ADILABAD: When G Radha, an Auxiliary Nurse Midwife (ANM), found seven-year-old Arju Bai, her health was deteriorating. “She was very weak and had white patches on her face indicating vitamin deficiency,” said Radha, who works at the Telangana State Tribal welfare school at Lokari.K village some 336 km from Hyderabad.
Arju belongs to the Gond village of Ganeshpur, Narnoor mandal of Adilabad district. Her step-mother neglected her and her father, a farmer, never intervened. Her birth mother had passed away two years ago.
“I would be hungry but my step-mother would not give me food. When I asked for food, she told me to work and only then I would get to eat,” said Arju.
There are 150 girls between six and 11 years at the residential school. When they first arrived their health was not very good either, noted Radha. The school has helped. “They are given food three times a day here. We give them rice, roti, dal, curry, and rava. Eggs too are a part of the menu,” said Radha. Arju’s health has improved significantly after she was brought here.
Walk 500 metres from the school and the situation at the village’s anganwadi centre is completely different. “The children here fall sick all the time. The quality of food supplies we get is poor. Often we have to throw out the eggs because they are rotten,” said J Subadhra, who has been an anganwadi worker for over 25 years.
The biggest problem Subadhra faces is the lack of a steady supply of cooking essentials to the anganwadi centre. She said the problem was not restricted to her centre. “The last time we got stock was a quintal of rice in Sept,” she said. She sometimes has to borrow provisions from other anganwadis or from nearby schools.
The Lokari.K anganwadi serves midday meals to 38 children in lower primary classes. The anganwadi also feeds 16 lactating women. The road leading to Lokari.K is the entry point to many of the 53 villages of Narnoor mandal. “If our anganwadi, which is at the start of the road, doesn’t get rations, you can imagine the state of those down the road,” Subadhra added.
Mid-day meal scheme
Mid-day meal schemes in India have a long history. First introduced across three states in the mid-eighties, the scheme got Central funding in 1995. The Integrated Child Development Service scheme, under which the anganwadis fall, serves approximately 100 million children. The funding pattern for the scheme until 2015 was 90:10 with Centre bearing 90 pc of the costs. But that changed in Nov 2015 with the funding pattern becoming 60:40, with states taking on a larger share. The 2015-16 budget saw a 7 pc cut in funding for the sole scheme.
Dr Ambika Patel of the village Public Healthcare Centre (PHC) said there was no serious health problems for the children as there was higher school enrolment in the tribal belt. She is one of only two doctors serving the population of 48 villages from Narnoor and Gandiguda mandals. “It is difficult to manage with just two doctors,” she admitted.
“The children here are prone to common cold and viral fever and there are cases of malnutrition in this belt but it is still better than other districts,” said Patel. Of the 214 pregnant women registered with the PHC since April this year, 51 in numbers or 24 pc of the women were found to be anaemic, revealed the hospital records.
The National Family Health Survery-4 (NFHS-4) 2014-15 puts the women in Adilabad as the most anaemic among TS districts (before reorganisation) but no data is available on the number of anaemic children. Maternal anaemia is one of the reasons for high infant stillbirths in the state and country. Nutritional factors too play a role.
India is among the high-ranking nations when it comes to maternal deaths, neo-natal deaths and stillbirths. All the three are related to anaemia in women.
“Over 10 pc of the children are anaemic in this area,” said Girija, the staff nurse at the hospital. If the mothers are anaemic, their children will be too.
The anganwadi workers said even though they provided the mothers with ‘nutritious food’, they shared it with their other children and family members.
The PHC maintains links with remote villages through the ANMs who have a crucial role to play in achieving last-mile connectivity in delivering health services to children. One such ANM is P Triveni, who works at the tribal welfare school at Arjuni.K village. She has not been paid her full salary since June. She has been paid only `8,000 whereas she is entitled to receive `5,000 per month. “It’s better to work rather than not work. At least I will be paid someday,” said Triveni.
We are able to provide mid-day meals to the children as the food ration is supplied by education department, she explained. But as anganwadi next door does not do that well, we share our rations. “We provide them with good quality rations. If the food quality is not good we send them back,” said M Umadevi, Adilabad district welfare officer (ICDS). The department has been facing problems in last few months with the billing of food supplies. “Whatever (supplies) we get we send across. We don’t get rice, dal and oil in a go so we are able to send as and when it arrives,” said Umadevi. “The budget gets sanctioned only once in three months. The bills have all been frozen by state government,” she added.
Sanitation facilities nil
If the food supply in rural Adilabad is inconsistent, sanitation facilities are almost non-existent. Few houses have toilets.
Ask Atram Lachu, the village chief of Arjuni.K how many toilets his village has and he chuckles. For the 48 families in this village, there are only six toilets and none in use, he admitted.
The main problem is water. During summers there is no water here, he said. The village does not have a water distribution system. “This is a hilly region and soil here does not retain water,” said Srikanth S, project coordinator with Mahita, an NGO working with tribal women and children at Adilabad. “We used to conduct medical camps but people were hesitant to approach the doctors...There are no awareness programmes on health and hygiene for the people of these areas,” he added.
“It is a problem with not just Adilabad but across the state,”he said.
‘Let’s be committed to reaching every last child’
The five-day ‘Child First’ campaign by The New Indian Express and Save The Children, that concludes today, has been an attempt to highlight ground realities in Telangana. Children constitute about 39 per cent of population of TS. The state has a high tribal population as well. There is need to address malnutrition, school drop-outs, child labour, early marriages, teen pregnancy, migration and child poverty. No child should be excluded from the opportunity to survive and learn, yet millions of children globally are being left behind simply because of who they are and where they live. India aspires to be a superpower largely with the confidence that in coming decades it would have a large young population. But, what if the youth of tomorrow are not healthy, educated and happy? The Sustainable Development Goals, agreed upon by 189 member countries of UN, commit us to make the world a happier and healthier place by 2030. The Child First stories were an attempt to hear from TS’s children and know their aspirations. Today is Children’s Day. Let’s make it a special one by realising responsibility in our individual and institutional capacity.
The writer, Alka Singh, is GM - Telangana & AP State Programme(Save the Children) state has much more to achieve on nutritional front: Save the Children
The real problem today in persisting poor health and nutrition status appears to be outreach. There is a need to strengthen service delivery of health, nutrition and education to reach “Every Last Child’.
Malnutrition is a serious impediment to a child’s well-being and is the underlying factor for morbidity as well as death. Despite numerous Centre and state-funded Reproductive and Child health programmes in operation, the data shows that state has much more to do on the health and nutritional front. Special focus has to be on the poorest performing regions that come under districts such as Adilabad, Warangal, Khammam and Mahbubnagar.
Age at the time of child birth needs to be observed as a social as well as a health issue. Data show that 24 per cent of the children born in the state were to young women in the 15-19 age groups. This puts the state at the eighth rank in the country. This is undesirable as it exposes young women to early pregnancy and is a health risk both for mother and child.
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