District Administration, Hazaribag, Jharkhand, India

The Problem

This initiative is undertaken in one of the most backward forested and naxal effected district of Hazaribag district of Jharkhand state of India.
This initiative is about empowering community, ensuring nourishment to underprivileged children especially girl children, fostering a collaborative interaction between the rich and the poor, reducing child mortality, arresting child marriages, accelerating rural urban continuum and enhancing participation of civil society in shaping its future.
This initiative has complemented the government’s effort of improving the nutritional and health status of deprived class.
The reach of administration is indeed limited as of now and the penetration of government programmes in deep interior areas is still yet to be achieved. As a result, many poor families living is those areas are untouched.
In Hazaribag district, which is extremely low in terms of socio-economic indicators, when the administration tried to get a feel of the health status of poor children, the observations were surprising and sympathetic as thousands of children were found to be severely acute malnourished when a survey was undertaken to account the number of children.
Due to the absence of a balanced diet to these children, many of them were found suffering from SAM (Severe Acute Malnutrition) syndrome. This malnutrition has finally resulted in various deficiency diseases to which the children were inflicted with. Prominent among them were Kwashiorkor and Marasmus, which were caused due to the deficiency of protein in their diet. Due to these diseases, there was a complete lack of physical developments of their bodies. Their bodies showed extreme wasting of muscles, swollen abdomens, very thin physique, protruding eyes, complete loss of bone strengthening, and scaly skin along with loss of immunity against other diseases.
Similarly, diseased due to deficiency of micro nutrients, vitamins and minerals were also prevalent. Night Blindness, Pellagra, Beriberi, Rickets, Scurvy, anemia, hemorrhage, dysentery etc. were the few examples.
Parents of these children were definitely not in a position to provide a diet with the sufficient presence of necessary food nutrients. Hence, their children were bound to suffer from an erratic growth full of life threatening diseases.
Children are the future of tomorrow. They are the foundations on which any society, state or nation builds the towers of development. Hence, a healthy childhood has a direct co-relation with the economy of the country. The presence of a huge number of malnourished children in the district was a clear indication that the future of the country is in hot waters. In order to prevent the same and to increase the reach of government, the district administration took this initiative to save the unfortunate children from the cruel clutches of malnutrition.
The initiative was exemplary as it turned out to be highly effective in raising the confidence of administration in the eyes of the public.

Solution and Key Benefits

 What is the initiative about? (the solution)
The initiative was focused to free the malnourished children from the ill effects of Malnutrition and provide them with a healthy and glorious childhood.
Though the government at the grass root levels runs many poverty elimination programmes, still the menace of poverty has its head on the top in every village. Government programmes do have certain limitations as far as funding, reach and implementation is concerned. Ignorance of villagers adds to the trouble further.
Hence, the district administration decided to take up some suo-moto initiative for the welfare of all the malnourished children without taking any help from the State government.
The initiative was about adopting all the malnourished children by the affluent society. An appeal before the esteemed citizenry, government officials, non-government organizations, voluntary organizations, social activists, philanthropist, intellectuals etc was made through various communication channels to save the life of poor children by adopting them. Many conferences and workshops were taken up with the public and public representatives at the district head quarter as well as in the rural areas and they were made to understand the need to adopt these poor children. The expense incurred in adopting a child was limited to Rs 150/- per month ($3 per month) to involve a larger population towards this noble cause.
The response to this appeal was hugely motivating and inspiring. People were greatly sensitized towards helping the poor children. Finally, various people and organizations adopted more than 2000 malnourished children. The meaning of adoption in this initiative does not mean adoption in the literal sense but a financial, social and psychological assistance to the actual child and its parents itself. The adopting parents provide Rs 150/- per month ($3 per month) or an equivalent foodstuffs with necessary nutrients to the parents of the malnourished child. In this way, the child is actually living with his biological parents only. This is a great example of convergence.
The impact of this initiative is tough to be described in mere words. The results were visible form the next month itself in the form of improved health of the previously affected child. It was clear that the socially and economically poor and deprived children were benefitted a lot. What was considered a mammoth task by the government was actually carried out in such a simple manner and that also by employing just the local resources without putting any pressure on the exchequer of the state. This innovation of district administration to protect the lives of so many marginalized children is indeed appreciable.
It would be definitely not unwise to say, that the true beneficiary of this initiative is not the poor child and neither his or her parents but the society and nation as a whole. The citizens, professionals and public representatives too learnt a lot through their interaction with the poor families. That level of sensitivity could they never have developed in their personality if they were not the part of this whole process.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
The central figure behind this whole initiative is the present district collector cum deputy commissioner of Hazaribag district, Dr. Manish Ranjan. He is an officer belonging to the Indian Administrative Service (IAS) of Jharkhand cadre of 2002 batch. As the chief executive officer for the implementation of all the government programmes in the district of Hazaribag, he conceptualized this whole initiative, laid down its process to determine the actual conditions on ground, developed the process and finally executed the task brilliantly with utmost commitment.

