospitals (PHCs and above). These were not just facilitators but became agents of change. They counselled patients and families with Behaviour Change Communication (BCC), encouraged them to access hospital-based care, and gave valuable support within the hospital environment. Their functions extended to setting up 24-hour help desks, overseeing service delivery, ensuring prompt referrals, coordinating transport, and agitating for the provision of medical facilities, food and basic amenities--
all aimed at rebuilding trust in government health sector. Fourteen government hospitals in Melghat and 3 government hospitals in tahsil and district places were chosen as the intervention site, and tribal blocks in Nandurbar and Gadchiroli were used as control sites for comparison. The project was implemented in two different phases--a research phase from 2006 to 2010 and a service phase, which started in 2011, continuing till 2025 (Petition 3278, 2010; PIL, 2010; Satav et al., 2011; Satav, 2018). What was unique about the programme was its localization. The effect was immense. By the end of the research phase in Vishal Parekar ...16 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt 2010, hospitalisation rates for malnourished children had shown a huge improvement: a rise of 96% in Melghat, 53.8% in Gadchiroli, and 34% in Nandurbar.(89) During the subsequent service period (2011-2024), these improvements were sustained. Hospital births increased from 2% to 70.72% (p < 0.0001), SAM hospitalisation rates from 0.12% to 14.53% (p < 0.0001), and recovery rates of hospitalised SAM children significantly improved (p < 0.001) and improved OPD, IPD compared to tribal areas without the intervention of counsellors (Petition 3278, 2010; PIL, 2010; Satav et al., 2011; Satav, 2018; Vyas et al., 2022; Commissioner HDoGoM, 2022; PIL 133, 2023). (89) Over time, the Melghat success caught the attention of state policymakers. At the behest of a directive from the Honourable High Court, the Government of Maharashtra officially took up the Counsellor Programme as a public health policy, and will replicate it in all government tribal hospitals throughout the state. What had started as a grass-roots intervention in one of India's most underserved areas became a replicable model for building healthcare systems through community-based, culturally responsive outreach. (Annexure 5) Recommendation for replication of existing successful Counsellor program all over Maharashtra, India:
a. Program should be a PPP of Govt. and VOs as per Melghat model. b. Recruitment, monitoring, training, empowerment, evaluation and payment of the counselors should be done by empowered Joint Coordination Committee.
c. Minimum Wages and PF should be given to counselors as per Govt. norms.
d. Programme should be included in the Annual Programme Implementation Plan.
e. Budget needed: <5 % of Hospital expenses.
Above interventions (1-5) are acceptable, tribal friendly, accessible, achievable with local resources, affordable, safe and hence, sustainable and replicable.
6. Problem: -lack of health & nutrition awareness:
Lack of health and nutrition awareness is seen in tribal of India. ii Recommendation:
Intensive Behaviour change communication (BCC) program for health & nutrition: (98, 99) As health awareness is vital, intensive BCC in all tribal villages. There should be strict monitoring with measurable outcome indicators. It should be in local language.
Methods for BCC: lecture, community meetings, one to one counselling, group counselling, discussion, street play, audiovisual shows, pictorial flipchart, demonstrations, sport clubs, library, etc. Topics- sanitation, hand washing, nail cutting, nutrition, water storage.
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BCC should be part of school and ashram school curriculum. (Annexure).
7. Problem: Under reporting of mortality and morbidity:
Prevalence of severe malnutrition & mortalities are very high in tribal regions. (Table 1, 2). It is under reported, as verified by UNICEF and RJMCHN mission of Govt. of Maharashtra.(100) Under directives of honourable high court of Maharashtra, the final verification report by UNICEF and MGIMS, Sevagram, has revealed significant discrepancy and under-reporting by state government.(101)
There is significant discrepancy in prevalence of severe malnutrition as reported by NFHS 5 (2022) as compared to government data. (31, 90) The ASMR (16-60 years) in tribal villages of Melghat is >400 per one lakh population while Govt. of Maharashtra did not have any record. (20) Recommendation: Correct reporting of severe malnutrition & mortality rates:
Unless we know the real figure of malnutrition & deaths, appropriate measures cannot be planned to reduce deaths and malnutrition. External vigilance committee consisting of class one Govt. officer, reputed experienced voluntary organisations (VOs) working for health and nutrition for at least 10 years, in tribal areas & external experts should be formed. Joint verification of deaths and severe malnutrition in all tribal areas should be done once in 3 months.
