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 Moribund ICDS
(a study on the ICDS and Child Survival issues in Madhya Pradesh)

Sanket - Centre for Budget Studies, Vikas Samvad

&
Right to Food Campaign Madhya Pradesh Support Group
Moribund ICDS
(a study on the ICDS and Child Survival issues in Madhya Pradesh)

Analysis & Report Writing

Vikas Samvad
E-7/226, Ist Floor, Opp Dhanvantri Complex, Arera Colony, Shahpura, Bhopal, MP
Phone 0755 4252789, email - vikassamvad@gmail.com, web - www.mediaforrights.org

Sanket - Center for Budget Studies

E-2/141, Arera Colony, Bhopal, MP. Phone 0755 2468050

Published by - Right to Food Campaign Madhya Pradesh Support Group, Vikas Samvad and
Sanket-Centre for Budget Studies, Bhopal

Data collection and field support Spandan (Khandwa), Saheriya Mukti Morcha (Sheopur),
Adiwasi Adhikar Manch (Satna), Manav Adhikar Forum (Shivpuri), Sanket (Bhopal), Lok Jagruti
Manch (Jhabua), Bundelkhand Janutthan Samiti (Tikamgarh), Patthar Khadan Majdur Sangh
(Panna), Community Development Center (Balaghat), Dalit Sangh (Hoshangabad), Adiwasi
Susashan Sangh (Seoni), Abhar Mahila Samiti (Chhatarpur) and NIWCYD-Bachpan (Bhopal).

Year of Publication - 2009

Printed Copies - 1000

Declaration - This study is resulted out of joint efforts by different NGOs, alliances and CSOs
working intensively for recognizing children's right to food, survival and nutrition across the
State.

We are deeply indebted to Child Rights and You (CRY), Action Aid, UNICEF and MDG Campaign of
UNDP for supporting us in building hypothesis, data collection, editing, designing and giving a
final shape to the study.

The views and analysis presented in the study is the responsibility are of publishers. Publishers
do not claim any copyright to this report and any part of it may be used or quoted with the due
credit.

Printed by - MSP Offset, Bhopal

Design and layout - Amit Saxena

Suggested Contribution - Rs. 100.00

 P R E F A C E

Malnutrition and food insecurity amongst the children has turned out death-defying owing to the
threatening fact that we have denied them their most basic right to sustain in the life. We the adult
people with strong mind and energy understand what our rights are even know very well to
demonstrate as and when needed. The children's right to health and nutrition has been out of the
democratic political framework of development for uncounted years. This reality has not given the
due respect at par with the human rights. May be for few intellectuals it is a technical issue but
considering its social implications it is one of the thought provoking and burning issue. But in the long
run it has severe repercussions related to overall growth and development of child to be a healthy
citizen; hence important from social context. It is this 44 percent proportion of population who
sacrifices basic human rights in the name of development and growth and occasionally faces
gender, caste and religion based discrimination.
The fourth goal of the Millennium Development Goals declared by United Nations is to reduce
mortality rate of children below 5 years age by two third till 2015 from the position of 1990. It is just not
possible to achieve the said goal unless and until the issue of child mortality is brought forward and
debated on the greater social and political platforms. EVEN THEN WE DO NOT HAVE EITHER A
CHILD HEALTH POLICY OR A LEGAL FRAMEWORK DEFINING THE CHILDREN'S RIGHT TO
HEALTH AND NUTRITION!!
Pace of growth based economic development process is so fast, that the common person is left
behind as if not in the existence. On one hand when the economy of the state is glimmering with rising
GDP on the other hand one out of every two children in the Madhya Pradesh succumbs to
malnutrition. It is not just a coincidence that Madhya Pradesh scores the top position for highest
Infant Mortality Rate (IMR), lowest life expectancy of 57.7 years in comparison to Indian average of
63.2 years and also staying top in list of Indian states with more than 60 percent malnutrition among
children under the age of 5 years. Alarmingly, the situation is critical among the tribal children where
140 out of every thousand live births dies before celebrating their 5th birthday. The world is renowned
medical research journal The Lancet establishes that the death chances due to diseases like
diarrhea, measles and malaria for a malnourished child increases 9 to 18 folds as compared to a
normal child. WHO and UNICEF also unanimously agree that malnutrition is the major killer of
children less than five years in age. Thus it is crystal clear fact that malnutrition is biggest challenge
before the state government and ignoring it will lead the state into a dark and hopeless tunnel with no
scope to revert back.
Nearly 12 million (16%) of the population in Madhya Pradesh is below six years age, needs health,
nutrition and development care. However, budgetary allocation for this section is just Rs 156 crore in
the health and Rs 325 crore in ICDS which comes out to Rs. 400 per child per year only. The past 35
years of experiences of Integrated Child Development Scheme (ICDS) are indicating many shortfalls
on the account of convergence and coordination among implementing government departments.
The issues of starvation and children deaths are directly related with the community but no efforts
had been yet done to promote and ensure the community's participation in tackling these menaces.
Instead, administration engages itself in hiding the truth of increasing malnutrition among children
deaths thereby by manipulating facts and figures.
Perhaps, Tamilnadu is the only state in India that has linked malnutrition not only with poor health
services but also with the poor conditions of poverty, hunger and social exclusion spread in the
society. It has taken the challenge to eradicate malnutrition and adopted Integrated Life Cycle
Nutrition Security Programme by earning community participation to overcome the problem.
Also, one can not ignore the truth that 6.6 million households in the state are surviving below poverty
line. These households are unable to live their life without the state support. Moreover still more than
half the districts of Madhya Pradesh are lacking the basic health services and infrastructure facilities.
Painfully, still majority population in the state is not prepared enough to face pro-market and pro-
capitalist economy. Thus, emphasizing greater need for responsible role of the state government in
addressing the issue.
In fact, ground reality of ICDS implementation is too dismal. Considering the severity of the problem
of persisting malnutrition in the state, it is lacking more than 40, 000 anganwadi centres at present.
Many of the centers lack regular supply of supplementary nutrition food, growth registers, weighing
machines, playing kits, medicine kits, and drinking water facility. Besides, anganwadi workers are not
getting their remuneration timely but showing the long time lag from 7 to 14 months.
It is evident from the above facts that it's high time to neglect the crucial issue like malnutrition among
the children of our state considering its social repercussions in the long run. It is therefore we are
urging all the civil society organizations to take note of the things and try to join hands to step firm
steps for the welfare of our children before it's too late. It is with this conviction we should make the
state government realized that we can survive without four lane roadways, multinational companies
and big commercial malls but our children cannot survive without nutritious food and proper health
services. It is for this the network and service delivery mechanism of ICDS should be made most
effective and efficient in the state.
This study has been prepared by Right to Food Campaign Madhya Pradesh Support Group and
Sanket Center for Budget Studies and Initiative of Sanket Development Group. But it would not have
completed without the kind help and co-operation and throughout involvement of our small group.
We are very grateful to all NGOs, alliances and CSOs across Madhya Pradesh for their support in
data collection and information from the field. The list of all the organization that has helped us our
endeavor is as follows :
Spandan (Khandwa), Saheriya Mukti Morcha (Sheopur), Adiwasi Adhikar Manch (Satna), Manav
Adhikar Forum (Shivpuri), Sanket Development Group (Bhopal), Lok Jagruti Manch (Jhabua),
Bundelkhand Janutthan Samiti (Tikamgarh), Patthar Khadan Majdur Sangh (Panna), Community
Development Center (Balaghat), Spandan Samaj Sevi Sanstha (Khandwa), Dalit Sangh
(Hoshangabad), Adiwasi Sushasan Sangh (Seoni), Abhar Mahila Samiti (Chhatarpur) NIWCYD-
Bachpan (Bhopal), and Madhya Pradesh Lok Sangarsh Saajha Manch.
We thank our contributors namely, Smriti, Seema Prakash, Prashant Dubey, Sachin Kumar Jain,
Rolly Shivhare, Sanjay Shrivastava and Pallavi K. Mali for putting immense hard work in analyzing
both primary and secondary data and then undertaking the report writing work. We also appreciate
Ms Pallavi for her efforts in undertaking the editing of this document.

MPRTFCSG & Sanket

 IND EX

A Executive Summary 1

B Hunger in Indian states is alarming 5

1. Basic Human Development Indicators 6
2. Key facts about Madhya Pradesh 7

1. Child Malnutrition-A Catastrophe in Madhya Pradesh 10

1.1 A Close Encounter 10
1.2 Malnutrition in Madhya Pradesh- Stories directly from the field 13
1.3 Health Status in Madhya Pradesh 20
1.4 Health Infrastructures 20
1.5 Far behind from GOALS 22
1.6 Status of Health Facilities 23
1.7 Accessibility to Health System 24

2. Integrated Child Development Services 26

2.1 Implementation process of ICDS 26
2.2 Services provided under ICDS 26
2.3 Population covered under an AWC 28
2.4 The Truth of Universalisation of ICDS 29
2.5 Status of ICDS in Madhya Pradesh 30
2.6 Allocation for Travel and Fuel 30
2.7 No more Medicine Kits ICDS 31
2.8 What is a Medicine Kit in ICDS? 31
2.9 Provision of Budget 32
2.10 Growth charts vs. Monitoring of growth 32
2.11 Field realities 33
2.12 Nutrition component testing 34
2.13 Targeted population Vs Actual coverage 34
2.14 Human Resources: Vacant posts, a bitter truth 34
2.15 Nutritional Rehabilitation Centers 36
2.16 Few more observations based on the Rapid Assessment Study of NRC 37
2.17 Bal Sanjeevni Abhiyan 38
2.18 Targeted Public Distribution System in MP 39
2.19 Midday Meal Scheme 39
3. Ground Realities of ICDS - A Field Study 41
3.1 Infrastructure of Anganwadi Centers 41
3.2 Exclusion of deprived sections 41
3.3 Functioning days of Anganwadi Centers 42
3.4 Toilet Facility 42
3.5 Drinking Water Facility 43
3.6 Availability of Supplementary Nutritious Food 43
3.7 Quality of Supplementary Food 44
3.8 Availability of Hot Cooked Meal 44
3.9 Relishing (Ruchikar) of Supplementary Food 45
3.10 Availability of Utensils 45
3.11 Availability of Playing Kits (Pre-School Education Kit) 45
3.12 Availability of Medicinal Kit 46
3.13 Growth Monitoring 47
3.14 Pre-School Education 48
3.15 Hot Cooked Meal Vs. Packaged Food 49
3.16 Conclusions of Field Study 50

4. Denial by State: Biggest Challenge for Child Survival 53

4.1 Children in Denial and Negligence Vs World's best child 55
survival in records in MP

5. Nutrition Policies Questioned 57

5.1 Importance of Cooked Meal over Packaged Foods 58

6. Judicial Interventions in ICDS 60

6.1 Supreme Court Orders in ICDS 60
6.2 Steps of High Court of Madhya Pradesh in ICDS 61
6.3 Orders of Supreme Court - Violation Continues 61

7. Budget Analysis of Supplementary Nutrition Programme : 65

A Deteriorating Condition
7.1 Growth of Children in MP 65
7.2 The Coverage under Nutrition Programme 66
7.3 Universalization of ICDS : A Legal Obligation 66
7.4 Resource Gap Analysis in the context of Universalization of ICDS 67
7.5 Response of the State Government through Budget Allocations 69
7.6 Budget Estimate and Actual Expenditure for SNP 70
7.7 Budget Utilization 70
7.8 ICDS in Budget Books 71
 7.9 Latest Addition 72
7.10 Criticism by Comptroller and Auditor General (CAG) 72

8. Exceptions are always there 73

8.1 Balaghat - A district paving its own way 73
8.2 Mai's local initiative for Child Protection in Khandwa 76

9. Strategies for Children under Six 79

A. Comprehensive Strategies 79
B. Strategies for the treatment of SAM 83
Boxes
01 Malnutrition in south Asia 5
02 Hunger in Indian States 6
03 Dance of Deaths 8
04 Joint Statement by UNICEF, WHO and UNSSCN 10
05 Distant Goals 12
06 Dilution of Supreme Court's Orders 16
07 A Complex Life 17
08 End begins from beginning 19
09 Losing Faith in System 21
10 An Eye Opener 22
11 Key facts about Maternal Health from NHFS-3 Statistics 29
12 Budget of NRC 36
13 Reality Bites 38
14 Ground Zero: Sidhi, a place on the brink of negligence 50
15 Denial mode on starvation deaths 54
16 Supreme Court Orders on ICDS 62

Tables
01 Health budget of Madhya Pradesh government
02 Total number of Health Institutions in MP
03 Available and required number of Health Institutions in MP
04 Available and Required number of Health workers in MP
05 Criteria for Anganwadi Centers
06 Nutritional Entitlements
07 Budget for Medicine Kit
08 Status of Growth charts in Madhya Pradesh
09 Available and Required numbers of CDPO/ACDPO/Supervisors in AWC
10 Infrastructure at Anganwadi centers
11 Functioning days of Anganwadi Centers
12 Toilet facility in AWC
13 Drinking Water Facility in AWC
14 Availability of Supp. Nutrition in AWC
15 Quality of Nutritious Food
16 Availability of Hot cooked meal in AWC
17 Relishness of SNF in AWC
18 Utensils availability in AWC
19 Availability of Playing Kit
20 Availability of Medical Kit
21 Availability of Salter machine
22 Availability of Adult weighing machines
23 Availability of Growth Monitoring Register
24 Pre-school education facility
25 Willingness to packaged food
26 Non-reporting of Infant deaths
27 Infant Mortality in MP-Far from comparison
28 Status of Malnutrition in MP
29 Growth indicators expressed as a percentage
30 Gap between the required number of anganwadi centres and
the sanctioned one
31 Resource Gap
32 Budget Allocations for Special Nutrition Programme
33 Allocations for Supplementary Nutrition
34 Budgets of ICDS

Annexure I 86

Annexure II 88

Annexure III 91

Annexure IV 100
 "A"
Executive Summary
Today malnutrition in the State of Madhya
Pradesh is not only recognized as a biggest
blight for the small children but the political
parties are also coming out with special
promises in there manifestoes to save the
future generation from malnutrition. Deaths
of innocent children across the state and
continuous negligence of administration
towards these deaths has spurt out the
urgent need for bringing positive changes
and generating demands for the benefit
poor and marginalized section. It would be
possible through bringing attitudinal
change on part of the health of children and
winning faith of the community, specifically
the rural and tribal folks, as well as making
the state administration more accountable
on this serious issue.
Both NFHS and IFPRI reports have
indicated the poor status of nutrition and
health services specifically of women and
children in the state of Madhya Pradesh.
However, state government through its
statistics presenting the incorrect picture of
malnutrition status in the state. The study
findings clearly shows that ICDS which is
the only scheme for addressing needs and
rights of children under six is not efficiently
implementing in the state. Besides the
orders of Supreme Court, to universalize
the ICDS; scheme it is not effective in terms
of low proportion of coverage of preg-
nant/lactating women and almost nil
coverage of adolescent girls of age group
11-18 as the beneficiaries.
Health Services
The health services available in the state
are also depicting threatening fact that
Moribund ICDS
most of needed persons are left without any
benefits of the facilities. State records for
highest infant mortality rate (72), second
highest in maternal mortality rate (379) and
about 60 percent children below six years
of age are under weight. The reach of
health and nutrition can be understood by
the fact that only 22 percent of the children
have received all vaccinations before 12
months and only 25 percent of children in
the age group 6-35 months received at
least one dose of Vitamin 'A'. Health
budgets has shown sharp decline as a
proportion to total expenditure from 5.1
percent in 2000-01 to 3.9 percent in 2008-
09. The public health infrastructure in the
state is far from satisfactory. The state is
lacking 1614 SHCs, 1625 PHCs and 128
CHCs. Shortfall of manpower is also a big
problem. Furthermore, the accessibility to
the health institutions is also in a dwindling
condition due to poor quality of care (62.9
percent), no nearby facility (50.8 percent),
long waiting hours (26.4 percent),
inconvenient timings (10.0 percent), health
personnel often absent (7.7 percent) and
other reason (1.6 percent) according to
NFHS III.
ICDS Services - Field study results
An action study was attempted to check out
the status of ICDS in 65 Anganwadi centres
from 12 blocks in 10 districts of the State.
Following issues in emerged about the
status of ICDS from the field :-
l Though the orders of Supreme Court
stated that the universalization of the
ICDS and providing all the 7 services
to all its beneficiaries is mandatory but
01
 the latest report from DWCD shows
that still 60 percent children and more
than 73 percent eligible women
beneficiaries are out of the focus.
l Exclusion of children and women from
ICDS services on the basis of caste
and community is also prevalent in the
state due to which a vast section of
tribal and dalit communities are kept
deprived of the facilities. The matter of
exclusion observed in Chhatarpur
district was worst compared to other 9
districts included in the study.
l Most of the anganwadi centres across
the state are lacking their own
buildings, the most vital requirement
to provide a safe, secure and
spacious environment for children. It
was observed that out of 65 centers
studied only 37 percent anganwadis
are having their own building.
l Supreme Court has strictly ordered
that each and every anganwadi centre
must open and provide the basic
services to its beneficiaries for 300
days annually. But in practice most of
the anganwadi centres were not found
functional as per the order, thus
violating the orders of Supreme Court.
The study revealed that out of the
studied centers only 43 percent
anganwadi centres were providing
services for 26 days a month which is
in accordance to the orders of
Supreme Court. While rest of the
centres were providing services either
for 21 days (40 percent), 15 days (15
percent). Two percent centers are
providing services only for 7 days in a
month.
02
l The study also revealed that most of
the centres were lacking the basic
facilities like availability of utensils (58
percent), safe drinking water (56
percent), toilet facilities (76 percent),
playing kit/pre-school education kit
(60 percent) and medical kit (89
percent).
l The quality of supplementary
nutritious food provided in anganwadi
centres across the state was poor and
also the availability of hot cooked
meal is a big question. It was found
that only 44 percent of studied centres
were providing good quality nutritious
food while the food of only 32 percent
centres found to be good in taste. Only
28 percent anganwadi centres were
providing hot cooked meal to its
beneficiaries.
l It is also mentioned in Supreme Court
orders that growth monitoring is a
mandatory service to be provided
through anganwadi centres but the
ground reality it is far from different.
Most of the centres across the state
were lacking the technical support
and equipments needed to monitor
the growth of children as well as adults
enrolled in anganwadi centres.
Only 72 percent of the studied centres
were having salter weighing machine,
only 66 percent centres were having
adult weighing machines and only 58
percent centres were having growth
registers.
All these ground realities shows that there
is a big gap in proper implementation as
well as monitoring system and accountabil-
ity towards ICDS in the state.
Moribund ICDS
Shortage of field staff
At present, there are 367 Child
Development Projects are sanctioned by
Government of India (GoI) in Madhya
Pradesh. Under these projects 69238
anaganwadi centres have been sanctioned.
Through 67770 functional anagan-wadi
c e n t r e s ' S u p p l e m e n ta r y N u t r i t i o n
Programme' is being currently imple-
mented in the state. The programme is
serving around 5340498 beneficiaries. To
look after such a vast number of ICDS
projects covering a noticeable number of
beneficiaries only 290 CDPOs, 46
ACDPOs and 2538 Supervisors have been
appointed till date. While 76 posts of CDPO,
69 posts of ACDPOs and 200 posts of
Supervisors are still vacant. Going with the
given situation one CDPO is responsible for
managing about 189 anganwadi centres.
Thus one can imagine about the quality of
ICDS services being provided in such a
scarce and lacking situation.
NRCs and Bal Sanjeevni Abhiyaan
These two are the programs that are run by
the state government to tackle the
occurrence of malnutrition among young
children but the government has failed to
assure the authenticity of these vital
programs. There are only 135 NRCs in the
State to take care of 13 lakh severely
malnourished children. Moreover out of
these NRCs only 95 centres are fully
functional while 40 are partially functional.
The budget allocated for these NRCs is
also not sufficient to provide proper care
and treatment to the malnourished children.
Similarly, the State is claiming that level of
malnutrition has decreased as per the data
of Bal Sanjeevni Abhiyan but the reality is
that the level of malnutrition is continuously
Moribund ICDS
increasing in the state, if one goes by NFHS
statistics.
Packaged food and hot cooked meal
The field study shows that due to socio-
cultural and sustainability reasons
community is not in the favor of packaged
food. Around 90 percent of the respondents
oppose the use of packaged food in
anganwadi centers and feel that locally
made, prepared and supplied food should
be made available.
There has always been a debate over hot
cooked meal being replaced by commer-
cial/packaged food. The administration is in
strong support of allocating packaged food
claiming that packaged food (supple-
mented with micronutrients) is more
nutritious and safe than hot cooked meal
and more effective in reducing the malnutri-
tion level in state. While many nutritionists
and activists are of the view that hot cooked
meal can not be replaced with any kind of
micronutrient supplemented packaged
meals. It has been proved through various
studies that hot cooked meal is more
nutritious than packaged food and the
chances of contamination are also less in
case of hot cooked meal than packaged
food. Hot cooked meal is the traditional
food and the children enjoy the traditional
food much as compared to any packaged,
non-traditional food. Also, the quality,
sustainability and regular availability of
packaged food are quite in question
whereas hot cooked meals are sustainable
and its regular availability can also be
assured. All this simply put forth the
importance of hot cooked meal.
Though RUTF is a therapeutic food to
tackle the severe acute malnutrition; its
impact has not been tested in the context of
03
Indian population. Further it would promote
the commercialization as well privatization
of food allocating practices which is again
the violation of the orders of Apex Court,
which states decentralized process must
be adopted to distribute supplementary
food in anganwadi centres.
Budget of ICDS
The claims of spending of Rs. 2 per
beneficiary is the key statement in all the
responses released from the State
Government. But when the implementation
and coverage analysis in terms of budget
04
provision was done, it is found that only Rs.
0.84 per beneficiary have been allocated in
Madhya Pradesh. Even if we believe that
Government has spent Rs. 2 per
beneficiary per day in this budget, then it
means all the covered (not actual
population) beneficiaries will get
Supplementary Nutrition for 126 days in a
year, whereas it should have been for at
least 300 days in a year, as per the
Supreme Court order. Even after the four
years of Supreme Courts orders the budget
allocation are not proportionate to the
needs of beneficiaries.
Moribund ICDS
 "B"
Hunger in Indian states is 'alarming'1
On the count of Global Hunger Index (GHI), hunger is a major threat in 33 countries says a
report developed by US-based, International Food Policy Research Institute (IFPRI) in
2008. Situation in these countries is either alarming or extremely alarming and world's
progress in hunger reduction since 1990 has been slow. The index shows that South Asia
and Sub-Saharan Africa continue to suffer from high levels of hunger. On one hand where
South Asia has made rapid progress in combating hunger, Sub-Saharan Africa has made
only marginal progress. GHI uses a multidimensional approach that gives a very
comprehensive picture of hunger in
developing and transitional countries.
GHI measures hunger on the basis of Box - 1 Malnutrition in
three indicators namely child malnutrition, South Asia
rates of child mortality and the number of
people who are calorie deficient. The In South Asia, the major problem is a high prevalence
problem of hunger is measured in five of child malnutrition, which stems from the lower
categories like low, moderate, serious, nutritional and educational status of women, as well
alarming or extremely alarming. as poorly designed and poorly implemented nutrition
and health programs and inadequate water and
India's GHI 2008 score is 23.7 with sanitation services. In contrast, the high GHI in Sub-
ranking at 66th position out of 88 countries. Saharan Africa is due to high child mortality and a
It is slightly better over previous year high proportion of people who cannot meet their
score of 25.03 and 94th rank out of 118 calorie requirements. Low government
countries in 2007. These scores indicate effectiveness, conflict, and political instability, and
towards little efforts made in curbing high rates of HIV/AIDS, have driven these two
hunger and poverty in India. indicators.
Neighbouring countries like Pakistan, Sri
Lanka and Nepal have faired better than
India in the GHI list. With more than 200 million food-insecure people (FAO 2008), India is
home to the largest number of hungry people in the world. India is long known to have some
of the highest rates of child malnutrition and mortality in under-fives in the world. This
situation is a consequence of very long neglect of agriculture; one of the heavily dependent
sector for livelihood for people in the country in the opinion of Mr. Yoginder K. Alagh, author
of India's poverty line and former planning minister.

'Scored Worse'
Twelve Indian states have "alarming" levels of hunger while the situation is
"extremely alarming" in the state of Madhya Pradesh, says the above report.
The India State Hunger Index (ISHI) 2008 was constructed in a similar fashion as the GHI
2008 to allow for comparisons of states within India and for comparisons of Indian states to
GHI 2008 scores and ranks for other countries. The ISHI 2008 score was estimated for 17

1
Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/2/hi/south_asia/7669152.stm,
Published: 2008/10/14 12:24:13 GMT

Moribund ICDS
05
major states in India, covering more than 95 percent of the population of India. ISHI 2008
scores for Indian states range from 13.6 for Punjab to 30.9 for Madhya Pradesh, indicating
substantial variability among states in India. Punjab is ranked 34th when compared with the
GHI 2008 country rankings, and Madhya Pradesh is ranked 82nd.
All 17 states have ISHI scores that are significantly worse than the low and moderate
hunger categories. Twelve of the 17 states fall into the alarming category, and one
Madhya Pradesh falls into the extremely alarming category. Madhya Pradesh's nutrition
problems, it says, are comparable to the
African countries of Ethiopia and Chad.
The best performing state was Punjab, Box - 2 Hunger in
which has a 'serious' hunger problem and Indian States
does less well than developing countries The results of the India State Hunger Index 2008
such as Gabon, Vietnam and Honduras. highlight the continued overall severity of the hunger
The report says, "Improving child nutrition situation in India, while revealing the variation in
is of utmost urgency in most Indian states. hunger across states within India. It is indeed
All states also need to improve strategies alarming that not a single state in India is either low
to facilitate inclusive economic growth, or moderate in terms of its index score; most states
ensure food sufficiency and reduce child have a "serious" hunger problem, and one state,
mortality. Madhya Pradesh, has an "extremely alarming"
hunger problem.
According to the Indian government
statistics two years ago, around 60% of
more than 157 million children in the country were malnourished. Nutrition experts say the
abysmal record of malnourishment is due to an inadequate access to food, poor feeding
practices and poor childcare practices in India. Furthermore, rise in the food prices globally
has reduced the food buying capacity of many poor families, making their situation worse.
In the past year food prices have increased significantly, but people's incomes haven't kept
pace, forcing many families further into hunger, experts say.

1. Basic Human Development Indicators

It is evident from the given data that performance of Madhya Pradesh on the basic human
development indicators is abysmally poor when compared to national figures.

Source Indicators Madhya India Rank

Pradesh

NFHS-III Neo-Natal Death Rate 44.9 39

NFHS-III Infant Mortality Rate 70 57 3

NFHS-III Child Mortality (Under 5Yrs) 94.2 74.3 2

NFHS-III Full Vaccination 40.3% 43.5%

NFHS-III Under Nutrition (Under 5 Yrs) 60% 42.5% 1

Moribund ICDS
06
 Source Indicators Madhya India Rank
Pradesh

NFHS-III Severe Malnutrition (-3SD) 27.3% 15.80%

NFHS-III Breast feeding within one hour of Birth 15.9% 25%

NFHS-III Anemia among children 74.1% 69.5% 2

(under the age of 5 years)

Economic Below Poverty Line (BPL) Families 38.3% 27.5% 5

Survey
(2007-08)

Economic MPCE (Monthly per Capita Expenditure) Rs. 439.06 Rs. 559 4 (low
Survey (Rural) (Rural) expenditure)
(2007-08) Rs. 903.68 Rs.1052
(Urban) (Urban)

Economic Life Expectancy (Average age) 57.7 Years 63.2 Years Lowest in
Survey the country
(2007-08)

Government Maternal Mortality Rate 379/ 100000 301 3

of India live births

Economic Literacy (Census 2001) 63.74% 64.64% 23rd rank in

Survey India
(2007-08)

2. Key facts about Madhya Pradesh

Threatening truth of malnutrition
l Infant Mortality Rate (IMR) is highest in Madhya Pradesh at 72 deaths per 1000 live
births as per Sample Registration Survey (SRS) 2007 released in October 2008.
l In Madhya Pradesh nearly One lakh eighteen thousand children of one year age have
lost their lives during the period from April 2005 to March 20092.
l According to National Family Health Survey (NFHS) III, Madhya Pradesh tops the list
of undernourished state with 60 percent children suffering from malnutrition indicating
less opportunity for the children in terms of overall health and development in their life
span.
l Only 40.3 percent children in the state are fully immunized, merely 14.7 percent
children are breast fed within half an hour of birth and only 15.9 percent children are
breast fed within one hour of birth in the state according to NFHS-III findings.

2
Source - http://www.health.mp.gov.in/bulletin (as accessed on 30th April 09)

Moribund ICDS
07
l Severe malnutrition among children (below 3SD level) is highest in Madhya Pradesh.
Around 12.6 percent children in the state are on the verge of death by being thin, low
weight, weak and sick compared to 6.4 percent in India. It means nearly 13 lakh 35
thousand children in the state have 30 percent more chances of death.
Reality of Integrated Child Development Services (ICDS) in the state
l ICDS is the one and only scheme catering the needs for the population below six
years that constitute for nearly 16 percent of the total population.
l Till date only 69,238 Anganwadi centres are in existence under ICDS against the huge
need of 1.46 lakhs. Government is reaching only three fourth or 76.51 percent of the
malnourished children in the state going by its own statistics and leaving around one
fourth malnourished children out of the coverage of ICDS.
l As far as universalization of ICDS is concerned the coverage turns out to only 36.58
percent for the children in the age group 0-6.
l State government's coverage of total expectant and lactating mothers under ICDS is
merely 9.5 lakhs that is just 30 percent of the eligible beneficiaries.
l According to the government statistics no adolescent girls in the age group 11-17 were
covered under nutrition programme although they are one of the eligible beneficiaries
under universalization of ICDS.
l There observed a shortfall of 47 percent anganwadi centres, if one follows the
Supreme Court's Directions for the
norm of one functional anganwadi
centre in each hamlet. Box - 3 Dance of
Deaths
l The '7th Report of the Supreme
Court Commissioners on Right to Nearly 230 malnutrition deaths have been reported
Food' states that 12985 tribal by the Civil Society Organizations (CSOs) after due
habitations have been covered by investigation in 4 districts of Madhya Pradesh in just
ICDS centres and about 4168 tribal four Months between May to August 2008. The
habitations are yet to cover under numbers of deaths reported in four districts were
the scheme. Satna -72, Khandwa-62, Sheopur-64 and Shivpuri-32
respectively. The issue of children deaths is very
l Furthermore, the existing Angan- much important because all the dead children belong
wadi centres are facing a huge crisis to tribal/indigenous communities like Kol, Mawasi,
of trained staff members. 76 posts of Saheriya and Korku.
Child Development Project Officer
(CDPO), 69 posts of (ACDPO) and
200 posts of Supervisors are still vacant throughout the State of Madhya Pradesh.
l Medicine Kit is an essential component of the ICDS services, for which Anganwadi
worker has been trained to provide initial medicinal support for the symptoms like
itching, injury, de-worming etc. But no such Medicine kit has ever reached the
Anganwadi centres.

