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Chhattisgarh: Grassroot Mobilisation for Children's Nutrition Rights

Chhattisgarh: Grassroot Mobilisation for Children's Nutrition Rights

As a part of the right to food campaign initiated in Chhattisgarh to improve children's access to nutrition especially in the tribal dominated areas, this article analyses the exemplary work of the Mitanin programme, a statewide community health volunteer programme in Koriya district.

CHHATTISGARH

Grassroot Mobilisation for Children’s Nutrition Rights

As a part of the right to food campaign initiated in Chhattisgarh to improve children’s access to nutrition especially in the tribal dominated areas, this article analyses the exemplary work of the Mitanin programme, a statewide community health volunteer programme in Koriya district.

SAMIR GARG

S
emi-starvation and chronic hunger are widespread in Chhattisgarh, especially amongst the tribal communities. Huge proportions of tribal children and women face constant malnutrition. According to the second National Family Health Survey (NFHS) (1998-99), 55 per cent of all tribal women in Chhattisgarh are undernourished (Body Mass Index – BMI – below 18.5). The same survey found that 61 per cent of all children (66 per cent of girls, 69 per cent for STs) are underweight, based on standard weight-for-age criteria. Proteinenergy malnutrition is the most widespread form of malnutrition, especially amongst children below the age of three years. The child undernutrition levels are particularly high in tribal regions.

In addition to protein-energy malnutrition, iron deficiency anaemia is also very common in Chhattisgarh. The NFHS data show that the prevalence of anaemia among children in the age group of six to 35 months is 88 per cent. It leads to increased risk of mortality as well as poor cognition and motor development. Iodine deficiency is another important form of malnutrition, with 40 per cent of households in the state still not having access to iodised salt. This affects all stages of child development and is the single most significant cause of preventable mental retardation and brain damage. Vitamin A deficiency, which increases the risk of blindness, is also widespread. These deficiencies, combined with protein-energy malnutrition, also increase the morbidity rates amongst children. A very high proportion of children are born with low birth weight. This form of malnutrition is very high in the tribal areas and urban slums, which have poor access to public healthcare. Poor maternal healthcare, maternal malnutrition, anaemia,heavywork during pregnancy and low age at marriage contribute to the high prevalence of low birth weight. In tribal regions, most of the deliveries take place at home, in remote hamlets. The government even finds it difficult to identify most of the low birth weight babies.

This situation is starkly reflected in a recent study of child malnutrition in the tribal-dominated Manendragarh block (tribal population proportion 70 per cent) of Koriya district. Select findings of this study are reported in Table 1.

Similar patterns were found in other tribaldominated areas of Chhattisgarh. Such severe rates of malnutrition result in extremely high child morbidity and mortality. Severe malnutrition causes high susceptibility to diarrhoea, malaria, TB and related diseases. Chhattisgarh’s infant mortality rate of 81 and child mortality rate of 123 are much higher than the all-India average (68 and 85 respectively), and malnutrition is largely responsible for this situation.

State Nutrition Policy

The government of Chhattisgarh does have a state nutrition policy (‘Suposhan Neeti’). This policy is founded on the goals of the National Nutrition Policy and the 10th Plan. The major goals set to be achieved by 2010 are: (1) Bringing down the infant mortality rate from 81 to 35 per thousand live births; (2) Reducing the prevalence of chronic undernutrition amongst children by 50 per cent, i e, from the present 26 per cent to 13 per cent;

(3) Reducing the prevalence of anaemia amongst children by 25 per cent, i e, from 88 per cent to 66 per cent; (4) Raising immediate breast-feeding of new-born

Economic and Political Weekly August 26, 2006

babies (within one hour of birth) from the current level of 10 per cent to 31 per cent;

  • (5) Increasing the proportion of exclusively breast-fed children (below six months) to 93 per cent; and (6) Reducing severe anaemia amongst children and women by 50 per cent.
  • The policy is aimed not only at children, but also at pregnant and nursing mothers as well as adolescents. It talks about intersectoral linkages, especially with the health department. The Integrated Child Development Services (ICDS) is the main implementation vehicle. Anganwadi workers and auxiliary nurses and midwives (ANMs) are expected to work together to deliver interventions at critical stages of the life cycle: during pregnancy, after delivery, first six months, 6-12 months and 12-24 months of childhood. The interventions will be in the form of: (1) supporting exclusive breast-feeding: early initiation and continuation till six months;
  • (2) providing appropriate complementary feeding; (3) providing Vitamin A doses every six months to children till age three;
  • (4) providing iron folic acid to children and pregnant women; (5) encouraging extra meal and rest during pregnancy; and (6) improving dietary practices.
  • The health department is supposed to provide the antenatal care and post-natal care. Other interventions are to be implemented mainly through ICDS.

