Re: Malnutrition in India

['Stephen Umemoto' via xUNICEFers]

UNICEF India does not yet seem to have internalized these findings.  The website says on the subject of child nutrition: 

"India is making good progress but there is a need for national leadership to accelerate already successful efforts to end stunting and other forms of undernutrition across India."

On Monday, 14 December 2020, 02:23:50 GMT, Gourisankar Ghosh <gourisan...@gmail.com> wrote:

https://indianexpress.com/article/india/malnutrition-in-kids-worsens-in-key-states-2015-19-7103820/

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['Susana Sandoz' via xUNICEFers]

Dear all,

Reading with surprise the increases in stunting in some Indian states despite real advances in decreasing Open Defecation.  Surprise, becasue it has been theorized that children growing up in Open Defecation Free communities have a much better chance of not being stunted (26% according to a 2015 study in Mali)- https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00144-8/fulltext, and environmental enteropathies, casued by fecal contamination, have always been seen as one of the main causes of long-term malnutrition and therefore stunting...oh, oh, we might have to revise our theories.

I am attaching a presentation which has often been used to demonstrate the importance of sanitation, making emphasis on its impact on malnutrition...we need to dig further into this, I think. Slide 4 below is of special importance:

 

Season's Greetings to all of you,

Susana Sandoz

ex WASH officer, manager and chief.

"Remember that when you leave this earth, you can take with you nothing that you have received - only what you have given."

On Tuesday, December 15, 2020, 06:39:44 a.m. EST, Anjana <anjana.ma...@gmail.com> wrote:

Thanks Stephen for drawing attention to UNICEF's website. 

Not only this, but in an article published by UNICEF just last week in mainstream media, it goes all out to rejoice the 'progress on nutrition' that India has made and regales on the success of the nutrition scheme (POSHAN Abhiyan) that was launched by the country's current prime minister in 2017. I am wondering if UNICEF is aware that only 30 percent of the 1.2 billion USD that was allocated for 3 years to the programme (50% is a loan from WB), have been spent (as per a report published in 2019).

A significant portion of the WB funds were to be used for monitoring, tracking and recording the delivery of services to children and mothers across all the central govt run early childhood centres (anganwadis, AWs) touted as the world's biggest nutrition system for pregnant mothers and children. With support from the Bill and Melinda Gates Foundation, a massive nutrition monitoring portal had been developed - the ICDS-CAS, an innovative web and mobile phone based application to ensure swift tracking, effective implementation and smart programme management. It had uploaded data of all the 700,000 AWs of the country.  No guesses who the Indian service provider is, a mobile and media technology company that enjoys a privileged position in the country and has grown in leaps and bounds in the last 3-4 years. 

The server was being hosted by the BMGF and its US collaborator. Once the ICDS-CAS got off to a great start, the Indian govt insisted that the portal be transferred to India, to an Indian service provider. In principle this sounds like a sensible step  - towards transfer of technology and management of the portal nationally. However, eversince the transfer, there have been endless snags that developed and the portal has been down now for sometime!

At a time when the need to intensify efforts to identify mothers and children in need of nutritional interventions is greatest, not only because of the ongoing high rates of stunting and malnutrition in the country but due to the COVID related aggravation of poverty and hunger, the collapse of the ICDS-CAS, the mainstay of POSHAN Abhiyan, has been a huge setback as real time monitoring of the situation is not possible any more. The delivery of nutrition services to all children as also targeted nutritional supplies for the most needy have been brought to a halt or slowed down hugely, due to the lack of the online data based on which the food supplies are released.  

Little wonder that the situation of nutrition is so dire in the country today. There are at least 2-3 articles published every month in mainstream media drawing attention to the worsening situation.      

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Anjana

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['Susana Sandoz' via xUNICEFers]

Sorry I can't comment about the Clean India Movement, the gvt's or UNICEF's involvement , I know practically nothing of this topic.

What I can say is that we have since discovered the eliminating Open Defecation (OD) is mainly about changing behaviours wrt OD, and reduction of fecal pathogens (combined) and NOTabout building toilets.  Once we learn this lesson, we will advance in the kind of impacts the WASH programme needs to achieve.

Don't get me wrong OD is only one aspect, we need to reduce fecal contamination as well to have this impact.  A clear example was work in rural areas with UNICEF Guatemala:  when we started the OD campaign in 2016: 92% of the population in the areas we were tackling HAD and PROBABLY USED latrines...but fecal contamination was rampant (no handwashing, dirty diapers everywhere, children's feces, flies spreading contamination, dirty latrines...and chronic child malnutrition was at 43% (and ODF was APROX 92%!)...this might help explain why despite "access to latrines" malnutrition is increasing in some states, probably becasue fecal contaminatio is still rampant.

