Leadership and learning go together. That, at least, is what a team of seven legislators from Rajasthan have discovered. In order to understand for themselves the best ways to address child malnutrition – a hot button issue in a state where the infant mortality rate, at 59, is much higher than the national average – they undertook a tour in November 2011 to study best practices in nutrition in neighbouring Madhya Pradesh (MP).
Suryakanta Vyas, the 73-year-old MLA from Soorsagar in Jodhpur, who is the chairperson of the Women and Child Welfare Committee of the state assembly and who headed this team of peripatetic MLAs, puts it succinctly, “It was an enriching experience.”
She points out that each region has its own way of dealing with such concerns and others can learn from it. She was struck, for instance, by the way one anganwadi (mother and child care centre) in Mayana village of MP’s Guna district, marks the third Tuesday of every month as ‘Janam Diwas Samaroh’ (birthday celebration), during which all the children who have their birthdays in that particular month are given small gifts like pencils or water bottles. They are also weighed after which their individual weights are entered in the anganwadi register.
The study initiative was organised under the aegis of a knowledge association between the UN in India and the Rajasthan Legislative Assembly. The field visit was jointly facilitated by four UN agencies – WFP, UNICEF, WHO and FAO – that have expertise in the area.
Vyas drew important lessons for Rajasthan from the study. She says, “Take the celebration in that small anganwadi at Mayana. Celebrations are a good way of bringing women and children to an anganwadi and ensuring community participation. Such events could take care of the problem we face in Rajasthan where a good number of mothers – 46 per cent, according to a study ‘Rajasthan Mein Aganwadi Kendron Ki Sthiti by the Resource Institute for Human Rights – enrolled with the aganwadis do not reap the benefits of its services. We need to change that reality.”
Vyas has already written to the Department of Women and Child Development (DWCD) to replicate this initiative in Rajasthan, according to Khimi Gowrani, Assistant Secretary, Women and Child Welfare Committee, who was also part of the group that visited Guna. Apart from Vyas, six other MLAs were in that team: Anita Singh (Nagar, Bharatpur), Anita Bhadel (Ajmer South), Ganga Devi (Bagru, Jaipur), Gangaben Garasia (Pindwara Abu, Sirohi), Promila Kundara (Chaksu, Jaipur) and Kamsa Meghwal (Bhopalgarh, Jodhpur).
During the course of their travels, the MLAs were introduced to a wheat flour fortification project that the WFP, in collaboration with the Government of Madhya Pradesh, has introduced as a pilot in the districts of Guna, Shivpuri and Sheopur. The group got a chance to observe how it worked in the villages of Bhadoura and Umri on the Shivpuri-Guna road, where it is meant to address the nutrition needs of the Sahariya tribals, one of the most deprived communities of the region.
MLA Ganga Devi, who represents Bagru, Jaipur, carefully compares the MP intervention with Rajasthan’s own food fortification drive that has recently been rolled out across all districts of the state. According to her, fortified flour is sold for Rs 8.60 (US$1=Rs 50) a kilogram in the four districts of Barmer, Churu, Bhilwara and Nagaur as well as divisional headquarters at Jaipur, Ajmer, Bharatpur, Udaipur, Jodhpur and Bikaner. For Below Poverty Line (BPL) families, the price of fortified flour, sold in packets of 10 kilos each is Rs 3.60 per kilo. In contrast, at Guna she noticed that the flour milled at village mills was fortified at no extra cost because the pre-blend was being supplied to mill owners by the WFP. “Cost is an important factor in the consumption of fortified food. We need to tell our government to replicate the Guna intervention in Rajasthan, at least in the poor, tribal districts,” she observes.
Another initiative that caught the eye of the visitors was the Nutrition Rehabilitation Centre (NRC) at the Guna District Hospital, with its special newborn care unit. Set up in October 2005 by the then collector of the district, with assistance from UNICEF as well as some donor agencies, it is meant to revive severely malnourished children, many of whom are in an almost emaciated state when they are first brought here. This unit not only provides regular health check-ups, medicines and the required nutritious food for them, it also counsels their parents on proper feeding habits. In order to build greater community awareness about the existence of such a facility and to create a demand for such services, UNICEF has a team of animators and village motivators that act as a bridge between the communities and government-run services of this kind.
What was interesting was the deep engagement the MLAs showed at a policy level. For instance, Gangaben Garasia, MLA from the tribal constituency of Pindwara Abu in Sirohi district, was especially impressed by the Nutrition, Counseling and Child Care Sessions (NCCS) being run at anganwadis. The NCCS has been piloted by UNICEF in partnership with the DWCD, as well as local civil society organisations in the two integrated districts of Guna and Shivpuri. Here families of all moderately and severely underweight children are urged to enrol for the NCCS through the anganwadi network. Twelve mothers and their children participate in each NCCS session – lasting about two to three hours – for 12 days in a row. During these 12 days, specially trained anganwadi workers counsel mothers on proper infant and young child feeding practices, nutrition, hygiene and health. The sessions are then followed up by home visits.
Says Garasia, “The underlying principle of the project is community-based management of malnutrition through improved caring practices, which includes counselling the mothers of all children enrolled at that particular anganwadi. I believe this model has been successfully deployed in states like Odisha and West Bengal and Rajasthan can certainly benefit from such an approach,” she remarks.
For the MLAs, there have been many takeaways from the study trip, which they hope will ultimately benefit their state. Everybody came back convinced that community-based participation for all services addressing malnutrition is the way to go, but they also understood that ensuring this was not easy, that government services – if they are to be effective – need out-of-the-box thinking and an efficient follow-through.
Says MLA Promila Kundara, “The nutrition situation in Rajasthan is worrying. Here, 41.7 per cent of infants (18-23 months) are underweight and 49.4 per cent of infants in the same age group are stunted. We need to act, and act fast. Which is why we also need to understand better what works and what doesn’t.” That trip to MP, she hopes, is the beginning of a long journey of engagement and action on addressing malnutrition in Rajasthan.