On 13 August, 2009 the Chief Officer of Women and Child Development Department in Khandwa district, Madhya Pradesh visited Spandan, a human rights group working on right to food. Since the children died of malnutrition in 2008 (for more details on this, please refer to previous Hunger Alert), the local administration started a new project to supply more nutritional foodstuffs to the Anganwadi centres (AWCs; Child care centre). As a point of information, this Nutrition Rehabilitation Centre has been run for severely malnourished children on an emergency basis since 2008.
The Integrated Child Development Scheme (ICDS), implemented through the AWCs was launched in 1975. Certainly, it should have improved national health care not only for children under six, but mothers, including pregnant women, and adolescent girls as well. Why then is child malnutrition still rampant in the village? Why have children died of malnutrition again this year? Are the AWCs accessible and available in all villages? Are they in the remote areas where more people are vulnerable to malnutrition, reflecting food and health insecurity? Are all the efforts of the administrative authority merely a perfunctory duty which has been carried on unsatisfactorily for the past 35 years? Or has it created substantial improvements to eradicate malnutrition and child mortality?
The fact is that the AWC, an actual channel performing the ICDS, is the only direct agency providing nutrition and health care for the children and women in the village. Its role cannot be underestimated. The discussion between the administrative authority and the Spandan explains how the administrative authority has been neglecting its duty, and is merely concerned with symptomatic treatment.
Lack of basic infrastructure, nutrition, and human resources
To provide more nutrition for the children, the ‘Shaktiman’ project launched in the latter half of 2008 is a complement program to the ICDS. It runs six hours a day providing three feedings daily. The menu includes boiled potatoes, yams, puffed rice, porridge and powdered rice. Pregnant or lactating women are provided with Take Home Rations. The project has been implemented in 101 out of 300 AWCs within Khalwa Block, covering 50 villages.
AWC generally provides dry rations for the women and children. The Shaktiman project supplements other vegetables and rice, but not foods containing more significant vitamin and protein nutrition. In particular, children from Below the Poverty Line (BPL), families of tribal communities living in remote areas, find it difficult to qualify to receive nutrition supplements. The neglected two thirds of Khalwa Block were not given any supplies at all.
The administration started decorating child-friendly AWCs. However, what about the villages without AWCs? What about the places with no accessibility or availability?
Approximately 85 out of 300 AWCs do not have buildings according to government statistics. One worker and a helper cannot look after all the children and women from several villages. AWCs are not open the entire day. It opens only to provide supplementary grains. Six operating hours of the Shaktiman project is not long enough either. As a result, the worker and the helper do not have time to care for the children to create an authentic child-friendly environment. Regularly, working mothers find it difficult to take their children to the AWCs and to return to their working place. Thus, quite a few children do not attend the AWCs due to distance and inefficiency.
Mothers have to take their children to the farm when they work unless somebody can look after them at home during the day. The National Rural Employment Guarantee Act (NREGA,) recommends that women take their children with them when they go to work. This is neither efficient nor safe.
Loopholes in the Nutrition Rehabilitation Center (NRC)
Severely malnourished children are referred to the NRC at district hospitals. Until July 2009, 548 children were identified with severe malnutrition by the NRC. 238 children (44%) did not get treatment at the NRC. The mothers do not want to take their malnourished children there. According to Spandan, only 21 out of 70 doctors assigned to district hospitals are available. In particular, four pediatric posts are vacant. Absence of medical experts to treat malnutrition can be one of the main factors for the failure to prevent childrens deaths from malnutrition associated with other diseases.
The administration cannot attribute its failure to the mothers reluctance in bringing their children to the NRC. The lack of human resources and facilities at the district hospital and at the NRC are not encouraging to the mothers. In addition, it is difficult for mothers to bring their children and to stay at the NRC for two weeks at a time. This means that her other children are alone at home. She cannot do her usual work on the farm. Regardless of the child’s condition, the administration requires them to return home in two weeks. Moderately malnourished children categorized in grade I and II are left in the village. They only receive supplementary nutrition at AWCs.
It is recommended that under the active cooperation of the community and human rights groups, all stages of malnourished children should be regularly provided with sufficient nutrition, proteins, vitamins, and micronutrients. This service should take place at the AWC village level. The severely affected children should be properly treated by a child specialist with no time limitations. The time is ripe for the administrative authorities to effect drastic changes in their basic setups.
No foundation for health care and food security
The administration failed because they have not built a foundation of child health care at the village and community level for the past 35 years. All the efforts they have put forth are still doing no more than merely fulfilling their assigned duties. No vision or creativity has been shown in the situation. Little has been accomplished to improve and ensure child health and food security. There appears to be no close cooperation between the significant programs such as the Public Food Distribution Scheme (PDS), ICDS and NREGA, in guaranteeing health and food security.
Despite the vulnerability of tribes in this area, the food distribution has been cut down to 20 kilograms of rice and wheat per month, down from the 35 kilograms earmarked under the Supreme Court Order 2005. The tribes are more exposed to food insecurity at home since many of them do not have sufficient livelihood to support the family for the entire year. In addition, soaring food prices continue. If there is not a joint effort from all sectors to eradicate malnutrition and ensure food security, the children will remain malnourished and may well encounter the same fate as the children who died last year.
To encourage the administration to closely monitor and to make significant, long-term efforts to alleviate the child malnutrition situation in tribal areas, the Asian Human Rights Commission (AHRC) will continuously monitor the administration’s positive responses.
