Backward districts, health infra: What mainstream media reportage can help change in 2023

 Broken News

Published in Newslaundry on December 29, 2022

Link: https://www.newslaundry.com/2022/12/29/backward-districts-health-infra-what-mainstream-media-reportage-can-help-change-in-2023

The end of the year usually leads to reflections on the year gone by. But let me break with tradition and instead set out a wish list for the kind of coverage we can hope for in the coming year. This could be wishful thinking given that 2023 is an election year with nine states going to the polls. But there’s no harm in hoping.

Even as the media is as usual dominated either by politics or, as in the case of TV news, nonsensical controversies – such as the saffron bikini drama – manufactured out of thin air to get eyeballs, there are some stories that somehow break through. It’s possible that only those of us interested in these issues read them (here I refer to print and the online portals). Yet, the very fact that a few stories of the kind I am going to highlight make it into print, gives us some hope that all is not lost.

The Mumbai edition of Indian Express has started a series on health care in rural Maharashtra. With the possibility of Covid once again rearing its head in India, health infrastructure is a relevant subject as we know from our experience of the last three years. As the redoubtable Dr Gagandeep Kang, Professor, Christian Medical College, Vellore has repeatedly reiterated, healthcare systems that are already stressed perform badly during an emergency – such as the pandemic we have lived through.

For rural India, the absence of adequate health infrastructure has been a tragic reality even as India struts on the global stage claiming to be a power that the world should reckon with. We remain mostly unaware of the extent of the health crisis in much of rural India because, in recent years, mainstream media has turned its attention away from such issues. 

The series in Indian Express, by Rupsa Chakraborty, begins by focussing on one of the poorest districts in Maharashtra, Nandurbar. Some parts of this district touch the banks of the Narmada river, and many Adivasi-dominated villages in this district were submerged in the backwaters of the Narmada following the construction of the Sardar Sarovar Dam in Gujarat. The story of their struggle for adequate compensation and relocation is well-known. 

The villages that escaped submergence continue to suffer much of the developmental neglect that affected those that had to move. For instance, even today, as reported by the Indian Express, levels of malnutrition and the number of severely malnourished children are higher in Nandurbar than in other districts in Maharashtra. The situation was no different in 1984 when I, then working in the Mumbai edition of Indian Express, first heard about Nandurbar.

Chakraborty assesses the state of the 11 primary health centres set up in the district in the last two years at a cost of Rs 6 crore each. They were brand new two years ago. Today, she writes, their condition is “abject”.

The one she visited in Bilgaon, inaugurated just a year ago in 2021, lacks basic infrastructure like electricity. The medical officer treats his patients using a torch once it is dark. This PHC covers 11 villages with a population of 14,221. The nearest alternative, a better equipped facility at the sub-district headquarters, is 104 km away.

Not just electricity, there is often no water either. After it was inaugurated, the PHC received water from a tanker. But this stopped well before a water connection was installed as late as September this year. Apart from these basic infrastructure deficiencies, the PHC is also poorly staffed, a depressingly familiar story. 

Apart from these PHCs on land, several villages on the banks of the Narmada were supposed to be served by floating dispensaries and water ambulances. Their state is not much better, as described by the reporter. 

She writes, “Over a decade ago, the state government had launched two floating dispensaries to provide healthcare to nearly 20,000 tribals residing in 33 hamlets – inaccessible by road along the Narmada river. These tribals were displaced during the construction of the Sardar Sarovar project…More than a decade later, one of the floating dispensaries has broken down beyond repair and presently lies in a godown. The other, around 20-ft long, is in a rickety shape, with medical staff as well as patients afraid to board it scared that it may capsize any moment.”

The point about narrating these details is that even though the stories are about a particular part of India, they reflect the reality in many parts of this country. Even during the pandemic, although there was some reporting from rural areas, it was inadequate. Most of the focus was on urban India where the media is based. As a result, even today, we don’t have the full story on how people – such as those living in districts like Nandurbar – dealt with the pandemic.  

The last three years have clearly established the need for well-trained health reporters who can understand the science, but also the politics and the economy of health care. For instance, more probing questions need to be asked not just of the government but also of the pharmaceutical industry. And editors need to back reporting that requires going to areas away from the limelight, such as these backward districts, that tell us the real story of disease, health care and survival. 

There are, of course, many more areas that mainstream media should investigate. But to start with, it could look at the state of health care and health infrastructure in India’s most backward districts. Even if the authorities don’t instantly respond to such stories, media scrutiny and civil society pressure represent the only hope for things to change for people living in these areas. 

I cannot end this last column of 2022 without once again reminding readers about journalists who are still in jail. Siddique Kappan, who was arrested in 2020 on his way to cover the gangrape, and subsequent death, of a Dalit woman in Hathras, UP, has finally got bail. But as of writing he continues to languish in jail.

