Four-year-old Pranita Shreedhar has slipped into acute malnutrition twice in two years. This time around, anganwadi workers believe it might take longer to pull her out it. “The Village Child Development Centre (VCDC) is shut,” says Shanti Dandekar, a worried anganwadi teacher.
In her orange frock that is now oversized, Pranita has become inactive. She was diagnosed as Severely Acute Malnourished (SAM) two years ago. Through VCDC in the anganwadi, she was given six nutritious meals per day. Her weight improved in a year. In 2015-2016, citing budget constraints, the National Health Mission (NHM) stopped VCDC in anganwadis and Children Treatment Centre (CTC) in public health centres (PHCs) across India.
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The VCDC cost the government Rs 40 per child per day.
Now, Pranita has slipped into SAM again. Her mother Babita works in a nearby farm, father Sakharam is away for nine months for fishing and Pranita and her two elder siblings stay hungry all day.
The local anganwadi gives her breakfast and lunch of laddoo and khichdi, that costs Rs 11 for a child, along with ‘take home ration’ of 1 kg sheera. But the entire family consumes the ration, meant to last a month, in just 10 days. With monthly income at Rs 3,000, however, staying hungry on certain days has become inevitable.
In Palghar’s villages, the issue of malnutrition is not just about underweight children not getting food to eat. It does begin from there, only to get further entangled in schemes that exist only on paper, medical care that is out of reach, illiteracy that is driving tribals to giving birth to multiple children and forced migration in search of employment.
Palghar has 6,694 SAM and 33,230 Moderately Acute Malnutrition (MAM) children, a figure that has escalated since the shut down of VCDCs and CTCs in 2015. And the latest move by BJP-led government to provide a banana and an egg, which will cost Rs 5 extra per child, is not going to solve the problem.
The state government’s flagship scheme Dr APJ Abdul Kalam Amrut Aahar Yojana launched in November 2015 to provide pregnant women and new mothers with free food supplements has not even kickstarted in most of these lush green hilly slopes. Palghar has 9,261 pregnant women and 12,251 lactating mothers — none of them beneficiaries of the scheme.
Another scheme, Adivasi Vikas Prakalp, provided financial aid of Rs 3,000 to families of undernourished children. “That scheme abruptly ended two years ago,” said J R Wasave from the ICDS office in Dahanu.
“In Melghat, after major efforts by the district collector to get funding from the tribal department, several VCDCs have been restarted. A similar approach is required in all other tribal pockets, especially Palghar and Nandurbar. If the NHM is not funding, the tribal department should,” said Abhijeet More, from Jan Arogya Abhiyaan.
Moreover, with spike in case of infections during the monsoon season, cases of underweight children too escalate.
In Dahanu, ICDS officer Vijay Dongre is a worried man. At the Gangangaon sub-centre, engulfed by pale yellow walls sit two equally worried mothers. One has two kids on her laps — Ruchita (3) and Gautam (5), and another has Nilesh (4) standing by her side. All three are suffering from MAM. For the last few weeks, all three have runny noses, fever and a constant cold. “The cases of malnutritions peak during monsoons because children fall ill more often,” Dongre points out. The nearest sub-district hospital in Dahanu is 20 kms away – and not an easy choice. There are 15 undernourished children in that village.
In August alone, ICDS data shows, there have been 69 deaths of infants aged less than six years.
These tribal families also live in Palghar’s remote villages during monsoons as that is when they can cultivate rice. The remaining year, they migrate to cities for daily labour. The sustained nutrition programme in local anganwadis is hence not continued.
In Dhundalwadi, Sheela Thappar is a clear victim of migration. At 4, she hardly weighs 10 kg. For a year now, she has been a moderately acute malnourished child. With five siblings and parents, Sheela migrates to Bhiwandi after monsoons where they work at construction sites in the day and sleep on the roads at nights.
Sheela has never been taken to Nutrition Rehabilitation Centre (NRC) for the 14-day nutrition programme, even when her health deteriorates. Her diet mostly comprises dal-chawal apart from breakfast and lunch served at anganwadi.
A sickle cell patient as well, her immunity is at an all time low. Her mother Manisha Thappar, a wiry woman herself, is a sickle cell carrier. None of her children can afford school. “I give them food whenever I have food to cook,” she says.
At present, Palghar has 2,577 anganwadis.
In a belated move, the health department is now starting VCDCs in few tribal pockets. In Saiwan, where VCDC began on October 1, 18 children have already been admitted. The region has 23 SAM and 81 MAM children.
“There is a need for not just VCDCs but also community-based monitoring system to ensure that the nutrition programme on paper is trickling down to the society,” said Abhay Shukla from Nutrition Rights Coalition.
On October 1, the state health department called for a meeting to address malnutrition — one of the several dozens already held so far. Navoday Gramin Sanstha has asked for special heed to undernourished children who also have sickle cell or thalassemia. “They need immediate attention. And currently there is no data on such children,” said Mushtaq Kotwal from the NGO.