The recently-released National Family Health Survey, NFHS -4 report’s key findings about Odisha shows a sign of improvement in areas of immunization coverage, fertility rate, decrease in infant mortality, increase in institutional delivery and financial benefits under maternity benefit schemes which are higher than the national average.
But still there are specific backward locations and marginalised social groups whose conditions are matter of concern. The national and State average development in condition of health must be inclusive of backward areas and marginalized groups. There has been a felt need of more data on health of women and children for comparison of status across social groups and regions.
The fundamental areas of improvement in health depend on availability of decent house, safe drinking water, better sanitation and hygienic condition and access to nutritious food for all poor households. It is a fact that due to continued income and assets inequality there is a need for improvement of basic infrastructure and amenities for the poor and socially excluded groups who have no access to such opportunities for generations but in spite of dedicated schemes in mission mode for a long time, the achievement is far from target due to very slow progress. The children and women of SCs and STs in interior parts, Particularly Vulnerable Tribal Groups (PVTG), scavengers, landless agricultural workers and wage earners in rural villages are suffering from extremely serious malnutrition problem.
The benefits of schemes are getting diverted while poor quality of food is served in the absence of strong supervision and monitoring systems under the control of beneficiaries. The IMR, CMR and UFMR of SCs and STs in the State show relatively much higher level compared to other social groups and the State and national average. The SC and ST women suffer from iron deficiency anemia and sickle cell anemia. The immunization coverage of BCG, polio and measles is yet to reach to all children as SCs and STs have relatively less access to quality health service because of their dependence on Government healthcare service providers in rural areas.
It is found that a majority of the hamlets inhabited by SCs and STs and other poor have no basic amenities such as adequate house, sufficient safe drinking water, toilet and other sanitary facilities. Almost all family members visit outside for open defecation and no personal hygiene is being maintained. low income, social discrimination and lack of productive assets at family level lead to minimal access to nutritious food and practice of hygienic food habits. The uneducated mothers are in practice of inhuman traditional treatment and blind beliefs such as Chenka or branding a hot iron rod on child’s body to cure it. The majority of households have no homestead land to produce crops, vegetables and other nutritional food for family consumption at their backyard and they have also restricted access to village commons such as pond and forest to collect food.
A vast majority of them has no agricultural land to grow crops as a result of which the marginalized poor mostly depend on State sponsored nutritional supplement to meet the need of the children and women in family. The community members have very less awareness on nutrition, personal health, hygiene, hand wash and cleanliness due to illiteracy and lack of exposure and above all lack of access to required facilities provided by the Government.
These days the focus of the Government is more visible to improve fair share of women in all spheres of social life and bring desirable change in life of children by including their concerns in budget with introduction of child and women budgeting.
There has been a whole host of national schemes by the Central Government such as the National Health Mission, the Integrated Child Development Services (ICDS), the Mid-Day Meal (MDM), the National Rural Drinking Water Mission, the Swachha Bharat, various maternity benefit schemes and the Prime Minister Awas Yojana (PMAY) to improve the quality of life of women and children which must reach to the inaccessible areas and excluded groups those who actually deserve such assistance. Evidence shows though these schemes have continuous flow of funds. There has been lack of public awareness and most significantly involvement of women of majority of beneficiaries groups in the implementation process as service providers. Any development intervention requires participation of the people for whom the scheme is being targeted. In this context, the participation of SC and ST women in most important schemes such as ICDS is quite discouraging in Odisha.
The ICDS is the world’s largest supplementary nutritional programme, which includes morning snacks, hot cooked meal and takehome rations ready to eat for 300 days in a year for the poor. It is operational since 1975 with a budget sharing arrangement ratio of 60:40 between the Centre and the State. AWCs are village level common space of children for health, nutrition and early learning and AWWs and helpers are social change agents. The AWCs take care of the most important period that is 0 to 6 years that shapes the physical and mental growth and early socialization process of a child. The scheme has roped international agencies such as UNICEF, DFID and FAO and corporates such as Vedanta in various roles for larger coverage and to meet the emerging resource needs. It also has made convergence of many rural schemes such as MGNREGS for construction of AWCs.
Currently there are about 14 lakh Anganwadi centers in the country with an annual expenditure of Rs 16 lakh crore in the year 2015-16 which primarily serve the children and women. It is told in the guideline of the scheme drafted by the Ministry of Women and Child Development that the population is the norm for setting up AWCs and mini AWCs to cover all habitations and particularly those inhabited by SCs, STs and minorities. There is provision of AWCs on demand where at least 40 children under six years are available. The tribal areas have relaxation with provision of one AWC having population of 300-800 and mini AWC having 150 to 400 population. Odisha has 74,154 approved AWCs and the Centre has released Rs 69,173 .49 lakh during the year 2016-17. The AWWs and helpers have regular salary and social security benefits, free dress and insurance, along with 50 per cent reservation of vacant posts of supervisor for experienced AWWs.
Ideally, 40 per cent of service providers, like AWW and helper, in ICDS projects must belong to SCs and STs in Odisha but unfortunately women of these communities have very insignificant representation in the ICDS activities.
It is observed that SC and ST women and their SHGs are not being preferred as service provider like cook or supplier of food and also not as members of supervising and mother committee because of their social identity based on caste and ethnicity. The fact is mostly the dominant upper caste women have the chance to get employment and income. The State Government has not made any effort to see the caste balance in ICDS projects in Odisha where SCs and STs do not have a reasonable share in public employment. It is suggested in policy that the SC and ST dominated hamlets must have AWCs on priority basis but in reality, the AWCs are being set up mostly in caste Hindu hamlets where SC and ST children face discrimination. The issues of social discrimination in access to nutritional food out of public fund must be taken seriously.
The scope of social benefit sharing must be socially inclusive which will not only bring nutritional improvement but also bring radical change in our age old discriminatory social systems and the ICDS and such other schemes can be used purposefully by the Government to bring larger social change in our caste ridden society.
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