Anjaneya’s hunger is a hundred years old. It begins with the story of his place of birth, Raichur. This district in north Karnataka has a history of plunder and neglect. “The Hyderabad Karnataka region has been exploited over the years,” says Ambanna Rohikar, who fights to correct regional imbalance in the state. “First under the Nizam and then by the British. Even after Independence, nothing much has changed.” Ambanna, who is also a field worker with a child rights organisation CRY, says the region has one of the highest infant mortality rates, school dropouts and malnourishment figures in Karnataka. According to a 2002 report, 21 of the 39 backward taluks in the state are in this region. This is the legacy of four-year-old Anjaneya of Maledevargudda village, only 12 hours away from Karnataka’s pride and joy: Bangalore. Given his condition he might as well be on another planet.
Everyone knew about the disparity and everyone shrugged. But it came back into sharp, disturbing focus on June 6, when six-year-old Viresha of Raichur died of malnutrition. It wasn’t history alone that killed Viresha or is stunting Anjaneya’s growth, but the failure of one of the world’s largest nutrition programmes, the Rs 44,000-crore Integrated Child Development Scheme. ICDS was 30 when Viresha was born.
“ICDS is very important,” says development economist Jean Dreze, who has been active in the Right to Food campaign and is part of the National Advisory Council of India. “It is the only national programme for children under six.” This is when the brain develops and body develops immunity.
It has a decent track record. Infant mortality rates were lower in ICDS areas: a National Institute of Public Cooperation and Child Development survey says cases of severely malnourished children fell from 7 per cent in 1992 to 1 per cent in 2006. So what went wrong and where?
Anjaneya’s case gives some answers.
According to ICDS procedures, he should be in the register of the anganwadi worker. It should have recorded his Grade 4 malnutrition (stick-thin limbs, protruding belly and wasting). But, his name’s not in it. Why?
“They never brought him,” says Padmavathi, the local anganwadi worker. Otherwise, she keeps a meticulous record of the 65 children who show up. “Around 25 have Grade I malnourishment, 20 have Grade II and three, Grade III,” she says. She is unsure of what is expected of her. The training of the workers was compromised a while ago. Its duration was shortened, the ICDS official says, from three months to one month. “This happened a few years ago.” Why?
He laughs. “Orders from higher officials.” Shorter course means no field visits, but mostly classes on theory. Can you blame Padmavathi? In neighbouring Nagola village Manjula has been waiting three years for her training to start.
Mothers in this region need particular care since literacy among rural women is very low — 28 per cent — compared to the rest of the state. Even Dr Bharathi G V, the Ayush doctor at the Community Health Centre in Anjaneya’s neighbourhood, says maternal illiteracy is a serious impediment to children’s well being. Amaresh, 4, is a case in point. He has constant wheezing and cold. His mother, who is illiterate, does not know what malnourishment means. She noticed something was wrong only when he started losing weight drastically after one year.
Anganwadi workers don’t make regular trips to her house to check on Amaresh.
But the AWWs, through whom the ICDS is implemented in the ground level, cannot be blamed. The system does not work in their favour either. “She is loaded with so many different kinds of work that she is left with little time for ICDS,” says the ICDS official. “She has to do work for BPL card distribution, census, government insurance scheme, even animal counting. Officials know AWWs will do whatever work is assigned to them.” As part of ICDS, there are 14 registers to maintain too. “This does not take much time, though,” says the official.
Let’s say everything went well initially and Anjaneya was registered. He would have to be weighed. But Padmavathi has no weighing scale. “Most anganwadis don’t,” she says. Manjula borrows scales from other anganwadi workers and makes home visits. Not that she has a register to record them. “I’ve been asking for three years,” she says. Thus, they don’t even have the essential tools of their profession. A 2005-06 survey by National Council of Applied Economic Research (NCAER) recorded that only half had basic necessities like mats, books and stove.
