With nearly half of its children malnourished, Madhya Pradesh has to work extra hard to contain and then remove this shame. That is a prerequisite for Madhya Pradesh to find a place among developing states, says Nivedita Khandekar
Let’s begin on an optimistic note. In most interviews on completion of one year in office, Chief Minister Shivraj Singh Chouhan has identified child and woman development as a top priority of his government. That is the most sensible thing for a chief minister of Madhya Pradesh to do, given the pathetic health indicators of the State.
For the chief minister of a State with half of the children being malnourished, every other dream should be an unaffordable luxury until the basic food needs are adequately taken care of. Over a dozen schemes are being implemented for improving health indices.
Funds to improve quality and quantity of diets to the poor have substantially gone up. However, commensurable improvement on the grounds is yet to be seen. The Chief Minister has admitted that the task is indeed daunting. The reports about plight of Sahariya tribe in the last few years must have made him focus on this sector.
That efforts in this direction are still inadequate is borne out by two recent developments. One, the National Family Health Survey (NFHS) III that says that malnutrition in MP has increased to 60 per cent since 1998-99.
Two, the Joint Commission of Enquiry (JCE), appointed by the Supreme Court, has dubbed predominantly tribal Sheopur district as one of the world’s ‘hotspots of malnutrition’.
The two reports have brought into sharper focus the (in)efficacy of the schemes and campaigns being implemented by the State Government. The Government has, of course, vehemently contested the NHFS report. It maintains that malnourishment in children below three years has actually come down from 57.57 to 49.13 per cent in the last five years.
“The NHFS covered only 2000 households in 21 districts of MP while the State Government’s data base was 80 lakh children covered in Bal Sanjeevani campaign,” points out Prashant Mehta, Principal Secretary, Child and Women Development.
The State Government has asked the Centre to have the NHFS reviewed. “Or, else, we will conduct an independent survey,” avers Mehta. The State Government’s protest is not unfounded. Its methodologies and scope are definitely more authentic than those of the NFHS. But the fact remains that even the 49.13 per cent malnourishment is still a grave cause for concern.
Sachin Jain of Right to Food Campaign, MP Support Group, which was set up as part of legal activism after a PIL on malnutrition in the Supreme Court in 2001, says, “If implemented properly, the schemes can make the much-needed difference.
Though more than 50 per cent children remained malnourished, the Integrated Child Development Services (ICDS) programme falls far short of need. There are only 50000 anganwadis against the needed 1.26 lakh and the management of these is woefully inadequate.”
“The anganwadis are not being run as expected. If these are strengthened, I think the picture can change,” says Trupti Tripathi, Indore’s Women and Child Development officer.
Even when an anganwadi workers identify a malnourished child, they are not able to help in the absence of doctors or health workers.
Official sources admit that 59324 anganwadis, which are catering to 60 lakh beneficiaries, are grossly inadequate. “We have urged the Union Government to open more anganwadis,” says a senior officer in the Woman and Child Development (WCD) Department.
He pointed out that the WCD budget has gone up from Rs 438.63 crore last year to Rs 590.10 crore this year. In the eighth round of the Bal Sanjeevani Abhiyan in November , nearly 80 lakh children were covered. Serious malnutrition has been brought down from 5.49 to 0.91 per cent.
From first to the last campaign the malnutrition has dropped by nearly eight per cent- from 57.57 to 49.21. However, according to data collected a few months ago by the Bal Sanjeevani Abhiyan scheme, 80000 children are suffering from most severe malnutrition and are on the verge of death.
The Abhiyan was launched by the government to address and control the problem of severe malnutrition in the State. It has completed eight phases since June 2001, but malnutrition persists.
Voluntary organisations feel that it is largely due to the manner in which children’s issues are vested with the WCD Department only. The Health Department as well as the Panchayat and Rural Development Department are not actively involved in addressing the menace. The WCD Department collects data from villages on children relating to their height and weight with the help of anganwadi workers and determines which children are malnourished. But the department does not collect data related to the livelihood, social discrimination and household food insecurity.