    Gaps in ICDS Programme

    The “right to food campaign” in Chhattisgarh has initiated grassroot action to improve children’s access to nutrition, especially in the tribal-dominated areas. Manendragarh block in Koriya district was one of the first places where the mobilisation process started, in 2003. This campaign got a major boost due to its collaboration with the Mitanin Programme, a statewide community health volunteer programme. The campaign began with a field survey of the ICDS in Manendragarh block, along with a study of ICDS-related state policy and operations. The field survey was also a kind of community awareness and mobilisation campaign, to create an understanding of ICDS issues. In December 2004, the study as well as the mobilisation effort were extended to seven districts across the state covering 17 of the tribal-dominated blocks in these districts. This extended exercise came to the following conclusions, in terms of gaps in the conception and implementation of ICDS.

    Under-recognising child malnutrition: The first and foremost gap is the lack of state and social recognition of the extent of child malnutrition in the state. The government’s Monthly Progress Report of February 2005 mentions that the ICDS programme weighed 15,29,000 children and found various levels of malnutrition. The report shows that 58 per cent of the weighed children were malnourished. But the report grossly under-represents the proportion of children with grades III and IV malnutrition. It says that only 1.6 per cent of the weighed children suffer from these levels of malnutrition whereas the NFHS data show that 18.5 per cent of children in the state are in this category. This underreporting of severe malnutrition is evident in the Manendragarh block study, which shows that the proportion of grades III and IV is 19 per cent whereas the government reports it to be 2.4 per cent only.

    But this is only one way in which malnutrition is under-recognised. The government goes on to say that 98 per cent of the malnourished children are in grades I and II, and that these grades represent only mild forms of malnutrition. The governmentbelief is that grades I and II level malnutrition is not serious. This thinking and practice trivialises the severity of risks associated with grades I and II malnutrition. In line with the national ICDS programme, the state government aims to provide double rations of supplementary food to malnourished children; but this additional supplement will be given only to children identified with grades III and IV malnutrition.

    Further, the government did not weigh the remaining 19,41,000 children and had nothing to say regarding this gap. The figure of 8,83,000 children is perceived and represented as the total number of malnourished children in the state. No mention is made of the fact that 56 per cent of the children in the state have not been weighed at all, and that there are likely to be at least another 11,00,000 malnourished children amongst them. These additional 11 lakh malnourished children remain unrecognised.

    The same apathy and lack of recognition of child malnutrition extends to most of the society as well. Most people in tribal areas are so used to seeing malnourished children all around that only extremely malnourished children, those almost on the verge of dying, are recognised as malnourished. Inadequate outreach: Chhattisgarh has a highly scattered population, especially in the tribal areas. Of the total 147 blocks in the state, 83 blocks fall under the Integrated Tribal Development Programme (ITDP) of Schedule V of the Constitution. These areas have low density population spread across numerous remote hamlets along with presence of streams and forests. This settlement pattern poses severe limitations on the ICDS outreach in Chhattisgarh. The existing number of ICDS centres is marginally short of the national norm of one centre per 1,000 population (and 700 for tribal areas). More importantly,

    Table 1: Nutritional Status of Children in Manendragarh Block

    No of children surveyed 1000 Proportion of children with normal weight (>80 per cent of Indian Academy of Paediatrics (IAP) standard weights)* (per cent) 2 7 Proportion of children in malnutrition grade I (70-80 per cent of IAP standard weights) (per cent) 3 2 Proportion of children in malnutrition grade II (60-70 per cent of IAP standard weights) (per cent) 2 3 Proportion of children in malnutrition grade III (50-60 per cent of IAP standard weights) (per cent) 1 4 Proportion of children in malnutrition grade IV (<50 per cent of IAP standard weights) (per cent) 5 Total proportion of malnourished children (per cent) 7 3

    * IAP standards used in this table and rest of the paper. Sources: ActionAid field survey. Throughout this paper, grades I, II, III and IV are as defined here.

    Table 2: Proportion of Children in Various Malnutrition Categories

    (Per cent)

    Chhattisgarh Chhattisgarh Manendragarh Manendragarh (Government Data*) (NFHS Data, Block Block (ActionAid 1998-99) (Government Data) Survey Data)

    Normal weight children 42.2 44.4 27 Malnourished children 57.8 55.6 73 Grade I 35.6 34.2 32 Grade II 20.5 19.0 23 Grades III and IV 1.6 18.5 2.4 19

    *

    Monthly Progress Report (February 2005), Directorate of Women and Child Development, Government of Chhattisgarh.

