This month has been a special month for the staff members at Nutritional Rehabilitation Centre (NRC), Pune, as it is the second time since its inception in November 2012, that this NRC has achieved the target of admitting minimum 20 malnourished children to undergo a 14-day session of supervised feeding at the centre. The last that it had achieved this feat was in July 2016 with 23 admissions.
Government of Maharashtra has set up 44 NRC’s in different districts of Maharashtra, where Severely Acute Malnourished (SAM) children are admitted for a dedicated supervised feeding under the guidance of dieticians.
The NRC at Aundh Civil Hospital in Pune is the only NRC under Integrated Child Development Scheme (ICDS) in the district. At NRC, a diet based on energy-dense local food along with multivitamin-multi mineral supplements is given at regular intervals under supervision of dietician for over a period of 14 days to the malnourished children.
This month is unusual as the beds at the NRC are full. Last month, the Pune NRC had organized a special meeting with staff of Rashtriya Bal Swasthya Karyakram (RBSK). The purpose of the meeting was to get more referrals of the malnourished children to the NRC by the RBSK staff.
Official data suggest that there are more malnourished children in Pune district than that are admitted in NRC. The set target for NRC is to admit minimum 20 malnourished kids every month, it has achieved it twice till date.
According to official data, NRC has admitted, as many as 138 malnourished children in 2013-14 and 135 malnourished children in 2014-15 followed by 130 in 2015-16 and 141 in 2016-17. This falls short of annual target of 240 by 102, 105, 110 and 99 respectively.
According to data provided by State Family Welfare Bureau, Pune, RBSK staff, for the year 2016-17 has confirmed 203 SAM children and 219 Moderately Acute Malnourished (MAM) children in Pune district. This takes the total to 422 malnourished children in Pune.
The ICDS updates monthly reports of underweight children every month. The latest updates of January 2017 stated that there are 25,918 moderately underweight and 2,070 severely underweight children in Pune.
The Velhe taluka in Pune district has recorded 6 cases of SAM children in the last year under RBSK. But only one kid was referred to NRC in Pune. Kartik from Velhe, who was identified as SAM child, was admitted to NRC last year. The last month’s visit by RBSK staff has identified him as SAM again.
Dr Shailesh Suryavanshi, working in Velhe taluka as part of RBSK team, said, “Kartik is identified as SAM again this year. Rice is the major portion of people’s diet here. Sustainable long-term strategy and not just 14 days attention should be implemented.”
“We do our best to convince people to go to NRC. But, who would afford to forgo their daily wages and go all the way to Aundh from their villages just to improve the child’s nutrition? Poverty does not allow them to do that. The government compensates them with Rs 50 per day, but the amount is not convincing for them,” he added.
Activists attribute different reasons for the underutilized capacity of the NRC. Non-affordability of forgoing daily wage in order to take the child to NRC for 14 days, lack of sustainable decentralized approach and inefficacy on the part of public health workers to identify malnourished kids and refer them to NRC are some of the primary reasons that activists point out.
Earlier, there was a mechanism of called Village Child Development Centre (VCDC) at village level to tackle malnutrition in a decentralized way. Activist demand that such decentralized mechanism should be restarted.
Shripad Konde, activist working with NGO named Rachana which works for public health related issues in Pune district, said, “The main reason is parents cannot afford to stay for two weeks by giving up on their work. The government must restart VCDC to ensure easy access at village level.”
All the public health institutions and its workers have been allotted the responsibility of referring a child to NRC. But, from April 2017 till this date, there is no referral from ASHA in Pune district. From the district, only four have been referred by Auxiliary Nurse Midwife (ANM), two by Primary Health Centre (PHC’s) and 15 by the RBSK staff. The pediatric OPD at Aundh Civil Hospital has referred 15 kids to NRC.
Neeta Somkumwar, a dietician of NRC Pune, is proactive in taking initiatives to increase the number of admissions in the centre. The highest numbers of admissions to NRC are by OPD run by herself in Aundh Civil Hospital. Her OPD has contributed to 29 admissions in the NRC during this financial year till date.
“As a dietician, I handle an OPD in the Aundh Civil Hospital and we conduct regular meetings with Asha workers and RBSK staff so that we get an opportunity to serve more children,” she added. NRC Pune has staff comprising one dietician, two ANM, one cook and two attendants, while the post of pediatrician is vacant.