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Empower community resource professionals to prevent a crisis of malnutrition

Covid-19 has only increased the prevailing inequality in child nutrition and health. Children are more vulnerable now as their parents have lost their jobs and incomes

September 1, 2020 9:17:59 am

For many of us, life under Covid-19 has been about spending time with family, getting fit, working from home and rediscovering our love for cooking or ordering from the latest take-away option. We must be grateful for these small privilege because Covid-19 has brought misery and uncertainty to a majority of Indian homes. Being able to provide a single meal has been a major challenge for these families.

Those who suffer the most are our children. They simply don’t have the option of choosing from a diverse set of food menus that children living in middle class families do. Even before Covid-19, lakhs of children were suffering from undernourishment or severe acute malnutrition. When the body of a child doesn’t get the right nutrition, it gets stunted or the child falls sick and eventually dies under the worst circumstances.

Malnutrition is a silent killer of our children. In 2018, a UNICEF study showed that 8.8 lakh children under the age of five died in India. Experts say that out of 100 children who die every year before they turn five years old, 68 die due to malnutrition. India is placed on the 102nd position on the Global Hunger Index. In certain districts of India, the rate of children dying under the age of five is so high that it can be compared with sub-Saharan Africa. So the inequality that children face in India is simply not just an economic problem, it is a human rights concern.

Covid-19 has only increased the prevailing inequality in child nutrition and health. Children are more vulnerable now as their parents have either lost their jobs, their daily wages, and face unemployment both in cities or villages. I’m a co-convenor of the Parliamentary Group of Children, a bipartisan group of Indian MPs from across the Lok Sabha and Rajya Sabha. Our own experiences in our constituencies and interactions with experts have revealed that children in poor families are struggling.

The world’s largest feeding programme, the mid-day meal programme which serves 11.59 crore children, is shut. Families without ration cards are not getting the food rations provided by the central and state governments. Prices of vegetables are rising.

Prior to Covid-19, the Union Government had launched the Poshan Abhiyan and Anaemia Mukht Bharat programme. Experts claim these were initially successful. But Covid-19 has the potential to derail all the progress made in our war on malnutrition. Therefore it is imperative that the Union Government acquire as much data on the impact of Covid-19 on child health and nutrition and prepare a roadmap in consultation with state governments, legislators and experts.

Further decentralisation is needed

The first lesson the Union Government must adopt is to decentralise. Far too much time and energy was wasted in having an overtly centralised top-down response to Covid-19. In my view this is the reason why there was no proper plan for migrant workers, economic revival and children’s health and education.
Now to an extent decision-making power has been decentralised to district collectors or magistrates. What is required is further decentralisation upto the level of Panchayat presidents and local panchayat committees. These committees can identify the actual problems faced by the people in local communities and develop appropriate responses. Panchayat presidents must be entrusted with the local development funds under the 14th and 15th Finance Commissions to frame appropriate village Covid-19 response plans. These response plans should focus on nutrition, livelihood, education and women empowerment, and be supported with the right tools and resources from the state government.

Carrying on with the need for further decentralisation, what is also needed is to empower our Aangadwadi workers and our Asha workers (community health workers). They must be given special training and additional financial support to carry on with their existing duties. Asha workers should be treated as essential workers because of their role in critical public health awareness programmes on pre-natal care, breastfeeding, post-natal care, undernutrition and early child development. Several states have also adopted mobile platforms that get the necessary feedback from our community workers so that at-risk families are identified well in advance.

A core principle in developing village-level Covid-19 response plans must be to involve the local community. Only when the local community is invested in making a plan succeed will the appropriate behavioural changes in terms of wearing masks or social distancing be enforced. Community-level assets can also be created with keeping child nutrition in mind. One such asset that has become popular over the last few years is the concept of nutrition gardens. These are essentially plots of land in the village where indigenous varieties of vegetable are grown, harvested and later distributed for free amongst nutritionally at-risk families. In Assam, an organisation called Farm2Food Foundation has set up 2000 such nutrition gardens in schools and local communities. These interventions are especially useful in populations that have higher rates of malnutrition, for example tea garden workers and tribal populations of Assam.

As a Member of Parliament, it is incumbent upon all of us to monitor the needs of children in our constituency. Many MPs belonging to our Parliament Group on Children have chaired virtual DISHA meetings in which they have instructed the local district administration to monitor the implementation of ongoing programmes. It is important that the existing infrastructure such as Nutritional Rehabilitation Centre and child crèches are functioning normally. It is also important that the relevant Standing Committees meet and deliberate over the issues raised in this article. There is a fear that the Union Government might cut on its planned expenditure in order to save its fiscal situation. During the Parliament Monsoon Session, the Union Government must declare that there will be no cuts and the entire sanctioned budget on child welfare and health will be completely utilised. Meanwhile, back in the states, state governments must ensure that the supplies of additional supplements such as iron, calcium, vitamin-A are maintained at a level sufficient to last the next six months.

Indians are known to be extremely resilient and creative. It is necessary that our response to urgent health and human rights concerns, such as child nutrition, must be practical and innovative. This will only happen if we abandon a centralised approach for a community-based approach. Along with medical staff, community resource professionals like aangawadi workers, Asha workers must be supported with the tools and resources to prevent a crisis of malnutrition. Technology must be used to capture data and get feedback on solutions that are both scalable and affordable. Every crisis presents an opportunity, and the opportunity in Covid-19 is to upgrade our health systems and strengthen our economy to significantly reduce the inequality between our children.

Gaurav Gogoi is a two-time MP from Kaliabor in Assam and co-convenor of the Parliamentarian’s Group for Children