hiring a vehicle. They also identified “giving birth” as a risk because mothers could not reach health centers due to inadequate road access, particularly during the rainy season (Van Dillen 2006).

While distance to health facilities in tribal pockets is an issue, a larger problem is of absenteeism of service providers. High absenteeism in turn is attributed to postings in tribal areas being perceived, generally, as ‘punishment postings’ that are assigned to the non-performers. Some frontline workers resign even before attending their first training; yet others continue to draw salary despite not visiting the Anganwadi or primary health center (PHC) for years altogether.

Migration of tribals during the lean season to cities and towns makes the task of health surveillance for antenatal care or immunization or growth monitoring of children even more difficult. For a family that is displaced often, getting their child immunized is no longer a priority. Finally, while administrators realize the value of recruiting local residents as field level medical personnel, it is often impossible to find even secondary educated tribal women who can fill the positions of nurses or female health workers. As a result the positions either remain vacant or are filled by non-tribal, non-resident providers.

**Poor health outcomes for tribals and their children need to be read against a context of their increasing alienation from traditional livelihoods, land and socio-cultural practices** . Mortality outcomes for tribal children in India cannot be analyzed in a contextual vacuum. Instead, they need to be looked at in the light of larger changes experienced by Scheduled Tribes as a people, more so in the past two or three decades. Changes in livelihood patterns and in socio-cultural practices as tribals enter the mainstream – all have an effect on tribal health indicators.

The relationship of tribals to land is beyond that of subsistence cultivation and extends to the use of forest products and their dependence on natural resources for a livelihood. This is evident given that about 60 percent of India’s forest cover lies in the 187 tribal districts covered by the Fifth and Sixth Schedules of the Constitution (Forest Survey of India Report, 2003). Estimates from Orissa indicate that one half to over one-fifth of annual income of tribal households comes from Non-Timber Forest Products (NTFPs). Many NTFPs (e.g. kendu leaves) are of high value and are prone to commercial exploitation. Their sale is usually governed by a complex set of rules and regulations and tribal rights activists allege that the state and middlemen work towards keeping the tribals’ share of the profits low. While there have been efforts to devolve the procurement and marketing of NTFPs to _gram sabhas_<sup>16</sup> , the lack of capacity of _gram sabhas_ in these areas has meant that middlemen may have benefited more than tribal people.

In addition to their tenuous hold over NTFPs, the Scheduled Tribes in India have also been gradually losing access to their traditional lands – a process that is referred to as alienation. The largest form of alienation from traditional land has taken place due to state acquisition of land for development. The 10th 5-Year Plan notes that between 1951 and 1990, 21.3 million people were displaced, of which 40 percent, or 8.5 million, were tribal people (Burra, 2008). Activists argue that such alienation and destruction of traditional livelihoods is the single largest factor

> 16 Orissa for instance has devolved the procurement and marketing of 69 NTFPs; the Gram Sabha is a village assembly of which each resident of the village is a member

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