And in Kashmir, Fahad Shah, editor of Kashmir Walla, Sajad Gul from the same publication, as well as Aasif Sultan of Kashmir Narrator, are still in prison under the draconian Public Safety Act.  

A senior Kashmiri journalist told me that up to 50 Kashmiri journalists have had to leave Kashmir and go elsewhere looking for jobs because workinSg in the erstwhile state has become virtually impossible. A Kashmiri journalist told the Committee to Protect Journalists that the media in Kashmir “has reached a breaking point, where journalists are wondering whether it’s worth it to report from Kashmir”.

This then is the other reality that we must remember, and repeatedly highlight, as we go into 2023. We cannot speak of freedom of the press so long as journalists are behind bars just for fulfilling their professional commitments as reporters. Journalism is not a crime.

Hunger games

The Hindu, Sunday Magazine, October 26, 2014

The Hindu Hunger, malnutrition, under-nutrition… are not the talking points at election rallies or television debates .

In this season of festivities, when urban lifestyle-based diseases are getting a boost as we stuff our stomachs with forbidden foods, and our homes eat up even more of scarce electricity, one in every third child will go to bed hungry. Her home will be dark, without even the light from the hearth that cannot be lit because there is no cooking fuel.

Hunger, malnutrition, under-nutrition… these are not the talking points at election rallies or television debates but they remain a hard and unrelenting reality for million of Indians. I fear that — in the drummed-up euphoria surrounding cleaning up India, making in India and other such slogans — this depressing reality will be obscured and forgotten.

The good news, we are told, is that acute hunger is decreasing. On the Global Hunger Index 2014, prepared by the International Food Policy Research Institute (IFPRI), India now ranks 55th of the 76 countries and its situation has moved from ‘alarming’ to ‘serious’. That is good.  But is it something to celebrate? That from 45.1 per cent of underweight children under five years of age in 2005-06, there are now 30.7 per cent of underweight children as of last year? It is progress, but that still leaves virtually one in every three children under five years of age that is underweight. This means this child will never be able to catch up as an adult because she has been deprived of adequate and nutritious food in the first five years of her life.

We should also be worried that the very programmes that helped this decline are now in danger of being neglected, or reformulated in a way that could prove detrimental. For instance, IFPRI acknowledges that government programmes that have contributed to this decline in child hunger are the Integrated Child Development Scheme (ICDS) under which balwadis in villages provide young children with a nutritious supplement; the committee to monitor malnutrition set up by the Supreme Court; the National Rural Health Mission (NRHM) that has increased access to health care for many in rural areas; the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), which has guaranteed employment to millions of people; and the Public Distribution System (PDS), which provides subsidised food grains to people below the poverty line.

Apart from hunger caused by inadequate quantity of food, millions also suffer from hidden hunger, due to the deficiency of micronutrients in the food. If you are poor, not only do you get little to eat, but what you eat is also of poor quality. This is what aggravates the already deadly impact of undernutrition. Whenever these subjects come up for discussion — and internationally and in India they do so all the time — there are many technical fixes that are discussed such as bio-fortification, which involves increasing the micronutrient content of food crops.  In other words, the same grain that you eat will be fortified so that even if you eat the same quantity, you will get more nutrients into your system.

While all that is well-meant, if you are poor, you need money to buy food, even if it is subsidised. And you need work to earn the money to buy that food. Despite its shortcomings, MGNREGA has been responsible for putting that money in the hands of millions of rural poor. Yet, this programme is being deprived of funds and could end up a mere acronym.

The technical fixes also misfire because the approach is sometimes top-down without taking in the particular needs of different parts of India. For instance, one of the solutions for malnutrition among children is to give them a high-energy protein paste, that includes crushed peanuts, through the ICDS programme. But the solution, although it makes sense, does not take into account the fact that children’s tastes and eating habits differ in various parts of India. Or that severely malnourished children — like those in isolated tribal hamlets in some parts of Maharashtra, for instance — cannot digest this rich mixture because they are so emaciated. Rather than giving them nourishment, the mixture can cause acute diarrhoea. So, universalised solutions do not work if there is no flexibility built into such programmes.

Just as a handful of long-handled brooms will not clean India, there is no magic wand for ending hunger. The real measure of a country’s progress should surely be the child hunger index. And here India continues to fall short. Moving from ‘alarming’ to ‘serious’ is simply not good enough.

(To read the original, click here.)

Saving India's children

The Hindu, Sunday Magazine, January 9, 2011

THE OTHER HALF

KALPANA SHARMA

Just under half of our children will grow up stunted because of malnutrition and hunger. How can we change this?

Photo: V. Sudershan 

Time to act:Aamir Khan, part of Citizens' Alliance, comprised of MPs across parties and NGOs, that aims to create social awareness of malnutrition among kids.