    Economic and Political Weekly August 26, 2006 the norm itself is problematic. The state government recognises 54,000 odd hamlets in the state (more than 60,000 as per civil society estimates), whereas the number of ICDS centres is only 20,289. Therefore, each anganwadi centre is supposed to cover nearly three hamlets on average. In actual practice, most centres are able to cover only one hamlet effectively. Therefore, about two-thirds of the hamlets get left out.

    As per government data, 68 per cent of the eligible children in Chhattisgarh are enrolled in the ICDS programme (Table 3). However, the programme is able to benefit only 39 per cent of all eligible children. The figures of coverage become worse if one looks at the tribal-dominated areas like Koriya district or further at blocks like Manendragarh. This coverage well below the national ICDS goal of reaching 75 per cent in tribal regions, not to speak of the Supreme Court order directing the government to achieve universal coverage in a short span of time.

    To overcome the problem of low outreach to some extent, the state policy proposes opening up “mini-anganwadi centres” in the left-out hamlets with a population of 150 or more. These mini-Anganwadis are supposed to distribute weekly dry rations only, and ignore other components of the ICDS. Even in this limited form, this policy has been implemented in a small proportion of such hamlets so far. In Sarguja and Bastar divisions, the mini-anganwadis have been set up in six tribal districts. However, many of the hamlets with a population of 150 or more are still left out, for mysterious reasons. For example, in Manendragarh block, 43 mini-anganwadis were opened but 30 eligible hamlets remain excluded.

    The low coverage of ICDS is further compounded by the lack of staff at the anganwadi centre level. The centres have only one anganwadi worker (AWW) and one helper. The mini-anganwadis have only the helper and no main worker. At the current ratio of centres to population in the state, an average centre having a total staff of two is supposed to cater to as many as 201 beneficiaries (Table 4). The AWW is heavily overloaded with tasks related to food, record keeping, data collection, preschool education, home visits, etc. As a to gather the children, thereby reducing outreach. Inadequate supplies: The state government aims to provide supplementary nutrition to various target groups. Their respective entitlements are shown in Table 5.

    These entitlements roughly correspond to the calorie and protein norms set by the national ICDS programme, as well as in recent Supreme Court orders.1 But there are major gaps in terms of exclusion of children with grades I and II malnutrition for double rations. Also, only the malnourished amongst adolescent girls are supposed to be covered.

    In actual practice, the ICDS has virtually abandoned some of the above entitlements at the state level itself. For instance, iron and folic acid (IFA) tablets for children have not been made available. Vitamin A has also not been given for the last three years. The instructions are to provide gur only to children aged three to six years, in cooked form. No gur is distributed to other children. Further, the quantity of gur being provided to ICDS centres (8.3 kgs per month, or Rs 125 per month to buy gur, irrespective of the number of beneficiaries) is hardly sufficient to reach all the target groups. The health department is supposed to supply the IFA tablets, but supplies have been very erratic. In fact, for most months of year 2004, IFA tablets were not available. Regarding adolescent girls, the practice now is that only five girls are allowed to be given supplementary nutrition at any given time in a particular ICDS centre. Victim blaming: A large part of the ICDS apparatus blames poor people for being malnourished and for not being able to access the services government so kindly provides. The blaming gets severe when the ICDS staff deal with poor women, especially from tribal or dalit families. They are told that the government is trying so hard to help them, and that they are undeserving and ungrateful. Further they are blamed for being lazy, unclean and superstitious, and thus responsible for the bad condition of children. This is a strategy consciously or unconsciously adopted by most of the staff. It has become so ingrained in the functioning of the programme that even a freshly recruited staff member from a poor tribal family picks up this attitude within a few months of joining the service.

    In a tribal setting, this has extremely damaging results. The tribal people feel offended and get discouraged from approaching ICDS programme. The other impact is in terms of reducing the effectiveness of messages around changing feeding practices for children. Blaming the recipients puts them in a defensive position, and the impact of counselling gets lost. In 23 out of the 29 villages where an initial survey was done in Manendragarh block, people reported having experienced discouraging attitudes from the ICDS staff. For example, they were told to keep clean. This really made the tribal people feel hurt because they keep their houses, clothes and bodies very clean anyway. Victim blaming behaviour by the staff has been a major reason for the non-acceptance of promotional and preventive messages in child nutrition. It has also reduced the popularity of ICDS programme. Lack of community monitoring and control: The ICDS programme is monitored by two agencies. One is the ICDS supervisory structure in which the sector supervisors monitor the functioning of ICDS centres and report progress to the block level child development project officer (CDPO). This structure can recommend punitive action against erring workers, mainly through temporary suspension of

