Fragile Truth Strengthening child health through nutritious medical supplements
In a state like Uttar Pradesh which has 46 deaths per 1000 live births and where a pregnant woman has one in 42 lifetime risk of maternal death, the bi annual Bal Swasthya Poshan Mah (BSPM) in all the 72 districts of the state is indeed an opportunity to strengthen child health especially in the remote rural pockets through nutritious and medical supplements.
But it is also vital to point out here at the onset itself that it is also very important for the authorities who had conceived this great programme to do some reality checks on this scheme on which depends the health of not just the children of most populous state of India—Uttar Pradesh, but the entire country. After all it is in this very state where in lives the maximum number of India’s children.
In the months of June and December along with the regular routine immunisation this special health drive BSPM has been carried out. All the under five children in every district get a health check-up, they are provided adequate vitamin supplements and routine immunisation (RI). Serious cases of malnutrition are identified and referred to district hospitals.
Along with RI all children under five years get a dose of vitamin A, the lack of which can cause blindness and serious protein calorie malnutrition. The local health team counsels the families on the importance of regular health check-ups. Along with supervision rounds, the team also imparted health education to the families mostly belonging to poor sections of society at the Anganwadi centres regarding breast feeding, Infant and Young Child Feeding (IYCF) practices, prevention of malnutrition and consumption of iodised salt.
Special medical college teams trained by UNICEF have been deployed in 15 districts which have been identified as High Risk (HR). These districts which include Lalitpur, Farrukhabad, Kaushambi, Siddharthnagar, Sitapur etc have history of high infant and maternal mortality rate and low nutrition levels.
The Community Mobilisation Coordinator (CMC) along with the team prepares a list of all the children from the age of 0 to 5 years in her area, whom she mobilises for the booth vaccination. On that day too she helps bring all the 0 to 5 year old kids (especially focus on new born) to the booth for Vaccination. She helps convince the members of resistant families in getting their children vaccinated. She usually takes help from the influencers in the community (people who help her advocate the importance of polio vaccination) to convince these families. Also she gets helps form bullawa tolis of adolescent kids from the community who go to different lanes in the area to call children to the polio booth for vaccination.
This year the BSPM session was delayed due to the census work being carried out in the country and so it took place from July 14 to August 14. A team of development journalists visited three of these districts to test the ground reality of BSPM.
At Kaushambhi they were told by the chief medical officer, Dr Dayaram Varma, “Extensive sessions in the schools were carried out in these districts to promote the consumption of iodised salt. Iodine testing was done in front of children. It has been documented that areas where consumption of iodised salt is more, better school performance has been noticed in children as iodine increases the IQ level by 13 points.” All the village pradhans have been sent a personal letter from the district magistrate urging them to give full support to the health authorities in implementing this programme.
Unhealthy Uttar Pradesh
According to a UNICEF report
- More than one-third of all maternal deaths in the country are reported from Uttar Pradesh and Uttaranchal.
- A child born in a least developed country is almost 14 times more likely to die during the first 28 days of life than one born in an industrialised country.
- In India, almost 50 per cent of under-five deaths occur in the first 28 days of life.
- The states with the top five neo-natal mortality rates—measuring deaths within the first 28 days of life—are: Orissa (52 deaths per 1,000 live births), Madhya Pradesh (51), Uttar Pradesh (46), Rajasthan (45), and Chhattisgarh (43).
- Sex ratio per thousand is 898.
- Literacy rate is 56.3 per cent.
- UP ranks 25th on the human development index among 28 states.
Lalitpur, the last district of the state which borders Madhya Pradesh. “Here there are a large tribal population of Sehrais who need to be given special attention. Lalitpur is thus the only district where instead of three days a week RI is carried out on five days,” informed Dr Harishchand Paliwal, in charge of UNICEF health programmes in Lalitpur for the last four years.
It was clear that BSPM is a well-tailored programme for the rural area. BSPM will in the long run really help Uttar Pradesh improve both its social as well as developmental index but the fact remains that its implementation is far from satisfactory.
As this programme is part of Congress National Rural Health programme it is alleged that it is often meeting with step-motherly treatment at the hands of Bahujan Samaj Party (BSP) which ruling Uttar Pradesh.
The fact that this year the UP health department took upon itself the task of supplying the vitamin A drops instead of UNICEF which had been doing so in the past but failed to do so, is a glaring example of government laxiticity.
Dr Shraddha Dwivedi, HoD, Community Medicine, Motilal Nehru Medical College, Allahabad, told the team of journalists when they met her at the hospital that there has been absolutely no supply of vitamin A anywhere in the state and that the districts had to make do with last season’s surplus was indeed a shocking statement. This is both shocking and a poor reflection on the intention of the government to sabotage a programme.
Another revelation came at Chayal, in Kaushambi district that despite all government efforts to introduce iodised salts many of its own ration or fair price shops under the public distribution system (PDS) are selling packets of unbranded salts at Rs 10 per kg.
“At the ration shop the shop keeper insists that he will only give the kerosene if we buy a packet of this salt,” said 17 year old Hameeda.
On the other hand the training programme health functionaries including the auxillary nurses and accredited social health activities called ASHA was found to be more then satisfactory. At a random visit at several centres the registers containing the birth, age, vaccination records were found to be in perfect order. The health functionaries also knew how to test the salt for iodine content, the vaccination procedures. Everything was neatly documented in registers.
But sadly the sate of the ‘nutritious diet material’ supplied by the government was found both sub-standard and inadequate. There was no proper storage place for the dry panjiri supplied to these aganwadis and in many cases because of being left in the open, the food stuff developed worms.
The fact that only Rs 2 is given by the government per diet of a child, pregnant and lacerating woman for the hot cooked food itself looks like a joke. In these times of inflation. No utensils are provided for cooking too.
“We are expected to give 60 grams rice and 30 gms pulses in the khichdi. The cost of cooking, salt is all included in this,” informed Shail Srivastava, officer incharge of ICDS in Kamaalganj block of Farukkabad district. She has under her 238 aganwadi centres.
Ms Srivastava confessed that the only option left is to cook the stuff at home and bring it to the school, hoping that the total number of children attending is less.
It is high time, somebody looked closely at these aspects of a very grand scheme that aims at strengthening the children of Uttar Pradesh. Monitoring and implementation of the scheme is most certainly a very vital component of the BSPM programme that should not be overlooked, otherwise a wonderful government scheme will collapse much before it has really taken off.
By Kulsum Mustafa from Lucknow