PRELIMINARY ACCESSMENT REPORT ON WASH AND NUTRITION IN DISTRICT OF

ASSESSMENT MADE BY VIVEK , NUTRITION AND HEALTH PROGRAMME MANAGER, ACF

28-29TH MARCH 2016

1

Contents

Acronyms and Abbreviations………………………………………………………………………………………………………………3 About the document…………………………………………………………………………………………………………………………..4 Background information of ……………………………………………………………………………………….5 1. Problem of Migration…………………………………………………………………………………………………………….8 2. Status of Health and Nutrition……………………………………………………………………………………………….9 2.1 Visit to District NRC & Karhal block NRC………………………………………………………………………….10 Challenges………….…………………………………………………………………………………………………….10 2.2 From ICDS point of view………………………………………………………………………………………………….11 2.3 Short case study of Ganesh from Mayapura village…………………………………………………………11 3. Water Sanitation and Health (WASH)………………………………………………………………………………….13 3.1 Orography & key indicators on WASH……………………………………………………………………………..13 3.1.1 Drainage………………………………………………………………………………………………………….14 3.1.2 Springs……………………………………………………………………………………………………………..14 3.2 Rainfall and Climate…………………………………………………………………………………………………………15 3.2.1 Geomorphology………………………………………………………………………………………………15 3.2.2 Soils………………………………………………………………………………………………………………….15 3.3 Ground water scenario…………………………………………………………………………………………………….15 3.3.1 Hydrogeology…………………………………………………………………………………………………..15 Vindhyan Formation…………………………………………………………………………………………16 Alluvium……………………………………………………………………………………………………………16 3.3.2 Ground water resources…………………………………………………………………………………..16 3.3.3 Ground water quality………………………………………………………………………………………..16 4. Field visit observations…………………………………………………………………………………………………………..17 4.1 WASH at NRC/School/AWC………………………………………………………………………………………….…..17 4.2 Availability of drinking water in village………………………………………………………………………….…..17 4.3 Village Kapura……………………………………………………………………………………………………………….…..18 4.4 Village Lehruni……………………………………………………………………………………………………………….….19 5. Meeting with key government department……………………………………………………………………….….19 6. Desk review information from secondary sources………………………………………………………………...20 6.1 Social audit by MGSA on ‘Status of toilet facilities at school’…………………………………………….20 6.2 Social audit by MGSA on ‘Availability of drinking water in rural areas’……………………………..20 7. Conclusion and recommendations ………………………………………………………………………………………..21

2

Acronyms and Abbreviations:

ANM Auxiliary Nurse Midwife

AWC Aanganwadi Center

AWW Aanganwadi Worker

ASHA Accredited Social Health Activist

CMHO Chief Medical & Health Officer

FHW Frontline Health Worker (ANM/ASHA/AWW)

ICDS Integrated Child Development Services

LAMA Left against medical advice

MAM Moderately acute malnourished

MUW Moderately Underweight

NGO Non-Government organization

NRC Nutrition Rehabilitation Center

SAM Severely acute malnourished

SUW Severely Underweight

TB Tuberculosis

TSC Total Sanitation Campaign

WASH Water Sanitation and Hygiene

3

About the Document

A two-day assessment has been carried out in the district of Sheopur, Madhya Pradesh, by Mr. Vivek Yadav, ACF Nutrition and Health Programme Manager, in 28-29 March 2016. The objective was to conduct a preliminary evaluation of the nutrition situation in this district identified as a high burden area by Government of Madhya Pradesh, and where Action Against Hunger (ACF) and Fight Hunger Foundation (FHF) are required to intervene as per their MOU signed respectively with MoHFW and MWCD. In addition, the WASH situation was to be considered in light of the drought that has started to affect the Region, and some information shared by GIZ after an assessment done in February.

Support in facilitation of field visit to villages, NRC, and meeting with key officials was provided by a Mahatma Gandhi Sewa Aashram, a local NGO in the district.

The document contains both primary and secondary information based on interviews, assessment, transit walk into villages and observations. Key emphasis on WASH and Nutrition was made to receive all major information that could support the requirement of the document. Section 3 of the document has been extracted from Sheopur Ground Water Handbook prepared by ministry of water resources, GOI in 2013. Part of information on health indicators for Sheopur district has been referred from Census of 2011, which has been mentioned within the content. All the photographs used in the document are originally captured by ACF during the assessment.

