Malnutrition: A curse for Odisha’s Adivasi children

By- Abhijit Mohanty

---

In India there are 11.5 million adivasi children under five years of age. More than half (54%) of these children under five years of age are “stunted”. India occupies in the global map of child stunting as 61 million (37%) of the 165 million stunted children under the five years globally are Indian children.

The World Bank estimates that India is one of the highest ranking countries in the world for the number of children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world and is nearly double that of Sub-Saharan Africa with dire consequences for morbidity, mortality, productivity and economic growth. According to the UNICEF, around one million children under five die due to malnutrition related causes in India. This is above the emergency threshold for “acute malnutrition” as per the standard of World Health Organisation (WHO).

The United Nation (UN) estimates that 2.1 million Indian children’s dies before reaching the age of 5 in every year for every four minutes due to prevalence illness such as diarrhoea, typhoid, malaria, measles, and pneumonia.  In Odisha the situation is even worse.

The recent death of 19 children in last four months from Juan Adivasi community in the village of Nagada of Sukinda block under Jajpur district in Odisha caught unflinching media attention and has shaken the competency of the State Administration. Nagada village is majorly inhabited by Juang tribe and the rate of malnutrition amongst the children is extremely high. “More than 40 children of the village and adjoining areas, all in the age group of within 5 years of age have developed blister-like rashes on their bodies due to lack of proper nutrition”, says a local reporter. Renuka Dehury, Sarpanch of the Chingudipal gram panchayat under whose jurisdiction Nagada falls, said: “Seventeen deaths have been reported from the village in the past five months. While the limbs of children looked like sticks, their stomachs were swollen.”

“It is a wake-up call for the Government and the Ruling Party is exposed. The reality is that all tribal villages like NAGADA in Odisha have the same status – high malnutrition, low illiteracy, ill-health, no infra-structure, zero employment, no Governance etc. The sad part is that the village is coming within the impact areas of Mining Corporates like Tatas which have to answer a few unpleasant questions – what is happening to their CSR activities?” emphasise Achyut Das, a veteran activist working with the tribals of Odisha for more than 3 decades.

Das furthers raised certain questions, “The bureaucratic approach of the Government is to form a TASK FORCE but to do what? What can a Task Force do to fight many decades of neglect and apathy? Would this Task Force guarantee an improvement in the quality of lives within a time line? And a structural change? Will there be a white paper? Will there be transparency and accountability? In Tribal Areas as the history indicates, such successful changes are the rarest of the rare”.

Despite of various health programmes initiated by our Government of India the achievement in addressing malnutrition is far from satisfactory. Take for the example of Integrated Children Development Service (ICDS) launched on 02.10.1974.  ICDS is considered to be the world’s largest Integrated Early Childhood Programme.

ICDS, a scheme with potential to reduce malnutrition

The objectives of the scheme are to improve the nutritional and health status of children less than six years; to lay the foundation for proper psychological; physical and social development of the child, to reduce the incidence of mortality; morbidity, malnutrition and school dropouts; and to enhance the capacity of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education.

The target groups under ICDS are pregnant women, nursing mothers, children less than 6 years and adolescent girls. ICDS is a centrally sponsored scheme with State government contributing 50 percent towards supplementing nutrition.

But, has the scheme been implemented in its true spirit? Were the children and other target groups benefited from it? Is there any active community participation in the implementation of the scheme? Whether transparency and accountability has been maintained under the scheme?

Several ground breaking research studies has revealed that in many States, there are lack of infrastructure and basic amenities in the Anganwadi Centres (AWCs). Besides, service delivery, non-formal pre-school, nutrition and health educations are not optimally functioning in the way they were planned to be.

The ground realities in Odisha

The Women and Child Development Department of Odisha states that malnutrition is being detected in around 28 children in every 100 children. The acute malnutrition condition is being observed in 2 of every 100 children weighted.

