Meeting Tellis

I finally met Dr Ashley Tellis for lunch yesterday at Mamu dhaba in JNU. He is forever surrounded by people, and yesterday, I was one of them. We were a mix of researchers from different centres of JNU (one was from IIT), straight and gay people, basically ‘feminists’ at heart. What was supposed to be a pure luncheon turned out to be the first meeting of a group called a ‘good idea’ (might have to check that again). Though I am cynical with on-campus groups since in the last few years one has only witnessed a declining level of discourse and politics on campus, still I kept my opinion to myself for then. Anyway, coming back to yesterday’s meeting with Tellis.

I have been circulating his petition for days now (http://www.ipetitions.com/petition/ashelytellis/; more than 800 signatures in 4-5 days means overwhelming support for him) and found it rather amusing to be meeting him after already sticking my neck out for him, his politics, whatever I have managed to perceive of it till now. His razor-sharp logic can tear apart any thought and give it dimensions that the speaker, who could be anyone, never thought of before opening his/her oral cavity. In that sense, the unplanned visit to Mamu’s was slightly draining but certainly very meaningful. No teacher, friend, family or office colleague ever stresses on ‘using the mind’ in an ordinary conversation as much as Tellis does. That is such a welcome treat but can get stressful if one is not used to an obscene amount of honest questioning of mundane experiences of life. So it’s almost like a challenge to sit in Tellis’s company and also to keep up with his very creative, rational onslaught, if I may call it that.

Btw, he referred to himself as a girl few times yesterday but that somehow didn’t sound as disturbing to my ‘heterosexual, slow, peace-seeking, forgetful and forgiving Vipassana’ mind, as I expected it to sound. Till before yesterday’s meeting, I still imagined myself to be a rigid person from the convent education regime imposed on me in childhood, but I guess I have (un)learned lots and moved on from there at least. Was introspecting that since gender is a social construct we grow up rehearsing in our minds (along with societal reinforcements) but what we call just ‘the mind’ must not have a notion of ‘gender’ by itself unless we feed it with stereotypes of how to look at itself and the person carrying it.

What I am then implying is that if a person’s gender has everything to do with his/her state of mind along with what one is feeling at that moment, then, at the cost of sounding complicated, I think it’s ok for a person to feel masculine and/or feminine traits and in different combinations at different points in his/her life. For instance, taking the two commonly used gender categories of man and woman, aggression as a quality is considered ‘masculine’ but women can be aggressive too when they have to fend for themselves as single women or single mothers. Being tender and caring is considered to be a ‘feminine’ trait but men can become caring too. I know at least three almost non-sexist, almost non-patriarchal and caring men - two male teachers and one male classmate precisely - while I also know of many more patriarchal and non-patriarchal but aggressive women, who survive the 'big bad world', which is considered a 'masculine' thing to do.

So, who else can decide that combination of qualities but the person concerned himself/herself as per his/her requirement/need? Then the logic of dividing people into distinct categories (queer vs. non queer, homosexual vs. heterosexual etc) also loses meaning to an extent unless it is done to fight a political fight, where asserting group identity becomes necessary to demand basic human rights.

Coming back to Tellis, I decided to be ok when I heard a statement like ‘I am a clean girl’ (in the context of hygiene practices) from a person who is physically a man, who exudes tender vibrations while uttering swear words all the time. I realise it’s a very interesting combination of qualities we have here but what is clear and certain is this person’s humanity. He might speak profanities and have the skill to mount rib cracking jokes on them, but one doesn’t ‘feel’ offended while sitting next to him. His vibration should have created lots of discomfort considering possibilities of all that can come out of his extraordinarily witty brain, but thankfully, he ‘feels’ like a very sensitive, genuine and reliable person. This I am sure about. Glad I finally met him.

SOS Call

http://www.hardnewsmedia.com/2010/10/3717

Recognising anganwadi workers as government employees will empower them and motivate them to work better

The Union Government's National Policy for Children acknowledged the dire needs of children way back in 1974. The result was the formulation of Integrated Child Development Services (ICDS) scheme in 1975 for holistic care of children of 0-6 years of age. Over 30 years into this national scheme, still a majority of our children continue to stay undernourished and uncared for. Who should be held responsible?

Statistics-wise almost half our children of age less than three years are underweight and about 80 per cent in the same age group are anaemic as per the third National Family Health Survey (NFHS) from 2005 to 2006.

