Non-provision of supplementary nutrition to children aged 6 months to 3 years has defeated objective of overcoming malnutrition in Gujarat

Malnourished child in village in Anand districtThe Comptroller and Auditor General (CAG), in its “Audit Report (General and Social Sector)” has sharply criticized the Gujarat government for failing to create necessary conditions to improve the nutrition status of children, despite the fact that Gujarat’s performance on this score was found to be one of the worst in the National Family and Health Survey (NFHS), 2006. Excerpts from the CAG report:

The Government of India (GoI) launched (1975) the Integrated Child Development Services (ICDS) to promote holistic development of children, expectant and lactating mothers and adolescent girls through package services comprising supplementary nutrition, immunization, health checkups, nutrition and health education and informal pre-school education of children. The performance audit of implementation of ICDS revealed several deficiencies.

The Government of India (GoI) instructions provide that anganwadi centres (AWCs) were to be opened for a population of 400-800 (rural and urban projects) and 300-800 (tribal projects). Mini-AWCs (MAWCs) were to be opened for a population of 150-400 (rural and urban projects) and 150-300 (tribal projects). Before opening of AWCs and MAWCs, mapping of the projects to identify villages inhabited by weaker sections of the society was required to be done for timely opening of the AWCs. However, the director, women and child development, Gujarat government, had no information regarding the actual distance of AWCs from the habitations.

The Government stated (September 2012) that as against 52,137 AWCs sanctioned by the GoI, mapping of 50,133 AWCs had been completed. However, completion of this work could neither be traced from the records of the Director nor the office could produce any records to audit in this regard.

Anganwadi centre in Mandvi taluka
Anganwadi centre in Mandvi taluka

Considering a population of 6.04 crore of the state (2011 census), 75,480 AWCs were required, against which 52,137 (69 per cent) AWCs were sanctioned and 50,225 were in operation (March 2012). The director, women and child, attributed reasons for non-operation of the sanctioned AWCs to non-availability of eligible/qualified anganwadi workers (AWW)/anganwadi health workers (AWH), time taking recruitment process, and shortage of staff. Failure to operationalise AWCs resulted in denial of benefits to the targeted population and loss of GoI assistance of Rs 10.38 crore. A population of 1.87 crore was deprived of the benefits of ICDS.

Out of 50,225 AWCs operational (March 2012), 20,521 AWCs were being operated from non-government buildings. Information on infrastructural facilities in respect of 2,664 AWCs was not available with the director. The government stated (September 2012) that these 2,664 AWCs were being operated from non-government buildings, which included rented buildings, school buildings, community halls, houses of AWWs, open-space and beneath trees. However, the details of these were not furnished by the Government. As such, some of the AWCs were working in open spaces or beneath the trees. Thus, the government failed to provide proper infrastructure for locating these AWCs.

Anganwadi centre in Kamrej taluka
Anganwadi centre in Kamrej taluka

In the 123 projects in eight test checked districts (consisting of 18,510 AWCs), basic amenities (building, safe drinking water and toilets) were not available in nine per cent to 40 per cent of the AWCs. Non-availability of basic infrastructure facilities in AWCs had adverse impact on the delivery of services to the beneficiaries. Data regarding provision of separate kitchen/ store, furniture, play-ground, etc. was also not available with the director. During field visits of AWCs of the selected projects, it was observed that though there were a few exceptions of well maintained AWCs, most of them were functioning in congested space, kutcha buildings and cattle shed.

The director attributed non-availability of land and site disputes, non-finalisation of list of centres, local level problems, non-opening of bank account, etc. for delay/non-commencement of construction of the remaining AWCs.

To cater to the needs of children of labourers, agarias and slums-dwellers, and those living in interior, scattered and tribal areas, etc., the women and child development department released Rs 2.21 crore for purchase of 46 vehicles for mobile AWCs. The vehicles were allotted to district panchayats/ municipal corporations, who were to bear the expenditure on maintenance including salary of driver and POL.

undernourished2
Infrastructure facilities in anganwadi centres in different districts

While replying (September 2012) the audit observations, the government stated that services were being rendered through 46 mobile vans. The reply is not correct as test check of records revealed that five mobile vans were not in operation; further, mobile vans were also not purchased out of Rs 1.72 crore sanctioned.

