Kolkata: Two tragic starvation deaths in the previous fortnight during the 76th independence day celebrations have rattled the state. Both the two deaths were reported from backward regions of West Bengal – one from Bhulabheda of West Medinipur district and the other from Kranti block of Malbazar in Jalpaiguri district.

The first incident involves the death of Sanjay Sardar died on August 3 due to malnutrition as he was left without food for days. The family has been in dire straits after he contracted tuberculosis in the month of June and Sanjay, a daily wage earner, could not go to work.

Though on paper there are schemes like Laxmi Bhandar and other schemes; however Sanjay didn’t have the required Scheduled Caste (SC) certificate, resulting in his family not receiving the stipulated Rs 1,000.

Based on a report by a Bengali news daily, a team from the Right to Food and Work Campaign visited Bhulabheda recently and surveyed the condition of people living there. In the fact finding report it is stated that the death of the daily wage earner should be seen in the context of the food crisis that has set in the area. Sanjay’s family admitted to the fact-finding team that getting even one square meal for a day was difficult for them. Moreover as the family didn’t have Aadhar card linkage with their ration card, they did not get the stipulated Rajya Khadya Suraksha Yojana (RKSY 2) ration which is monthly 1 kg of rice and 1 kg of wheat.

Sanjay Sardar was a migrant labourer who lost his job during the first lockdown, according to the report. After coming home in March 2020 he did not get any work in the village. Sometimes, he got paid as a farmhand but that was extremely irregular. While the family needed an Antyodaya Anna Yojana (AAY) ration card, the government instead gave them a RKSY 2 ration card which is meant for relatively better-off persons. It should be noted that in AAY scheme, a family gets 35 kgs of rice and wheat and cereals.

The second starvation death occurred in a closed tea garden where a tea garden worker, Dinesh Orao, lost his life on August 13 due to malnutrition as he was left without food for months.

The name of the tea garden is Raj Project Garden. As the tea garden owner, Dharmendra Thakur arbitrarily closed the plantation on July 10, Orao’s family had been starving for months.

“The owner of the garden is singularly responsible for this death,” family members of the deceased told reporters.

It may be recalled that in the Malbazar area, a number of tea gardens including Nageshwari tea estate, Bagrakote tea estate, Kilkote tea estate and many other tea estates are closed, and this has resulted in widespread hunger among tea garden workers in the area.

Courtesy: Newsclick

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In the first week of the ongoing Lok Sabha session, a few questions were asked about child health and the central theme of these questions centred around malnutrition. A recent UNICEF report has found that India ranks highest in annual number of deaths of children under the age of 5. Here’s a brief look at the findings of the report that also examines how India’s heath care policies have been able to cope with the issue of malnutrition, which is the cause of 68.2% deathsof children under 5 years of age.

About the report

The UNICEF report titled “The State of World’s Children 2019-Children Food and Nutrition” is being annually published by the UNICEF since 1980. The aim of publishing this report is to spread awareness and knowledge about issues affecting children and it advocates solutions that can improve children’s lives. This report is one of the many initiatives of the UNICEF. The report states that the triple burden of malnutrition – under nutrition, hidden hunger and overweight – threatens the survival, growth and development of children, young people, economies and nations. The overall findings of the report are that, at least 1 in 3 children under 5 is undernourished or overweight and 1 in 2 suffers from hidden hunger, undermining the capacity of millions of children to grow and develop to their full potential.

The UNICEF report may be read here:

India findings

According to UNICEF, 38% of children under the age of 5 in India suffer from stunting. In the worst affected state, almost 50% children suffer from stunting: in the least affected state 1/5th of the children suffer from stunting. Stunting is a clear sign that children in a country are not developing well – is both a symptom of past deprivation and a predictor of future poverty. The report also explains the triple burden of malnutrition, being – under nutrition, hidden hunger and overweight – which undermines children’s health and physical and cognitive development. Analysis of 2011-12 data suggest that in India 5% of rural and 8% of urban population bears the triple burden of malnutrition.

The report states that although India stands a chance of a good demographic dividend in the coming years, the same can only be realized with improvement in human capital, by investing in people’s education, training, skills and health and malnutrition stands as a hurdle in the path of a good demographic dividend in the future.

The report also mentioned that India’s health system provides curative care and foster positive family practices such as breast-feeding. In India, national and state governments implemented a multi-pronged strategy to support breastfeeding, including large-scale programmes, effective capacity-building initiatives, strong partnerships, community-based action, and communications campaigns. As a result, early initiation of breastfeeding rose from 24.5 per cent in 2006 to 44.6 per cent in 2014.

There was also a detailed mention of how India’s Comprehensive National Nutrition Survey (CNNS), which ran from 2016 to 2018 across all states captured the nutritional status of pre-school, school going children and adolescents up to 19 years of age.

Yet, India topped the list of countries with highest annual number of under-5 deaths in 2018, at 8,82,000 such deaths.