Srinibas Das who works as a District Coordinator in Rayagada under a Right to Information project being implemented by Agragamee a local NGO highlights, ‘’In reality, very few AWCs in the District functions regularly. The situation in the interior villages is quite pitiable where neither AWC building exists nor AWW visits and deliver her service. Therefore, there is an urgent need to sensitize and encourage active community participation which will streamline many issues under ICDS. This will empower the community to access maximum benefits from the scheme”.  

Take for instance, Durukhal is a remote tribal village of Chandragiri panchayat in Kashipur block under Rayagada district of Odisha. Here, the delivery of ICDS service is perhaps the worst in the entire district. According to Jaimal Majhi, a community leader of the village, “It was almost 4 years since the sanction of an AWC in the village, but to date, AWC building is not constructed. Though, an Angan Wadi Worker (AWW) and a helper have been appointed, but they hardly visit the village and deliver their service regularly. They provide cooked food to the children only 2 to 3 days maximum in month. The situation turns more pathetic during the rainy season when finding a dry and hygienic place for cooking becomes a challenging task and therefore AWC never functions during monsoon”.

Recently, 2 cases of child deaths were reported due to acute malnutrition in the village. Upon enquiry, Phuldei Majhi, the mother of the deceased girl laments “My child was only 3 months of old and very weak since her birth. She could not even abled to drink my milk and eventually died”. Just after one day of the sad incidence, a similar case was also reported where a 13 months boy of the village died.

Similarly, Dandabad is a village which is located in the border area of the Kashipur block.  There are total 2 hamlets in the village, one is known as Tala Dandabad and the other is Upar Dandabad. There are around 28 children in the Tala Dandabad who never get food supplements under ICDS as the AWC is located in the Upar Dandabad, nearly 2.5 km away from their village. Jaimati Majhi, an active woman leader of Tala Dandabad shares, “In the last 2 years, total 6 children of our village have died. Most of them were within 6 months to 2 years of age. We were informed that the reasons for such deaths were due to acute malnutrition. But, the children of Upar Dandabad are getting food items from AWC and our children are dying due to lack of food. This is injustice. We have filed several complaints to the BDO in this regard. But, nothing has been done to date’’.   

In Koraput district, Tariguda is a revenue village of Tunpar panchayat in Laxmipur block. The village is inhabited by 75 households belonging to the Koi community of adivasi. “It has been 5 years since the foundation of the AWC was partly constructed in the village, but to date, there is no building of AWC. The AWW comes once in a month and distribute chatua (dry food prepared from wheat, cereals and pulses) to the villagers. The quality of chatua is also bad” complaints Palai Jani, a native of the village. “We had filed several complaints to the BDO, District Social Welfare Officer, CDPO (Child Development Project Officer), Sub-collector to construct the AWC building and streamline the service delivery, but to no avail”, Palai said in a frustrating tone.

The situation in Haridaghut village of Thakurmunda block under Mayurbhanj district is very pathetic. Here, the AWC runs in a dilapidated wooden hut. Similarly, in Kaptipada block of the district, Dekhacaturi is a village under Natta Panchayat. Though, in Official records an AWC was sanctioned for the village, but to date, there is no such AWC building. AWW brings cooked rice, egg curry and dal from her own house. The AWW says, “It has been more than 1 years since either CDPO or Supervisor visited the village on the ground that there is no building of AWC. For record verification, I have to walk 5 km to another AWC located in Bagdapha village”.

Numerous complaints have been received from the AWWs that many CDPOs are demanding Rs.1000-2500/- from every AWC for release of the monthly disbursement. Manmohan Pradhan, Secretary of Agranee, a local NGO based in Mayurbhanj district complaints “The monitoring and review mechanism of ICDS scheme is extremely poor. Nobody visit the village. In pen and paper, everything is well maintained by the concerned authorities. There are instances where 1 egg is divided into 2 pieces and served to 2 children. Is it under the provision of ICDS to give 1 egg to 2 children? Absolutely not. Public Hearings and Social Audits on ICDS scheme should be organised at the panchayat level and community should present their oral testimonies. This will effectively address such corruption and ensure transparency as well as accountability under the scheme”.   