The report contains findings and details of the study as follows:

. Background information of Sheopur District . Status of Health and Nutrition . Status of WASH . Field visit observations . Meeting with key government officials . Desk review information from secondary sources . Conclusion and recommendations

4

1. Background Information of Sheopur District

Map representing blocks in Sheopur district.

Sheopur District is a district of Madhya Pradesh state in . It is a newly formed district situated in the North Western corner of Madhya Pradesh and forms part of Division. It came into existence by reorganization of District. The town of Sheopur is the district headquarters. Other towns include , Karahal and . The Seopur district is bordered by on the west and on the north. The adjacent districts are Morena, and in the east and in the south. The district lies between North Longitude 76030’ to 77040’ and east latitude

5

25015’ to 26015’1. The district covers an area of 6,606 km. As of 2011, its population is 687,952 and it is the third least populous district of Madhya Pradesh (out of 50), after Harda and Umaria. It is one out of 21 tribal districts of Madhya Pradesh. The district has a population density of 104 inhabitants per square kilometre (270/sq mi). Its population growth rate over the decade 2001-2011 was 22.96%. Sheopur has a sex ratio of 901 females for every 1000 males, and a literacy rate of 57.4 %.

No. of Gram Block Area (Km2) No. of Villages Panchayat

Vijaipur 2,893 182 77

Sheopur 1,426 249 94

Karhal 2,347 118 48

Description* (*Source: Census of India 2011) Year 2011 Year 2001

Actual Population 687,861 559,495

Male 361,784 295,297

Female 326,077 264,198

Population Growth 22.94% 29.70%

Area Sq. Km 6,606 6,606

1 Survey of India toposheet No’s 54 C/10, 11, 14, 9, 13, 54 F/4 & 8 and 54 G/2, 3 & 9

6

Density/km2 104 85

Proportion to Madhya Pradesh Population 0.95% 0.93%

Sex Ratio (Per 1000) 901 895

Child Sex Ratio (0-6 Age) 897 929

Average Literacy 57.43 46.40

Male Literacy 69.33 61.76

Female Literacy 44.23 29.07

Total Child Population (0-6 Age) 116,639 112,229

Male Population (0-6 Age) 61,490 58,166

Female Population (0-6 Age) 55,149 54,063

Literates 328,025 207,536

Male Literates 208,201 146,457

Female Literates 119,824 61,079

Child Proportion (0-6 Age) 16.96% 20.06%

Boys Proportion (0-6 Age) 17.00% 19.70%

Girls Proportion (0-6 Age) 16.91% 20.46%

According to the preliminary information the economy of Sheopur district is mainly based on agriculture. Main crops are wheat, maize, gram and mustard. Tribal population lives in all the three blocks of district. Karhal and Vijaypur blocks have highest number of tribes. Big farmers from other states have moved in to Sheopur and captured the farms and lands of tribal; as per law an outsider is not permutable to purchase land from tribal but these big farmers and local influential parties trapped the sahariyas by influence or offers and at present sahariyas are working on their own land as bonded labor.

In the discussion with key district officials and NGO, it strongly came out that Karhal block is among the worst performing block in Sheopur on many indicators. Availability of water for drinking and irrigation is

7

lowest in the block, and rate of migration remains high from Karhal block. Data from district NRC reveals maximum referral of severely malnourished children from Karhal block.

The initial assessment is based on the discussion made with MGSA (NGO), different district level government officials, visit to NRCs, field visits made to villages of Karhal block, interaction with community, group discussions and general observations.

1.1 Problem of Migration:

Drought-hit Sheopur district in northern Madhya Pradesh witness large scale migration of tribal population in search of employment to neighboring districts of Gujarat, Uttar Pradesh and Rajasthan that bordering the tribal dominated district. Migration of tribe takes place from neighbouring Shivpuri, Morena and Bhind districts. They take up menial jobs at construction sites and farm lands. Maximum migration is been reported from Karahal and Vijaypur tehsils of Sheopur. Crops failure in large area of cultivation across Sheopur is due to scarce rainfall, and there is hardly any labour intensive work in the district that could generate employment and prevent migration. Major migration takes place from February to June, and from October to November. More than 70% migration takes place from rural areas2 each year. Officially there is no data available to undermine the situation.

