Maharashtra has a persisting malnourishment problem. Almost 24,000 children died due to malnourishment in 2011, according to state government statistics. In the four financial years before that, 1.17 lakh children had similarly lost their lives.
Even so, the death of 14 children due to malnutrition in Bhadli, a village in Aurangabad district of Maharashtra, in 2000, came as a shock. It spurred the local administration to start - from 2002 - tracking and trying to improve child nutrition levels across the district. Three years later, the Maharashtra government expanded this into a mission which, in stages, expanded the area being covered until the entire state was being tracked.
The Rajmata Jijau Mother-Child Health & Nutrition Mission (RJMCNM) has UNICEF as a partner, and works with Maharashtra government's Women and Child Development department, and the Centre's Integrated Child Development Services (ICDS) programme. "Our aim is to strengthen the ICDS, achieve convergence between different administrative arms, provide technical guidance and try different models of development using the village child development centre as the crux of the effort," says Vandana Krishna, its Director-General.
Children at an anganwadi in Hiware Bazar village, in Maharashtra's Amravati district. Photo: Rachit Goswami/www.indiatodayimages.com
Although, as the statistics show, the problem is still far from overcome, the findings of a study by the International Institute of Population Sciences released in November 2012 are encouraging. They reveal that the mission has led to distinct improvement in nutrition levels. While 39 per cent of children had stunted growth in 2005/06, the corresponding figure in 2012 is 22.8 per cent. In the same period, cases of children 'wasting away' has fallen from 19.9 per cent to 15.5 per cent, as has that of underweight children, from 29.6 per cent to 21.8 per cent.
Of course, it all began in Aurangabad. Despite the skeletal staff available for the initiative, V. Ramani, then Divisional Commissioner of Aurangabad, started providing children of Aurangabad district with vitamin A supplements and getting them dewormed regularly, and setting up nutrition care centres. "These were for children being treated for malnourishment at the hospitals and primary health centres," says Ramani. "Here they got regular food and nutrition supplements for six months.
Their mothers were also compensated for staying with them." Since such centres were expensive to maintain, a cheaper variant called 'development centres' were also started, located closer to the children's homes. "These were places where parents could leave their malnourished children during the day and they would be given two-hourly nutrition," adds Ramani. After the RJMCNM began, Ramani was made its first director and the same measures repeated on a larger scale.
16.2 point reduction in children with stunted growth in Maharashtra between 2005/06 and 2012
To keep people informed of the improvement - or otherwise - in the nutritional levels of their children, the mission also set about preparing colour-coded graphs on large plastic sheets. During village communication meets, children were physically stretched out on the plastic sheets and their height and other vital statistics measured, so that parents could see for themselves the physical changes being recorded. Earlier, growth charts of children maintained by anganwadi (day care centre) workers had never been made public. "This helped communicate nutrition and its correlation to growth to the mothers. They could see why their children were being moved from the red zone to the green zone on the graph," says Ramani.
A number of other states are set to replicate Maharashtra's efforts. Gujarat has already done so, while Uttar Pradesh, Madhya Pradesh, Jharkhand and Orissa have shown interest in it. "The Mission's achievement shows how data monitoring and a joining of hands by the bureaucracy, politicians and civil society can work wonders," says Ramani. "We did not create any alternative machinery, just used the district apparatus and still achieved our goals."Suman Layak