Supplementary nutrition and growth monitoring are the two important high cost input activities of the ICDS programme. Supplementary nutrition is given for 300 days in a year. Growth monitoring is done to assess nutritional status. Under supplementary nutrition, 800 kcal of protein per day is given for pregnant and nursing mothers, similarly, 12 – 15 grams of protein for children aged 6–72 months, 20-25 grams for a severely malnourished child and 18-20 grams for pregnant and nursing mothers per day is given. But all these provisions seem to be on pen and paper only. Sundri Ho of Haridaghut village shares that, “Last year, weight measurement of children was done in our village only once. Total 8 children were identified as underweight and 4 mothers were reported as suffering from anaemia. But, neither a single mother nor a single child in our village had received any supplementary nutrition”.

Some success stories

In spite of many hurdles and rampant corruptions under ICDS at the grassroot level, there are also some instances where the communities with active support and facilitations by local NGOs are asserting their rights and entitlements to streamline the service delivery and ensuring accountability and transparency under the scheme. One such classic example is the case of Kuruda village of Lailai panchayat in Gajapati district. There is an AWC in the village and total 20 children are enrolled. But, the AWW used to come to the village only 3-4 days in a month. When the villagers asked the AWW to come regularly to the village and deliver her service as per the government provisions, she cunningly replied, “My supervisor has never instructed me to regularly come to the village and deliver service round the month. It depends on me, whether I should come regularly or not? Who are you to instruct me? Do you have given me employment???

Such adamant attitude of the AWW has infuriated the villagers to take forward the issue to the higher government authorities. To do this, they took assistance from Society for Welfare of Weaker Section (SWWS), a local NGO. Finally, a group of 10 women of the village lodged a written complaint to the Supervisor and CDPO for urgent action. Meanwhile, the villagers had also locked the AWC. Soon the issue caught the attention of the District Administration as well. The Collector visited Lailai Panchayat on the grievance day where the villagers met with him and shared, “We have locked the AWC, because, the AWW never comes regularly and deliver the services. Until, the problem is solved, we will not un-lock the AWC”. The Collector instructed the CDPO and Supervisor to take immediate action and resolve the issue as soon as possible. After 2 days, Supervisor accompanying the AWW visited the village and organised a village meeting. Here, the AWW accepted her irresponsibility and promised to deliver her service regularly. Now, the AWC of Kuruda village is smoothly functioning and the children are getting regular cooked food as per the provisions.

It has been also reported that massive corruption are taking place in the purchase and distribution of food items, furniture, utensils, teaching materials, toys, etc which are purchased by the ICDS supervisor. An RTI reveals that the major irregularity was reported in the distribution of food items purchased for the AWC in Pirimajhi village of Koraput district. Here, huge quantities of various food items shown as distributed to the AWC were in fact, never distributed. Maheswar Jani, a village resident who filed RTI shares “We were astonished to know from the RTI records that every month regularly food items has been sanctioned from the Block for our village AWC. And it was shown that the food items have been distributed to 19 children within 6 months to 3 years, 25 children within 3-6 years, 15 adolescent girls within 11-18 years and emergency feeding for 15 old age persons. But, in reality, we have never received any food items from the AWC”. Based on this information, the villagers instructed the AWW to regularly distribute food items and warned her that if she will not render her services properly than next time they will file complain to the Collector. Eventually, the filing of RTI has made ripple effect. Now, the AWC is running smoothly and the AWW is delivering her service regularly.

Kaliamba is yet another village of Dasmantpur block. In 2012, an AWC was sanctioned for the village. According to the villagers, till 2015, the AWC used to remain closed. Moreover, the women were deprived from getting benefits from Mamata Yojana also. To alleviate the issue of maternal and infant under nutrition, Government of Odisha has launched a State specific scheme for pregnant women and lactating mothers called MAMATA Yojana – a conditional cash transfer maternity benefit scheme. All these factors had enraged the villagers and they sought help from Agragamee to assist in filing complaints to the concerned authorities. The villagers finally filed a written complaint to the CDPO and urged for immediate action. This has finally yielded result. After 1 month, the supervisor visited the village and instructed the AWW to deliver her service regularly. Since then, the AWC is running smoothly and the AWW is delivering her service regularly. The women who have been deprived from getting benefits under Mamata Yojana too got their due entitlements.