    Table 4: Beneficiaries per ICDS Centrein Chhattisgarh

    Number of children eligible for

    ICDS services (<6 yrs) 3470000 Number of pregnant and lactating

    mothers identified by ICDS 508685 Total number of anganwadi centres

    (AWC) 20289 Children per AWC 171 Pregnant women per AWC 2 5 Adolescent girls per AWC 5 Total eligible beneficiaries per AWC 201

    Source: Monthly Progress Report (February 2005), Directorate of Women and Child Development, government of Chhattisgarh.

    Table 3: Coverage of Children under ICDS

    Chhattisgarh Koriya Manendragarh
    District Block
    Total number of children aged 0-six years (Census 2001) 3470000 98000 18000
    No of children registered under ICDS 2364409 47186 6741
    Proportion of children aged 0-6 (per cent) 68.1 48.2 37.5
    No of children getting benefit 1342781 32285 3435
    Proportion of children aged 0-6 (per cent) 38.7 3 3 19.1

    result, she has no time to enhance outreach through home visits, family counselling and related activities. The anganwadi helper (AWH) is supposed to cook as well as gather the children from their houses. In actual practice, the helper is often unable

    Source: Monthly Progress Report (February 2005), Directorate of Women and Child Development, government of Chhattisgarh. Also ActionAid survey of Manendragarh Block.

    Economic and Political Weekly August 26, 2006 payment of honorarium to the worker. But monitoring at this level is hampered by the fact that at present 37.7 per cent of the block and sector posts at supervisory and senior levels are vacant (Table 6).

    The other set of monitoring roles is with panchayati raj institutions (PRIs), mainly the sarpanch and the janpad panchayat. The ICDS workers are appointed by the janpad panchayat general body on the recommendation of the sarpanch. The procedure for removal is also similar. However, this monitoring by the PRIs is rarely effective, because the process of removal of erring workers and appointment of fresh staff is a very long one, often taking more than a year. More importantly, the village-level gram sabhas do not enjoy any powers in monitoring, penalising irregularities, and appointments or removal of ICDS workers. This is a big weakness, given that 56 per cent of the blocks in Chhattisgarh (83 out of 147) are Schedule V areas, covered under the Panchayats – Extension to Scheduled Areas Act (PESA Act), which gives special powers to the gram sabhas in tribal areas to monitor village-level government functionaries. As a result of its non-implementation, the community does not have any direct say in the governance of a crucial institution functioning in their own hamlet. Micro-level problems in functioning of ICDS centres: The organisations associated with the “right to food campaign” conducted a survey on ICDS entitlements in four districts of the state, i e, Sarguja, Raigarh, Raipur and Dhamtari in January 2005. Table 7 presents selected findings from this survey.

    The positive aspects include the reasonably high regularity in opening of centres and regular provision of hot cooked meal for children aged three to six yeras. But there were major irregularities in the THR system, particularly with respect to gur, oil and salt. Very similar results had been obtained in an earlier survey in Koriya district, conducted in 2003.

    Grassroot Mobilisation

    Mitanin cadre: The mobilisation to improve child nutrition was initiated by an organisation of tribal people called Adivasi Adhikar Samiti in Koriya district in July 2003. This organisation conducted the campaign in about 200 villages of Manendragarh and Bharatpur blocks. This organisation is led by “Mitanins”, who are a set of community volunteers selected by the community. The adivasi Adhikar Samiti has a Mitanin in each of the 650 odd hamlets that it is active in. The Mitanins play the lead role in initiating the struggle for securing the rights of marginalised tribal communities. They have undergone a series of trainings, and they have formed committees in each hamlet to build collective strength. One of the focus areas of Mitanins has been around securing nutritional rights for children of tribal communities living in remote areas. The Mitanins took up the issues related to nutrition because it forms the core of their work on health and food issues. This 650 strong cadre brought the issue of child malnutrition high on the community’s priorities.

