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PRELIMINARY ACCESSMENT REPORT ON WASH AND NUTRITION IN SHEOPUR

DISTRICT OF MADHYA PRADESH

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

28-29TH MARCH 2016

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Contents

Acronyms and Abbreviations………………………………………………………………………………………………………………3

About the document…………………………………………………………………………………………………………………………..4

Background information of Sheopur District……………………………………………………………………………………….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

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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

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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 Bundelkhand 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

India 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

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1. Background Information of Sheopur District

Map representing blocks in Sheopur district.

Sheopur District is a district of Madhya Pradesh state in central India. It is a newly formed district

situated in the North Western corner of Madhya Pradesh and forms part of Chambal Division. It came

into existence by reorganization of Morena District. The town of Sheopur is the district headquarters.

Other towns include Bijeypur, Karahal and Badoda. The Seopur district is bordered by Rajasthan on the

west and Uttar Pradesh on the north. The adjacent districts are Morena, Gwalior and Bhind in the east

and Shivpuri in the south. The district lies between North Longitude 76030’ to 77040’ and east latitude

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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 %.

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

Vijaipur 2,893 182 77

Sheopur 1,426 249 94

Karhal 2,347 118 48

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

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

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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

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%

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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 Saharia 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

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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 Breastfeeding children age 6-234 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)

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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

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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

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.

Figure 1: Ganesh suffering from Marasmus i.e. a sever form of acute malnutrition

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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’.

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

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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

ii). No of Panchayat/Villages

iii). Population (Census 2011)

iv). Normal Rainfall

6,666 Sq. Km

219/533

6,87,861

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

b. Net area sown

c. Cultivatable area

2,922 Sq. Km

1,575 Sq. Km

1,575 Sq. Km

4. Major Soil Types Alluvial soil and soil formed by erosion

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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

Tube well/Bore well

Tanks/Ponds

Canals

Lift irrigation scheme

Net irrigation Area

Gross irrigation area

3,155 96

8,345 358

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2 605

11,512 46.5

- 1,131

- 1,178

7. Dynamic Ground Water Resources (2009)

Net Ground Water Availability

Gross Annual Ground Water Draft

Projected demand for domestic/ industrial uses

upto next 25 years

Stage of Ground Water Development

39,679 ha

14,509 ha

1,740 ha

37%

Source: Sheopur ground water handbook

3.1.1 Drainage

The Chambal River 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

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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.

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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.

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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.

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.

Figure 4: Defunct latrine at school at Kapura village of Karhal Block; water not available

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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

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 5: Dry open well in Kapura village of Karhal Block

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

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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.

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.

Figure 7: Latrines do not have proper sewage system in Lahruni village of Karhal Block

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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.

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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.