Malnutrition

India’s struggle with the malnutrition among children under the age of 5 (U-5) has been a long one. Malnutrition refers to a pathological state of deficiency or excess of nutrients. Under nutrition is known to be one of the most common causes of morbidity and mortality among children <5 years of age.

India’s policies tackling malnutrition

India has multiple health schemes many of which promote maternal care and nutrition as well child care and nutrition and there is a lot of awareness about the same among the masses that need it the most, i.e. the poor (urban as well as rural) and the rural population at large. One of the most successful models of child health and nutrition is the Integrated Child Development Scheme (ICDS) which was originally launched in 1975 but gained traction much later. ICDS was providing ineffective in tackling the issue of malnutrition as providing primary health care and nutrition is not the only provision in the scheme.

The government later launched Nutrition Rehabilitation Centres (NRCs) at public health centres to treat Severely Acute Malnutrition (SAM) cases. A recent study of these NRCs revealed that shortage of human resources was one of the major issues faced by them. The study was carried out in 4 NRCs and it was observed that only 70% of doctors, 7.4% of nursing staff, and 30% of attendants and cleaners were available across the four NRCs. NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted. To sustain the benefits and prevent relapse, there is a need to integrate the services at NRC with the community-based therapeutic care to deliver a continuum of care from facility to doorstep and vice versa.[1]

By the insertion of Article 21A in the Constitution, the right to education, hitherto an obligation on the State under the Directive Principles of State Policy became a justiciable right: through this, the 86th amendment to the Constitution in 2002, the State must provide free and compulsory education to all children of the age 6 to 14 years. The 86^th amendement also went further. It replaced Article 45 that comes under the Directive Principles of State Policy and was previously the only provision related to the right to education with a renewed pledge to read (amended Article 45): “The State shall endeavour to provide early childhood care and education for all children until they complete the age of six years.”

CNNS (Comprehensive National Nutrition Survey)

In the data provided on the Lok Sabha recently mentioned that CNNS results highlighted improvement in the U-5 category stating that in comparison to NFHS -4 (National Family Health Survey) which was carried out in 2015-16 there was reduction in cases of stunting from 38.4% to 34.7%, in cases of wasting from 21% to 17.3% and in cases of underweight children from 35.7% to 33.4%.

POSHAN (Prime Minister Overarching Scheme for Holistic Nourishment)

Under POSHAN, the government aims to attain a malnutrition free India by 2022. It was launched in 201 by Prime Minister Modi and it targets to tackle malnutrition by ensuring convergence of various nutrition related schemes. Its large component involves gradual scaling-up of interventions supported by on-going World Bank assisted Integrated Child Development Services (ICDS) Systems Strengthening and Nutrition Improvement Project (ISSNIP) to all districts in the country by 2022.

Since POSHAN is the foremost policy for tackling malnutrition and has such an ambitious target of eliminating completely, the menace of malnutrition that has plagued India’s health care for years now, it is important to study how well and effectively has this ambitious policy been implemented.

The government had planned to release a “Status of India Nutrition” report in March 2019 to rank states according tot heir performance under the POSHAN Abhiyaan. The report however, has not yet been released.

An opinion piece in Livemint argued that Anganwadi centres are supposed to be the point of delivery of all health related schemes and these centres are themselves struggling with infrastructure problems. Around 24% of them lacked their own building and operated from small rented premises, and around 14% lacked pucca buildings. Only 86%, 67% and 68% of AWCs had drinking water facilities, electricity connections and toilets respectively, some of which are either dysfunctional or could not be used due to conditions imposed by landlords. There is also lot of room for improvement in terms of achieving universalization of coverage and advanced service delivery in health care. When the cogs that POSHAN scheme depends are only not functioning at their best output, how can a scheme like POSHAN with such a behemoth task achieve its target completely.

It was reported in September 2019 that a recent study conducted by Indian Council of Medical Research (ICMR) estimated that many Indian states are running behind and may not be able to reach their targets under the POSHAN Abhiyaan.

Way forward

This indicates that India has still a long way to go in achieving its goal of eradicating malnutrition and thus malnutrition related deaths. What India needs is one integrated health plan for children below the age of 6 where all current elements of health care are firstly provided with the infrastructure they need and ensuring maintenance and periodic monitoring of records and data (for ease of assessment of performance) and regular and timely follow-ups. While awareness already exists, multiplicity of schemes makes the task convoluted.

Related:

Most states won’t meet Poshan Abhiyaan targets to curb child malnutrition: Study

Karnataka gov’t delays malnutrition alleviation report, HC warns of contempt proceedings

Gates Foundation study: Child malnutrition reduction targets impossible to achieve

38% Of Indian Children Under 4–Poor And Rich Alike–Are Stunted: Study

Mini Anganwadis Could Help The Poorest And Most Disadvantaged

Why India Is Likely To Miss Its Nutrition Targets For 2022

Budget for Children in #NewIndia in 2018-19

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Image: HT / File Photo

Giridih, Jharkhand: The earthen stove in 58-year-old Savitri Devi’s house had not been lit since May 30. All the borrowed rice she and her two daughters-in-law had procured was not enough for the family of five including three children. Her two sons, working in different states, were unable to earn any money that could be sent home for six months. After surviving on a little bit of rice and its starch, she allegedly breathed her last on Sunday after not having eaten for three days.
 
