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Recent events in Bihar and other states bring out fallacies in implementation of Nutritional Support Schemes. The tragedy was a question to us that "Are we serious about health of children of our country?" Very high numbers of stunted children, anaemic girls and poor infrastructure to deliver Nutritional Support Schemes like Mid-Day Meal are serious doubts in answering above question in affirmation.
So the main question is where are we now and from here where should we go? Presently, schools and Anganwadis are institutions for delivery of hot meals and iron and folic acid tablets for anaemic children. The problem with these institutions is hygiene of lack of funds at disposal of ASHAs. Important point to note is that coverage of Mid-Day Meal has been impressive and the problem is with better delivery.
In the case of Bihar, fertilizers were found in very high proportion in food, lizard was found in Rajasthan and there are similar other problems with quality of cooked food. The problem was compounded when it was not properly tested by the person in-charge and hence even though smell and taste of food in Bihar was filthy, children went on to eat it anyway. Since funds are not available to ASHAs they have to go ahead with government's supply of food which is usually of substandard quality.
While providing iron and folic acid tablets, though there is availability of them with better funding from Central Government, reachability has been an issue especially for girls due to less attendance in Anganwadis and Schools.
Having described the problems, it can be easily concluded that complete revamping is needed especially at implementation phase. Corrective measures at every step are needed. Headmasters who are in-charge of keeping food supplies at their home in absence of storage facility and tasting food before given to children should be aware about the repercussions of their lethargic actions. A proper code of conduct from Government can be of great help here listing all the duties of headmasters and other officials included in the scheme. Regulatory mechanism to enforce this code of conduct is also needed to oversee adherence to it.
Hygiene is the biggest culprit and this should be corrected at the earliest. Clean dining and cooking are needed to prevent addition of any unnecessary organisms at the corresponding stages. For this, allocation should be enhanced first to come up with such an infrastructure and then a mechanism is needed to maintain the cleanliness. Mid-Day Meal Scheme can be amended to induce cleaners which can be a welcome change and can also generate employment. Giving statutory status to the cleanliness aspect of Nutrition Support Scheme is hence needed.
ASHAs should be empowered financially so that they can use the funds for better execution and it can also prevent leakages of funds in between the flow of funds. They can procure iron and folic acid tablets and can also buy standard quality of food items for children. Proper auditing and connection of ASHAs bank accounts through AADHAR can bring transparency in the usage of funds to prevent any misuse of funds.
Delivery of iron and folic acid tablets should be innovated. Lately, some states have introduced home delivery of these tablets periodically to ensure proper iron intake especially in girls. This should be made a national practice. A health record should be maintained (preferably electronically) and this record should be connected to State and Centre so that they are better equipped in gauging the status of delivery of tablets. Parents should also be made aware about the outcomes of iron deficiency and should be encouraged to monitor periodic intake of these tablets for their children.
Hence, it can be concluded that for inclusive development of Children, community led implementation is needed. With proper empowerment of parents and lower public servants, more funds to the scheme and use of technology for efficient implementation and relevant amendments in Nutritional Support Schemes, dream of healthy India can be realized. Then, the question of seriousness could be easily answered in affirmation and events like Bihar tragedy will not arise. Investment in children's nutrition today is dividend for tomorrow.
- Prashant jain