Not long ago, the pictures of severe malnourished children from Nagada in the north to Kashinagar in south were galore in Odisha, the bitter home truth to the fore today is the tally of severe acute malnourished (SAM) children in the State was up by over 48k during the last two decades.
The State government seems less bothered over the rise is evident from the fact that Odisha could utilise only 46 percent of the total POSHAN allocation made available by the Centre in 2020-21. And the irony was that the State had foregone a whopping Rs 151 cr between 2017-20 for not implementing the scheme, despite having saddled with a massive 2.094 lakh SAM children in 2005-06.
As per the recent NFHS-5 data, the proportion of severely wasted (weight to height ratio) under -5 children in Odisha has increased to 6.4 percent from 5.2 percent in 2005-06. And the estimated SAM U-5 children have increased to 2.578 lakh in 2020-21 from 2.094 lakh in 2005-06. This show during the last two-decades, the estimated SAM children in the State has posted a rise of over 48,340.
POSHAN Link With SAM
The POSHAN Abhiyaan was launched in 2017 by the Union Government with a goal to improve the nutritional status of children (0-6 years), adolescent girls, pregnant women and lactating mothers.
The target of the mission is to bring down stunting in children (0-6 years), from 38.4% in 2016 to 25% by 2022. Besides, it also aims to reduce anemia among women and adolescent girls (15-49 years) and improve birth weight. The mission of the scheme is to eradicate undernutrition at the grassroots and make India malnutrition-free India by 2022.
The State didn’t implement the scheme till 2019. However, Odisha made a U-turn in 2020 and implemented the scheme. The Centre allocated Rs 163.58 cr in 2020-21, but the utilisation in the State stood at Rs 75.55 cr.
Significantly, one of the main features of the POSHAN scheme is to set up Nutritional Resources Centres (NRCs) in districts having high prevalence of Severe Acute Malnutrition (SAM).
NRC And SAM
Nutrition Rehabilitation Centres (NRCs) function at public health facilities exclusively to cater to the under-five sick Severe Acute Malnourished (SAM) children who are admitted for clinical management of their medical complications along with nutritional management.
Recently, a Union Women and Children report revealed that the Centre has identified a high of around 15,595 SAM children in Odisha who have undergone treatment at NRCs.
Odisha has established 45 NRCs vis-a-vis 315 by MP,62 by Chhattisgarh and 68 by Jharkhand. All the states have been grouped in High-Focus states in the country where undernutrition and SAM children are among the top-10 in the country.
Moreover, only around 16 NRCs are functional in as many as nine high-burden western Odisha districts where the infant mortality and U-5 deaths are very high.
As per WHO and Unicef, NRCs play a vital role in cubing the rising SAM children, if the concept of NRCs (started in 1955) is to be implemented holistically.
Nagada And NRC
July 2016: Odisha hit national headlines when as many as 19 children died of malnutrition. This could have been prevented had the Odisha government established NRCs there.
How?
Here is what a WHO report has observed.
“Linking of NRCs with the community-based core model of management of severe malnourished needs to be implemented in letter and spirit. This model as envisaged by the WHO provides a framework for an integrated public health response to curve malnutrition, treat most patients with SAM at home, and that in-patient care is reserved for those with acute medical complications,” observe a WHO report.
Had the State government implemented the NRs in letter and spirit, lifes of 19 innocent tribal children could have been saved.
Despite Nagada setback, Odisha refuses to take any lesson, which is evident from the lackadaisical implementation of the POSHAN scheme.
Malnutrition Scenario In Odisha
NFHS-5 2020-21:
• Stunted U-5 children in Odisha is 34 percent.
• Under weight U-5 children at 34.4 percent.
• While State has recorded a drop in stunted and underweight proportion during the last 2-decades, it has posted a rise in the proportion of wasted and severely waste children.
• Odisha has high U-5 mortality rate. And SAM is the major cause.
• Worst hit districts number is 18 (Malkangiri, Koraput, Rayagada, Gajapati, Ganjam, Kandhamal, Kalahandi, Balangir, Nabarangpur, Nuapada, Bargarh, Boudh, Subarnapur, Sambalpur, Jharsuguda, Sundeargarh, Keonjhar and Mayurbhanj), where nearly half of the child populace under-five are in stunting category. The proportion is nearly 35 percent in four other districts.
• On an average, at least one-third of children under five years of age in 29 of 30 districts are in the grip of malnutrition, reveals a NRHM (National rural Health Mission) report.