[Hunger Alert] UPDATE (India): Home-based treatment for the malnourished children living in remote rural area needs to be encouraged
The Asian Human Rights Commission (AHRC) has received updated information regarding two malnourished children from a human rights group based in Madhya Pradesh, Spandan Samaj Seva Samiti (Spandan). One was taken to the district hospital to get treatment while another was not. As the family live in remote rural village, they find it difficult to take the child to the district hospital which is 100 kilometres away from the village. In addition, to this if the mother takes the child to the hospital and remains with the child there is no one who can take care of the other children and do the housework in her place. The AHRC recommends that the government provide special medical care to malnourished children, not only by the Nutrition Rehabilitation Centre but also by strengthening existing facilities and services in the villages.
23 June 2009
[RE: AHRC-HAU-003-2009: UPDATE (India): Two children suffer from malnutrition in Khandwa district of Madhya Pradesh]
INDIA: Home-based treatment for the malnourished children living in remote rural area needs to be encouraged
ISSUES: Right to food; right to health; malnutrition; government neglect
The Asian Human Rights Commission (AHRC) has received updated information regarding two malnourished children from a human rights group based in Madhya Pradesh, Spandan Samaj Seva Samiti (Spandan). One was taken to the district hospital to get treatment while another was not. As the family live in remote rural village, they find it difficult to take the child to the district hospital which is 100 kilometres away from the village. In addition, to this if the mother takes the child to the hospital and remains with the child there is no one who can take care of the other children and do the housework in her place.
The AHRC recommends that the government provide special medical care to malnourished children, not only by the Nutrition Rehabilitation Centre but also by strengthening existing facilities and services in the villages.
Two-year-old girl Sumantra, accompanying her mother was taken to the Nutrition Rehabilitation Centre (NRC) at Khandwa District Hospital in May. She suffered from Severe Acute Malnutrition (SAM) which was reported in AHRC-HAU-003-2009.
In response to the AHRC's report, the Chief Medical Officer, Dr. Laxmi Baghel visited Chadida village and encouraged the families of the two malnourished children to take their children to the NRC for proper treatment.
The district administration provided free transportation for Sumantra and her mother to reach the district hospital which is 100 kilometres away from the village. Sumantra was admitted at the hospital and underwent nutrition and medical treatment for twelve days. She gained weight after the treatment and is now able to crawl. The Anganwadi Centre (AC; Child Care Centre) in the village also currently provides dried rations for her either by AC worker visiting her home or by her mother visiting the AC.
On the contrary, the family of the three-year-old boy, Sonaram could not manage medical treatment for him at the district hospital. Although Sonaram's parents were worried about his health, there are other children to be looked after by mother. As they live in remote forest area, the district hospital is too far away from their village. The family are trying to take care of Sonaram at home whilst looking after the other children and doing the house and farm work.
Both of the families were issued Antyodaya ration cards with which the families can afford to collect rice and wheat at three rupees and two rupees per kilogram respectively. Earlier, Sumantra's family had an Above the Poverty Line (APL) ration card and Sonaram's family had a Below the Poverty Line (BPL) card. The AC gradually started functioning better by providing dried ration to the malnourished children in the village. However, only 35 kilograms of rice and wheat per month are given to each card holder which is not sufficient for all family members.
The rainy season in Madhya Pradesh starting from June is called 'season of death' as many children die of malnutrition and various diseases during this period. Sixty-two children in Khandwa district alone died of malnutrition since June 2008. The children from different villages are currently being taken to the NRC at district hospitals. For the details about the children's death in 2008, please refer to the AHRC-HAC-002-2009.
According to the Spandan, thirty children from Khalwa Block have been already taken to the NRC. It seems that the district administration, in association with the state government is making an effort to prevent child death during this particular period by providing nutrition and medical attention at the centre.
As was seen last year from the government announcement, particularly from the Department of Women and Child Development, the parents who have malnourished children are encouraged to take their children to the NRC at the district hospital. It is also suggested to that they do not remove the children from the NRC without letting the medical officer know.
Given the fact that the NRC merely pay attention to the SAM including stage III and IV, many children who suffer from malnutrition still remain at home without proper treatment. It was already observed in previous hunger alert that even some children taken to the NRC last year were sent back home as the doctors did not diagnose them as SAM patients although the children suffered from malnutrition.
Moreover, the parents find it difficult to take care of other children and their housework while they stay with the malnourished child at the NRC. Often the NRC is far way from villages, which in itself is an impediment for the villagers, in addition to their difficulty to cope up with the life in the towns which is alien to them. Both of the families in this case have to manage farming everyday which also makes it difficult for them to stay away from home for long periods.
A mother accompanying her malnourished child is expected to receive 65 rupees a day for her own meals and the daily income which she loses due to having to attend to her child at the NRC. The amount is earmarked as the official minimum wage in Madhya Pradesh. However, the minimum wage of the agriculture workers (65 rupees) is lower than other industry sectors (93 rupees). Despite soaring food prices as well as the rising costs of goods, the minimum wage of the agriculture workers remains much lower than the actual cost of living. The government takes it granted merely because the agriculture workers are traditional and unskilled labour although the population of the agriculture sector accounts for more than 60 percent of the total industry. In addition, a number of small-scale-farm owners even do not pay minimum wage to the agricultural labourers in practice.
