Child Malnutrition in
Maharashtra (India)
August 2013- January 2014
2013-

Situation, Efforts, Decline and Challenges

A R...
Transforming the Anganwadis in
Maharashtra (India)

Powerpoint 3/6
A New Anganwadi Center (AWC)
AWCs got a new facelift in many districts --Aurangabad, Ahmednagar,
Latur etc.
Repairs and ma...
Transformation 2012

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

4
More space for children,

New AWCs

Surroundings, and a compound
to protect AWC.
Internal kitchen, toilet and
often the wa...
AWC with Garden in Aurangabad

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

6
New Paint, Chairs and Tables.

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

7
WaterWater-filter and a toilet

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

8
Anganwadi --the Next Generation
--the
AWCs started in seventies have now completed 3-4 decades.
Younger AWC sevikas have j...
New Generation and Use of IT

The computers arrived in few
Anganwadis

Transforming the Anganwadis in
Maharashtra,A Review...
Sustaining Enrolment
Against Competition
People aspire now for better education and not just food any more.
In many distri...
More Resources from
People
In many districts local communities have helped the AWCs.
More resources came – Repairs, chairs...
An AWC from inside

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

13
Dress, Tie and even Shoes
Parents or villagers have given 1-2 dresses for
the children, at places even tie and shoes too.
...
AnganwadiAnganwadi- in a tribal block

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

15
The ISO AWCs in Aurangabad
In Aurangabad district
1300 AWCs have been
upgraded with ISO
standards.
This costs some money
B...
Happiness is essential for learning –
AWC has to provide the
environment

Transforming the Anganwadis in
Maharashtra,A Rev...
Also Some Discipline and Restraint

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

18
Getting Toys from People
Toys

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

19
And Kitchens improved too

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

20
AWC and Supplementary Feeding
3-6 years age group

6 months to 3 years

Transforming the Anganwadis in
Maharashtra,A Revie...
Weighing Scales
AWCs have clock like weight scales
to hang from the roof.
Some of them need repairs more
often. The kohino...
New Growth Charts
Separate Charts for girls
and babies

Growth chart is the
basic record in AWC

Transforming the Anganwad...
Some AWCs have Electronic
Weighing Scales

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

24
Height Measurement
No standard equipment for height
measurement.
Most AWCs have a digitally printed
measuring tape fixed o...
Height Weight Tables.
From height and weight chart
we can grade the child by
checking in the booklet.
This chart has three...
Mid Upper Arm Circumference
(MUAC)
MUAC)
The AWC has a colored MUAC tape. This is for a
child of age 6 months to 36 months...
Pre Primary Education (PPE)
Among the 6 AWC tasks Pre Primary
Education (PPE) no less important.
PPE implies involve only ...
PPEPPE- Talking walls
Marathi

And English also

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

29
PPE – Educating through Pictures

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

30
PPE – Educating through Pictures
A toilet wall in an AWC in
Akola talks to the child.

Transforming the Anganwadis in
Maha...
Some AWCs got even TV &
computer

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

32
Beyond PPE
Many AWCs offer good PPE component.
Beyond this many AWCs expose a child to letters (Marathi and
English), nume...
Mother tongue and the Multilingual child
Many tribal blocks have local dialects.
But in the AWC both the dialect and Marat...
But its Not Rosy Everywhere
Many AWCs in tribal blocks are badly leaking.
Many are dingy and depressing,
Many are less equ...
Leaking AWCs & broken toilets are not rare

A leaky AWC in Nandurbar

A broken AWC toilet in Akola.

Transforming the Anga...
Even then...

