Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

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

Maharashtra (India)

Powerpoint 3/6

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.


3

Transformation 2012


4

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.

5

AWC with Garden in Aurangabad


6

New Paint, Chairs and Tables.


7

WaterWater-filter and a toilet


8

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 .


9

New Generation and Use of IT

The computers arrived in few
Anganwadis


10

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.

11

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.

12

An AWC from inside


13

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.

14

AnganwadiAnganwadi- in a tribal block


15

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.

16

Happiness is essential for learning –
AWC has to provide the
environment


17

Also Some Discipline and Restraint


18

Getting Toys from People
Toys


19

And Kitchens improved too


20

AWC and Supplementary Feeding
3-6 years age group

6 months to 3 years


21

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

22

New Growth Charts
Separate Charts for girls
and babies

Growth chart is the
basic record in AWC


23

Some AWCs have Electronic
Weighing Scales


24

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.

25

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

26

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.

27

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.

28

PPEPPE- Talking walls
Marathi

And English also


29

PPE – Educating through Pictures


30

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


31

Some AWCs got even TV &
computer


32

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.

33

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!

34

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.

35

Leaking AWCs & broken toilets are not rare

A leaky AWC in Nandurbar

A broken AWC toilet in Akola.


36

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

37

Some Four Thousand Supervisors are
Monitoring the AWCs


38

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

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


40

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

41

Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

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