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08
l Moreover, the State Government is allocating just Rs. 1.44 per beneficiary for
addressing small health problems at each anganwadi centre under ICDS.
ICDS and Budget
l Madhya Pradesh budget expenditure on Child specific sectors specially Child Health,
as a proportion of State Domestic Product is merely 0.1 percent.
l In order to cover all the beneficiaries under universalization of ICDS, the required
budget allocation should be six times greater than the present one.
l The total budgetary requirement for 2007-08 was Rs 1320 crore including Children of
0-6 age group, Pregnant and Lactating women and Adolescent girls @ Rs 2 per
beneficiary. However, the present budgetary allocations by the government for
nutrition were Rs 320 crore in 2007-08, in which nutrition or food component
comprised of around 80 percent that comes to Rs 255.54 crore.
l These allocations would be able to fulfill only 19.35 percent or one fifth of the
requirement of the beneficiaries, which a very miniscule proportion considering the
severity of the problem.
l State government has been actually ended up spending just Rs 212.89 crore against
the total allocation of Rs 320 crore on 53.40 lakh beneficiaries in the state. It means
per beneficiary expenditure comes to only Rs 1.33 per day in 2007-08 as against the
Supreme Court's order of spending at least Rs 2 per beneficiary per day.
l Low allocation of funds and under spending of the funds further aggravated the
ineffective results of ICDS.
l If taken into account the total budgetary requirement inclusive of administrative cost
and other expenditure the figure turn out to be Rs 1650 crore for the year 2007-08 as
against the miniscule budget allocation of Rs 535 crore taking together the allocations
made under Supplementary Nutrition Programme (SNP) and ICDS.
Veracity of NRCs
l Madhya Pradesh Government has established Nutritional Rehabilitation Centers
(NRC) at the block level to tackle the severe malnutrition. Total 135 NRCs has been
established; out of which only 95 are fully functional.
l These centers have only 1678 beds to take care of nearly 13 lakh malnourished
children in the state. Normally one child gets services for minimum 14 days, indicating
no end to sever malnutrition!
l Alarmingly 49 NRCs do not have adequate trained staff.

Moribund ICDS
09
 1
Child Malnutrition-A Catastrophe in
Madhya Pradesh

1.1 A Close Encounter

Malnourished Children Flood Hospitals in Madhya Pradesh
Number of malnourished children hospitalized for treatment of malnutrition and
resultant life threatening complications swollen to 150 in Khandwa district.
About 200 children admitted to government-run-NRCs in 13 other districts of MP
Situation is alarming in the tribal pockets of Khandwa, Satna,
Jhabua and Shivpuri Districts.
Chhatarpur district hospital cites lack of beds at NRCs, malnourished kids left on floor.

These were the few headlines of the daily newspapers of the past few months that have
uncovered the shocking but the eye opening stories related to nutritional status of children
in Madhya Pradesh. Malnutrition death figures are roaring by each passing day. Yesterday
it was Satna, Shivpuri, Khandwa and Khargone, today it is Dhar, Jhabua, Sheopur, Rewa
and Satna. Latest by now the children in the state capital Bhopal, are also engulfed by the
deadliest malnutrition.
You just name it and Box - 4 Joint Statement by UNICEF,
the list of malnutrition- WHO and UNSSCN
a ff e c t e d d i s t r i c ts ,
Severe acute malnutrition remains a major killer of children under five years
blocks and the
of age. Until recently, treatment has been restricted to facility-based
pockets within the
approaches, greatly limiting its coverage and impact. New evidence
districts it goes count-
suggests, however, that large numbers of children with severe acute
less. But Madhya
malnutrition can be treated in their communities without being admitted to a
Pradesh government health facility or a therapeutic feeding centre.
seems deaf to all the
screaming for scourge The mortality rates (among children with severely acute malnutrition)
of hunger news across reflect a 5-20 times higher risk of death compared to well-nourished
the state. It has been a children. Severe acute malnutrition can be a direct cause of child death, or it
constantly denying the can act as an indirect cause by dramatically increasing the fatality rate in
pragmatic fact saying children suffering from such common childhood illness as diarrhea and
that malnutrition is not pneumonia.
really the reasons for - Community based management of severe acute Malnutrition,
children death. A Joint Statement by the World Health Organization,
The World Food Programme, and the United Nations
Malnutrition is directly System Standing Committee on Nutrition and the United Nations
or indirectly responsi- Children's Fund

Moribund ICDS
10
ble for two-third deaths of children under the age of five; out of which two- third of these
deaths takes place in the first year of child's life. In India, these deaths are preventable if the
quality and nutritional outreach is taken better care of.
Malnutrition turn out to be the biggest curse for children in Madhya Pradesh. It is not a new
phenomenon but put the state on backburner in terms of various social development
indicators. The horrifying stories from the field would stun every sensitive citizen in the
state. On the contrary state government statistics shows decrease in levels of malnutrition.
However the ground reality differs to great extent. NFHS III reported that infact the level of
malnourished children in Madhya Pradesh has become worst and rose from 54 percent in
1998-99 to 60 percent in 2005-06.
Further the recent report of IFPRI corroborates the fact of children death in MP is owing to
hunger. IFPRI reports that 59.8 percents of the child population in the state are caught in the
vicious cycle of malnutrition and hunger death. The graveness of the malnutrition situation
in Madhya Pradesh can be assessed using following statistics. Out of the 63 lakhs
malnourished children in the state more than 13 lakhs or one fifth children falls in the
severely malnourished category3. The serious impact of malnutrition on the life of children is
resulting in 72 deaths4 before completing one year and 94 children in every 1000 births die
before celebrating their 5th birthday.
The issue of malnutrition deaths of children came into limelight when the death cases of 7
children from Satna district was raised by the Right to Food Campaign Support Group and
M.P. Lok Sangharsh Sajha Manch in the second week of May 2008. There after the death
cases were also reported from Khandwa, Sheopur and Shivpuri districts. The civil society
organizations and media continuously came up with the related facts on the issue of
malnutrition; the important factor behind the early demise of children in M.P.
In spite of all these revealing facts along with the field reporting of dire increase in
malnutrition levels; the State Government is in complete denial of malnutrition deaths in the
State. Instead the state government manipulated the truth by establishing the fact that
children are dying due to diseases or heat strokes but not due to malnutrition. The two
departments namely Health and Women and Child Development (WCD) departments are
cross firing each other on the whole issue. The former is stating that malnutrition was the
underlying cause leading to multiple infections and some infections are too severe to be
medically treated. However, WCD is putting the blame on Health department saying that
the deaths were due to outbreak of diseases and the Health department could not able to
control it.
However, World Health Organization (WHO) categorically stated that malnutrition can be
the direct killer of the children. It raises the risk of mortality from 5-20 times. The Indian
Association of Pediatrics has held the same opinion. In the light of all these innocent
children were continuously losing their life to malnutrition as evident from the following data.
68 children died in Satna district, 163 children died in Sheopur, 62 in Khandwa district and

3
Source NFHS III Report
4
SRS 2007

Moribund ICDS
11
32 children died in Shivpuri district of Madhya Pradesh over a span of 4 months from May to
August 2008. But most importantly these children belong to tribal communities of like Kol,
Mawasi, Korku and Saheriya tribes, which are one of the most deprived communities in the
State with no land holding and no permanent source of income. Status of these families
revealed a sorry state of chronic hunger and acute poverty. The government policy too has
contributed to this food crisis among the poor.
It was observed in the field that although various government schemes have been
launched yet the problem of food insecurity persists continuously due to lack of proper
implementation. NREGS is the biggest anti-hunger programme and has a potential to
transform the face and fate of rural India. The scheme was launched with a huge promise of
providing 100 days employment but it is not gearing up as it was expected. A study by
Centre for Environment and Food Security (CEFS), New Delhi stated that actually not more
than 16 days of average employment was given to the needy households during 2007-08
against the State government's claim of
63 days of average annual employment.
The data gap arises out of the fact that in Box - 5 Distant Goals
the information provided by the state Even after completing seven and a half years; the
government, only 25 percent of the job time limit set for achieving Millennium Development
figures are based on actual data while the Goals (MDG), around 44.77 lakh or 38 percent
remaining three-fourth job figures are families in Madhya Pradesh are living below the
based on fake job cards and fake entries poverty line (BPL). The starkest truth is that out of
in the muster rolls5. The information total BPL families nearly 15.81 lakh families fall in the
collected by local organizations working category of extreme poverty. Thus at present there
at Satna, Khandwa, Sheopur and are near about 60 lakh families are deprived of
Shivpuri are also in agreement with the enough food and the possibility of leading
findings of CEFS. Villagers of Hardua, respectable lives. The National Sample Survey
Nakjhir and Kirhai- Pukhri villages of Organizations (NSSO) report of 62 st Round
Satna district have actually received 2 to 8 highlighted that Orissa, Chhattisgarh, Madhya
days of work while government records Pradesh, Bihar, Jharkhand and UP remains the
shows 14 to 94 days of employment. poorest states in the country in terms of Monthly Per
Similarly, in Khandwa district the cases of Capita Expenditure (MPCE) of the rural population. In
undue delay in payments and false Madhya Pradesh, 47 percent of the rural population
entries of employment days in job cards is living on Rs 12 a day followed by Bihar and
were encountered. Jharkhand 46 percent, Uttar Pradesh 33 percent,
Karnataka 32 percent and Maharashtra 30 percent.
Most of the deaths occurred in the
families possessing BPL or Antyodaya
Ration Cards; indicating the fact that malnutrition has hit the most vulnerable families with
greater food insecurity. The grain allocation for BPL families under Public Distribution
System (PDS) has been gradually decreasing from stipulated 35 kg to barely 20 kilograms
a month. Moreover, Satna, Sheopur, Shivpuri and Khandwa districts are also facing
consecutive drought for past 4-5 years aggravating the problem.

5
Source : http://www.cefsindia.org/reports/ (Report of CEFS)

Moribund ICDS
12
1.2 Malnutrition in Madhya Pradesh- Stories directly from the field
Madhya Pradesh is a centrally located state of India and it is divided into 50 districts with the
population between 1 to 2 million in each district. There are 55393 villages in the state
covered by 22 thousand elected Panchayats - Local governance body. The state has yet to
achieve real developmental goals to come out of the group of BIMARU state. Economic
Survey of Union Government states that 38 percent of the state's population (6.44 million
families) is leaving below poverty line and deprived of basic amenities like food, shelter and
cloth, struggling every day for survival.
1.2.1 Satnaa silent deprivation
Right to Food Campaign and Lok Sangarsh Saajha Manch raised a case of death of 7
children in Satna district in the second week of May 2008. In next 20 days the death toll
moved up to the level of 27. Action began, but only on papers and State Government
continued to deny the malnutrition deaths, instead cited diseases or heat stroke as the
reasons behind the deaths. Malnutrition deaths are considered closest to hunger deaths.
One can identify malnutrition but can not investigate or prove any malnutrition deaths. It is
because in forensic science and in pediatrics there is no clear definition to identify the
symptoms of deaths due to malnutrition. The local organizations argued on the basis of
circumstantial evidences that the families belonging to communities of Kol and Mawasi
tribes were living with acute poverty, chronic hunger and uncertainty of life. The victim
families got merely 2-3 days of work under National Rural Employment Guarantee Scheme
(NREGS) and received only 15 to 20 Kgs of subsidized food grains from PDS.
In the villages where Aadiwasi Adhikar Manch and Right to Food Campaign visited it was
not a normal encounter with situation, where 2-6 children died in a short span of 20 days.
However, it is worth mentioning that particularly August and September months were
identified as most food insecure and disease prone months especially for the tribal,
migrants and labour communities. In spite of various promising programs to ensure the
better growth and survival of children, the death toll continue to increase in Satna district
and reached to 68 by August 2008. It was observed that during the whole period role of the
state government was not proactive. It's true that simply organizing health camps or
providing supplementary nutrients to Anganwadi centers after the children's death is by no
means going to sort out the serious problem like malnutrition.
This area is suffering from drought trouble for past four years but no concrete steps have
been taken to help the villagers. Records of state government say that 28745 children
under the age of one year died in the state during 2008-09 and Satna tops the list with 1856
deaths. In 2007-08 there were 29383 children below one year age died in the state and
again Satna topped with 1668 infant deaths.
Adiwasi Adhikar Manch an ally of M.P. Lok sangharsh Sajha Manch and Right to Food
Campaign Group together presented a report to the Advisor to Supreme Court
Commissioners about Right to Food on 11th June 2008 mentioning the poor implementation
of the Government schemes in the district along with the cases of continued deaths of
children. The then Collector of the Satna district was asked to submit a detail report about

Moribund ICDS
13
hunger and starvation deaths and failure of government programmes related to food
security and employment schemes till 15th July 2008. But unfortunately Collector, the most
responsible officer of the District, was busy in election campaign.
Probably the issue of deaths of children was not of so importance as Collector did not take
any action on the grim situation until 14th of July 2008, except stating that the deaths were
due to seasonal diseases and not due to malnutrition. When the number of died children
reached 27 and the issue got the momentum in media, it was only then, on 15th of July
Collector visited the field that to just one village Hardua and announced number of relief
measures on the spot in order to console the families who lost their kids. Some of those
relief measures were as follows:
l 65 kg ration to families of children died due to malnourishment.
l Suspension of salesman of Puraina village to correct the PDS supply
l Sanction of fund for anganwadi and EGS Centres.
l Allotment of Social Security Pension, NREGS Job cards and Ration cards to
eligible beneficiaries.
l Work order for plantation and cement concrete (CC) road construction were
sanctioned.
l Free treatment of weak & malnourished children and landless patients at Nagaud
or District health centre.
l Regular medical camps in the villages were announced every week.
Here the question comes to mind that such short span announcements are sufficient
enough to tackle the devastating problem like persistent malnutrition? Moreover, all the
promises made were seem to be faked one for the obvious reasons. It is because within the
7 days of the announcement of the relief measures, the work under NREGS was halted,
construction of anganwadi centre was limited to base work of the building only and the
regularity of health camps were maintained just for two weeks. Another sorry state that with
the denial of malnutrition deaths by the government; the issue of just compensation to the
families of victims was ruled out quite cleverly.
District Collector submitted his report to the Advisor to Supreme Court Commissioners on
15th of September 2008 a month later after the due date. The report clearly mentioned that
all the deaths of children were due to some seasonal diseases like heat stroke, measles,
diarrhea, etc. rather than malnutrition. Meanwhile, two enquiry commissions visited Satna
district to enquire about the deaths, but the result presented by these commissions once
again established no evidences of malnutrition deaths, as it was expected previously!
Status of ICDS in Satna
In Satna district children; the prime beneficiaries like are deprived of the benefits to the
fullest. According to the Supreme Court orders, one anganwadi centre should cater to 40-
80 children but in case of Uchhehra block of Satna, there are 21380 children enrolled in 152

Moribund ICDS
14
anganwadi centers. It means on an average 140 children are enrolled per anganwadi
center. This shows there is a need of 267 more anganwadi centers in the block to provide
services to all the children. Besides, anganwadi centers lack basic amenities like proper
arrangement for drinking water, separate toilets and even separate space for cooking
nutritious food. Almost all the centers deprived of growth charts, playing kit and educational
materials and weighing machines called salter machine. Furthermore, almost all the
anganwadi workers are untrained and illiterate and inexperienced to handle the job
responsibility. Quality of supplementary nutritional food being supplied in anganwadi
centers is really dubious one. It was observed that the Panjiri supplied by the contractor was
actually the animal feed. When the district Administration was informed but no steps were
taken against. Thus to check the malnutrition with such minimal existing facilities is the real
challenge.
Reality of NRCs
In Satna district proportion of under six population is 15% i.e 2.8 lakh and number of
malnourished children is around 33,820. To cater these children there are merely 2 NRCs
and with only 30 beds. Thus it is a blunt fact that the malnourished children have no other
option but to wait for their turn with such a sparse medicinal facilities. According to the NRC
norms, each child should be given a treatment of at least 14 days to cope up the
malnutrition, but in Satna the children are admitted in the district NRC for only 7 days due to
shortage of facilities. It was only after the cases of malnutrition and deformities were
highlighted against the Health and Women and Child Development departments, the
treatment days were increased to 14 days. It is a further shabby work that once the children
are relieved from the NRC, there is no proper follow up about health of children and also
there observed the communication gap between NRC and Anganwadis in the field.
1.2.2 Khandwa.children living on verge of death
When such mess was continuing in Satna, at the same time news regarding critical
incidences of malnutrition deaths started flowing from Khandwa district. Khalwa Block of
Khandwa District is a Korku tribal dominated block. By virtue of backwardness it has been
earmarked as Fifth Scheduled Area. Traditionally it is a chronic malnutrition prone area and
it was not the first incidence when the malnutrition among the children under fives or deaths
thereby has been reported from the region. For past many years the children have
continued to die and tribal families have been appeasing the traditional deities for saving
their children.
Back in 2003-04, Spandan Samaj Seva Samiti, an NGO working in the region brought to
light the issue of severe malnutrition and deaths of children. About dozen of deaths were
recorded and the fact was highlighted that acute food security at the household level was
one of the contributing reasons. This initial efforts exerted substantial pressure and
government took steps like starting of Nutrition Rehabilitation Centers (NRCs/Bal Shakti
Kendras) and running Bal Sanjeevani Abhiyans (campaign to weigh and grade
malnutrition). The Bal Sanjeevani reports have now become the official statistics for
measuring malnutrition. Over the years these figures showed drastic reduction in
malnutrition and it was claimed that the malnutrition situation in the state is under control.

Moribund ICDS
15
But the grass roots reality is far from such Box - 6 A Complex Life
claims when the recent malnutrition
deaths were reported in the district. Sivram, a landless wage earner from village
Medhapani lost his 18 months old daughter, Shivani.
Till date the deaths of 39 children across He do not posses a ration card and hence was forced
18 villages of Khalwa block shows that the to borrow 1000 rupees recently to buy grains but was
average deaths were more than two per failed to save his child.
village. This reveals the severity of the
Amarsingh Vishram from village Jamnapur lost 3
situation in the district. Out of the recently
years old Ravishanker is also a landless wage earner.
reported 27 deaths, more than 50 percent
He neither has a ration card nor a job card to ensure
deaths were mainly from the three
food security.
villages namely Mohalkhari, Salidhana
and Ambada. These villages are located Suraj from the village Mohalkhari lost two children
within the radius of three kilometer from Chhotu (4years) and Sagar (6 months) recently. He
the Government Hospital at Roshni. possess two acres of un-irrigated which is not
Among the dead 12 children could not yielding sufficient for feeding the family. The family is
have celebrated even their first birthday so pressed with sickness of the children that they
and the severity of problem among girl could not even weed their field this year. They
child seems to be worst with 10 out of 11 borrowed 2000 rupees for treatment of the children
succumbed to malnutrition deaths. In one and will have to return one and a half time the
of the striking case both mother and the amount borrowed. Recently they have borrowed one
child died in a span of just two days owing quintal of grains for which they will have to return
to hunger and malnutrition. double the quantity. Family with disabled mother
earlier had a Antyodaya Ration Card but that has now
Malnutrition seems to be widespread in been replaced with BPL card as a result often they
Khalwa block and the extreme poverty is are unable to buy ration as they have to pay more
triggered by acute household food now. Family claimed that elder daughter alone
insecurity citing as a major cause of worked for two weeks in NREGA but the job card
deaths. The families who lost their does not show the dates of work.
children were found to be forced to borrow
grains or money for purchasing grains at
soaring interest rate, sometimes double the rate. Most of the deaths occurred in the families
that are either BPL or Antyodaya Ration Cards holders, justifying the fact that malnutrition
has hit in the most vulnerable and food insecure families.
Although the acute household level food insecurity seems to be the major underlying cause
of the tragedy, but the bottlenecks and irresponsibility of programme implementing
individuals and agencies cannot be sidelined. The intriguing facts is that despite the mishap
the government field staff like Anganwadi workers, Auxiliary Nurse Midwife (ANMs) and
Panchayat secretaries are not monitoring the ground situation properly. If proper data had
maintained at the district level; it would have prompted the early administrative response to
averting many deaths. Prima facie investigations revealed that the records of Anganwadi
worker about name of the deceased children, their weight or date of death had aura of doubt
over the authenticity. For example, the name of a deceased child named Amarsingh (as
parents informed us and as media reported) was later altered to Ramsingh. Anganwadi
worker reported another deceased child named Aarti Totaram's weight as 9 kilograms but

Moribund ICDS
16
the child actually weighs 4.5 kg only. The severity of malnutrition can be inferred from the
fact that at least three children died at the NRC itself and one of them could not be saved
even after visiting Chacha Nehru Hospital at Indore.
1.2.3 Sheopurusual incidents
In Sheopur, Saheriya Mukti Morcha has reported that 162 children belonging to Saheriya
Primitive Tribal Group have lost their
lives. This community is known for highly Box - 78 End begins from
vulnerable in terms of food insecurity and beginning!
malnourishment in the country. Many
reports are coming from the field briefing Guddi wife of Gamandi is a severely malnourished
about continuous deaths in the district woman. She lost her five children in past few years.
In her own words "Woh to sookh ke mar gaye". Upon
and denial from government side. Prior to
enquiring the mother Guddi, when she would start
the present situations, Patalgarh village
breast-feeding her infants, replied very painfully,
of Sheopur district has been the center of
"How I can feed my infant when I myself did not had
discussion since February 2005 where 13
anything for last seven days". Tulsi, another severely
child-deaths were reported, due to
malnourished woman in the village, lost her two
malnutrition. The issue was highlighted
children, a girl and a boy last year. The above cases
almost at every platform. Taking note of
throw light on the fact that the real problem starts
gravity of situation, the Hon'ble Supreme
with unsafe motherhood and resulted into never-
Court nominated a Commissioner for
ending vicious circle of malnutrition.
reviewing the remedial measures, and in
turn issued directions for curbing
malnutrition.
In this village, merely 5 days work has been allotted to villagers during last three years
under various employment schemes. There is absolutely no trace of the provisions like
mid-day meals and anganwadi centres, for the simple reason that the village population is
very sparse and in numbers it is less than 700. As far as other facilities are concerned, rural
hospital is about 63 kilometers away from this village. It is due to scarcity, poverty and non-
availability of proper and nutritious food, one out of every 10 expectant mothers succumb to
death during delivery.
Subsequently, between March to May 2006, 10 more untimely child-deaths were reported
from the same area. The then Adviser to the Commissioner, Supreme Court of India in the
'Right to Food Case' once again wrote to the District Collector urging him to take more
decisive actions in the matter. Following this a Joint Commission of Enquiry (JCE) was
constituted to examine the cases reported and to look into the status of implementation of
food-related schemes in the district. The committee consisted of Shri P.S. Vijay Shankar
(representative of Dr. Mihir Shah), Dr. SK Singh, Dr. Vijay Gupta, Shri R.N. Raghuvanshi,
Joint Director, WCD, GoMP and Dr. Mohan Singh, Divisional Joint Director, was constituted
in November 2006.
During their visit, JCE quoted that the infant mortality rate for the district at 110 infant deaths
per 1000 live births is comparable to some of the poorest regions in the world like Sub-
Saharan Africa. The most critical issues mentioned in the report of JCE are as follows:

Moribund ICDS
17
l Poor functioning of various Government Schemes like ICDS, Mid Day Meal
(MDM), Targeted Public Distribution System (TPDS), and National Old Age
Pension Scheme (NOAPS) were observed in the villages visited.
l Poor implementation of NREGA where minimum wages are not being paid for work
done.
l High Incidence of starvation deaths, particularly among the children and poor
status of delivery of health services to women and children.
l The JCE also noted several cases of neglect of child health in the villages where to
some extent the ANM is little active.
l The JCE recommended that there are structural reasons (like inaccessibility to and
fro in the villages, lack of development thrust in the region, poor implementation of
various government programs, etc) for persistent of poverty and malnutrition which
need to be immediately tackle on a war footing basis, if the starvation deaths in the
area have to be checked.
l The committee suggested that the kind of "nutritional emergency" prevailing in a
small district like Sheopur is completely preventable if the administration
undertakes the steps as outlined above and work in close partnership with civil
society organizations to achieve these common goals.
Visits of JCE and the submitted report clearly depicted the pictures of ground realities that
the grim situation of malnutrition and hunger in the districts are nothing but the reflection of
poor implementation status of the government programmes and schemes. It was observed
that with the overall lack of development thrust, no concrete steps have ever been taken to
resurrect the failure of the system in the region. Reporting of child death is still continuous in
the district and in 2008 the toll of children succumbed to malnutrition has reached to 160
merely in past 5 months from May to September 2008.
Since February 2008, except for allocation of panjiri on 21st August 2008, there was no
supply of supplementary nutrition to any of the anganwadi centers of the district. Also, the
basic amenities like pre-school education, weighing machines, utensils, and medicine kits
were missing from the anganwadi centers. Even there is no anganwadi bhawan in most of
the villages of the district. The job cards of most of the villagers are in the hands of
Panchayat secretary. Villagers have got only 10-15 days of employment under NREGS
while the entries in job cards shows that 50-150 days of employment has been provided.
1.2.4 Shivpurideaths continue
Shivpuri is another Sahariya tribe dominated district. This community never bother about
their future, because they are confident that forests, which they respect and protect, would
never leave them hungry. However, continuous exploitation of forest by other social groups
in the district has resulted in irretrievably damaging the very source of food security to the
families of `Sahariyas' tribe. Left with no alternative, the Sahariyas had to look out for labour
work in the local stone mines to earn their livelihood. But again the mystery does not stop

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18
here as the elders working in the stone mines Box - 8 Losing faith
succumb to deaths at the early age of 40 years
in the system
due to silicosis.
Prakash Adiwasi, resident of village
Shivpuri district has been badly hit by drought for Bamhouri of Shivpuri district, lost his 3 kids
the past 5-6 years. During the drought periods in just 15 days. There were 9 members in his
most critical problem, people used to face is family with 2 son, 4 daughters, his wife and
about securing the means of livelihood. Caught in he himself. Prakash is the only earning
the web of constant shrinking of forests and strict member in the family and every day he has
provisions of various forestry laws, the Sahariya to struggle for livelihood. As there is no
tribes were left to face an unending state of availability of work in the village, he has to
hunger. In this district cases of children dying of go out of the village for earning. His
malnutrition have been reported during 2003. daughter Neetu (3 years) caught in fever
Manav Adhikar Forum surveyed the district and and finally succumbs to death in the
reported about 47 children have succumbed to absence of any medical help owing to poor
death in the District in just 2 months (June and financial condition. The family has yet to
July) in 2008. recover from the shock of the death of
Neetu and suddenly the siblings Raju (6
The issue of death of 8 children came into
months) and Chhoti (6 months) also died in
limelight from the village Bamhouri of the district
the same conditions. Meanwhile, Prakash
but there was no response from Government until
tried his level best to save his children; he
media raised the issue. Though there is a PHC in
ran from pillar to post but failed to arrange
the village and ANM also has posted in the village
money for medical treatment to his ailing
but she hardly visits the village, usually once in a
children. The family now being left with only
month. The allocation of supplementary nutrition
6 members who have lost the hope of
in the anganwadi center of the village is irregular
surviving anymore in the village and finally
thus the beneficiaries of AWC are deprived of the
decided to migrate and left for Gwalior
nutritional feed. Not a single family is getting the
forever.
benefit of Deendayal Antyoday Upchar Yojana6 in
the village. Although the Government claims to undertake relief work, but the fact is in spite
of resorting to hard labour work with empty stomach, they have not been paid their wages
for about two years now. According to Shyam Adiwasi of Bamhouri village false entries of
100-150 work days have been made in the NREGS job cards of villagers against the actual
work of 2-4 days, they really do not know as to who is responsible for scuttling their rights.
The situation is further aggravated due to prevailing political and social system that tribals
do not have the strength and courage to stand for and demand their just rights. The only aid
provided by the Government was through organizing the health camps in the regions that
were in the media glare by providing mosquito nets and plastic sheets to the families living
in huts.

As per a study of Right to Food Campaign7, although 26 percent people of Sahariyas tribe
possess 5-8 Bighas of land, but nearly 70 percent of this land is unirrigated and stony and
6
The scheme provides free medical treatment and investigation in all government health facilities up to a
limit of Rs. 20000/- to all BPL families.
7
Jain, Sachin. (2006) 'Poverty, migration & national rural employment guarantee scheme a case study on
Sahariya primitive tribal group in Madhya Pradesh', http://www.righttofoodindia.org/links/field_reports.html

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19
situated at mountainous slopes. Unless these lands are developed properly cannot be put
to suitable for cultivation or any other useful purposes. In the last one year more than 60
hunger deaths of Sahariya tribes were reported from Shivpuri district. Although some
temporary measures were taken by the Government at that time, but not a single long term
solution was initiated. Besides, these tribals are often gets exploited at the hands of
government staff. To give an example of such exploitation, the bicycles belonging to
scheduled tribe people of 30 villages of Kolaras block, including Bairasia, Sanwara and
Gugwara, were confiscated by the Forest Department staff and demanded a penalty of
Rs.200/- each, on the pretext that they were carrying the dry and dead woods from the
forest area for selling, ignoring the fact that the tribals living in the forest area are duly
authorized to do so. The plight of their financial condition was such that they could not
secure the release of their bicycles for about six months and it was only upon intervention of
some local organizations, district administration has instructed the Forest Department to
return the bicycles. Facing the social ignorance, anger, deprivation and inhuman treatment
inherent in the system, the people of `Sahariyas' tribe is once again in the miserable
condition. In the absence of sources of livelihood, this tribal group is again forced to resort to
migration.