The number of 'wasted' children who are too thin for height has increased from 16 per cent in 1990s to 19 per cent by the time of the last NFHS survey. Even if you look at under-nutrition statistics for children under five years at an international level, India stands at 48 per cent, much higher than Ethiopia (39 per cent) or Malawi (22 per cent)!

The ICDS scheme envisions simultaneous provisioning of health, nutrition and pre-school education for children below six years of age while also caring for nutrition and health education needs of pregnant, lactating mothers, and more recently, for an additional category of adolescent girls under the Kishori Shakti Yojana.

The original conceptualisation of ICDS was to run it as a long-term community-based programme, sustained by members of the community, especially women who benefit from this novel scheme. It gets operationalised through local Anganwadi Centres (AWCs), each with one part-time Anganwadi Worker (AWW) and a helper to carry out multiple tasks and record details of each task in registers daily. Though all the backbreaking work is part of their job profile, yet they're not recognised as government employees who get some facilities if not many.

However, higher level officials like supervisors or Child Development Project Officers (CDPOs) are recognised as government employees whose role is to make sure that 'work gets done' at the ground level. We can safely say that they ensure that registers get filled up with nutrition and health-related data by AWWs, whose accuracy or methodology of collection is not anyone's concern.

"When I first became an AWW in 1988, the ICDS system was much more effective than what it has become now," said Parvati (name changed). She works as an AWW in one of the anganwadis in Dakshinpuri, Delhi.

The main work of an AWW is to provide nutrition to small children, provide them pre-school education, record and refer cases of malnourished or ill children, pregnant or lactating mothers to the nearby medical facility, provide health and nutrition education to expecting mothers and adolescent girls, perform surveys related to mortality, pregnancy and ill-health in the community, cooperate with the Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) during immunisation drives, help them in other health related work etc, since she is well-known in the community and has all the data the government needs to run any of its programmes.

"Can you imagine this kind of workload on me and my helper, daily, even though we are supposedly part-time 'social workers' getting an honorarium for our services? We get no recognition for the worth of our work, no old-age benefits or security, not even minimum wages, but the blame is entirely ours when anything goes amiss. For instance, when food served at the anganwadi turns out to be of poor quality, we're held by the neck by everyone, including the media. But we don't cook the food here anymore like we used to earlier, so how can we be held responsible for its quality?" she asked desperately.

Showing the rusted and unsteady weighing machine she still uses to record weights of children - this is how levels of malnutrition are calculated - she admitted, "I know this machine cannot weigh correctly, still, I use it because I cannot afford to purchase a new one myself. Obviously the data calculated from readings I record in registers is fudged and won't show the real picture regarding health of people in the community. But I cannot help it as no one listens to me when I demand more facilities for children here."

"The government doesn't give us money for paying timely rent for the AWC, which is mostly a room in the house of the AWW, with no colourful charts or educational material, not even a silly board to identify the room as an AWC! We cannot hire a room for the measly amount of Rs 750 per month given by the government. Our own salary is no more than Rs 1,500 per month, and sometimes we get it only after six months. Who can work for the government like this forever?" she questioned.

"Some of us pay AWC rent from our own pockets and even for the data entry registers. Often, I end up entering government data in my children's notebooks since the registers and stationery given to us is inadequate," lamented Parvati.

In the 1980s, however, the scenario was drastically different. "We used to get paid on time even though the amount was a lot less than our current pay. There used to be timely provisioning of materials required for running the anganwadi. We got everything from phenyl, weighing machines, registers and utensils to pre-school education material for children like clay, wooden toys, colourful fruit and vegetable charts, drawing sheets, crayons, storage cupboards etc. That is how we could achieve at least some of the AWC's goals," she reminisced.

"Then, children used to spend quality time with us, learning and developing skills while also getting nutritious, freshly made food at regular intervals. Unlike today, we used to get raw food and the helper used to cook for the children on a daily basis. Today, the prepared food comes from somewhere far, perhaps from an NGO that has a private contract with the government. We don't know how stale or hygienic this food is, what quality of food material was used during preparation etc. We even had people complaining about cockroaches and worms till recently. Everyone avoids having this food anyway because it is neither tasty nor nutritious," she rued, fearfully exposing the current situation of her AWC in Dakshinpuri.

"Yahan poshan nahin shoshan ho raha hai. Netalog humare naam pe khub paisa kama rahe hain (There is no nutrition being given here, only misuse and exploitation of resources in the name of government schemes in which leaders end up making lots of money). Hummain kya milta hai yahan, sirf logon ka gussa (What do we get here, only public anger)?"