A year of scams and scandals is over. Can we expect 2011 to be different? If one had a wish list for 2011, topping mine would be a wish that the government make tackling child malnutrition in India one of its topmost priorities.

Everyone knows the glaring contrasts in India — between some of the richest men in the world and some of the poorest who also inhabit this country, between a high economic growth rate and increasing disparity and inequality, between unchecked consumption in our cities and the absence of basic survival needs of people in the villages and our forested areas.

What stands out as the worst statement about the state of India today is the fact that 46 per cent of our children are stunted because they simply do not get enough to eat. How can we accept this and at the same time boast about having moved up from the company of the poorest countries in the world into a middle-income country?

I began 2011 by looking again at the data on child malnutrition in India and it was like a cold shower. Sobering. Shocking.

India has more malnourished children than neighbouring Bangladesh which, until a decade back, was considered something of a basket case. Even African countries like the Congo, Lesotho, Tanzania and Rwanda are better placed than us.

Fundamental issue

Why be so concerned about this one issue? Because the very fact that almost one out of every two children in this country goes to bed on an empty stomach is shocking in itself. Malnutrition is the principal cause of child deaths. Half of all child deaths in India could be prevented if this one issue was tackled. Children die because malnutrition lowers a child's resistance to infection. As a result, they become vulnerable even when they have eminently treatable conditions like diarrhoea and respiratory infections.

What is worrying is not just the high percentage of children who are malnourished, but the fact that the rate is going down so slowly as to be virtually negligible. Between 1998-99 and 2005-06, the rate only came down by one per cent. At this rate, the challenge of cutting down on the prevalence of malnutrition in children by half by 2015, a part of the Millennium Development Goals, will be impossible.

So why is this happening in a country where there is an enviable economic growth rate? Development economist A.K. Shiva Kumar points out in a recent article that the belief that malnutrition automatically comes down if the per capita income improves is not necessarily true. He points out, for instance, that 28 out of 37 sub-Saharan African countries have a lower per capita income than India's and yet also have lower rates of malnutrition. Within India, Manipur has a per capita income of only Rs. 8,114 (1997-98), yet its child malnutrition rate is 28 per cent. By way of contrast, Gujarat has a per capita income of Rs. 16,251 and its child malnutrition rate is 45 per cent.

Dr. Shiva Kumar's contrasting data on two Indian states, Sikkim and Madhya Pradesh also brings out another important angle to malnutrition, that of gender.

Sikkim has 13 per cent children born with low birth weight; MP has 24 per cent. Sikkim has 11 per cent ever-married women with a BMI (Body Mass Index) of less that 18.5 (considered very low); MP has 38 per cent. The 0-6 years male female ratio in Sikkim is 986; in MP it is 929. The age of marriage for women in Sikkim is 22; in MP it is 19. Female literacy in Sikkim is 62 per cent; it is 50 per cent in MP. In Sikkim, 89 per cent of girls in the age group 6-17 years are in school; in MP it is 71 per cent.

Vital link

In other words, women in Sikkim marry later, are more educated and are in better health. As a result, there are fewer children born with a low birth weight. The link between women's status — both in terms of access to education and health — and under-nutrition in children is obvious. Women who are themselves malnourished, anaemic (56 per cent of women in India suffer from some form of anaemia), and become pregnant when young, give birth to low birth weight babies who never catch up.

Interestingly, the National Family Health Survey – 3 (2005-06) that gave the latest data of anaemia in women also shows that while 56 per cent women were found anaemic, only 24 per cent men had the same problem. Clearly, there is a gender dimension even to anaemia. Also, 47 per cent of girls in the age group 15-19 years are anaemic. Furthermore, 59 per cent of all pregnant women in India are anaemic.

These might seem like a set of numbers. But translate that the next time you read about children dying in a village, or even in a slum in your city. Last month, people in Mumbai woke up to the rude reality that living in a fast-moving metropolitan city in India does not mean that poor children have better chances of survival. The story of 15-month-old Sahil Salim from the Shivaji Nagar slum in Govandi, who weighed just 9 kg and died from “fever and cold”, was a stark illustration of how hunger haunts the poor in city and village. Indeed, although the rate of malnutrition in children in urban areas is better than in rural areas, it is still unacceptable — 32 per cent or one in three children.

This is not the India we like to think about. Yet the numbers tell us that this is the India in which half of our women are anaemic, where just under half of our children have diminished chances of survival.

What do we do to change this? The government has to make this a priority and look again at programmes like the Integrated Child Development Scheme (ICDS) that was designed to deal with this issue.

But we need more than that. The media has run campaigns to save the tiger. That is a valiant campaign. I would suggest that India's children are also endangered. That they too need an active campaign by media, schools, colleges, politicians, corporates, anyone who cares, to see that we break this circle of poverty and hunger.

(To read the original, click on the link above)