Prancing around her house with her friends, her tiny body doesn’t seem to get tired that easily. While we take a closer look, 6 year old Pancho carries on, oblivious to the attention, which she has been so used to lately. Pancho weighs only 15.5 kilos. To many, this might not seem as the appropriate weight for her age. But considering she was diagnosed to be severely malnourished about a year and a half ago, this has been quite a recovery for the little girl.
Pancho belongs to the Saharia tribe, living in a village in district Baran, Rajasthan. The village is 40 kms away from the block headquarter in Shahabad and about 120 kms away from district headquarter in Baran. The primitive tribe has been residing in Baran district for years now after being forced to move out of their original habitat, the forests. The abject poverty the tribe lives in is probably the first thing that strikes you when you visit.
It comes as no surprise thus, that children of the tribe bear the brunt of the deprivation. While the families struggle to make ends meet, providing healthy, nutritious and wholesome food for the children in the households remains a distant realty. Pancho’s condition was the repercussion of this situation. It also reflects the vulnerability of other children in the community to fall prey to malnutrition and probably of many such children living in similar conditions across the country.
The village has an Anganwadi which is accessible as well as operational yet there is no visible impact of its services in changing the nutritional status of children like Pancho. As we go deeper to find out the reason, we realize that apart from irregularity of services, parents are not adequately counseled to understand the severity of the situation for the child. It was only when a local NGO, Prayatna Sanstha, which works in partnership with CRY, noticed Pancho in one of their community visits early last year, did her condition come to light. Unaware of the situation and ignorant of its severity, the parents had to be relentlessly counseled by the NGO, the community collective and Child Protection Committee to take the child to the Malnutrition Treatment Centre (MTC) also referred to as NRC (Nutritional Rehabilitation Centre) in many states.
While the treatment and special care at the centre lead to improved nutrition status of the child, she fell back in to the malnutrition trap after 2-3 months, owing to inadequate nutrition and care at home. The child is admitted to the centre for a maximum of 15 days, during which he/she has to be accompanied by a parent. The parents of the child get allowances for the same. Despite this, a number of parents do not send take their children to the NRCs as it means giving up on the means of income in that duration, which is a huge price to pay for families which struggle for two square meals. It was only after convincing her parents and prolonged treatment at the District Hospital in Baran, that Pancho is on the road to recovery.
Despite government efforts and schemes, the nutrition figures in the country pose a grave concern. Under the Integrated Child Development Scheme (ICDS), the Aanganwadi Centres aims to provide the requite nutrition, health services and care to children in the age group of 0-6 years and pregnant mothers. According to the Ministry of Women and Child Development, in 2012-13 while 1373349 Anganwadis were sanctioned, 34617 were still not operational. 33 % of the children in the country were not covered under the Anganwadis, as per data from the Ministry in 2013. This comes to prominence all the more in remote areas like Pancho’s village and backward communities like those of the Sahariyas.
What we need is a well defined system for management of malnutrition, which would involve the convergence of all stakeholders; not just Anganwadis but the health care centers, hospitals and NRCs as well. While ICDS is a well designed programme and we have functional Anganwadis running in most places, bottlenecks in service delivery and community outreach pose a challenge in its proper implementation. The quality of services needs to be improved, with strict emphasis on growth monitoring of children and flagging off possible cases of malnutrition. In this case, Pancho should have been referred to the MTC (NRC) by the Anganwadi. What is seen as a rather disturbing trend is while the growth of a child below the critical age of 3 or 4 is religiously monitored, Anganwadis become a bit lax in their approach for children above that age. As Pancho would have transitioned to primary school after turning six, her state of malnutrition would have possibly been ignored especially when the growth of the child is not monitored post that.
It remains imperative that severe malnutrition should be treated as an emergency and admission to an MTC is non-negotiable. Even though Baran district has been in focus for child deaths due to malnutrition, the situation on ground has witnessed little change. Sustained and systematic approach is needed to tackle the problem, as has been learnt in the case of Pancho who took over a year and a half to even reach the path of recovery. Also, our on ground experience has shown that variation of specific components of ICDS as a response to local needs should be implemented in states which will be more effective than the prescribed guidelines. This was also to be seen in case of Pancho where the parents were made aware of home based nutrition options and foods according to local palette.
Pancho represents thousands of children in the country today. The nutrition and care for a child under the age of 6 lays the foundation of a happy and healthy life for the child. With improved service delivery of ICDS, preventive rather than reactive approach to tackle malnutrition, better community outreach, the nutrition status of children in the country will surely witness a significant change.
Pancho’s journey from being severely malnourished to being on the road to recovery. She weights 15.5 kilos now.
The author, Komal Ganotra is Director, Policy, Research and Advocacy for CRY- Child Rights and You