This situation is not unique to Delhi. "In terms of infrastructural provisioning, about 40 per cent of the AWCs in India still run under thatched roofs, huts or under trees instead of pucca government buildings. If the government cares for its children, it has to provide at least a decent roof over their head," said Kandikuppa Hemlata, general secretary of the All India Federation of Anganwadi Workers and Helpers in an interview with Hardnews.

"By the end of 2007, only 6.29 crore of the eligible 16.6 crore children were being covered by the ICDS," said Hemlata while explaining the rationale behind the Supreme Court's order to universalise the spread of anganwadis to every human habitation in India so that children and mothers, especially those who are poor and from the marginalised communities, can claim their right to food. This would lead to building more anganwadis to connect with more people and provide them with basic nutrition and health facilities.

Priya John, senior programme manager at the ICICI Centre for Child Health and Nutrition, said, "In Sunderpahari block, Godda district of Jharkhand, the AWW is usually more disempowered as is the case with most AWWs of north India when compared to those of south India."

"You can at least think of AWWs mobilising women in Delhi, but in the most backward interiors of the country, where households are also separated by vast distances, it is difficult to do any community activity with prejudices against AWW women, who are also tribal, playing out. Besides, the level of apathy and corruption among those administering the ICDS is very high, with probably everyone bribing everyone in a top-bottom chain." Even though the anganwadi scheme is very comprehensive and has great potential, it has to be administered properly all over the country, she said.

According to the 2007 report filed by the Working Group on Children under Six, only about one per cent of the Union budget is spent on children under six years of age - that is, those who genuinely need help from anganwadis don't get it. "Most children don't visit us at the AWC. Sometimes we also fail in our duty to reach out to them. This is especially true of the last few years because we feel highly demotivated and pressurised to fill registers despite knowing that the data being entered is not accurate," rued Parvati.

"In terms of physical infrastructure, about 17 lakh AWCs are needed to cover our entire population - 11 lakh more than what we currently have," said Dipa Sinha from the team of Commissioners to the Supreme Court (CWP 196/2001), recently appointed to ensure that apex court's order regarding universalisation of AWCs and right to food for all gets properly implemented.

"Further, the government should first get all the current vacancies in the existing AWCs filled by conducting exams and selecting capable candidates on a priority basis," said Hemlata. Data shows that there are 2,551 CDPO seats, 16,245 supervisor seats, 69,924 AWW seats and 1,21,896 anganwadi helper seats lying vacant at the end of 2009. "The government has to get proactive, advertise about vacancies and get them filled, besides setting up new AWCs," she added.

The Focus on Children under Six Report of 2006 (abridged) also highlights the fact that not only is there a need to make more AWCs available with adequate facilities like nutritious food, pre-school education material, drinking water, toilets, seating arrangement for children etc, but there is also a need to achieve universalisation of AWCs across the length and breadth of this country, but with quality services that are distributed with equity.

"The overworked AWW can be given some relief by appointing a second AWW, besides better remuneration. Coordination between the health workers and AWWs has to be improved, with full attention given to ensuring health rights of children, mothers and adolescents through the anganwadi," Sinha told Hardnews

"The AWW's salary should be increased to match the rising prices. One also has to reorient all the administrators, right from the top. All village-level workers, including AWWs and helpers, should be motivated again about the purpose of running an AWC. Consistent dialogue and communication at all levels are needed to understand the importance of caring about the health of women and children in the community," said Prof Ritupriya Mehrotra, Centre of Social Medicine and Community Health, Jawaharlal Nehru University.

"Just because the government didn't start such community processes earlier, it doesn't mean they cannot be put in place now. After all, ICDS is a very large, comprehensive public programme with huge potential and outreach, if administered conscientiously," she added.

G Dilip Diwakar, who is researching ICDS in Kancheepuram district of Tamil Nadu, said, "The state government has to be given credit for increasing the salary of AWWs and helpers, providing pension to workers who have completed 30 years of service, and giving AWCs all the required materials to run them effectively. Children and mothers are fed well with a rich diet of sathumavu (nutritious powder made of cereals and sugar), eggs and vegetables in different combinations on different days and in sufficient quantity. Tamil Nadu is a privileged state in this context."

This positive experience can be repeated in many other states if the government and the administrators show will-power and sensitivity towards women and children. There is a certain correlation between good nutrition, reduced morbidity and mortality rates that must not be forgotten.

From the print issue of Hardnews : OCTOBER 2010

Hunger Kills (June 2010 story)

http://www.hardnewsmedia.com/2010/06/3577

Why do governments in India refuse to accept mass malnutrition and starvation deaths, while the reality is so intensely stark, widespread and tragic?

