My name’s Aalok, and I have spent the past year working at Swasthya Swaraj. We are a non-profit organization dedicated to the holistic upliftment of the Kutia Kondh people, an indigenous community living in remote hamlets and villages deep within the dense forests of south-western Odisha.
The region carries a disproportionately high prevalence of illnesses such as malaria, tuberculosis, severe acute malnutrition, sickle cell disease, and anaemia. Swasthya Swaraj has relentlessly been working towards the reduction of their incidence with the help of grassroots programmes that focus on preventive care, early diagnoses, prompt interventions, and timely referrals.
There is reduced food intake and food diversity during the lean season between the Rabi and Kharif crops. Most households have only one meal a day during this period.
One of the biggest challenges we face is the high incidence of malnutrition, both as a cause and a consequence of disease. Recurrent illnesses such as malaria, gastroenteritis, and pneumonia further worsen the situation, especially in the paediatric age group. Studies among Odisha’s Particularly Vulnerable Tribal Groups (PVTGs) indicate about 75% underweight prevalence and about 55% stunting among underfive children, with an even higher prevalence among girls. Nearly 38–44% of adults in tribal communities are underweight. This indicates that nutritional deprivation spans across all age groups.
There are several reasons that contribute to this, and it is driven by interlinked structural factors. There is poor dietary diversity across all seasons. Most households here consume rice with dal and a small quantity of a selected group of vegetables (commonly chilli, onion, brinjal, and cauliflower). Green leafy vegetables such as saga are eaten less than once a week, and there is little or no use of cooking oil.
There is reduced food intake and food diversity during the lean season between the Rabi and Kharif crops. Most households have only one meal a day during this period. This is largely because of poor employment opportunities/difficulties in migration, non-availability of forest products, and financial constraints.
This leads to poor maternal nutrition, which subsequently leads to low birth weight and intergenerational malnutrition.
There is a high incidence of protein deficiency, which may be attributed to a reduction in the diversity of pulses and legumes. Although several varieties (such as kandula, kolatha, and black gram) are cultivated on mountain slopes, households often sell them without keeping adequate amounts for the household’s nutritional security. Meat is consumed only on special occasions such as festivals and marriages, sometimes only once or twice a year, when villagers consume mutton or pork. Chicken and eggs are consumed once a month or so from the poultry that they rear, whereas dried fish is consumed on special occasions.
The incidence of malnourishment is higher amongst women of all age groups. This may be explained by factors such as low school enrolment amongst young girls due to familial pressure (being forced to care for younger siblings, being forced to work in the fields), neglect of the girl child, and social customs such as women eating after the boys and the men have been fed. This leads to poor maternal nutrition, which subsequently leads to low birth weight and intergenerational malnutrition.
There is also a high incidence of calcium deficiency. This is because the Kutia-Kondhs believe that the consumption of milk is a cultural taboo, as a result of which very few households consume dairy products. The availability of finger millet, a rich source of calcium, has declined over time because of monocropping practices and heavy reliance on rice.
The advent of high-yielding rice varieties and modern agricultural practices is leading to the loss of local germplasm and genetic diversity.
The calorie intake has certainly gone up because of the government’s rice-distribution scheme. However, a calorific deficit still exists amongst vulnerable population groups such as women and children. Moreover, because rice is cultivated primarily for subsistence, families often sell their best produce. This leaves them with lower-quality grains, which in turn contributes to poor nutrition.
The increased dependence on the public distribution system, as well as the government’s high paddy procurement price, has also led to an increased consumption of rice. There has also been a decreased consumption of millets. This is likely to lead to an increase in the incidence of noncommunicable diseases such as diabetes.
The presence of unofficial (and often oppressive) credit networks, coupled with the fact that most people have small unirrigated land plots, further compounds the problem of food insecurity.
The increasing loss of traditional rice varieties also needs to be addressed. Tribals cultivate many landraces. Most of these traditional landraces harbour genes resistant to diseases, insects and pests, and abiotic stresses. They also have genes for richness in nutritional value and taste. The advent of high-yielding rice varieties and modern agricultural practices is leading to the loss of local germplasm and genetic diversity. This cultivation mostly takes place as monoculture. This is leading to the gradual diminishment of traditional varieties. This further increases the incidence of crop failure.
We help them to learn about culturally appropriate measures that they can implement to improve their families’ nutritional status.
One final consideration is that forests form an important part of livelihood security. They supply food, fodder, fuel, house-building materials, medicinal plants, and herbal products. They are also home to Mahua trees, the fruits of which are collected for extracting cooking oil, and the flowers of which are brewed into liquor. Increased demand for timber due to rapid industrialisation has led to large-scale and illicit felling of forests. This has led to biodiversity loss, which in turn has an impact on the tribal economy, which is heavily reliant on forest produce.
One of our interventions that has been making a substantial impact in the community’s nutritional status is the rural creche programme. Our creches are run in 60 of our project villages. They serve more than a thousand children between ages 7 months and 3 years. These centres, which are open from 9 am to 4 pm, enable young mothers to work in the forest, and on their mountain farms. They are run through community participation. Enrolled children are provided nutritious meals, hygiene care, supervised rest, and intellectual stimulation through play and learning. This fosters better physical and cognitive development, as well as social and economic growth. Additionally, their physical growth is monitored regularly, and severely and moderately malnourished children are provided special focus. Caregivers are trained to provide first aid and refer sick children to the nearby clinic if the need arises.
Our nutritional interventions prioritise under-5 children and pregnant and lactating women. We do this through our special monthly nutritional clinics for SAM and MAM children. Our village-level volunteers identify and refer affected children to our clinics. During these clinics, we teach parents about the importance of nutrition. We help them to learn about culturally appropriate measures that they can implement to improve their families’ nutritional status. Sick children are screened for diseases such as malaria and pneumonia, and are provided outpatient/inpatient care. Additionally, we provide antenatal and postnatal care in our project villages. We screen for anaemia and malnutrition, and provide appropriate supplements.
Traditional forest dwellers should be enabled by giving them land rights and allowing them to protect and manage forest resources.
We also work closely with 15 government schools through our Health and Nutrition Promoting Schools programme (HNPS). We ensure the availability of midday meals, strengthen hygiene practices such as routine handwashing, and provide nutritional awareness. We have also tried to increase food diversity by the setting up of kitchen gardens in these government-run schools. We conduct training programmes that encourage the cultivation of locally available seasonal vegetables.
Whilst some of these interventions have demonstrated a positive impact in the community, the need for broader, structural change remains essential. Some additional measures that should be implemented include increasing nutrient diversity, through the promotion of traditionally cultivated millets, pulses, legumes, and landraces. This can be done by establishing community seed banks to promote traditional agriculture.
The government should also aid tribal communities during the lean season by promoting rural employment, providing food subsidies (keeping in mind the nutritional deficits faced), and providing migrant labourers with alternate livelihood sources in their native villages.
Traditional forest dwellers should be enabled by giving them land rights and allowing them to protect and manage forest resources. The recognition of community forest rights and the subsequent formation of community forest resource management committees can lead to more sustainable forest management. This will improve both forest health and the food security and livelihoods of local people.
Lastly, all the severely malnourished children in the region should be routinely screened for illnesses such as malaria, and strengthening of the region’s primary care delivery as well as robust referral links for nutritional rehabilitation will ensure better health outcomes.
If we strive towards improving the nutritional status of the Kutia-Kondh community, we can achieve many things in the process, including better health outcomes for children and mothers, more livelihood security, more resilience to climate change, and better management of ecological resources.