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Alwar’s Fight Against Child Malnutrition Is Off To A Great Start

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Rajasthan’s Alwar district has been in the news for all the wrong reasons. Two beef lynchings in a year and low-intensity communal clashes throughout have got the national media’s attention. The state law and order machinery really needs to buckle up, because, other than normalizing hate, it is also making some of the inspiring initiatives with potential progressive impact invisible. “Making It Happen” is one such move.

It is a collaboration of Rajasthan government and the Tata Trusts. In Rajasthan, it is running in five districts, i.e. Dausa, Tonk, Kaurali, Dholpur and Alwar. Another part of the collaborative is in the works in Seemandhra in Krishna, Guntur and SPSR Nellore districts. (This article is limited to Alwar, Rajasthan, which, I visited on August 21, 2018).

So what are these governments and their partner agencies making happen? They are trying to address the under-nutrition burden in the said districts holistically with a systems’ approach rather than as bits of its parts. Haven’t we heard ever so often, the whole is more than the sum of its parts? So is nutrition, and hence having a multi-sectoral approach is so important, i.e. addressing the whole rather than the sum of its parts. This is being tried via a multi-pronged strategy, i.e.:

  • Refurbish the AWCS with better infrastructure, repair the Anganwadi Centre (AWC henceforth) building, paint the building, construct toilets and kitchen (if food is prepared within the AWC) and ensure safe water supply.
  • Improve delivery of services through active Village Health Sanitation and Nutrition Days (VHSNDs). Also ensuring food safety in meals and promoting fortified salt and oil to enrich the micronutrients in food through targeted messages in the VHSNDs.
  • Improve early childhood care and education (ECCE), pre-school education kit, notebooks, uniform, toys and dolls, i.e. all that is needed to enhance learning by playing and cognitive development of the children
  • Supporting community mobilisation and behaviour change with special emphasis on Maternal, Infant and Young Child Feeding practices amongst mothers and their families.
  • Establish and support coordination cells at the Integrated Child Development Scheme (ICDS) directorate. This cell functions as a technical resource centre for nutrition for the state. The coordination cell constitutes different civil society organizations and multilateral agencies working in the state on nutrition initiatives to one place and also coordinates with other relevant ministries like Water Sanitation, Health et al.
Machdi Anganwadi Centre

Why Rajasthan, one would ask. Well, it is a no-brainer. Rajasthan sort of self-selected itself. Rajasthan is India’s largest state by area with a population exceeding 6.86 crores (per the 2011 census). Scheduled Caste and Scheduled Tribe groups make up about 31% of Rajasthan’s population. Rajasthan’s poverty headcount ratio is 14.7% which works out to over 1.02 crore people living below the state-specific poverty line. Recurrent spells of drought in Rajasthan has meant water scarcity and agrarian crisis. The economy is primarily agricultural and pastoral with 70% of the population involved in agrarian activities. Agrarian crisis coupled with long and recurrent spells of drought has affected food and nutrition security in the state.

Child malnutrition is a major public health concern in the state. NFHS 4 (2014-15) has shown that 39.1% of children under five years are stunted, 36.7% are underweight, and 23% are wasted. Anaemia prevalence in children is as high as 60.3%. There is reduction in malnutrition in children compared to NFHS 3 (2004-5), but the rate of reduction is slow and far short of the pace needed to achieve the global goals, i.e. the Sustainable Development Goals. Further, the rate of reduction does not commensurate with the investments being made through several programs targeted at improving the health and nutrition of the population.

But the fact that Rajasthan government has set up the State Nutrition Council under the stewardship of the Chief Minister herself is also an indicator of the state government’s commitment to addressing the under-nutrition challenge head-on.

In Alwar, 20 AWCs have been chosen in the pilot phase. The Machdi AWC in Umren block is one such. The AWC in Jatav Basti in Umren is another one. For the selection of the 20 AWCs, an additional set of criteria was added, i.e. post-matriculate Anganwadi worker (AWW), engaged the community and regular presence/attendance of children.