The Supplementary Nutrition Programme (SNP) aimed to improve the health and nutrition status of children in the age group of six months to six years (6m- 6y), pregnant women, lactating mothers and adolescent girls. SNP provided (January 2010) for supply of 500 calories and 12-15 gram protein per day for children between 6m-6y of age and 800 calories and 22-25 gram protein for malnourished children. Pregnant women, lactating mothers and adolescent girls were to be supplied 600 calories and 18-20 gram protein. Supply of the food module comprised a variety of food items acceptable among children.

Provision of breakfast in addition to one meal was also made (January 2010) for children in the age group of three to six years. Apart from this, food grains as take home ration (THR) were to be distributed to children in the age group of 6 months to 3 years, pregnant women, lactating mothers and adolescent girls.  The Supreme Court ordered (October 2004) to provide supplementary nutrition as per norms to all the eligible beneficiaries of AWCs.

Audit scrutiny revealed that as against 223.16 lakh children aged 6 months to 3 years, pregnant women and lactating mothers enrolled (2007-12), target fixed was only 170.32 lakh beneficiaries (76 per cent) in the state. Out of these, only 159.79 lakh actually benefited, thus 63.37 lakh beneficiaries were left out. Non-provision of supplementary nutrition to all the enrolled beneficiaries defeated the objective of achieving universalisation of the scheme as envisaged.

Percentage of children in red category showed increasing trend during 2007-12 (0.65 per cent to 4.66 per cent). As per National Family Health Survey-3 (2005-06) in Gujarat, every second child below five years, every third women and every second adolescent girl were underweight. However, despite providing SNP to targeted children during 2007-12, the Monthly Progress Report (March 2012) states that every third child was underweight.

The Government focused more on nutritional status of children in the age group of 3-5 years whereas maximum under-nutrition was noticed in children between 0-3 years. The government focused only on weighing and recording, but not much on counseling and intervention under the Nutrition and Health Education Programme under ICDS. There was limited focus on addressing long term under-nutrition, which was largely due to long term food deprivation and maternal under nutrition (among one-third of mothers).

During Exit Conference (January 2012), the government stated that convergence of various initiatives resulted in reduction of child mortality from 50 deaths (2008) to 44 deaths (2010) out of every 1,000 birth and decrease in maternal mortality rates. The reply was not justifiable as, in spite of the corrective steps, the percentage of malnourished children had steadily increased during 2010-11, showing a reduction during 2011-12. In 80 tribal projects of 11 districts percentage of moderate (yellow) and worst (red) malnourished children during 2011-12 ranged up to 44 per cent and five per cent respectively.

As per the prescribed norms, each identified malnourished child was to get 800 calories and 20-25 gram of protein per day. Scrutiny of records of eight selected districts revealed that despite 69,453 Grade-III beneficiaries identified as malnourished during March 2008-12, instead of the stipulated nutrition, the AWCs provided 500 calories and 12-15 gram of protein only to 25,673 (37 per cent) malnourished beneficiaries. Thus, the scheme failed to reach 63 per cent intended beneficiaries and reached the remaining beneficiaries only partially.

Further, in Ahmedabad, Anand, Junagadh, Sabarkantha and Surat districts, double the ration was provided (69,901 beneficiaries) against the 29,072 actual beneficiaries identified. The excess issue of ration ranged between eight per cent (Surat) and 933 per cent (Sabarkantha). No explanation was furnished in respect of issuance of excess ration and issue of ration to beneficiaries in excess of the identified number.

Government of India directives (January 2006) provided for supply of 50 per cent of micro nutrients as per recommended dietary norms through 80 grams of supplementary food to different target groups (6m-6y children, Pregnant and Lactating women and adolescent girls). However, this was not implemented in the State. Child development project officers (CDPOs) in the test checked projects stated (November/December 2011, June 2012) that a provision for expenditure on fruits (twice in a week) was being made in state budget (January 2010).

When pointed out, government explained (September 2012) about the efforts made by them in this regard. The fact, however, remained that the GoI directives to provide 50 per cent of micro nutrients was not implemented.

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