declining child malnutrition in maharashtra-3 the anganwadi improvements

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Child Malnutrition in Child Malnutrition in Maharashtra (India) Maharashtra (India) August 2013 August 2013- January 2014 January 2014 Situation, Efforts, Decline and Challenges Situation, Efforts, Decline and Challenges A Review A Review Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 1 For the State Nutrition Mission For the State Nutrition Mission PowerPoint3/6 PowerPoint3/6 AWC improvements AWC improvements Dr Shyam Ashtekar, MD (Community Med) [email protected]

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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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Page 1: Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

Child Malnutrition in Child Malnutrition in

Maharashtra (India) Maharashtra (India) August 2013August 2013-- January 2014January 2014

Situation, Efforts, Decline and ChallengesSituation, Efforts, Decline and Challenges

A Review A Review

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 1

A Review A Review For the State Nutrition MissionFor the State Nutrition Mission

P o w e r P o i n t 3 / 6P o w e r P o i n t 3 / 6

AWC improvementsAWC improvements

Dr Shyam Ashtekar, MD (Community Med)

[email protected]

Page 2: Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

Transforming the Anganwadis in Transforming the Anganwadis in

Maharashtra (India)Maharashtra (India)

Powerpoint 3/6

Page 3: Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

A New A New AnganwadiAnganwadi Center (AWC)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 � 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

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Transformation 2012Transformation 2012

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 4

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New AWCsNew AWCs� More space for children,

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

Page 6: Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

AWC with Garden inAWC with Garden in AurangabadAurangabad

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 6

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New Paint, Chairs and Tables.New Paint, Chairs and Tables.

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 7

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WaterWater--filter and a toiletfilter and a toilet

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 8

Page 9: Declining Child Malnutrition in Maharashtra-3 The Anganwadi Improvements

AnganwadiAnganwadi ----the Nextthe Next GenerationGeneration

� 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

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New GenerationNew Generation and Use of ITand Use of IT

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014

The computers arrived in few Anganwadis

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Sustaining Enrolment Sustaining Enrolment

Against CompetitionAgainst Competition

� People aspire now for better education and not just food any more.

� In many districts English schools have started buses to fetch

children.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

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More Resources from More Resources from

PeoplePeople

� In many districts local communities have helped the AWCs.

� More resources came – Repairs, chairs, tables, utensils, cupboards,

fans and power in some places. 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

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An AWC from insideAn AWC from inside

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 13

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Dress,Dress, Tie and Tie and eeven Shoesven 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.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

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AnganwadiAnganwadi-- in ain a tribal block tribal block

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 15

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The ISO AWCs in Aurangabad The ISO AWCs in Aurangabad

� In Aurangabad district

1300 AWCs have been

upgraded with ISO

standards.

This costs some money� 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

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Happiness is essential for learningHappiness is essential for learning ––

AWC has to provide the AWC has to provide the

environment environment

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 17

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Also Some Discipline and Restraint Also Some Discipline and Restraint

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 18

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Getting TGetting Toys from Peopleoys from People

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 19

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And Kitchens improved tooAnd Kitchens improved too

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 20

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AWC and Supplementary FeedingAWC and Supplementary Feeding

� 3-6 years age group � 6 months to 3 years

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 21

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Weighing ScalesWeighing 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

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New Growth ChartsNew 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

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Some AWCs have Electronic Some AWCs have Electronic

Weighing Scales Weighing Scales

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 24

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Height MeasurementHeight 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

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Height Weight Tables.Height Weight Tables.

� From height and weight chart

we can grade the child by

checking in the booklet.

� This chart has three grades-� This chart has three grades-

normal, moderate wasting and

severe wasting.

� However the ICDS is currently

not monitoring stunting

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Mid Upper Arm Circumference Mid Upper Arm Circumference

((MUACMUAC))� 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 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

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Pre Primary Education (PPE)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.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.

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PPEPPE-- Talking wallsTalking walls

� Marathi � And English also

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PPE PPE –– Educating through PicturesEducating through Pictures

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 30

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PPE PPE –– Educating through PicturesEducating through Pictures

� A toilet wall in an AWC in Akola talks to the child.

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 31

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Some AWCs got even TV & Some AWCs got even TV &

computercomputer

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 32

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Beyond Beyond PPEPPE

� 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.

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Mother tongue and the Multilingual childMother 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 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!

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But its Not Rosy EverywhereBut its Not Rosy Everywhere

� Many AWCs in tribal blocks are badly leaking.

� Many are dingy and depressing,

� Many are less equipped. � 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

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Leaking AWCs & broken toilets are not rareLeaking 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

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Even then...Even then...

• Maharashtra State has 1.7 lakh AWCs including mini AWCs

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014

including mini AWCs

• The picture is changing and will change further.

• Community participation is the watch-word

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Some Four Thousand Supervisors are Some Four Thousand Supervisors are

Monitoring the AWCsMonitoring the AWCs

Transforming the Anganwadis in Maharashtra,A Review 2013- 2014 38

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The Geographic Information SystemThe 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

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 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 Sangramsoftware at village 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- 201439

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For community participation 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

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Best WishesBest Wishes

Dr Shyam Ashtekar (MD, Community

Medicine)

21 Cherry Hills Society, Anandwalli,

Nashik 422013

[email protected]

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