“Last year, my six-month-old son suddenly came down with high fever and died before we could reach the local primary health centre,” said Sundri Majhi, a native of Haridakut village in Mayurbhanj, the district in Odisha with the highest population of tribes. “We do not know what killed him.”

Odisha has the largest number of Adivasi or tribal communities, 62 to be precise, in India, including 13 particularly vulnerable tribal groups. The state has a tribal population of 9.59 million, constituting 22.86% of the total population, according to Census 2011. Mayurbhanj district has the highest tribal population (1.48 million) and the highest proportion of tribes (58.7%).

Around 57% of under-five tribal children are chronically undernourished, according to the United Nations Children’s Fund. Infant mortality among tribal communities in Odisha is 92, as against the national average of 84. The Integrated Child Development Services scheme could play a vital role to reverse the grave situation.

Integrated Child Development Services

The Integrated Child Development Services scheme is one of the flagship programmes launched by the government of India in 1975 to combat malnutrition and ill health of children under six years of age, besides expectant and young mothers. However, the results have not been satisfactory across India.

Several studies have revealed that the scheme has not been implemented effectively. Large-scale corruption and irregularities of food supply have plagued the programme.

The Comptroller and Auditor General of India report released in 2017 found lacunae in the implementation of the scheme in the state. The state-level monitoring and review committee, headed by the chief secretary, had met three times during 2011-’16, against the mandate of holding a meeting at least once every six months.

Poor infrastructure

Anganwadis serve as the principal centres for implementation of Integrated Child Development Services, primarily supplementary nutrition and pre-school education. In March 2011, the Government of India had mandated that an anganwadi centre must have a separate sitting room for children and women, a kitchen, a store room for provisions, child-friendly toilets, drinking water facility and a play area.

The dilapidated hut that serves as an anganwadi centre in Haridakut village in Odisha. (Photo credit: Abhijit Mohanty).

But the anganwadi centre in Haridakut village is running from a dilapidated hut. “You can see the poor condition of the centre for yourself,” said Ghasiram Majhi, a native of the village. “In rainy days we cannot send our children to the anganwadi.”

According to the Comptroller and Auditor General report, out of 71,306 anganwadi centres in the state, only 28,187 (40%) had dedicated Integrated Child Development Services buildings. “There is no separate kitchen in our centre, therefore we cook in the open,” an anganwadi worker told VillageSquare.in.

Poor quality food

There have been instances of short supply or non-supply of eggs and Take Home Ration of rasi laddoo or sesame balls, due to mismanagement. “There are several cases of supply of adulterated or sub-standard chhatua made of roasted gram, due to poor quality control mechanism,” said Srinibas Das, a Koraput-based development professional.

The objective of the supplementary nutrition programme of the Integrated Child Development Services is to bridge the protein-energy gap between the recommended dietary allowance and average dietary intake of children, pregnant women and lactating mothers.

The program entails special supplementary feeding of severely malnourished children and referral to health centres. Residents of Haridakut village hardly receive such referral services.

Irregular health check-up

The health check-up of children is extremely low and that of pregnant women and nursing mothers is also significantly low, according to the Comptroller and Auditor General report. Children below the age of three need to be weighed once a month and those between three and six years of age need to be weighed every quarter, as per the guidelines.

Such regular monitoring helps the health department staff detect growth deficiency and assess nutritional status of the children and categorise them as normal, moderate or severely malnourished.

According to the villagers of Haridakut, officials check weight once in four or five months. As per Integrated Child Development Services guidelines, every anganwadi centre should have kits containing medicine for diarrhoea, de-worming, skin disease, etc. However, no such medicine kit is available in the anganwadi centre of Haridakut.

“Three years back, I lost my daughter, when she was four months old,” Parvati Majhi of Haridakut told VillageSquare.in. “She was very weak when born, even unable to drink my milk.” The doctor had said that the baby died due to pneumonia.

Bajuram Ho, a tribal leader, told VillageSquare.in: “In the last two years, many children of our village died due to malnutrition. Media do not report most of these cases.” He said that there were some cases of measles too.

Positive initiatives

“There is a need to scale up proven nutrition interventions during the first 1,000 days of life, increasing access to essential nutrition services,” said Das.

In 2015, Azim Premji Philanthropic Initiatives and the Odisha government started a programme to bring down malnutrition in the state. In 2017, the state government, in partnership with Azim Premji Philanthropic Initiatives and UNICEF, extended the Community Management of Acute Malnutrition to all the 30 districts.

“Children with acute malnutrition will be treated with Ready to Use Therapeutic Food and Energy Density Therapeutic Food through AWCs [anganwadi centres],” said Prasant Kumar Reddy, director of the Social Welfare Department.

The Community Management of Acute Malnutrition model was initially piloted in Sudan in 2001 and adopted as an emergency intervention in a country that has a high rate of acute malnutrition exceeding the emergency threshold. Instead of merely replicating the model, the state government of Odisha should give priority to modify the Community Management of Acute Malnutrition to suit local conditions.

Abhijit Mohanty is a Delhi-based development professional. He has worked with the indigenous communities in India and Cameroon especially on the issues of land, forest and water. Views are personal.

This article first appeared on Village Square.