• Maharashtra State has 1.7 lakh AWCs
including mini AWCs
• The picture is changing and will change
further....
Some Four Thousand Supervisors are
Monitoring the AWCs

Transforming the Anganwadis in
Maharashtra,A Review 2013- 2014

38
The Geographic Information System
RJMCHN has now extended a
GIS system for the entire
state.
This GIS is available on
www/...
For community participation
See this website .. http://www.icds.gov.in/#
Also this one
http://nutritionmissionmah.gov.in/S...
Best Wishes
Dr Shyam Ashtekar (MD, Community
Medicine)

21 Cherry Hills Society, Anandwalli,
Nashik 422013
shyamashtekar@y...
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Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

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The Anganwadi Center (AWC) are the main system of service delivery for child care-nutrition, health, pre-primary ed etc. Over 1 lakh AWCs dot the spread of Maharashtra. The ICDS has made substantial improvements in the AWCs , attracting parents and children. This was a joint effort of the dept and the community. There is a Change indeed.

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Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

  1. 1. Child Malnutrition in Maharashtra (India) August 2013- January 2014 2013- Situation, Efforts, Decline and Challenges A Review For the State Nutrition Mission PowerPoint3/6 AWC improvements Dr Shyam Ashtekar, MD (Community Med) shyamashtekar@yahoo.com Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 1
  2. 2. Transforming the Anganwadis in Maharashtra (India) Powerpoint 3/6
  3. 3. A New Anganwadi Center (AWC) AWCs got a new facelift in many districts --Aurangabad, Ahmednagar, Latur etc. Repairs and maintenance of old Anganwadis was necessary but there was no provision for this. They asked for public participation. New AWCs were constructed in every district --- hundreds of new AWCs Zilla Parishads provided the funds from Govt. grants. In Akola district the money was handed over to village panchayats. New models such as pre fabricated AWCs were also introduced. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 3
  4. 4. Transformation 2012 Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 4
  5. 5. More space for children, New AWCs Surroundings, and a compound to protect AWC. Internal kitchen, toilet and often the wash basin. The roofs of Zilla Parishad structures commonly leak in monsoons. To prevent this..In some districts slanting roofs were provided to prevent leakage. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 5
  6. 6. AWC with Garden in Aurangabad Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 6
  7. 7. New Paint, Chairs and Tables. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 7
  8. 8. WaterWater-filter and a toilet Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 8
  9. 9. Anganwadi --the Next Generation --the AWCs started in seventies have now completed 3-4 decades. Younger AWC sevikas have joined the ICDS in significant numbers. There is a quiet competition of the AWC with English KGs and nurseries. The societal expectations about children have risen. The means of transport, communications and incomes have increased. The AWC is also changing . Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 9
  10. 10. New Generation and Use of IT The computers arrived in few Anganwadis Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 10
  11. 11. Sustaining Enrolment Against Competition People aspire now for better education and not just food any more. In many districts English schools have started buses to fetch children. Many families are willing to offer 10-15 thousand Rs. for this annually. The AWC enrolment was declining. The AWC had to reform itself. We saw that many AWCs could compete with English medium KGs. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 11
  12. 12. More Resources from People In many districts local communities have helped the AWCs. More resources came – Repairs, chairs, tables, utensils, cupboards, fans and power in some places. The walls got posters, calendars, portraits etc. In some places AWC has TV, DVD, and even computers. Many AWCs have small gardens and toys for children. AWC has changed – scores of them. In many places locals have donated valuable land. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 12
  13. 13. An AWC from inside Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 13
  14. 14. Dress, Tie and even Shoes Parents or villagers have given 1-2 dresses for the children, at places even tie and shoes too. A well dressed child is eager to attend the AWC than sit at home—so says a CDPO. It brings a sense of tidiness. The child knows now that he/she needs to be in the AWC and the community knows it too. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 14
  15. 15. AnganwadiAnganwadi- in a tribal block Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 15
  16. 16. The ISO AWCs in Aurangabad In Aurangabad district 1300 AWCs have been upgraded with ISO standards. This costs some money But this has created ownership and pride. This is essential for retaining attendance. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 16
  17. 17. Happiness is essential for learning – AWC has to provide the environment Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 17
  18. 18. Also Some Discipline and Restraint Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 18
  19. 19. Getting Toys from People Toys Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 19
  20. 20. And Kitchens improved too Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 20