"Remember that when you leave this earth, you can take with you nothing that you have received - only what you have given."

On Wednesday, December 16, 2020, 03:27:09 a.m. EST, Devinder Chopra <ddch...@gmail.com> wrote:

GOURISANKAR  Ji,

                               " TODAY WE HAVE CHEQUE WRITERS "  makes one wince a little !

                                   Much has indeed changed a lot from the times of JPG & DPH !

                                   Warm regards...Stay Safe & in Peace       dev chopra in gurugram

On Wed, 16 Dec 2020 at 12:43, Gourisankar Ghosh <gourisan...@gmail.com> wrote:

Yes Peter ! Thanks for correcting the typo ! I may share a fact . The sanitation programme was launched first time in India by the then PM Sri Rajiv Gandhi in 1985 . Then UNICEF India did an independent evaluation after I took over that programme in 1986 in the government and found that 70% of the constructed toilets were not in use or used for something else ! There were also corruption in the approach of construction by contractors ! I presented the findings to the then PM and with his approval was able to stop the implementation and reevaluate the programme . No ego was involved . 

After that successful model was established by UNICEF in Midnapur District in West Bengal particularly by Benoy Das of UNICEF Calcutta . Ramakrishna Mission Rural Development programme was involved as NGO and linked the hygiene education as part of literacy campaign . Ladies and youth clubs were partners . It was a success with more than 2 million people having access to knowledge of sanitation within four years and the impact was visible . The model was successfully used in other districts of Bengal.

The difference of the then UNICEF and of today’s one is clearly visible ! 

We have number of India UNICEF stalwarts in this group which includes Tom ,Steve , Alan among others who honestly but diplomatically could tell the government when things went wrong . Today we have cheque writers ! 

Wish you and friends a very joyous festive session !

Gouri

On Wed, 16 Dec 2020 at 9:51 AM, Peter Chen <peterc...@gmail.com> wrote:

Dear Gourisankar, 

In your statement "The entire Clean India movement isn’t a big hoax and implemented to provide contracts to petty as well as big suppliers and contractors only", I think you actually meant "The entire Clean India movement is a big hoax...." You also said " the programmes spend more on publicity than in its substance and UNICEF India is a conniving party to this approach. UNICEF and their staff are kowtowing the lines of government.." and I fully agree with you (having worked in UNICEF India country office from 1983-1990). I hope that the present UNICEF ICO Rep and especially the WASH staff are listening to you.

Best regards and greeting to all for the festive season. Stay safe everyone.

On Wed, Dec 16, 2020 at 9:32 AM Gourisankar Ghosh <gourisan...@gmail.com> wrote:

Dear Susana,

The comments of Anjana and you are very valuable . When the great sanitation programme was launched as Swachch Bharat by the current PM , I kept on insisting on the priority of Hygiene education and implement ion of the hardware as per the created demand but they juggernauted the programme with a WB person as the head ! Then I tried to advise them on the impact evaluation and there was none . No involvement of grassroot NGOs as the current government does not trust them . So we have a clear case where the country is claiming a huge success in stopping open defamation but it is not the case. Besides mere stopping open defamation if not a total sanitation achievement unless hygiene Knowledge and practice is improved . Without the complete WASH you will not get the end result . 

In India the programmes spend more on publicity than in its substance and UNICEF India is a conniving party to this approach. UNICEF and their staff are kowtowing the lines of government and stopped doing independent analysis . 

The entire Clean India movement isn’t a big hoax and implemented to provide contracts to petty as well as big suppliers and contractors only . 

Gujarat is a state which is trumpeting it’s development model but where steadily the malnutrition is increasing since the current Indian Prime Minister was the Chief Minister there . I personally pointed the same to him long before he became the PM but with no result excepting in organising industrial jumbories like Garvi Gujarat ! 

Gourisankar Ghosh 

Please use my new e mail address  as <gourisan...@gmail.com>

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['Stephen Umemoto' via xUNICEFers]

Dear Geeta,

        You provide the sort of frank, grassroots feedback we used to seek and act on --- not pushing it in the face of our goverment counterparts, but gently suggesting that all was not as it should be and we had together to strive for major change.  It may be that some current UNICEF staff at national or state office levels are indeed  doing this now, but the short passage on the Country Office website seemed reflect a perspective that all is moving forward well. 

