A committee set up to study child malnutrition in Karnataka has recommended several institutional mechanisms to improve coordination between the departments of Women and Child Development and Health and Family Welfare, the lack of which has resulted in “overlapping goals with accountability at stake.”
The final report of the committee on “Convergence and monitoring” — one the three set up under the direction of the Karnataka High Court following a Public Interest Litigation petition — was finalised in January. It was subsequently submitted to the court. Clifton Rozario, adviser from Karnataka to the commissioners of the Supreme Court, said he had submitted to the court that the government should spell out an action plan based on the report and increase budgetary allocation for nutritional needs of children.
Among the subcommittee's major recommendations is a re-survey of children aged below 6 within six months in the State to identify severely malnourished children.
It is to be taken up by the Department of Women and Child Development, in collaboration with the Health Department.
The committee points out that overlap and lack of co-ordination begins at the very basic level. It says that several tasks “slip through the cracks” at the village level since there are no clearly defined roles for anganwadi workers, who are under the department, and auxiliary nurse-midwives and ASHA workers, who are under the Health Department.
The report also points to several problems with the logic that guides existing programmes. For instance, it says that denial of entitlements to pregnant women under the age of 18 — in a bid to discourage child marriage — can be counterproductive in the interest of the mother and child. Pointing to the lack of adequate coverage under Integrated Child Development Service , it says that only about 55 per cent of children aged between 0 and 6 are covered under it.
It is far worse in urban areas like Bangalore, where the coverage is 12 per cent, which has in turn led to mushrooming of unmonitored private child-care centres.
Suggesting a strong institutional mechanism to bring about convergence, the committee has recommended setting up of four bodies: a nutrition council at the State-level to oversee implementation of the National Nutrition Policy (NNP), an inter-ministerial co-ordination committee, special working groups in each department concerned and a nodal agency for implementation of NNP.
On the medical front, it says that GPS system needs to be installed on all ambulances and there must be a call centre established to receive calls from mothers requiring transportation for delivery or emergency medical care. Malnourished child requiring medical care must be treated as an emergency and provided access to 108.
