|Malnourished tribal children die because ICDS schemes are all but non-existent, and the government is in denial.|
At Hardua village in Ucchera block of Satna district, a child with Grade 3 malnourishment and suffering from skin infection.
THE final five kilometres to Ramnagar (Khokla), as the village is officially called, in Satna district of Madhya Pradesh has to be done on foot down a hill thick with shrubs and bushes. As we enter the village, eager eyes scan us for food or some other kind of livelihood support only to droop in disappointment once they learn that the wait has been in vain. The people of the Kol and Mawasi tribes who inhabit this village are a desperate lot: they have neither employment nor food, and their malnourished children are dying. In the past four months at least four children have died and those standing by the side of their elders had protruding stomachs, sunken eyes, wrinkled legs and slightly deformed heads, all symptoms of malnutrition.
Ramnagar has one small pucca house where the school, the anganwadi (government-run creche) and the panchayat sub-office function from. The people overcame their timidity despite the presence of the village patwari and the gram panchayat secretary to tell Frontline that the anganwadi and the ration shop had been closed for almost the whole of last year.
Sukhlal, one of the village elders, said: “Only a month back the preparation of the midday meal in the school and the anganwadi’s supplementary nutrition programme and the work through the National Rural Employment Guarantee Programme [NREGP] were given to us. We didn’t get even six days of employment by the government last year and the ration shop opened only once in six months.”
But the district records claim that one person from each of the 100 families in the village was given 60 to 94 days of employment and each family got 35 kg of grain (wheat or rice) every month.
The story is no different in Hardua and Nakgheer villages, a 60-km drive from Satna town cutting through difficult rocky terrain and streams. Neither village has electricity but it is not a priority for the residents. “All we want is food and employment,” said Jagannath, an elder in Hardua. Here, too, children have died of malnutrition-related causes.
Pappu, a resident of Hardua, lost two of his children in August on consecutive days. “We don’t know what happened to them. They had fever for many days and none of the medicines we gave seemed to have any effect,” he said. “And because we have very little money and a very low income, we could not feed them well,” he added.
Most of the people living in such difficult conditions blamed destiny for the deaths, and in the extreme called it God’s will. They have been looking forward in vain to the government support they had been promised by political parties during elections. The issue came to the fore when people from 150 villages of Satna district at a meeting on August 24 decided to boycott elections if their women and children continued to suffer for want of food.
An investigation by the Right to Food campaign claimed that at least 163 children died of severe malnutrition in the past four months in four districts of Madhya Pradesh – Satna (69), Khandwa (47), Shivpuri (32) and Sheopur (15). All the children belonged to tribal/indigenous communities – Kol, Mawasi, Saheriya and Korku.
These are some of the most deprived communities in the State; most of their members are landless and have no permanent source of income. Their food insecurity and deprivation have been worsened because of schemes that do not function and corruption in the NREGP and the public distribution system (PDS).
In Bhopal, a senior official of the Department of Women and Child Development, who did not want to be named, said: “Why is the government blamed for everything negative that happens in the State? Shouldn’t the tribal community be blamed for malnutrition in the villages, for neglecting their children and for lack of hygiene in their houses?”
Such bureaucratic insouciance is up against a court directive. On September 26, the Madhya Pradesh High Court ordered Chief Secretary Rakesh Sahni to file a report on the malnutrition deaths in the State by October 13. It also asked the Collectors of the four districts to file affidavits regarding the deaths. The court was hearing a public interest petition filed in May 2007 by the Madhya Pradesh Right to Food campaign. The court also stated that malnutrition could be a possible reason for the recent deaths. This was in contrast to the State government’s position.
The public interest petition sought District Collectors and the Chief Secretary to be made accountable for the lack of implementation of the Integrated Child Development Services (ICDS) Scheme. Earlier, the Supreme Court, while passing an interim order on May 8, 2002, in PUCL vs. Union of India and others, stated that District Collectors, Chief Executive Officers and the Chief Secretary should be held responsible for the lack of implementation of the ICDS.
