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Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues
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Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues

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The Anganwadi has a supplementary feeding program for last 3 decades, with several problems of provision, services, quality etc. We need a review of this component and change is necessary. The system …

The Anganwadi has a supplementary feeding program for last 3 decades, with several problems of provision, services, quality etc. We need a review of this component and change is necessary. The system has done some efforts with local help in many districts.

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  • 1. Child Malnutrition in Maharashtra (India) August 2013- January 2014 2013- Situation, Efforts, Decline and Challenges A Review For the State Nutrition Mission PowerPoint4/6 The supplementary nutrition component Dr Shyam Ashtekar, MD (Community Med) shyamashtekar@yahoo.comnganwadi-supplementary feed--Dr Shyam A ashtekar jan 2014 1
  • 2. Supplementary Nutrition Program in the Anganwadi (AWC) in Maharashtra PowerPoint 4/6 Jan 2014
  • 3. SNP -Importance and limitations The supplementary feed in the Anganwadi can only provide a third of the child’s requirements. But the AWC feeds help to attract children and parents. It also answers the need for the two meals in 4 hours of the AWC But for malnutrition prevention it is a secondary support. The major feeds must come from home Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 3
  • 4. Schedule of AWC Feeds Breakfast is served when the Anganwadi starts and there is a meal before AWC closes in the afternoon. For the breakfast they serve cooked legumes (usal), porridge or daliya (broken wheat). The meal has either khichadi (rice and dal) or similar items. Every district has almost similar time schedule. This schedule is displayed on the AWC wall. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 4
  • 5. Schedule of the weekly AWC Meals Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 5
  • 6. Supplementary feed & AWC Assistant Till sometime ago it was the AWC who cooked the meals. For this she got some resources and provisions. Even now the assistant prepares the meals where there is no SHG. Many AWCs have a small kitchen for this purpose. A Chullah or kerosene stove is used if there is no gas. (usually) But there are some limitations about what an assistant can cook. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 6
  • 7. The Current provision is only 4.92Rs. Currently the per child daily provision for supplementary feed is only 4.92 Rs. This includes grains, dal, salt, spices and oil. In tribal projects, Rs1 is added to this. For severely malnourished children , additional provision of Rs1 is available. The assistants get 60ps. per child per day, firewood / kerosene included. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 7
  • 8. Fair Price Grain Supply from PDS In Some districts AWC have managed to get foodgrains and some dal, oil, sugar, rockel etc. from the PDS. In some districts these items are purchased from other shops. But the AWC or SHC can not afford this. Possibly the food security scheme will solve this problem. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 8
  • 9. Supplementary Feeds and Self Help Groups The Hon Supreme Court has mandated the local SHGs for supplementary meals and THR Consequently SHGs provide all the meals to AWCs. But in the end even the SHG delegates the cooking to the AWC assistant. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 9
  • 10. Supplementary feeds and Self Help Groups (SHG) But many SHGs cannot afford to provide theses meals in the meager budget, they either avoid this or are reluctant. Some prefer other employment. There are complaints about quantity and quality of meals supplied by SHG to AWC. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 10
  • 11. AWC Worker & Self Help Groups The AWC-SHG relations are strained on the issue of supply of meals. Financial loss, late payment, decline of AWC attendance and inevitable loan arrangement with the local grocer are all factors of friction. In some districts SHGs are merely working for their husbands, causing more corruption and strike. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 11
  • 12. Quality of AWC meals The quality of meals is declining. Difficult to afford food, especially oil, peanuts, Moong dal etc. At times sub standard food items are used to save on costs. There are many complaints about bad test or insufficient meals. In some places they combine breakfast and lunch to save on costs. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 12
  • 13. Protests about Meals In Jawhar some political activists gheraoed an ICDS Officer for complaints about food. The ICDS Officer referred the problem to the SHG and pleaded helplessness. Political activists may not understand this complexity. Many AWC sevikas and supervisors insist on closing the SHG arrangement and hand over the task back to AWC. This also causes complaints. Even raising the provision will not solve this problem, since there is also corruption factor. There is no solution in sight Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 13
  • 14. Solutions tried in some districts. Aurangabad, Akola, Ahmednagar, Latur are some districts where some solutions were found for this problem. Essentially the villagers contributed food items to the AWC to bridge the gap. For this some methods were used.. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 14