1.3 Health Status in Madhya Pradesh

Malnutrition among children stirred the political environment and took a central stage in
Madhya Pradesh after media and civil society organizations spearheaded the whole issue
through people's campaign mode. Undoubtedly it is very difficult on the part of the State
Government to accept the fact that children in the state are dying in huge numbers due to
malnutrition. Meanwhile the death toll reached to 360 in the same 4 districts namely Satna,
Khandwa, Sheopur and Shivpuri. Reports of severe malnutrition started flowing from the
districts like Barwani, Jhabua, Dhar, Burhanpur and around, where 2450 severely
malnourished children have reached to the Nutritional Rehabilitation Centers. In recent
years, malnutrition as one of the indicators of the status of human development has been
on the steady rise in Madhya Pradesh. NFHS III data states that 12.6% children in Madhya
Pradesh are suffering from most severe malnutrition and are on the verge of death. It
means around 13 lakh children in the state are at highest risk of survival, thus indicating the
urgent need to address the issue with some serious interventions in the state in general and
in the affected areas very particularly. If we take a look at the various governmental
schemes, we will find huge discrepancies in proper implementation of these schemes and
programmes at the village level. The following section presents some of the hard-core facts
about the situation in the State.

1.4 Health Infrastructures

In Madhya Pradesh, of the total population nearly 20 percent population belongs to
indigenous tribes; mostly resides on the fringes of forest and greatly dependent on forest for
their livelihoods. It is important to mention this because these are the areas where health
facilities are minimal and incidence of malnutrition is even greater8. Malnutrition lowers the
8
Alert note on Malnutrition in Madhya Pradesh by Right to Food Campaign Madhya Pradesh Group

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20
resistance power making the people Box - 9 An eye opener
weak thus succumb to ordinary diseases
that could be cured easily. The important One out of every four children in the world, who die
step in curbing child or infant mortality under the age of one, is an Indian. The infant
would be a promising health facilities mortality rate in the country is 57 per thousand live
reaching to the remotest rural areas births and neo natal mortality at 43 per thousand live
through wide spread functioning births. When compared to the provisional data of the
anganwadi centers with due recognition national census for 2001 it is clear that there has
to their importance. Aanganwadi centers been no improvement in the last seven years. This
not only run the programmes of women after the Government has spent 20-23 thousand
and child development department but crore in total on the National Rural Health Mission.
also the programmes of the health One of the main reasons for high infant mortality is
department like vaccination, nutrition, malnutrition. The problem states that account for
and school education and look after and more than 65 per cent of infant and neo-natal
monitor the malnourished children. mortality are Rajasthan, Uttar Pradesh, Madhya
Pradesh, Bihar and Orissa. Unicef says that the
As evident from the table below state problem of malnutrition and infant and maternal
government's expenditure on health as a mortality can be solved if it is addressed at the
proportion to total expenditure has ground level in villages and districts. But to make this
declined sharply from 5.1 percent in possible the ministries of health and woman and
2000-01 to 3.9 percent in 2008-09. In child need to collaborate in a joint plan.
Madhya Pradesh, public expenditure on (Source: "State of the World's Children's Report
health is just 25 percent while out of 2008" by UNICEF)
pocket expenditure is one of the highest
at 75 percent9. Under the pressure of bilateral agencies like World Bank and World Trade
Organization (WTO), Indian government shying away from its responsibility and exerting
more pressure on people to spend on the basic facility like health. Madhya Pradesh
government's contract basis recruitment policies for Doctors are in question with lack of
minimum basic facilities like earned and medical leaves and pension. With these conditions
one cannot expect the doctors to offer dedicated services.
Table 1: Health budget of Madhya Pradesh government
States expenditure on health as a
S No Financial Year
proportion of total expenditure
1 2 000 - 01 5.1
2 2001 - 02 4.1
3 2002 - 03 4.1
4 2003 - 04 3.3
5 2004 - 05 3.1
6 2005 - 06 3.4
7 2006 - 07 3.8
8 2007 - 08(RE) 3.7
9 2008 - 09 (BE) 3.9
Source: State budget Books, GoMP for various years

9
State Health Policy Draft for M.P. (http://www.health.mp.gov.in)

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21
The basic issues like health and malnutrition in Madhya Pradesh are summarized as
follows:
l The state has highest rate of infant mortality and malnutrition among children. Nearly
55 percent of all children below 3 years are under weight, 51 percent are stunted, 20
percent are wasted and 75 percent
are anemic. Box - 10 Key facts about
l Various reports of UNICEF state that
Maternal Health from
out of every thousand live births 100 NHFS-3 statistics
children die in the developing 8 Mothers who had at least 3 antenatal care
countries. Preventable diseases visits for their last birth- 40.2 percent
cause the deaths. Moreover, in M.P. 8 Births assisted by a doctor/nurse/Lady Health
a child dies every 5 minutes. Worker (LHV)/ANM/other health personnel -
l Proportion of children receiving 37.1 percent
immunization against all prevent- 8 Institutional birth-29.7 percent
able diseases in the age group 12- 8 Mothers who received postnatal care within
24 months is only 22.4 percent. two days of delivery-27.9 percent
8 Women whose body mass index is below
l Only 25 percent of children 6-35
normal-40.1 percent
months having received at least one
dose of Vitamin 'A'. 8 Ever married women (age 15-49) who are
anaemic-57.6 percent
l Maternal mortality rate in the State, 8 Pregnant women (age 15-49) who are
which is second highest in the anaemic-57.9 percent
country i.e. 379 per lakh live births.

l IMR is also highest at 72 per thousand live births10.

l One has to understand the fact that the high level of Maternal Mortality also
contributes to the high level of Infant Mortality. Medium term health sector strategy for
Madhya Pradesh-2006 has recognized the MMR at the rate of 400 per lakh but no
projections has been made to reduce it by three quarters till 2015 in order to achieve
the MDGs.

1.5 Far behind from GOALS

It is important to note that the Reproductive Child Health (RCH)-II programme
implementation plan sets itself a goal of reaching IMR of 60 by 2010, which in itself is a
modest goal, after the MDG commitment. But what is more interesting to know is that based
on the predictive modelling exercise published in the National Commission of
Macroeconomics and Health Report predicts that the given current trends of IMR for the
state would reach 69 by 2010 and to 60 by 2015 (with a range from 51 to 71 even the lower
limit of the range being well above the commitment and comparatively the lowest amongst
the states.). Clearly there is a need to work out strategies to accelerate the pace of

10
SRS Data-October 2008

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22
improvement of child survival11. It would be only an exaggeration if we say that India/MP
would achieve the target of MDG by 2015, going by the above statistics. It seems that
government efforts are not adequate, although it is mobilizing many schemes for achieving,
the target for maternal health like 'Janani Suraksha Yojana (Safe Motherhood scheme)
towards the convenience for pregnant women, institutional delivery scheme, transport and
treatment for pregnant women are the chief ones. But the real challenge lies in whether the
beneficiaries are actually getting benefited or not. Not only this, but also the attitude of the
hospital management, their poverty, the lack of facilities in the hospitals, the
encouragement of privatization and many other reasons which act as obstacles in
reduction of maternal deaths12.

1.6 Status of Health Facilities

If one goes by the latest human development report of Madhya Pradesh 2007, the status of
health in the state is far from satisfactory. The estimate for longevity, measured in terms of
life expectancy at birth, which were 59 years for males and 58 years for females
corresponding to the period 2002-06 were the lowest among all the major states in India
and a good four to eight years lower than the national average.
The public health infrastructure facility is also not satisfactory. As per the Madhya Pradesh
Economic Survey for 2007-08 there is a huge gap in the need and availability of health
institutions in the state. It mentions that Government of India is still following the 1991
census indicators, and because of that state is facing the lack of 1384 sub-health centers
and 572 Primary health centers. Though the state has adopted an innovative approach of
mobile health dispensaries through public private partnership and other health schemes, its
impact on primary health is yet to be evaluated.

Table 2: Total number of Health Institutions in MP

Urban FW Centre Urban

State No. of District Civil CHC PHC SHC Health
Blocks Hosp. Hosp. Type I Type II Type III Post
Madhya
313 48 54 278 1142 8834 16 7 73 80
Pradesh
Source: www.health.mp.gov.in (Health Institutions in Madhya Pradesh, as on August' 2007)

As per the norms, there should be one PHC per 20,000 people in tribal areas and 30,000
people in other areas. Similarly, there should be one SHC per 3,000 populations in tribal
areas and 5,000 populations in other areas.
The ground level situation of the State shows that the system is operating far below the
norms.
There is great shortfall of health facilities in rural areas. As per the population of MP, there is
a great need to increase the facilities while government is privatizing of existing facilities
which will further devoid general public from utilizing them due to its cost implications.

11
MP Draft Health Sector Reform Strategy Aug 2006
12
Robbinson, Nick, Visiting Madhya Pradesh, a study on Maternal Health Scheme in Madhya Pradesh

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23
 Table 3: Available and required number of Health Institutions in MP

S No Health Centre Available Required Short fall

1 CHC 278 406 128
2 PHC 1142 10457 1625
3 Sub Centre 8843 10457 1614
Source: www.health.mp.gov.in (Health Institutions in Madhya Pradesh, as on August' 2007)

It has been mentioned in the report of JCE that in Sheopur district the required Primary
Health Centres (PHCs) and Sub Health Centres (SHCs) according to norms are 21 and 127
respectively while the existing numbers are only 8 PHCs and 89 SHCs. Similarly, in Satna
and Khandwa districts also the infrastructure facilities are in scarce.
Even if we look at the basic requirement of the health centers in terms of manpower, we will
find the Health Institutions in the State are under significant shortfall.
13
Table 4: Available and Required number of Health workers in MP
S.No. Posts Required Available Short fall
1 Specialists 916 49 867
2 Medical Officers 4708 3039 1659
3 Staff Nurse 2800 2600 200
4 A.N.M. 10285 9807 1098
5 Pharmacists 1421 216 1205
6 Lab Technicians 1421 386 1035
7 MPW (Male) 8874 902 1893
8 Nurse/Midwife 2795 902 1893
9 Accredited Social Health Activist (ASHA) 52143 40549 11594

Looking the condition MP Govt. should focus on establishing more centers, allocate more
budgets and employ more doctors and other staff rather than going for privatizing the basic
health facilities.

1.7 Accessibility to Health System

Accessibility and availability of health care is important for ensuring a community's general
health status and reflects the coverage of health facilities. NFHS -3 shows a decline in the
number of people availing health facilities from public sector. In Madhya Pradesh, 62.6
percent population generally does not use government health facilities, whereas for all
India level the proportion is 65.6 percent. Highest reasons for not using public health care
facilities are as follows. Poor quality of health care (62.9 percent), no nearby facility (50.8
percent), too longs waiting time (26.4 percent), non-convenient facility timings (10.0
percent), Health personnel often absent (7.7 percent) and other reason (1.6 percent).
The most commonly reported problem by one-quarter women is distance to a health facility.
Availability of health facility in the tribal region is very bleak owing to the factors like hilly

13
MP report People's Rural Health Watch (PRHW)-2008, MPJSA

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24
terrain, bad roads and lack of transport facilities. As a result the habitants are completely
deprived of the government PHCs. Around 44 percent women from scheduled tribe
reported distance to be a big problem. Only 17 percent of the deliveries of women belong to
Scheduled Tribes were assisted by a doctor, compared to 47 percent births to women of
other classes. Prevalence of anaemia is highest in the Scheduled tribes; both men and
women.

The undernourished System

214 children were registered in the AWC of Lakhrawan village falling under Rajnagar block of Chhatarpur
district; however capacity of the centre is just enough to support only 40 children. Also these children have not
received any hot cooked supplementary nutritious food for the past two months (i.e. since March 2009). It was
observed during the field visit that the amount of Rs. 3765/- per month was allotted for the supplementary
nutritious food to this anganwadi center in the Kota Panchayat. This meager amount is not at all sufficient to
support all the children of age 3-6 years enrolled in Anganwadi. Even this scanty fund is not reaching in the
hands of SHG (authorized for cooking food in the center) but the fund get siphoned off due to prevalent practices
of corruption. The irony of the situation is that the ICDS Supervisor of the center and the officials of W&CD
department are totally unaware of the fact that there is no supply of SNP in the Anganwdi of Lakhrawan since
March 2009. It clearly shows how strong the monitoring system of the ICDS network is! The things don't end
here; the anganwadi worker of Lakhrawan village has not received her remuneration for the past seven months
and the same situation is being faced by the anganwadi workers of Kota and Para village also.
This case study has been observed by Right to Food Campaign Madhya Pradesh Support Group. (June 2009)

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25
 2
Integrated Child Development Services

Integrated Child Development Services programme has main focus on catering the need of
children under the age of six years through supplementary nutrition, health care and pre-
school education. It also covers adolescent girls, pregnant women and nursing mothers.
Government of India started it in 1975 with the following objectives;
l To improve nutritional and health status of children below six years age.
l To lay down the foundation for proper psychological, physical and social
development of the child.
l To reduce the incident of mortality, morbidity, malnutrition and school dropouts.
l To achieve effective co-ordination of policy and implementation among various
departments to promote child development.
l To enhance the capability of mother to look after the normal health, nutritional and
developmental needs of the child through proper community education.

2.1 Implementation process of ICDS

Women and Child Development department is the nodal department for implementing
ICDS scheme. Medical and Public Health department has been given the responsibility of
immunization of children under health services.
Basic services provided under ICDS can be categorized under three heads namely,
nutrition, health and pre-school education. In nutrition services there is supplementary
feeding, growth monitoring and nutrition and health counseling. Health services include
immunization, basic health care and referral services. These health services are delivered
through public health infrastructure viz. PHC, CHC and SHC. Under Pre-school education
various stimulation and learning activities are covered at the anganwadi.

2.2 Services provided under ICDS

Different services under ICDS are provided through 'Anaganwadis' a network of ICDS
centres. Anganwadi Worker (AWW) is assigned with the responsibility of operating
anganwadi. An Anganwadi Helper (AWH) supports them. The seven basic services
provided through Anganwadi centers are as follows
1. Supplementary Nutrition - This includes the allocation of supplementary
nutritious feed to all the children below the age of six, adolescent girls and pregnant and
nursing mothers for at-least 300 days per annum or 26 days a month. By providing
supplementary feeding, the anganwadi attempts to bridge the protein energy gap between
the recommended dietary allowance and average dietary intake of children and women to
control vitamin A deficiency and nutritional anaemia. According to this component children

Moribund ICDS
26
are given supplementary food containing 300 calories energy and 8 to 10 grams of protein
while women (pregnant & lactating) are given food with 500 calories energy and 20-25
grams of protein. Besides, severely malnourished children are given special
supplementary feeding and referred to sub health centres and PHCs as and when required.
Prioritizing the nutritional needs of children (0-6 years), new norms have been released by
Ministry of WCD in Feb. 2009.
2. Growth Monitoring - Growth monitoring is another important activity that is
supposedly to be operational at anganwadi centers is one of the many ICDS functions. The
programme is expected to monitor the growth of children by weighing them every month
and plotting their growth on a chart. It is important for assessing the impact of health and
nutrition-related services and enabling communities to improve the same. As per ICDS
guidelines, children below three years of age should be weighed once a month and children
3-6 years of age quarterly. Weight for age growth cards or growth registers is supposed to
be maintained for all children below 6 years of age in the village. These help to detect
growth faltering and to assess nutritional status. The entire monitoring of malnutrition is
based on this system of growth monitoring data. To monitor the growth each anganwadi
center is provided with three types of weighing machines one adult weighing machine to
record weights of adolescent girls and pregnant/lactating women, second salter weighing
machine to weigh the children of 3-6 age group and the third machine to weigh young
children below three years of age. A growth chart register is provided to keep a record of
weight and age of the children enrolled in anganwadi center.
3. Nutrition and Health Counseling - Anganwadi workers are trained to impart
Nutrition and Health Counseling to the women enrolled in AWC. This forms part of BCC
(Behaviour Change Communication) strategy. This has the long term goal of capacity-
building of women especially in the age group of 15-45 years so that they can look after
their own health, nutrition and development needs as well as that of their children and
families.
4. Immunization - Immunization of pregnant women and infants protects children
from six vaccine preventable diseases-poliomyelitis, diphtheria, pertussis, tetanus,
tuberculosis and measles. These are major preventable causes of child mortality, disability,
morbidity and related malnutrition. Immunization of pregnant women against tetanus also
reduces maternal and neonatal mortality. The Ministry of Health and Family Welfare deliver
this service under its Reproductive Child Health (RCH) programme. In addition, the Iron
and Vitamin "A" supplementation to children and pregnant women is done under the RCH
programme of the Ministry of Health and Family Welfare.
5. Basic Health Care - This includes health care of children less than six years of
age, antenatal care of expectant mothers and postnatal care of nursing mothers. The ANM,
Sub Health Centres and Primary Health Centres provide these services. The various health
services include regular health check-ups, immunization, management of malnutrition,
treatment of diarrhea, deworming and distribution of simple medicines etc.
6. Referral Services - During health check-ups and growth monitoring, sick or
malnourished children, in need of prompt medical attention, are referred to Nutritional

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27
Rehabilitation Centers (NRC) or Primary Health Centre or its sub-centre. The anganwadi
worker is oriented to detect disabilities in young children. She enlists all such cases and
refers them to the health centers. The cases referred by the Anganwadi workers are to be
attended by health functionaries on priority basis.
7. Pre-school Education - This component for the three to six years old children in
the anganwadi is directed towards providing and ensuring a natural, joyful and stimulating
environment, with emphasis on necessary inputs for optimal motor and concept
development, acquiring language and social skills and preparing the child for schooling.
The early learning component of the ICDS is a significant input for providing a sound
foundation for cumulative lifelong learning and development. It also contributes to the
universalization of primary education, by providing to the child the necessary preparation
for primary schooling and offering substitute care to younger siblings, thus freeing the older
ones especially girls to attend school.

2.3 Population covered under an AWC

Each anganwadi centre is supposed to cover a population of 1000 persons or around 200
families. The new norms for opening of an anganwadi are as follows:

14
Table 5: Criteria for Anganwadi Centers

Sr no Area Determined necessary population

1 Rural and Urban Area One anganwadi centre per 400-800 population
2 Tribal area One anganwadi centre per 300-800 population
3 Rural and Urban Area One mini-anganwadi centre per 150-400 population
4 Tribal area/hamlets One mini-anganwadi centre per 150-300 population

State government's rates of supplementary nutrition to be provided in the anganwadi

centers are as follows:
Table 6: Nutritional Entitlements15
Quantity of Quantity of
Sr. Protein to be Calorie to
Beneficiary Rate
no made be made
available available
1 Children (6 months to 6 Rs 2.00 per 10 gm 300 calorie
years age) child per day
2 Severely malnourished children Rs 2.70 per 20 gm 600 calorie
(6 months to 6 years age) child per day

3 Pregnant and lactating Rs 2.30 per 20 gm 500 calorie

mothers and adolescent girls beneficiary per day

14
Source: Administrative Report, Department of Women and Child, GoMP, 2007-08
15
Source: (1) Administrative Report, Department of Women and Child, GoMP, 2007-08. (2) Revised Nutritional
& Feeding norms for supplementary nutrition in ICDS scheme - See Annexure-II.

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28
2.4 The Truth of Universalisation of ICDS
Supreme Court of India in its order dated 29th April 2004 mentions the definition of
Universalization of ICDS by saying that all the Children under the age of 6 years, all the
Pregnant and Lactating Women and all the Adolescent Girls must be provided with all
seven services from the ICDS center, but latest report from DWCD provides information
that still 60% children and more then 73% eligible women are out of the focus.
ICDS in the field
ICDS is one of the biggest and the only scheme which addresses the nutritional needs of
children in the age group 0-6 which comprises of 16 per cent of the total population in the
State according to Census 2001. But the performance of ICDS in the field is not complying
with its objectives of reaching the beneficiaries with adequacy. The Seventh Report of the
Commissioners of the Supreme Court stated that as per Census 2001 as many as 6.6
million children should be enrolled in anganwadis that are running under ICDS in Madhya
Pradesh. But only 3.89 million, (35.9 percent of total children population), gets the
supplementary nutrition from the State through Anganwadis, indicating ICDS benefits are
not reaching even to all the malnourished children of state considering the severity of the
problem.
Box - 11 Dilution of Supreme
State government with the assistance
Court's Orders
from United Nation's Children Fund
(UNICEF) and World Food Programme In the light of vested interests and rampant
(WFP) launched special schemes like Bal corruption in the present system, the Supreme Court
Shakti Yojana, Shaktimaan and the Bal of India has given strict directions four years back to
Sanjeevani Abhiyan to reach out severely all the State governments stating "Contractors
malnourished children. All these schemes should not be engaged in for the supplying nutritional
are being implemented under the food in anganwadi's, but it shall be utilize the
umbrella of ICDS but have been failed to services of village communities, self help groups and
contribute in tackling the problem of mahila mandals in the villages"
villages". The system of having
malnutrition. If budgetary allocation of the nutritional food supplied through these groups
funds is any indication, then state has many advantages. First and foremost among
government is spending 0.86 percent of them is the fact that it would bring about a definite
its total budget for the children under six. change in the economic condition of women through
income and employment generation. And secondly
Another key component of the ICDS is the the system would also pave the way for the
supplementary feeding that is being community to have closer links with ICDS
provided to the beneficiaries including implementation. Further it will also strengthen the
children in the age group from 6 months to involvement of local institution i.e. Panchayati Raj
6 years, pregnant and nursing mothers through decentralized supply of SNP. But despite the
and adolescent girls. But in reality this orders from Supreme Court the State government is
basic service has come to a grind halt in promoting the distribution and supply of the
most of the Anganwadi centers of the supplementary nutrition food to the Anganwadi
State mentioned the field reports. Major Centers through contractors or private firms by
blockade in reaching the supplementary sidelining the local community based initiatives.

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29
feeding to the beneficiaries is the fact that this entire programme is into the hands of private
contractors over the years; who are supplying ready to eat food powders. These
readymade foods are not culturally acceptable, calorie wise inadequate and in many of the
cases never reached the ICDS centers at all.
Another side of the story is that the state government is promoting the supply of Ready to
Use Energy Food (RUEF) and Ready to Use Therapeutic Food (RUTF) under strategic
guidance of non-governmental agencies and corporate alliances like Global Alliance for
Improved Nutrition (GAIN). This will gradually destroy the traditional food habits of the
indigenous people. Though it is true that such ready to eat food is a boon to tackle the
problem of acute malnutrition but at the same time one has to be cautious because
presently these foods are the imported one and its impact on indigenous population of India
is yet to be tested. The most critical question arises here is how the government could
promote the use of ready to eat foods without being tested in the first place and secondly
would this imported food component be a sustainable solution to tackle the problem of
malnutrition in our State? Can't the RUTF be replaced with some locally procured
alternatives or can't we have locally produced RUTF?

2.5 Status of ICDS in Madhya Pradesh

l Total population (under the age of 6 Years) - 1.078 Crore

l Total Children covered under SNP - 439062417

l Proportion of children covered - 40.72%18

l Total pregnant and lactating women - 36 Lakh19

l Actual benefited women in this category - 9 Lakh
l Proportion of women covered - 26.5%
l Number of adolescent girls age (11-17) - 64 Lakhs
l Proportion of adolescent girls covered - Nil

2.6 Allocation for Travel and Fuel

On one hand, in the past 3 years rates of petroleum products have been increased more
than 25 percent and on the other hand 20000 new anganwadi centers have been opened in
the same period. Thus it requires substantial increase in allocation for Fuel and Oil for the
field visits under ICDS implementation. But actually it has gone down heavily by nearly half

16
Source: Note has been prepared by Right to Food Campaign Support Group Madhya Pradesh.
mprighttofood@gmail.com
17
Administrative report 2007-08, Department of Women and Child Development, Govt of MP, Page 17.
18
Administrative report 2007-08, Department of Women and Child Development, Govt. of MP, Page 17.
19
Calculated as per the population growth rate 3.2% per year in Madhya Pradesh. It includes 24 lakh
pregnant women and 12 lakh lactating women.

Moribund ICDS
30
the rate from 0.72 percent in 2006-07 to 0.35 percent in 2008-09 as a percentage of total
departmental budget for this head.

l Year 2006-0720 - Rs. 2.18 Crore (0.72% of the total Expenditure)

l Year 2007-0821 - Rs. 2.985 Crore (0.55% of the total Expenditure)

l Year 2008-0922 - Rs. 2.179 Crore (0.35% of the total Expenditure)

District officials including District Women and Child Development Officer and District
project Officers-DPO in the Department of Women and Child Development gets an amount
of Rs. 50000 per year for Vehicle and Fuel. Unfortunately, the amount has remained
unchanged in the past five years. It has a practical implication on the effectiveness of the
scheme, because of it's directly link to the monitoring mechanism of the scheme.
But on the same line allocations for the transportation of professional/expert services has
been increased from Rs13.92 lakh in 2006-07, to Rs 41.86 lakh in 2007-08 and to whopping
high at Rs 1.02 crore in the year 2008-09. This increase in meant for the transportation of
contractual staff, professional experts etc, but not for the field staff.
23
2.7 No more Medicine Kits in ICDS
It is an essential component of the ICDS services, where Anganwadi worker has been
trained to provide initial medicinal support for symptoms like itching, injury, de-worming etc
through medicine kit component. For this purpose there is a system to ensure the
availability of essential medicines through Medicine Kit in all anganwadi centers. These
medicine kits should contain prescribed drugs, so that motive of the program could be
fulfilled and basic health problems are addressed at the very primary level. Unfortunately,
there is no separate provision of budget allocation for the medicine kits under ICDS for the
past two years but a minimum possible amount on the basis of tenders received is spent on
buying medicine kits for Anganwadi Centers. Moreover, the medicines kept in these kits are
not according to the need of a particular area but these are according to a fixed chart
depicting which medicines should be kept. This shows how sensitive is our government
towards the health of unborn and young children; the next generation of the State.

2.8 What is a Medicine Kit in ICDS?

As per the Government of India norms following drugs should be available in each
medicine kit
1. Paracetamol Tablets IP 500 mg - 500 Tablets.
2. Paracetamol Syrup IP 125 mg - 1 Bottle
20
Budget Book Demand for Department of Women and Child Development for the Year 2008-09 page 24.
21
Budget Book Demand for Department of Women and Child Development for the Year 2008-09 page 24.
22
Budget Book Demand for Department of Women and Child Development for the Year 2008-09 page 24.
23
Informations and Data provided in this section are based on the informations provided by the
Department of Women and Child Development under Right to Information on 15th December 2008.

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31
3. Mebendazole Tablets - 450 Tablets
4. Benzyl Benzoate Lotion - 500 ML Bottle
5. Chloramphenicol Eye Ointment - 10 Tubes
6. Sulphacetamide Sodium Eye drop - 6 Vials
There is no specific budget provision for purchasing medicines for Anganwadi Centers.
Department of Women and Child Development procure the medicines from the budget they
are allocated for overall ICDS project. These drugs are procured under a tender based
purchasing system it means it is not a part of any ongoing Health program and Department
of Women and Child Development has to make provisions in their budget, so that medicine
kits could be provided to the Anganwadi centers regularly.
We started with analyzing the programmatic systems and budget provision issues related
to availability of medicine kits, we started. The finding of policy level analysis gave a
shocking sketch.

2.9 Provision of Budget

It is interesting to see the budget allocations for medicine kits. The informations provided by
the Department of WCD for this study makes it clear that the allocations are too little when
compared to actual need.
In the Year 2002-03, State Government made an allocation of Rs 268.47 Lakhs for 47433
Anganwadi Centres (AWCs). This comes out to be Rs 5.65 in 2002-03 and Rs 5.74 in 2005-
06 for the proposed medi-
Table 7: Budget for Medicine Kit
cine kit comprising essential
Sr Year Allocated Covered Allocation
drugs. Considering the large No. Budget AWCs per
quantities of medicines Medicine
Kit
required the allocation is too
little. Allocations for medi- 1 2002 - 03 268.47 Lakhs 47433 Rs. 5.65
cine kits continued until 2 2003 - 04 275.18 49784 Rs. 5.52
Lakhs
2005-06 only and then no
3 2004 - 05 290.18 49784 Rs. 5.84
allocations were made for Lakhs
the medicine kits. It seems 4 2005 - 06 340.67 59324 Rs. 5.74
that, ICDS has been de- Lakhs
linked from the mandate of 5 2006 - 07 No allocation 59324 Nil
basic health care services 6 2007 - 08 No allocation 69238 Nil
envisaged in larger perspective.

2.10 Growth charts vs. Monitoring of growth

Growth charts or weight charts are to be kept with the anganwadi worker for the purpose of
recording the weight of the child up to the age of 6 years. The growth of the child is required
to be monitored through this chart where the anganwadi worker is expected to record the
child's weight every month. It is also to be used as an educational tool to teach mother to

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32
enable her to understand the growth of her child. Furthermore, it has to be used as a tool for
identifying malnourished and 'at risk' children based on their weight related to their age. The
chart is also used for monitoring the child growth like if the child weight falls below line III
indicating severe malnourishment and require doctor's consultation. Children whose
weight falls below the serious level should be immediately hospitalized for treatment.
As information provided by the DWCD shows that UNICEF provides necessary support for
the printing or procuring the Growth Register / Charts and considered as main accessories
for regular monitoring and recording the impact of the program on undernourished child
population24.

2.11 Field realities

l According to the data collected from Women and child development department
dated 6-1-09, growth charts for ICDS are provided by UNICEF.
l In the year 2004-05, government provided 25489 growth charts for 49784
Anganwadi centers thus covering only 51.19 percent of the anganwadi centres in
the state. The information provided by the department clearly mentions that at
present only 39 districts were provided with Growth Charts.
l Similarly in the year 2006-07 only 8559 (14.42 percent) anganwadi centers (out of
total existing 59324 anganwadi centres) were given growth charts in 42 districts.
l The more shocking is the data of year 2007-08 which shows that only 5933 (8.56
percent) anganwadi centres of 30 districts could receive growth charts.
l In this context some anganwadi centres were visited by the researchers and found
that since last one and half years anganwadi centres do not have the charts and
they are recording the growth in a plain register. Anganwadi worker of Banganga
project of Bhopal District told us that from last year the registers were discontinued
and they have to make entries in a plain register, which was very hectic for them.