  21. 21. AWC and Supplementary Feeding 3-6 years age group 6 months to 3 years Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 21
  22. 22. Weighing Scales AWCs have clock like weight scales to hang from the roof. Some of them need repairs more often. The kohinoor scales require more repairs. But older scales provided by Unicef (salter) are still working Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 22
  23. 23. New Growth Charts Separate Charts for girls and babies Growth chart is the basic record in AWC Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 23
  24. 24. Some AWCs have Electronic Weighing Scales Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 24
  25. 25. Height Measurement No standard equipment for height measurement. Most AWCs have a digitally printed measuring tape fixed on the wall. In some AWCs they have a steredometer(?) fixed on top to be pulled to the head. Better height measurement calls for better instruments and methods. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 25
  26. 26. Height Weight Tables. From height and weight chart we can grade the child by checking in the booklet. This chart has three gradesnormal, moderate wasting and severe wasting. However the ICDS is currently not monitoring stunting Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 26
  27. 27. Mid Upper Arm Circumference (MUAC) MUAC) The AWC has a colored MUAC tape. This is for a child of age 6 months to 36 months. This is applied on the mid point of the left arm. The color appearing in the window of the tape suggests grade-- red severe wasting, yellow is border-line and green is normal But MUAC probably underestimates malnutrition. We need to remodel this measurement (12.5cm as cut of point for severe wasting) Currently this is only an additional test to find severe malnourishment. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 27
  28. 28. Pre Primary Education (PPE) Among the 6 AWC tasks Pre Primary Education (PPE) no less important. PPE implies involve only sensitizing and exposing the sense-organs of the child. That is Pedagogy. AWC has started much more than that. AWC has introduced play, hygiene, discipline, social interaction, etc. Many AWCs have ensured this happens. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 28
  29. 29. PPEPPE- Talking walls Marathi And English also Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 29
  30. 30. PPE – Educating through Pictures Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 30
  31. 31. PPE – Educating through Pictures A toilet wall in an AWC in Akola talks to the child. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 31
  32. 32. Some AWCs got even TV & computer Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 32
  33. 33. Beyond PPE Many AWCs offer good PPE component. Beyond this many AWCs expose a child to letters (Marathi and English), numerals, songs and stories and in some places craft too. We saw introduction of English even in some tribal AWCs in Navapur, not to speak of non-tribal districts. Competition with private KGs makes all this necessary. But we must also think and discuss about it from pedagogy point of view. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 33
  34. 34. Mother tongue and the Multilingual child Many tribal blocks have local dialects. But in the AWC both the dialect and Marathi coexist. But the script is Devnagari. In some places English is introduced. In some blocks even Hindi is used as spoken language. The AWC Sevikas are adept at all this and pass it on to the children. This is welcome! Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 34
  35. 35. But its Not Rosy Everywhere Many AWCs in tribal blocks are badly leaking. Many are dingy and depressing, Many are less equipped. Some places are without an AWC shelter and in some places there is no place at all except under the tree or in a temple. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 35
  36. 36. Leaking AWCs & broken toilets are not rare A leaky AWC in Nandurbar A broken AWC toilet in Akola. Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 36
  37. 37. Even then... • Maharashtra State has 1.7 lakh AWCs including mini AWCs • The picture is changing and will change further. • Community participation is the watchword Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 37
  38. 38. Some Four Thousand Supervisors are Monitoring the AWCs Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 38
  39. 39. The Geographic Information System RJMCHN has now extended a GIS system for the entire state. This GIS is available on www//:mhnss.ind.in Basically it has all the 1206 boxes of the monthly progress Report-MP The AW sevika can get it done in 30 Rs provision and within 30 min. She can upload the AWC abstract info (5-7 KB file)on the site thru the Sangram software at village level. This can help to Generate MIS from AWC to state level and update within 48 hrs Generate info for action on every level. It can generate both process and outcome indicators We can generate about 1500 reports from this data It also provides camera sites for physical verification at each AWC Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 39
  40. 40. For community participation See this website .. http://www.icds.gov.in/# Also this one http://nutritionmissionmah.gov.in/Site/Home/Index.aspx Think of CSR You can adopt an AWC (s) s)Your help will take the movement a step ahed, enjoy the involvement Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 40
  41. 41. 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 Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 41

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