She would have lived if the authorities had done due diligence and processed her ration card. “Due to the negligence of authorities, her ration card could not be made, which is why she was unable to get food,” a district official Sheetal Prasad told news agency ANI.
 
In a report by Hindustan Times, Deputy development commissioner (DDC) who is officiating as deputy commissioner (DC) of Giridih, Mukund Das, denied the starvation theory and said the investigation is underway. “Initial findings say the woman was suffering from paralysis and she could have succumbed due to it. A team of senior officers has been sent to the village to conduct a detailed inquiry,” he added.
 
Ration cards and Aadhaar cards: Service or Weapon?
What was meant to make lives easier and serve people better is being used as an instrument of harassment.
 
“Several people have died of alleged starvation in Jharkhand in the last few months. Eleven-year-old Santoshi Kumari died crying for rice in Simdega district in September. In January, Lukhi Murmu, a 30-year-old woman from Dhawadangal village in Pakur district, reportedly died of under-nutrition and exhaustion. According to a fact-finding report by activists from the non-profit Right to Food Campaign, Murmu had been denied rations since October because the Aadhaar-enabled point-of-sale machine at the local ration shop had failed to authenticate her biometrics,” stated a report by Scroll.
 
State manufactured starvation-related deaths are not new for Jharkhand. Four such deaths were reported in Jharkhand last year and now two have occurred within 10 days of each other. It seems that they have learned nothing from Santoshi’s death. Authorities have clearly denied rightful food to legitimate ration card holders who are dependent on this access to cheaper food.
 
In a timeline of such deaths and their link to ration cards and Aadhaar cards, The Wire chronicled the apathy of authorities and their negligence. It stated-
 
Though the state government had initially stated that Santoshi was ill and suffering from malaria, Jharkhand food and civil supplies minister Saryu Roy had later admitted their mistake. “It’s a fact that the names (of Santoshi’s family) got struck off the ration list due to Aadhaar issues, which means they stopped getting ration. The cancellation of the family’s ration card was our mistake. We are on the back foot,” Roy was quoted as saying.
 
In late October 2017, Ruplal Marandi died in Deoghar district after being denied grains as the Aadhaar-based biometric authentication of members of his family had failed. Then on December 1, a 64-year-old widow, Premani Kunwar, died of hunger and exhaustion in Danda Block of Garhwa district, Jharkhand. In her case, the Aadhaar-based payment system had redirected her pension money to a different account without her knowledge, they alleged. She was also denied her foodgrain entitlement in August and November.
 
Finally, on December 25, Etwariya Devi, a 67-year-old widow, reportedly died due to starvation in Sonpurwa village of Garhwa district’s Majhiaon block. Her family was reportedly unable to procure food after the Aadhaar-enabled point of sales (PoS) machine couldn’t authenticate the biometrics of her daughter-in-law.
 
All these deaths took place after the Jharkhand government cancelled 11.6 lakh ration cards claiming that these were bogus as they were not linked to Aadhaar by their holders. The information of these cancellations was provided by the state secretary of food and civic supply Vinay Chaubey.
 
Gaurav Vivek Bhatnagar also reported on Savitri Devi’s demise and the ration cards that were denied to her family. 

“Despite such a state of affairs, even as the family slipped into dire straits and battled to gain access to government foodgrains, no support was forthcoming from village or block officials. “The family did not have a ration card and it was the main reason why it had no access to subsidised or free foodgrain through the PDS. District officials told the media that they were probing if Savitri Devi’s family had submitted an application to get a ration card made. Ram Prasad Mahto, the head of Chainpur panchayat, said Poornima Devi (daughter-in-law) had met him and that he had verified her ration card application, but he was unsure if she had submitted it in the block office for further procedure. His statement assumes significance as it is being alleged that the forms of 120 beneficiaries were indeed sent for endorsement to the panchayat sewak (panchayat helper), but he had not carried the process forward. The local legislator, Jagarnath Mahto, expressed his regret at the starvation death and termed it an example of the failure of the state BJP government’s inability to meet the needs and aspirations of its residents,” said the report.

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The report compares the average consumption of different food groups by the urban population, to the scientifically calculated Required Dietary Allowance (RDA). RDA, for any food group, is the amount which a person needs to consume every day to avoid malnutrition. Upon such comparison, it was found that India’s urban population, which constitutes about more than 30% of the country’s population, consumes far lower amounts than what is required to stay healthy, of most food groups.

An average urban household consumes only 69% of the RDA for cereals and millets. This means that they fall short of the RDA by 31%. Similarly, most households consume only 81.3% of the RDA for milk and milk products and only 59.5% of RDA for green leafy vegetables.