Now the district administration has taken this step at the state level and issued directions to prioritise such families with malnourished children in the Food for Work programme. But the implementation of the FFW programme is at the discretion of the Department of Rural Development which is not responsive towards children’s issues. A report prepared by RCVP Narhona Academy of Administration, which evaluated the Bal Sanjeevani Abhiyan affirms that the Health Department is not taking any responsibility.
The report also observed that even if children suffering from severe malnutrition were saved they would become blind due to the lack of vitamin A.
Malnutrition in itself is a multi-dimensional problem because it is related with the process of socio-political transformation like social behaviour, household livelihood, state services, equality and human rights with dignity.
It has been observed that immediately after the birth of a child, mother feeds it for around six months and then the child does not get nutritional food for his growth and development due to household food insecurity.
According to a report in Madhya Pradesh 37 per cent deaths registered between 0 to 4 years are due to chronic hunger.
“ The mission mode has helped the Government take care of the grade III and IV malnourished children during Bal Sanjeevani Abhiyan but we cannot change food habits and circumstances of those falling under BPL as yet. So we have to leave out 38 per cent BPL population,” says Dr Sanjay Dixit of MGM Medical College, Indore, Department of Community Medicine.
Dr Premlata Parikh of the government Chacha Nehru Children’s Hospital at Indore agrees. The WCD has tried to provide daliya (porridge) and panjiri (bulgar) to children up to the age of six years. But this approach has had limited success.
MP is one of the most populous states in India and together with Bihar, Orissa, Rajasthan and Utter Pradesh will account for 50 per cent of the country’s population by the year 2012, says the 10th Five-Year Plan of Planning Commission. It is also the state with the highest malnutrition. Experts say low birth weight babies - 55.1 per cent in MP - are more vulnerable to malnutrition deaths.
Government officials usually say that children are dying due to TB, diarrhoea and measles and not due to malnutrition. True. But they conveniently forget that malnutrition creates the ground for these diseases. Only 31 per cent of immunisation has been done in Madhya Pradesh, for which the health department is responsible.
These diseases occur due to the lack of immunisation and decrease the life expectancy of children. Again, the Women and Child Development Department is held responsible for children dying, even though the health department has responsibility too.
Amidst all this, the Department of Child Development announced a new scheme in August 2005 called Bal Shakti Yojana. According to the department, severely malnourished children will be hospitalised and State will also make arrangements for their parents taking care of them in the hospital. The government says it is going to spend an amount of Rs. 12 crores under this scheme, but the facts and figures make these colourful dreams dark.
One, according to a perspective document of the Health Department itself, only a tiny Rs 125 per person is being allotted in the annual budget of the department and this includes costs of medicines and other services. Two, in MP there are only 12407 beds available in the rural hospitals which are always occupied even when services are not available.
Further, there are only 90-child specialists working in the state system. The state health system requires 718 doctors, (428 in community health centres, 48 in district hospitals and 6 in medical colleges) and emergency doctors. But due to the pressure of the government’s work culture and unavailability of infrastructural facilities, many doctors are not ready to work in rural areas. Ignorance and illiteracy also contribute to malnutrition.
As Sadhana Khoche-Streubel of Kalyani Institute of Community Development working in Katthiwada block of Jhabua district points out.
“For most of these tribal people, health is not a priority at all. Besides, they do not have any trust in the government system”.
Dr Parikh points out to peculiar social problems. The social set up is such that a girl child is not given proper food and even during pregnancy, the expectant mother is not properly fed.
Dr Savita Inamdar, former chairperson of State Women’s Commission, says, “Most programmes are not people- friendly. These need to be framed according to awareness level of the masses”. Moreover, she adds, all these are target-oriented schemes and most of the projects follow a tubular vision.