A Long Road Ahead: Some Reflections on the NFHS (2015-2016) District Report for Nawada
By: Gautam Anand
The National Family Health Survey (NFHS)[1] is conducted under the aegis of the Ministry of Family and Health Welfare (MoHFW), Government of India to provide information on various indicators related to demography, health and nutrition. The fourth round of the NFHS, conducted in 2015 – 2016 across the country, marks a remarkable departure in its reporting as it published district-wise reports for the first time. It provides an excellent opportunity for those interested in understanding the status of health and nutrition indicators in their respective districts.
Similarly, for the NIRMAN team, the NFHS-4 district fact sheet[2] for Nawada provides a window of opportunity to reflect on the performance of our district on these indicators as well as to understand its needs. Health and nutrition status of children and women, the status of sanitation, literacy, and so forth are critical indicators of development for any district. Before we start to plan for any intervention, it is essential to understand our needs based on the facts and data provided by surveys like NFHS.
Now, let us see what the 2015-16 NFHS district fact sheet tells us about Nawada. The table below shows the status of Nawada district regarding some of the indicators from NHFS-4 compared to the national and state level.
Source: NFHS 2015-16
The information above presents the harsh reality of underdevelopment of Nawada in particular and Bihar in general. The difference between the national and district level performance on most of the indicators mentioned above vary from 10% to 20% which implies a considerable gap. We must understand that these indicators are also related to each other. We can see in the table that around 50% of the children under five years of age are suffering from malnutrition and 56% of the children are anaemic. It presents a grim picture of children’s health in the district. The widespread poverty in Nawada can be a reason for this. However, it also indicates the possible non-performance of government schemes like Integrated Child Development Scheme (ICDS) given it is targeted to improve the nutritional status of children, pregnant and lactating mothers. Similarly, around 60% of the women between the age group of 15 to 49 years are anaemic. Within the same age group, only 47% of the women are literate. Given the skewed gender roles in our society, it only reflects the marginalisation of women regarding their access to food as well as education and health facilities. It has severe implications for the health of children, especially girl children, in a household. There is an urgent to need to address these challenges given the development of our district, or any district, is not possible without healthy and educated women and children.
The table above also shows that only 29% of the households in Nawada use improved sanitation facility[3], implying 71% do not have access to proper sanitation facility within the household. Inadequate access to sanitation results in poor health indicators as it can cause many health issues. It also means that households have to spend their limited income on medical treatments given only 19% of the households have some health insurance coverage. Inadequate access to sanitation also poses threats to the security of women. One may argue that the situation might have improved in Nawada since 2015-2016 given the Government of India launched Swachh Bharat Mission (SBM), laying strong emphasis on the need for improved sanitation. However, this does not seem the reality for Nawada. According to the reports made public by the State Government, in Nawada, only 3.46 % and 6.71% of the fund for the Swachh Bharat Mission (SBM) has been used in FY 2016-17 and FY 2017-18[4] respectively. Such a poor utilisation of funds under the Swachh Bharat Mission (SBM) does not provide any hope for significant improvement in the dismal performance of Nawada on this indicator under the NFHS-4. The State Government, as well as the District Administration, must identify the roadblocks in the implementation of the SBM and try to address them so that poor households can get access to improved sanitation facility.
This brings us to the question that what do we learn from these facts? The NIRMAN team understands that reasons for the acute underdevelopment of Nawada are multi-faceted. The dismal performance of the district on these indicators can be attributed to poverty and inefficient implementation of government programs. However, there can be many other socio-economic and financial barriers too. At NIRMAN, we are committed to identify some of these barriers and try to help our communities to overcome the same. There is an urgent need for the people to be aware of the existing government programs and pressurise their local representatives and government officials to implement these programs effectively. We understand that this is not an easy task to achieve but a beginning needs to be made, an initiative has to be taken.
[2] http://rchiips.org/nfhs/FCTS/BR/BR_FactSheet_237_Nawada.pdf
[3] Flush to the piped sewer system, flush to the septic tank, flush to the pit latrine, ventilated improved pit (VIP)/biogas latrine, pit latrine with slab, twin pit/composting toilet, which is not shared with any other household.
[4] http://sbm.gov.in/sbmreport/Report/Financial/SBM_StateReleaseAllocationincludingUnapproved.aspx