Page 1
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
Page 2
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
Page 3
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
Page 4
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 4
Page 5
Schedule of the weekly Schedule of the weekly AWCAWC MealsMeals
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 5
Page 6
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 6
Page 7
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 7
Page 8
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 8
Page 9
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 9
Page 10
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 10
Page 11
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 11
Page 12
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 12
Page 13
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
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 13
Page 14
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..
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 14
Page 15
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 15
Page 16
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
Page 17
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 17
Page 18
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
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 18
Page 19
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 19
Page 20
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)
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 20
Page 21
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 21
Page 22
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 22
Page 23
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 23
Page 24
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 24
Page 25
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 25
Page 26
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 26
Page 27
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 27
Page 28
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 28
Page 29
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?
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 29
Page 30
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.
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 30
Page 31
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
Anganwadi-supplementary feed--Dr Shyam ashtekar jan 2014 31