Even a preliminary inquiry concerning starvation in India would reveal numerous reports of entire families wiped out by chronic malnutrition. People get trapped in a negative spiral of poverty, malnutrition, starvation, unemployment, ill-health and severe immune deficiency till death comes to their rescue, releasing them from this unbearable misery.

Take the recent case of five starvation deaths in the Bariha family of Balangir district of Orissa between September and December of 2009, which were attributed to 'a medical condition' like malaria - the usual official practice of denial when it comes to reacting to such easily preventable deaths. "Research shows that even medicine does not work on an empty stomach, so people starving with chronic malnutrition are bound to die within a couple of days, despite last-minute medical interventions," said Prof Ritupriya Mehrotra at Jawaharlal Nehru University (JNU). "This is just the tip of the iceberg. Therefore, such deaths, when reported, should be used as a marker by the government to identify communities in need of urgent government assistance," she told Hardnews.

After the reported deaths in Balangir, the National Human Rights Commission (NHRC) was compelled to appoint a special team in March 2010 to investigate deaths in the Bariha family and prepare a detailed report on the underlying causes. The report is not in the public domain yet. Ironically, Damodar Sarangi, who led this special NHRC team, refused to share his experience of interaction with impoverished village survivors, trapped in the same vicious circle of poverty, starvation, unemployment and sickness - and already in the death-queue, awaiting their turn. Instead, he asked this reporter to file an RTI to get the required information.

The Kalahandi-Balangir-Koraput (KBK) belt of Orissa is one of the most starvation-prone regions in India. NHRC has made special recommendations to provide free cooked food to old, infirm and destitute people here in the past. "The problem is not so much about how many schemes there are. It is about how many get implemented and reach out to the people they're meant for. There are 22 central government schemes already in place that could benefit the people but actually do not," Devinder Sharma, a renowned food policy analyst, told Hardnews.

Dr Preet Rustagi, senior fellow at the Institute for Human Development (IHD), Delhi, said, "Besides other districts in India, we have identified the KBK belt where priority or urgent interventions are needed not just to ensure food security by enabling access to food, whichever the government scheme may be, but also to improve communication, infrastructure and literacy amongst women to improve overall well-being." IHD has studied eight Indian states on behalf of the UN World Food Programme to identify the most food-insecure groups.

"In an interim order of 2002 passed in the famous People's Union for Civil Liberties (PUCL) vs. Union of India and Others case (famously called the Right to Food case), the Supreme Court said no state in India should have starvation deaths or else the state administration would be held responsible. That is the reason why no government official will formally admit to these deaths as 'starvation deaths' or else they will have to face the heat. Starvation deaths like in the Bariha family are, therefore, said to be caused by anything but under-nutrition," said Pradeep Baisakh, a writer-activist who met some of the starving families in Balangir.

When Hardnews contacted Balangir Collector Sailendra Narayan Dey, he flatly rubbished media reports about starvation deaths and disconnected the phone after saying, "Deaths keep happening everywhere because of one or the other reason, mostly diseases. All these reports are false. You journalists make up stories. There are no starvation deaths here."

A collector who denies media reports about starvation deaths would obviously go on to deny any relief claims by members of the family. He will not accept that the deaths were due to (preventable) malnutrition in the larger community. "Had he acknowledged these starvation deaths for what they were, he could have put his act together and prevented further deaths by ensuring that the poor and needy get the food security benefits due to them. So you can only imagine the kind of suffering people are living in," said Kumaran from JNU, who is researching food security and hunger.

"Those left behind to fend for themselves when the head of the family starves to death, literally, beg to die themselves. Their situation is so deplorable because they have no financial assets left after everything they had is sold off to meet medical expenses in their last ditch effort to save the loved one. To make conditions worse, the promise of 100-days annual work under the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) stands broken because neither is work provided for even half of the days promised, nor are timely wages given. Instead of waiting for three-four months to get their dues, people migrate out in a desperate search for work to get money to buy food," lamented Baisakh, after returning from his field-survey. Land is not a sustainable source of income in the entire KBK belt as it is a drought-prone area with dwindling forests and natural resources, he added.

"How can we call the society we live in 'civil' when the degree of inequality between the rich and poor is so immense? Only the top five per cent are well-to-do, while, a sizeable percentage of farmers, widows, children and the destitute are either dying of under-nutrition or committing suicides every year," said Dr Vandana Prasad, joint convener, Jan Swasthya Abhiyan.