His hindsight propelled this initiative. Being an administrator, he was aware of the hapless situation of the children. During one of his field visits in the interiors of the district, he was able to observe the ground realities. The climax came on a day when he personally encountered a SAM (Severe Acute Malnourished) child embedded in dust and dirt lying unprotected on a street in a village. This incident shocked the district collector heavily after which he decided to intervene with full vigour.
He roped in whole of the district administration to find out all such children in the district by making various teams with specifying their roles and allotting different geographical areas. The principal department involved in this initiative was the social welfare department upon whom the major responsibility was fallen.
Apart from the public enforcement genies, plenty of stakeholders were associated with this programme. Village heads, Aanganwadi workers, Nurses, Auxiliary Midwives, Block level officers, Medical officers, Parents of malnourished children, Voluntary people, NGO’s, Schools along with the general citizens were also involved.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The implementation of this initiative required enormous homework to be done at the first place. The prime requirement at the forefront was the identification of the malnourished children. In a district spanning 16 blocks with each block housing more than 40,000 families, the identification task was definitely not an easy one.
However, given the dedication of the district Collector, an outstanding survey was conducted throughout the district. Setting an example, Hazaribagh became the first district not just in Jharkhand but in the whole country to conduct such kind of survey of malnourished and underweight children up to five years of age under National Family Health Survey.
In all, 1735 Aanganwadi centre were surveyed just in a single day. Around 900 teams were formed comprising of Aanganwadi workers- Sevikas as well as Sahiyas, Child Development Project officers, teachers, panchayat mukhiyas, pramukhs and district level officals. Zonal Managers were appointed throughout the district to collect the report from these teams and forwarding them to the administration after final compilation. Proper temporary control rooms were established in order to transmit communications and also to meet any unforeseen situation.
The criteria followed by the teams to identify the SAM (Severely Acute Malnourished) children were based on standards set up by the UNICEF. The teams measured weight, oedema (Oedema, also known as dropsy, is where there is an excessive build-up) and biceps of every child using MUAC (Measuring Mid-Upper Arms Circumference) Tapes. After comparing the particulars of every child with the specific established standards, 1934 SAM children were identified who were found to be in immediate need of medical intervention.
As per the existing services of the government, these children are sent to MTC (Malnutrition Treatment Centre) where free medical attention & food is made available to them. Nevertheless, due to the limitations of the available resources, (the district having only two MTC with a capacity to serve only 300 children per year), it became necessary to wage a literal battle against malnutrition in under to successfully counter it.
The initiative of child adoptation is nothing but the strategy similar as used in any battle.
Along with child adoption, the health of mothers was taken care of by distributing iron folic acid tablets to them. This practice was extended to adolescent girls as well.
A booklet on immunization was placed with every health worker to update mothers with the same.
A Generic Medicine centre was opened at the District for the sale of generic medicines at much-reduced prices.
Such a participatory and innovative mechanism brought laurels to district by the achievement that the Hazaribag district hospital became one of the pioneers in eastern India by achieving ISO 2001-2008 certification.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
The ground works for this programme had commenced several months before the actual initiative. At the most preliminary levels, a number of “Jan Samvad” (Public Hearings) were conducted in more than 500 villages across the district. The basic agenda of the discussions in these hearing was nutrition. These hearings saw a very diverse participation in the form of Mukhiya, members of Gram sabha, PDS dealers, Schools Teachers, Health personnel, village level workers and all the government staff at village level including the Block Development officer. A schedule used to be circulated in the hearings that pertained to questions regarding general health of children between 0-5 years of age in that village.
The schedule tuned out to be a good medium to gauge the state of health and status of its delivery among the under privileged & deprived families. Fortunately, every family could be connected through those schedule and the impediments of ignorance and unawareness among the villagers failed to affect the hearings.
Another home-work was the inspection of the Mid Day Meal Scheme at all the government schools. Overall, 1648 schools were inspected under the guidance of District Education Officer. It was observed that the meals available to the children through such programmes are not balanced enough to take care of the entire required nutrient.
Hence, it was decided to develop a micronutrient food at local level using conventional recourses itself which is cheap, easily available & can take care of children’s needs. Apart from these activities, some form of Social Marketing was done in remote villages through street plays with artists of NSD (National School of Drama), New Delhi. The villagers themselves took the protagonist’s role with themes on nutrition and women empowerment and also conveyed the messages effectively.
The combined effects of these ground works proved to be immense beneficial as they paved way for the future development. Every week, an Aam Sabha (General Meet) started to be held at panchayat level with Nutrition being a compulsory item for discussion. Even the money received by the 13th Finance commission for the village development was spent on development of health and nutrition status of deprived class of the village.
All these efforts brought nutrition on the limelight of policy intervention and implementation. Nutrition came at the centre stage with community getting empowered through convergent approach, taking its charge and shaping its future.