8. Problem: under -utilization of government schemes:
Many good government schemes are not reaching the tribal as local needs and ways of deliveries for tribals are not considered. There is improper monitoring. There is administrative failure. People are not aware of funds allocated for tribal welfare, and mis- utilization of funds can be a contributory factor.
Recommendations:
a. External vigilance and expert committee Joint committee of VOs, Govt. officers (class I), and academicians, IMA, IAP, FOSGI, API, etc. should be formed. This joint committee should have power of monitoring, evaluation of implementation of government schemes. Joint committee should be district wise and state wise. Physical verification of vital statistics, malnutrition and government
schemes, in the form of random sampling of villages with door-to-door visit of every household, should be done.
They should evaluate and empower report of village health-nutrition- sanitation committee.
The findings should be discussed at state level quarterly. It will regularly guide, train and monitor the various government health and ICDS activities in all tribal areas. This will check under reporting of deaths and undernutrition & reduce the problem.
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The committee members should be transparent, reputed, experts of the
subjects, reformer and working in tribal areas for at least 5 years and accepted by community and VOs accredited by TISS-CSR hub/Give India/Guide-star/ Credibility Alliance.
b. Community based monitoring of government schemes: All government schemes should be utilized properly. There should be community-based monitoring of all schemes (e.g. health and ICDS dept.) by community and grass root VOs. Reputed, expert & experienced NGO should be part of that process. (Annexure 8).
c. Dissemination of information of all government schemes to VOs, grass root government staff and village key peoples and help the tribals to avail it. (Annexure 9).
9. Problem: Severe shortage-74%(102)-80%(103) of Specialist doctors:
Obstetricians, Pediatricians, Anesthetists, Physicians, Surgeons, in SDH & RH. Published by MOHFW, GOI, and submission by Govt. of Maharashtra in PIL.
Recommendations:
Affiliation of tribal hospital with medical colleges (government and private).
There should be monthly visit of experts from medical colleges to tribal hospitals. Additional posts for this purpose should be created in medical colleges.
Voluntary Organisations run tribal hospitals should be considered for specialists' bond.
Degree, diploma and certificate courses for tribal health should be started by Health Universities.
Good tribal hospitals of Govt. & VOs should be recognized for such courses.
10. Problem- Lack of timely and appropriate patient treatment:
There is no standard treatment protocol for common illnesses coupled with scarcity of doctors and paramedic staff resulting in unnecessary heavy burden of referral to higher centers.
Tribal don't accept such referral and prefer to die at home. Recommendation: Up gradation of government hospitals in tribal areas.
Govt. must fulfil IPHS standards for all tribal hospitals including PHCs. A SOP / protocol for treatment of common illnesses should be followed. A SOP/ protocol for referral should be prepared and followed. Genuine risk-taking by health staff for treatment should be supported.
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11. Problem: Less Health Budget and Expenditure:
Health budget of India is less, which is <2% iii of net state domestic product (NSDP) (GDP) for the current year, 2025-26. Thus per capita health expenditure is very low in the country. Maharashtra has allocated 3.66% of its total expenditure towards health, which is lower than the average allocation for health by states (6.2%) for the year 2024-
25.iv As per NFHS 5, the tribal health expenditure allocations under NRHM are grossly inadequate in Maharashtra. (5) Recommendations:
a. Ideally 7-10 % of GDP should be used for health budget over tribal area. At any case, as per WHO (2022), more than 5% (77) of GDP should be used over health budget by govt. to solve tribal health problems. National Health Policy (2017) recommendation is that public health expenditure should account for 2.5 per cent of Gross Domestic Product (GDP).(105) Release of financial allocations should be done at proper time at least quarterly.
A State like Mizoram which is tribal, hilly and forested like Melghat, whose per capita income is half of Maharashtra, has very high public health Expenditure per capita which is over 7% of its NSDP and is many times that of Maharashtra. The rest of Indian states should follow the pattern.
b. Tribal population of the India is 8.85% of the total population of country. In Maharashtra, tribal population is 9.4% of total population and geographical area covered under tribal subplan is 16.5% out of total area.
c. As per Maharashtra Govt. policy, about ?% of the total annual plan funds should be spent for benefit of tribal and 3.78% of total was allocated for welfare of schedule caste, schedule tribes and other backward classes.v Additionally, in Maharashtra, out of total general Health budget, Rs. ?? is for tribal health, and out of total states expenditure on social sectors, the expenditure related to tribals, was 17.6%. (5) The GOI and Govt. of Maharashtra have proposed contributions of Rs. 13,684.21 lakhs each for tribal in Maharashtra under National Rural Health Mission.(5) In addition, there is Rs. 12461.88 crores of financial assistance by GOI for tribal welfare in FY 2023-24.vi d. Out of above 3 sources, sufficient budget of 5-7% of GDP can be and must be provided for tribal health in tribal areas of the Maharashtra. Similarly, it should be implemented in other states of India. e. Part of the money allocated for tribal is unspent. Accountability must be fixed for non-expenditure of allocated funds for tribal areas. e.g. GOI fund for tribal has not been spent by Mah. Govt. Tribal dept. in 2021-22. Tribal funds should be completely used only for tribal welfare.
