Last month, Surya Mariappa and Nandini Nadar, two four year olds were brought to Sion and JJ Hospital respectively after they lost their eye sight because of vitamin A deficiency.
The two were suffering from Severe Acute Malnutrition (SAM), a physical indicator used by the World Health Organization to describe malnutrition.
Relatives said the children were not registered with an aanganwadi run under the central government’s 37-year-old Integrated Child Development Scheme (ICDS). Though the ICDS scheme (see box) is functional in the Santacruz slum where Surya lives and also in Malwani, Malad, where Nandini stays, both children didn’t get its benefits.
Experts said the scheme often missed those who were in real need of cooked food, micronutrient powder and monitoring, which is the aanganwadi’s responsibility.
Lack of adequate co-ordination between the agencies, government and private, means that all promised benefits don’t reach their intended beneficiaries.
For instance, the civic body has to administer vitamin A to children every six months, but health workers said it was not happening. “Two years ago, the civic body had told us to procure vitamin A as they didn’t have stock. But as it isn’t supplied regularly, people assume the BMC stopped giving it,” said Leena Joshi, project director of Transforming M/East, a community project in Shivaji Nagar area by TISS.
“We had a meeting with civic officials and they have agreed to provide vitamin A to the children. They will also allot slum areas to civic hospitals to conduct check up camps for mothers and malnourished children,” said Vandana Krishna, director general, RJMC Health and Nutrition Mission, an advisory body to the ICDS.
However, experts believe that intervention needs to happen at the pregnancy stage. Krishna said anaemic mothers and low weight at birth were major factors leading to malnutrition in children.
“Malnutrition begins in the womb: an undernourished mother delivers an underweight baby who will remain that way despite feeding,” said Dr Wasundhara Joshi, executive director, SNEHA, an NGO working for children and women.
To increase the efficacy of the scheme, government officials said they were trying to get agencies to co-ordinate. “We have identified 23 different departments that will have to work with the women and child department to reduce malnutrition,” said a senior government official.
However, non-profit groups believe that ICDS being a centre-based (aanganwadi) system lacks curative approach. There are 33 projects operational under the ICDS, each should have a child development project officer to monitor it. But there are only 13.
Space in cramped slums is another constraint. Under the scheme, Rs750 is allotted as rent for space to run the aanganwadis. Most are run out of one-room homes already occupied by a family. “As attendance in aanganwadis increases, congestion also increases, and adequately sized centres are difficult to find,” said Dhun Davar, chief executive officer, Apnalaya, an NGO working in Shivaji Nagar in Govandi.
Experts, however, warned that government figures for malnutrition could be grossly understated. “Aanganwadi workers have a tendency to under report, as they fear action,” said Joshi.
“Aanganwadis have been reduced to measly khichdi distribution centres,” said Leni Chaudhari, programme head, health, Narotam Sekhsaria Foundation, a charity trust.
When HT visited the aanganwadis, we found that many weighing machines were not in working conditions also. “We are aware of the problem and setting up a mechanism to have functional weighing machines,” said, Ujjwal Uke, principal secretary, state women and child development department.