Loss of family. Loss of family income. Dearth of food. Lack of nutrition. Difficulty in survival. Schools closed. Parents at home, or not at all. Masked adults everywhere. Constant tally of sickness and death all around them.
The world of children has drastically changed both physically and emotionally within a span of few days. Their normal lives have been uprooted and there is a constant looming threat of contacting the virus. The largest threat to the lives of children in India is not from the coronavirus itself but from the prolonged socio-economic effects of the pandemic.
Even before the pandemic struck India, the state of public health was distressed to say the least. According to the Global Nutrition Report, 2020, 37.9 per cent of children in India under the age of five were found to be stunted, i.e., impaired growth of children arising from the severe lack of nutrition. About 20.8% of the children were also found to be wasted; a status of nutrition where the child is too thin for its age and height. These embarrassments of the country were also compounded by the fall in India’s position to rank 102 out of 117 countries in the Global hunger Index, wherein the country held the position of 83 out of 113 countries in 2000.
This is despite the various on-paper scheme and programmes launched by the government in order to tackle the problem of food insecurity and malnutrition in India. A recent manifestation is the launching of the PM’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan with the aim of making India malnutrition free by 2022. This effort is buttressed by the National Food security Act, 2013 along with the Targeted public distribution system (TPDS), which provides ration to the underprivileged families at minimal or zero costing and the Mid-day meals programme which is aimed at providing lunches to the children studying at government schools. The working of these ration distribution systems have been questioned in various studies and leakages in the distribution chain have been identified.
The already distressed state of public health in India has been pushed against the wall in the ongoing pandemic. The routine government services have been suspended, food supply chains have been disrupted, and the loss of family income due the pandemic has had an adverse effect on the already critical health status of underprivileged children in India. The pandemic has put a stress on the already weak public health distribution system. Due of the paucity of food available with the distributors, the distribution of grains and food to the underprivileged has taken a huge hit. As a result, the children who depended on the public distribution system starve with one meal in almost two days. And even where the supply has been working fairly well, the ration provided has been crumby. According to a Lancet study, UNICEF predicted that around 2.5 lakh to 11 lakh children could die due to malnutrition in the pandemic over the next few months if nothing is done to improve the state of public health.
Since the closure of schools, the system of providing Mid-day meals to children has been completely defunct. With the announcement of the lockdown, the government promised to keep this scheme alive and provide delivery of food for the students. However, the implementation of this promise still remains shoddy which has left the kids hungry amidst the lockdown. Moreover, where there has been a possibility of supply of food, it has not been utilised due to the lack of workers. The responsibility of distributing food by most states have been given to ASHA workers and Anganwadi ‘sevikas’. These functionaries have been handed out different COVID-19 surveillance activities where they have to devote more time than usual and there is little motivation left to contribute time to their usual responsibility of proper distribution of ration.
Apart from the lack of nutritious food, the non-availability of hygienic living spaces and public toilets has been a major cause of concern for the migrant workers and their families. Reports of death of migrant children have come to light resulting from the migration by the workers soon after lockdown and travelling without food for days. There is crowding in the shelters, with the spread of other diseases like diarrhoea, typhoid etc due to the unhygienic living conditions, which can act as a spreading ground for the coronavirus itself.
Ways to tackle malnutrition and access of health services in the pandemic
- Managing cases of acute malnutrition
Since there are ongoing programmes like POSHAN with the aim of reducing acute malnutrition, the best way forward is to strengthen these mechanisms in order to identify and treat the cases of acute malnutrition which need immediate care. The food delivery in acute malnutrition cases should be augmented by the delivery of medical supplies while taking all the covid-prevention measures in order to tackle the problem to access to health facilities.
- Protecting the supply chain
It is becoming increasingly easier to fix the disruption in supply chain for the delivery of food due to the progressive unlock-ing system adopted by the Indian government. The smooth transportation of food should be ensured by reducing the cost of transportation to incentivise transportation and also exploring the possibility to using government buildings as storage centres to increase the availability of adequately equipped storage space.
- Constant nutrition surveillance
The key in many cases of malnutrition is early identification. The earlier a child is identified as malnourished, the easier and faster is the recovery process. For early identification, revival of continuous monitoring of areas is necessary in order to identify the areas which show increased cases of malnutrition. Monitoring would also help identify areas which are in need of urgent help. Following this process, the restricted supply and resources during the pandemic can be targeted towards children who are in most need of it. The pandemic has taken a huge toll on the child health in the country with the disruption of food supply chain, lack of access of hygienic living spaces. The socio-economic effects of the prolonged pandemic are a major cause of concern for the state of child nutrition in the country. There is a need for the government to act now because with the end of the pandemic nowhere in sight, it can no longer be taken as an excuse to neglect child health.