By Alka Gupta
January 15, 2008, Cuttack, Orissa: The little child in the arms of Mumbai pediatrician Dr Samir Dalwai lay still. With a fixed glaze he neither laughed nor cried although he was held in a stranger’s arms. His hands and arms were swollen. And that was unsettling for the group who looked at him.
“Is he among those malnourished?” asked Supriya Sule, Member of Parliament and member of the Citizens’ Alliance Against Malnutrition. “No,” said the anganwadi worker. She picked up another child, who was thin and crying. “This one is in grade 3 of malnutrition, but doing well under the Nutrition Care and Counseling Scheme.” “One of the first signs that a child is not doing well is his or her crankiness,” explained Gayatri Singh the UNICEF nutrition expert.
“What do you feed the children?” asked Gauri Karnik, actor and another member of the Citizen’s Alliance. “Our approach is called Ame Bi Paribu which translates into “We Too Can”. The programme is also called Positive Deviance and families coming for the feeding programme are referred to as the PD group” came the reply.
“Adapted from West Bengal, the project believes that in each community there are healthy families with healthy children. It seeks to teach mothers with malnourished infants some of the good community practices in feeding their own child” explained Kumudini Sathypathy, the anganwadi worker from Madhyakachha village in Salepur Block, Cuttack district.
This was the 3rd field visit of the Citizen’s Alliance against Malnutrition. This time the effort was focused on understanding the interventions that have made a difference, since malnutrition rates in Orissa came down by ten points during the last 7 years. Ame Bi Paribu is one such initiative in Orissa that was piloted in Mayurbhanj district and now scaled up to cover 4,000 centres by the Orissa government.
The Alliance had visited Madhya Pradesh and Maharashtra earlier to get a feel of the problems at the ground level.
Women’s Self Help Groups (SHGs) is another success story in Orissa and there are 300,000 of them in the state. The SHG members play an important role in cooking the mid day meals and supplementing food for the nutrition programme run by the anganwadis. After the visit, Supriya Sule remarked, “There is a great deal of commonality of approach between Maharashtra and Orissa insofar as the involvement of SHGs goes.”
The Alliance members commented upon the way the anganwadi worker (AWW), auxiliary mid-wife nurse ANM and accredited social health attendant (ASHA) worked together at the village level and they found this to be another positive feature in Orissa.
The Alliance members made a surprise stop at Balugram village in Salepur block. The issue of lack of supplies came up as the anganwadi had had no food to give to the children for the last 10 days. Flexibility and improvisation within the system was discussed as there was food for the mid day meals in the schools and the anganwadi children could have been fed with some of the same rations.
A common complaint that the SHGs made was that the government allotted them only 0.15 paise for vegetables in the Mid Day Meal programme. This was inadequate to buy sufficient quantities. In some anganwadis, a `handi’ (large cauldron) was hung on the roof of the Anganwadi Centre in which SHG members invited the village community to give vegetables, eggs or milk as supplementary food for the under-nourished children. This community involvement formed a key part of the Positive Deviance programme.
At another surprise stop at Baldevjee village, the group found that while the Anganwadi was operational, the village like many other, had very few toilets and lack of public hand pumps.
On the previous day the Citizen’s Alliance members had an hour long interaction with the Chief Minister of Orissa, Mr. Naveen Patnaik. The CM had called his senior secretaries and three collectors from Cuttack, Mayurbhanj and Ganjam districts to meet with the Group and apprise them about the initiatives taken by his government to combat malnutrition.
The officials present included the Commissioner & Secretary Department of Women and Child Development, the Principal Secretary Health & Family Welfare. The discussion was frank; the officials were candid both about the good practices and the problems that continued to dog them.
The Group also addressed the media in a press conference. Speaking about the role the Alliance could play, Sachin Pilot, Congress MP said, “The group can be a ‘bridge’ between the government and people.” He stressed on the need for civil society, NGOs, media and governments to come together to focus national attention on the issue of child malnutrition. The Alliance, he said, was an attempt in that direction.
Jay Panda, BJD MP from Orissa who had helped organize the Alliance’s visit to the state, told the media, “Malnutrition has not got the attention it deserves. The Alliance aims to bring the issue of malnutrition high in the media. The end goal is to make the issue a priority among the national and state governments.”
Commenting on the visit, Shyam Benegal, who is nominated MP and an eminent film-maker known for the sensitivity with which he has handled social issues in his films, remarked, “India has the largest number of young people in the world. With this in mind malnutrition among children becomes an extremely grave issue.”