Most of all, considering the living conditions of the tribal community, it is recommended to provide special medical care to the children in all stages of malnutrition, not only at the NRC but also in the village through the existing facilities such as AC which will be more prompt and effective. Thus the parents also can manage to look after other children, house work and farming whilst remaining at home.
On 12 June, the Department of Women and Child Development announced that they plan to select 250 villages out of a total of 1000 that are prone to food insecurity and child malnutrition, in order to provide special attention to the children by strengthening the ACs in the village. The villages in Khalwa block occupied by the Korku tribal community have lost many of their children to malnutrition. The community still have a number of malnourished children who should be given priority.
Please write a letter to the authorities named below to express your concern for the children and their families. The AHRC is also writing a separate letter to the UN Special Rapporteur on the Right to Food and on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health respectively calling for intervention.
To support this appeal, please click here:
INDIA: Please provide medical care for the malnourished children not only at the Nutrition Rehabilitation Centre but also within the villages, Madhya Pradesh
Children suffering from malnutrition:
1. Sonaram Manag Kasde, three years old, suffering from Sever Acute Malnutrition
2. Other malnourished children from Khalwa Block currently admitted at the Nutrition Rehabilitation Centre of Khandwa district
Location: Khalwa Block, Khandwa district, Madhya Pradesh
I am writing to express my concern about the malnourished children in Khalwa Block in Khandwa district who do not receive appropriate medical care to escape from starvation and malnutrition.
I have learned that the Asian Human Rights Commission (AHRC) has reported in April 2009 the case of two children who were suffering from Severe Acute Malnutrition living in remote rural area in Khalwa Block, Khandwa district.
I am informed that one of two children reported in that case received treatment at the Nutrition Rehabilitation Centre (NRC) after the Chief Medical Officer visited the village and encouraged the parents to take the child to the NRC. It is good to hear that the child and her mother were provided with transportation and medical care by the government. I am informed that the child gained weight and now is able to crawl around.
However, I am concerned about the second child, Sonaram, who could not receive appropriate treatment at the NRC. I am informed that Sonaram's family could not take him to the NRC since the family could not afford to stay away from home leaving other children and their job which is their only source of income and since the NRC is far away in the town. As of today Sonaram is yet to receive an appropriate treatment.
This exposes one of the practical yet important deficits of the treatment scheme. Instead of the patients reaching the NRC, the facilities provided at the NRC must reach the patients, particularly in the rural backdrop, were the patients reside in remote areas away from town. The treatment programme must be geared to ensure that while one child receives treatment, the rest of the family must not be pushed to starvation since the earning member in the family is forced to leave his or her job to accompany the child.
As the parent has to look after other children, housework and farm work for a living, they find it difficult to take the child to the NRC at the district hospital which in Sonaram's case is 100 kilometres away from the village. The tribes living in remote forest area are also not familiar with town life which is another reason for them not to stay away from the village for long period of time. In addition, the subsidy given to mother for three meals a day and daily income is not sufficient to manage it. The existing scheme and service provided through agencies like the NRC must therefore be made available in the village.
Most of all, considering the living condition of the tribal community, it is recommended to provide special medical care to the all stages of malnourished children not only at the NRC but also in the village through the existing facilities such as AC which will be more prompt and effective. Thus the parent also can manage to look after other children, house work and farming at home whilst remaining at home.
I am of opinion that to eradicate child malnutrition and to ensure food security, the government needs to take more active and prompt action by fortification of village level of medical service and nutrition supply.
I am aware that on 12 June, the Department of Women and Child Development announced that they plan to select 250 villages out of 1000 villages that are vulnerable to food security and child malnutrition, in order to provide special schemes for the children by strengthening the ACs in the village. The villages in Khalwa block occupied by Korku tribal community who have faced many child deaths and who still have a number of malnourished children should be given priority.
I am looking forward to your positive and effective action for all the malnourished children in Madhya Pradesh.
PLEASE SEND YOUR LETTERS TO:
1. Renuka Chowdhury
Minister of Women and Child Development
Government of India
Fax: +91 11 2307 4054
2. Justice Mr. Balakrishnan
Chief Justice of India
Through the Office of the Registrar General
Supreme Court of India
1 Tilak Marg, New Delhi
Fax: +91 11 2338 3792
3. Principal Secretary
Ministry of Health & Family Welfare
Maulana Azad Road
New Delhi - 110011
Fax: +91 11 2306 1751
4. Mr. Shivraj Singh Chouhan
Fax: +91 755 2441781
5. R. C. Sahni
Government of Madhya Pradesh
Bhopal 462 004
6. S.B. Singh
Khandwa District, Madhya Pradesh
Fax: +91 733 2224233
7. Country Director
World Food Programme
2 Poorvi Marg, Vasant Vihar
New Delhi 110057
Fax: +91 112 615 0019
73 Lodi Estates
New Delhi 110 003
Fax: + 91 11 2462 7521 / 11 2469 1410