Table 8: Status of Growth charts in Madhya Pradesh

Year Total AWCs in Total growth No. of AWCs with Percentage of
Madhya Pradesh charts with the no growth charts AWCs having
Department Growth charts
2004-05 49784 25489 24295 51.19
2006-07 59324 8559 50765 14.42
2007-08 69238 5933 63305 8.56
Source: Analysis is based on the information provided by the department of WCD under
Right to Information on 06.01.09

The analysis shows that the government is not equipped and cautious enough to monitor
the growth of children in very sensitive age. In the Year 2004-05, 51.19 percent anganwadi
centers were equipped with Growth charts. Thus we can say that the growth of half of the
beneficiaries were being monitored, but since then there is continuous decline in availability
24
Manual on Integrated Child Development Services, published by NIPCCD, First edition, 1984, page 178.

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33
of this essential document. The availability declined from 51.19 percent to 8.56 percent.
Growth chart is actually a register, representing the monthly weight gain and growth of a
child in a simple way with line or bar diagrams. The graphical picture helps the illiterate
mother to enable her to understand the growth of her child but the complicated entries in
registers makes them difficult to learn the things. Further more the government has
discontinued the supply of charts without intimating the AWW and without knowing the need
after 2007-2008.

2.12 Nutrition component testing

At present there are 69238 anganwadi centres being run by the Madhya Pradesh
Government and are providing supplementary nutrition to more then 53 lakh (5.3 million)
beneficiaries for 300 days in a year as claimed by the DWCD. But for such a big effort there
is no support for the testing of the quality of material being provided under supplementary
nutrition by the state government.
There is norm in the scheme and from the Supreme Court Order on the nutritional
component that each and every child should receive 300 calorie and 8-10 gram protein
from the ICDS centers. Earlier for checking this component department used to send
samples of nutrition to the Labs located in Mumbai or Delhi. The report of Comptroller and
Auditor General has also pointed out that in Madhya Pradesh ICDS System is not fulfilling
the criteria of 300 Calorie and 8-10 Gram protein being provided through anganwadi
centers.

2.13 Targeted population Vs Actual Coverage

As per Monthly Progress Report (MPR) for the month of May' 2008 available on the website
of Department of Women and Child Development shows that the total population of
Children under 6 years is 86.96 lakhs, but as per the Census 2001, the population of this
age group is 1.078 Crore. It means the existence of approximately 2.1 Million Children is
still out of the focus. Government is reporting that it is providing supplementary nutrition to
45.28 lakh children under the 6 years age, thus it is covering only 42% of the total child
population if one goes by the provisions under Universalization of ICDS.
When the implementation and coverage analysis in terms of budget provision was done, it
was found that the state government is allocating only Rs. 0.84 per beneficiary, but is
claiming the spending of Rs. 2 per beneficiary in all its key statement responses. On the
other side, if we believe that Government has spent Rs. 2 per beneficiary per day in the
allotted budget, then it means all the covered (not the actual population) beneficiaries will
get Supplementary Nutrition for 126 days only in a year, whereas it should have been for at
least 300 days in a year, as per the Supreme Court Order. Thus this shows a case of
complete negligence and violation of norms of Special Nutrition Program.

2.14 Human Resources: Vacant posts, a bitter truth

In ICDS program, Child Development Project Officer (CDPO) is a key person to ensure the
proper implementation of ICDS services. This person is a bridge between field

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34
functionaries and the policy makers. Presently Madhya Pradesh has 366
approved/sanctioned posts of CDPO, but according to the MPR (Jan. 2009), 76 CDPO
posts are lying vacant and in most of the places Supervisors have been put in charge for
these posts. Story continues with the post of ACDPOs, where only 46 officers are posted,
against the 115 sanctioned posts thus 69 posts are still lying vacant. Supervisor is the
closest capable officer to the Anganwadi worker. Supervision includes monitoring the
functioning, quality of services, proper growth monitoring processes, immunization and
pre-school education program are being implemented with spirit. This has to be ensured by
Supervisors by making 2 visits every month to each anganwadi center and by giving the
technical inputs. But 200 posts of Supervisors are lying vacant in the state. Out of 2738
sanctioned posts 2538 post are filled. In that case one Supervisor has to look after 27
anganwadi centers. It means one supervisor would be able to spend only one day per
anagnawadi every month. Considering this very exhaustive job he is left with there is no
spare time to undertake regular monitoring and providing technical support besides
keeping all the records up to date with latest information. In ICDS, CDPO is responsible for
the holistic performance of the scheme at the Project level. They have to ensure that all the
services are being provided to all the beneficiaries. CDPO monitors whether the records
are properly maintained or not, supplementary nutrition is available in the center on a
regular basis or not? CDPO is the key official in establishing the environment for
coordination with other departments. Also CDPO has to prepare monthly performance
report of the project and submit it to the Upper level officials.
There have been 138 projects are created by establishing huge number of Anganwadi
centers in the state. It was observed during the analysis that 138 CDPOs are responsible
for more than 200 Anganwadi centers. More surprisingly 16 projects or CDPOs are
covering 300 or more than 300 Anganwadi Centers. Their area of work varies from looking
after 51 centres in Ashok Nagar Urban project, 67 centers in Harda Urban and Datia Urban
to 536 Centers in Sidhi Rural, 409 in Chittangi project or 384 in Petlavad project. CDPOs
are made solely responsible for the projects under him and usually is caught in bad
situations, without taking into consideration the burden of work he is carrying as discussed
in above section. It is quite sure from the structure engaged in implementation of ICDS that
CDPO alone will not be able to deliver the things unless he gets proper support of different
departments, especially the Health department.

Table 9: Available and Required numbers of CDPO/ACDPO/Supervisors in AWC

Total Total CDPO ACDPO Supervisor

number of Anganwadi (As per MPR/Jan. 2009 - (As per MPR/Jan. 2009 - (As per MPR/Jan. 2009 -
Districts centers Info. Accessed on Info. Accessed on Info. Accessed on
20th June 2009) 20th June 2009) 20th June 2009)

Sanctioned Posted Sanctioned Posted Sanctioned Posted

Total 48 69238 366 290 115 46 2738 2538

l Avg. AWC per CDPO Avg. AWC per Avg. AWC per
189 (Sanctioned Post) ACDPO (sanctioned supervisor (Sanctioned
post) = 602 Post) = 25
l Avg. AWC per CDPO Avg. AWC per ACDPO Avg. AWC per super-
Posted) = 239 (Posted) = 1505 visor (Posted) = 27

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35
2.15 Nutritional Rehabilitation Centers
As we all know that 60 percent of children in the State are suffering from malnutrition and
moreover alarmingly 13 lakh children are on the verge of death being severely
malnourished. In order to tackle the issue, state government is running a scheme called
Balsanjeevni Abhiyan to check the problem of malnutrition. Outcomes of this scheme are
magical in the sense that it claims that the number of malnourished children get noticeably
decreased with every round of Bal Sanjivani with an interval of six months.
Like Balsanjeevni many more initiatives have been taken by the State Administration to
tackle the malnutrition by involving Health Department. Starting NRC last year, is one more
such scheme which includes an important component of referral services provided under
ICDS through anganwadi Centers. Functioning of NRC is a joint responsibility of WCD as
well as Health departments. Severely malnourished children that are falling in the category
of grade 3 and grade 4) along with their parents preferably anganwadi worker refers the
mother of a child to NRCs. Children can be kept in NRC at least for a period of 14 days.
During this treatment period, every child is given special treatment in terms of nutrition,
health and psychological as well as social development. NRC at the district level is having
20 beds and 10 beds at the block level. Categorically Department of Health has to play a
very crucial role in malnutrition eradica-
tion efforts through institutional channel
like NRCs for addressing issues of severe Box - 12 Budget of NRC
malnourished children. NRCs are Let us take a look at the budget component of NRC.
established in District Hospitals or An ideal NRC with 20 beds has been allotted an
Community Health Centers (CHCs) run amount of Rs. 2160/- per child for 14 days. The
by the Health Department. amount includes cost of food @ Rs 25 per day for the
Each NRC is suppose to be a well child, wages compensation of 14 days and the food
maintained center with a neat and clean costing @ Rs 65 per day for the mother of child along
environment, a kitchen and facility of safe with travel expenses (@ Rs 200/-) and the stipend
drinking water, separate toilets for parents (Rs. 100/- per child) given to Anganwadi worker for
bringing the child to NRC. Along with fulfilling all
and children and a recreation room with
these requirements, we can now imagine that how
plenty of educational toys for children. A
much money is being is being left for the medicines
Nutritionist and Child specialist along with
and supplementary nutrition of the child; its
sufficient trained staffs are posted in each
astonishing only Rs. 600/- for 14 days! Similarly, to
NRC to take care of malnourished
establish NRC with kitchen, recreational room,
children. Once the children are cured of
treatment ward, separate toilets and other basic
malnutrition and all subsequent infec-
requirements, a sum of only 1. 35 lakhs is being
tions, they are relieved from NRC and it is
sanctioned. Also the budgetary provision meant for
expected to undertake a regular follow up
the follow-up process is kept too little. It's a gigantic
at the intervals of 15 days, 1 month, 3
question in front of development practitioners that
months and 6 months.
with such inadequate resources at hand, how the
All these provisions for a standard NRC state government would be able to check the
are posing a picture perfect situation with horrendous situation of malnutrition in the state?

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36
good and effective place to cure the malnutrition among the children. But once again the
reality bites are very extremely in which the concept of NRC is being implemented in the
field. To take care of 13 lakh severely malnourished children in the State there are only 135
NRCs that have been established so far. Moreover, out of these only 95 centers are fully
functional while 40 NRCs are partially functional. There is a facility of merely 1678 beds to
take care suffering children and alarmingly 49 NRCs do not have trained staff. In such pity
circumstances, even if every thing functions properly in the system, it will take long 33 years
to reach and serve all the severely malnourished children in the state.
We would like to throw more light on the grim situation on the field on account of dichotomy
in registering the malnutrition cases. Although the four districts namely, Satna, Khandwa,
Sheopur and Shivpuri where deaths of 325 malnourished children have been reported
between May to September 2008, the number of malnourished children admitted in the
NRC centers is either nil or negligible. On this basis the state administration use to point out
that there is no severe malnutrition in the districts. But when the local organizations and
media continuously raised the issue of malnutrition deaths than suddenly the NRC centers
of these districts get flooded with malnourished children. Nearly 100 children were admitted
in Khandwa NRC while it had the capacity of only 20 children. 40 children were admitted in
Satna district and similar was the conditions of NRCs of Sheopur and Shivpuri districts.
Thus with this the question arises here that would it be possible that would there not be any
cases of malnutrition in other district as well? Also if there are malnourished children in
other districts, then why the NRCs are not reporting any?
One more lacuna observed in the operational system of NRC is lack of any co-ordination
between the NRC center and field staff i.e. anganwadi worker under ICDS. For example,
there is no means by which anganwadi worker would come to know whether there is a
vacant place to admit a new (malnourished) child in the center or not. Another major
drawback is that the child admitted in NRC is essentially relieved from the center in 14 days,
no matter whether he/she is fully cured off malnutrition and infection or not! The follow-up
system of children relieved from NRCs is also very weak due to which the children dies
even after being treated in NRC in the absence of continued treatment. All these lacunae
show that there is a great need of establishing a proper co-ordination among the
implementing agencies.

2.16 Few more observations based on the Rapid Assessment Study of

25
NRC
In order to collect the facts and actually analyze the ground veracities of the situations of
NRCs in the State, 23 NRCs of 14 districts were studied by the Right to Food Campaign
Madhya Pradesh Support Group. Following observations were revealed from the filed
study:
l There were total of 16638 severely malnourished children found in the selected
NRCs of 14 studied districts.

25
Conducted by Organizations working on Right to Food issues in Madhya Pradesh in Dec. 2008 - Feb. 2009

Moribund ICDS
37
l But out of which only 308 children have been found admitted in 23 NRCs in these
districts on 14th September 2008.
l It is disturbing that no district has a playroom as per the concept of the NRC.
l Only 2 centers out of 23 centers have toilets for children and caretaker.
l 381 beds were sanctioned in these NRCs, out of which only 271 beds were in
place.
l The children admitted to NRC exceeding the bed limits were found in Satna and
Khandwa districts.

2.17 Bal Sanjeevni Abhiyan

Under 'Bal Sanjeevani Abhiyan' (Child Treatment Campaign) run by the state government,
it is expected that the children suffering from malnutrition has to be identified from each and
every village and should given the additional nutrition and medication. But in reality it was
observed that the squad associated with the campaign has not even visited many of the
villages from where the cases of malnutrition were reported. Bal Sanjeevani Abhiyan has
completed its 12 phases since June 2001, but malnutrition still persists in the state with
cases erupting from time to time. This demands a strong need to give a serious thought to
the way in which malnutrition can be controlled in the existing circumstances in Madhya
Pradesh, where the responsibility of
children's welfare is vested with the Box - 13 Reality Bites
Women and Child Development
If we calculate the number of children malnourished
Department.
according to Bal Sanjeevni report and taking 0.92
Many shortfalls are noticed in the percent as the severe malnutrition percentage in the
implementation of Balsanjeevni Abhiyan. District, the number comes to 2941, it reduces to
The major one is about wrong 2546 if apply the rate of severe malnutrition as 0.80
presentation of the number of actual percent. This clearly shows that the Government is
malnourished children. For instance, directly vanishing off 395 children out of the records.
report of 11th Balsanjeevni Abhiyan26 for This is the reality of Balsanjeevni Abhiyan the
Satna district, shows that 3, 18,371 promising program to eradicate child malnutrition.
children were weighed out of which only or eradicating Children itself? Similarly, in Khandwa
2941 children were found to be severely district, 12th round of Balsanjeevni Abhiyan claimed
malnourished. The report says that malnutrition to be around 47 percent but when the
malnutrition in Satna District is 50.08 grassroot organizations working in the area
percent and proportion of severe conducted a sample survey, the figures turn out to be
malnutrition is 0.92 percent. However, the around 70 percent. Likewise the Government of
very next page of the same report shows Madhya Pradesh has been claiming that the ratio of
that the percentage of severe malnutrition undernourishment has come down to somewhere
has decreases to 0.80 percent. It's really around 49 percent while according to NFHS III
surprising that from where this sudden fall malnutrition proportion for the state of Madhya
arises out? Pradesh is at 60.3 percent.

26
www.mpwcd.nic.in

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38
Persistence of malnutrition among tribal belt has many reasons like lack of anganwadi
centers in the tribal areas, lack of timely and regular vaccination, non-distribution of regular
nutrition etc. But the foremost reason is non-availability of adequate livelihood
opportunities so that the people can get enough food for both meals, and do not reach the
stage of malnutrition. But this is not happening and in fact the situation has deteriorated,
which is why as compared to the 53.5 percent children below 3 years suffering from
malnutrition in 1998-99 the number has risen to 60.3 percent in 2005-0627 and the number
of those children below 3 years breastfed within one hour of birth is 14 percent.28

2.18 Targeted Public Distribution System in MP

The Supreme Court in its order dated 8th May 2002 gave the clear directions that the PDS
shops should remain open throughout the month during fixed hours. Also details of what the
shop would contain shall be displayed on the notice board. In its order dated 2nd May 2003,
the Supreme Court further directed that the licenses of those who do not keep their shops
open throughout the month during the stipulated period would be cancelled. In the same
order, the Supreme Court directed to permit BPL families to purchase grain in installments.
But the ground realities of TPDS are not at all in consonance with the direction of Supreme
Court. In Madhya Pradesh the TPDS shops are kept open only for 3-4 days instead of the
whole month29. Also, the norms for the amount of ration allocated through the shops is 35 kg
for Antyoday Anna Yojna (AAY) card holder and 20 kg for BPL card holders while the actual
amount of ration being allocated is different in different districts. For instance, in Karahal
block of Sheopur district 32 kg ration is being provided to AAY card holders while in Satna
the ration allocated to AAY card holding families is only 20 kg30. This deformity in ration
supply is also one of the factors responsible for prevailing food crisis among the poor
population of the State.

2.19 Midday Meal Scheme

A survey of Indian Council of Social Science Research (ICSSR) in year 2004 survey
concluded, "The shift to a ruchikar (relishing) mid-day meal in Madhya Pradesh in 2004
marks a dramatic improvement over the earlier daliya-based meal. The ruchikar meal is
being provided with fair regularity in most schools across the state. The meal is an immense
contribution to overcoming classroom hunger for millions of children whose families may
have been unable to provide them food.31 However, in Madhya Pradesh, the sorry state of

27
Fact sheet of National Family Health Survey-III
28
Fact sheet of National Family Health Survey-III
29
Real stories of Public Distribution System Document of case studies collected during the state level public
hearing conducted by Right to Food Campaign Madhya Pradesh Support Group in collaboration with Sampark
& Sopan in Bhopal on 28th December'04.
30
As revealed in the field survey done by Saheriya Mukti Morcha (Karahal) and Right to Food Campaign
Support Group of MP (Satna)
31
Shah, M. & J. Jain (2005): Antyodaya Anna Yojana and Mid-day Meals in Madhya Pradesh:
Findings of a Survey in Seven Districts, Economic and Political Weekly, 26th November

Moribund ICDS
39
primary education renders the MDMS almost ineffective. In almost every school in the
state, the actual number of teachers is less than the sanctioned number of posts. As a
result, many of the government primary schools in the state are highly understaffed; on an
average a primary teacher in rural parts of State handle about 100 pupils in most of the
schools32. As a result schools do not open every day and hence midday meals are served
only on those days when the school opens. Satna, Khandwa, Sheopur and Shivpuri all are
drought affected regions. According to orders of Supreme Court, MDM should be made
available in the schools of drought affected areas even during the summer vacation. But the
field reality is something very different. The local organizations working in these districts
reported about the irregular allocation of MDM not only during the summer vacation but also
during the complete past years.

Actions all across

As mentioned, 62 children died in Khandwa in the span of 4 months from June to September 2008. These
deaths were exposed by the efforts of local organisation Spandan & Media. After that a fact-finding report was
subsequently submitted to the Supreme Court Commissioner. In response the Supreme Court Commissioner
send a 16 points recommendation to the district administration asking for instant actions and report within 15
days. They also urge to provide 35 Kgs of food grains every month to all the BPL and AAY card holder. The
recommendations by the Supreme Court and the continuous pressure of community's agitation, actions of
people's organizations and media forced the administrative authority to provide relief for the children in the
villages. Hundreds of children were brought to the Nutrition Rehabilitation Centres (NRC; Bal Shakti Kendras)
and the Shaktiman project was introduced in 299 Child Care Centre (Anganwadi centre; AWC) all over the
district. The NRC is a child rights structure to treat malnourished children living in remote forest villages. The
Shaktiman project was launched in 2007 to ensure nutrition for children with a focus on predominantly tribal
areas in MP.
Few months back The Asian Human Rights Commission (AHRC) started intervening in the matter. The AHRC
has also written a separate letter to the UN Special Rapporteur on the Right to Food calling for intervention. They
commission regularly keep an eye on government action regarding the victims and their family. They also
release an appeal and update in the month of April & May 2009 for the cause. In one of their appeal they
mentioned that on 8 May 2009, the district government officially announced that they would issue the AAY
ration cards within three days to all families who had lost children due to malnutrition in 2008. It means that the
government has admitted the fact that the children died of malnutrition and intends to take responsibility for
their deaths.
This case study has been observed by Spandan Samaj Sevi Sanstha, Khandwa . (June 2009)

32
A survey conducted by National Institute of Education Planning and Administration, 2003.

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 3
Ground Realities of ICDS - A Field Study

Very often there is a tussle between the state administration and the grassroot workers from
various civil society organizations about what the ICDS programme is expected to deliver
and what actually happens on the ground. This tussle was very clearly seen in the past 8
months when the continuous deaths of young innocent children due to malnutrition came
into limelight during the period from May to October 2008. Administration used to claim that
the scheme is being implemented smoothly according to the norms and opposite is the view
of grassroot workers based on the field experiences.
To verify the actual situation so as to present a concrete proof of the ground reality of the
scheme, a survey study of 65 Anganwadi Centers from 12 blocks of 10 districts was done
during September 2008. The study was conducted by Right to Food Campaign group of
Madhya Pradesh with the intensive support of field partners namely, Manav Adhikar Forum
(Shivpuri), Lok Jagruti Manch (Jhabua), Bundelkhand Janutthan Samiti (Tikamgarh),
Patthar Khadan Majdur Sangh (Panna), Community Development Center (Balaghat),
Spandan Samaj Sevi Sanstha (Khandwa), Dalit Sangh (Hoshangabad), Adiwasi
Sushashan Sangh (Seoni), Abhar Mahila Samiti (Chhatarpur) and NIWCYD-Bachpan
(Bhopal). In this study 487 people from villages were covered, out of which 337 were direct
beneficiaries of ICDS (pregnant and lactating women, adolescent girls and children) were
interrogated about the conditions of anganwadi centers in their villages. Major findings of
this study are presented in following section. For district-wise details please refer Annexure
II.

3.1 Infrastructure of Anganwadi Centers

During the study we found
that only 37 percent Table No. 10 - Infrastructure At Anganwadi centers
anganwadis are having
No. of AWC Own Building
their own building while 63
percent are lacking their Yes No
own edifice. Study shows Total 65 24 41
that the villages where there
is no edifice for anganwadis, Percentage 100 % 37 % 63 %
the centers are used to run in
either in a rented structure, panchayat bhawans or at the residence of anganwadi worker or
helper. This shows that though somehow government has managed the running of
anganwadi centers in these optional structures but it is also true that these options are not
the permanent solutions and moreover these structures fail to provide the basic facilities
like sufficient space for children to sit, play rooms, proper cooking space and toilet facility.

3.2 Exclusion of deprived sections

The study also reveals that whosoever is accessing the anganwadi centre is influenced by

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41
its physical location as well as the caste/community profile of its workers as well as the
village community. Access to services by deprived communities like the Scheduled Caste
(SC) and Scheduled Tribe (ST) gets restricted if the centre is located in upper caste
predominant hamlets. The study also show what appears to be a glaring lack of any proper
method to assess the need and requirement as a result of which mostly the tribal and dalit
communities have been excluded of the ICDS benefits. In Chhatarpur district this situation
was seen most where tribal and dalit children and women are not getting any benefit from
anganwadi centers. One more fact came out in the study that the conditions regarding the
building of anganwadi center are worst in Panna which is the home district of the Minister of
Women and Child Development, also the conditions of Seoni and Chhatarpur districts are
also found worst.

3.3 Functioning days of Anganwadi Centers

Though the Apex Court has passed strict orders that every anganwadi center must provide
services and should be open for 300 days in a year but the ground reality came out of the
survey study shows
that only 43 percent Table No. 11 - Functioning days of Anganwadi Centers
anganwadi centers No. of AWC Functional days of AWC
were providing
services for 26 days 7 15 21 26
a month which is in Total 65 1 10 26 28
accordance to the
Percentage 2 % 15 % 40 % 43 %
orders of Supreme
Court. While 40
percent centers provide services for 21 days, 15 percent centers provide services
only for 15 days in a month and 2 percent of the surveyed centers hardly provide
services for 7 days in a month.
In the 65 anganwadi surveyed, two centres centers in Singro village (Block-Rajnagar of
Chhatarpur district) and Tila village (Block-Khaniyadhan of Shivpuri district) were never
opened since the day of their establishment indicating gross violation of the Supreme
Court's order.

3.4 Toilet Facility

Under the ICDS scheme, it is mandatory that every anganwadi centre should have a well-
maintained separate toilet for girls and boys. This facility is important because it will further
ensure the presence of
girls in the anganwadis. Table No. 12 - Toilet facility In AWC
But the grassroot fact is
No. of AWC Toilet Facilities
very different. Separate
toilets for girls and boys Yes No
are a distant dream; most Total 65 15 50
of the centers do not have
any toilet facilities at Percentage 24 % 76 %

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all.The study shows that only 24 percent centers were having toilets but the conditions
of these toilets are pathetic while rest 76 percent were devoid of any toilets. The
centers of Chhatarpur and Panna districts are totally lacking of the facility.

3.5 Drinking Water Facility

We attempted to analyze the availability of safe drinking water for children in anganwadi
centers. It was found that lack of safe drinking water resulted in a number of water born
diseases. If the availability is ensured the occurrence of water born diseases like diarrhea,
cholera etc. can be
controlled which are one Table No. 13 - Drinking Water Facility in AWC
of the reasons behind No. of AWC Drinking water Facility
deaths of malnourished
children Yes No
Total 65 28 37
Study reveals that only
4 4 p e r c e n t o f t h e Percentage 44 % 56 %
centers were having
the availability of safe drinking water while rest 56 percent centers do not ensures
the facility of safe drinking water. Conditions of aaganwadi centers, particularly in
Chhatarpur and Tikamgarh districts were found to be worst without any arrangement for
drinking water. In those aaganwadi centers where water availability has been reported,
water is available only for cooking of food. Availability of water for drinking was not seen as
essential factors hence the children were asked to get drinking water from their home.
Unavailability of water in anganwadi centers further questions the availability of hot cooked
meal to children. It is quite possible that either the children are given panjiri (bulgur) or the
anganwadi helper use to bring cooked meal from her home or someone else's home, which
is not hot. In such situations the order of Supreme Court to provide hot cooked meal must be
served to every child in the anganwadi centers is violated.

3.6 Availability of Supplementary Nutritious Food

According to the orders of Supreme Court every anganwadi center must provide hot
cooked supplementary nutritious meal to all its beneficiaries for at-least 300 days per
annum or 26 days a month. During the survey it was found that only 39 percent centers
provided the nutrition for 26 days while 32 percent centers provided for 21 days. 26
percent centers provide for 15 days and 3 percent centers have provided hot cooked
supplementary nutri-
Table No. 14 - Availability of Supp. Nutrition in AWC
tious meal just for 7
days in a month. No. of Availability of nutritious food
AWC (in days)
The condition of Shivpuri
7 15 21 26
and Chhatarpur districts
were worst, as out Total 65 2 17 21 25
of 15 anganwadi centers
Percentage 3% 26 % 32 % 39 %
studied in both the

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districts only one center was found where hot cooked supplementary nutritious meal is
being supplied for all the 26 days in a month. Most shocking fact came out in the study
where anganwadi centers in the Sigro village of Rajnagar block in Chhatarpur district did
not supplied the nutritious supplements to the children even for a single day!
Study showed that in Bhopal district only all the centers were reported to give
supplementary food for 26 days a month. This is because a centralized process is being
followed in Bhopal for providing cooked meal where the meal is prepared in one place and
from here it is supplied to each AWC in Bhopal, daily. It has also been seen that children
come to the anganwadi centers just to collect their daliya (porridge); they does not even
want to stay at the centers. Thus the identity of anganwadi centers is getting limited only as
a daliya distributing centers.

3.7 Quality of Supplementary Food

For studying the quality of nutritious food provided in the anganwadi centers, all the team
members engaged in undertaking filed work were briefed about the check points for
ensuring quality of nutritious food viz daliya/panjiri/rice/pulses. It should be of good quality
in terms of properly cooked, Table No. 15 - Quality of Nutritious Food
clean; free of moisture, dust and No. Quality of Nutritious Food
insects, safe clean water must of Good Normal Bad
be available at anganwadi AWC
centers for cooking food. On the Total 65 6 30 29
basis of above checkpoints, it Percentage 10 % 46 % 44 %
was found that only 44 percent
centers were providing good quality nutritious food to its beneficiaries and in 46
percent the quality was reasonable, while in 10 percent centers the quality of food
was disappointing.
Quality of nutritious food provided in anganwadi centres of Jhabua and Balaghat districts
were satisfactory, while performance of Shivpuri district was not up to the mark. It is worth
mentioning that Balaghat district has taken an innovative step to resurrect the grassroots
problems with community participation.

3.8 Availability of hot cooked meal

The availability of hot cooked meal under supplementary nutrition programme in ICDS is a
form of implicit income support and an intervention in poverty since it saves feeding costs to
the parents. But even
then this component is Table No. 16 - Availability of Hot Cooked Meal in AWC
kept deserted. As we
have already discussed No. of AWC Availability of Hot Cooked Meal
that the availability of Yes No
safe water in anganwadi
centers is in quite pity Total 65 18 47
conditions and thus the Percentage 28 % 72 %

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availability of hot cooked meals in anganwadi center is also a matter of concern.
In the study we found that only 28 percent anganwadi centres were providing hot
cooked meal to the children while the rest 72 percent centers were devoid of the
facility. None of the studied centers in Chhatarpur and Seoni districts have ever provided
hot cooked meal.

3.9 Relishing (Ruchikar) of Supplementary Food

Though the State Administration has decided a menu for each day to be provided in
anganwadi centers but
the reality at the field is far Table No. 17 - Relishness of SNF in AWC
different. The menu is
No. of AWC Ruchikar Food
only in papers and
beneficiaries are getting Yes No
panjiri and daliya most of Total 65 21 44
the times. Beneficiaries
o f t h e 3 2 p e r c e n t Percentage 32 % 68 %
anganwadi centres
under study were satisfied with the taste of food while remaining 68 percent were not
really happy.

3.10 Availability of Utensils

Providing supplementary nutritious food with dignity to each and every child is a mandatory
service under ICDS. As per ICDS norms mentioned in Supreme Court orders as well, every
anganwadi has to be provided with enough utensils to serve the hot cooked meal to children
of age group 3 to 6 years
in the anganwadi centers Table No. 18 - Utensils availability in AWC
itself. But again this norm
is not followed and No. of AWC Availability of Utensils
children are bound to Yes No
bring utensils with them if
they want the food. Total 65 27 38
Percentage 42 % 58 %
In the survey it was found
that out of the total
aaganwadi centers studied utensils were available only in 42 percent centers. In
Chhatarpur and Shivpuri centers condition is more pathetic. Moreover, in those centers
where availability of utensils was reported, the number of utensils was not found enough to
provide food to all the children enrolled in the centers at same time.