Meanwhile, in Satna, the district administration’s response to the deaths has been one of denial. District Collector Vijay Anand Kuril said: “There are malnourished children in Satna and we have already submitted our report to the Health Department. However, the recent deaths of children in the district were not because of malnutrition but because of various diseases like jaundice, diarrhoea and fever, heat stroke, and so on.”
A joint team of State and Central government officials visited the district in the last week of September and, according to the Collector, found no Grade 3 and Grade 4 malnourished children in its villages. The district officer of the Women and Child Development Department, M.L. Mehra, also denied any malnutrition-related deaths.
The United Nations Children’s Fund (UNICEF) has graded malnutrition cases into four, and of these Grade 3 and Grade 4 represent severe malnourishment and children detected to be in these categories require immediate care.Damning statistics
A typical example of a Grade 3 malnourished child at Ramnagar(Khokla) village in Majhgawan block of Satna district.
Madhya Pradesh tops the list of States in infant mortality rate (IMR), with 72 deaths per 1,000 live births, according to the Sample Registration Survey 2007-08. Even the State government website shows that 97,223 children in the age group of 0-1 year died of malnutrition between April 2005 and July 2008.
Madhya Pradesh also tops the list of States in undernourishment in the latest National Family Health Survey (NFHS-3), with 60.3 per cent of the children suffering from malnutrition. The NFHS-3 shows a 6 per cent increase over NFHS-2 in malnutrition-related deaths in the State. The total number of malnourished children in the State has risen to more than six million, according to the report. Of them, 12.6 per cent are severely malnourished as against the national average of 6.4 per cent.
According to senior officials in the administration, the State has, with the assistance of UNICEF and the World Food Programme, unveiled special schemes such as the Bal Shakti Yojana, Shaktimaan and the Bal Sanjeevani Abhiyan to treat severely malnourished children. Besides, it has advocated community-based programmes to tackle the problem.
All these schemes come under the ICDS, a major scheme for children under six years of age, who comprise 16 per cent of the total population in the State according to Census 2001. If allocation of funds is any indication, the ICDS is not a priority for the State government.
It spends only 0.86 per cent of its total budget through the ICDS for children under six. Incidentally, only 1.51 per cent of the State’s budget is allocated for the Department of Women and Child Development. In money terms, the allocation is Rs.590 crore, up from Rs.190 crore last year. But only Rs.222 crore has been allocated for the implementation of the ICDS in 2008-09 against the need of Rs.799 crore.
All the 1.078 crore children under six years of age in the State should be covered through universalisation of the ICDS, the Supreme Court had ruled in PUCL vs. Union of India and others. For this purpose, only 67,000 anganwadi centres are functional, whereas, according to informed sources, the actual need is for 1.26 lakh centres.
The Seventh Report of the Commissioners of the Supreme Court states that as per Census 2001 as many as 6.6 million children are enrolled in anganwadis run under the ICDS in Madhya Pradesh, but only 3.89 million, or 35.9 per cent, get supplementary nutrition from the State through anganwadis.
Satna district, where the deaths of children were first reported, presents a bleaker picture. Even the Women and Child Development Department’s figure for Grade 3 and Grade 4 malnourished children in 28 villages in the district is more than 4,000, but between January and August 2008 only 435 children were brought to nutrition rehabilitation centres (NRCs).
Of the eight blocks in Satna, there are only two functional NRCs, with a total of 26 beds. The one in Satna has 20 beds and 36 children are being treated there, and the one in Nagod block has six beds. An NRC has been sanctioned in Malhar block but it is not yet functional. The NRCs, which fall under the Public Health Department, get a list of malnourished children from the Women and Child Development Department.
However, officials of both the departments deny their responsibility for the deaths in the district and shift the blame to the other.
A senior official of the Women and Child Development Department, who did not want to be named, said children were 10 times more prone to fatal infection because of malnutrition.
