Friday, January 13, 2012

Malnutrition in India : What should the private sector do?


I have just finished a trip to India to help contribute to the efforts on ending malnutrition. The politicians and media were talking about the sparkling new economic growth and development figures. There was no such attention given to the “other” growth and development figures — those related to child nutrition. These figures are less than sparkling. If current rates of progress in reducing undernutrition are not improved upon, India will reach the U.N. Millennium Development Goal of halving undernutrition by 2043. The target date is 2015. China has already exceeded the target.
Celebrating 9% Growth of GDP
There are some glimmers of hope. The State of Karnataka has just adopted a Nutrition Mission which promises to give focus, coherence and urgency to efforts to combat undernutrition. There are some initial indications that the decline in undernutrition rates may be accelerating in one of the worst affected States, Madhya Pradesh. More and more international agencies such as the U.K.'s Department for International Development have ramped up their focus on nutrition. But there are worrying signs at both the national and State levels. It is at least 18 months since the creation of the Prime Minister's Council on Nutrition. It has not met once. The scandal of rotting food grains in the midst of hunger and undernutrition has rightly been getting a lot of media coverage. And we still don't know who in Delhi is responsible for leading efforts to reduce undernutrition.
During my stay I went to Bihar to visit some ICDS Anganwadi centres. The Anganwadi workers in charge of the centres were inspirational in their attempts to make the best out of the resources at their disposal. But the conditions in which they have to teach and feed about fifty 3-6 year olds, do home visits, and monitor child growth are testing and undermining. The centres are understaffed. Many are without toilets, washing facilities, clean drinking water, decent floors or food storage facilities. It is a miracle that the centres have any positive impact on nutrition status. I visited several AWCs in the mid 1990s. Nothing much seems to have changed. More pressure for change needs to be generated.
So how do we make more noise about undernutrition? During my visit I gave a presentation at a conference on “Nutrition: Reaching the Hard Core” organised by the Britannia Nutrition Foundation. For me, there are three key puzzles on how to overcome undernutrition: (a) how to raise the quality and expand the coverage of interventions such as ICDS; (b) how to make investments in various related sectors (such as agriculture) more pro-nutrition; and (c) how to create an environment where it is hard for anyone to neglect malnutrition.
My presentation was on the third area and was entitled “The 7 Habits of Highly Effective Environments for Nutrition”. The 7 habits are: (1) developing new surveillance techniques using mobile technologies to allow the government and civil society to react in real time to the changing nutrition situation, (2) the importance of creative campaigns to reset norms around what are acceptable rates of undernutrition reduction, (3) the need to support and expand the cadre of nutrition champions, (4) the need to learn from success within India (taking advantage of the federal set-up) and internationally, (5) the potential of a new class of “commitment indices” which monitor the nutrition commitments of governments, civil society and businesses, (6) the insights to be gained from adopting the new generation of economic growth diagnostics for nutrition to help prioritise and sequence the laundry list of potential nutrition actions in a given context, and (7) the value added of feedback — asking intended beneficiaries to score existing services and suggest what to do differently. Too little attention has been given to these issues.
Undernutrition is insidious — it sucks the life out of kids before clinical signs show. Undernutrition requires action on many fronts and hence it requires coordination and leveraging. Undernutrition requires scaling up of quality. All of these features — invisibility, scaling, coordination, leveraging — demand leadership. Sometimes leadership just emerges as in Mexico or Brazil or Ghana or Karnataka. But with so many lives being ended or wrecked by undernutrition, we can't afford to wait. We need to make sure nutrition is not easily neglected. And that means putting pressure on leaders throughout society to focus on nutrition. These seven habits will play a big role in doing that.
What should the private sector do?
Despite the aforementioned conference being organised by the Britannia Nutrition Foundation there was little discussion of the roles of the private sector in accelerating undernutrition reduction. Is there a role at all? The provision of nutrition is a prime public good — undernutrition generates negative spillovers for the current and next generation, is often generated through information deficits and affects the poorest — all classic features of a public good provided by the state. But that should not preclude dialogue on the question “are there any overlaps between commercial interests and sustainable and equitable improvements in nutrition?” This is a discussion that many are afraid to have — and not just in India. It seems to me that four things are being mixed up when we talk of the private sector. First, what can business do to make its core activities more supportive of nutrition? This means going beyond corporate social responsibility and making sure for example that advertising is responsible, that legal resources are directed in ways that do not only protect shareholders, that labelling is clear and gives consumers real choice, and that transparency is high on the business agenda so that civil society can hold businesses accountable.
Second, when can business act as a substitute for the state? I am not too optimistic here about the role of business — in the end, nutrition is a public good. But there might be things that the private sector can do better than the state. Would the private sector have handled the supply chain management of food grains as badly as the state seems to have done? Third, when can business be a complement to the state? For example, while fortification of salt and other widely used low cost foods is only a small part of an effective nutrition strategy, international experience has shown that the private sector is usually the best way of implementing it. The fourth and perhaps the most promising area is to work with businesses outside the traditional food and health areas to make the environment more enabling for nutrition. For example, when renewing a contract for mobile telephone operation, could the state build in requirements to set up sms services to remind health workers about childhood vaccinations? And could computing companies be engaged to help improve nutrition surveillance? I don't know the answers to these questions. They can only come through a dialogue that is sorely missing in India and elsewhere.
To be fair to the Government of India, it needs help to combat undernutrition. It is such a huge burden (43 per cent of children are malnourished) that the government cannot do it alone. Civil society, business, and the academic community have to help. International donors have an important catalytic role to play. But nutrition is a public good. Leadership has to come from the government. I still do not see it.
(Author : Professor Lawrence Haddad is director of the U.K.-based Institute of Development Studies and president of the U.K. and Ireland's Development Studies Association.)

