The initiative by the Karnataka judiciary in combating malnourishment holds important lessons.
“How can there be only one solution of providing egg and milk to overcome the problem of malnourishment?” asked Justice N.K. Patil, while addressing the media in Gulbarga on April 26. He was speaking on the recommendations of a committee appointed by the Chief Justice of the Karnataka High Court following complaints of child malnutrition and starvation in the State.
Justice Patil, who heads the committee, followed up on these recommendations by meeting senior officials in Gulbarga where directions were issued that henceforth, the deputy commissioners of every district would take on the responsibility of taking steps to combat malnutrition. This initiative holds lessons for all parts of the country.
Linked to health of mothers
The gist of the question that he posed is that malnutrition is a complex issue and that solutions should go beyond just providing milk and eggs to children at Integrated Child Development Services (ICDS) centres.
Malnutrition among children is linked to the health of mothers. In fact the 1,000 days that include the nine months of pregnancy and the first two years of a child's life are most crucial in laying the foundations of lifelong and good health for children.
Justice Patil has demanded individual health status reports on the 68,000 malnourished children in Karnataka, as reported by the State government. This is an important first step as one of the key failures is in the ineffective monitoring of the status of children at ICDS centres. It is not because we do not have the procedures in place; they are just ineffective. An anganwadi worker is expected to fill in numerous registers and forms and send reports that wend their way through the system. The information is compiled at the project, district, State and finally at the national levels. It is hardly available to the right people at the right time to review and take act upon.
Role of technology
Today, we have the ability to replace these outdated procedures with electronic reporting using hand-held devices like cell phones that can send data on the weight and height of individual children to computerised databases. This information can be instantly converted to colour coded maps that can highlight not only the districts and centres where the problem is most acute, but also the status of individual children at risk.
The direction to the deputy commissioners also highlights another key weakness of our interventions — the lack of coordination and convergence among the several programmes that are already working for this purpose.
In the ICDS, we have the world's biggest programme addressing the early needs of children. We have special programmes targeting adolescent girls and pregnant women that address issues like anaemia even before pregnancy starts. We have “flagship” programmes like the National Rural Health Mission (NRHM) and the Total Sanitation Campaign. Yet we have 42 per cent of children who are underweight and 58 per cent who are stunted by the age of 24 months, as the HUNGaMA report covering 112 districts in India has recently highlighted. The children most at risk are the ones who are also the most hard to reach. So the emphasis on coordination and convergence must also include a special effort in locating and reaching such children.
Importance of self-help groups
Government initiatives should involve a wider constituency. The families and communities from where the children come need to be engaged in a process that make them partners in understanding what is being done and to share in the process of making changes. Here, women's self-help groups can play a significant role. A national meeting on decentralisation and equity for children was held in Kochi in mid-April. Senior officials dealing with children's issues from a number of States went around gram panchayats studying what was being done for children. The role of Kudumbasree, the women's self-help group, in supporting ICDS centres in Kerala including in the local processing of nutritious food supplied to the children was an eye-opener for many participants.
If followed through with the priority and attention it deserves, the Karnataka initiative has the potential of showing a way out of a long-standing problem of vital national concern.
(The author is a retired civil servant. Email: firstname.lastname@example.org)