In contrast to these shortfalls, the consumption of Roots and tubers was 188% of RDA and the consumption of oils was 159.5% of the RDA. Clearly, it shows that the families’ consumer more of the cheaper food groups.

This pattern of food consumption had a direct impact on the health and well-being of the families, with the population being deficient in most of the vital nutrients.

The average urban family was deficient in the macronutrients – protein and energy, both falling short of the RDA. The average family was also deficient in vital micronutrients. The intake of Calcium, Iron, Vitamin B1 and Vitamin B3 was significantly lower than the RDA, while the intake of Vitamin B2 and Vitamin A were abysmal at 50% and 23% of the RDA.

Families have sufficient intake of only two important nutrients, Vitamin C and Vitamin B9.

The effect of the insufficient nutrient intake has a particularly large impact on the children from urban families, with more than 25% of children below 5 years of age suffering from undernutrition. The report also indicates that children from urban poor and deprived communities are the most affected by undernutrition.

It is generally thought that malnutrition is a problem of rural India. But when we compare the present report with a similar one on rural India, brought by NNMB in 2012, the extent of undernutrition is not significantly different in urban and rural areas. For example, an average rural family, in 2012, was consuming 85% of the RDA for protein as opposed to 89% by an average urban family in 2016.

What is the reason behind the persistently high rates of undernutrition, even though India has grown at very high rates in the past decade and more?

The government claims that poverty rate in India has fallen from 45% to 21.9%, between the 1990s and the 2010s. If that is indeed the case, it is a significant reduction in poverty, by more than half. But the data on undernutrition gives a different and a less optimistic picture. Between the 1990s and 2010s, the percentage of children (under 5) who were underweight fell from 43% to 35%. A modest fall of 7 percent compared to a fall of 25 percent in the official poverty rate.
Could it be that the so-called trickle down of economic growth to the poor urban working class was not substantial enough to compensate for the gradual withdrawal of the government from the provision of affordable food in the form of Public Distribution System (PDS) and other welfare schemes?

It has been widely covered by many researchers, how a shift to a targeted form of PDS, where families were arbitrarily classified as below poverty line (BPL) and Above Poverty Line (APL) deprived many families of affordable rations, thereby negatively affecting the nutritional status of these families. The results are clear to see in the data above. Undernutrition persists despite the decline in official poverty figures.

The poor coverage of ICDS (Integrated Child Development Services) in the urban areas, could also be a significant reason behind the dismal nutritional indicators of children in urban areas. Even though urban population constitutes 31% of India’s total population, only 10% of the ICDS projects are allotted to urban areas and only 8% of all Anganwadi centres are situated in urban areas.

A significant part of urban working families, who live in unregistered slums, by the same reason are denied access to ICDS. Similarly, the poorest of the urban families which tend to migrate to different regions, depending on the availability of work, loose access to ICDS. As a result, children and pregnant women who are most vulnerable to undernutrition in urban areas, are not served by ICDS. These same factors also affect the access of the urban poor to PDS, which has already been diluted through targeting.

One hopes that the NNMB report will open the eyes of the establishment towards the need for a universal public distribution system. Considering the under consumption of a wide variety of essential nutrients government must include a larger range of food groups to be covered under the PDS. It is also the need of the hour to expand ICDS infrastructure in the urban areas, to serve the needs of the most vulnerable of the urban poor.

Courtesy: Newsclick.in
 

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The number of deaths is not extraordinary, B Bhushan, medical superintendent of the state-run Mahatma Gandhi Memorial Medical College hospital, told IndiaSpend. “More deaths were reported this month because more children were admitted,” he said, adding that patients from Bengal too come to the hospital.
 
The deaths in Jamshedpur come two weeks after 70 children died at the Baba Raghav Das Medical College Hospital at Gorakhpur, Uttar Pradesh, revealing the depth of the crisis in India’s public-health system.
 
Jamshedpur, a city of 1.3 million, is the largest city in Jharkhand by population, and one of India’s oldest industrial cities, but the state’s health indicators are among India’s worst, according to an IndiaSpend analysis of 2015-16 national health data, the latest available.
 
Forty of these 52 infant deaths were in the neonatal intensive care unit (NICU) and 12 in the pediatric intensive care unit, said Bhushan. “Thirty-eight of the 40 infant deaths in NICU were due to low birth weight, other deaths were due to premature births and other complications like asphyxia,” he added.
 
“The most common reason for low weight babies is malnutrition in mothers,” he explained, saying that many mothers who come to the hospital are tribals, and from the poorest strata of society.
 
Jamshedpur better off than Jharkhand but poor child-health indicators
 
While the district of Purbi (eastern) Singhbhum, in which Jamshedpur is located, has a better infant mortality rate (IMR), with 25 infant deaths per 1,000 live births, than the average for Jharkhand (44) and India (41), the proportion of wasted children–with low weight for height–is 11 percentage points more than the state (29) and almost double the Indian average (21). Wasting is one of the indicators of malnutrition.
 
Purbi (eastern) Singhbhum is ranked among the 10 worst in India for the proportion of wasted children, with 40.6% of children under five wasted.
 
