Good health and access to a safe and balanced diet are undeniable characteristics of an existence that meets the basic standard of living. Our health determines our ability to participate in society and contribute to the economy. Good health, according to the renowned economist Amartya Sen, is the minimum that an individual should have to be considered not-poor in terms of capability deprivation. Going by this definition, India is one of the poorest nations in the world.
“A malnourished mother is more likely to give birth to a malnourished child,” says the Down To Earth magazine’s article on 'Why India Remains Malnourished' in 2018. According to the last National Family Health Survey conducted in India for 2015-16, 54.3% of women in rural India aged 15 to 49 were anaemic, and only 8.8% of the children of the 6-23 months age range in rural India receive an adequate diet. It is not surprising that almost a fifth of children under the age of five in rural areas are wasted whereas almost half of the children are stunted.
For 2015-16, India noted the fastest economic growth in five years at 8.2% GDP growth and was considered one of the fastest-growing economies in the world. Yet, according to the Global Nutrition Report published in 2018, India is home to one-third of the world’s stunted children.
As per the International Food Policy Research Institute, “nutrient-rich non-staple foods are up to ten times more expensive than staple foods in most poor countries”. Widespread poverty in India makes it difficult for people to purchase nutrient-rich food to meet their dietary requirements. Compounded by the lack of education and awareness, the ability to consume a balanced diet ranks pretty low in the lives of rural poor in India. Consequently, we see poor health indicators in the form of high malnutrition and infant mortality rates.
This scenario has been exacerbated by the onset of the COVID-19 pandemic. A sudden lockdown, closed ration shops, and a disrupted food chain has made access to basic nutritional requirements, for the already deprived in India, even more difficult and with the schools closed, children are deprived of the balanced meal plans under the midday meal programmes run by the Indian provincial governments.
Additionally, malnutrition makes children and women in rural India extremely vulnerable to disease. To meet the nutritional requirements of the nation and to reduce the vulnerability of women and children to COVID-19, the Government has started prioritizing national food security programmes such as the public distribution systems, POSHAN Abhiyan (Nutrition Scheme), and the national health mission. These schemes play a significant role in reducing mortality and deaths in rural areas. One such scheme is the Integrated Child Development Scheme.
The Integrated Child Development Scheme (ICDS) is considered the world’s largest scheme for childhood care and development, which is appropriate when we recall that India consists of one-third of the world’s stunted children. Launched in 1975, the ICDS aims to “provide pre-school non-formal education on one hand and break the vicious cycle of malnutrition, morbidity, reduced learning capacity and mortality on the other”. As of 2019, the estimates suggest that there are over 85 million children from the ages of zero to six and lactating and pregnant women who are beneficiaries of the scheme.
Under this scheme, the government offers services of supplementary nutrition, immunization, health check-ups, and referral services to the beneficiaries. These services are provided by the front-line workers under the scheme called the Anganwadi workers and Anganwadi helpers. Additionally, pre-school education to children of age three to six years and nutrition and health education to women of age 15-45 years is also provided through Anganwadi workers and Anganwadi helpers. Anganwadi centres are established according to population parameters. These centres are built to meet the infrastructural needs and requirements of the Anganwadi workers and are the epicentre of operations. These services offered under the ICDS are divided into six smaller schemes: Anganwadi Service Scheme, Pradhan Mantri Matru Vandana Yojana (the Prime Minister's Maternity Benefits Programme), National Creche Scheme (daycare facilities), POSHAN Abhiyaan (nutrition scheme), Scheme for Adolescent Girls (nutrition and gender support for young girls) and Child Protection Scheme.
However, the impact of the ICDS on rural undernutrition levels has been less than what one would expect from a scheme of ICDS’ level. ICDS has been mired in a series of troubles because of inefficient funding and infrastructural growth, including technological advancement.
Looking at the funding allocated to the ICDS in the last five years, we see a consistent rise in the budget allocation to the Indian Ministry for Women and Child Development, but we still see various complaints of inadequate funding and infrastructural inadequacies in Anganwadi centres for the scheme.
The Anganwadi workers are the backbone of the scheme and without their contribution, the scheme would not be able to achieve its objectives. According to the 2015-16 records available on the official ICDS website, there is one Anganwadi centre (AWC) for a population of 400-800, two AWCs for 800-1600, three AWCs for 1600-2400, which amounts to one worker per 20 individuals. However, this allocation is not always followed. The salaries of the workers vary across the country, starting from as little as Rs. 2,500/month to Rs.12,000/month. This remuneration has to suffice for living costs, essentials, meals as well as accommodate travelling. The Anganwadi workers are demanding a minimum monthly wage of Rs.18,000 along with better benefits in the form of maternity leaves, paid sick leaves, and internet access. The workers have often complained of poor quality food provided to them.
They are in charge of the polio programmes as well as other health services in the villages. However, they are ill-equipped and untrained in dealing with these illnesses. The Anganwadi workers have been protesting for better pay and work environment since 2018. Since the beginning of the COVID-19 pandemic, the Anganwadi workers have taken charge of limiting the spread of the disease as well.
To lay the foundation for proper psychological, physical, and social development of the child, pre-schools have been established in villages near the Anganwadi centres. However, provisions for teachers and essentials like books, stationery, seating arrangements remain absent. Learning and education are constantly disrupted due to the aforementioned reasons and have been exacerbated by COVID-19, hence defeating the purpose. The ICDS has also focused on reducing dropout rates for young girls. But there are no provisions or incentives for young girls to stay in school. Lack of information and awareness only worsens the situation, and Anganwadi workers are too overworked to take over this aspect as well.
These workers are responsible for all the services provided under the scheme and have minimal contact with their supervisors to file complaints. The centres are poorly furnished and maintained. They are also required to file and report for each service provided under the latest attempt to digitize, leading to one-sided accountability. The Anganwadi work is vital and imperative in rural India regardless of its deficiencies. However, due to its innumerable failings, it makes for a poor employment opportunity.
These issues can be easily solved by paying better wages to the workers, providing them with proper orientation and training, and establishing a system of checks and balances to ensure that funds are appropriately utilized. The Anganwadi workers are the implementers of a vision of India where at least children have health and are, thus, not poor. But the way they are treated and the support that is given to the schemes that they implement is shambolic. The funding and infrastructural deficiencies of the ICDS programme are an obstacle to the government’s aim of tackling malnutrition in India. Following the devastation of the COVID-19 pandemic, the government must prioritize solving these issues, lest it be held responsible for the doom of the future citizens of a country of 1.3 billion due to a lack of healthcare.
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