Fighting malnutrition in AP

It is heartening to know that the Government of Andhra Pradesh has issued orders, GO Ms No 9, dated April 30, with regard to food at the Anganwadi centres and for lactating and pregnant women. The Centre has approved the continued implementation of the ICDS scheme in the 12th Five-Year Plan and implementation of restructured and strengthened ICDS scheme in "Mission Mode" which includes repositioning the Anganwadis as a vibrant E&D centre to become the first village outpost for health, nutrition and early learning, with minimum of six hours of working.

Acknowledging problems of low birth weight among children in Andhra Pradesh (19.4% which was the highest among the southern States) underweight children (<3yrs) in AP (37%) and prevalence of anaemia among married women which has increased from 49.8% in 1998-99 to an alarming 62.9% in 2005-06, the commissioner (WD& CW) recommended modification of the nutrition programme of ICDS to address challenges in early stages of life, and meeting the nutritional needs of pregnant women.

This is well in keeping with the objectives of the ICDS programme and the directives of the Supreme Court in the right to food case. The introduction of "one full meal" for pregnant and lactating women under Indiramma Amrita Hastham programme at the cost of Rs. 15 per day per mother is expected to provide more than 40% of the day's requirement of calories, proteins and calcium to the mothers. One hundred and two projects out of the 387 ICDS projects identified as high-risk areas where malnutrition levels are high benefit from 'one full meal' from January 1, 2013.

SC/ST population in these 102 ICDS projects is more than 40% and the additional expenditure for "one full meal" is expected to be met, if necessary, from SC/ST Sub Plan. This scheme does not operate in habitations covered by the nutrition cum day care centres (NDCCS) of the Indira Kranti Pathakam (IKP), (GO Ms 33 Dt 01 December 2012).

Operational guidelines were issued for implementation of 'Indiramma Amrutha Hastam' programme for pregnant and lactating women in the high-risk 102 ICDS projects. Village-level organisations and officials, Mandal and Zilla Mahila Samakyas, Anganwadi workers, supervisors/ CDPOs and PDs, etc, are all in some form or other responsible for the implementation of Indiramma Hastham.

The cost of 'one full meal' with increased quantity and nutritive value of food items has been revised taking into account the present cost and to provide feasibility. As for food at the ICDS (Anganwadis) pre-cooked ravva mixes of AP Foods (a Government of A P undertaking) are being supplied now all over the State with a few exceptions. Several complaints and reports of workshops were filed with the WCD&SC by AP State advisors to the national commissioners in the right to food case in the Supreme Court.

Nutrition experts have also pointed to the futility of pre-mixes in solving the problem of malnutrition among children. The Supreme Court, in several of its directives, maintained that a freshly cooked 'meal' must be served at AWCs and that there can be no substitute for a hot cooked meal. In response to this, the Commissioner, WD&CW constituted a State committee under the chairmanship of managing director AP Foods with representatives from NIN, UNICEF, and Home Science College, NGOs etc., to study existing food models and to make modifications in accordance with the revised cost norms approved by the Government of India.

The committee recommended provision of hot cooked meal on the lines of mid-day meal for 3-6 years children and weaning food for 7 months- 3 years children in all ICDS projects. The committee also suggested considering adding of 10 gms of milk powder and increase sugar content in the weaning food to improve acceptability, palatability and nutritive value for children below three years.

The commissioner proposed new food models with revised norms and the government has allowed introduction of these new models in 11 selected districts: Srikakulam, Vizianagaram, Visakhapatnam, East Godavari, Guntur, Adilabad, Karimnagar, Khammam, Nizamabad, Ranga Reddy and Ananthapur from 2014-2015. The main meal consists of rice, dal in recommended quantities, vegetables, condiments and four eggs per week. AP Foods that supplied pre-mix ravva to the centers will now limit itself to supplying a snack food, kurkure, made of channa dal and peanuts.

In the remaining 12 districts, the same model, ie hot cooked meal with two eggs per week (instead of four) and without the snack food will be implemented from 2014-15. Weaning food based on wheat, Bengal gram, milk powder, sugar and oil, two eggs per week will be provided for children aged between 7 months and 3 years.

This is indeed a welcome shift from pre-cooked ravva-based food to children. However, there are some imperatives that must accompany the provisions of hot cooked meals for children. The immediate need is to provide infrastructure, which is a kitchen, a dining room and a class/play room for children. The cost of construction has escalated over the years, and for school kitchens the amount has been increased from Rs 50,000 to Rs 75, 000.

Even this may not be sufficient. A properly planned kitchen and two rooms for Anganwadis today will cost nothing less than Rs. 1, 50,000. The need for proper toilets and clean drinking water cannot be over-emphasised. Anganwadis are not merely eating places, but provide pre-school education for children under 6. The ambiance at the centre should be conducive to learning and enjoying for children.

In a country where inequalities are increasing and the cost of education is rising beyond the capacity of the poor and marginalised, the schooling at Anganwadis is a step towards enabling children to access education/schooling at the later stage. As majority of children at Anganwadis belong to SC/ST population and are from poorer families, class/caste convergence has implications for an analytical framework for politics of food security.

The writer is AP State Adviser to the National Commissioners in the Right to food Case in the Supreme Court