Similarly, in Rayagada district, Kodesu is a village of Pitamahal panchayat. The villagers complaints that the service of AWC was extremely pathetic until recently. As there was no AWC building, so children used to seat on open veranda of the village even in the summer days. And the AWW distribute dried food to the children once in the month and that too of poor quality. Therefore, Anumani Melaka, a woman leader along with some other villagers met with the CDPO and Social Welfare Extension Officer (SWEO) of the district and filed a written complaint for construction of AWC building and appealed to ensure regular service delivery. But, there was no response. Thereafter, the villagers met with the Collector and raised the issue. Soon after 2 months, the construction of the AWC was finally started. Today, the AWC building is constructed and the service delivery has been also streamlined. Instead of dried food, the AWW is now providing cooked food to the children.

Podapadu is a village of Halua panchayat where the Pre-School in AWC functioned hardly earlier. It was only after a series of complaints given to the AWW by the villagers, now regular cooked food is given to the children. In every week, the AWW is providing 3 eggs in the week along with rice and dal.

A similar case is also reported in the Tobhapadar village. Here, a AWC was constructed long back but over the years the building collapsed. According to the villagers, though a new AWC building was sanctioned for the village since 6 years, but the construction work had never started. To address the issue, the women of the village met with the BDO, CDPO and Sub-Collector and requested to start the construction of new AWC building. Lucky Santa, a village youth shares “In the last 6 months, we have met with the BDO, CDPO, Sub-Collector more often and filed petitions and complaints to address the issue. Finally, we got success. Today we have our own brand new AWC in our village. The AWW is also coming regularly and providing cooked food to the village children, pregnant women and old persons. We all are happy now”. In Nabarangpur district under Tentulikhunti block, Khandiaguda is a village inhabited by 135 households. During the period of 1995-96, an AWC was opened in the village. Over the years, the AWC building collapsed and therefore children were forced to seat on the veranda of a village native. The AWW complains that, “We don’t AWC building in the village, therefore in summer and rainy day, working in AWC becomes very difficult”. In response, the villagers met with the BDO and CDPO and urged for construction of the AWC building soon. After 2 weeks, 3 government officials from the block administration visited the village and verified the condition of the collapsed old AWC building. Parvati Muduli, who is the President of “Indiravati Mahila Mahasangha” (a women federation constituting of 1000 members), shares, “The BDO and Welfare Extension Officer have recently shared us that a AWC has been sanctioned for our village and the construction of AWC building would begin within 2 months”.

Thus due to the active community participation and facilitation by local NGOs and taking up advocacy initiative like interfacing with the government line department’s officials and filing petitions, complaints and RTIs, issues of the ICDS service delivery in tribal villages like Lailai, Pirimajhi, Kaliamba, Kodesu, Podapadu, Khandiaguda and Tobhapadar has been effectively addressed and streamlined. Most importantly, the involvement of women in addressing the issues and standing up to the situation is phenomenal.

It is no doubt that the ICDS scheme has potential to reduce malnutrition in the rural and tribal hinterlands. But, to make it possible, Government has to play a more enabling role, infrastructure and basic amenities need to be strengthened. The coverage of supplementary nutrition needs to be increased with maintance of continuous supply, inclusion of millets under ICDS will critically address malnutrition as millets are rich in protein, mineral and vitamins, the ministry should consider constituting a State level Food and Nutrition Board to ensure quality of food, active community participation has to be ensured, organising Social Audits and Public Hearings on ICDS will critically highlight corruption and can ensure transparency and accountability under the scheme.

---

Abhijit Mohanty is a development professional based in Odisha and writes on tribal development issues.