During Chait3 period, the maximum wages earned by Sahariyas people are for harvesting the wheat crop. But instead of cash payment, they receive a part of total crop. As per prevailing practice, they receive about 5% of the total crop as their wages i.e. in return of harvesting one quintal of wheat; they receive 5 Kgs of wheat as their wages.

The Sahariya migrant workers are crowded into the lower spectrum of the labour market and have little entitlement in regard to their employers or the public authorities and suffer from deprivations. They usually live in deplorable conditions with inadequate provision of drinking water and other basic services. Seasonal migrant laborers live in open spaces or makeshift shelters and being non-registered are not entitled for ration cards and as such are forced to spend more on food and other basic necessities. Obliged to work in harsh and unhygienic conditions, the Sahariya migrants become vulnerable to diseases and occupational health hazards and because of their temporary status, have no access to various health and family care programmes. They carry their children to work place where they are exposed to most unhygienic conditions leading to various health problems, poor nutrition, apart from no educational facility for them.

Family migration implies the migration of the younger members of the family leaving the elderly behind, who have to cope with additional responsibilities. Exposure to different environment and the resulting emotional stress, affect the attitudes, habits and awareness levels of migrant workers.

2 Reported by MGSA 3 Harvesting months after Holi, as per Hindu calendar

8

2. Status of Health and Nutrition

Sheopur district remains an eye catcher in state in terms of malnutrition and deaths of children by malnutrition. According to local NGO and health officials apart from poor care practices and weak socio economic status, migration remains a big reason for malnutrition. Families take away their children to the work sites where proper nutrition to children cannot be ensured. Expenditure on tobacco products like bidis, guthkas, tambakhu and on liquor also remains high. During the field visit to villages of Karhal block it was observed that mothers are equally at the same consumption level as men. According to Chief Medical and Health officer of Sheopur district average life expectancy in Sahariya tribes has reduced as compared to other communities mainly because of poor diet diversity, consumption of low protein rich food and excessive use of tobacco products in family.

According to latest NFHS-4 data for Sheopur district: . Health issues like TB, HIV, Cerebral palsy, skin diseases, hearing impairment and water borne diseases has been reported high . More than half of all the children born are stunted; and more than 8% children are severly acutely malnourished. . 78% children under 5 suffers from Iron deficiency and more than 61% of all women reproductive age group are anemic.

Rural Total Children under age 3 years breastfed within one hour of birth (%) 43.2 44.0 Children under age 6 months exclusively breastfed (%) 60.6 63.5 4 Breastfeeding children age 6-23 months receiving an adequate diet (%) 0.0 0.4 Total children age 6-23 months receiving an adequate diet (%) 0.9 1.1 Children under 5 years who are stunted (height-for-age) (%) 50.1 52.1 Children under 5 years who are wasted (weight-for-height) (%) 27.3 28.1 Children under 5 years who are severely wasted (weight-for-height) (%) 8.8 9.0 Children under 5 years who are underweight (weight-for-age)(%) 53.6 55.0 Children age 6-59 months who are anaemic (<11.0 g/dl) (%) 78.0 77.5 Non-pregnant women age 15-49 years who are anaemic (<12.0 g/dl) (%) 62.1 61.9

Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) (%) 57.4 56.3 All women age 15-49 years who are anaemic (%) 61.8 61.6 Source: NFHS -4 data Sheopur

4 Breastfed children receiving 4 or more food groups and a minimum meal frequency, non-breastfed children fed with a minimum of 3 Infant and Young Child Feeding Practices (fed with other milk or milk products at least twice a day, a minimum meal frequency that is receiving solid or semi-solid food at least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months, and solid or semi-solid foods from at least four food groups not including the milk or milk products food group)

