The title of the study report, ‘Systems that failed – Major gaps in public systems for tackling malnutrition among children below three years of age’ actually says it all. And it seems the gaps are rooted in the different approaches followed by the two key ministries dealing with malnutrition: the Health & Family Welfare and Women and Child Development.
As the study points out, the Integrated Child Development Services (ICDS), run by Ministry of Women and Child Development and health system today follow divergent criteria for identifying malnourished children.
As a result, many malnourished children are denied services from Nutrition Rehabilitation Centers (NRC). In this qualitative study which covered 55 children across tribal areas, rural districts and urban areas of Maharashtra including Amravati, Nandurbar and Gadchiroli, 24 out of 55 severely malnourished children were not referred for any treatment and out of seven severe acute malnutrition (SAM) children, only one was identified with SAM by ICDS.
As Dr Vandana Prasad, former Member, National Commission for Protection of Child Rights, who released the report pointed out, the ICDS today does not deal with all malnourished children, they only focus on treating SAM. Thus, ICDS effectively waits for a child to become severely malnutritioned, before taking action, instead of taking comprehensive preventive measures.
For instance, in the areas covered by the study, researchers found that malnutrition was not being detected early enough at the anganwadi level because workers were not aware or trained to use WHO standards to detect malnutrition. Instead of using the three criteria mandated by WHO viz. weight for height/ length, upper arm circumference (MUAC), and edema (swelling on feet), anganwadi workers were recording only the first.
Thus children were being labeled as severely underweight (SUW) or moderately underweight (MUW) using growth charts when they were actually in the SAM or moderate acute malnutrition (MAM) categories.
As they were not being identified properly, these children could not avail essential services such as Village Child Development Centers (VCDC) or referral to NRCs for malnourished children.
Worse, VCDCs were observed to be closed in the region covered by the study and since NRCs were only at the district/ sub-district level, they were inaccessible in most cases. And when families did get help, it was quite a waste: Take Home Ration (THR) packets were not being given to children due to the ‘bad taste’ and in some cases mothers admitted to feeding them to animals like cattle, hens and dogs.
Clearly, there is a lack of coordination between ministries and their implementation agencies, with a lack of supervision and investment in training resources at the frontline of the battle against malnutrition, i.e. the anganwadi workers and families of such children, especially mothers.
Such first hand ground reports, like the study released at TISS, question the validity of official malnutrition statistics like Union Minister of Women and Child Development, Maneka Gandhi’s statement in a July 23 PIB release, that there is a reduction in underweight among children under five years of age from 42.5 per cent in the National Family Health Survey (NFHS)-3 to 29.4 per cent as per a provisional India Fact Sheet of the Rapid Survey on Children (RSoC) commissioned by her Ministry with assistance from UNICEF India.
While there are corporate bodies and NGOs involved in the battle against malnutrition, activists like Ulka Mahajan of the Anna Adhikar Abhiyan point out that with nutrition being a constitutional right, it is the government’s duty to set the agenda and implement it and cannot be allowed to walk away from this duty.
While there can be partners from the private or NGO sector, this might lead to a piecemeal approach with each third party having different approaches (and agendas). One hopes that the Maharashtra Government takes strong and speedy steps to plug the gaps identified in this report. Solving larger socio-economic issues like the impact of migration on malnutrition will take long term action but work can certainly start at the grassroot level, with every anganwadi worker being taught to correctly categorise the children under her care.
Ending on some good news from the study: Pilot studies on community based monitoring and action to improve child nutrition have shown some positive results which can be scaled up to larger areas. Which shows that where there is a will, there is a way.
Viveka Roychowdhury
Editor