3.11 Availability of Playing Kits (Pre-School Education Kit)

It is well known that ICDS provides 7 basic services to its beneficiaries through aaganwadi
centers and pre-school education is one of them. This component of pre-education is

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45
directed towards promoting holistic child development with emphasis on necessary inputs
for optimal growth and development. It also contributes to the universalization of primary
education and preparing the child for schooling. For this purpose learning by playing
technique is being applied for which anganwadis are made available with (learning) toys or
playing kits. These toys are also helpful in providing and ensuring a natural, joyful and
stimulating environment
for young children. Thus
Table No. 19 - Availability of Playing Kits
the availability of playing
kit in anganwadi is No. of AWC Availability of Playing kit
beneficial to attract
Yes No
towards the center and
keep engaged young Total 65 26 39
children.
Percentage 40 % 60 %
In our study we found that
only 40 percent centers were having playing kits while rest 60 percent were not
having the same. In the centres where playing kits were available were actually not
reaching the children because either the kit is kept wrapped or are kept in the house of
anganwadi workers. However, many of the anganwadi workers reported that they never
received any playing kit. It is rather kept under the possession of supervisors or sometimes
not supplied from higher authorities. Study shows that the condition of Hoshangabad and
Chhatarpur districts is very poor where all the anganwadi centres studies were devoid of the
facility of playing kits.

3.12 Availability of Medicinal Kit

Of the basic services provided through ICDS, primary health care is one of the important
component and to
provide primary health Table No. 20 Availability of Medical Kits
care a medicine kit is
made available in every No. of AWC Availability of Medical kit
anganwadi center. This Yes No
kit also called first aid box
is consists of bandage, Total 65 7 58
tincture, medicines for Percentage 11 % 89 %
normal fever and de-
worming tablets.
The children of 6 to 36 months are very much susceptible to parasitic infections and thus
these children must be given de-worming doses in every six months on priority basis. In
such circumstances, availability of medicinal kit at aaganwadi centers is really beneficial
but unfortunately these kits are not available at most of the centers. The survey study shows
that only 11 percent centers were having the medicinal kit facility.
Moreover, if we see the budgetary component for this facility we will find that the service is
kept quite in negligence. There has been no single rupee expenditure on the medicine kit

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46
component since past 2 years i.e. 2006-07 and 2007-08. In the year 2006-07 a budget of
Rs. 21.65 lakh was allocated to the department of women and child development for
medicinal kits while in year 2007-08 this amount was decreased to Rs.1 lakh, despite the
fact that number of anganwadi centers is increasing day by day all across the State.
Furthermore, even if the medicines are made available, they are not distributed on the basis
of demand or need in the areas but variety of medicines are prescribed and allocated to
each and every aganwadi centers. Also if we analyze the budget further, we will find that our
Government is providing Rs. 1.44 per anganwadi center only that turn out to be miniscule
figures of expenditure just 2 paisa per beneficiary.

3.13 Growth Monitoring

As mentioned above that the entire monitoring of malnutrition is based on the system of
growth monitoring through growth charts and weight records. In the survey we tried to look
at the availability of the machines and growth registers in the studied anganwadi centers.
We came across the dire truth of growth monitoring component of the ICDS scheme that not
a single center studied was having the machine to weigh the young children below three
years of age.
a. Availability of Salter Machine
Out of the studied AWC, 72 percent centers were having the machine. This clearly
indicates that in the
centres where there is no Table No. 21 - Availability of Salter machine
salter machine, no No. of AWC Availability of Salter Machine
growth monitoring would
have been done for the Yes No
children aged 3-6 years. Total 65 47 18
Anganwadi workers of
these centers revealed Percentage 72 % 28 %
that children are weighed
only during the Balsanjeevni campaign by borrowing the machines from nearby centers. It
means children are weighed once in six months. Out of the 10 districts studied the status of
Jhabua was worst. Besides appalling fact is that in the centers with of weighing machines,
children are not weighed regularly because most of these machines are not working
properly.
One more thing to be noticed here is that UNICEF provides the technical support for ICDS
services and the salter machine is also provided by UNICEF. About 10000 new anganwadi
centers have been started in the State during past four years and according to UNICEF
records no machines have been purchased or supplied to WCD department since past four
years. It means that these centers are devoid of any weighing machines and thus no growth
monitoring or growth records are being maintained in these centers. All these conditions
clearly spelt out the seriousness of the government's towards health and well being of
children in the state.

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47
b. Availability of Adult Weighing Machine
The problem of malnutrition in children has not cropped up suddenly but it began to take
shape much before the
birth of a child. Most of Table No. 22 - Availability of Adult Weighing Machines
the women especially the
No. of AWC Availability of
tribal women are found to Adult Weighing Machine
be undernourished and
anemic. The data of Yes No
NFHS III shows that more Total 65 43 22
than half the women
(nearly 56 percent) in the Percentage 66 % 34 %
State are anemic and
figure closely correspond to the national figure of 55.3 percent. Madhya Pradesh stands in
third position with 42 percent proportion of undernourished women. Ultimately a weak
mother will give birth to an undernourished child. In order to control the existing malnutrition
in the children; keeping a check on the health of women and adolescent girls is compulsory.
With this vision regular health check-ups and weighing of pregnant/lactating women and
adolescent girls is expected to undertake in anganwadi centers with the provision of adult
weighing machine.
The study revealed that only 66 percent of the studied centers were having the
machines to weigh adults. Also there were no scales in any of the centers to measure the
height of girls and women. When there are no records of monitoring the health of pregnant
women; it means there is no system in place to aware them about any complications in the
delivery.
c. Growth Registers
To monitor the health and Table No. 23 - Availability of Growth Monitoring Register
to keep proper monthly
No. of AWC Availability of
records of weight and
Growth Monitoring Register
age of children is an
essential service Yes No
provided under ICDS Total 65 38 27
scheme and growth
registers are provided for Percentage 58 % 42 %
the same. In our study we
found only 58 percent aaganwadis were having growth registers. Moreover, if we
compare the availability of weighing machines and growth registers we saw that there were
14 percent centers where weighing machines are available but there is no growth register
to keep record of weights of children in thee centers.

3.14 Pre-School Education

Pre-school education is an important service provided by AWCs so that young children get
comfortable with education and studies by learning with playing in AWCs. But in Madhya

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Pradesh most of the anganwadi centers are just identified as a daliya distributing center
and the pre school education component is either miniscule or not taken into consideration
at all. In the study we found that only 24 percent centers were imparting the pre-school
education to children.
Anganwadi centers in Table No. 24 - Pre-School Education Facility
Balaghat district were
performing better while No. of AWC Pre-school education facility
the condition of the Yes No
centers in Chhatarpur
district is awful. Total 65 16 49
Percentage 24 % 76 %
In the centers where pre-
school education is being
imparted is for the namesake with lacking minimum resources like education charts and
toys. Also no proper training has been given to Anganwadi workers about the importance
and how to bestow pre-school education to young children, thus the vital component is left
untouched.

3.15 Hot Cooked Meal Vs Packaged Food

New concern is being raised regarding providing the supplementary nutritious food in
anganwadi centers in the form of tin packed food instead of hot cooked meal. The DWCD is
trying hard to introduce the concept. Solely WCD department has taken decision about this
without asking for the opinion of the community/beneficiaries, which are going to be
affected directly.
In the survey we also tried to capture the view of the local community about packed
supplementary nutrition.
We found that 90 percent Table No. 25 - Willingness to Packaged Food
of them were not at all in
No. of AWC Willingness to tin packed food
the favor of packaged
food, 8 percent people Yes No
were not aware of the
Total 65 6 59
pros and cons of packed
food against the hot Percentage 10 % 90 %
cooked meal and rest 2
percent did not give any comments on the issue. The reason and explanation for opposing
the packed food by majority of the community members were cited as below-
l The packed food is not made up of traditional food ingredients that are in use for
centuries.
l The packed food cannot provide the freshness and the taste that a hot cooked
meal can give.
l Some people were of the opinion that some company will supply the packed food
and companies are generally working for their own commercial interests.
l Quality of food will not remain same all the time rather it will degrade after a few
months of service.

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49
Anganwadi workers also supports the views of communities and beneficiaries by saying
that hot cooked meal is far better than the packaged food and children must get the
traditional, hot cooked meal in anganwadi centers instead of some tin packed food.

Box - 14 Ground Zero:

Sidhi, a place on the brink of negligence
The AWC in Amha village of Mata panchayat of Sidhi district is a case depicting the utter negligence
towards the operation of AWC at ground level. There is no building for the center and no supply of
supplementary nutritious food from July to September 2008, and with no food there is no question of
quality. There is no weighing machine, no playing kit and no medicine kit in the center. Post of anganwadi
worker (AWW) is lying vacant since last year. Absence of supporting staff has adversely affected the
provision of basic services to needy beneficiaries. Not a single child or pregnant/lactating women have
received any vaccination for the past 6 months.
Despite the fact and urgent need for health facilities and monitoring of the prevailing situation of ICDS, no
administrative staff from both health and WCD department is willing to visit the village owing to its distant
and remote location. In the village children are weighed only once in a year during the Balsanjeevni
Abhiyan round.
With the support of Mahila Adhikar Manch, 24 AWC were studied in the district. It was found that only one-
fourth (6) centers were having the building. There was no salter-weighing machine in 12 centers whereas
15 centers were devoid of adult weighing machines. Neither of the centers were having medical kit facility,
playing kit and the facilities for pre-school component were also missing from all the centres studied in the
district. Most of the centres were either lacking utensils, if having they were inadequate to support all the
children enrolled in the AWC. It was also observed that in many centers anganwadi worker is appointed
but helper is not and vice-versa thus it affected the preparations of cooked meal.
During the 12th round of Balsanjeevni abhiyan 52 children were identified in serious malnourished stage
from these 24 villages but not a single child have been referred to NRCs till October end 2008. When
explored further the reason behind it was found that in the NRC children are admitted according to the list
of malnourished children prepared by the district officials. No preference has been given to the condition
or stage of malnutrition. It means that children have to wait for there turn to get treated of malnutrition.
Under the ICDS scheme monitoring of anganwadi centers, capacity building of anganwadi workers and
motivating anganwadi worker/helper as well as community for health and nutrition education are the
important components. Separate supervisors are appointed at block level. It is expected from these
supervisors to visit every anganwadi center at least twice a month. But in the studied 24 centers in Sidhi
district no visits have been reported in the past three months. On further exploring we found an appalling
fact that the ICDS project of Sidhi is the largest one in the State that include 536 ICDS centers, while there
is only one supervisor has been appointed to manage this huge number of centers making it quietly
impossible for the supervisor to visit all the centers even once in a month. Shortage of working staff is not
only the problem of Sidhi district but the whole State is facing this problem.

3.16 Conclusions of Field study

What do all the observations from the field study lead to? What are the lessons that we can
learn from the gaps between what the ICDS programme is expected to deliver and what

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50
actually happens on the ground? Child development programmes of the state government
need an extraordinary attention. Given the size of the problem, and the complexity of issues
involved government has to take the lead and ensure that the persisting problem of hunger
and malnutrition among children has to be addressed with great care and sensitivity. A
rigorous monitoring of the implementation process has to be followed coupled with and a
concerted effort to make the programme more participatory by involving the local people.
New strategies are to be shaped that would go long way to help ICDS functioning effectively
in reducing widespread malnutrition.
Ground realities pose a very serious question why is the flagship programme meant for
child nutrition and development is in such a terrible state? May be the following points
throwing some light on the probable reasons.
l It seems health and well being of children is not really a priority with political parties.
The political leaders raise no debates on the conditions of children in State,
whether the leader is of ruling party or the party in left. Also, there are no provisions
of making better policies for children in the manifestos of any political party
because the children are not the eligible vote banks.
l There is a big gap in proper implementation as well as monitoring system and
accountability towards ICDS which is the only scheme for children under six year
age group.
l The original intent of the ICDS programme was to address the various sub-stages
(like from birth to 6 months age, less then 3 years and 3-6 years of age) of growth.
Purpose of this was to ensure that the negative health and nutritional outcomes for
a child any one stage would not be carried forward to the next. But it is apparent
from the ground realities that the programme effectively concentrates only the
children in the age group from 3 to 6 years only. Various empirical studies reveal
the fact that reaching out the children below three is one of the major constraints in
ICDS implementation.
l Exclusion on the basis of caste and class is also a big problem as it refuses the
deprived sections of the society most needed access.
l Non-recognition of malnutrition deaths by the state government is one of the
foremost challenges in front of development practitioners working closely on the
issue. The problem gets aggravated in the light of fact as constant denial by the
state government of the malnutrition deaths but the deaths are due to disease.
l Lack of co-ordination and continuous blame game between the women and child
development department and health department also contributes to the
ineffectiveness of the scheme.
l Owing to socio-cultural and sustainability reasons community is not in favor of
regular supply of packaged food. 90 percent of the respondents' feel that locally
made, prepared and supplied food will be welcomed.
The survey study clearly shows that despite the higher extent of undernourishment in the
state, performance of ICDS is far from satisfactory levels. Many of the Anganwadi centers in
the state are not even providing the basic services to children like supplying supplementary
nutrition, growth monitoring and nutrition surveillance and imparting pre-school education.

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51
Consequently children with severe malnutrition are not identified properly and these
children remain far away from the prescribed special treatment or referral services. This not
only shows faulty implementation but also indicate gross negligence in delivering ICDS
programme. Field reality emerged from ground definitely demands an extra ordinary efforts
to improve the efficiency of the programme and ameliorate malnutrition and ill health of
children in the state. The time has come to turn the ICDS programme upside down doing
away with the existing model and thinking afresh on how best we can reach out to the most
vulnerable. State government has to play a more proactive role and should try its level best
to accomplish universalisation of the ICDS programme. We need to plan separately for
different sub-groups of children looking at the specific needs of home-based care and
outreach services up to 3 years and a centre based approach for the 3+ groups of children.
Concrete efforts are necessary in the sense that poor health, malnutrition and frequent
bouts of illness at the young age of 6 months to 5 years have an irreversible impact on the
overall health and well being of children.

Who else will take care!!

In Tamia block of Chhindwara district, there is a place called Patalkot which is recognized for its natural beauty
and unique location. No body tries to unveil the problems the tribal people living in Patalkot faced due to gradual
effects of climate change, hiking markets and various policies of government through which common people's
reach to natural resources are being limited. Patalkot is the valley mainly habited by the Baiga tribes (one of the
3 PTG of MP) and the health status of their children is becoming inferior day by day.
To take care of the health of children and to provide them the benefits of Integrated Child Development Scheme,
an Aganwadi Center was established in the Gaildubba village of Patalkot valley in 2007. Really it's an
appreciating effort of the district administration that it took an initiative to establish AWC in such an hard to reach
area. But see the irony! At present the AWC of Gaildubba is now converted into a Guest House for government
authorities. Actually, when the AWC was established then our Chief Minister in the year 2007 reached there to
inaugurate the centre and as there was no other option, the same AWC was used as the guest house for him.
Since then the local administration said that this building will be used as a guest house rather as an Anganwadi
Center. The villagers are yet fighting for converting the guest house turned AWC back into AWC for children.
This case study has been observed by Right to Food Campaign Madhya Pradesh Support Group in June 2009

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 4
Denial by State :
Biggest Challenge for Child Survival

According to the 12th Bal Sanjeevni Campaign data; around 48,220 (0.56%) children in
Madhya Pradesh are suffering from severe malnutrition. So stark is the situation that one
evaluation report of UNICEF said that even if the children were saved, they might go blind
due to lack of vitamin A.
In last 3 years malnutrition; an indicator of human development has been on the rise in
Madhya Pradesh. According to data collected by the state government's own Bal Sanjeevni
Abhiyaan, eighty thousand children are suffering from most severe malnutrition and are on
the verge of death.
Malnutrition in itself is a multi-dimensional problem because it is related with the process of
socio-political transformation like social behavior, household livelihood, state services,
equality and human rights with dignity. It has been observed that immediately after the birth
of a child, mother feeds the child for around 6 months but after that the child does not get
required nutritional food for his growth and development owing to household food
insecurity. Its well-known fact that child requires more attention and supplementary
nutrition during the first two years of birth, as in this period of age, 80 percent physical and
mental growth takes place. But due to poverty child do not get required qualitative food and
is been pushed towards hunger deaths.
In Madhya Pradesh the proportion of children who are severely malnourished is also
notable: 24% children are severely stunted and 16% are severely underweight33. Women
and Child Development Department has tried to provide daliya (porridge) and panjiri
(bulgar) to children up to the age of 6 years. But this approach has had very limited success
as a cup of boiled daliya cannot improve health condition of malnourished children?
Moreover every time when children die out of chronic hunger, Government officials usually
say that children are dying due to TB, diarrhea and measles and not due to malnutrition
forgetting the truth that malnutrition actually creates the ground for these diseases. These
diseases occur due to the lack of immunization and in turn decrease life expectancy of
children. In MP, only 40.3 percent of the children receive proper immunization according to
the NFHS III data.
The state administration and the political groups do not have a strategic understanding to
solve the problem of malnutrition. They see it as an untouchable issue to protect their self-
interests. The government does not want to believe that malnutrition is result of its anti-
human rights development policies. There is no magic that can solve the problem. Lack of
accountability and coordination among various related Departments like Women and Child
Development, Department of Health, Department of Panchayat and Social Welfare,

33
NFHS III Data

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Departments of Rural and Urban Development, and Department of Education has to be
seen as a big draw back in the campaign against malnutrition. Also it's reprehensible that
not only the system but also the society has not given much priority to the matter, which has
already taken a huge toll on the poor. Government has failed to provide a life with rights and
dignity to its people and even unable to save the lives of children which is the future of the
State. Malnutrition can be linked with a number of other issues like the functioning of the
PDS in the region, the break up of the traditional food security system of the people, the non
functioning social security schemes and the ineffective ICDS implementation, lack of
means to earn livelihood, and above all the irresponsible attitude of the government
functionaries. The health status of a family is directly dependent on the earning capacity of
the family. Most of the children dying due to malnutrition belong to tribal communities that
used to depend mainly on the forest and its produces for livelihood. It is not that the
condition is out of control. Still all these mishap can be handled simply by resurrecting the
systems and by making some positive changes in policies. This can be achieved fairly
quickly, given the right combinations of political commitment, strategic programming and
resources. But no one is even ready to accept the truth that there are some problems in the
policies and systems.

Box - 15 Denial mode on starvation deaths

For several months now the media has been flooded with reports on starvation deaths in Satna, Sheopur
and Khandwa districts of the Madhya Pradesh. The State administration, however, is in a denial mode. We
are in great pain to dismiss the state government's claim that the starvation deaths occurred due to
reasons other than starvation. There is nothing new in this denial. I learnt it very early in my police career
that at any given time any State Government is wary of admitting even single starvation death leave aside
scores of them as in the present case. And, that too in the election year - Na baba na! It is a taboo.
I was posted as a trainee Station House Officer at Ramgarh Police Station, Bilaspur district in 1963. One
afternoon, a kotwar brought the report of a starvation death. As the rest of the staff had gone out on
various duties, I was the only one available at the police station. On interrogating kotwar, I was convinced
that the deceased had in fact died of hunger; I was about to make a roznamcha (Day Book) entry that Head
Constable Moharrir Abdul Karim entered the police station office. I told him about the starvation death and
what I had intended to do. With a look of disbelief and he remonstrated me that by doing so I might loose
my job in future. All such reports have to be treated as natural deaths and its better the Head Constable be
handled the case.
Head Constable sat down to make a roznamcha (Day Book) entry of a marg (filing an incidence in police
records, so that the investigation process of the incidence could be started) and then picked up his bag and
left with the Kotwar for the village of occurrence. On return, he made a detailed entry in the roznamcha
that the death had taken place due to natural reasons. He had a copy of the postmortem report too which
endorsed with his panchnama duly attested by two witnesses. The medical officer had certified the cause
of death due to old age. Putting the postmortem report in my hands he muttered 'dheere dheere sab
samajh me aa jayega.'
How long shall we continue to do the fudging? The latest World Bank report says that one third of the
world's poor live in India. Those of us who have seen the abysmal poverty in the countryside know that
starvation deaths are not unusual. Denial may temporarily help a political party to return to power but it
doesn't solve the basic problem of deprivation, poverty and hunger and State's indifference.

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4.1 Children in Denial and Negligence Vs World's best child survival
in records in MP
The Health Department of Madhya Pradesh Government claims that not a single infant
death has been reported from Dhar and Chindwara districts (both the districts are tribal
populace districts) of Madhya Pradesh. On the contrary the Department of Women and
Child Development have registered 560 infant deaths in just a short period of 7 months from
November 2007 to May 2008 in the same districts. No infant mortality was reported from
Chindwara district in past 42 months (April 2005 to September 2008) and Dhar district
shows no infant death in last 30 months (April 2006 to September 2008).
The analysis is based on the data provided by the Monthly Health Bulletin of Department of
Public Health and Family Welfare. This report the Maternal and Infant deaths regularly and
hence can be considered as the authentic information.
l For the past more than 3 and half years only 6 infant deaths have been registered
in Chindwara district. In that sense ranking the district as best performing with
lowest infant mortality. Interestingly all these 6 deaths have been registered in the
month of October 2008.
l Dhar has registered 233 infant deaths in 2005-06 but since then, in the past two
and half years there is not a single infant death.
l Jabalpur has registered 9 infant deaths in 2005-06, 10 deaths in 2006-07, 23
deaths in 2007-08 and 4 deaths in first 7months in 2008-09.
With the above information State government would like to pursue the feelings that the state
is not reeling under storm of malnutrition by putting the few districts under the category of
world's best places with lowest IMR, however the field reality and well as national level
survey figures quoted in NFHS turn down all the claims. It's really shameful on the part of
the health department that the state with highest Infant Mortality Rate in India, along with
the Highest Malnutrition level in the country provides such fake and unbelievable
information.
But on the other hand, MPRs of Integrated Child Development Services revealed a clear
contrasting picture. The analysis of MPRs shows that in the 7-month period from November
2007 to May 2008, 469 infants in Dhar, 91 infants in Chhindwara and 213 infants under the
age of one year have died in Jabalpur district. This definitely propel upon the Health
department for not having proper accountable system that keep serious records of child
deaths in the state. This provokes the larger debate of coordination between Women and
Child Development department and Department of Public Health and Family Welfare on
effective ICDS implementation on the field.
Few calculations were done based on the IMR data, actual registered births and the official
IMR figures registered by the health department of the state government. According to
latest Sample Registration Survey report 2007 released in October 2008, Infant Mortality
Rate of Madhya Pradesh is 72 per one thousand live births. The inferences of the trend

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55
analysis are quite ruthless as it shows that in the past 4 years from 2005-06 to 2008-09
more than 77 percent (4.24 lakhs) of the Infant and Child Deaths have gone unreported.
We must understand that this is not an issue that could be judged on the basis of any
particular incident or one time data. We all know that the category wise registration of
deaths is not an old technology. But due to non-reporting of deaths, causes of child deaths
neither come in to action based debates nor becomes the policy priorities. Above analysis
seeks an urgent demand and proactive action for strengthening Birth and Deaths
registration section.

Table No. 26: Non - reporting of Infant deaths

S. No. Year Infant Deaths Actual IMR Infant Deaths
officially Infant not reported
34 35
Registered Deaths

1 2005-06 30157 135564 79 105407

2 2006-07 30278 134976 76 104698

3 2007-08 29385 131328 72 101943

4 2008-09 28745 126113 72 112603

Total 118565 527981 424651 (77.54%)

This case of non-registration makes it amply clear that the lack of coordination even among
the government departments resulting into creating non-positive environment for rights
based action in course of children's protection.

34
Source: www.health.mp.gov.in/bulletin accessed by the researchers on 6th November 2008
35
Calculated on the basis of IMR and actual registered births.

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 5
Nutrition Policies Questioned

An important component of ICDS scheme is that all the beneficiaries of ICDS must be
provided supplementary nutritious food. The children above 3 years of age are entitled for
getting hot cooked meal at Anganwadi center itself while children below 3 years, pregnant
and lactating women are provided with take home foods which are ready to eat energy
foods like daliya, panjiri etc. It is because small children (under 3 years) and pregnant and
lactating women are not part of the hot cooked meal scheme as yet. The ready to eat energy
food provided by ICDS should not be commercial but locally prepared foodstuff with locally
grown grains with the shelf life dependent on how often is the food is distributed by AWC
(daily/weekly/twice a week/twice a month). But the reality of this service in the State is
something else.
Supplementary nutrition services have come to a grinding halt in large parts of Madhya
Pradesh with the orders of Supreme Court to ban contractors in Supplementary nutrition
supply to ICDS. State government then encouraged the Self Help Groups (SHGs)
formations and also promoted/invited local women's self-help groups and Mahila Mandals
for supply of supplementary nutritious food through ICDS but the very same government
that set up the SHG's for the so-called empowerment of women has today started digging
the grave for it. The Women and Child Development Department of the Government of
Madhya Pradesh is inviting sealed bids from the eligible manufacturers or producers to
supply of Ready to Eat Energy Food as a Supplementary Nutrition Food to ICDS Projects in
various districts. If one go through the terms and conditions of the tender it is obvious that
large manufacturers and producers only be able to bid for the work. The notification
specifies that the bidder should possess ISO 9001 or 9002 series Quality System
Certification and Hazard Analysis and Critical Control Point (HACCP) Certification for the
manufacture of supplementary nutrition and the average annual turn over of the firm should
not be less than Rs. 24 crores in the past three completed financial years. No wonder the
SHGs in the state in at any cost would be able to qualify the criteria mentioned above to get
the work order.

Mr. Harsh Mander37 mentioned in his letter dated 17th October 2008 to Shri R.C. Sahni, Chief
Secretary, Government of Madhya Pradesh that SHGs have been asked to tender for
supplying ready to eat food under ICDS in the state. This seems an extraordinary formality
to be completed on the part of SHGs. It is because the genuine SHGs and mothers'
committees would be locally rooted and unlikely to be able to engage in formal tendering
processes and also who would they be competing against? He recommended that this
process must be discontinued for the larger interest of the society. He also mentioned that
the current practice of purchasing from the MP Agro-Industries Corporation is nothing but
an indirect purchase from contractors, which is again a violation of the Court's orders. He
further wrote in his letter that weaning foods for the children below 3 years could best be

37
Special Commissioner of the Supreme Court [in the case:
PUCL v. UOI & Ors. Writ petition (civil) no. 196 of 2001]

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locally produced. It should be prepared using culturally and nutritionally appropriate recipes
from every region in the state. He very strongly recommended reverting back to the varied
weekly menu of hot cooked meals that included food item like puri-sabji, kheer-puri, poha,
halwa etc. that were being served until a few months ago.
Another evidence of negligence of local SHGs and mothers committee (Matru Sahyogini
Samiti) by state government can be gauged from the example of Bhind district. Here on one
hand government has stopped the allocation of budget for SNP flowing to the joint account
of Anganwadi Worker and Mother's Committee for the reason of financial irregularities
observed38. On the other hand the government is slapping a fine of Rs. 10/- per day on the
firms engaged in supplying SNP in Angawadis in case of gap in the supply39. It means if local
organizations are unable to supply SNP regularly then they would be directly banned from
further supplying, but for the same fault private firms./companies would be charged with
fine of miniscule amount are not supplying SNP on regular basis they will only be charged
(fined) Rs. 10/-. Such actions hint a conspiracy to keep off the local organizations out of
loop.
Mr. Ajai Singh, Ex-Minister and a Congress Member of Legislative Assembly (MLA), wrote a
letter to the Chief Minister Mr. Shivraj Singh Chauhan stating that pursuant to the Supreme
Court Orders, the procurement and distribution of the food for the Anganwadi's had been
handed over to the Self Help Groups. This would unable in providing employment to a large
number of marginalized families especially the women at local levels. But now the
concerned department has taken steps to privatize and centralize it, which can be clearly
understood by the tender specifications and this move is not the one that is welcome. The
then Chief Minister is also believed to have written to the District Collectors saying that the
distribution should be continued through the SHG's.

5.1 Importance of Cooked Meal over Packaged Foods

Another point where Government is trying hard is the efforts to promote the ready to eat
energy food. It seems that by doing so Government is trying to destroy the traditional food
habits of the people. Also Government has not shown any concern to chalk out nutrition
programs, which are practically applicable, and at the same time sustainable at village/local
levels. The food supplied by the government-undertaking firms like Madhya Pradesh Agro-
Industries Corporation (which procures supplementary nutrition from various private
producers) is not the traditional food of the local communities across the State. For
instance, MP Agro supplies panjiri to all the AWCs across the State while panjiri is not
consumed readily in all the parts of the State. We are all aware of the fact that the food habits
in the state are diverse and vary from groups/society and region to region. This is true
especially in case of tribals who largely consume food collected from the forest that is very
nutritious.
The food supplied by the local SHG's are in compliance with the food habits with regional
flavor and taste of the local people as against food supplied by the private companies pays
38
Letter of WCD department, Govt. of M.P. dated 31st May 2008.
39
Agreement letter between Govt. of M.P. WCD department and Ms. Vaishno Food Products Pvt. Lim., Gwalior.