        I wonder Geeta, do you think there are any corners in the country (even in only a single district) where the Anganwadi system is receiving the support and resources to have a significant impact on child nutrition?  Years ago, when we were faced with dismal performace, we looked for the corners of success (no matter how small or remote) and tried to shine light on what they were doing right. 

         I am not in the least eager to critizise the current operatoin of UNICEF in the country, but honestly wishing to understanding how they are operating in this important field, from national advocacy, down to possibe inputs at community level to facilitate the work and impact of Anganwadi workers. 

          Steve

On Wednesday, 16 December 2020, 09:18:43 GMT, Geeta Athreya <geetaa...@gmail.com> wrote:

India is not making any progress in getting rid of malnutrition. This is the usual UNICEF rhetoric in not annoying the government by speaking anything against it or its orogrammes. I did it for 20 odd years in UNICEF. Doing the doable and handholding the government at all stages. 

I have been working in the slums of  Govindpuri for the last four under a hare brained scheme of the AAP government. The scheme is a non starter but I have been working with a total free hand because they don't really care about the scheme! 

What I have seen is listed in an article which I hope will get published. But let me give a few examples. 

1. The nutrition for children in Delhi Anganwadis comes from  a cooked meal and a snack delivered to the AW every morning. 

2. There are take away dry panjiri ration for PW and lactating mothers. 

3. The mother's can collect food for under 3's from the AW. 

4. The cooking is outsourced to an NGO which delivers food according to a set menu. The food comes at 9 a.m. and the children are fed at 12 noon. By then the food has congealed into a hard mass. 

5. The snack on most days is a dry chana snack. 

6. The Anganwadis do not have running water facility. No attached toilets. 

7. They have no plates and katoris, spoons.

8. They have no new daris for the last 6 years. There is no place for any furniture. 

9. There are no weighing scales to measure weight. Out of the 29 Anganwadis, 5 of them had some old weighing scales. 

10. Yet they all report everything. 

11. So what is the use of any monitoring system when what is needed is improvement at literally the dari level? 

12. The AAP government gave smart phones to all workers to report data. They were writing false data. Now they punch in false data. 

13. The Anganwadis don't have anything. No toys, no books, no colouring materials, no playthings, no daris, no plates and spoons , no nothing. Then what are they monitoring? 

Let's look at rural Anganwadis. I went to Rajasthan on some other work and insisted on seeing Anganwadis. The food they get was so shockingly little that each child will get a half katori of rice and dal. Thats all. When I asked them how is this enough, they said we get so little money. We can't do any better than this. 

There are many more things about the Delhi urban Anganwadis. I think we get the general picture that malnutrition is not going anywhere, when it is do happily ensconced in India. 

The moment we say this they will come up with some 70 good examples. 70 against 700,000. What a travesty. 

On Mon, 14 Dec, 2020, 7:53 am Gourisankar Ghosh, <gourisan...@gmail.com> wrote:

https://indianexpress.com/article/india/malnutrition-in-kids-worsens-in-key-states-2015-19-7103820/

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['Stephen Umemoto' via xUNICEFers]

Gouri,

        A great wealth of history based on your extraordinary role in both with GOI and UNICEF is moving the country forward in the water and sanitation area.  Also you and your WASH compatriates are absolutely correct in hi-lighting the criticallink bewteen sanitation and child nutrition. 

        Why did I introduce the link between the issue of apparent recent regression in child nutrition and what I could find about UNICEF's involvement?  I think all in the x-unicef community hope and pray that the organization continues to be relevant in addressing the long standing and emerging challenges to child survival, well beng and development.  So when I encounter news of a new (continuing and/or returned) challenge, I really, really want to know what UNICEF is doing on the ground. 

       Now the country office websites may or may not be the best available place to look, but it is at least a start.  We of course can guess that part of the puropose of these websites if for profile and fundraising, but we should hope and expect that they might also reflect operations and actions on the ground.  I find that the "Research and Reports" tab on most of the UNICEF country office websites tends to be the most substantive.  So I found a reasonably hot-of-the-press (April 2020) study "Children and Adolescents in Urban India - Scale andN 

atureof Deprevation".  And indeed it has a major section on Nutrition and another on Water, Sanitation and Hygene Facilities. 

With my aging eyes not up for reading dozens and dozens of  pages, I had a look at the three pages of "Conclusion and Policy Implications" for the nutrition section.  (I lifed it out and its attached).   Reading it I found my optimistic and less optimistic selves have different takes. 