9

2.1 Visit to District NRC-Sheopur and NRC-Karhal

Interviews with ANM at NRC. The inpatient facility is 20 bed having 2 ANMs, 3 caretakers, 2 cook and 2 doctors (1 gynecologist + 1 pediatrics), similarly NRC Karhal (20 Beds) has 2 caretakers, 2 cook as feeding demonstrator, 1 sweeper and NO pediatrician. As per the discharge criteria5 a child remains in NRC for minimum of 14 days and maximum 21 days. Often children with complication from block level NRC are referred to district NRC. The caretakers receive food from hospital and are entitled to receive Rs. 70 per day as wage compensation loss. ASHA/ANM is provided incentive of Rs 100 to admit a SAM child to NRC and Rs 400 on completion of 4 successful follow-up by the children. ANM reported to have 8 cases of Oedema admitted in NRC in the month of February out of total 25 children admitted in the month. The rate of children getting LAMA is around 10%. August to September remains high risk season with maximum admissions

Challenges: (as reported by ANM)

 Difference in screening criteria by ICDS and NHM. AWW/ASHA do not screen children with MUAC rather follow underweight criteria to refer children to NRC which sometimes results in rejection of children from NRC. The rejection rate is as high as 10-15%.  ARI, diarrhea, cough & cold, TB, skin disease, fever are the major complication found in children.  As per 2011 NRC figures for Karhal; out of total 440 children admitted 15 were identified to be suffering from Tuberculosis. TB test on mothers is not done.  Each month 2-3 children with complication from Karhal block NRC are referred to district NRC  It is observed during the discussion with ANM that health staff at NRC do not have complete knowledge on admission criteria because as per national criteria for admission the child can be admitted either using MUAC (less than 115 mm) or by Z-score (less than -3 SD). But the ANM confidently replied that the child should follow both the criteria for admission.  Each month 2-3 children are detected with Oedema  As per Karhal ANM, maximum SAM children admitted are from following clusters: Tictoli, Nichli khori, Moravan, Kheri, Badretha pahadi, kapoora villages

5 15% weight gain

10

2.2 From ICDS point of view

According to ICDS, there are average 4% SUW and 36% MUW out of total children in the district under the age of six, whereas according to NHFS-4 data, Children under five years who are underweight (weight-for-age) are 55%. DPO acknowledges the contradiction and recommends that there is a huge need to develop the capacity of FHWs at AWCs.

2.3 Short case study of Ganesh in Mayapur village of Karhal block.

Name of the child: Ganesh (M) Age: 3 years MUAC: 75 mm Siblings: 4 Father & mother both works in farms. Family not ready to take the SAM child to NRC. The child is looked after/cared by her aunt. The three year old child is very weak to stand and eat by his own.

In the village there are 6 children who are severely underweight.

According to local myth mothers avoid eating green leafy vegetables because it is not good for children.

No plants, vegetation of common fruits like lemon, guava etc were found in village.

According to local ASHA, consumption of bidis, guthka, tobacco products are very common in mothers and adolescents. She claims that Figure 1: Ganesh suffering from Marasmus i.e. a sever form of acute malnutrition almost 100% women in the village consume tobacco products.

According to on mother average consumption cost on tobacco (products) is Rs. 30 per person per day.

Lack of knowledge of mothers on age appropriate feeding and poor IYCF practices can be observed clearly in the villages.

11

Figure 2: Ganesh suffering from Marasmus i.e. sever form of acute malnutrition

In the early stage marasmus is recognized as loss of weight. As the diseases progresses sever wasting occurs until the skin hangs loosely from bones, especially around the buttocks where the lack of fat and muscle causes skin to hang like “baggy pants” the eyes becomes sunken, producing an ‘old man’s face’.

12

3. Water Sanitation and Health (WASH)

Figure 3: Village Kapura, Karhal Block

3.1 Orography and key indicators on WASH

S.No Items Statistics 1. General Information i). Geographical area 6,666 Sq. Km ii). No of Panchayat/Villages 219/533 iii). Population (Census 2011) 6,87,861 iv). Normal Rainfall 944 mm 2. Geomorphology 1. Major Physiographic Units Hilly, Valley fills 2. Major Drainage Chambal, Parvati, Kunnu, Sip nadi & Kadwal Nadi 3. Land Use a. Forest area 2,922 Sq. Km b. Net area sown 1,575 Sq. Km c. Cultivatable area 1,575 Sq. Km 4. Major Soil Types Alluvial soil and soil formed by erosion

