declining child malnutrition in maharashtra-3 the anganwadi improvements
DESCRIPTION
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.TRANSCRIPT
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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
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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)
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Transforming the Anganwadis in Transforming the Anganwadis in
Maharashtra (India)Maharashtra (India)
Powerpoint 3/6
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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.
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Transformation 2012Transformation 2012
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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.
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AWC with Garden inAWC with Garden in AurangabadAurangabad
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New Paint, Chairs and Tables.New Paint, Chairs and Tables.
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WaterWater--filter and a toiletfilter and a toilet
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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 .
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New GenerationNew Generation and Use of ITand Use of IT
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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.
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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
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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.
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AnganwadiAnganwadi-- in ain a tribal block tribal block
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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.
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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
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Also Some Discipline and Restraint Also Some Discipline and Restraint
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Getting TGetting Toys from Peopleoys from People
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And Kitchens improved tooAnd Kitchens improved too
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AWC and Supplementary FeedingAWC and Supplementary Feeding
� 3-6 years age group � 6 months to 3 years
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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
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New Growth ChartsNew Growth Charts
� Separate Charts for girls and babies
� Growth chart is the basic record in AWC
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Some AWCs have Electronic Some AWCs have Electronic
Weighing Scales Weighing Scales
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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.
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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.
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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
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PPE PPE –– Educating through PicturesEducating through Pictures
� A toilet wall in an AWC in Akola talks to the child.
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Some AWCs got even TV & Some AWCs got even TV &
computercomputer
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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.
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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.
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Even then...Even then...
• Maharashtra State has 1.7 lakh AWCs including mini AWCs
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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
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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
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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
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Best WishesBest Wishes
Dr Shyam Ashtekar (MD, Community
Medicine)
21 Cherry Hills Society, Anandwalli,
Nashik 422013
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
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