Major gaps in addressing malnutrition in kids: Study

A study report titled 'Systems that failed' showcases major gaps in public systems in tackling malnutrition among children below three years of age. The research, undertaken by Nutrition Rights Coalition, with the help of six NGOs, including Rachana, Khoj, Amhi Amchya Aarogyasathi, Janarath, Lokseva Sangam and SATHI, was conducted across tribal, rural and urban areas of Maharashtra, in Amravati, Nandurbar and Gadchiroli districts, covering 55 children with severe under weight (SUW).

The report was released at a two-day state level convention, organised by Jan Arogya Abhiyan (JSA- Maharashtra), Anna Adhikar Abhiyan (Right to Food Campaign), Tata Institute of Social Science (TISS) and Nutrition Rights Coalition at TISS on October 28 and 29. The convention addressed the question: "Public systems, Model of Development and Social Justice: Which comprehensive measures are required to tackle malnutrition in Maharashtra".

The study revealed that the overall current measures under Integrated Child Development Scheme (ICDS) and Public Health are failing to deal with the needs of severely malnourished children. Dr Abhay Shukla, under whose guidance the report was prepared, said, "There is no consistent criteria to identify malnourished children and hence many malnourished children are denied services from Nutrition Rehabilitation Center (NRC)- 24 out of 55 severely malnourished children were not referred for any treatment. In fact, 6 out of 7 children with Severe Acute Malnutrition (SAM) in sample were not even identified as Sam by ICDS."

The study also highlighted that only 3 out of 31 malnourished children received complete immunisation. It recommended giving regular, detailed and individualised nutritional counselling to mothers of children. This may be dealt by appointing second Anganwadi worker at least on pilot basis, added the report.

Dr Vandana Prasad, former member of National Commission for Protection of Child Rights, was a key speaker at the convention. "ICDS does not deal with all the malnourished children. They only focus on treating SAM. This implies that ICDS waits for a child to land up in SAM to take action, instead of taking preventive measures," Vandana remarked, responding to the study findings.

Activist Ulka Mahajanof Anna Adhikar Abhiyan criticised the model of development in Maharashtra, calling it unjust and inequitable.

"In one year, more than one lakh hectares of agricultural land was diverted for non-agricultural purposes in Maharashtra alone. People's livelihoods are being snatched, natural resources are being privatised. There is a decrease in the generation of employment opportunities. How then could we address the problems of food security? The issue of malnutrition will only become more complex in the years to come," Mahajan remarked.

During a session on Public Distribution System (PDS), Suresh Sawant, activist of the Right to food Campaign noted that the provisions of the Food Security Act are currently not being implemented. He emphasised on the importance of locally grown grains like nachani, whose production has almost stopped. "The government should provide minimum support price to the farmers for such grains, as these are more healthy and even require less water for production," Sawant added.

Studies on Take Home Ration (THR) packets, conducted in four districts of Maharashtra covering 234 children, were also presented in the convention. The study claims that children consuming the THR packets have come down from 11% in 2013 to 5% in 2014. Moreover, 79% households feed the packets to animals, instead of giving them to the children. However, the quality is to be blamed for this as 98% respondents blamed bad taste. Consequently, the report recommends "stopping of commercial THR packets and providing daily hot cooked meals or locally produced dry, nutritious food instead."

While the speakers at the convention pointed out the failures in implementation of government schemes, they also emphasised on greater public and community participation to improve services. Bandu Sane from Jan Arogya Abhiyan said, "Children's voices are unheard as their rights are suppressed. Out of 616 deaths in Amravati due to malnutrition, 344 have been in Melghat itself. The situation is indeed grave," Bandu said.

Pointing out the priorities of the central and state governments, Dr Shukla said: "The ICDS budget has been slashed by a whopping 50% by the central government and by 4.5% by the Maharashtra government. Additionally, the Union and Maharashtra state's health budget have come down by 16% and 8% respectively. The Village Child Development Centers (VCDC) are also observed to be closed down in the current year because of the budget cut."

Several recommendations emerged from the convention to devise a comprehensive action plan to deal with malnutrition in the tribal, rural and urban areas of Maharashtra.

Major gaps in ICDS services:

Non-use of electronic weighing scale
Lack of appropriate and adequate supplementary nutrition
Delayed commencement of complementary feeding
Referral to nutrition centres
Ineffective communication by anganwadi workers regarding under-nutrition and measures to overcome this
Major gaps in Health Services:
Lack of regular health checkups of children
Inadequate referral for illness
Source: Summary of study report coordinated by Nutrition Rights Coalition, Maharashtra