Despite this, the State has only 121 NRCs, according to the official figures, and only 95 of them are fully functional. These centres have only 1,678 beds to take care of 13 lakh children. A Right to Food campaign activist, Prashant Kumar, said: “With the present 14-day package for children at NRCs, it would take 33 years to reach and serve all the malnourished children in Madhya Pradesh. Alarmingly, 49 NRCs have no trained staff.”
After the local media carried reports of the malnutrition-related deaths, the NRCs extended their seven-day supplementary nutrition programme to 14 days. Under this package, the child is brought to the NRC and given adequate nutrition for 14 days. After that the NRC has to follow up on the condition of the child every seven days until the child comes out of Grade 3 malnutrition.
Given this state of affairs, it was no surprise that the Satna district administration was wary of giving the media details of the implementation of various schemes. In fact, throughout the Frontline team’s stay, its movements were monitored by the police and the civil administration. The police said the monitoring was being done because free movement in the area involved risk as it was a “dacoit-infested” area.
However, they seemed more interested in knowing what the team was doing and what conversations it had with the people. Collector Kuril even said the reporter should have sought his permission before coming there.
According to informed sources, the district administration has been suppressing details of severely malnourished children in Satna. According to Kuril, all the Grade 3 and Grade 4 category children in the district are being treated in the NRCs.
However, doctors in the blocks, who did not want to be named, said there were many more severely malnourished children and alleged that there was pressure from the district administration not to report such cases.
In the 11th edition of the six-monthly report of the Bal Sanjeevani Abhiyan, published in November 2007, the government committed a faux pas. The report says that 3,18,371 children were weighed and only 2,941 of them were found to be malnourished. It says that the severely malnourished in Satna district form 0.92 per cent, which would be 2,557 children.
The meeting on August 24 in Majhgawan block, at which people from 150 villages in Satna district participated and decided to boycott elections if the government continued to neglect their women and children.
In the same report, in another table, this figure is given as 0.80 per cent, which would mean 2,173 children. That is, 384 children were wiped out of the records. When the local media highlighted the anomaly, the government removed the second table from the report.
The figures of malnutrition in the NFHS and UNICEF reports are very different from those in the government’s records. The NFHS-3 says that there are 12.65 per cent severely malnourished children in the State as opposed to the State government’s figure of 0.56 per cent.
Officials in the ICDS say they have their own parameters to judge malnutrition. This is despite the fact that UNICEF was appointed by the Madhya Pradesh government to oversee the process of women and child development in the State.
The shoddy implementation of the PDS and the NREGP has compounded the problem in the villages worst affected by malnutrition. The Supreme Court has stipulated that the poor, including below poverty line and Antyodaya Anna Yojana cardholders, should be provided at least 35 kg of grain, but people in Satna district say they do not get more than 20 kg.
While the district administration claimed that it gives 94 days of employment in the villages, the people said they did not get even a single day of work last year and not more than six days this year. The residents of Hardua village also said that the sarpanch had taken away their job cards and that he himself filled up the registers.
With the government looking to promote private industrial investment, the tribal people may have to face a new problem: large-scale displacement. The government claims to have signed memorandums of understanding (MoUs) worth Rs.3,00,000 crore with private companies, particularly in the mining sector.
A move to privatise the health sector is also apparent in the setting up of the Rogi Kalyan Samiti, a public-private venture where the community would generate funds for treatment of the poor. There are also plans to give children in anganwadis ready-to-eat food provided by private companies through the supplementary nutrition programme. This may not go down well with the tribal people, who have their own unique food habits.
A pilot project to distribute ready-to-use therapeutic food (RUTF) has been on since September in Khalwa block of Khandwa district under the directive of the Union Ministry of Women and Child Development. The aim is to treat severely acute malnourished (SAM) children, but critics of the programme see in it an avenue to generate a market for ready-to-use foods among the poor.
With almost all their community rights over forests taken away and with employment opportunities dwindling, the future looks anything but promising for the tribal people of Madhya Pradesh.