    The first intervention was to start an awareness campaign on child malnutrition. The Mitanins received training on child health and nutrition. Each Mitanin along with a trainer did family counselling sessions by visiting each household in her hamlet having one or more children below the age of five. This family counselling was exclusively focused on child nutrition. As a part of it, the Mitanin first found out the socio-economic condition of the family. In each household, children below the age of five were weighed in front of the mothers as well as other family members. The nutritional status of the child was found out on the spot and the significance of each grade of malnutrition was conveyed to the family. This really made not just the mothers, but also the father and grandparents take malnutrition in their children seriously. This drive made the community recognise the extent of child malnutrition. Further, the Mitanin counselled the parents by suggesting simple ways of preventing malnutrition. Along with the messages, the rationale for each measure was also provided. The essential messages were:

  • (1) The child should be breast-fed within one hour of birth. The mother should be given food immediately and should get ample rest. This will prevent weakening of the mother as well as of the child. Also, the first breast milk contains properties that enhance the resistance of the child against infections.
  • (2) The child should be exclusively breastfed for the first six months so that no infection occurs due to outside food.
  • (3) Once the child reaches six months, supplementary soft food like rice, dalia, dal soup, green vegetable soup, etc, should be given. The supplementary food is necessary because a six month old child requires more food to grow and be active.
  • (4) The child should be fed at least six times a day, because the child requires almost half the amount that an adult needs, but has a very small stomach. So the required quantity can be fed only by increasing the frequency of feeding.
  • (5) Green vegetables and dal should form essential parts of the child’s diet, as they are important for the growth of the child.
  • (6) The child should be given fat in the form of oil in rice or roti, because the child requires energy and a little local edible oil can help a lot. Half a roti with some oil on it can give strength equivalent to a full roti.
  • (7) Feeding should be continued even when the child is ill so that it has enough strength to fight the disease. After the child
  • Table 6: Vacancies at Supervisory and Senior Levels

    Pos t Sanctioned Vacant Vacancies as
    Strength Positions Percentage
    of
    Sanctioned
    Posts

    CDPO 152 57 37.5 ACDPO 103 55 53.4 Supervisors 1027 371 36.1 Total 1282 483 37.7

    Table 5: Supplementary Nutrition Entitlements in Chhattisgarh

    Target Group Entitlement
    Wheat Gur Oil Iodised Vitamin A Iron
    Dalia (gms/day) (gms/day) Salt (Doses) Folic
    (gms/day) (Kg/month) Acid

    Children aged six months to

    three years Children aged three to six years Children (below age six) with

    grades III or IV malnutrition Pregnant women Lactating mothers (with children

    aged below six months) Adolescent girls (age 12-19 and weighing less than 40 kgs)

    80 THR* 8 THR 8 THR 2 THR 5 100**
    80 cooked 8 cooked 8 cooked cooked
    160 THR 16 THR 16 THR 2
    160 THR 16 THR 16 THR 2 THR 100
    160 THR 16 THR 16 THR 2 THR
    160 THR 16 THR 16 THR 2 THR

    Notes: * Children aged three-six years are meant to be fed cooked wheat dalia (porridge). Other target groups are given “take home rations” (THR) on a weekly basis. ** Paediatric iron folic acid tablets, for children below three years.

    Economic and Political Weekly August 26, 2006 recovers from illness, feeding should be increased to recover from the weakness caused by the illness.

    Also, suggestions were given about preventing and treating diarrhoea, respiratory infections and malaria, explaining the reason for each step. Each counselling session with one family lasted about an hour. The Mitanins were trained in counselling methodology and special care was taken that they don’t adopt any of the victim-blaming behaviour. For instance, they were discouraged from giving any advice like “keep the children clean” or “feed them a balanced diet.” During the counselling, a conscious effort was made to praise the good efforts of the mothers. The main message to the families was that though they were making good efforts to take care of their children, their children could gain further by adopting some simple inexpensive measures.

    The family counselling took place not just in Koriya but all over the state due to the Mitanin programme. This had an unprecedented effect on the feeding practices. For instance, it is a common practice in tribal areas to give goat milk to a newborn child and keep the mother hungry for more than three days. The Mitanins, being hamlet-based, reached most of the child birth cases immediately and ensured that the mothers were fed in front of their eyes and that the child was breast-fed. After one round of counselling by Mitanins, 25 per cent change has been observed in Manendragarh block. Further behavioural changes are expected after two or three rounds of counselling.