Friday, January 6, 2012

CSR in Health sector, What industries overlook

DB Power, A Bhaskar Group Company is planning to establish a 30 bed hospital under Corporate Social Responsibility (CSR) at Dharamjaigarh in Raigarh district in the state of Chhattisgarh, where company has been allotted coal block for its power project. The Clearance for coalmines is awaited. Company has demanded 2.5 acre of land for construction of hospital building from Gram panchyat, According to published reports in News papers.

Construction of such Hospitals is example of CSR works, going on in this district. it brings some satisfaction. Earlier, The Jindal organization has also build a Hospital in Raigarh which is run by Fortis group. 

Public Healthcare facilities in district need a boost, as government hospitals have repeatedly come under scanner of government itself, for their mode of functioning. Lack of Doctors, Machines, and Operators and have made government hospitals last choice of common men, even if he agrees to tolerate cracking infrastructure and poor hygiene. Nowadays, private healthcare industry is booming and benefitting by abysmal performance from government institutions.

Jindal Fortis Hospital at Raigarh 
However, few such Examples by industries are also not going to take care of people’s all healthcare needs. Making hospitals can turn-up a drop into ocean, as standalone hospitals cannot replace crumbling and overburden community health providing system. Healthcare providers like ANMs, Dais, Depot Holders, MPWs and Mitanins provide invaluable service in rural and tribal hinterland. Even RMPs, “Jhola Chhaps” and 3 year MBBS save a lot lives in such areas. They are easy to access, Cheap and have faith of people. Strengthening network, capacity and accuracy of these community health providers shall come under radar of CSR people.   


One Parallel Could be drawn from the works in education sector by Jindal CSR. They have made schools of their own, but also appointed social teachers to government schools where teacher student ratio was too high. This made visible difference to quality of education and also provided employment to local youth. 


Similarly in health sector, Putting paramedical, or BHMS, BAMS doctors (As MBBS are scarce and Costly) on payroll of industry, can strengthen basic health delivery system in CSR areas. (Provided, they stay among people rather than mammoth shiny buildings surrounded by 8 Km long and 10 feet high wall)  
A Mitanin, Making Malaria Slides in a village of Ghaghoda block
Most Pockets of Tamanar, Gahrghoda, Dharamjaigarh and some Parts of Raigarh (Blocks where most industries are doing CSR) are prone to epidemics. Very less is done in those villages to stop their recurrence. Sanitation, Hygiene and Nutrition are grey areas in our development stories. They pull people to hospitals, sooner or later. A serious deliberation by CSR think-tank of all industries needs to be made that, if health sector is your priority, please make hospitals last line of defense, not first.   
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By: Manish singh       janmitram@gmail.com           +91-989261-87810
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Wednesday, January 4, 2012