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f. PPP: Participation of community through gramsabha, VOs and Govt. is necessary to decide health and nutrition budget as per intensity of the health and nutrition problems. This will improve health-care and nutrition status.(106)
12. Problem: In difficult to access tribal areas, causes of deaths are not known in 67% of the cases.(29, 30) Hence no proper policy can be framed to prevent deaths.
Recommendations: Verbal autopsy (VA)(93, 107) and Minimal Invasive Tissue Sampling (MITS) should be done for knowing cause of death. (108, 109) As per research of "MAHAN", Melghat, MITS can be done in villages in ambulance and VA can be done in villages, to improve vital statistics and detection of causes of deaths. Factual policies based on such data will be effective to reduce mortality of tribal.(20, 110)
13. Problem: Scarcity of nutritious food.
There is scarcity of green vegetables, pulses, oil, etc. in diet of tribal especially children and pregnant women leading to malnutrition as per National Institute of Nutrition, Indian Council of Medical Research (111-113) and "MAHAN" Melghat study. Scarcity of water in tribal areas, only one agriculture produce per year is possible.
PDS do not supply pulses at all and oil supply is occasional. (https://nfsa.gov.in/search/PDS_supply) Recommendations:
Kitchen garden and nutrition farm. (114) MAHAN has developed >11000 kitchen garden and nutrition farms along with water conservation activities in >20 tribal villages of Melghat. It has improved nutritional status and reduced malnutrition. This is replicable model.
Agriculture department and village health sanitation and nutrition committee (VHSNC) should develop solar dried vegetables and cold storage projects for preservation and regular vegetable supply to villagers. PDS must include regular supply of pulses and oils.
14. Problem- lack of coordination between government and community:
Government has scarcity of dedicated staff and there is communication gap between government and tribal. Government is reluctant to involve community VOs for catering health and ICDS services to common tribal.
Recommendation: Community and Public Private partnership (PPP):
Government should involve VOs, private doctors and social workers who have good community network for government health and ICDS programs. (Annexure 10).
PPP should be started in hospitals of accredited VOs. The schemes like MJPJAY, Tribal hospitals of central government, and other government Vishal Parekar ...21 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt schemes should be allocated to VOs and charitable hospitals to increase impact and coverage of govt. schemes in tribal.
Hospitals run by VOs having specialists and private experts, should be recognised by Govt. for referral of patients and therapeutic camps.
There should be online government portals so that the schemes should be easily approachable to grass root VOs.
The VOs should be screened by TISS-CSR hub, Give India, Credibility Alliance and Guide star agencies approved by government.
15. Problem: No coordination between teaching in medical colleges and requirement of doctors in public health care delivery system.
Problem Statement There is a lack of alignment between medical education and the actual needs of public healthcare delivery in rural and tribal areas. Specifically:
MBBS doctors posted at PHCs (Primary Health Centres) are often ill- equipped to address local disease burdens or national health priorities. They lack understanding of tribal geography, sociocultural dynamics, and challenges such as language barriers, health beliefs, and access limitations.
Medical graduates are not adequately trained in leadership, community engagement, or managing teams and resources in resource- limited settings.
The current MBBS curriculum is largely urban-centric, with minimal focus on the real-world challenges of rural and tribal populations.
Recommendations for Viksit Maharashtra /Bharat Health Reforms To bridge this systemic gap and strengthen India's grassroots health delivery, the following recommendations are proposed:
1. Reorient Medical Curriculum o Modify undergraduate and postgraduate medical syllabi to include modules on tribal health, rural epidemiology, local disease burdens, and public health management.
o Introduce field-based training in remote areas as a mandatory component of medical education.
2. Specialized Courses for Tribal Health o Establish dedicated short-term and diploma programs in essential specialties like paediatrics, obstetrics, anaesthesia, emergency care, and critical care, tailored for doctors serving in tribal and rural PHCs. o Courses should emphasize hands-on, context-specific skills such as managing malnutrition, neonatal emergencies, high-risk deliveries, and tropical diseases.
