An NGO in Chhattisgarh is addressing the urgent deficit in nutrition by providing three meals a day to children under three along with daycare

Sumita Dhruv’s life revolves around rice — sowing, irrigating, and harvesting it. And yet very little of it reaches her two-year-old daughter Shristi. Like most children in the village of Baigahara, 50 km from Bilaspur in Chhattisgarh, Shristi was born underweight. Her eyes were vacant, she cried often, and fell ill almost every month. The vicious cycle of disease and poor health would have continued if Sumita, a daily wage worker, had not decided to send her to the village crèche. In a matter of months, things began to look up. “I never realised she could eat so much, Uski bhook jaga di (She has found her appetite),’’ says Sumita. As Shristi lines up for her share of sattu (a local mix of cerealpulse-oilseed), and it is hard to imagine her being anything but playful.

Shristi and a dozen other children at the crèche run by NGO Jan Swasthya Sahyog (JSS) are a small part of the solution. The problem, though, is the sheer number of hungry, overlooked young children in India. Since 2009, JSS has been running crèches or phulwaris where children under the age of three can stay for eight hours. They eat three meals, including khichdi and sattu, eggs (twice a week) and iron supplements, and are taught to maintain hygiene. As a result, the proportion of underweight children has come down from 56% to 27%, and that of children suffering from wasting (low weight for height) has come down from 26% to 5%.

Tumne to bachche mein aag laga di (You have lit fire in the bellies of our children),’’ is what a parent told Dr Yogesh Jain, public health physician and JSS founding member, after her child started gaining weight and looking healthy. JSS now runs 91 crèches in 38 villages for over 1,200 children in Bilaspur district. Every crèche has an average of 10 children. The NGO provides each crèche with a worker, spending Rs 27 per child every day. Phulwaris started when Jain and others — who have been running a rural hospital in Ganiyari village since 2000 — realised that over half the children went to bed hungry. “Treating sick children was only a short-term solution. We had to prevent malnourishment,’’ Jain says.

Undernutrition in the first three years of life has both immediate and long-term consequences. Once a child is malnourished due to a chronic dietary inadequacy, the catch-up is likely to be difficult. What should put Indians to shame is the fact that our infant and young child feeding practices are worse than those of poorer neighbours like Bangladesh and Nepal, say experts.

In most poor families, an aged relative or an older sibling must stay behind for childcare. JSS found that schoolgoing girls dropped out to take care of younger siblings. In desperate times, children are even tied by a rope to a cot allowing them to roam in a small area. The child is usually given breastmilk at the beginning of the day, left behind at home with the day’s leftovers, before the parents come back home at night. The child is deprived of adequate food and attention, Jain says.

A toddler, Amrita, sings and copies her dai’s (crèche worker’s) actions with great gusto. Her thin arms and legs move in unison as she sways to the tune. She weighs a little over 7.5 kg, much below the average 11 kg for her age. She has to be given extra food so she can catch up, says Jhigadpur village worker Rambai Yadav. It is this chronic hunger that the JSS is trying to prevent. Public health expert Dr Ramani Atkuri supports the phulwari model: “Many argue that it is expensive and not sustainable, but do we expect chronically starving people to be sustainable? And why do we always expect results when we don’t want to spend the money for it? Many parents see the phulwaris as a safe place to leave their children when they are out at work.’’ Unicef data says emerging economies have improved their malnutrition rates significantly over the last two decades. China has reduced under-nutrition from 25% to 8% between 1999 and 2002, Brazil from 18% to 7% from 1975 to 1989. In comparison, India has reduced undernutrition from 48% in 2005-06 to 38% in 2015-16, according to the National Family Health Survey. The country’s Integrated Child Development Scheme (ICDS) is centred around take-home rations with a budget of Rs 2- Rs 5 per child and anganwadi workers who are paid honorariums instead of wages.

Many states appear to see the benefit of the programme, but have found it difficult to replicate, admits JSS coordinator for the phulwari scheme, Dr Ravindra Kurbude. Chhattisgarh tried to introduce the programme in 2,000 crèches in Naxal-affected areas but with patchy success. However, the JSS model is being practised with some success in Odisha, Bihar and Jharkhand.MP aims to start 75 crèches this year.