Five New AIDS Patient Detected in Raigarh


Five New AIDS Patient detected in health checkup of High Risk Group (HRGs), conducted by Janmitram, in ICTC this month, including female sex workers and MSM (Male Sexing Male). These patients shall now be referring to ART (Anti-Retroviral-Therapy) centre. The incident emphasizes the prevalence of deadly disease in city and vulnerability of its residents. this detection makes a tally of ten New HIV+ Cases in year 2011.
Raigarh is getting ecologically vulnerable to HIV/AIDS. Many Cases of HIV positive have been detected in last few years.  Due to rapid growth of Industries & mining, Migration of People has increased manifold. Huge number of Truckers, Migrant laborers and related people stay in city and nearby areas, mostly without families. This has increased prostitution and high risk behavior. NACO (National AIDS Control organization) and State Aids control society is working with few NGOs to check spread of this disease. JanMitram is working with Female Sex workers and MSM community.
Programme Staff of TI During A meeting 
“The number of Female sex workers is likely to be 1500-2500 in Raigarh and nearby areas. While we are regularly Serving 750 odd FSWs”- Says Sougat Mahapatra, Programme Manager of AIDS-TI Programme in JanMitram. Organization has registered over 1150 HRGs till date, 28 of which are MSM. We have stopped further registration as our programme is for 800 FSWs only. We shall approach SACS to enhance our target this year.  
Organization provides free condoms to HRGs in proportion of encounters they make in given period. It also ensures Blood Sample Check in every quarter, and treatment of Sexually Transmitted Diseases. Few Doctors are empanelled for such services, especially trained for AIDS-TI programme. They do free checkups; fee is later paid by project. Government established ICTC (Integrated Counselling and Testing Center) provides counseling and testing facilities.
PPP Doctors During a Training organized under TI programme 
Sweta (Name changed) is Peer educator of programme, actually one from the sex worker community. She tells that HRGs covered in the programme are now safer and well aware. Complete secrecy of identity in this prgramme helps them to come forward and join in. Services regarding STI have given them big relief as a most FSWs have to suffer this, at some point of time. Earlier they have spent from themselves for cure and medicine. 
However, all these efforts from NGOs and Government have not stopped emergence of new AIDS cases. It is up to people to take care of their behavior and every section our society should make a deep intro-inspection. Without this, once a sleepy town of Raigarh shall turn hotbed of such diseases in no time. 
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A Detail Investigative Story Published by Dainik Bhaskar on 5th January 2012.- Author, Click http://www.facebook.com/photo.php?fbid=249031465166065&set=a.249031461832732.56887.152770364792176&type=1&theater to read 
Manish Singh- 098261-87810       janmitram@gmail.com
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Convergence Drive in Village Development Programme

A majority of the villages in the country still face constraints such as access to education, health facilities, drinking water, power, roads, Credit, Information and Market. Against this background, adoption of especially villages in backward regions through preparation of Village Development Plans (VDPs) would go a long way in ensuring holistic and integrated development of the villages concerned. 

Objective of Village Development Plan is to develop the selected village in an integrated manner. This would include economic development, infrastructure development and other aspects of human development i.e., education, health, drinking water supply, etc., besides access to credit. The programme is Assisted by National Bank for Agriculture and Rural Development-NABARD.

( see http://www.nabard.org/farm_sector/vdp.asp for more information of VDP Scheme) 

JanMitram is running Village Development programe at Four Villages of Gharghoda Block of Raigarh Distirct in Chhattisgarh. This programme is to make people in a These villages are Dangninanra,Baspipali Tenda and BarounaKunda. Our Reponsibility is To create awareness in the village and play effective leadership role in building People’s Organisation/ Groups for various developmental activities. Main Element of The programme is to facilitate convergence/integration of various programmes of NABARD, State/Central Government and other agencies in the village.


In this connection on 27th Dec,2011, A Farmers Meet was organized. Objective of programme was to galvanized development activities and peoples associations. Hon Parliamentary Secretary to CG Govt. and local MLA Mr. Ompraksh Rathia attended the programme. 


He declared sanctioning of many infrastructural and livelihood development schemes in project villages form his MLA-LAD fund and other govt. schemes. Some Promment Works Are High School Building at VDP Village Bastipali – 10 Lakhs, Pulia At Danginara Village – 10 Lakhs, Pulia At mithilapur ( Dangninara ) – 6 Lakhs, PDS Shops in Baronakunda And Tenda Village – 6 Lkahs, Boundary Wall of Anganwadis at Tenda and Baronakunda- 4 Lakhs

 
Above said Works come into-fore during PRA done by orgnisation at starting of VDP in these villages. Distribution of Seedkits, Vermicompost kits and other farm implements from Agriculture and horticulture departments. These were distributed agriculture inputs to 150 farmers. The programme was attended by over 800 People from SHGs, Farmers, youth, PRIs from Nearby Panchyats and Block, all enthusiastic with galvanizing development activities in the area. 

Further, Our team is Striving hard to Improve food production in the area through intensification of rice, increase in net cropped area in selected villages.  

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Contributed By Ashwini Chouhan, Programme officer -JanMitram +91-98265-82806