Similarly, the percentage of underweight children in Purbi Singhbhum (49.8%) is higher than the average for Jharkhand (47.8%) and India (35.7%).
 
Child undernutrition can not only lead to child deaths, but malnourished children also have lower cognitive abilities and are less productive members of a country’s workforce. “A failure to invest in combating nutrition reduces potential economic growth,” this 2015 World Bank report noted.
 
Jharkhand has the 6th worst infant mortality rate in India
 
Jharkhand’s IMR is India’s sixth worst, worse than the African nation of Ethiopia (41).
 
Some of the state’s districts have India’s worst health indicators, according to 2015 National Family Health Survey (NFHS) data, analysed by the International Food Policy Research Institute in New Delhi.
 
Paschim Singhbhum in Jharkhand has the 7th highest rate of stunting–low height for age–in India, with 59.4% of children stunted.
 
Three of Jharkhand’s districts are among 10 Indian districts with the highest rates of wasting in children under the age of 5 years–Purbi Singhbhum (40.6%), Dumka (41.4%) and Khunti (43%). These districts are also among the worst off when it comes to severe wasting among children.
 
Jharkhand spent Rs 750 per capita on health in 2014-15, compared to Rs 810 spent by other empowered action group states (EAG)–states that have some of the poorest socio-economic indicators in India.
 
Jharkhand spent 1.14% of their state’s gross domestic product (GDP) on health in 2015-16, less than than the average of 1.35% of GDP spent by EAG states, according to the 2017 National Health Profile.
 
High proportion of tribal population, low maternal health outcomes
 
One explanation for these indicators is that  62.5% of Purbi Singhbhum district is tribal. In general, tribals are among India’s most disadvantaged communities, and their children among the most malnourished.
 
Jamshedpur, named after Sir Jamshedji Tata, the founder of Tata Steel, was founded in 1919. As one of the few cities in a state where 76% of the population lives in rural areas–compared to 69% for the Indian average–it caters to scores of poor, tribal-dominated villages and towns.
 
There is also a direct positive correlation between the mother’s health and her child’s health as IndiaSpend reported on January 5, 2016.
 
Thirty eight of the infant deaths in Jamshedpur were due to low birth weight, of which there are three underlying reasons, all traceable to the mother: Poor nutritional status before conception, short stature (mostly due to undernutrition and infections during childhood), and poor nutrition during pregnancy, IndiaSpend reported in November 2016.
 
Over a quarter (28%) of rural women, 15-49 years, in Purbi Singhbum had a body mass index (BMI) lower than normal, one sign of undernutrition, according to 2015-16 data from NFHS. In Jharkhand, 31.5% of all women had a lower than normal BMI.
 
Jharkhand also has a high prevalence of anaemia, which caused 20% of maternal deaths in India and was the associate cause in 50% of maternal deaths, according to a 2014 study published in Nutrition, an international journal. Anaemia during pregnancy also increases chances of foetal deaths, abnormalities, pre-term and underweight babies.
 
Two Jharkhand districts–Simdega and Saraikela Kharsawan–are the 5th and 6th worst in the country, with 78.2% and 78.8% women of reproductive age anaemic in 2015-16.
 
Further, 62.6% of pregnant women in Jharkhand were anaemic compared to 50.3% in India.
 

Source: National Family Health Survey 2015-16 and Health Management Information System 2015-16 NOTE: Infant mortality rate for Purbi Singhbhum is for the year 2012-13
 
1.08 million child deaths a year in India, but low government spending on health
 
Jharkhand reflects the state of India’s children and its lack of health spending.
 
Nearly two children under the age of five died every minute in India in 2015, many due to preventable and treatable causes, IndiaSpend reported on August 16, 2017.
 
Most common causes of death below the age of five years were neonatal causes (53%), pneumonia (15%), diarrhoeal diseases (12%), measles (3%) and injuries (3%).
 
In 2015, India had the highest under-five mortality rate among BRICS (an acronym for Brazil, Russia, India, China and South Africa) at 43 deaths per 1,000 live births in 2015, followed by South Africa (41), Brazil (16), China (11) and Russia (10).
 
Despite poor health indicators, India had one of the lowest public spending on health in the world in 2015-16, spending 1.18% of GDP on health compared to the the global average of 5.99%.
 
The Indian government contributed 31.3% of total citizen health spending in 2014, 15.7 percentage points less than the median government share of 47% in BRICS countries, our analysis on May 8, 2017 showed.
 
(Salve is an analyst & Yadavar a principal correspondent with IndiaSpend.)
 
We welcome feedback. Please write to respond@indiaspend.org. We reserve the right to edit responses for language and grammar.

Courtesy: India Spend
 

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Representation Image       Source: Express photo by Tabassum Barnagarwala

The report is a shocking indictment of Mumbai, being the financial capital of India and speaks poorly of the Mumbai Mahanagar Palika run by bureaucrats and politicians, the richest corporation in India.