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
Worth-mentioning, are the challenges and obstacles faced by the administration during the implementation of this initiative.
The biggest impediment was the backwardness of the district. Due to the poor infrastructure of the health facilities and lack of funds, it was not possible to execute the task in a smooth manner. However, lack of funds could not present such big trouble as it was balanced with detailed planning, dedication, team work and disciplined work force.
Another hitch was the presence of Naxal insurgency in some of the blocks of the district. The health personnel’s were scared to reach out to such places. Even the residents of such villages were not allowed by the Naxals to take part in this programme since the Naxals do not tolerate government interventions in their area. Fortunately, some persuasion from the administration side clicked enough to compel the Naxals to understand the importance of this initiative.
Initially it was thought to address the health requirements of the malnourished children though the MTC which are especially meant for the same purpose but the capacity of the MTC’s in the district were limited to merely 300 per year while the requirement was more than seven times its capacity. However, this limitation turned out to be a blessing in disguise as due to this very factor, the administration was able to chalk out the most unique innovation of child adoption for the very first time in the country or even in history of this universe.
By far, the biggest obstacle to disrupt the programme was the unawareness, illiteracy and orthodox nature of the some of the villagers. These people were hesitant to adopt any innovation and tend to remain satisfied with whatever meager they possess. It really required a firm determination from the administration that successfully compelled them to shed their orthodoxy and join the mainstream.

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
The district administration carried out the whole programme without taking any additional help from central/state government agencies. It was a pure local programme executed by local staff with the help of locally available resources.
Prominent activities carried out during this programme were the survey, advertisements, workshops and meetings. Survey was an activity that required a huge human work force that fortunately was available with the administration.
Requirement of funds was not much and whatever was required was managed out of funds currently available with the district social welfare and health departments.
The biggest funding of course came out of the esteemed citizenry who came forward and voluntarily shed their pockets towards this noble cause.
Bodies like UNICEF provided some technical guidance. They helped to set standard for the identification of malnourished child.
The benefits of employing local resources were immense. The administration was able to bypass the painful process of getting any sanction from the government that is severely associated with the red tape. In this way, tremendous amount of time could be saved which under given circumstances was the most precious resource. The excitement was at its zenith at the time and any delay could have caused the thinning of that excitement.
As against the tangible resources like finance, manpower or technicians, the intangible resources played an equally important role. The sensitivity towards the poor child, the dedication, the humanity, the togetherness, and the philanthropy all the emotional aspects were instrumental in the success of this programme.
At last, it was proved that funds, money, resources are just a mere cog but the real wheel which can accelerate the development lies in the real commitment of the people.

Sustainability and Transferability

  Is the initiative sustainable and transferable?
The initiative is indeed sustainable and transferable. An impact study of the initiative undertaken by the UNICEF team has revealed substantial benefits. The team has declared that this intervention is having very high potentials of replicability across the country.