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little heed to the traditional food habits of the people. By pursuing ready to eat food, State
government is instrumental in promoting rumors like it is higher in nutritious value
compared to the traditional food supplied by the SHG's, also establishing that the cooked
meals have the possibility of food borne diseases. However, the studies of University
School Resource Network of Jawaharlal Nehru University (USRN)40 acknowledged that
such situations have been very few and far between. Such incidences where cooked food
has been found with the problems of food borne diseases in overall implementation are rare
and this is an achievement for SHGs of the program. On the other hand, there are instances
particularly in the context of contractor-supplied rations in ICDS where packaged food was
of bad quality and was sometimes rotten.
A study conducted by the Department of Food Science and Technology, Jabalpur, on the
nutritious value of traditional food products like Kodo, Kutki, Ragi etc shows that it is rich in
calcium and fibre content and hence is used in the formulation of various weaning and
supplementary foods. These could be consumed as ready to eat food for various categories
of people like young children, pregnant women and old persons, as it is a cheap source of
good quality proteins and minerals. The study recommended that it could be
commercialized for ease of preparation at household or at commercial levels. This is what
exactly the SHG's have been doing through preparing Ready to Eat Energy Food from
traditional pulses and supplying them to the ICDS Centers. By bringing in privatization into
the whole system the government is misleading the people by saying that their food habits
are not upto the mark and devoid of nutritional component. With such circumstances
government is once again all set to repeat the stupidity committed by it in the 1960's, when it
had proclaimed that supplementary milk products like Lactogen and Nan were better than
breast milk for new born babies. However, it's now the established fact that breast milk is the
best for infants and now government is investing huge sums on campaigns to draw
attention of the people on this.
Utility of dry snacks or ready to eat energy food has been questioned. It is seen that
nutritious value of dry snacks is far lower compared to a cooked meal. A freshly cooked
meal offers a better range of nutrients while packaged food is costlier in terms of per rupee
nutrient yield. In both the cases of ICDS and MDM evidence suggests that children often
take the dry foods home and may or may not eat it later; also in the context of poverty, the
chances are that these gets shared with the family members often41. Cooked meal provides
general protection against hunger especially in drought-affected areas and districts with
poor levels of socio-economic development. Besides, children also learn to sit and eat
together often contributing to breaking barriers of caste and class.

40 & 41
Mita Deshpande, Rajib Dasgupta, Rama Baru And Aparna Mohanty, The Case For
Cooked Meals: Concerns Regarding The Proposed Policy Shifts in The Mid-day Meal And
ICDS Programs; Indian Pediatrics 2008 Volume 45:445 -449

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 6
Judicial Interventions in ICDS

6.1 Supreme Court Orders in ICDS

In April 2001, People's Union for Civil Liberties (PUCL, Rajasthan) submitted a writ petition
to the Supreme Court of India seeking enforcement of the right to food. The basic argument
is that the right to food is an aspect of the fundamental right to life enshrined in Article 21 of
the Indian Constitution. Indeed, the Supreme Court has made it clear that the right to life
should be interpreted as a right to Live with Dignity, which includes the right to food and
other basic necessities. The public interest litigation initiated by the PUCL petition is known
as PUCL vs. Union of India and Others, Writ Petition (Civil) 196 of 2001. The final
judgment is still awaited, but meanwhile, the Supreme Court has issued a series of interim
orders aimed at safeguarding various aspects of the right to food. The first major order,
dated 28 November 2001, directed the government to fully implement nine food-related
schemes (including ICDS) as per official guidelines. In effect, this order was converted into
the benefits of these schemes as legal entitlements. It also directed the government to
universalize the ICDS programme. It means every hamlet should have a functional
Anganwadi centre, and that ICDS services should be extended to every child under six,
every pregnant or nursing mother, and every adolescent girl.
The Court directives related to ICDS, however, received very little attention for several
years. Virtually no serious action was taken to implement them until April and October 2004,
meanwhile several hearings on ICDS were held in the Supreme Court and further orders
were issued. For instance, the Supreme Court explicitly directed the government to expand
the number of anganwadis from 6 lakhs to 14 lakhs, to ensure that every settlement is being
covered. The Supreme Court orders of April and October 2004 gave a wake-up call to the
government. As a result, universalization of ICDS was included in the National Common
Minimum Programme of the UPA government in May 2004. The National Advisory Council
submitted detailed recommendations for achieving Universalization with Quality in
October 2004, and simultaneous follow-up recommendations in February 2005. The
expenditure of the Central Government on ICDS was nearly doubled in the Union Budget
2005-06. However, there has been relatively little progress in terms of the situation on the
ground. The expansion of ICDS is quite slow, and in most states there is little evidence of
substantial quality improvement. This reflects the fact that Supreme Court orders and
budget allocations are not enough. Ultimately, what is required is a broad based movement
for the universalization of ICDS, involving not only the government but also the public at
large.
As per the Supreme Court recommendations, under the consolidated child development
program; the children under 6 years of age should be provided supplementary food on
regular basis and should be given 30 calories or 8 to 10 grams of food containing proteins.
But if the case is of malnourishment then the child should be given double amount of stated
meals. But on the ground especially in the tribal populated area this concern is ignored, as
supplying double amount of supplementary meals is not possible at the anganwadi

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because of low quantity supply from government itself where the increased demand has
not taken into consideration.
Apex Court has ordered the allocation of Rs. 2/-per child per day for supplementary
nutrition food, State government is allocating budget on the same lines but the interesting
point to be noted here is that there is no provision of extra budget for the transportation of
SNP. It means that the expenditure on transportation and fuel for the same are included in
the amount of Rs. 2/- per day per child, ultimately declining the per child expenditure on
food. The SC Commissioners have also tried to raise the issue of malnutrition and non-
compliance with the Court's orders in many letters to the State Government, but have
received no response. And the malnutrition deaths continue in the state.

6.2 Steps of High Court of Madhya Pradesh in ICDS

A petition was filed by Mr. Sachin Kumar Jain a member of Right to Food Campaign Support
group in November 2005 when the government of Madhya Pradesh was inviting big
contractors to supply nutritional food supplements and violating its own policies. Highlights
of the petition are as follows:
l The ground for petition was the order dated Oct 7th, 2004 of honorable Supreme
Court case 196/2001 which stated that contractors shall not be allowed for supply
of nutrition.
l Women and Child development department has invited sealed bids on 28-9-2005
from the eligible manufacturers/ producers for supply of Ready to Eat Energy food
(Supplementary nutrition food) to various ICDS projects in various districts of M.P.
l The petitioner had drawn the attention of the administration towards the guidelines
of the Hon'ble Supreme Court in his letter-dated 29.10.2005 and had requested to
immediately stop the process of tender notification.
6.2.1 Response of Administration
In the above case the State Administration answered that the scheme was earlier started by
the State Administration in the year 2003 where self-help groups supplied food. However,
administration experienced that supply by self-help groups was not proper and successful
and therefore it was decided by the Cabinet that self-help groups would supply food for 4
days and the manufacturers in all the districts would supply remaining 2 days food. It was
also decided that if the self-help groups would able to make proper supply then they would
given a chance for supplying food for all the days.

6.3 Orders of Supreme Court and Violation Continues

The Supreme Court directed on October 7th, 2004 that contractors shall not be used for
supply of nutrition in Anganwadis and preferably ICDS funds shall be spent by making use
of village communities, self-help groups and Mahila Mandals for buying of grains and
preparation of meals.
l Besides the above order of Supreme Court Women and child development
department involved manufacturers for the supply of supplementary nutrition food

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 for 3 days in a week in anganwadis of Gwalior district. The WCD of the district gave
contracts to the private suppliers via following letters-
l Letter Q-19/ WCD/SNF/06/484 DATED- 22-2-06
l Letter-Q-19/WCD/SNF/06/374 DATED- 10-2-06
l According to the contract by WCD dated 19 January 2006 with Anil industries
Indore for one year clearly mentioned the supply panjiri for 2 days and murmure for
2 days (i.e. 4 days in a week) in urban and rural projects of ICDS in Dewas district.
l In Ratlam district WCD department has made a contract with Ms. Anil industries,
Indore on 1-3-06 for supplying supplementary nutrition for 4 days in week in urban
areas of the District.
It is amply clear from the above facts that Court's order, whether it is Apex Court or High
Court, are not decisive enough to resurrect the whole system but a collective effort from civil
society is need of an hour for constantly pursuing the issue. The facet of accountability has
been constantly ignored. Although the Supreme Court has stated that, in the case of
starvation deaths and deaths due to malnutrition, the Chief Secretary of the concerned
State and the Collectors are to be held liable. But the order seems too remained on the
paper itself and not followed religiously in practice. It is high time that the order be complied
with. As a general trend it was observed that whenever there is death reported, each time,
lower level authorities like village level health worker or panchayat secretary are the first to
be blamed for and may suspended at times. But the higher-level officials like the District
Medical Officer, Collector etc, had never been held liable on the account. Such incidences
are repeated owing to no stringent action against the concerned authorities.
Not only this is the case of Madhya Pradesh but also almost all the states across the country
are facing more or less same deformity. Besides Madhya Pradesh, news about large-scale
disruptions is coming from Jharkhand and Uttar Pradesh. Organization named CARE used
to provide food to ICDS centres in large parts of Jharkhand, but the supply was abruptly
discontinued in year 2002 following a dispute between the governments of US and India
over the presence of genetically modified (GM) food in the supply. Failure to make reliable
and alternative arrangements by the Jharkhand government led to major set back in the
providing supplementary food to ICDS centres. In Uttar Pradesh food distribution to ICDS
centres is often held up for months together for trivial reasons such as the failure to sanction
tenders. But the most shocking part of the story is that none of this has led to furor, as
hungry children have no voices.

Box - 16 Supreme Court Orders on ICDS

Significant amount of public attention has been drawn to the ICDS in recent years. This is partly due to
interim orders passed by the Supreme Court in the 'right to food case', a writ petition currently pending
before the Supreme Court of India (Civil Writ Petition 196/2001, People's Union for Civil Liberties v. Union
of India and others). In this writ petition, the Supreme Court has taken the view that the denial of the 'right
to food' amounts to the denial of the fundamental 'right to life and personal liberty' enshrined in Article 21
of the Constitution of India. The ICDS has since been recognised as central to safeguarding the 'right to
food' of young children (up to six years of age), pregnant women, nursing mothers and adolescent girls.
The noteworthy orders are highlighted here.

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Order dated 28 November 2001
l Each child up to 6 years of age should get 300 calories and 8-10 grams of protein.
l Each adolescent girl to get 500 calories and 20-25 grams of protein.
l Each pregnant woman and each nursing mother to get 500 calories and 20- 25 grams of protein.
l Each malnourished child to get 600 calories and 16-20 grams of protein.
l Every settlement is to have a disbursement centre called anganwadi.
Order dated 29 April 2004
l All 0-6 year old children, adolescent girls, pregnant women and nursing mothers shall receive
supplementary nutrition for 300 days in the year.
Order dated 7 October 2004
l The number of anganwadis shall be increased from 6 to 14 lakh in the country.
l The minimum norm for the provision of supplementary nutrition should be increased to Rs. 2/- per
child per day.
l All sanctioned anganwadis shall be operationalize immediately.
l All SC/ST habitations shall have anganwadis as early as possible, and habitations with high SC/ST
populations should receive priority in the placement of new anganwadis.
l Earnest efforts should be made to cover all slums under ICDS.
l ICDS services should never be restricted to BPL families (BPL shall not be used as an eligibility
criterion for ICDS).
l Contractors shall not be used for the supply of supplementary nutrition.
l Local women's Self-Help Groups and Mahila Mandals should be encouraged to supply the
supplementary food distributed in Anganwadis. They can make purchases, prepare the food locally,
and supervise the distribution.
l The Central Government and States/UTs shall ensure that all amounts allocated are sanctioned in
time so that there is no disruption whatsoever in the feeding of children.
l ICDS funds provided by the Central Government under the Pradhan Mantri Gramodaya Yojana (PMGY)
should be fully utilised by the State Governments. Further these funds should supplement, and not
substitute for, ICDS funds provided by the State Governments.
l All State Governments/UTs shall put on their websites, full data for the ICDS programme including
where AWCs are operational, the number of beneficiaries category-wise, the funds allocated and
used, and other related matters.
Order dated 13 December 2006
This landmark judgment clearly orders the government to ensure "Universalization with Quality" in a time-
bound manner and further strengthen the entitlements of children under six.
l The universalisation of the ICDS involves extending all ICDS services (Supplementary nutrition,
growth monitoring, nutrition and health education, immunization, referral and pre-school education)
to every child under the age of six, all pregnant women and lactating mothers and all adolescent girls.
l All 14 lakh AWCs shall be sanctioned and operationalized in a phased and even manner starting
forthwith and ending December 2008. In doing so all SC/ST habitations must be identified on priority
basis.

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l Population norms for opening of AWCs must not be revised upward under any circumstances. While
maintaining the upper limit of one AWC per 1000 population, the minimum limit for opening of a new
AWC is a population of 300 may be kept in view. Further, rural communities and slum dwellers should
be entitled to an "Anganwadi on Demand" (not later than three months) from the date of demand in
cases where a settlement has at least 40 children under six but no anganwadi.
l The order also specifies the monetary allocation to be made per beneficiary under the ICDS scheme.
The court instructed all State Governments and Union Territories to fully implement the ICDS scheme
by, inter-alia-
v Allocating and spending at least Rs. 2/- per child per day for supplementary nutrition out of
which the Central Government shall contribute Rs. 1 per child per day.
v Allocating and spending at least Rs. 2.70 for every severely malnourished child per day for
supplementary nutrition out of which the Central Government shall contribute Rs. 1.35 per child
per day.
v Allocating and spending at least Rs. 2.30 for every pregnant woman, nursing
mother/adolescent girl per day for supplementary nutrition out of which the Central
Government shall contribute Rs. 1.15.
l Chief Secretaries of all State Governments/UTs are directed to submit affidavit-giving details of all the
habitations with a majority of SC/ST households, availability of AWCs in these habitations, and the
plan of action for ensuring that all these habitations have functioning AWCs within two years.
l Chief Secretaries of all State Governments/UTs are directed to submit affidavits giving details of the
steps that have been taken in regard to the order of this Court of October 7th, 2004 directing that
"contractors shall not be used for supply of nutrition in Anganwadis and preferably ICDS funds shall be
spent by making use of village communities, self-help groups and Mahila Mandals for buying of grains
and preparation of meals". Chief Secretaries of all State Governments/UTs must indicate a time-
frame within which the decentralization of the supply of SNP through local community shall be done.
Several of these orders are yet to be implemented in fully by the Central and State Governments. The most
significant amongst these are orders to ensure that all children from 0-6 years, pregnant and nursing
mothers and adolescent girls have access to ICDS services and further that all settlements, especially
SC/ST settlements have access to an anganwadi. (For further details see Supreme Court Orders on the
Right to Food: A Tool for Action, available from the secretariat of the right to food campaign.)

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 7
Budget Analysis of Supplementary Nutrition
Programme: A Deteriorating Condition

Infant mortality rate in MP is one of the highest in the country besides other states
like Orissa, Uttar Pradesh, Assam and Rajasthan. Incidence of infant mortality is
much higher in rural areas as compared to urban areas. Infant mortality; whether in
rural or urban areas of MP is much greater when compared to national level figures.

Table 27: Infant Mortality in MP - Far from comparison42

Total Rural Urban
MP 72 77 50
India 55 61 37

According to the figures given by Bal Sanjivani Abhiyan, Madhya Pradesh claimed that the
malnutrition has come down by 10-percentage point from 57.57 percent in 2001 to 47.50
percent in 2007. While number of malnourished children has reduced from 62.33 lakhs in
2001 to 38.96 lakhs in 2007. The details of Bal Sanjivani Abhyan are as follows:

43
Table 28: Status of Malnutrition in MP
Bal Sanjivani Units Number General Grade Grade II Grade Grade Total
Abhiyan of Grade I III IV Malnutrition-
Rounds Children Grade I to IV
Weighed

Round I Numbe 62.33 26.44 20.39 12.07 2.71 0.72 62.33

(2
nd th
to 9 rs (in
Lakh)
October 2001)
(Perce 42.43 32.72 19.36 4.34 1.15 57.57
ntage)
Round XII Numbe 85.60 45.90 39.21 4.82 39.69
th
(15 May to 15
th rs (in
June 2008) Lakh)
(Perce 53.63 45.81 .56 46.37
ntage)

7.1 Growth of Children in MP

The following table throws light on the comparative nutritional status of children in MP using
data for the few indicators as given by the NFHS rounds.

42
SRS Bulletin, VOLUME 43, NO. 1. Released in October 2008
43
Source: Administrative Report, Department of Women and Child, GoMP, 2007-08

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65
 It is amply clear from the above table that children in MP are faring only in one indicator. The
proportion of stunted children has reduced from 49 percent to 40 percent between the two
rounds of NFHS. Stunted growth is the reduced growth rate in human development. It is
primary manifestation of malnutrition in early childhood, including malnutrition during fetal
development brought on by the malnourished mother. Children who fall below the fifth
percentile of the reference population in height for age as defined as stunted, regardless of
the reasons.
Table No. 29: Growth indicators expressed as a percentage
On the other hand data
Stunted Wasted Underweight
emerges a contrasting
scenario where the NFHS-2 49 20 54
proportion of wasted
(measured in terms of NFHS-3 40 33 60
weight for height) and
underweight (measured in terms of weight for age) children has rather increased over a
previous NFHS figures. At present there are 33 percent children are wasted and around 60
percent children are underweight in MP according to NFHS-3. Adding to the worst the
proportion of children who are anemic in the age group 6-35 months has risen from 71.3
percent in NFHS-2 to the level of 82.6 percent in NFHS-3. The empirical evidences
unambiguously spelt out the deteriorating condition of the child nutrition in MP despite the
state government's make-believe estimates about malnutrition in the state.

7.2 The Coverage under Nutrition Programme

At present, in Madhya Pradesh, there are 367 Child Development Projects that are
sanctioned by GoI. Under these projects 69238 Anganwadi centres have been sanctioned.
Out of which through 67770 functional anaganwadi centres 'Supplementary Nutrition
Programme' is being currently implemented. The programme is serving around 53 lakhs
(53, 40,498) beneficiaries. This include 43, 90,624 children and 9, 49,874 pregnant and
nursing mothers. The statistics is given in administrative report for women and child
development department for the year 2007-08.

7.3 Universalization of ICDS : A Legal Obligation

Supreme Court in its order dated 29th April 2004, directed the government to Universalize
the ICDS the programme. Universalization of ICDS means every hamlet should have a
functional anganwadi, and that the full range of ICDS services should be extended to
every child under six, every pregnant or nursing mother and every adolescent girl.
Prior to Supreme Court's order also, ICDS was intended to serve all the sections of the
population with main focus on children under the age of 6 years in both urban-rural areas.
But even then Governments (State and Central Government) are directly or indirectly
pushing the BPL criterias to limit the coverage by ways and means. In this context Supreme
Court has clearly mentioned that no criteria should be used in ICDS and it should cover all
the children under age six in both rural and urban areas and not just the BPL children. Thus
all the malnourished children irrespective of caste, below poverty line status and whether in

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rural or urban area should be covered.

7.4 Resource Gap Analysis in the context of Universalization of ICDS

7.4.1 Required number of Anganwadi Centers
Projected population for Madhya Pradesh for 2007-08 is 68666478 that is around 6.87
Crore44. As per government norm one anganwadi centre should be opened per 400-800
population. Considering the maximum population of 800, there is a need of at least 85,833
anganwadi centers in MP. But going by the coverage figures given by WCD, GoMP, there is
a gap of around 19.33 percent between required and sanctioned one. The gap increase to
21.04 percent when taken into consideration the number of functional anganwadi centers.

Table No. 30: Gap between the required number of anganwadi centers and the sanctioned one

Required Number of 85833 Required Number of 85833

Anganwadi Centre Anganwadi Centre

Sanctioned 69238 Functional anganwadi 67770

anganwadi centers centers

Gap 16595 (19.33%) Gap 18063 (21.04%)

Hamlet-wise Number 127397 Hamlet-wise Number 127397

of anganwadi of anganwadi centers
centers45

Gap 58159 (45.00%) Gap 59627 (46.80%)

Going by Supreme Court's order for universalization of ICDS, there should be a functional
anganwadi centre in every hamlet. Numbers of hamlets in Madhya Pradesh are around
1.27 lakhs46. In that case MP should have 1.27 lakhs functional anganwadi centre in the
state. When compared with sanctioned number of anganwadi centers the gap is of 45
percent, which gets widen further to around 47 percent in comparison with number of
functional anganwadi centers.
7.4.2 A truth of beneficiaries covered
The projected population of children in age group 0-6 for Madhya Pradesh is 12081967,
that is 1.20 crore approximately47. The prevalent rate of malnutrition in the state, according
to 10th round of Bal Sanjivani Abhiyan is 47.5 percent. Going by this there are around 57.39
lakh (57, 38,934) children in the state are suffering from malnourishment. State government
44
Projected population for the state for 2007-08 has been calculated by applying growth
rate on the projected population figure of 2006 as provided by the Census of India.
45
As Supreme Court mentions it its orders that each hamlet should have anganwadi center.
46
Source: National Habitation Survey, GoI, 2003.
47
Projected population for the age group 0-6 for 2007-08 has been calculated on the basis of
2001 population and then by applying the growth rate provided by Census of India.

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67
is claiming that around 43.9 lakh children are covered through ICDS programmme. Using
above statistics it is amply clear that the government has actually reached only 76.51
percent malnourished children. Yet, around one fourth (around 23.5 percent) of the
malnourished children have not been covered or reached until 2007-08. Hence the
cases of child malnutrition flashing in the newspapers would not be a surprise then.
Around 24 lakh deliveries (both institutional and non-institutional) take place in Madhya
Pradesh every year. It means there are around 24 lakh pregnant women per year48. It is
considered that out of the total deliveries taken place by latest; approximately 33 percent
are the lactating mothers. Then in case of MP, there would be around 8 lakhs of lactating
mothers in a year. Thus taken together the population of pregnant women and nursing
mothers would be 32 lakhs per annum. However, as claimed by the WCD, GoMP, ICDS is
reaching out only 9.5 lakhs beneficiaries in this group. Thus the total coverage of
pregnant women and nursing mothers in MP is shameful to around 30 percent only.
Besides, the administrative report of Women and Child Development Department does not
talk about any coverage of adolescent girls in the age group 11-17, under ICDS, when they
are included in the beneficiary group. According to estimates of demographers, the
adolescent girl's population constitutes 10 percent of the total population. Thus ICDS
programme is out of reach of the roughly 64 lakh adolescent girls in the state, which
is a complete violation of Supreme Court's directions ordered four years back.
7.4.3 The Sorry State of Budget Allocation for Nutrition
Whatsoever is the government's allocation made for the nutrition has to be tested for the
adequacy. It should also be judged whether or not the budgetary allocations made are in the
tune with the guidelines given by Supreme Court. We have attempted to find answer to the
question posed above.
Considering that the expenditure incurred at an anganwadi is Rs 2 per child per day and in a
year around 300 days the supplementary nutrition is provided at the anaganwadi centre.
On the basis of per beneficiary expenditure and number of projected beneficiaries the
required budget allocation has been calculated in the following table.
7.4.4. Resource Gap Table No. 31: Resource Gap
for Nutrition in Targeted Numbers Current Shortfall in Required
Beneficiary (in Coverage the coverage budgetary
2007-08 Lakhs) allocation
(in Lakhs)
(in Rs Crore)
l The total budget- All the children 120.00 43.90 76.10 720.00
ary requirement in the age (63.41%)
group (0 -6)
exclusively for Expectant and 32.00 9.50 22.50 192.00
nutrition or food Lactating (70.31%)
Mothers
component only Adolescent 64.00 Nil 64.00 408.00
would be Rs 1320 Girls (100.00%)
crore for 2007-08. Total 220.00 53.4 166.60 1320.00

48
Calculated as per the population growth rate of Madhya Pradesh.

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68
l However, budgetary allocations made by the government for nutrition is Rs 320
crore in 2007-08. Out of which allocation for nutrition or food component is Rs
255.54 crore in 2007-08. Thus in its total budget government spending around 80
percent exclusively on the food component.
l Going by the present allocations it would fulfill only 19.35 percent or one fifth of the
nutritional requirement which a very miniscule proportion considering the severity
of the problem.
l Based on the revised estimates for 2007-08, government is actually ended up
spending Rs 212.89 crore on 53.40 lakh beneficiaries in the state. It means per
beneficiary expenditure comes to only Rs 1.33 per day in 2007-08 as against the
Supreme Court's order of spending at least Rs 2 per beneficiary per day.
l If we considered the total budgetary requirement inclusive of administrative cost
and other expenditure the figure turn out to be Rs 1650 crore for 2007-08 as
against the budget allocation of Rs 535 crore taking together the allocations made
under SNP and ICDS.
l It can be inferred from the analysis that the budget allocations for the nutrition
should be at least three times more than the present allocations, if the government
is serious about fighting and eradicating malnutrition from the state.

7.5 Response of the State Government through Budget Allocations

A detail of Government's investment on the nutrition is given in the following table. From the
budget heads Major Head 2236 titled Nutrition was selected. Further its Sub Major Head
[02] titled- Distribution of Nutritive food and liquid material and Minor Head {101}- Special
Nutrition Programme.

49
Table No. 32: Budget Allocations for Special Nutrition Programme (in '000 Rs)

Sr. No. Name of scheme 2005-06 BE 2006-07 BE 2007-08 BE

1 SNP- General 1350725 2167654 2195499
2 SNP- TSP 155800 340074 555000
3 SNP- SCP 240000 424889 450000
Total 1746525 2932617 3200499

It is evident from the table that the government's allocation on nutrition has been more than
doubled, (increased by 67.9 percent) from 2005-06 to 2006-07. But the rapidity of
increased proportion has declined drastically to miniscule of 9.1 percent from 2006-07 to
2007-08. Not only the state governments outreach is poor but also the budget allocation is
not the progressive one in the context of the severity of the problem. Perhaps that is the
reason why the malnutrition is more prevalent in the state. The startling feature of the
budget allocation is that there is slight increase in the allocations under SNP general

49
Source: Budget Books, Volume III, GoMP, for various years

Moribund ICDS
69
and SCP from 2006-07 to 2007-08. This trend would definitely have a repercussion on
the nutritional status of beneficiaries particularly, general population and scheduled
caste population in the rural areas, where the problem is most importunate.
Differently in case of SNP-TSP the allocations has sharply increased by 38.72 percent in
2007-08 over previous a year owing to the fact that more allocation is needed in tribal
dominated areas due to its less developed nature and high incidence of malnutrition. The
point to be noted over here is that this budget includes administrative expenditure as well as
the expenditure on nutrition and other components as well.

7.6 Budget Estimate and Actual Expenditure for SNP (Fig in '000 Rs)
The following table gives the details of actual expenditure incurred against the budget
allocation made for the nutrition in MP.

Table No. 33: Allocations for Supplementary Nutrition50 (figs in 000 Rs)
Sr. Name of 2005-06 2005-06 2006-07 2006-07 2007-08 2007-08
No. scheme/Activity BE Actual BE Actual BE RE
1 SNP- General 1350725 630632 2167654 1187356 2195499 2189729
2 SNP- TSP 155800 215293 340074 330447 555000 555000
3 SNP- SCP 240000 127042 424889 271029 450000 450000
Total 1746525 972967 2932617 1788832 3200499 3194729

7.7 Budget Utilization

The following chart elucidates the status of actual expenditure incurred by the state
government on SNP. The chart speaks about the performance of the state government on
the ground of efficiency with which government is utilizing the allocated money for the said
purpose. This angle needs to be explored in detail from the point of view that government
just can not skip of its responsibility by merely allocating the funds, but the actual utilization
of resources for the cause of public welfare is definitely a major issue of the accountability of
the state government towards its citizens.

Actual Expenditure on SNP as a Proportion of Budget Estimate

138.2

97.2

54.8 63.8 61.0

52.9 55.7
46.7

General TSP SCP Total

2005-06 2006-07

50
Source: Budget Books, Volume III, GoMP, for various years

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The above chart depicts a very disheartening picture of utilization of public funds. The
overall actual expenditure although has increased in 2006-07 over the previous year, its
utilization rate is very poor. The WCD department has been able to utilized only 61
percent of its budget allocation leading to exorbitant savings of around 40 percent in
2006-07. This has been very rightly pointed out by CAG report for Madhya Pradesh. Similar
trend is observed in case of budget utilization for the general category and the utilization for
dalit population. It is only the utilization for the tribal population showing at par budget
utilization on paper. Higher utilization in 2005-06 is due to increased budget in revised
estimates owing to supplementary budget. But the ground realities have many more
reasons to question the performance as discussed in detail in the previous chapters. It's a
total underutilization of the allocated funds indicating lack of efficiency of the concern
government functionaries to spend what was budgeted for and indicates their
insensitiveness towards the prime issue in the state.

7.8 ICDS in Budget Books

To locate ICDS sce in the budget books, one has to search for the Major Head 2235- titled
Social Security and Welfare with Sub Major Head [02]- Social Welfare, Minor Head {102}-
Child Welfare and then the Sub Head (658)-ICDS. Details of ICDS budgets are given in the
following table. It is evident from the table that the budget allocation for ICDS has increased
by almost 58 percent from Rs 104 crore in 2005-06 to Rs 253 crores in 2008-09. Budget
allocation for 2007-08 shows the highest annual increment of about 63.2 percent over the
previous year. Similarly, in the year 2006-07, both revised estimates and actual figures
shows tremendous increase over of 85.4 % and 116.4 % respectively over the previous year.
As far as budget allocation part is concerned over here the things are doing fine but the real
crunch is noticed when it comes to budget utilization. The performance in the budget
utilization is definitely on the lower side. There were unutilized funds to the tune of around 30
percent and 20 percent respectively in 2005-06 and 2006-07, although the utilization
proportion has increased in 2006-07 over the previous year. However, the work does not
really stopped here; the numerous reasons for the underutilization and the major defaulters
in the system needs to further investigated using both primary and secondary researchemh.
Interestingly, under the object head of the ICDS programme # 34- Material and supply a
fund of Rs 28 crore has been booked under the detail head 009- other expenditure in 2008-
09. While if one compared these heads with that of Nutrition, its 004- value of ration or
nutrition expenditure, with allocation Table No. 34: Budgets of ICDS (excluding nutritional component)
of around Rs 216 crore. Therefore Year Budget Estimates Revised Estimates Actual (AC)
question arises out here is that (BE) (RE)
whether it's a same nutritional 2005 -06 1048532 1065815 736131
2006 07 1322567 1976338 1593090
component of ICDS or the something
2007 -08 2158264 2371907
else? The fact needs to be corrected 2008 -09 2530617
before going for detailed analysis.
But the interesting part is that this amount does not take into account nutritional component.
Rather one has to search another major head 2236-titled Nutrition for identifying the
component of Supplementary Nutrition Programme.