13

from Vindhyan sand stones/shale 5. Principal Crops (2012) Wheat, paddy, gram, jwar, bajra, tuar and udad etc 6. Irrigation by different sources Structures Numbers Coverage Area (Sq. Km) Dug wells 3,155 96 Tube well/Bore well 8,345 358 Tanks/Ponds 12 11 Canals 2 605 Lift irrigation scheme 11,512 46.5 Net irrigation Area - 1,131 Gross irrigation area - 1,178 7. Dynamic Ground Water Resources (2009) Net Ground Water Availability 39,679 ha Gross Annual Ground Water Draft 14,509 ha Projected demand for domestic/ industrial uses 1,740 ha upto next 25 years Stage of Ground Water Development 37%

Source: Sheopur ground water handbook

3.1.1 Drainage The flows along the northern periphery of the district whereas the Parbati River, the biggest tributary of Chambal, forms the western boundary of the district. The length of the Chambal River is about 250 km. All other rivers which are tributaries of the Chambal are generally flowing from south to north. Other major tributary is Kunnu, Sip Nadi & Kadwal Nadi. The Chambal and its tributaries form the major drainage pattern.

3.1.2 Springs There are numerous springs in the hilly areas of Sheopur-Kalan district. Most of the springs are located in difficult terrain and are unapproachable or ooze out in Nala beds and as such their discharge could not be measured

3.2 Rainfall & Climate

The climate of Sheopur- Kalan District, M.P. is characterized by a hot summer and general dryness except during the south – west monsoon season. The year may be divided into four seasons. The cold season, December to February is followed by the hot season from March to about the middle

14

of June. The period from middle of June to Sept. is the south west monsoon season. October and November forms the post-monsoon or transition period. The normal annual rainfall of the district is 944.0mm. The district receives maximum rainfall during south-west monsoon period i.e. 92.1% of the annual rainfall. Only 7.9% of the annual rainfall takes place between October to May period. Thus surplus water for ground water recharge is available only during the monsoon period.

The normal maximum temperature recorded during the month of May in 42°C and minimum during January is 7.4°C. The normal annual means of maximum and minimum temperature of Sheopur- Kalan district is 33°C and 18°C respectively. The wind velocity is higher during pre-Manson period as compared to post monsoon period. The maximum wind velocity (11.3 Km/hr) observed during the month of June and minimum 4.30 Km/hr. during December. The average normal annual wind velocity of Sheopur-Kalan is 6.9 Km/hr.

3.2.1 Geomorphology The southern hilly and upland area constituting Vindhyan sandstone, shales and limestone occupies 6640 Sq km are of the district. The maximum elevation is 456m above MSL and the surface gradient is generally from South to North.

3.2.2 Soils Mainly two types of soils are found in the area namely alluvial soil & soil formed from erosion/ degradation of Vindhyan sandstone/shale/limestone found near the foot hills of high hilly area/ forested area.

3.3 Ground Water Scenario

3.3.1 Hydrogeology The major geological formation in the district is upper Vindhyans which are overlain by Alluvial deposits belonging to Plestume to recent age. Occurrence & movement of ground water is mainly controlled by secondary porosity through joints & fractures. Ground water in general occurs under unconfined to semi-confined conditions. The occurrence and movement of ground water in different geological formations is described below:

. Vindhyan formation The sandstones are hard compact with siliceous matrix and as such are completely devoid of primary porosity and permeability. But whenever they are jointed and weathered, secondary porosity and permeability are developed in them and such areas are water bearing. The water bearing capacity largely depends upon the intensity of jointing and degree & thickness of weathering which varies from 2 to 4m in thickness.

15

The shales are fine grained and compact in nature. These are porous but not permeable. The water bearing capacity in shale depends upon degree of weathering and jointing along and across the bedding planes. In general these shales are not rich in ground water potential. The limestone generally is compact and massive and occurs at the hill top and as such do not possess water bearing capacity. In Vindhyan rock, ground water occurs under water table condition.

. Alluvium The alluviums consisting of clay and silt with intercalated bands of sand, gravel & pebbles and having good water bearing capacities. The thickness of these layers ranges from half a meter to more than a meter. The thickness of the alluvium deposits is more towards the Northern periphery of the district. In alluvium, ground water is found under phreatic as well as semi-confined to confined conditions.