Now, let’s assume Padmavathi had a weighing scale. Then, her Grade III malnourishment numbers would have increased by one and she would need funds for extra nutrition. Only, Padmavathi does not receive these funds. “We are supposed to get Rs 750 per child. I don’t get it,” she says.
The food — in packets — reaches on time. And perhaps Anjaneya could be persuaded into having that. But he does not always get it. Nobody comes home to give it to him (though ICDS staff are supposed to). With his parents away, in search of work, his ageing grandmother doesn’t think the food is worth the walk. You can’t blame her, nobody thinks much of the “fortified” food anyway.
“Nobody likes it,” says Padmavathi. The packet food is powder that has to be mixed with warm water to make porridge. In Viresha’s village, Yeragera, AWW Shabana Begum has to coax the toddlers to have it.
Shabana at least has a pucca (even if with a leaking roof and a broken floor) anganwadi room, like Padmavathi (not that it helped Anjaneya). Viresha’s has no building. It works from a nearby temple. The NCAER survey registers this paucity. It shows that only a little more than 46 per cent operate in a pucca building. Manjula built her anganwadi with Rs 5,000 — rickety and thatched.
When the ICDS fails you, the next resort is the local PHC. Here, Hyderabad-Karnataka’s history comes to haunt its children again. No one wants to work here. District health officer Venkatesh Naik admits as much. “He told us that only 23 of the 46 PHCs in the region have doctors,” says Pravin Shivashankar of CRY. Dr Bharathi agrees.
“There are no field workers here,” she says. “Staff nurses have to go for immunisation. There are no hostels for young working women, and most field workers are that. They are so many vacancies.”
At four years, Anjaneya has a history to overcome. Even a small shortcoming in the system can be fatal. ICDS with all its faults should not be abandoned, says Dreze. “Giving up on ICDS would be like giving up on children. Bringing ICDS under the purview of the National Food Security Act would help in accountability. But only to a point.”
So when will the holes be plugged? It has to be soon, at least for Anjaneya, who lives far from the bright lights of the city.
— ashamenon@expressbuzz.com
The food that no one wants
Four-year-old Ugranarasimha’s mother gets Rs 400 as widow’s pension and an irregular income of Rs 50 to Rs 75 a day from her half-acre plot. But she spends Rs 150 a month on Junior Horlicks for Ugranarasimha. He has Grade III malnutrition and, like other children in his neighbourhood, does not like the anganwadi packet food. It is extremely unpopular. Yet, in Karnataka that is what children get. There have even been demonstrations against it.
Ambanna of CRY says that anganwadi workers in Raichur’s slums were selling the packets to people who own buffaloes. “They don’t know what to do with it when children refused it.” There was a dramatic protest in Bellary, in May. Anganwadi workers cooked the food and made the Deputy Commissioner B Shivappa taste it. People present at the site — police people, press people and the general public — are said to have agreed with the protestors. Individual workers have registered complaints with their seniors. Strangely, an official of the Christy Samsthan who trains village women in making and transporting this food says they had not received even one official complaint. It came into being a few years ago. Protests led to the phasing out of private contractors in the scheme. A Supreme Court order dated October 7, 2004, said that contractors should not be used in providing supplementary nutrition to ICDS. It further added that village communities, mahila mandals and self-help groups should be given preference for preparing food. Therefore, Christ Friedgram Industry which produces Amylase Rich Energy Food (a product under ICDS) came to run the Samsthan as “capacity builders”.
Jean Dreze, who works on the Right to Food campaign, says packed food should be resisted in child feeding programmes wherever cooked food can be provided. ‘‘Packed food tends to be provided by commercial suppliers who are hard to regulate. Cooked food can be just as nutritious, and is more popular. It also provides employment to poor women. Last but not least, sharing a nutritious meal is a positive socialisation experience.
“My guess is that commercial lobbies are pushing for packed food. This is a common experience in other states, and also with the Central government. The same lobbies tried to replace cooked midday meals with packed food in primary schools, without success.”
— AM