Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues

Child Malnutrition in Child Malnutrition in

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

Situation, Efforts, Decline and Challenges

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

1

For the State Nutrition MissionFor the State Nutrition Mission

P o w e r P o i n t 4 / 6P o w e r P o i n t 4 / 6

The supplementary nutrition componentThe supplementary nutrition component

Dr Shyam Ashtekar, MD (Community Med)

[email protected] feed--Dr Shyam ashtekar jan 2014

Supplementary Nutrition Supplementary Nutrition Program in the Program in the AnganwadiAnganwadi (AWC)(AWC)in Maharashtrain Maharashtra

PowerPoint 4/6PowerPoint 4/6PowerPoint 4/6PowerPoint 4/6

Jan 2014

SNP SNP --Importance and limitations 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 � 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

Schedule of Schedule of AWCAWC FeedsFeeds

� 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.


Schedule of the weekly Schedule of the weekly AWCAWC MealsMeals


SupplementarySupplementary feed & AWC feed & AWC AAssistantssistant

� 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.� 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.


The Current provision is only The Current provision is only 4.92Rs.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.� 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.


Fair Price Grain Fair Price Grain Supply from Supply from PDSPDS

� In Some districts AWC have managed to get foodgrains and

some dal, oil, sugar, rockel etc. from the PDS.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.


Supplementary Feeds and Supplementary Feeds and Self Help GroupsSelf 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.


Supplementary feeds and Self Help Supplementary feeds and Self Help Groups (SHG)Groups (SHG)

� But many SHGs cannot afford to provide

theses meals in the meager budget, they either

avoid this or are reluctant. avoid this or are reluctant.

� Some prefer other employment.

� There are complaints about quantity and

quality of meals supplied by SHG to AWC.


AWC WorkerAWC Worker & Self Help Groups& 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 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.


Quality of Quality of AWCAWC mealsmeals

� 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. There are many complaints about bad test or insufficient meals.

� In some places they combine breakfast and lunch to save on costs.


Protests about MealsProtests 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 � 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


Solutions tried in some districts.Solutions tried in some districts.

� Aurangabad, Akola, Ahmednagar, Latur are some districts where some solutions werefound for this problem.

� Essentially the villagers contributed food Essentially the villagers contributed food items to the AWC to bridge the gap.

� For this some methods were used..


1. Akola1. Akola-- handful of grain from each homehandful of grain from each home

� In 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.


2. The Aurangabad 2. The Aurangabad ExperimentExperiment

� Aurangabad district also asked for food donations to

the AWC.

AWCs have essential items donated by families.� AWCs have essential items donated by families.

� Many mothers and families learned to prepare various

foods recipes from these provisions.

Anganwadi-supplementary feed--Dr Shyamashtekar jan 2014 16

3. The 3. The GopalpangatGopalpangat in in AhmednagarAhmednagar & & LaturLaturdistricts.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.


GopalpangatGopalpangat ……….……….

� 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


The Child’s Food The Child’s Food cornercorner

� 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.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.


But in tribal districts...But in tribal districts...

� No such scheme worked in tribal areas.

� Not that tribal families have no food to eat or give. 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)


The Supplementary meals in The Supplementary meals in AWCAWC--Gains Gains and Pains.and Pains.

� Causes some carelessness about

feeding at home.

� The needs to be guarded against

� Laboring families get some

respite from child care/ feeding.

� Children learn to eat together.

� Some Problems. � Some Advantages

The needs to be guarded against

� The middle class in the village

turns it’s back on the AWC

Children learn to eat together.

� Child learns to eat with own

hands.

� Child learns different tastes.

� We can give micronutrients

through the meals.


SHGSHG and Take Home and Take Home RationRation

� 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.


Take Home Take Home RationRation

� 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.


Take Home RationTake 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.


Take Home RationTake Home Ration---- ComplaintsComplaints

� 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.� Some families cook and share THR in the entire family.

� Thus somehow the child hardly benefits from the THR.


Experiments with Experiments with THRTHR

� 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.


Does THR help?Does THR help?

� But many families are unable to prepare

such food items.

� Hence it is a big question mark on the

THR.


Only big Only big SHGsSHGs can bag can bag THRTHRcontracts.contracts.

� Local SHGs can not secure THRcontracts.

� Only big units can � Only big units can get the contracts.

� So the original idea of SHGempowerment no longer works.


Challenges of Supplementary Challenges of Supplementary Feeding.Feeding.

� How to improve and sustain the quality of AWC

meals.

� How to sustain the social participation in

supplementary feeding programme.supplementary feeding programme.

� How to increase the protein factor in the meals.

� Will increasing of provision ensure better

compliance?


RUTF? Better Protein Foods?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 � 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.


BestBestWishesWishes

Dr Shyam Ashtekar (MD,

Community Medicine)

21 Cherry Hills Society, Anandwalli,

Nashik 422013

[email protected] +919422271544Cell +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


Health & Medicine

Declining Child Malnutrition in Maharashtra-4 The Suppl Nutrition issues