Why have the incidents of malnutrition increased six times from 2013 to 2016? The figures accessed by NGO Praja Foundation show that among screened students in BMC schools, the number of malnourished kids increased from 11,831 in 2013-14 to 53,408 in 2014-15, and further to 64,681 in 2015-16. Malnourishment af fected more girls (35%) than boys (33%) in 2015-16.

Govandi, which houses a large percentage of Dalits and Muslims is at the very bottom of Mumbai’s development index and its not surprising that this suburb tops the starvation list.In this ward, one of every two schoolchildren has been malnourished in the past three years. In 2015-16, Govandi was followed by H East (Khar, Santacruz East) and Kurla, with 9,100 and 6,586 malnourished children. Data obtained under an RTI query point to severe undernourishment of children studying in civic schools in Mumbai.

Nitai Mehta, founder of Praja Foundation which obtained the figures, said a huge crisis seems to be unfolding in the BMC schools. “We have sourced the numbers from BMC's own school health programme. It clearly shows that they are not looking at their own data. All agencies of the government, which are linked to the subject of child nutrition, must tackle this problem urgently ,“ he said.

 The data showed that the percentage of undernourished children is the highest in the 1st and the 2nd standards, meaning children aged 6-7 years are the worst affected. “It raises a very important question about the efficacy of nutrition schemes such as the one run by the Integrated Child Development Scheme (ICDS) through anganwadis for children between 0-6 years. If the scheme was working optimally, we won't have so many malnourished children coming to schools,“ said Milind Mhaske of Praja. He added that this could also be a reason behind the growing cases of diarrhoea in the city . An assessment of the data reveals that a little over 50% of the children were referred to BMC clinics and hospitals for treatment. The fact that health almost never features on the priority list of leaders is a known thing. The RTI has further reiterated the point by showing that in 2015-16, councillors have asked only 16 questions on the issue. Successive councillors from the worst-affected M East ward have asked only five questions highlighting malnutri tion in the last three years.
 
BMC's executive health officer Dr Padmaja Keskar told The Times of India that she would have to study the data before commenting on it. “We carry out the health checks annually . The moment our team finds that a child needs care, we immediately refer them to our tertiary hospitals such as KEM, Sion and Nair,“ she said.

 The data on malnutrition among school children is shocking, to say the least. If government is unable to organise an efficient nutrition program for underprivileged students within Mumbai where better facilities and support staff are likely to be available, one dreads to think what the state of affairs would be outside the city. No wonder Maharashtra's tribal belts
 

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The court also observed that the government has not taken any serious steps to address the problem.

A division bench of Justices V M Kanade and P R Bora was hearing a bunch of PILs highlighting increasing instances of malnutrition-related deaths and illness among those living in Melghat region of Vidarbha and other tribal areas.

“In our state, the children’s population must be over 40 crore. Out of this, 50 per cent children are below poverty line and suffering from malnourishment. What is the point of prosperity and progress in the state when this is the situation,” Justice Kanade observed.

The court further said the state government ought to make separate allocation of funds to address the issue in the upcoming budget session.

The court has posted the petitions for further hearing on March 1, when the secretaries of Women and Child Welfare department and the Tribal Welfare department will have to submit power-point presentations to HC on how they propose to tackle the problem and what measures will be undertaken.

The court had earlier too come down heavily on the government for failing to initiate steps to solve the problem, and had said the concerned ministers will have to take more interest.

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Tribal woman with child; all pics by GASS

The Nagada village of Chingudipala Panchayat of Sukinda block in Jajpur district, Odisha caught headlines of the state and national media due to continuous child deaths in July-August, 2016. Now five to six months have already passed. A six-member team of the “Ganatantrik Adhikar Surakha Sangathan” visited the place on February 4, 2017 to learn about the on-going programs of the state government in addressing malnutrition problems of Nagada village.

The team visited villages such as Upara Nagada, Majhi Nagada, Tala Nagada and Naliadaba villages of Chingudipala panchayat. Two months back our team had gone to Malkangiri district where more than hundred children died in few months due to Japanese Encephalitis (JE). We will bring a detailed report soon on continuous death of children in Odisha due to malnutrition. Here we are bringing before you some of the findings of the team which had gone to Nagada village.

It was in the month of July 2016 that a two-month-old son of Laxmi Pradhan of Tala Nagada suffered with red boils in his entire body including mouth followed with heavy fever, loose motion and vomiting. The child stopped breast feeding and he died within 48 hours. Similar symptoms were noticed in other children of age group varying from 2 months to 4 years, mainly from Tala Nagada and Majhi Nagada hamlets.

Within few weeks, that disease spread to number of children and most of them died within two to three days of suffering. The state government has confirmed 19 such deaths. The team confirms the fact that it was due to malnutrition those children became prone to diseases and died instantly.

Nagada village, Odisha

During discussions with the women of these hamlets, it was revealed that the pulse-polio programme of the government of India had not reached Nagada till 2016. Only when negligence and apathy of the state government came in for severe criticism were two mini-anganwadi centers opened. Laxmi Pradhan and Kamala Pradhan of Nagada village who lost their child in recent past have been assigned with food distribution work at the Anganwadi Center without any formal training. The government has not yet posted even an Anganwadi worker there on a permanent basis.

