Mini anganwadis for malnourished kids in remote areas is need of the hour

On the morning of India’s Independence Day in 2019, Kuna Munda, 30, of Jayapura village, along with a group of 70 villagers, gathered in a small community building in Chasagurujang village. They were demanding that a mini anganwadi centre — a childcare centre catering to a population of 150 to 300 — be set up in their village.

“Our child’s nutrition has been compromised because we don’t have an anganwadi centre in the village,” said Munda, who lives in a small hamlet in the Pallahara block of Odisha’s Angul district. “We have to cross a river to get to the nearest anganwadi. How am I supposed to send my four-year-old son to the centre every day?”

The poorest people — those in the “lowest wealth quintile” or the 20 per cent with the least amount of wealth—and other disadvantaged social groups such as the scheduled castes (SCs) and scheduled tribes (ST) living in small hamlets such as in Pallahara have the least access to anganwadi services, data from the fourth National Family Health Survey (NFHS) show. Living in remote areas, as many from STs do, exacerbates this inaccessibility.

STs comprise 8 per cent of India’s population (104 million) but 45.9 per cent of those from STs were in the lowest wealth bracket, more than any other social group, as IndiaSpend reported in February 2018. In 2015-16, as many as 19.7 per cent of ST children under five years were stunted—had short height for age —and 19.0 per cent of SC children, as compared to 16.4 per cent of other backward castes and 11.9 per cent of ‘general’ castes, NFHS data show.

Low- to middle-income social groups are more likely to get food supplements, health check-ups and other ICDS services, NFHS-4 data show. In 2015-16, 63.3 per cent of the poorest children did not get a health check-up as against 54.9 per cent children from the second wealth quintile (poorest 21 per cent to 40 per cent of the population). Those better off prefer private services and hence have a low utilisation of ICDS services.

In 2015-16, a higher proportion of ST children received food supplements, health check-ups and pre-school education than other social groups, but this is low as compared to the proportion of poor people belonging to STs that need these services. For instance, even though almost half of the ST population (45.9 per cent) belongs to the poorest quintile (poorest 20 per cent), and 24.8 per cent to the second lowest quintile, 60.4 per cent of their children received food supplements under ICDS, NFHS data show.

Compare this to other backward castes: 18.3 per cent of their population belongs to the lowest wealth bracket, and 19.3 per cent to the second lowest, while 45.6 per cent of children received food supplements under ICDS, data show.

Administrative shortcomings

The meeting that Munda attended was organised by members of the gram panchayat (elected village committee) and community leaders to hear people’s concerns and educate them about the need for a mini anganwadi.

“We are proposing two mini anganwadi centres in distant hamlets,” said Sashank Shekhar Naik, 47, sarpanch (village head) of Chasagurujang. “Our priority is to make mini-anganwadi centres available to children from the scheduled tribes who live in faraway villages. Children from here never get their take-home rations. It is impossible for parents to take them to the anganwadi centre every day and lose their wages.”

Since 1975, the government has run a supplementary nutrition programme under ICDS, which provides take-home rations — chhatua (powdered grain), eggs and pulses in the case of Odisha —for pregnant women, lactating mothers and children. It also provides hot, cooked meals for children, as well as pre-school education for children aged three to six, at anganwadi centres, as IndiaSpend reported in August 2019.

This helps support a child’s first 1,000 days — a window of opportunity in early childhood when a child’s growth and cognitive development are the fastest.

ICDS was universalised in 1995-96 to cover all community development blocks, and now reaches remote corners of the country. However, the poor, especially those from disadvantaged groups, are still left behind, as IndiaSpend reported in February 2018. Even in better-performing states such as Odisha, the lowest on the social ladder are excluded as they often live in remote areas.

“Anganwadi workers are not from our village, even if our children go to the centres, they are the last ones to be fed,” said Munda Saunto, 44, a panchayat member. “Auxiliary nurse midwives and ASHAs (grassroot health workers) hardly ever visit our village because of the rough terrain.”

“Children from distant hamlets are supposed to come to my anganwadi centre, but their attendance is the lowest,” said Nirupama Nayak, 31, an anganwadi worker in Udayapur village, which also covers Jayapur village. “They cannot travel 3 km every day, alone, to visit the centre. As a result, they miss out on their hot cooked meals, neither do they get pre-school education.”

The government sanctioned 116,848 mini anganwadi centres in 23 states and Union Territories in 2007, data from the National Institute of Public Cooperation and Child Development show. There are no data on how many mini anganwadis are currently operational.

Until 2005, only one of the six services — hot cooked meals —were provided in a mini anganwadi under the ICDS. In 2007, norms were revised so that all six services were to be provided, ICDS guidelines show.

Even though the villagers in Pallahara want an anganwadi, there is an administrative issue: Kuna Munda’s village, Jayapur, overlaps with another gram panchayat; half the population comes under that panchayat, which means that Jayapur does not have the minimum 150 people to make it eligible for a mini anganwadi centre. The villagers have proposed two mini anganwadis, one in each gram panchayat.

Even the panchayat members were unsure whether Munda’s village belonged to the panchayat of Chasagurujang, where the meeting was taking place, or if he should have gone to the other panchayat that Jayapur is also a part of.

“We have submitted proposals to the government for a mini anganwadi centre especially in the hamlets without an anganwadi, where children cannot reach the nearest centre by foot. It is under consideration and the government will sanction it soon,” said Manoj Mohanty, district collector of Angul.

Renu Pati, the child development project officer for Angul district who oversees ICDS services, and should have been involved in sending the proposal, said she had not received any proposals yet for a mini anganwadi. She refused to answer any other questions.

Reduced burden, improved health

The lack of access to nutrition could be felt most acutely in disadvantaged communities. For instance, in 2013, 19 infants died due to malnutrition when the Odisha government ran a special project for the development of vulnerable tribal groups — the most disadvantaged among STs. Under the project, 216 children were identified as severely underweight and suffering from severe acute malnourishment, but 60 of these were not referred to any hospital, found the 2017 Comptroller and Auditor General report, the latest on particularly vulnerable groups. “No remedial measures were taken by micro-projects to eradicate malnutrition,” the report said.

In addition to helping children and families, mini anganwadi centres would also reduce the burden on the government. Currently, nutritional rehabilitation centres support highly malnourished children and mothers, spending Rs 125 a day per child and mother in Odisha. A malnourished child, along with their mother, is kept for a minimum of 15 days at the nutritional rehabilitation centre under close observation, while focusing on their nutrition.

In January 2019, Nayak, the anganwadi worker, sent three children to the nutritional rehabilitation centre in Pallahara block’s community health centre, 40 km from the village. Two of the children were in the red zone — signifying severe malnourishment with very low weight for height — and the third child was in the orange zone, showing moderate malnourishment. A closer anganwadi centre could have helped these mothers and children supplement their nutrition and avoid severe malnourishment.

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Printed with permission from Indiaspend.org, a data-driven not-for-profit organisation