    The second step was to create nutrition monitoring committees in each hamlet, called ‘Dekh Rekh Samitis’. These samitis consisted mainly of tribal and dalit women. The Mitanins and their trainers shared the data on child malnutrition in each Dekh Rekh Samiti at the hamlet level. This allowed the community to monitor the nutritional status of children by weighing the children again at an interval of six months. The Mitanins gave more importance to grades I and II malnutrition because it is conventionally the most underrecognised. Also, if a child in grades I or II malnutrition gets ignored, it is likely that it will slip into grades III or IV. Improving ICDS: The Mitanins started linking all the children and pregnant women with ICDS so that they can access supplementary nutrition as well as health services like immunisation, etc. They did it by holding meetings (mainly of women) in each hamlet and encouraging mothers to access the ICDS centres. They informed all the mothers about their entitlements from the ICDS and built the idea that it is a right that they should demand and it should not be seen as a dole from the government. On immunisation and dry ration distribution days (all Tuesdays), each Mitanin used to gather a large number of women from her hamlet and take them to the ICDS centre. This drive led to an increase in the number of beneficiaries being effectively served by the ICDS.

    However, it did not happen in 27 per cent of the villages because they had poorly functioning anganwadi centres. The women felt discouraged to go to the centre as they were never sure of receiving the food items. The Adivasi Adhikar Samiti (AAS), the federation of Mitanins in Koriya district, took up this issue and started a campaign to improve the ill-functioning centres. As a first step, mothers were encouraged to go to their AWC in large numbers and collectively demand their food entitlements. This mobilisation gained strength and immediate improvements were observed in about a third of the ill-functioning centres. But in a majority of the centres, the problems continued. In villages like Bairagi, the tribal women walked 10 kilometres to the ICDS sector supervisor and complained about the AWC being totally closed over the previous six months. The supervisor did not take any action for months to come.

    Another series of meetings were organised in these villages and mothers were asked to share their experiences of demanding food from the ICDS. Based on these discussions, the Mitanin trainers asked the women to give their complaints in writing in the form of a collective affidavit. These complaints were then forwarded by AAS to the district collector. The collector accepted that the situation of ICDS was not good and that most of the complaints

    Table 7: ICDS Entitlements in Four Districts of Chhattisgarh

    Part 1: Survey Findings for Children Aged Three to Six Years Who Attend ICDS Centres

    Dimension Categories Proportion of Centres (Per Cent)

    Regularity of opening Number of opening days per month: 1-10 11.7 11-20 15.7 21-30 72.5

    Anganwadi helper gathers the Does not gather 57.8

    children (age 3-6) from homes Gathers for (days/month): 1-10 43.2 11-20 0 21-30 0

    Discrimination practice based on Discrimination happened 6 caste experienced Never happened 94 Cooked dalia is served to children Not served 16.4 aged 3-6 years at the centre Served dry 1.8 Served 3-4 days/week 1.8

    Served everyday 80 Cooked dalia given to children No gur 53.2 aged 3-6 years contains gur Given (days/month):

    1-10 17 11-20 10.6 21-30 19.1 Weighing of children during past Weighing not done 47.3 six months Weighing done 52.7 Double food for malnourished Not given 68.4 children Given 31.6 Cleanliness in cooking dalia in Sometimes unclean 8 last one month Never unclean 9 2

    Part 2: Survey Findings for Children Aged Six Months to Three Years, Adolescent Girls and Pregnant or Lactating Women Who Get THR Every Week on Tuesday

    Beneficiary Group Category Wheat Edible Oil Gur Salt Dalia (Per Cent) (Per Cent) (Per Cent) (Per Cent)

    Infants Do not get 25.5 56.4 89.2 41.5 Get lower than entitled quantity 9.1 25.4 2.7 29.3 Get full quantity 65.4 18.2 8.1 29.3 Adolescent girls Do not get 78.4 98.2 100 97.6 Get lower than entitled quantity 5.4 1.8 0 0 Get full quantity 16.2 0 0 2.4 Pregnant and Do not get 26.8 58.2 98 48.8 lactating women Get lower than entitled quantity 24.4 31.9 2 4.9 Get full quantity 47.8 10.9 0 46.3

    Economic and Political Weekly August 26, 2006

    were likely to be genuine, but expressed his inability to take any punitive action against the erring staff. The collector advised the AAS to mobilise the gram sabhas or gram panchayats, as they were the competent authorities to punish or replace erring workers. The Mitanins waited for the next set of gram sabha meetings to be announced (in Chhattisgarh, gram sabha meetings can only be called by the collector). In a few of the most severe cases, the Mitanins mobilised the women to go to the gram sabha and ask for action against the erring AWW. But all the gram sabhas proved to be ineffective as the complaints made by women were not heard. In villages like Dulku, the sarpanch openly took the AWW’s side and the panchayat ‘sachiv’ (secretary) refused to write the resolution calling for her removal.