The optimistic:  This coopeeration between UNICEF Delhi and the Institute of Urban Affairs is a really good piece of work -- comprehensive and very well presented.  I can see us back in the 70s,80s and 90s being very please and with a sense of accomplished once the final copies were on our desksfor distribution to policy makers, HQ and donors. 

My less optimistic:  Could we not have arrived at much of the same conclusions back in the 80s?  Could there not be more references  to recent history and why some of the problems are still with us.  If some of the incredible initiatives that Gouri and others recount have not had a long-lasting impact, then why?   No mention in the study of regression, as suggested in the recent report. 

Please be assured that my interest is NOT to be critical of UNICEF, but merely to discover if an how they may be addressing various needs of children.  It may be that UNCEF in India is doing absolutely the best job possible in addressing child malnutrition in India -- and if so, as a member of UNICEF-UK I would to know exacdtly how.      

And on a lighter note, even the best editing cannot catch every blooper.  So in the middle of the attached conclusion section is the passage:  "The low level of malnutrition is reinvorced by illiteracy, an inadequate housing environmennt, sanitation and water."    Should we be going for illiteracy?

                          Steve   

On Thursday, 17 December 2020, 03:43:04 GMT, Gourisankar Ghosh <gourisan...@gmail.com> wrote:

Dear all,

It was a very interesting discussion . I had no intention to start any debate but just tried to point out why the well intentioned intentions do not bring in expected results because people planning it or designing it either do not implement it with knowledge of lessons learned or do not intend to use the tools properly.

Let me put some historical facts. These are apolitical and unemotional :

1. The first sanitation problem of India was recognised by Sri Rajiv Gandhi and it was with his direct intervention he launched the National Sanitation programme in 1985 to improve the rural sanitation in India. yes, it is true he did not make any announcement from the Red Fort!

2. That programme was based on toilet building only and as I mentioned before it was stopped with his approval in 1988 after the UNICEF survey . I took over the charge after it was launched and then requested UNICEF to do that survey which they did ( incidentally through a reputed NGO) 

3. The Sanitation committee of the Planning Commission of which I was the chair recommended the restructured programme starting with education of hygiene and behavioural changes and construction of the toilets with full participation of the community with their partial contribution to its cost.

4. The programme again started in its new form and UNICEF also focussed on the school sanitation with success.

5. The announcement of Clean India or Swachch Bharat was not  any new programme but a campaign to give a boost to sanitation but the programme to be implemented under the same National sanitation Programme of 1985. Incidentally when the WASH campaign was launched in Bonn by WSSCC with the support of DFID, SDC and Dutch AID to get the sanitation goals in WSSD Johannesburg, the Indian Minister of the then NDA govt refused to attend the ceremony. South Africa took the lead and in 2002 we got sanitation as one of the Millennium goals.

6. Agreeing with Susana , I did not dismiss the CLTS or ODF campaign. I only said they are the tolls and part of the whole. Here comes the hoax with deliberate use of a term or methodology but not following in practise on ground. Susana may calculate how much time should  take to sensitize the Billion plus population and nearly 665000 villages to be covered in four years after  changing the behaviour , mobilise the community with at least three visits to each village and then to construct . Is it possible physically ? I can add pictures after picture but here we were not criticizing the political leaders but the implementation !

7. Today's headline in Indian lead papers shows the slip of India further to 131 in the Human Right Index. The GDP is now lower and as per the IMF forecast going to be even lower further in the coming years . I attach a link below as in 2017 where the UN representative expressed concern about the human right violations in the Clean India campaign. In the name of stopping open defecation, low caste people were beaten to death! all these in the name of CLTS !

https://www.outlookindia.com/website/story/top-un-expert-says-pm-modis-swachh-bharat-mission-flawed-it-lacks-a-holistic-hum/304173

8. Looking at India through a binocular is very nice but the realities on ground are different and specially when the truth is like an onion ! My only humble submission is that if anyone wants to do good for the country then one has to be physically here and work with facts and people to understand not with emotion and their beliefs. Development programmes are not 'surgical strikes' , a phrase again became very popular due to media publicity. 

9. So far UNICEF India is concerned , I really have no opinion or interest. I do not consider at the given position any UN agency is influential . They are all in a peripheral position just towing the lines given to them. So though I lamented for their inaction it is immaterial in the current context. 

I still will adhere to my choice of word 'hoax' as it was in the case of demonetisation , Gujarat Model , Seven Trillion dream , etc. etc. However this is not the forum to discuss politics. But as we know politics is a reflection of a society and directly connected to social development . The social fabric is being torn and the Indian society is in turmoil.

Gouri

Please use my new e mail address  as <gourisan...@gmail.com>

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