From failed schemes to vacant posts: Maharashtra's tribal health crisis in focus as HC pulls up govt

The Bombay High Court has sharply criticised the Maharashtra government over continuing deaths due to malnutrition in the state’s tribal belt, saying official efforts to address the crisis are “too little” despite repeated warnings and judicial scrutiny. 

Hearing a clutch of petitions highlighting deaths of infants, children and pregnant women in tribal regions, particularly Melghat, the court underlined that malnutrition remains a systemic failure rather than an isolated problem. 

What the HC bench noted

The bench, comprising Justices Revati Mohite Dere and Sandesh Patil, said the persistence of such deaths points to deep administrative gaps in nutrition, healthcare access and social welfare delivery. The Justices were hearing a public interest litigation filed in 2007 by Rajendra Sadanand Burma and another petitioner. 

The petitioners informed the court that "about 65 children between 0 and 6 months from June 2025 till date, have died due to malnutrition."

The judges noted that the parties had not submitted a joint report on steps to tackle malnutrition, despite an earlier order dated July 29, 2025, directing them to do so.

According to information placed before the court, over 115 deaths of infants, pregnant women and lactating mothers have been reported in recent months from the affected areas. While the state government attributed some deaths to “multiple causes,” the High Court made it clear that malnutrition cannot be brushed aside as a secondary factor.

The judges noted that many women in these regions are married at a young age, sometimes as early as 13 or 14, and face repeated pregnancies, anaemia and poor access to institutional healthcare.

Premature deliveries and related medical complications further compound the risks.

Evidence of negligence

The petitioners’ affidavit dated October 16, 2025, explains how the Raipur Sub-Centre in Chikhaldara was shut for three months, resulting in the death of Sugati Ghode, who could not receive timely treatment. In Hathras village, a child was delivered at midnight under the torchlight of a mobile phone because there was no electricity and no medical help. Another woman, Rupali Dhande, seven months pregnant, died en route to Dharni hospital after delivering at home without assistance. Roads between Bairagad and Dharni were described as being in such poor condition that a woman went into labour during transit and delivered in a vehicle jolted by potholes.'

The petitioners have further pointed to deep-seated irregularities in the NGO ecosystem operating in the region, alleging that while official records list as many as 380 NGOs, barely 20 are actually functional—raising serious questions about oversight and possible diversion of funds. 

Basic infrastructure, they argued, has been allowed to decay: only about 60 per cent of roads have been built, and most have not seen maintenance in nearly two decades. Repeated warnings from the Comptroller and Auditor General over the state’s failure to ensure essential healthcare have been ignored, while assurances made on the floor of the Assembly remain unkept. Even a December 2001 court directive to establish an ultramodern hospital at Dharni continues to await implementation.

The document lays bare a chain of systemic breakdowns. In Koylari and Pasdongari, twelve people lost their lives after drinking contaminated water when supply schemes failed following electricity disconnections. Even as these deaths were reported, around 365 villages continue to live without power, while solar units installed at health centres have been defunct for nearly five months.

The affidavit also flags chronic underinvestment in public health, noting that Maharashtra allocates just 0.4 per cent of its income to healthcare, with per capita spending falling from ₹975 in 2019 to an even lower level in 2024–25.

Staff shortages have further hollowed out the healthcare system. Nearly 60 per cent of Primary Health Centres function without regular doctors, while sanctioned posts for medical officers and frontline health workers remain vacant. Mobile medical vans lie idle due to a lack of spare parts and funds, undermining outreach in remote areas.

Welfare schemes for women

Welfare schemes meant to support pregnant women, including the Matrutva Anudan Yojana, have failed to release payments for the past five years, depriving an estimated 250–300 women of assistance. The affidavit also points out that although ₹5,000 crore has been released under the Poshan Abhiyaan since 2017, the state has utilised only about half the funds, with NITI Aayog repeatedly flagging serious implementation gaps.

The Maharashtra government told the court that not all deaths were directly caused by malnutrition and cited factors such as illness, social practices and delayed medical intervention. However, the bench questioned why, despite decades of schemes and policies, tribal areas continue to report preventable deaths linked to undernutrition.

The court observed that identifying the root causes of malnutrition and ensuring effective implementation of welfare schemes, such as ICDS, maternal health programmes and nutritional support initiatives, cannot remain a paper exercise.

Expressing concern over the recurring nature of the crisis, the High Court urged the state to conduct a thorough assessment of why existing interventions are failing and to take immediate, measurable steps to prevent further deaths. 

It also signalled that continued judicial monitoring may be necessary if conditions do not improve.

Public health experts say the observations once again spotlight the intersection of poverty, gender, early marriage and fragile healthcare infrastructure in Maharashtra’s tribal belts, issues that require long-term political will rather than episodic crisis management.

The court was particularly critical of the funds allocated for nutrition under Anganwadi services, describing the provision as grossly inadequate. Referring to figures cited in the state’s affidavit, the Bench noted that the allocation last revised in 2017 was “paltry” and clearly in need of urgent revision and enhancement.

The judges also expressed frustration over what they described as a lack of seriousness on the part of the administration. Despite multiple directions issued by the court over the years, they observed, little appeared to have changed on the ground. In view of this, the Bench directed the Principal Secretaries of the Tribal Affairs, Public Health, Finance, Women and Child Development, and Public Works departments to appear before the court via video conferencing at the next hearing.

Dr Abhay Shukla, co-convenor, Jan Swasthya Abhiyan, said the case reflects a deeper systemic failure rather than a lack of awareness. “This matter has been before the courts for nearly a decade. If you keep doing the same thing, with the same resources and in the same way, and expect different results, that is the definition of insanity,” he said.

He pointed out that repeated judicial directions have failed to translate into meaningful change on the ground. “The court keeps telling the government to ‘do it right’, but the system continues to function exactly as it did earlier. Unless the system itself is changed, how can outcomes change? This has become a purely procedural exercise rather than a serious attempt at reform.”

According to Shukla, malnutrition cannot be addressed without overhauling the public health and nutrition machinery. “If you have a completely dysfunctional system and you ask it to perform better without adding staff, without allocating substantial additional resources, without changing implementation strategies, and without redefining the relationship between the system and the community, nothing will change. You will only keep reporting deaths.”

He stressed that viable alternatives already exist. “There are proven approaches to reducing malnutrition, even in Adivasi areas of Maharashtra. One such model is Community Action for Nutrition, which has been implemented in 400 tribal villages across the state. It led to a 50 per cent reduction in severe acute malnutrition within eight to nine months.”

The intervention, he said, has been independently evaluated by the Tata Institute of Social Sciences and accepted by the state government. “The evidence exists, the methodology exists, and the resources exist. The government has even implemented it on a pilot basis. Yet, it has not been scaled up.”

“What we are seeing is not a lack of solutions, but a refusal to implement systemic change,” Shukla said. “Civil society organisations on the ground are willing and capable of working in Melghat. But they need government support and a fundamentally different approach.”

Drawing from direct experience, he added, “Based on interventions, not just studies, I can say that malnutrition in Melghat can be reduced by half within a year. Everything needed to do this is already available. What is missing is the will to change the system.”

As the matter returns to the court for further hearing, the spotlight remains firmly on whether Maharashtra can translate judicial warnings into meaningful action before another set of preventable deaths forces the issue back into the headlines.