It’s a silent epidemic that we’ve never been able to put a finger on. In debates on food security, the issues of hunger and malnutrition have always been add-ons. But for millions, getting the next meal is the difference between life and death. Four-year-old Akash Sahariya can barely stand up. His bleached hair, distended belly and matchstick arms are harbingers of certain death that awaits him. He is the fourth child (and only son) of Kashumal, an adivasi mother living in Bankuri village in Madhya Pradesh. Kashumal’s second daughter gave up the fight for survival at four. The poor tribal mother does not realise that her children’s lives, lost to malnutrition, could have been saved.
All the 56 families in this village are from the Sahariya tribe. They are below poverty line (BPL) families. The village is 20 km from Karahal block town; the nearest bus stop is 8 km away after which one has to walk through jungles of thorny leafless bushes to reach the village. Needless to say, there is no school, anganwadi or ration shop in the village. The only tubewell has been dry for six months in the year and when it does fill, the water is contaminated. Only the very old and very young stay back in this hellhole, everyone else migrates to the Chambal valley, 40 km away, or beyond.
Karahal symbolises the tragedy of so many parts of India where the sons of the soil sit on mineral and other resources but don’t have the means to stay alive. But, to many in the media, their stories are not sexy enough. They are people with no purchasing power and no influence. Sadly, even those who purportedly speak in their name, the Maoists, seem more worried about mining the wealth and controlling it. As for the health of the people to whom this legitimately belongs, who cares?
But the latest National Family Health Survey-3 (NFHS) data tells us that Kashumal and her son Akash are no exception. Almost half the children under the age of five in India are chronically malnourished. That is, they have very low height for their age. Forty-three per cent of children under the age of three are underweight, a rate twice as high as the average in sub-Saharan Africa and 20 times higher than would be expected in a well-nourished developed country. Further, 20 per cent children are severely malnourished. ‘Severity’ is a term used to refer to low weight for height. Or, in other words, describing the condition of wasting away. Seven out of 10 children in India are anaemic.
Madhya Pradesh has the most number of malnourished children, followed by Uttar Pradesh and Bihar. In terms of belly count, of the approximately 180 million chronically malnourished children worldwide, more than one-third is in India. Of this, over 8 million children suffer from acute malnutrition or severe wasting. This is recognised by experts as one of the major killers of children under five and is responsible for approximately one million child deaths every year.
Having been part of an organisation that feeds over a million schoolchildren everyday and having spoken to hundreds of brave mothers of malnourished children across the ‘hunger route’ of India, I believe that this shame of hunger and malnourishment can definitely be eradicated. I think it’s long overdue that we give this ‘non-communicable’ disease its due share of attention. And the solutions are not rocket science, but simple and doable.
First, there is neither hide nor hair of either the public distribution system (PDS) or the schemes under the National Rural Employment Guarantee Act (NREGA) in any of these regions. Public health centres and potable water have never been seen or heard of. The universalisation of the PDS or fortification of foodgrain will do nothing to help these starving people. The real challenge, which we don’t seem up to so far, is to identify all the villages and blocks where we have a concentration of hungry and malnourished children, tag them and have a targeted programme across these villages on a war footing. Let there be a state of nutrition ‘emergency’ declared in these villages.
And while initiating targeted interventions, we need to build up a data bank of severely and acutely malnourished children and track how therapeutic food can save their lives. After this, both these children and the moderately malnourished ones should be tracked. They should, through the anganwadi system, be given food through ‘nutrition outposts’ (how about putting post offices to use for this?) which if found to falter should be made a culpable offence. Those who shortchange these children are condemning them to death. Of course, for these outlets to be corruption-proof, we will need the involvement of civil society, gram sabhas or community-based organisations set up exclusively for this purpose.
Second, we need to extend the idea of social security or ‘right to work’ that is behind NREGA in a different way. Why can’t the State provide wages equivalent of six months to all expectant as well as lactating mothers in the unorganised sector — their version of the organised sector’s maternity leave? This will ensure that these frail women will get at least six months of much-deserved rest. These wages can be credited into their accounts directly or given as money orders on a monthly basis.
Third, let the hunger and malnutrition data in these blocks and districts be monitored and reviewed at least annually. Everyone from the district collectors to the prime minister can make this a mandatory statistic that will be tracked as an index of progress and development. The blocks with the fastest turn around and the best officers can be given suitable incentives. Needless to say, there will have to be objective third party assessments held annually.
Fourth, two major subsidies — for fertilisers and fuel — both politically-motivated and economically unsustainable can be phased out and invested in targeted universal coverage of nutritional security of the inhabitants of the worst 100 districts. But for Kashumal and millions of similar mothers to access food supplies and nutritional supplements, we need to know where to locate them. These villages need to be tracked, the children tagged and only then can any meaningful intervention become viable.
The first step in this battle against HUNGer and MALnutrition is for us to identify on a real time basis where these millions of children live and how many have survived since the last NFHS data was collected in 2005-06. Further, to have precision targeting for maximum impact we need data disaggregated at district level, if not block levels. Current NFHS data at the state level is too much of a helicopter view for any meaningful intervention to be carried out.
We could call this survey HUNGaMA, because surely that is what we must make so that so many children don’t die so early and so painfully.
Manoj Kumar is CEO, Naandi Foundation and a Core Member of the Citizens’ Alliance to Fight Malnutrition. The views expressed by the author are personal