MALNUTRITION: India: Spoon-feeding Melghat

KumKum Dasgupta., Hindustan Times
October 31, 2012

Melghat is an incredibly beautiful place — especially, if you visit the forest-rich area after a robust monsoon (like I did). The weather was cool, the sky pale azure and the spectacular cliff-and-ravine landscape green. But this gem of a place, 750 kilometres northeast of Mumbai in 

Maharashtra’s Amravati district, has an ugly side story: hunger and malnutrition have been killing tribal children and women here for years. Things came to a head in 2010-11, when the two killed 509 children and 20 women.

In India, tribals have historically fared badly than others on malnutrition indicators. Nearly 54% of children (under-5) are underweight; the national average is 43%. Melghat’s Infant Mortality Rate (IMR) is the worst in Maharashtra: 48 per 1,000 live births, higher than the state’s score of 33 and India’s 46.7. The area’s Maternal Mortality Rate (MMR) is 120.6 (per one lakh births). Maharashtra’s MMR is 130 and India’s is 212.

My first stop was Chandras-hekhar Dholene’s office, a slightly dilapidated British-era structure at Chikaldhara, one of the two tehsils of the area. Dholene, a garrulous man in his fifties, is the child development officer of the Integrated Child Development Services (ICDS), the country’s premier social welfare scheme for tackling malnutrition and health problems of children and mothers.

“I don’t even have an official vehicle. How can I keep an eye on the health of children and women?” replied Dholene rhetorically to my question on the region’s health record, deftly skirting any comment on the state of the ICDS programme in Melghat.

As I pondered over his comment, Dholene continued, pointing towards an old, laminated map of Melghat on the wall: “Look, how v-a-s-t my area is. It’s difficult to monitor without a gari.” Then, without waiting for my next question, he added: “Some of the villages are not connected by roads and remain cut off during the rainy season. It’s difficult to deliver even the basic health and nutrition services then.”

Along with this crippling lack of infrastructure, there are many other factors that have aggravated the health crisis in Melghat: under-equipped and under-staffed public health and ICDS centres, the tradition of early marriages and early motherhood among the Korku and Gond tribals, lack of sanitation and clean drinking water facilities and the tribals’ blind faith in bhumkas (quacks).

India’s forest laws are also blamed for hunger and malnutrition among the tribals because it restricts their access to forest produce, which once ensured year-long food and nutritional security. Then there are over-zealous babus and their plans to ‘modernise’ the tribal way of life, which only end up complicating the situation further.
For example, in Melghat, the government introduced cash crops like soybean and cotton, replacing nutritious local crops like kodo, kutki and savarya. Today, thanks to these crops, tribals have become dependent on the government’s Antyodaya rice scheme for their food. But the scheme’s patchy delivery has left many hungry.

At Patsalai, a tribal village inside the Melghat Tiger Reserve, I heard another story about the mismatch between the needs of the tribals and policies. Some years ago, the government gave tribals farm equipment to improve agricultural production. “But most of us could not use them because they were too big for our small fields,” recounted a resident of the village. As hunger increased in the area, migration also spiralled.

Fortunately, a fightback — led by women — has begun in Melghat.

Sitting on a raised platform outside her grass-and-bamboo home at Patsalai, Ganga, a 30-year-old community health worker, proudly showed me her latest weapon in the fight against malnutrition: a mobile phone. It’s a regular set but is pre-loaded with an application called CommCare.

“Whenever a pregnancy is reported, I register the women’s name and other details via the phone,” she explained. Once the registration is done, the software gives her the woman’s expected delivery, check-up and immunisation dates. “The phone also has pre-recorded messages on maternal and child health that I can play for the women here,” she added.
Once data is collected, it is saved on a central server of World Vision India (WVI), a non-profit organisation that works closely with the government, which distributed these phones. The information then helps in monitoring the health of pregnant women, lactating mothers and young children.  The government is now toying with the idea of expanding this successful service to other districts of the state.

But the blockbuster of an effort to tackle malnutrition happened in March at Chikaldhara with the inaugural edition ‘Masterchef Melghat’, a novel fete which focused on nutrition, another brainchild of the WVI team.

The idea was simple: self-help groups were asked to prepare recipes with high nutritional value, but only with local products. Twenty self-help groups (SHGs) came forward. Among them were women from Badnapur and Solamoh. Since their village is milk-deprived, they decided to design a recipe for milk-based rice pudding. But milk was not available; an anganwadi worker showed them how to make soya milk.

At the end of round one, 15 groups were selected for the main contest. A government dietician was brought in to give tips to improve the nutritional value of the dishes. On the day of the fete, the women surprised the visitors with 13 easy-to-make nutritious dishes. Today, these recipes are being popularised in the villages of the area to ensure that the children and women don’t go hungry or remain malnourished.

The health of Melghat cannot change overnight. But tough monitoring and creative solutions along with the State-led ones, the primary being the crucial Right to Food law, can hopefully nurse it back to good health in future.