When I visited the AWCs, it was a sight to behold! From sprucing up the AWCs with bright colours, graphic stories, painting the specifics about the staff and the services on the walls, to equipping the AWC with height and weight charts and equipment, water purifier and clean toilet, the AWC had it all. But most importantly it had 10 children engaged in learning, chirpy and noisy and full of energy. The Anganwadi worker, Sunita Yadav, at Machdi AWC, was almost giving a performance to the children while teaching!

The AWC was visibly bright and happy and almost beckoning one and all to visit. That is precisely the point, shared Bijendra Singh, the programme officer of “Making It Happen” in Alwar. To make the AWC a bright and happy destination, an aspirational address, so the community members want to send their children, they want to spend time and engage with AWC specifically and the ICDS programme generally, is the focus, Mr Singh explained.

Dr Rajan Sankar, Tata Trusts’ nutrition head, shared why refurbishing the physical space of the AWC, brightening it up is so important. There is so much emphasis on making malnutrition visible to the naked eyes so parents can recognise the symptoms, but most of the malnutrition conversation is conceptual, normative. For mobilising communities, it is equally important to have something tangible, visible, desirable, aspirational, and that is precisely what refurbishing these 20 AWCs in Alwar and 100 throughout Rajasthan, is trying to achieve, Dr Sankar emphasised.

Rajasthan is also a state with vibrant people’s movement and active citizenship. From Lok Jumbish, Mazdoor Kisan Shakti Sangathan to the iconic Right to Information Act, who can forget the contribution of Rajasthan state to the democratic template of India. So it would be remiss not to tap into that people’s movement spirit, the activism of citizens. Emphasising on building community awareness on the package of ICDS services and demanding the same is tapping into that activism too.

At the time of my visit, it was just four months since the initiative had been rolled out. But the green shoots were already visible. The bright AWCs, the engaged parents and the used, dog-eared ECE books of the children, was a visual experience! Rajasthan government has come out with a set of age-appropriate books for children. Kilkari, Umang and Tarang are the three books catering to the age group of 3-6 years. The stories and concepts in the books are local and speaking to the living realities of the children. This is an exciting time for ECE in India, from Delhi to Rajasthan, we are witnessing exciting experiments. I have discussed ECE initiatives and their absolute necessity (in a low learning outcome country like India) in detail here.

Many nutrition and public health initiatives have invited criticism for being too expensive, human resource heavy, discordant from the state perspective, and hence un-scalable. Health apps fad is one such. “Making It Happen” is acutely aware of that and wants to steer clear of over-resourcing a public funded programme. Hence they want to operate within the state framework. Keeping the budgets and human resources real and scalable is their mantra.

The systems’ constraints in the ICDS need addressing too. There is a vacancy of almost 40% from the supervisory cadre onwards. That is bound to impact the programme delivery, shares Ms Shanti Verma Chhaprawal, the Deputy Director, ICDS for Alwar.  When the department operates with such a staff shortage, it affects the state’s capacity to deliver shrinks, Ms Chhaprawal elaborates. The registration rates of children in the ICDS need to be 100%. And the community engagement for 100% registration and attendance of children requires AWCs to become aspirational for the neo-rich, the middle class, just like private schools and private crèches are. Public financed programmes like ICDS and AWCs are for the public, and making them the go-to destinations for all children is the impact, we want, she shares. Children of all class, caste, creed growing together would be aspirational for the state too. She is hopeful the staff shortage will be addressed too.

Considering the programme rolled out in April 2018, it is still early to look for under-nutrition reduction impact. But if the brightly painted AWCs, the chirpy children and the committed AWWs are anything to go by, the impact will be worth the wait!

And “Making It Happen” could be as much an active citizenship project, citizens’ solidarity project as much as under-nutrition reduction project. Just what Alwar needs in these difficult times!

The author is a fellow with the International Centre for Journalists, Washington DC, and writes on childhood matters. She can be reached at biraj_swain@hotmail.com

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  1. Sharvani Sharma

    Hello Mr. Biraj. Well collated data. Would want to add that being a CSR professional and working extensively in Alwar, I would contribute to your sharing that there’s a lot more than this, happening and done for the apt growth of the children. This one’s a portion of actually comes in for the upliftment of these kids especially in terms of providing them with nutritious meals and proper sanitation facilities.
    Thanks.

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