Naveen Pattnaik, chief minister of Odisha formed Task Force comprising various bureaucrats to address the situation. As part of this Task Force, Bishal Kumar Dev, IAS and Secretary, Department of Women and Child Development, had said that health camp would run permanently at Nagada. But the fact-finding team did not see any such health camp in Nagada village. The team did find women and children who are suffering from fever but are not getting medical attention.

The nearest government run bedded hospital, Community Health Center, is at Sukinda, 50 km away from the village. The only Nutrition Centre which was opened at Tata Mines Nursing Home, Kaliapani in August last year with the help of the government was stopped in October, 2016.

Manoj Ahuja, Principal Secretary, Agriculture and Cooperation had said that Nagada villagers would get ration items, rice and kerosene, of double amount. But this continued only for two months and was stopped in October, 2016. The villagers said that they are only getting 5kg of rice per head under new Food Security Programme.

The intention of the government in addressing the problems of Nagada village is quite doubtful. Nagada is a revenue village and its latest survey and settlement was done in 1980s. As per the Record of Rights, out of total 761.45 acres of geographical are only 19.38 acres of land has been designated as private land whereas 618.6 acres has been shown as forest land.

The Juanga tribals are covered under the classification of ‘Particularly Vulnerable Tribal Group’. When the government’s negligence in implementation of Forest Rights Act, 2006 came into question after recent incident the revenue department hurriedly initiated process of distribution of pattas under Forest Rights Act.

The team members observed that few families have received 8 decimal of land as homestead in Sal forest having same Khata Number 6 and Plot number 174. The supposed beneficiary families failed to identify the land that belongs to them when the team members enquired. This clearly means the revenue department has not followed the process properly.

Though the government claims that it is encouraging Juanga tribals to adopt agriculture as their main livelihood, it has not given them appropriate land pattas. As per the FR Act, the families are entitled to get 8 to 10 acres of forest land for cultivation. The villagers said they depend on the forest for 8 to 9 months for their livelihood. They collect different roots, fruits and leaves which they showed the team members. But the government has not yet given community rights over their own forest land.

Connecting Road from Kalianpani Mines to NALCO Nagar via Nagada village

Though they are covered under ‘Particularly Vulnerable Tribal Group’ little attention has been paid towards protecting the social and cultural life of Juanga tribes. Rather, both central and state governments have started playing with the life of tribals even as they claim to be trying to mitigate the severe malnutrition problems of Juangas. The government has yet to provide any medical care. Meanwhile, the rural development department has come with a mega plan of building a 10-14 meters wide road through the Harichanpur Telekoi Reserved Forest area.

Already the contractors engaged for construction of such road have uprooted or cut down hundreds of big trees using heavy machinery. This road will go past Nagada hamlets. While the villagers require an all-season village road, what is coming up is a wide road for connecting Kaliapani chromite mines to Angul NALCO aluminium city through Kamakhaprasad. This is a plan of investing crores of money by both Rural Development Ministry of the government of India and government of Odisha, according to the road workers.

On different occasions the government officers have asked the Juangas to have faith in policies of the government and to leave the forest. They had insisted that the tribals come down to plane area near the mining site and settle there.

Prafulla Ghadei said in a TV interview, “Juanga tribals of Nagada are partly responsible for their situation. We have tried persuading them to go down to the planes. They will be provided with houses and land. But they are refusing.”

The question is, has the government rehabilitated those 4 lakh tribals who were displaced by different mega projects including Hirakud Dam? Now tribals of Kalinga Nagar industrial area of same Jajpur district are going from pillar to post to get justice. Why then would the Juangas would leave their forest? Who would be benefited?

Cutting of tress inside Reserved Forest for road construction

The team members suspect intention of the government in constructing roads inside the reserved forest. There are 13 chromite mines of 12 companies operating around 15-20 km radius of Nagada for last 40 years. These are Sukinda Chromite Mines of Tata; Jindal Chromite Mines; Balasore Alloys Limited of Birla; IMFA; Sukinda Mines, Kaliapani Mines and Dhaneswar Mines of Odisha Mining Corporation, a government Odisha Unit; IDCOL; Mishrinal Chromite Mines and BC Mohanty and Sons Chromite Mines etc.

These companies have not done anything for development of the region, not even plantation or even opening a health care unit. But for ‘addressing malnutrition problem’ now the government is constructing a wider road for industrial development of the area. If this continues, the Juanga tribals will soon be uprooted from their villages.

It is pathetic that even today the government of Odisha has failed to open an Anganwadi Center, a primary school and a Primary Health Center at Nagada. But it is constructing a mega road spending crores of money. This road is chopping down hundreds of trees which would have been the livelihood of these Juangas.