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71
7.9 Latest addition
State government has launched another programme Project Shaktiman by the in 2007-
08. Main objective of the programme is to eradicate malnutrition completely among the
children of tribal dominated villages and other villages, as well as among the women.
Presently, 39 blocks of 19 districts have been chosen for the implementation of the
programme. On an average each anaganwadi centre provides nutrition of Rs 2 per child per
day. But under the programme Project Shaktiman, state government from its side providing
additional Rs 4, thus under the programme the expenditure on children would be Rs 6 per
child per day. The names of the districts are: Vidisha, Dhar, Jhabua, Khargone, Barwani,
Shadol, Anuppur, Umaria, Betul, Mandla, Dindori, Seoni, Balaghat, Sheopur, Shivpuri,
Ashoknagar, Hoshangabad, Harda and Chhindwara. Government has set the target of
reaching around 60,000 children. Although the programme has been launched in 2007-08,
the concomitant budget allocations were found only in the year 2008-09, indicating a year's
lag in actual programme implementation. Government has made allocation of Rs 16 crore
for Project Shaktiman.

7.10 Criticism by Comptroller and Auditor General (CAG)

CAG in its report for 2005-06 had scorn off openly at the WCD of Madhya Pradesh
government on poor implementation of ICDS while mentioning its observations. Some of
the CAG remarks are summarized as follows:
1) Impact of welfare schemes for women and child was marginal especially on the
health and nutritional status of children as more than 55 percent of children were
malnourished in the state.
2) Nutritional support could not be provided to eligible beneficiaries due to low budget
provisions.
3) Substantial and persistent savings were registered owing to poor budgetary and
expenditure control.
4) Large number of posts remaining vacant and improper manpower planning
affected implementation and monitoring of the scheme.
5) Due to inadequate budget provision and delay in the release of funds to districts
offices, 52 to 62 percent children and 46-59 percent expectant and nursing
mothers were remained deprived of the nutritional support.

Finally : It is the fact corroborated from the analysis once again that the pace of imple-
mentation of the nutrition programme is despicable, not only it can be overlooked as the
routine poor implementation but needs a thorough brainstorming. Government has failed in
preventing malnutrition deaths. The responsible agencies must be held accountable for the
shameful deeds for the sake of saving the children from the deadliest situation. There is a
complete violation of the Supreme Court's directions as far as beneficiaries covered and
the amount being spent per beneficiary. Even after the four years of Supreme Courts orders
the budget allocation are not proportionate to the needs of beneficiaries. One has to be very
clear their mind that this overwhelming situation has not spurted out in a day or two but is out
of sheer negligence that has been carried out in since the past.

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 8
Exceptions Are Always There

So long we have seen that the Integrated Child Development Scheme has always been the
sufferer of utter negligence even though ICDS is the only national programme to address
the health, nutrition and pre-school needs of children under six years. Though children
contributes about 15 % of the total population but still the rights of this most important
section of our society has always been neglected or under estimated whether it is in policies
or priorities of government and political leaders. This is perhaps because these young
children do not form the vote bank so as to facilitate politicians. But in spite of all these
adverse conditions, still there exist a hope that the very purpose of ICDS i.e. "to make the
childhood a healthy one for transforming into a strong, healthy and all round physically fit
younger generation" can be served to each and every child if the community participation is
ensured. The care of young children cannot be left to the family alone it is also a social
responsibility. Social intervention is required, both in the form of enabling parents to take
better care of their children at home, and in the form of direct provision of health, nutrition,
pre-school education and related services.
ICDS centers of Balaghat district and Khalwa block in Khandwa district of the State are
setting the example before every one that occurrence of malnutrition can be controlled
through proper implementation of ICDS scheme and most importantly by promoting
community participation thus proving that exceptions are always there.

8.1 Balaghat : A district paving its own way

Balaghat district of Madhya Pradesh is setting an example for other districts to tackle the
grass root problems with an innovative idea. The community of the district has attempted to
sort out the issues by their own. Now, the malnutrition is no more a problem here,
malnourished children have not to lose their life any more. Now the list of malnourished
children is displayed at panchayat bhavan; the panchayat and community take the
responsibility of saving as well as treatment of these children. Every malnourished child is
identified at time and referred to NRC for sure. To promote the use of traditional food
practices in such a manner that they fulfill are the nutritional requirements, Grain Kits are
displayed in Anganwadi Centers. Similarly, Maternity Kit is being promoted to make aware
women about health and hygiene.
All these initiatives taken by the people of Balaghat district are setting a modal for others
and showing a new light of hope. The community is not only taking the responsibility to
tackle the problem by their own but also making aware public leaders about the issues,
especially the malnutrition and making them to act on the same. These steps of the district
are no doubt setting as example, which must be replicated in other districts also. But the
probing question is that will the State Administration ever recognize the initiative of
Balaghat district?
Today even the most backward community residing in Balaghat district i.e. Baiga (which is
also one of the 3 Primitive Tribal Group (PTG) in the State) is also well aware of the benefits

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73
of vaccination, medicines and even institutional deliveries. The situation was not so
favorable in Balaghat a few years back but continuous efforts of the district and its people
make it possible.
Effort - 1
Sukwarobai Baiga from Baigatola of Gohra panchayat, which is 15 km far from Baihar block
of the district, had already lost four of her children and now she is expecting for the 5th time.
When Anganwadi worker and ANM tried to approach Sukwarobai for her immunization, she
use to escape in the near by forest at the moment. Not only Sukwaro bai but also most of the
women of the village were afraid of getting immunized and other health services. But due to
the regular efforts of AWW and ANM to aware Sukwaro bai as well as all the villagers about
the advantages of immunization and safe delivery, Sukwaro bai not only agreed to get
immunized but also went for institutional delivery. Her newly born baby also got all the
vaccinations on time and the result is healthy Sukwaro bai with healthy and YES alive baby!
Effort - 2
Similarly, the baigas of Karwahi panchayat use to affraid of and were far off the benefits of
vaccination, institutional deliveries and other health services. Due to this the percentage of
vaccination was about nil in the baigatola of karwahi panchayat but today about 98%
vaccinations is done in this region. It seems to be untrue but all this is due to the restless
efforts of Bansilaal Tilagaam, one of the panch along with Anganwadi worker of the village.
This is not only the story of the mentioned two villages but there are a number of villages in
Balaghat district, which are now well aware of the importance of health services. And the
peoples have adopted a participatory approach to plan for a better maternal & child health,
community health as well as vaccination programs.
Effort - 3
A health initiative named Integrated Nutrition and Health Project (INHP) was started in the
four blocks of Balaghat district by a local organization called Community Development
Center (CDC) with the help of CARE four years back. The ultimate aim of INHP program
was to bring qualitative changes in the health status of children and women. Director of
CDC Mr. Ameen Charles says that starting this project in Balaghat district was not an easy
task because the district is a tribal populated area, which is far from the main stream of
development. But still we accepted the challenge. The first task done by CDC was
organizing orientation programs for Anganwadi workers so as to strengthen them, says
Ameen. Besides this, the community was also being sensitized and mobilized about the
health services and their benefits using banners, posters, short plays, hamlet meetings etc.
The Government departments of WCD and Health plays important role in this project and
because there is no co-ordination between these departments so the task becomes further
challenging. Sometimes Anganwadi workers were performing well but were not getting the
support of health workers due to which the health services and vaccination program were
not functioning properly at village level. These situations make the task more challenging.
The CDC members first of all tried and assured the presence of health workers in the sector
meetings of anganwadi workers and vice-versa. This result was worth and meetings

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74
resulted in creating a co-ordination between the two departments at grassroot level and at
the same time the difficulties as well as needs related to the health status of villages were
well identified. The efforts of INHP can be analyzed by the fact that there is a remarkable
decrease in the level of malnutrition in Balaghat.
Mamta, one of the members of CDC told that previously the occurrence of malnutrition
among children was high in the district and consequently the rate of child mortality was also
high. Therefore, they (CDC team members) focused the issue of malnutrition and
organized special workshops for Anganwadi workers (AWW) to tackle the problem.
Anganwadi workers were told that the locally available food stuffs are sufficiently rich in
protein, iron and fats and thus their nutritious value is also good, the only thing is the right
utilization or consuming practices of these food stuffs. The hurdle before AWW was how to
each the villagers about the right consuming practice of locally available foodstuffs. Making
Nutritious Food Kit locally known as Anaj Kit then solved this problem. The kit contains
samples of rice, maize, pulses (urad & tuar), gram, groundnut, murmure along with jaggery
and oil. The kit was displayed in each Anganwadi Center and it really worked in teaching
mothers as well as the community how and what to feed a malnourished child.
Effort - 4
According to health workers along with malnutrition deaths of kids the district was also
facing the problem of maternal health. The rate of deaths of pregnant women was also quite
noticeable in the district. So they started the counseling of pregnant women and told them
about the advantages of institutional deliveries and disadvantages of home deliveries.
Women were also told that if (in any case) home delivery is the only choice than one should
take the help of trained dais (midwives). All the pregnant women were made to learn to
make a Health Kit containing a fresh reel of thread, a fresh piece of cloth, soap, iron tablets
and a new blade on every Mangal Diwas of Anganwadi Center. Also, all the expecting
mothers were made to take oath on every Mangal Diwas that they will go for institutional
deliveries anyhow and if in any case it is not possible than they will use the Health Kit during
their deliveries.
Effort - 5
Anganwadi worker Vimla Meshram told that previously women use to dispose off the iron
and folic acid tablets given to them but now they not only take the tablets timely but also
promote their neighboring women to take the tablets regularly. In Madhya Pradesh
probably Balaghat is the only district where Anganwadi workers are having there uniform.
Here AWW are having a special status in the society, they are given respect and get proper
support of community. Anganwadi Centers of the district are being developed as a Child
Right's Center and the attendance of children in the Centers is also satisfactory.
Effort - 6
The process of innovative steps to tackle grassroot problems like malnutrition does not halt
here, says project coordinator Mr. Satish Jain. We tried that the list of malnourished children
get displayed at panchayat bhavans and the panchayat should take the responsibilities of
these children. Though we have to face a lot of difficulties in starting but the regular efforts

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75
and discussions with panchayat members made it possible and slowly & gradually
panchayats also showed interest in the process and started to take the responsibilities of
malnourished children. Along with panchayat leaders, parents/mothers committee was
also sensitized about the issue. And now the list of malnourished children is displayed at
panchayat bhavans. Now every malnourished child is the responsibility of the panchayat as
well as community groups and they are ready to take all the possible stands to save the
children life. Sarpanch of Boda panchayat Smt. Seema Meshram has invested money from
her pockets to arrange milk and nutritious food for underweight children so as to bring them
to normal grades.
The communities are also aware of severe malnutrition and its consequences and are
promoted to take the severely malnourished children to NRCs.
Effort - 7
Nirmala Uike, the Anganwadi worker of village Chhinditola says that previously we find it
quite difficult to work as an Anganwadi worker and to convince people to send their children
as well as get associated with Anganwadi Centers. Also, we were not getting the proper
support of health department but now there are no such difficulties. The coordination
between WCD and Health Departments has made the things better and now we are having
an identity and respect in society, we have a special uniform also. Now the women are
conscious about their health and health facilities. The practice of breastfeeding to newly
born child within half an hour of birth as well up to 2 years has also increased in the district.
On one hand when all across the State the issues of children deaths due to malnutrition are
continuously being encountered at the same time the joint efforts of CDC and CARE have
made it possible in Balaghat district to reduce the death tolls due to malnutrition. The INHP
program has made the community conscious about the grassroot issues and a participatory
approach has been developed among the community. The result of these efforts is that the
level of malnutrition deaths in the district has decreased by 6 percents in last 2 years. All
these efforts being practiced in Balaghat district have proved that if there is a will there is a
way. The district has set an example that with a little attention and a proper coordination
between the related departments any problem, even the huge malnutrition problem, can be
handled with an ease. Now the point is whether our State administration will ever give
attention to the brilliant attempt of Balaghat district so that it can be replicated in other
districts also or not!

8.2 Mai's local initiative for Child Protection in Khandwa :

Effort - 8
Fokatpura tribal habitation of Khalwa. Almost all the children of this tribal hamlet visit
Anganwadi regularly they comethey play. they learn.Shantabai is not a next of kin
of these 74 children but she is known as "Mai" of these children. Four severely
malnourished children were brought out of severity in this hamlet. For past one and half
years none of the children here succumbed to death. Here this miracle was possible with
the locally grown corn porridge and nutritional supplements made of groundnuts has

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brightened the health of the children. What transformation can happen in children's lives by
sheer committed efforts of a tribal woman in her village; this amazing truth is revealed in
Fokatpura hamlet of Khalwa Block.
For past five yeas or more cases of serial deaths of smaller children due to malnutrition and
infectious diseases have been recorded in this Korku tribe dominated Khalwa Block During
this time in May 2007, unschooled Shantabai started an Anganwadi voluntarily at her
doorsteps braving all needs, adversity and deprivations. Dozens of underfives in
Shantabai's neighborhood were unable to reach the existing Anganwadi as it was more
than a kilometer away and the children had to cross the highway bisecting the hamlet and
the main village. Despite 74 children so prevented there was no Anganwadi center in this
hamlet and Spandan's survey had identified 34 children to be malnourished with 4 of them
being severe. In a way the Fokatpura initiative at child protection lacked an institutional
effort. The situation demanded a new Anganwadi Center at Fokatpura that was not being
heeded to. On 13th December 2006 Supreme Court in the case People's Union for Civil
Liberty (PUCL) versus UOI & others directed that Anganwadis be started on demand within
three months in those settlements (especially Dalit and Tribal hamlets) where children for
some reason or other are unable to reach the existing center.
Spandan based on its survey and the said Supreme Court order demanded a new
Anganwadi. At this time not waiting for the formal sanction, Shantabai and her husband
started the Anganwadi at her home. As a matter of fact the Anganwadis in the state are seen
merely as a formal and loose structure and the community and society view them as
centers run as distribution of Dalia for the poor and disadvantaged children. But Shantabai
has changed this perception of Anganwadi in past one and half year. When Spandan
surveyed the children it was sure that the Administrative process will take time for this
Anganwadi to begin. She would gather the children, ask her school going daughter to keep
the children busy with songs and games. To encourage Shantabai's initiative, Spandan
provided her a token support for some time. Shantabai dedicated more than half of her
small house for the center, as she believed the situation of children in a small closed room
would be like chickens in cage. Her family grows corn and groundnuts in their 3 acres land.
They used part of this production for supplementary nutrition for children. The government
of Madhya Pradesh has been continuously advocating the supply of supplementary
nutrition in a centralized manner and through contractors despite Supreme Court's
directives in 2004 that contractors or any company will not supply supplementary nutrition
neither the supply will be centralized. Then the Mahila Mandals and Self Help Groups were
assigned this responsibility. But the government of MP through an affidavit in the High Court
tried to prove that these community based groups are incompetent in campaign against
malnutrition and persisted with the centralized supply. It needs to be mentioned that
companies prepare some supplementary nutrition at a place that is supplied to various
places across the state.
In this system not only delays in supply were recorded but in many tribal pockets it was not
used for being not according to the traditional food habits and in many places pests were
found strolling in them. The frequent changes in nutritional policy by the state could not let a
systematic process be established. Then in 2007 it was decided that Matra Sahyogini

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Samiti (that has village women and the worker) will look after this system but in 2008 they
were declared indulged in corruption. In such a scenario where the community
understanding of nutrition is not believed upon, Shantabai presented an example of
arresting malnutrition through corn and groundnuts. The Administrative processes and the
norms for selection of an Anganwadi worker delimit the role of the community. Shantabai
though initiated a process but she could not become an Anganwadi worker or helper, as she
is unschooled. But she has no regrets, she just want to see children living graciously. The
Anganwadi center at her home has been operating since past one and a half year but she
has not been paid any rent. She still does not cry over but says for the initial six months
DWCD did not provide any nutritional supplements and she fed the children from her field's
corn and groundnuts; she did not receive any reimbursement of the same either. She
herself fetches the drinking water. On this Shantabai says: "we shouldn't expect our daily
bread from someone else." The children should get home food and not the shop food for
those alone ticks the life. How long the government will feed the Company Foods.
In most parts of the country Anganwadi Center means Dalia Distribution Centers but here
Shanta Bai's daughter Sumitra manages the pre school education. Not a single day passes
by when the hamlet is not echoed with the chorus of Sumitra Didi and those 70 children and
here there is no need to gather children; it is "Life Development Home" for them. Sumitra is
a full time voluntary worker here. This family has become a pillar. ShantaBai's husband
Bihari too is involved in this effort without any expectations. Bihari Bhai says: "Till the
Department wants they can run Anganwadi at our home and when they need a place to
construct the Center we will provide our land even. Children's love is our greatest property
we are not interested in wealth".
When we view this initiative in present context the greatest need seems to be that the
community wisdom and role in their effort at protecting the child rights should be respected
and not rejected. Even the UNICEF and the WHO in their joint statement has stressed that
the permanent solution to malnutrition problem can be sought only by promoting
community systems and Shanta Bai's efforts seems to be justifying this thought.

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 9
Strategies for Children under Six

A - Comprehensive Strategies51
Children under six years of age need good nutrition, education and care in order to meet
their full potential of health, well being and capacity for the rest of their lives. However,
children under six (particularly those under two) and their needs rarely get any recognition
in policies, programmes and budgets. Their feeding, development and care is assumed to
be the responsibility only of the family.
Children are the future of society, and society has the responsibility for ensuring that they
are given adequate and appropriate care. The only government programme that addresses
the rights and needs of this age group is the Integrated Child Development Services
(ICDS). However, the coverage of ICDS is quite limited, and the quality of the programme is
also quite poor. Universalisation with quality is urgently required to protect the
fundamental rights of children under the age of six.
The policy and programmes of the 'restructured' ICDS programme that is supposed to meet
the nutritional, health, learning and development needs of children below six years of age,
are in the process of being finalized. Any policy on Early Childhood Care and Development
should focus on providing holistic and comprehensive care for children under six, and
contain the following essential components:
l A system of food entitlements, ensuring that every child receives adequate food,
not only in terms of quantity but also in terms of quality, diversity and acceptability.
The food should be locally procured and produced by village communities,
womens SHGs, mahila mandals or the most appropriate decentralised village
forum.
l A system of child care that supplements care by the family and empowers
women. Such care needs to also address their learning needs and must be
provided by informed, interested adult carers, with appropriate infrastructure.
l A system of health care that provides prompt locally available care for common
but life threatening illnesses. Such a system needs to address both prevention and
management of malnutrition and disease.
Further early child care programmes should cater to the needs of the children of different
age groups with different strategies. The three crucial age groups are:
l children 0-6 months of age the period of recommended exclusive breastfeeding,
l children 6 months to 3 years until entry into pre-school, and
l children 3 years to 6 years the pre-school years, until entry into school.
51
It is a part of the paper on strategies for the children under six prepared by the working group on
children's right to food on the request of Planning Commission of India in the year 2007.

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Based on this framework, the following are the ten essential interventions required to be put
in place:
1. Universalised Maternity Entitlements
Women need adequate nutrition and care, including health care, during pregnancy, after
delivery and when they breastfeed. They need skilled counselling and support to begin
breastfeeding within the first hour. During the six months of exclusive breastfeeding, they
need to stay close to their children, at the risk of losing their wages. Therefore it is necessary
to have maternity entitlements that include:
l Compensation for staying home to breastfeed the very young child at the risk of
losing wages or affecting their economic status, on the lines of the Dr.
Muthulakshmi Reddy Maternity Benefit Scheme in Tamil Nadu, where women are
given cash support of Rs 1,000 per month for six months starting from the 7th
month of pregnancy, for care during pregnancy and after delivery.
l Adequate nutrition during pregnancy and lactation, including good quality
supplementary nutrition for pregnant and lactating mothers through the ICDS.
l Adequate access to quality health care services.
l Adequate access to skilled counselling and support for early initiation of
breastfeeding and exclusive breastfeeding.
2. Exclusive Breastfeeding for children up to six months
ICDS and the Health System should mainstream providing skilled counseling and support
for women to practice exclusive breastfeeding for six months through adequate training of
frontline workers such as ASHA, anganwadi workers and ANMs. Mitanins in Chhattisgarh
have shown the way.
3. Skilled Counselling and nutritional support for children under three
Children require solid foods that are calorie-dense, including fats, after six months of age
(complementary feeding). Nutritious and carefully designed take-home rations (THR)
based on locally procured food should be provided as supplementary nutrition for children
in this age group. Currently THRs are in the form of just grain this is inadequate.
Also, THRs must be combined with nutrition counselling and nutrition and health education
sessions for mothers and family members to ensure that children of this age group are
given appropriate and adequate foods at home. Further, skilled counselling is also required
to educate the family on the psycho-social and learning needs of the child.
4. Pre-school and hot, cooked meals for all children in the age group of 3 years
6 years
Pre-school education is very significant in helping children to prepare for formal schooling.
Pre-school education assists children both to enter school and to remain in the system. The
ICDS must provide a centre-based play-school facility at the anganwadi with the worked
trained in conducting preschool activities.

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For these children a culturally acceptable, varied, adequate, energy meal that has multiple
nutrients including micronutrients like Vitamin A and Zinc must be provided at the
anganwadi centre. A hot cooked meal provided at a centre also has many benefits as it:
l serves as an incentive for regular attendance,
l promotes social equity,
l provides income support to poor households,
l acts as a form of nutrition education,
l tackles hunger and can contributes all nutrients required,
5. Day Care Centres or Crches
Women across the country work long hours at paid and unpaid work, often starting to work
very soon after delivery. They need support to provide adequate care and attention to their
children. They need safe places or crches, close to their work sites, run by trained workers,
where they can keep their infants, and where their older children will receive hot cooked
meals and health care.
Crches must be designed to meet the varying needs of children of different age groups.
Infants 0-6 months need to be breastfeed on demand. Children 6 months - 3 years of age
5-6 times small but nutritious and energy dense meals a day. Children 3-6 years of age
need 3-4 small but nutritious meals a day. All these children also require organized play and
learning in areas that are safe, to help them develop adequate motor and learning skills
appropriate to their age, acquire concepts, language, habits and develop relationships with
peers and adults.
To begin with a model of anganwadi-cum-crches can be introduced to provide this service
in the village. This would be mean that these centres are open full-time, with adequate staff,
training and infrastructure. Existing crche schemes such as the Rajiv Gandhi Crche
Scheme and provision for crches under the NREGA must also be expanded and
strengthened.
6. Second Anganwadi Worker for ICDS Centres
Adequate care of children under three, which includes skilled counselling on breastfeeding,
nutrition and learning needs, combined with effective preschool education for children aged
3-6 years cannot be achieved without the involvement of two Anganwadi workers (along
with the Anganwadi helper). The availability of at least two anganwadi workers at each
anganwadi centre would make it possible for one of them to concentrate on providing the
home-based services, while the other can provide centre-based activities such as pre-
school. The helper would have a role to play in bringing the children, cooking and serving
and keeping the centre clean.
7. Convergence between Health and WCD Department at all levels including
provisioning of basic Health Care Services including Nutritional
Rehabilitation Centres for highly malnourished children
Regular interventions like health screening and referral, growth monitoring, immunisation
and de-worming must be carried out by the ICDS and health department together.

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There are several factors that affect the nutritional status of children, including food and
health factors Tackling malnutrition effectively will require that the health department and
the ICDS work together at all levels. The ASHA programme offers great opportunities for
convergence provided:
l ANMs / AWWs and ASHA to be trained and mentored together on tackling
malnutrition.
l Nutrition Rehabilitation Centres located at PHCs should be the focal point of
dealing with severe malnutrition.
l Block and District level Health, RCH and WCD officials should routinely monitor
malnutrition together.
8. Investing in the ICDS workforce through training and capacity building
The training programmes should recognise pre-school education and nutrition counselling
as essential components. Within the overall framework, training curriculum, material and
approaches should be developed in a decentralised manner, to be appropriate to the
specific state/district level. Anganwadi Training Centres should be allocated for capacity
building in a specific region at the District or Sub-District level. A system for continuous field
level support should be developed (for instance, identifying a relatively accessible
Anganwadi centre and developing it as a local resource centre, where the supervisor/
trainer can facilitate peer learning through monthly cluster-level meetings).
9. Building a comprehensive monitoring and evaluation system
A more robust, regular and independent monitoring and evaluation system, where workers
are not forced to under-report malnutrition. As things stand, the most reliable source of
information on child nutrition is the National Family Health Survey (NFHS). However, the
NFHS surveys have been conducted at intervals of 6-7 years. Further, these surveys are
too small to produce nutrition indicators at lower levels of aggregation than the State level
(e.g. the District level). Ideally, NFHS-type surveys should be conducted every five years on
a scale that would allow the estimation of District-level health and nutrition indicators, and
every year on a smaller scale. At the very least, national NFHS-type surveys should be
conducted at intervals no larger than three years. Expert scrutiny of this issue is urgently
required.
A high-level overseeing mechanism should be created which will serve as a strategic
oversight, technical support and ensure convergence and accountability in the range of
interventions concerned with child nutrition.
10. Improving governance and involving communities
Decentralisation is the key to reducing corruption. A decentralized approach is required,
fostering participatory planning, community ownership, responsiveness to local
circumstances, and the involvement of Panchayati Raj Institutions (PRIs).Key decisions,
including decisions on recruitment and transfers should be taken locally. Procurement of
food should be done at the village level without private contractors, as the Supreme Court

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has ordered. Medicine kits and Pre-School Kits should be procured locally. Monitoring and
evaluation should also be carried out at the block and district level with the active
involvement of PRIs.

B - Strategies for the treatment of SAM

An Open letter to Policy Makers
We would like to share with you our position and concerns in relation to the strategies for
addressing the issue of Severe Acute Malnutrition (SAM). Millions of young children in
Madhya Pradesh are facing the prospects of lifelong disadvantages or even death in some
cases, due to severe acute malnutrition. We therefore understand the urgency of the
situation and the need for the government to respond to this at the earliest.
We would like to begin with saying that we agree that there is a need for a High Energy
Therapeutic Food (which can also be in the form of RUTF) for the treatment of Severely
Malnourished Children and this should be provided in required quantities to all SAM
children. At the same time, it must be understood that the high energy therapeutic food or
RUTF is just one of the components of a treatment protocol for SAM, which includes among
other things early identification, treatment of infections and so on. Further, we also feel that
it is critical to place SAM in broader context of prevention and management of all forms of
malnutrition among children under 6.
The following are some of our specific concerns and comments on the strategies to address
severe acute malnutrition in the state:
1. Local Production and No to commercialization of RUTF:
While accepting the need for a therapeutic food for the treatment for SAM we feel that
principles of diversity (respecting cultural acceptability among different communities) and
decentralization must be adhered to, while designing the RUTF that is to be used as part of
the treatment protocol. The group working of children's right to food is in favor of local and
decentralized production of RUTF and is against the entry of any kind of commercial
interests, including through indirect processes or sub-contracting, into the production and
distribution of RUTF.
To begin with, we suggest that a unit for production of therapeutic food for the treatment of
SAM should be set up under a public sector undertaking or institution like the SANCHI
Cooperative Group in the state.
You may also be aware that National Institute of Nutrition (NIN) is the apex body to provide
knowledge and guidance on this issue. We suggest that the services of NIN should be
sought by the state government for help in finalizing recipes and production processes for
RUTF.
A system of using milk based F75 / F100 while at the NRCs and decentralized ready mixes
for community management can be developed. SAM children with complications need to
be provided proper institution (Nutritional Rehabilitation Centers and Primary Health

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Centers) based services, while the uncomplicated cases can be treated in the community
with support from the ICDS.
2. Need for a comprehensive package:
As mentioned earlier we strongly believe that the use of RUTF in isolation is not enough to
reach the goal of elimination of malnutrition or even SAM from Madhya Pradesh. Our
experience of studying the impact of RUTF in Khandwa district showed that a strong system
of follow-up and monitoring is absolutely essential. While we understand that the response
in Khandwa was to an emergency situation and therefore some important aspects could
have been neglected, as part of a long term strategy we need to establish clear protocols for
the treatment of SAM, including the use of RUTF.
Further, while once a child enters the category of SAM he/she needs to undergo the
treatment protocol; we must also understand that the very reason for the child becoming
severely malnourished is an outcome of socio-economic imbalance and chronic hunger.
Since we are not addressing this situation, after the treatment the child will go back to the
same conditions of access to food and is likely to become malnourished again. The other
children in the family are also vulnerable. The group therefore feels that, while working on
the treatment protocols for SAM children, the affected families should be given protection
through food and employment entitlement based schemes (like AAY, NREGS, Social
Security Pension etc.). Our analysis shows that having a social security net is a
fundamental requirement to address malnutrition.
Similarly, the treatment protocol for SAM must identify promotion of breastfeeding up to two
years of age as one of the non-negotiable components. The linkages of malnutrition with
low breastfeeding are quite visible. In Madhya Pradesh also, malnutrition rises once the
cycle of breast feeding is broken. While support must be provided for exclusive breast
feeding for the children under the age of 6 months, those in the age group between 6-36
months should be provided with locally made and culturally accepted nutrition in the form of
take home rations. Children in the 3 to 6 years age group can be provided hot cooked meals
in the anganwadi centre.
In our view malnutrition is a complex problem, and therefore demands complex solutions as
well. The strategy for prevention and management of malnutrition must also address issues
such as access to quality institutional services, capacities of personnel (like ANM, AWW,
MPW, ASHA etc.), quality of services, accountability, community participation, nutrition
counseling and so on. The clinical treatment and nutritional care for SAM children will be a
critical component of this larger framework and cannot be addressed in isolation.
3. Convergence and Responsibilities:
A system needs to be put in place at 3 levels:
1) Community for early identification and referral to medical institution
2) Nutrition Rehabilitation Centres once children are identified and brought to the
institution
3) ICDS or in the community again for follow up of the treatment protocol.