  • 15. 1. Akola- handful of grain from each home AkolaIn 2011 the ZP officers in Akola district appealed to all villages / families to donate food items to AWCs. This easily met the food requirements of the AWC. The excess food was donated to other needy people. But in 2013 the excessive rains forced heavy damage and AWC sevikas had no heart to ask for help. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 15
  • 16. 2. The Aurangabad Experiment Aurangabad district also asked for food donations to the AWC. AWCs have essential items donated by families. Many mothers and families learned to prepare various foods recipes from these provisions. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 16
  • 17. 3. The Gopalpangat in Ahmednagar & Latur districts. The ICDS Officers requested community meals in every village 1-2 times each week. The children enjoyed this Gopalpangat and learned to eat and taste many food items. Families queue up for this opportunity as an honor. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 17
  • 18. Gopalpangat ………. Villagers have learned to feed the children and the importance of the issue of malnutrition. Additionally this may help to reduce the social divides in villages Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 18
  • 19. The Child’s Food corner The food corner is also called the child corner (Balkopra) Ready to eat food items are stored in plastic jars in a corner of the house. Children can see this and eat as they want. Mothers learnt this trick of feeding the child. In some places THR was used for this purpose. Laddus and sweets were made and kept in the plastic containers. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 19
  • 20. But in tribal districts... No such scheme worked in tribal areas. Not that tribal families have no food to eat or give. But poverty and migration did not allow such participatory schemes in tribal blocks. Hence the constraints remain in tribal areas (additional grant of 1 Rs is available in tribal projects, also 1 more Rs for the malnourished child) Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 20
  • 21. The Supplementary meals in AWC-Gains AWCand Pains. Some Problems. Some Advantages Causes some carelessness about Laboring families get some feeding at home. respite from child care/ feeding. The needs to be guarded against Children learn to eat together. The middle class in the village Child learns to eat with own turns it’s back on the AWC hands. Child learns different tastes. We can give micronutrients through the meals. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 21
  • 22. SHG and Take Home Ration As per Supreme court decision and Govt. order only SHGs should prepare THR. The provision for THR costs is also 4.92Rs. per child per day. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 22
  • 23. Take Home Ration Children under 3 years can not attend sit in the AWC. Hence children 6 to 36 months get THR for home use. THR packets are also given for severely malnourished child of any age under 6. THR comes in three packs of 1kg. Shira, Upma and Sattu. Pregnant and Nursing mothers also get THR. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 23
  • 24. Take Home Ration It is expected that a small portion of the THR from the pack is mixed in hot water and or cooked fed to the child. Mothers are expected to eat their own THR provided from the AWC. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 24
  • 25. Take Home Ration-- Complaints Ration-There are complaints about the quality of THR Many people refuse to take THR. Some others throw it to cattle or to the chickens. Some families cook and share THR in the entire family. Thus somehow the child hardly benefits from the THR. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 25
  • 26. Experiments with THR Mothers were taught to prepare sweets and spicy food items from the THR and the children like this. Frying involves oil and ghee which adds more calories. In some districts THR was put to good use. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 26
  • 27. Does THR help? But many families are unable to prepare such food items. Hence it is a big question mark on the THR. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 27
  • 28. Only big SHGs can bag THR contracts. Local SHGs can not secure THR contracts. Only big units can get the contracts. So the original idea of SHG empowerment no longer works. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 28
  • 29. Challenges of Supplementary Feeding. How to improve and sustain the quality of AWC meals. How to sustain the social participation in supplementary feeding programme. How to increase the protein factor in the meals. Will increasing of provision ensure better compliance? Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 29
  • 30. RUTF? Better Protein Foods? Can we give RUTF (Ready to Use Therapeutic Food) in AWCs to satisfy quality and quantity of supplementary feeds? There are debates about RUTF Milk or egg powder is also a good idea for ALL children (not just the malnourished) Can we think of better quality and smaller packs of THR? We must think about providing a solution that works. Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 30
  • 31. Best Wishes Dr Shyam Ashtekar (MD, Community Medicine) 21 Cherry Hills Society, Anandwalli, Nashik 422013 shyamashtekar@yahoo.com Cell +919422271544 Website: arogyavidya.org, bharatswasthya.net A study of Anganwadis and campaign against malnutrition in Maharashtra for and with support of Rajmata Jijau Mission, August to Dec 2013 Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 31

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