Since the initiative is free of any government funding and is purely taken care by the philanthropic citizens hence, no political interference could ever stall its progress. The implementation process being very simple could be carried out easily at any place.
The amount involved is also very nominal (only Rs 150/- per month per child, i.e. $3 per month) which is not a tough deal for any adopting parent. The transfer of the amount to the beneficiary family follows a very simple channel through the Aanganwadi Centres. Since no complicated procedure is involved in the transfer so the adopting parents are also sure of their donations reaching to the right people well in time and hence their doubts are cleared.
Initially this programme was to continue for six months only but given the huge response by the citizens, it is possible to extend the monetary assistance to an indefinite period till the child is free of malnutrition or that the parents income rise to a satisfactory level.
The supervision process too has been kept simple. The regular check up of the child’s health is undertaken by the Aanganwadi workers and ANMs who have confirmed the success of the programme.
At the higher level, Child Development Project Officer (CDPO) and Medical officers conduct regular meeting and monitor the programme.
The direct link between adopting parents, medical personnel and the child has been made possible by this programme which must be replicated throughout the nation or even to some of the other developing and underdeveloped nations.

The district has already prepared the waiting list of those citizens who are interested to adopt malnourished children. This process is continuing in the district. In each month, a meeting is held where mal nourished children are attached with the family willing to adopt the child. The experience so far has been tremendous satisfying and is certainly sustainable and transferable. Many social groups and government employees of other districts have visited Hazaribag to study the process in detail in order to replicate this in their districts.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
Malnutrition is the principal cause for poor physical and mental growth of any child making them vulnerable to deficiency diseases that lead to either poor physique or premature death. This mainly happens due to lack of awareness and illiteracy.
There was a need to educate people on halting malnourishment. Villagers were not aware of the correct way of feeding their child. Hence, in the workshops, stress was laid on the fact that children must to be fed with the first milk of the mother (which contains colustrum) soon after the birth, exclusive breast-feeding for the first six month and that the supplementary diet must be started after six months in addition to breastfeeding. Strong immunity against diseases develops in the child with these simple feeding methods, which involve no costs.
Further, balanced diet should be given to child. The Aanganwadi centers in the villages are dedicated to provide such diet to both mother and child from deprived backgrounds. The Aanganwadi workers also administer vaccines, provide regular health checkups and educate the mothers about her and her child’s health.
Unfortunately, even after the presence of such facilities, poor children suffer from life threatening diseases because of ignorance. There are constraints on the service delivery of the government agencies given its vast and complicated procedures overridden with rules and regulation. Its simplification is necessary and it is actually possible to simplify them at the district level if the administration wishes so.
According to the researches done in the past years, a malnourished child can be cured at home thus people’s participation becomes very important. This was meticulously carried out during this programme which made an impact.
The democratically elected bodies and the panchayats at the village level have tremendous potential to do wonders. Interestingly, the panchayats have now started addressing the issues related to nutrition, health and education in their gram sabha in addition to other development interventions like construction of roads and buildings.
The impact of this initiative was that the district administration was able to mobilize Civil Society to adopt thousands of children; link affluent people with poor and mainstream them out of their ignorance and hesitation. Educating them about their child’s health and their human right was the true motive behind this initiative. Knowledge is the medicine for all the diseases and thus our focus will be on that.
During the entire process, many lessons were learnt- team work being key to success in large scale interventions. Motivation can transform individuals to produce outstanding results. Sustainable social change,requires continuous IEC in local language and persistent communication. Civil Society is keen to supplement the efforts of the Government, if it finds it sincere, dedicated and socially relevant. Availability of money in any initiative is not a constraint, what requires is an idea substantiated with meticulous planning and commitment.

Contact Information

Institution Name:   District Administration, Hazaribag, Jharkhand, India
Institution Type:   Government Agency  
Contact Person:   Dr Manish Ranjan
Title:   Deputy Commissioner cum District Magistrate  
Telephone/ Fax:   +91-6446 224805 and 224806 and +91-9430177777
Institution's / Project's Website:   www.hazaribag.nic.in
E-mail:   manishranjan2@gmail.com  
Address:   Office of Deputy Commissioner (DC) cum District Magistrate (DM), Hazaribag
Postal Code:   825301
City:   Hazaribagh
State/Province:   Jharkhand
Country:   India

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