Tackling the killer
The fight against malnutrition has to be intensified by upgrading the anganwadi system and using technology to monitor children at risk, writes MANOJ KUMAR
G ujarat chief minister Narendra Modi is often in the news for wrong reasons. But when he says that India’s major problems are Naxalism and malnutrition, we need to sit up and listen.
It was on January 10, 2012, that Prime Minister Manmohan Singh called hunger and malnutrition a national shame while releasing the Naandi Foundation’s Hunger and Malnutrition (HUNGaMA) Survey Report 2011. It was a high-profile occasion, given that the multi-party Citizens’ Alliance comprising young MPs from all parties was the guiding force behind the initiative. Such a rare coalition was meant to express solidarity of all parties to not politicise the issue but ensure that the nation stands united in its war against malnutrition. Modi’s comments are indeed a success of the Citizens’ Alliance’s ability to capture the imagination of the nation. But this should not lead to subsequent politicisation and defeat the purpose of the alliance.
The alliance has identified Rajasthan, Orissa and Madhya Pradesh as the ground zero of its fight against malnutrition. To make this well-documented, replicable model, Avantha Foundation has pledged support to the alliance and Naandi. In the next two years, three districts are expected to turn the tide. Thereafter, this approach will be widened to include other states, as part of a national approach to eradicate malnutrition.
There were many significant findings in the HUNGaMA report, the most seminal being that while 95% of anganwadi workers were able to recognise signs of malnutrition, 93% of the mothers could not do so. Given the weak symptomatic leads to this ‘silent and invisible epidemic’, the main challenge is to empower mothers with the knowledge of what causes
AN ANGANWADI WORKER HAS TO FILL 119 COLUMNS IN A FORM TO MONITOR A CHILD. THE WORKER, WHO IS OFTEN SEMI-LITERATE, IS NOT UP TO THE TASK
malnutrition, its impact and how one can prevent it. The second step would be to create a structured linkage between mothers and anganwadis.
All this is simple and doable and does not require huge investments. It requires us to focus on data, information, knowledge and bring the community (mothers and anganwadi workers) to be on a dynamically engaged platform.
The Naandi Foundation did this in a place called Bajna, a Bhil-dominated area in Ratlam, where the Madhya Pradesh government and World Bank were partners. The plan was to empower mothers and communities with knowledge and link them with different layers of government.
Talking about data, here are some: at present, an anganwadi worker has to fill 119 columns in a form to monitor a child. The worker, often semi-literate, is not up to the task. How on earth is she expected to tell mothers about say, the importance of breastfeeding, if she is forced to spend her time doing paperwork? The use of the right technology can help us bypass this problem. There is a machine that can record the height and weight of children and transmit the data. If we get the accurate data daily, we can track malnourished children. Our focus should be to get data on time and put it to use immediately.
A further fillip to the effort would be linking it to the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). Under such a scheme, maternity leave benefits, like six-month wages, could be provided to mothers. In poor families, the mother has to go back to work almost immediately after childbirth, jeopardising her health and that of her baby. There is a need to intensify communication about the need for exclusive breast-feeding in the first six months. Ways can be devised on how to help the mother with food (even if we have to inspire the private sector to provide affordable solutions) as the first 1,000 days are crucial for her well-being. Social audits can be used to track the Integrated Child Development Services (ICDS) implementation and thereby create a culture of monitoring of the status of expectant mothers and children.
The recent acceptance by the government that we face a challenge in dealing with malnourishment and malnutrition among children is the first step in our battle. We need to activate the anganwadi system, upgrade it and, most important, get the point of view of mothers. We need to incorporate malnutrition data in the annual health survey of states. It is time we moved away from monitoring inputs rather than outcomes.
Modi is a canny politician. He knows that the development model he is showcasing in Gujarat cannot work if its children are not healthy. This attention should now trickle down to every panchayat to conquer the scourge of malnutrition. We also need to scale up the report and move forward to Hungama 2 now. Manoj Kumar is CEO of Naandi Foundation and a member of
the Citizen’s Alliance Against Malnutrition.
The views expressed are personal