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Prioritising the Health of our Children
Every year in India, the first week of September is observed as the National Nutrition Week. This was conceived first time in 1982 by the Food and Nutrition Board. This is an annual event to intensify awareness on nutrition and its impact on productivity, economic growth and ultimately on development. In 2016, the National Nutrition Week turned 34. However, observing the week over the years has not really brought any tangible changes on the ground. Be it Assam or Madhya Pradesh, Bihar or Odisha, the stories of our infants and children are the same. Many are either underweight or stunted. Most are severely undernourished and lives are lost because of this. The recent deaths of 19 Juang children in Nagada, a village in Jajpur district of Odisha, is just a tip of the iceberg.
There is no dearth of reports on the status of undernourishment among children in the country; government data, UN agencies, reports from international agencies all of them present the same sorry state of affairs. Undernourishment first came up for discussion during the first round of the National Family Health Survey (NFHS) data. NFHS-1 was released in 1992-93. This debate intensified further with startling data during the NFHS-2 and NFHS-3 results in 1998-99 and 2005-06, respectively.
In 1993, the Ministry of Women and Child Development came up with the National Nutrition Policy to tackle the complexity of the problem. However, the subsequent rounds of survey reflected negligible improvement in the status of undernutrition. A comparison of the second and third round of NFHS show that despite the efforts, especially through the Integrated Child Development Services (ICDS) programmes, the nutritional status of children under the age of three did not improve much.
Between 1992-93 and 2005-06, the percentage of stunted children (children too short for their age) reduced from 51 to 45 and that of underweight children from 43 to 40. Though these numbers are on a decreasing trend, the rate of decrease has been very slow if put in a periodic frame. The percentage of children wasted (low weight for their height), however, rose from 20 in NFHS-2 to 23 in NFHS-3.
The first phase of NFHS-4 (2015-16) data, for 15 states, was released in January this year. Although numbers for Odisha, Jharkhand, and Chhattisgarh are yet to come, the overall trend is not very encouraging. Though there is decrease of underweight, stunted and wasted children but the rate of this reduction is very slow. NFHS-4 highlights another anaemia, another key issue. As per the released report more than half of children are anaemic in 10 out of 15 states; this is a widespread problem.
The question then is ‘do we have a long term and an explicit plan to fix the problem of undernutrition among children?’ ‘Are we looking at the causes that have led us to this situation?’
ICDS is one of the key government programmes to fight this problem. However, there are lot of questions on prioritizing and funding of this programme. During the previous UPA government, ICDS programme received regular and decent budget allocations. However, with the new government in place, it has substantially reduced in last two financial years. For 2016-17, Rs 14,862 crore was allocated for the programme which is the lowest in last five years.
Earlier, there was also a proposal for restructuring the programme and creating a position for a second ICDS worker – an assistant to share the load of work of the existing worker. But with the proposal of financial devolution under 14th finance commission, the onus now lies on the states to take a call on the new appointments. Huge budget cuts and passing the buck shows the lackadaisical commitment of the government towards children.
In Odisha, undernourished children and their state has been making headlines in every newspaper in recent times. The state had a Nutrition Operation Plan (NOP), prepared with the support of DfID, for the 2009-13; this still continues. The state government has identified 15 high burden districts to intensify support to improve nutritional status of children. The last review of NOP which was held in January this year reflects the existence of high rate of underweight children in these districts. Koraput tops the list with 41.2% underweight children followed by Malkangiri (38.3%), Nabarangpur (35.4%) and Nuapada (33.7%).
The proposed appointment of a second ICDS worker is a far cry, in Odisha, at the moment, there are unfilled position for 2906 ICDS workers. In addition, 30% of the supervisor positions are vacant. These are critical positions that need to be in place in order to deliver and monitor the nutrition programmes.
Like Nagada, there are many villages in the state which are waiting to make the headlines with news of undernourished and dying children. The state government has identified 5864 villages in 15 high burden districts which are in far flung areas. The incidence of Nagada village shows that the trend is changing. The geography of undernourishment is not limited to the poorest districts (Jajpur is one of the developed districts) and they must be identified.
Although ICDS needs more attention, there are other steps that need to be taken to tackle the undernourishment problem. The state government, on a pilot basis, plans to promote millet in ICDS. This is a baby step in this direction. Though there is a provision for the involvement of the community in the running of the Anganwadi, there is neither any participation by the community nor are steps taken towards promoting community based monitoring of nutrition and health services. These should be encouraged.
Fighting undernutrition and ensuring better health for our children needs a multi-dimensional, convergent and life-cycle approach. Promotion of traditional food practices and bringing dietary diversity in the food intake, and strengthening the system of community governance (especially focusing on community based monitoring) could be the game changers. Furthermore, there is a need for proper and timely identification of undernourishment among children by using all the three parameters that are weight for age, height for age and weight for height. Establishment of Nutrition Mission in some of the states is a very positive step and it must be established in the remaining states too.
India is growing. But this growth will mean nothing if the condition of our children does not change. There are many priorities but children must be the foremost.
Written by: Jitendra Rath, PO, Odisha.
Photo credit: Savvy Soumya Misra/ Oxfam India
 Juang are Particularly Vulnerable Tribe (PVTG) a tribe in Odisha.
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