"The high GDP is just an average number that hides the income disparities between the haves and haves-not. The rates of infant mortality and maternal mortality are so high in India, with 50 per cent children dying of under-nutrition and a large number of women dying of anemia. These are all preventable deaths that can be avoided by adequate, nutritious food that people should be able to buy, considering the steadily rising prices of foodgrains," she said.

"Starvation death, therefore, is not a technical or a medical issue, and should not be conceptualised as an individual's problem. It reflects a larger socio-economic reality that must be dealt with at a systemic, macro level," she explained.

Said Alaknanda Sanap, "In terms of fair distribution of the benefits of government schemes, people in north India face a higher degree of caste and class bias from administrators as compared to those in south India, even though there are other issues there." Sanap has researched provisioning under the Integrated Child Development Services (ICDS) scheme at the National University of Educational Planning and Administration, Delhi.

A groundbreaking writ petition filed in 2001 by PUCL in the Supreme Court regarding hunger in Rajasthan has led to the emergence of a Right to Food (RtF) campaign in India with the core demand of making the right to food and secure employment a fundamental right of every citizen as part of Right to Life enshrined in the Constitution. There have been 50 interim orders since then as the case continues.

Major Supreme Court orders regarding the RtF campaign have converted food and employment schemes into legal entitlements and achieved universalisation (expansion) of food entitlement programmes like ICDS through anganwadis and the mid-day-meal scheme in primary schools run or aided by the government.

NC Saxena and Harsh Mander (both top retired government officials) have been appointed commissioner and special commissioner to the apex court, respectively, to monitor all food schemes in the country. They have the authority to hold states accountable for not providing people their legal entitlements with regard to the right to food.

Saxena has experienced first-hand the high level of under-reporting of severe malnutrition by state governments. Despite documented hunger and destitution in the Kalahandi district of KBK, for instance, the official 'severe malnutrition' figure is a laughable one per cent. "Most state governments, in our experience, deny extreme hunger or starvation in their states and present wrong data. It is a serious problem that must be resolved urgently. Then there is the problem of governance. State-level administrators, especially in the ministry of women and child development, think it is an easy place to make quick money, especially after the recent hike in nutrition-related project funding. This attitude has to change. Thirdly, we need to decide upon a protocol to identify starvation deaths," said Saxena.

"The main challenge for us is to recognise hunger and starvation while it is happening, not after the deaths have taken place," said Harsh Mander. Revealing heartrending details about how poor people respond to hunger, he said, "There are some whose longing for food gradually fades away because they don't get it, others eat less and get habituated to low diet, or else find pseudo-foods for psychological relief. There are people in Orissa who beg for starch leftovers after rice is cooked by their neighbours. This starch is their main food. There are others who boil and eat grass and tubers, sometimes even poisonous ones, to fill their stomach even though the nutrition value of such food is zero. Some people, like the elderly, end up grazing cattle for the whole day to get two chapattis in return. So high is the level of hunger and destitution in India, but it becomes visible only when people die."

Identifying the challenges in dealing with the situation, Mander said, "We do have the famine code in a few states but what we don't have is a 'starvation code'. But before deciding on that, we need to adequately define and agree upon a common definition and some 'measurement' criteria for starvation." Saxena and Mander were speaking at a national conference on identification of acute hunger to prevent starvation deaths held recently in JNU.

The RtF campaign has led to a demand for a proper Food Security Act. The draft bill ran into trouble recently as the empowered group of ministers suggested clauses like a reduced entitlement of 25 kg food grain at Rs 3 per kg (as against the existing 35 kg at Rs 2 per kg), that too for a few 'targeted' people, even though the majority live below the poverty line. "The draft bill is a very unfair document that doesn't look at overall nutritional needs and multiple entitlements of everyone in society. Hopefully, the improved draft will be designed bearing in mind the larger issues of food production and distribution, and economic and agricultural policies, all of which tend to be anti-poor," said Dr Vandana Prasad.

Devinder Sharma suggests that if self-reliant, traditional food security systems are re-introduced in five out of six lakh villages of India, it would go a long way in significantly reducing the existing high level of nutritional and food insecurity. He said, "If only we could go back to our traditional roots wherein village community elders preserved foodgrains for collective or emergency usage - there would not be a single starvation death." He cited a popular saying in these self-sufficient villages, "Jide ghar daane, aude nyane vi syaane (a household with enough foodstock will obviously have healthy children/family members)." Are the state governments, and the aam aadmi government, listening?

From the print issue of Hardnews : JUNE 2010