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The systems of co-ordination between the network of NRCs and ICDS centers need to be
operationalised. It must be ensured the victims themselves are not blamed for failure in
treatment, with arguments mothers of or parents of the child don't want to get their child
treated, They themselves go back to home, what government can do? Any treatment
strategy must be sensitive to the the limitations of the deprived families.
The Women and Child Development and the Health Department must co-ordinate in the
treatment of SAM children. The health department has the responsibility of not only treating
children with SAM in the institutions but their community outreach workers such as ANMs
and ASHAs must be involved in the counseling and other processes taking place in the
community. On the other hand the capacities of the ICDS needs to be built so that they can
identify SAM children, ensure timely referral, counsel the families and are able to ensure
the rehabilitation of children in the community after the treatment phase.
4. RUTF vs. RUF:
We are also concerned about RUTF being converted into RUF. While making the guidelines
and protocol, we hope the state government will also take necessary steps to prevent this
possible conversion. The department should clearly state in its nutrition policy that the
provision of supplementary nutrition in anganwadis will be in line with the orders of the
Supreme Court i.e. providing hot cooked meals for children in the 3 to 6 years age group
and locally produced take home rations for younger children. As directed by the Court
SHGs, community groups, Mahila Mandals etc. may be involved in this process.
We would like to conclude by reiterating that we believe that severe acute malnutrition is a
serious concern in our state and the government must urgently set up systems to address
this problem. In doing so it must be kept in mind that any strategy for the treatment of SAM
must be within the larger framework of prevention and management of malnutrition for all
children and ensuring health, nutrition and education services for all children under six.
Further, while there is indeed a need for a therapeutic food for the treatment of SAM, this is
only one of the components of the treatment protocol. Attempts must be made to provide
therapeutic food (could be in the form of RUTF) which is produced within the state at as
decentralized a manner as possible, which is free from the interference of any commercial
interests. For this we recommend involving co-operative groups that are already in
existence in the state. We do hope that these concerns are kept in mind while finalizing any
strategy for SAM in the state.

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 Annexure - I
Table showing number of sanctioned and
posted ICDS officials in 48 districts of the State

Total Child Development Assistant Child Supervisor Average

Angan- Project Officer Development AWC
wadi (Source - Latest Project Officer per
centers MPR/Jan. 2009) (ACDPO) CDPO
(Source - Latest
MPR/Jan. 2009)

Sr.
Districts Sectioned Posted Sanctioned Posted Sanctioned Posted
No.

1 BETUL 2002 12 10 4 2 82 79 167

2 BHOPAL 1578 7 7 3 4 65 65 225
3 HARDA 493 4 4 0 0 19 19 123
4 HOSHANGABAD 1239 9 7 1 1 46 46 138
5 RAISEN 1139 7 6 2 2 46 53 163
6 RAJGARH 1335 6 5 2 0 55 45 223
7 SEHORE 1104 6 6 1 1 45 48 184
8 VIDHISHA 1320 8 7 0 0 53 51 165
9 ASHOKNAGAR 747 5 3 0 0 30 18 149
10 BHIND 1750 7 3 4 1 58 45 250
11 DATIA 671 4 2 1 0 23 19 168
12 GUNA 1011 6 4 0 0 42 32 169
13 GWALIOR 1178 7 5 0 0 49 50 168
14 MORENA 1894 8 3 5 3 78 56 237
15 SHIVPURI 1501 9 7 1 0 60 51 167
16 SHOEPUR 894 3 2 0 0 36 19 298
17 BARWANI 1404 7 7 3 1 58 58 201
18 BURHANPUR 721 3 3 1 0 29 24 240
19 DHAR 2929 14 12 6 1 119 116 209
20 INDORE 1415 8 8 2 1 59 59 177
21 JHABUA 2541 12 7 4 2 102 96 212
22 KHANDWA 1392 8 7 5 2 56 56 174
23 KHARGONE 1837 10 9 7 0 75 75 184
24 BALAGHAT 2045 11 10 3 0 81 81 186
25 CHINDWARA 2486 11 8 4 0 99 102 226
26 DINDORI 1518 7 5 4 0 63 64 217
27 JABALPUR 1808 10 10 0 0 75 75 181
28 KATNI 1212 7 7 2 2 48 47 173
29 MANDLA 1778 9 9 6 3 73 75 198
30 NARSINGHPUR 913 6 5 0 1 38 39 152

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 Total Child Development Assistant Child Supervisor Average
Angan- Project Officer Development AWC
wadi (Source - Latest Project Officer per
centers MPR/2008) (ACDPO) CDPO
(Source - Latest
MPR/2008)

Sr.
Districts Sectioned Posted Sanctioned Posted Sanctioned Posted
No.

31 SEONI 1718 9 9 7 6 70 72 191

32 ANOOPPUR 1007 4 4 7 1 47 47 252
33 REWA 2154 10 8 3 2 89 83 215
34 SATNA 1845 9 7 4 0 25 15 205
35 SHAHDOL 1192 6 5 4 2 48 48 199
36 SIDHI 2628 9 5 3 1 95 66 292
37 UMARIA 643 3 3 3 1 25 20 214
38 CHHATARPUR 1480 9 7 0 0 61 59 164
39 DAMOH 1057 8 7 2 1 43 46 132
40 PANNA 941 6 6 1 0 39 33 157
41 SAGAR 2007 13 7 0 0 84 84 154
42 TIKAMGARH 1218 7 3 1 2 50 42 174
43 DEWAS 1306 7 6 4 0 52 51 187
44 MANDSAUR 1125 6 4 2 0 42 24 188
45 NEEMUCH 715 4 1 0 0 29 16 179
46 RATLAM 1600 8 5 2 2 66 62 200
47 SHAJAPUR 1233 8 6 0 0 50 49 154
48 UJJAIN 1514 9 9 1 1 61 58 168

Total 69238 366 290 115 46 2738 2538 189

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 Annexure - II
Revised Nutritional and Feeding norms for
Supplementary Nutrition in ICDS scheme

Prioritizing the nutritional needs of children (0 to 6 years) which comprise 16 percent

population of the country, new norms have been released by Ministry of Women & Child
Development in February 2009 to all the States/UTs laying down the new nutritional feeding
norms for supplementary nutrition provided under ICDS.
The guidelines are trend setting but still there are some aspects which compel to think on
the government's intention. On one hand the budget has been doubled and on the other
hand the government has given a due recognition to the feeding habits of children under 2
years of age. The guidelines call for takeaway home rations (THR). It is clearly notified that
the complementary food to children under three must be in a form that is palatable to the
child and cannot be consumed by the entire family. The guide lines also emphasize the
importance of hygiene, immunization and spreading the significant message of
breastfeeding within one hour of birth.
The major thrusts have been given to following points in the revised guidelines
l Universalizing the ICDS scheme and priority must be given to the
villages/habitations pre-dominantly inhabited by SC/ST/Minority community.
l Under the ICDS scheme, it must be ensured that the nutritional gap is effectively
bridged and all children and women in the target group are brought under its
coverage.
l Revising the existing cost of supplementary nutrition provided to children and
women under ICDS scheme.
No doubt the revised guidelines are beneficial and are made keeping in focus the target
groups (children and women) BUT at the same time there are some noteworthy
loopholes in it which can not be passed up.
Financial Norms : The Government of India has revised the existing norms of
Supplementary Nutrition Program which are as under

S. No. Category Pre-revised norms Revised norms w.e.f.

(per beneficiary per day) 16/10/08
(per beneficiary per day)
1 Children (6-72 months) Rs. 2.00 Rs. 4.00
2 Severely underweight children Rs. 2.70 Rs. 6.00
(6-72 months)
3 Pregnant women and Rs. 2.30 Rs. 5.00
Lactating mothers
4 Weighted Average Rs. 2.06 Rs. 4.21

Moribund ICDS
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Though the budget has been increased two folds but there is no detail about the
supplementary nutrition and its budget for adolescent girls. While the Apex Court in its order
has clearly mentioned that ICDS services should be extended to every child under six,
every pregnant or nursing mother, and every adolescent girl even then there is no clarity of
supplementary nutrition supply for adolescent girls. Moreover, the revised norms were to be
undertaken from October 2008 but even after passing of 7 months the previous norms are
being followed in Anganwadi Centers across the Madhya Pradesh.
Meeting the nutritional gap: The existing norms of calorific values for supplementary
nutrition program were those fixed during the inception of ICDS scheme in 1975. The
Government itself accepts the fact that those norms are not adequately meeting the gap
between Recommended Dietary Allowance (RDA) and Average Dietary Intake. It means for
the past 34 years, the Government was supplying low energy supplementary food to
children of the nation thus causing a gradual increase in the level of malnutrition among
children.

S. No Category Energy (kcal) Protein (g)

RDA Intake Gap RDA Intake Gap
1 Children (1 to 3 years age) 1240 687 553 22 18.6 3.4
2 Children (4 to 6 years) 1690 978 712 30 26.5 3.5
3 Pregnant women 2175 1654 521 65 45 20
4 Lactating mothers 2425 1852 573 75 46.7 28.3

Following table shows the Recommended Dietary Allowance (RDA), Intake and the Gap in
meeting the required nutritional intake-
Now if we see the recommended dietary allowance and the Average daily intake we found
that there is a huge gap between the two values. To meet this gap the Government was
following the norms of providing 300 kcal and 8-10 g proteins to children and 500 kcal and
20-25 g protein to pregnant women & lactating mothers which is a far low value to bridge the
gap between RDA and intake.
The revised calorific norms are as under-

Pre-revised norms Revised norms w.e.f.

(per beneficiary per day) 16/10/08
(per beneficiary per day)
S. No Category
Energy (kcal) Protein (g) Energy (kcal) Protein (g)

1 Children (6 months to 6 years age) 300 8-10 500 12 -15

2 Severely underweight children 600 20 - 25 800 20 - 25
(6 months to 6 years age)

3 Pregnant women and lactating mothers 500 20 -25 600 18 -20

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Though the revised norms suggest that now onwards the calorific value of supplementary
diet given to children and women under ICDS will be increased but from when these revised
norms will be in action is not known!
Promoting Micronutrient fortified foods in ICDS scheme: The Central Government has
recommended in the new guidelines that because the children of age group 6 months to 6
years are not capable of consuming a meal comprising 500 kcal energy and 12-15 g
proteins therefore as an alternative the government has suggested that for children aged 6
months to 3 years Take Home Ration (THR) facility will be adopted and the parents will be
given THR which could be in the form of Micronutrient Fortified Food or Energy-dense Food
(which may be called Ready to Use Food, RUF). The parents will be advised to give this
food in small frequent meals. Similarly, for children of age group 3 to 6 years it has been
suggested that state/UTs governments may arrange to provide a morning snack in the form
of milk/banana/egg/seasonal fruits/micronutrient Fortified Food etc.
Likewise, for severely malnourished children (of age groups 6 to 72 months) an additional
300 kcal energy and 8-10 g protein rich food (along with 500 kcal energy and 12-15 g
protein rich food given at AWC) should be given in the form of Micronutrient Fortified Food
and/or Energy-dense Food as THR.
We can see that the government is totally in favour of introducing Micronutrient Fortified
Food or Energy-dense Food (which may be called Ready to Use Food) in ICDS system in
one or the other way. This is clearly a hint that government has set a frame of mind for the
commercial interest of private firms and sooner or later these private firms will be
introduced in the food supply system of ICDS for supplying supplementary nutrition food.
This will be a sheer violence of orders of Apex Court which has strictly denied the
involvement of private firms in supplementary nutrition supply system for ICDS.
Let alone the children who could not consume the supplementary food at one sitting, the
revised guidelines instruct to provide 600 kcal and 18-20 g protein rich food to pregnant and
lactating mothers in the form of Micronutrient Fortified food and/or Energy-dense Food as
THR. Are pregnant women and lactating mothers also not able to consume the prescribed
amount of food in one sitting that government is recommending Energy-dense Food for
them!
Such policies of government clearly shows that, even after very clear cut orders from the
Supreme Court of India, there is a planned action to replace the traditional system of
serving Hot-Cooked Supplementary Nutrition Food followed in ICDS networks with Ready
to Use Foods (RUFs). Though it has been seen that for the treatment of severe malnutrition
the Ready to Use Therapeutic Food (RUTF) has given some positive indications but it is
also true that this RUTF is a medicated therapy and should be given under medical
supervision with a definite protocol. Also this RUTF is not procured locally so its
sustainability is again a question. Similarly, for the supply of Micronutrient Fortified Food or
Energy-dense Food, we have to depend on private firms and thus its regular supply and
sustainability will also be the things out of our control. Moreover, acceptability of these foods
is yet to be proved.

Moribund ICDS
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 Annexure - III
Tables showing the ground realities of available facilities in the
studied 65 Anganwadi Centres of 10 districts in the State.

Table No. 1 - Infrastructure At Anganwadi centers

District Blocks No. of AWC Buildings
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 3 7

Jhabua Petlavad 13 6 7
Tikamgarh Niwari 7 3 4
Panna Ajaygarh 5 1 4
Balaghat Laalbarra 5 3 2
Khandwa Khalwa 5 3 2
Hoshangabad Sohagpur 5 2 3
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 1 4
Bhopal Bhopal (Urban) 5 1 4
Total 65 24 41
Percentage 37 63

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91
 Table No. 2 - Functioning days of Anganwadi Centers
District Blocks No. of Functional Day of
AWC AWC
7 15 21 26

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 1 1 5 3

Jhabua Petlavad 13 0 0 2 11
Tikamgarh Niwari 7 0 3 2 2
Panna Ajaygarh 5 0 2 2 1
Balaghat Laalbarra 5 0 3 2
Khandwa Khalwa 5 0 1 2 2
Hoshangabad Sohagpur 5 0 4 1
Seoni Kurrai 5 0 1 4
Chhatarpur Rajnagar 5 0 2 2 1
Bhopal Bhopal (Urban) 5 0 0 0 5
Total 65 1 10 26 28
Percentage 2 15 40 43

Table No. 3 - Total Facility in AWC

District Blocks No. of AWC Total Facility
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 2 8

Jhabua Petlavad 13 1 12
Tikamgarh Niwari 7 1 6
Panna Ajaygarh 5 0 5
Balaghat Laalbarra 5 3 2
Khandwa Khalwa 5 1 4
Hoshangabad Sohagpur 5 4 1
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 2 3
Total 65 15 50
Percentage 24 76

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 Table No. 4 - Drinking Water Facility in AWC
District Blocks No. of AWC Drinking Water
Facility
Yes No

Shivpuri Khaniyadhan, Pichhor & Kolaras 10 3 7

Jhabua Petlavad 13 9 4
Tikamgarh Niwari 7 0 7
Panna Ajaygarh 5 1 4
Balaghat Laalbarra 5 4 1
Khandwa Khalwa 5 2 3
Hoshangabad Sohagpur 5 5 0
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 3 2
Total 65 28 37
Percentage 44 56

Table No. 5 - Availability of Supp nutrition food in AWC

District Blocks No. of Availability of nutrition
AWC food (in days)
7 15 21 26

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 1 4 4 1

Jhabua Petlavad 13 0 0 2 11
Tikamgarh Niwari 7 1 3 2 1
Panna Ajaygarh 5 0 2 2 1
Balaghat Laalbarra 5 0 1 2 2
Khandwa Khalwa 5 0 1 2 2
Hoshangabad Sohagpur 5 0 0 4 1
Seoni Kurrai 5 0 3 2
Chhatarpur Rajnagar 5 0 3 1 1
Bhopal Bhopal (Urban) 5 0 0 0 5
Total 65 2 17 21 25
Percentage 3 26 32 39

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 Table No. 6 - Quality of Nutritious Food
District Blocks No. of Quality of
AWC Nutritious Food
Good Normal Bad

Shivpuri Khaniyadhana, Pichhor,Kolaras 10 0 4 6

Jhabua Petlavad 13 2 7 4
Tikamgarh Niwari 7 0 3 4
Panna Ajaygarh 5 0 1 4
Balaghat Laalbarra 5 3 2 0
Khandwa Khalwa 5 0 1 4
Hoshangabad Sohagpur 5 0 3 2
Seoni Kurrai 5 0 4 1
Chhatarpur Rajnagar 5 1 0 4
Bhopal Bhopal (Urban) 5 0 5 0
Total 65 6 30 29
Percentage 10 46 44

Table No. 7 - Availability of Hot cooked meal in AWC

District Blocks No. of Availability of
AWC Hot cooked meal
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 2 8

Jhabua Petlavad 13 1 12
Tikamgarh Niwari 7 2 5
Panna Ajaygarh 5 1 4
Balaghat Laalbarra 5 5 0
Khandwa Khalwa 5 1 4
Hoshangabad Sohagpur 5 1 4
Seoni Kurrai 5 0 5
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 5 0
Total 65 18 47
Percentage 28 72

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 Table No. 8 - Relishness of Supp. Nutritious Food in AWC
District Blocks No. of Ruchikar
AWC Food
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 3 7

Jhabua Petlavad 13 9 4
Tikamgarh Niwari 7 0 7
Panna Ajaygarh 5 1 4
Balaghat Laalbarra 5 4 1
Khandwa Khalwa 5 2 3
Hoshangabad Sohagpur 5 5 0
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 3 2
Total 65 21 44
Percentage 32 68

Table No. 9 - Utensils availability in AWC

District Blocks No. of Availability of
AWC Utensils
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 1 9

Jhabua Petlavad 13 5 8
Tikamgarh Niwari 7 3 4
Panna Ajaygarh 5 3 2
Balaghat Laalbarra 5 3 2
Khandwa Khalwa 5 3 2
Hoshangabad Sohagpur 5 2 3
Seoni Kurrai 5 2 3
Chhatarpur Rajnagar 5 1 4
Bhopal Bhopal (Urban) 5 4 1
Total 65 27 38
Percentage 42 58

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 Table No. 10 - Availability of Playing Kit
District Blocks No. of Availability of
AWC Playing Kit
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 2 8

Jhabua Petlavad 13 7 6
Tikamgarh Niwari 7 1 6
Panna Ajaygarh 5 4 1
Balaghat Laalbarra 5 3 2
Khandwa Khalwa 5 3 2
Hoshangabad Sohagpur 5 0 5
Seoni Kurrai 5 2 3
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 4 1
Total 65 26 39
Percentage 40 60

Table No. 11 - Availability of Medicine Kit

District Blocks No. of Availability of
AWC Medicine Kit
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 2 8

Jhabua Petlavad 13 1 12
Tikamgarh Niwari 7 0 7
Panna Ajaygarh 5 0 5
Balaghat Laalbarra 5 1 4
Khandwa Khalwa 5 1 4
Hoshangabad Sohagpur 5 1 4
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 0 5
Bhopal Bhopal (Urban) 5 0 5
Total 65 7 58
Percentage 11 89

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 Table No. 12 - Availability of Salter machine
District Blocks No. of Availability of
AWC Salter machine
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 9 1

Jhabua Petlavad 13 4 9
Tikamgarh Niwari 7 5 2
Panna Ajaygarh 5 5 0
Balaghat Laalbarra 5 5 0
Khandwa Khalwa 5 3 2
Hoshangabad Sohagpur 5 5 0
Seoni Kurrai 5 3 2
Chhatarpur Rajnagar 5 3 2
Bhopal Bhopal (Urban) 5 5 0
Total 65 47 18
Percentage 72 28

Table No. 13 - Availability of Adult Weighing Machine

District Blocks No. of Availability of Adult
AWC Weighing Machine
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 5 5

Jhabua Petlavad 13 7 6
Tikamgarh Niwari 7 6 1
Panna Ajaygarh 5 4 1
Balaghat Laalbarra 5 5 0
Khandwa Khalwa 5 4 1
Hoshangabad Sohagpur 5 4 1
Seoni Kurrai 5 3 2
Chhatarpur Rajnagar 5 2 3
Bhopal Bhopal (Urban) 5 3 2
Total 65 43 22
Percentage 66 34

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 Table No. 14 - Availability of Growth Monitoring Register
District Blocks No. of Availability of Growth
AWC Monitoring Register
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 2 8

Jhabua Petlavad 13 11 2
Tikamgarh Niwari 7 1 6
Panna Ajaygarh 5 0 5
Balaghat Laalbarra 5 4 1
Khandwa Khalwa 5 4 1
Hoshangabad Sohagpur 5 5 0
Seoni Kurrai 5 3 2
Chhatarpur Rajnagar 5 3 2
Bhopal Bhopal (Urban) 5 5 0
Total 65 38 27
Percentage 58 42

Table No. 15 - Pre-school Education Facility

District Blocks No. of Pre-school
AWC Education Facility
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 1 9

Jhabua Petlavad 13 2 11
Tikamgarh Niwari 7 1 6
Panna Ajaygarh 5 1 4
Balaghat Laalbarra 5 3 2
Khandwa Khalwa 5 1 4
Hoshangabad Sohagpur 5 1 4
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 1 4
Bhopal Bhopal (Urban) 5 4 1
Total 65 16 49
Percentage 24 76

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 Table No. 16 - Willingness to Tin Packed Food
District Blocks No. of Willingness to
AWC Tin Packed Food
Yes No

Shivpuri Khaniyadhana, Pichhor, Kolaras 10 0 10

Jhabua Petlavad 13 0 13
Tikamgarh Niwari 7 1 6
Panna Ajaygarh 5 0 5
Balaghat Laalbarra 5 0 5
Khandwa Khalwa 5 0 5
Hoshangabad Sohagpur 5 1 4
Seoni Kurrai 5 1 4
Chhatarpur Rajnagar 5 1 4
Bhopal Bhopal (Urban) 5 2 3
Total 65 6 59
Percentage 10 90

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 Annexure - IV
NFHS 3 Report on Status of Children in Madhya Pradesh

The very recently released state specific report of NFHS -3 brings out a very grim picture of
status of ICDS in Madhya Pradesh. According to the report only 54.2 per cent children of
age 0-35 months and 45.8 per cent children of 36-71 months are having an access to any
services of ICDS. Similarly, merely 52.8% and 51.9 % children of age 0-71 months
respectively belonging to schedule caste and tribal population have an access to any
services of Anganwadi centers. It puts a big question mark on the prime objective of
integrated child development services (ICDS) to improve the nutritional and health status of
children below the age of six years
The NFHS report also reveals the bleak reality of Health and Nutritional status among the
children of deprived sections (SC/ST/OBC) of our society. The status of child survival
among tribal and dalit communities is a great matter of concern in Madhya Pradesh. The
report mentions
that 140 tribal and Background Neo-natal Infant Under 5
110 dalit children Mortality Mortality Mortality
perish before
celebrating their India 39 57 74.3
5th birthday. These Madhya Pradesh 44.9 69.5 94.2
figures are much
Residence (Madhya Pradesh)
higher then the
Madhya Pradesh Urban 41.2 71.6 86.6
average for Under Rural 54.3 84.8 114.1
5 mortality of 94.2
Caste/Tribe (Madhya Pradesh)
per one thousand
live births. Explo- Scheduled Caste 50.2 81.9 110.1
r i n g t h e b a s i c Scheduled Tribe 56.5 95.6 140.7
underlying causes
of such a high Other Backward Class 53.3 79 97.6
prevalence of child Other 39.6 66.8 79.9
mortality among
these vulnerable section of the society divulge that circumstances like malnutrition and
persistent anemia among the young kids, low rate of initial breastfeeding, no vaccination
and micronutrient deficiency are the major determining factors.

There are mounting evidences1 showing that Madhya Pradesh has become a synonym for
malnourishment among children of 0-6 year age group. More than 60 percent children
(under 5 years age) of the state are suffering malnutrition while this figure for India stands at
42.5 percent. Children of deprived sections are highly suffering with the problem of
malnutrition and of those tribal children are even more at the worst condition with 71.4
percent of malnutrition. 57.4% children of OBC community are malnourished which is
1
NFHS 3 report, IFPRI Report, 2008

Moribund ICDS
100
below the state average and on the contrary 62.6% SC children are above state average of
60.3%. But if we perceive it on the whole all three SC, ST and OBC children are at risk.
Providing safe childhood to their young children is just a day-dreaming for parents
belonging to downtrodden classes in the state and the children had to pay the cost of taking
birth in these classes by giving away their life. In Madhya Pradesh 56.5 neonates born in
Schedule tribe and 50.2 neonates born in Schedule castes die in the first 28 days of birth
per thousand live births. Children form Urban and Rural arenas of Madhya Pradesh are
though in better situation as compared to tribal and dalit children but still the mortality rates
of these children are significant.
Situation of children belonging to SC, ST and OBC in terms of all basic indicators of health is
defenseless. The chance of survival of tribal child is very stumpy with 71.4% children
malnourished, 82.5% children having anemia under different grades. Merely 11.7 percent
tribal children born in last five year preceding the survey are breastfed within an hour of birth
in comparison to 15.9% total children given breastfeeding & merely 22.3 percent children of
ST having all basic vaccination!
Children belonging to other backward class are having little advantage over schedule caste
in terms of anaemia, breastfeeding practices and status of malnourishment among the
children. Against 75.6% children from schedule caste suffering from anemia, 70.6%
children from other backward classes are bearing it.

Background Any Breastfeeding All basic Malnutrition

Anemia within an hour vaccination in children
in Children of birth (12-23 month) (Under 5 yrs)
percentage
below -2 SD
India 69.5 24.5 43.5 42.5
M.P. 74.1 15.9 40.3 60.3
Residence
(Madhya Pradesh)
Urban 68.9 23.9 68.7 51.3
Rural 75.7 13.3 31.5 62.7
Caste/Tribe
(Madhya Pradesh)
Scheduled Caste 75.6 17.4 40.5 62.6
Scheduled Tribe 82.5 11.7 22.3 71.4
Other Backward Class 70.6 16.8 41.0 57.4
Other 68.5 18.2 62.4 45.3

Moribund ICDS
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The rural children are comparatively much more anemic (75.7 %) than the 69% urban
anemic children. Schedule caste and schedule Tribe children are worst sufferers of
aneamia in the state. More than eighty percent of tribal children undergoes through various
stages of childhood aneamia. Similarly 4.6 % children from schedule caste are in the grip of
death monster in the form of severe anaemia. These anemic children must be provided with
additional nutritional foods to triumph over undernourishment but it is so unfortunate that
merely 35.9% of children receive supplementary foods from Anganwadi centers in Madhya
Pradesh.
Though micronutrients are required in very small amounts, the consequences of their
absence are severe. Micronutrient deficiency in children also significantly contributes to
childhood morbidity & mortality. According to WHO estimates approximately 50% of all
anemia can be attributed to iron deficiency In Madhya Pradesh only 3.5 percentages of
children of 6-59 months were given iron supplement in last seven days preceding the
survey, which further reduced incase of children belonging to low wealth index to 2.3% &
1.8% for Muslim community children. Vitamin A deficiency (VAD) causes slow growth and
development in children in addition to the manifestations of its deficiency in the eye. And
NFHS-3 results shows that merely 14.1% children had received Vitamin A supplement in
last six month preceding the survey and just 11.4% marginalized tribal children received the
same in a given period.
In spite of such sky-scraping infant & child mortality no special efforts has been made for
providing the better survival conditions to the children of State. The children from
downtrodden classes of our society are the utter sufferer of the negligence of State towards
health and nutrition policies.

Moribund ICDS
102
 Abbreviation
AAY Antyoday Anna Yojana
ACDPO Additional Children Development Project Officer
ASHA Accredited Social Health Activist
ANM Auxiliary Nurse Midwife
AWC Anganwadi Centre
AWH Anganwadi Helper
AWW Anganwadi Worker
BIMARU Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh
BPL Below Poverty Line
CAG Comptroller and Auditor General
CC Cement Concrete
CDC Community Development Centre
CDPO Child Development Project Officer
CEFS Centre for Environment and Food Security
CHC Community Health Centre
CSOs Civil Society Organizations
DWCD Department of Women and Child Development
FAO Food and Agriculture Organization
GAIN Global Alliance for Improved Nutrition
GHI Global Hunger Index
GoI Government of India
GM Genetically Modified
HACCP Hazard Analysis and Critical Control Point
ICDS Integrated Child Development Services
ICSSR Indian Council of Social Science Research
IFPRI International Food Policy Research Institute
IMR Infant Mortality Rate
INHP Integrated Nutrition and Health Project
ISHI India State Hunger Index
ISO International Organization for Standardization
JCE Joint Commission of Enquiry
LHV Lady Health Worker
MDG Millennium Development Goals
MDM Mid Day Meal
MLA Member of Legislative Assembly
MMR Maternal Mortality Rate
MP Madhya Pradesh

Moribund ICDS
103
MPCE Monthly Per Capita Expenditure
MPJSA Madhya Pradesh Jan Swasthya Abhiyan
MPR Monthly Progress Report
NFHS National Family Health Survey
NIWCYD National Institute of Women Child and Youth Development
NOAPS National Old Age Pension Scheme
MPW Multi Purpose Worker
NGO Non Governmental Organization
NRCs Nutritional Rehabilitation Centers
NREGS National Rural Employment Guarantee Scheme
NSSO National Sample Survey organization
PDS Public Distribution system
PHC Primary Health Centre
PMGY Pradhan Mantri Gramoday Yojana
PRHW Peoples' Rural Health Watch
PRIs Panchayat Raj Institutions
PTG Primitive Tribal Group
PUCL People's Union for Civil Liberty
RCH Reproductive Child Health
RUEF Ready to Use Energy Food
RUTF Ready to Use Therapeutic Food
SC Scheduled Caste
SCP Special Component Plan
SD Level Standard Deviation (for measuring malnutrition level)
SHC Sub Health Centre
SHG Self Help Group
SNP Supplementary Nutrition Programme
SRS Sample Registration Survey
ST Scheduled Tribe
TPDS Targeted Public Distribution System
TSP Tribal Sub Plan
UNICEF United Nations Children's Fund
UP Uttar Pradesh
USRN University School Resource Network of Jawaharlal Nehru University
UT Union Territories
WFP World Food Programme
WHO World Health Organization
WTO World Trade organization

Moribund ICDS
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 They are more then us
They are small but much more then a unit of Kilogram,
Millimeter, a tiny part of any group,
Beneficiary of a government scheme,
They are more then a man or woman!
You see them on streets
doing business for survival!
They bid every morning for today
at the cost of tomorrow!
You see them searching an opportunity
in bundle of garbage,
Which gives them a hope for food!
They have been restricted to keep
dreams, in their close eyes!
They should have an equal independent identity
but we have made them lost!
They can not be common,
They are more then anything now!
They should be treated as special in totality!
They should not survive by chance, but rightfully!
Don't you know them!

Neglect of them is a crime!!!

Right to Food Campaign Madhya Pradesh Support Group

Sanket - Centre for Budget Studies
&
Vikas Samvad

ISBN - 978-81-908302-1-8