3.3.2 Ground water Resources Sheopur district is underlain by Vindhyan Sandstone and Alluvium. Dynamic ground water resources of the district have been estimated for base year -2008/09 on block-wise basis. Out of 666,600 ha of geographical area, 80% are ground water recharged worthy area, and 20% are hilly area. There are three number of assessment units (block) in the district which fall under non-command (87% Karhal) and command (13%) sub units. All blocks of the district are categorized as safe. The highest stage of ground water development is computed as 60 % in Vijaipur block. The net ground water availability in the district covers 39,679 ha and ground water draft for all uses is 14,509 ha, making stage of ground water development 37% (19% in 2003/04) as a whole for district. After making allocation for future domestic and industrial supply for next 25 years, balance available ground water for future irrigation would be 24,714 ha.

3.3.3 Ground water quality Quality of ground water is generally low to medium saline as electrical conductivity varies between 475 μS/cm to 5,620 μS/cm. Constituents like chloride, fluoride, sulphate, calcium and magnesium are within safe limit as per BIS standards. Nitrate in the ground water varies between 3.4 to 267 mg/l. Nitrate more than 45 mg/l was found in Pura, Panchol colony, Kuroh & Karhel villages. High nitrate in the villages appears due to excessive use of fertilizers and agriculture waste. Fluoride varies from 0.08 to 1.7 mg/l. Arsenic has been detected in the district. Water samples in the district fall in C1S1, C2S1 & C3S1 is U.S. salinity diagram. Ground water is generally safe for Irrigation.

16

4. Field visit observations

During the visit to Sheopur it was assessed that Sheopur really face water scarcity problem, in the discussion with community, NRC staff and AWW the fact strongly came in light that in shortage of water ensuring WASH practices are challenging. Summers are the toughest part of year when children start falling sick, limited scope in agricultures, migration increases, less or no vegetation in villages, thirsty cattle dies in large quantity, water level goes down, and quality of drinking water diminishes. Visit to four villages of Karhal block was made to access and observe situations around WASH and Nutrition. Below are some key observations:

4.1 WASH at NRC/School/AWC:

 Both NRC at district and block level were found neat and clean. The source of drinking water for families at NRC are Reverse Osmosis (RO) device installed, which is accessible 24 x 7.  Liquid hand washing soap was found in NRC washrooms.  Parents at NRC are counselled to wash hands before meals.  No drainage systems were found at hand pumps  Many Hand pumps at school were either dried or nonfunctional.  AWW has to bring water from distance if there is no Hand pump around AWC.  Treatments like chlorination, boiling and filtering are not observed at AWCs. Figure 4: Defunct latrine at school at Kapura village of Karhal Block; water not available

4.2 Availability of drinking water in villages (discussion points with villagers/observations) and key problems reported:

 The sources of drinking water in villages are hand pump, open well, pond and bore wells.  Community reported that most of the time color of water is not transparent. Dirt and impurities often come along with water. Sometimes reddish water arrives from hand pumps.

17

4.2.1 Village Kapura (Karhal Block):

 5 hand pumps in the village, 3 are defunct and 2 dries by mid- summer as the water level decreases. People walk 3-5 Km for water.  1 open well in the village, dried in January  No electricity in the village  No latrines, 100% open defecation  Nearest sub health center 4 Km away  1 bore-well at school, works with generator, people contribute for Figure 5: Dry open well in Kapura village of Karhal Block generator.  More than 150 cow/buffalo/goats died last year during summer  People take bath in 5-6 days  No water for hand washing before meals, nails of mother and children were observed long.