3. Establishment of a Tribal Health University o Create a state/National Tribal Health University or tribal- focused faculties in existing medical universities to serve as centres of Vishal Parekar ...22 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt excellence for training, research, and policy development in tribal health. o This institution can also be a hub for developing culturally sensitive protocols and innovative rural healthcare models.
4. Incentivize Rural Posting Linked Training o Link promotions and incentives with rural service and successful completion of tribal health certifications.
o Encourage states to adopt a uniform cadre structure to retain trained doctors in underserved regions.
By integrating these reforms, we can create a cadre of compassionate, skilled, and context-aware doctors capable of transforming healthcare delivery in tribal and rural India. This step is essential to achieving universal health coverage and honoring the spirit of Antyodaya--uplifting the last person.
16. Research and innovations:
Problem Statement There is a critical lack of research and innovation focused on tribal health needs at the national and state levels. This manifests in multiple ways:
Neglect of Tribal Health Priorities: Government-supported research largely ignores diseases and health systems issues that are unique to tribal regions-- such as zoonotic diseases, malnutrition, sickle cell disease, anemia, snakebite, addiction, very high maternal, under 5 and neonatal mortality and adult mortality.
Urban-Centric Research Agenda: Research institutions and funding bodies prioritize urban and tertiary care topics, with minimal investment in rural or tribal implementation science. Lack of Local Data and Community Participation: Without grassroots-level studies, policy and programs are disconnected from on-ground realities. Indigenous knowledge, cultural practices, and community health innovations are under-documented.
Weak Collaboration Ecosystem: VOs working in tribal area, Tribal community, field doctors, and community health leaders are rarely involved in national research networks or grant mechanisms.
17. Tele-sonography, Tele-ECHO, Tele- ICU and Tele-microscopy:
Problem: There is scarcity of radiologist, intensivist, pathologist, microbiologist and cardiologist in tribal areas. So, patients are referred to higher centres in cities, which is not accepted by tribal leading to untreated morbidities and deaths.
Recommendations: "MAHAN" has tele-USG, tele-ECHO, tele- microscopy and tele-ICU with experts from cities. It has improved quality care, reduced expenditure, saved time and reduced mortality. Practising specialists from cities should be utilised for telemedicine in tribal India.
Summary of "MAHAN" -
"MAHAN" (Meditation, AIDS, Health, De-Addiction, Nutrition): is established in Vishal Parekar ...23 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 ::: 901-pil-133-2007.odt 1998, influenced and following Gandhian philosophy of empowering villages. Melghat is the hilly, forest difficult to access, impoverished tribal area with medical facilities having limited coverage and impact. Melghat has very high mortality and malnutrition,2-3 times that of the national average. After completion of postgraduation, the founders, Dr. Ashish (M.D. Internal Medicine) and Dr. Kavita Satav (M.S. ophthalmology), established "MAHAN" in 1998, to understand and address high morbidity & mortality of tribal, in Melghat. Interventions and impact: "MAHAN" started with curative services in Mahatma Gandhi Tribal Hospital and expanded to community research which is still continued and benefitted 1 million tribal people across the state of Maharashtra. MAHAN, has credit of 43 publications in international medical journals like Lancet, BMJ, and is recipient of WHO, World Economic forum, Consulate Generals of 26 countries and ICMR awards, and the efforts were recognised by Honourable. Rashtrapati of India.
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i International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571
Review Article Tribal Health in India: A Need For a Comprehensive Health Policy Dandub Palzor Negi 1 , Dr. Monica Munjial Singh2 ii Study of awareness and utilization pattern of antenatal care services among tribal women of the reproductive age group in Kodagu district, Karnataka Sharvanan Udayar, Mubarak Parveen Department of Community Medicine, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India Correspondence to: Sharvanan Udayar, E-mail: [email protected] Received: August 30, 2019; Accepted: October 16, 2019 iii https://www.drishtiias.com/daily-updates/daily-news-analysis/health-initiatives-in-union- budget-2025-26 iv https://prsindia.org/files/budget/budget_state/maharashtra/2024/ Maharashtra_Budget_Analysis_2024-25.pdf v https://www.cbgaindia.org/wp-content/uploads/2024/03/Budget-in-Brief.pdf vi https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1994794 ::: Uploaded on - 01/04/2026 ::: Downloaded on - 03/04/2026 21:39:31 :::