    These setbacks led AAS to think about approaching the commissioners appointed by the Supreme Court to oversee the implementation of interim orders in the “right to food” litigation (PUCL vs Union of India and Others, Civil Writ Petition 196 of 2001). The commissioners had in turn appointed advisors in many states including Chhattisgarh to monitor the situation of food entitlements on the ground and forward public complaints regarding violations of court orders. The AAS decided to approach the advisor of Chhattisgarh with their affidavits. The advisor forwarded the complaints to the commissioners and the commissioners wrote to the state government demanding an immediate enquiry into the complaints. This created a panic in the district administration and among ICDS officials. Immediately, the ICDS supervisors and child development programme officer (CDPO) conducted an enquiry in 15 villages and the erring AWWs were reprimanded.

    This action led to an antagonistic relationship between the AWWs and the Mitanins. In order to reconcile both sides and make the community more aware about positive changes in the ICDS, a revival campaign for AWCs was planned. This revival plan was jointly planned and implemented by the ICDS supervisors, the health department ANMs and Mitanins. A series of revival meetings were organised in 45 villages (covering all the centres with problems) in which the community and the ICDS staff were brought together and duties of every side were explained. In many villages, the community came out with exaggerated expectations regarding preschool education in terms of demanding formal teaching of children. In such cases, they were made to understand the real nature and purpose of pre-school education and the rationale for using only songs, stories, games, group activities, etc. This drive was a major success, and most centres (apart from two) showed major improvements in functioning as well as utilisation. But the relationship between Mitanins and AWWs finally improved only when they came together to build gender solidarity against violence. Many of the AWWs were themselves victims of domestic violence. The Mitanins helped them to get protection and justice. In a few cases, the Mitanins collectively supported the AWWs in getting medical examinations done and securing police action.

    The above steps took the proportion of beneficiaries actually able to access ICDS services to 20 per cent from the earlier level of only 9 per cent. However, a large number of hamlets (around 260 in one block alone) were still left out because they did not have ICDS centres. For such hamlets, a two-pronged strategy was devised along with the ICDS district project officer. The hamlets within two kilometres of existing centres were linked to the nearest AWC. The mothers from such hamlets were allowed by the department and encouraged by the Mitanins to take dry rations every Tuesday from the nearest centre. Some of the children in the age group of three to six years also started going to the AWCs as their school-going elder siblings were escorting them. The hamlets three or more kilometres away from AWCs had bigger difficulties. It was not possible for all the eligible mothers to walk to the centre every Tuesday. They were formed into a committee which nominated a set of volunteers to go every Tuesday and bring dry rations to all eligible families in the hamlet. The ICDS officials agreed reluctantly to this proposal and tried it out as an experiment in five villages. The community-managed distribution centres took off well and started bringing and distributing dry rations, while very tight monitoring was done by the committee members. But this process became very labour-intensive as requirements of facilitation were huge, record-keeping was not easy (given the abysmal level of adult literacy amongst tribal women in Manendragarh) and coordination problems with the ICDS machinery kept on rising.

    Meanwhile an opportunity came in the form of the Sarguja region development authority that had funds as well as willingness to open mini-anganwadis in hamlets with a population above 150. This measure increased the number of centres in the district by 40 per cent. This took care of many bigger hamlets. These minianganwadis were supposed to be only dry ration distribution centres, and a single worker was recruited for each minianganwadi. The Mitanins and the hamlet level community monitoring committees (Dekh Rekh Samitis) kept a close watch to ensure that the right candidates from destitute households were selected for the job.

    The next step was to consolidate the Dekh Rekh Samitis so as to institutionalise community monitoring of nutrition and related services. The Dekh Rekh Samitis started monitoring the functioning of all the food schemes in the hamlet. Each samiti maintains a register in which its volunteers maintain attendance records of the ICDS centre, primary school, PDS shop and ANM. This kind of monitoring has made it clear to government functionaries that the community is taking a keen interest in the various schemes, and is keeping a close watch. This has helped to demolish, to a great extent, the victim-blaming strategy of the government staff.