Figure 6: Defunct hand pump in Kapura village of Kadhal block

18

4.2.2 Village Lahruni (Karhal Block):

 3 Hand pumps, only 1 in working condition  1 private bore well  25 toilets constructed under Nirmal bharat mission (now Swatch Bharat Abhiyaan), average cost for each toilet INR 10,000  Toilets did not had safety tank/soak pit, all connected with pipe and left open, which indicates that none of them has ever been used.  81 families in the village, all 100% migrated to work. Figure 7: Latrines do not have proper sewage system in Lahruni village of Karhal Block

5 Meeting with key government officials on WASH & Nutrition

. According to Mr. K.R. Goyal (Executive Engineer of the district) there are three ground water zones in Karhal block o below 300 fts o between 200-300 fts o between 100-200 fts Possible interventions could be: a. 3 x 4 meters water recharging pit b. Stop dam on channels/drains outside village each at 100 meters . According to Mr. A.B. Sharma of Irrigation department ‘over irrigation’ is a problem in the area, having proper awareness programme in place water can be saved or water could be used to cover larger area. . Ms. Dhuleshwari Sharma of Total Sanitation Campaign (TSC) reports that: o Stone at surface area is a problem in construction of latrines. o Need to build awareness on issues like problem with open defecation, hand washing, hygiene practices o TSC programme’ s coverage is 35% (old +new) in the district o Last year 650 latrines were constructed (INR 10,000 each) o This year 1,500 latrines with INR 12,000 each will be constructed.

19

o Having water tank near toilets/latrines is made mandatory this year. o Total sanitation campaign (TSC) basic principal is Open Defecation Free (ODF) which includes: 1. Toilet construction and usage 2. Hand Washing (School, AWC, HH level, villages) 3. Fieces management 4. Pure and safe drinking water

List of government officials and NGOs met during assessment

Date Name of official Designation Department 28/3/16 Ran Singh Secretary Mahatma Gandhi Sewa Ashram 28/3/16 Dr. Pradeep Mishra CM&HO Health Department 29/3/16 B.M.Swami Block Development Officer Panchayati Raj Department 29/3/16 Dhuleshwari Sharma Block Coordinator Total Sanitation Campaign 29/3/16 K.R. Goyal Executive Engineer Public Health Engineering Division 29/3/16 A.B. Sharma Dy. Director Irrigation Department 29/3/16 Jayant Verma District Programme Officer ICDS

6 Desk Review: Information from secondary sources

6.1 A social audit has been done by MKSA in September 2015 in 264 schools of Karhal block on status of toilets/facilities at schools, below are the key findings:

 Out of 264 schools (primary, middle, higher secondary & hostels) only 83 schools (31%) have separate toilets for boys & girls.  136 schools (51%) have single toilet for both.  45 schools (17%) do not have toilet facilities.  Out of the 250 toilets available in schools, only 77 are functional and rest 173 are defunct.  Out of 77 functional toilets, 31 don’t have water facility (40%).

6.2 Social audit by MKSA on availability of drinking water in rural area has been done in February 2016 in 26 villages (6 panchayats) of Karhal block, below are the key findings:

 All 26 villages of 6 panchayats namely Sesaipura, Jakhda, Maherwani, Nimaniya, Partwada and Gothra have been covered in the audit.  Out of 141 hand pumps in 26 villages, 99 were found defunct (70%)  Because of regular fluctuation in electricity most of the bore well schemes are in bad situation today.

20

 People complained that when humans do not have water to drink, how can we arrange water for the animals.  Because of less water available the milk production quality of cattles has gone down tremendously

7 Conclusion and Recommendation Sheopur district of Madhya Pradesh is one of the weakest performing districts on nutrition and health indicators. Various cultural and socio-economic factors have a deep impact on the lives of rural communities. For the tribal community, ensuring source of livelihood remains first and higher priority than dealing with malnourished children at home or poor WASH practices. Communities in rural areas are very open and respond well, they look with hope to see a change in their intergenerational condition of being deprived.

Survey on status of acute malnutrition is not visible with departments, looking at the NRC admission rate one can easily assess that hundreds of SAM children in villages still need to be identified and requires timely treatment. On the other hand the status of WASH has been result of poor availability of water, also resulting in increased water borne diseases in all age group. Systematic strategies needed to address the situation with focus on both Nutrition and WASH at the center.

. To better analyze the prevalence of acute malnutrition a SMART survey in the district would help identify the target pockets and prevalence. . Huge scope to access the link between consumption of tobacco by parents having deep impact on the life of children under 5. . Nutrition and WASH to go hand in hand to better uptake of knowledge and practice. . Gap in the skills and knowledge of frontline health worker can be addressed to support areas like identification of SAM children, referral and follow-ups. . To improve the access and quality of drinking water.

21