At this juncture the team demands:

1. Every human being has a right to get proper drinking water, proper health care and education. These should be provided immediately to the Nagada villagers. 
2. The road construction work should be stopped and a village road should be constructed. 
3. More fruit bearing trees should be planted inside the reserved forest which could be useful for the Juangas. 
4. The government should distribute forest pattas after conducting palli sabha and the adivasis should be provided with community rights. 
5. The government should stop giving new mining leases and should review work of existing mines bearing in mind the problems of industrial pollution and preserving the lifestyle of existing Juanga tribals.

We hope that the government would give respect to the fifth schedule of the constitution and bring changes in its attitude.

(This report has been prepared Dr. Golak Bihari Nath, Working President, Ganatantrik Adhikar Surakha Sangathan, Odisha, Bhubaneswar).
 

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India is home to 472 million children. Forty percent of India’s population consists of minors. The country is home to one-third of the world’s population of women who become mothers even before they have reached adulthood. Yet the budget allocated for their health is only 4% of India’s already meagre health spending.

In the remote hamlet of Mai in Bihar’s Munger district the tragic consequences of this low spending is immediately apparent. Situated on the banks of the Ganga, Mai is home to around 100 families. Most of them do not have ration cards or any other official documents.

For the past 11 years, the village has played host to a facility of the Integrated Child Development Scheme, which aims to provide provide food, preschool education, and basic healthcare to children under six years of age and their mothers. In fact, the facility in Mai has been named a “model ICDS centre”. But the condition of the building appearance belies this accolade. The area surrounding the centre is occupied by children, buffaloes and other domestic animals.

The building also serves as the village community centre, which means that ICDS services are not available any time there is a community programme or meeting. The roof of the centre is rickety and the floor is blistered. A solitary weighing machine that arrived after two years of asking for it stands in a corner and there is no other equipment to monitor children’s growth.

Whether the ICDS centre is a model one or nor, it is unlikely that children of this village, with little access to enough nutritious food, will grow up healthy. Mai is evidence of the conclusions drawn from the fourth round of the National Family Health Survey – that nine out of 11 states surveyed have not been able to reduce the rate of infant mortality by even two points annually. In India, 40 out of 1,000 infants do not reach their first birthdays.

In Damodarpur Mohuli, a small village on the outskirts of Samastipur district also in Bihar, the ICDS centre has not been functioning for the past six months due to a lack of funds. “If I cannot give the children proper medicines or nutritious food, what is the point of keeping the ICDS centre open?” asked Savita Devi, the government-appointed helper or sevika at the centre who has not got her salary for half a year.
 

Intent versus investment

The ICDS has the right intent – to provide a sound foundation for children given that 90% of human brain development occurs within 5-6 years of age. Implemented from 1974, this scheme is implemented through the wide network of anganwadi centres, giving it the potential to provide comprehensive coverage. Over the years, the coverage and services of this scheme have increased multi-fold. The latest policy speaks of restructuring the ICDS to enhance anganwadis with crèches that will provide universal healthcare and also preschool education.

Such a transition will require special training of ICDS staff. The plan can only be realised with adequate investment – but funding for the scheme has only been falling.

The budget allocation for the ICDS in 2016-’17 has declined 9.6% from 2015-’16. Some states have seen deeper cuts than others. Maharshtra’s ICDS spending fell from Rs 3,463 crores in 2015-’16 to Rs 1,307 crores in 2016-’17.
 

Moreover, the scheme is presently able to cover only about 50% of the population of children under the age of six. Large number of children still only have access to anganwadis that are devoid of education services.

The ICDS also lags in terms of reach, leaving more than 18 lakh of the 35 children who should be covered by the scheme without ICDS services – a poor strike rate of just 50%.

It also suffers from many vacant positions in anganwadis.

The case of Meera, a child in Pokhadia village near the Jharkhand-Bihar border, illustrates what might be happening in places with no anganwadis. Meera was born prematurely three years ago to a malnourished mother and was so fragile that her family thought she was dead and was ready to bury her. However, anganwadi worker Lila Bai rushed to the house and saved the baby. She taught Meera’s mother how to look after the premature child and encouraged her to make sure she was vaccinated. It may like likely that other children have not been saved because there was no anganwadi worker at hand.
 

Getting priorities straight

Investing in children has a cascading effect on individual growth and development and on economic growth. It also reduces social inequity and breaks cycles of poverty.

Over the past few years, the Indian government has initiated policy recommendations to provision early childhood care under the Right to Free and Compulsory Education, 2009, and has introduced the National Early Childhood Care and Education Policy. The government also acknowledges the critical links between early learning and improvement in learning outcomes in formal primary schooling.

The need of the hour is to translate this intent to action. While policies can be created and legal frameworks can be built, as long as there is minuscule investment, these grand visions will come to naught.

Komal Ganotra is the director of policy, research and advocacy at CRY – Child Rights and You.

Courtesy: Scroll.in

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RTI query reveals 6000 maternal and child deaths in the past six years in the region.

Children enjoy the meal in an anganwadi in Semadoh, a village in Chikhaldhara block in the Melghat region.

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