    The campaign on ICDS is now two years old in Koriya. Recently problems were reported again by the Dekh Rekh Samitis in terms of repeated shortage of stocks in most centres, and that too of not just gur or oil but even wheat dalia. This time, the Mitanins were able to take the AWWs into confidence. The AWWs expressed their innocence in the matter and held pilferage at higher levels responsible for the repeated shortages. The district women and child development officer had been transferred three months ealier and no replacement had been sent. This situation led Adivasi Adhikar Samiti to organise a large public hearing on food issues, with special focus on corruption in the ICDS. The public hearing took place on March 24, 2005. More than 2,000 women came from over 135 villages spread over three blocks to raise their demands for arresting the decline in the ICDS. The authorities have promised remedial action, but it is likely to take several rounds of struggle to combat the corruption at higher levels. Expansion of the campaign: Over the last six months, more organisations of tribal people have taken up the campaign to improve the ICDS in their respective areas. Pahadi Korwa Mahapanchayat and Chhattisgarh Kisan Mazdoor Andolan have started their campaign on ICDS in Sarguja

    Economic and Political Weekly August 26, 2006 district. Baiga Mahapanchayat in Kawardha and Bilaspur, Abhayaran Mahapanchayat in Dhamtari, Adivasi Dalit Morcha in Raipur, Lokshakti Samiti in Raigarh and several other groups associated with the right to food campaign have initiated focused campaigns on ICDS. The campaign has grown to cover more than 1,000 villages in 17 blocks, spread across seven districts. This group of social activists has adopted a concerted strategy and has carried out a survey on ICDS entitlements. In case of poorly-run AWCs, public protests have taken place at the village and block levels. The survey reports have been shared with the district collectors and action has been demanded. Community monitoring of ICDS has been initiated by forming monitoring committees at the village level. As a result, improvements have already been reported in many cases. This extended campaign is going to adopt strategies like family counselling, nutrition monitoring and public hearings to deepen the impact of mobilisation

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    This campaign has brought to light the condition of three of the highly marginalised primitive tribal groups, namely, baigas, pahadi korwas and kamars. These groups suffer from the worst levels of malnutrition and morbidity. Most of these tribes are settled in thick forests and remote hilly areas. The outreach of ICDS to these groups is minimal, because: (a) villages exclusively inhabited by these groups have not been allocated any AWCs (e g, in Achanakmar area of Bilaspur district, there are enough centres in the area as per the population norm, but in a majority of cases, the AWCs are located in non-Baiga villages); (b) They stay in hamlets which are far from the main hamlet in the village, where the AWC is typically located. Their own hamlet is considered too small even for opening a mini-Anganwadi, e g, for Pahadi Korwas in Sarguja, this was found to be a common problem. The struggles to universalise and strengthen ICDS so that it reaches the (socalled) primitive tribal groups will remain the main focus in future interventions of this campaign.

    Recommendations

    (1) Universal coverage: A highly intensive and successful campaign like the one in Koriya district could take the access rates to around 30 per cent of beneficiaries. But the campaign is not able to go any further because the rest of the population is either too scattered or distant from existing AWCs. No amount of demandside interventions can increase the coverage. The ICDS staff are already too overburdened to be active beyond their existing coverage zone to increase outreach per centre. The only way is to increase access by having more AWCs. The population norms need to be revisited. Even with additional staffing, an average centre cannot cater to more than 100 beneficiaries. Therefore in Chhattisgarh, the number of AWCs needs to be doubled, at least in the tribal blocks. The mini-anganwadis can be opened as a stop-gap arrangement in all hamlets with populations above 100 (about 20 beneficiaries).

  • (2) Preference to primitive tribes: In opening of new centres, preference should be given to the hamlets inhabited with primitive tribal groups.
  • (3) Sensitising/training AWWs: The AWW cadre needs to be given sensitivity training to overcome the victim-blaming tradition in the ICDS. Like the Mitanins, they should be trained in family counselling methodologies a non-prescriptive, simple and positive nature.
  • (4) Strengthening the AWC: Each AWC needs to be strengthened by having at least two AWWs in addition to the anganwadi helper. This will improve the quality of pre-school education and also enable the AWW to make home visits for family counselling.
  • (5) Monitoring by gram sabhas: The gram sabhas, at least in the Schedule V areas, should be empowered to monitor AWWs, hold them accountable and even appoint and replace them.
  • (6) Variety in food: The cooked food for pre-school children should be diversified by introducing local leafy vegetables.
  • EPW

    Email: koriya@gmail.com

    Note

    [This paper borrows heavily from ideas shared by Biraj Patnaik, Sulakshana Nandi and T Sundaraman in numerous discussions. It also draws on field surveys and documentation of action done by Gangaram Paikra, Rajesh Tripathi, Rashmi Dwivedi, Beni Puri, Anita Dhruv and the Sangathans they represent. I am also grateful to Paromita for helping with the data analysis of field surveys, and to all the Mitanins and leaders of the Adivasi Adhikar Samiti, Koriya, who have contributed to documenting this set of experiences.]

    1 PUCL vs Union of India and Others (Civil Writ Petition 196 of 2001). For further details of this public interest litigation, and the Supreme Court orders, see www.righttofoodindia.org.

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