Health and Nutritional Needs of Ashram Schools - tiss.edu€¦ · Prof. K Anilkumar, Dean, SHSS, for his motivation and support in bringing out this report. Special mention and thanks

Tata Institute of Social Sciences, Mumbai | ACKNOWLEDGEMENTS 1

ACKNOWLEDGEMENTS

The successful completion of this report wouldn’t have been possible without the valuable

contribution from a number of people. The Tata Institute of Social Sciences (TISS), Mumbai

expresses gratitude to Tribal Research and Training Institute (TRTI), Pune for entrusting us

with this research project. First of all, we would like to express our special thanks to former

commissioner Mr. Narendra Poyam (IAS), and Dr Kiran Kulkarni (IAS), Commissioner,

TRTI, Pune for initiating this much needed task of commissioning this study. We owe our

gratitude to Mr. Yogesh Choudhari, Tribal Development Inspector, Mr. D. S. Dastane, Smt.

Chetana More, Research Officer and the entire TRTI team for their constant support

throughout the study in diverse capacities. We also want to express our sincere thanks to all

the four Additional Tribal Commissioners (ATCs) of the state and their project offices, which

were instrumental in carrying out the study in selected districts.

At this juncture, we would like to offer our sincere thanks to former TISS Director, Prof. S

Parasuraman for initiating the project during his tenure and for the continuous support and

motivation offered by our incumbent Director, TISS, Prof. Shalini Bharat. We are thankful to

Prof. T Sundararaman, former Dean of the School of Health Systems Studies (SHSS), for

helping our team to carry out the study within the School. We also express our gratitude to

Prof. K Anilkumar, Dean, SHSS, for his motivation and support in bringing out this report.

Special mention and thanks are due to the Public Health Department, Government of

Maharashtra, for their cooperation and support in diverse capacities to capture the health and

nutrition related information by facilitating their teams across the study districts. We owe our

heartfelt gratitude to Dr Satish Pawar, former Director, DHS Maharashtra, who has

personally taken interest to facilitate the support of district public health officers and civil

surgeons of selected districts for the conduct of the study. We wish to extend our special

gratitude to Dr Geeta Kakade, Assistant Director, Leprosy/TB, for her valuable inputs and

relentless and constant support which has facilitated the process of data collection smoothly.

Special thanks to Dr Kharat, Dy Director, Dr Shirodkar, Assistant Director, for their kind

assistance at the DHS and Dr Renge, District Health Officer, Thane. We want to thank the

Civil Surgeons, DHOs, Superintendents of the selected districts for their timely help and

support extended to our research team. Our team could move safely due to their constant

support. Thanks to the medical team of selected districts and other personnel who were

directly or indirectly part of the study by providing transport, food and accommodation

during the field visits.

We thank Dr Geeta Sethi, Consultant on Health and Development, Mumbai, for her valuable

inputs during various stages of the project, especially for her initial comments on the first

draft of this report. Our sincere thanks to our friend and colleague Dr Shaileshkumar Darokar

and his research team Mr Atman Padale, Ms Swati Kamble and Ms Shraddha Ghatge for their

continuous support and assistance.

Tata Institute of Social Sciences, Mumbai | ACKNOWLEDGEMENTS 2

Our thanks to Ms. Diana Thomas, who shouldered the responsibility as a Research Officer of

the project and has overseen data collection, coordinated with the research team in the field,

and looked after the documentation and drafting of the preliminary report of the study. We

also acknowledge the contribution of the field investigation team Dr. Amit Mohite, Ms.

Avanti, Ms. Sneha Gedam, Ms. Monica Jambulkar, who offered to go to the remotest of the

villages for gathering information from the adolescent girls, teachers and other stakeholders.

We are thankful to our data entry operators Ms. Rani Dhende and Ms. Pragati Londhe for

carrying out the data entry and cleaning as necessary. The analysis of qualitative data would

not have been possible without Ms. Karishma, Ms. Supriya, Ms. Madhuri who transcribed

and translated the interview data and Focus Group Discussions (FGDs). Mr. Jayakant’s

contribution in the additional statistical analysis is also hereby acknowledged.

We extend our sincere appreciation to all the secretariat staff of SHSS for their ardent support

and cooperation towards whatever the School does. Special mention has to be made of the

accounts and administration team of TISS for their support during various stages of the

project. Last but not least, we thank all the respondents and school authorities involved in the

study for their patience and cooperation. A study of this kind could not have been possible

without the passionate support of its respondents, the adolescent girls, who have been

instrumental in sharing information and cooperating during our data collection process. There

are several members of various blocks of the selected districts: college principals who offered

logistic support and accommodation for our research teams, local leaders who offered support

in diverse capacities in facilitating the study. More importantly, the extended support of

ashram school officials needs to be specifically acknowledged as they have been an important

support group who contributed immensely in making this study happen. It is impossible to

mention and acknowledge all the contributors towards this kind of an effort, however, we are

grateful for their contributions that have directly or indirectly helped in completing this

project. We also hold ourselves accountable for any errors and oversights in this report.

Narendra Kakade, Ph.D

Mathew George, Ph.D

Bal Rakshase, Ph.D

Tata Institute of Social Sciences, Mumbai | ABBREVIATIONS 3

ABBREVIATIONS

o AG - Adolescent Girls

o APO - Additional Project Officer

o ATC - Additional Tribal Commissioner

o BMI - Body Mass Index

o CHC - Community Health Centre

o DBT - Direct Benefit Transfer

o DH - District Hospital

o FGD - Focus Group Discussion

o Hb - Haemoglobin

o HM - Headmaster

o ICMR - Indian Council of Medical Research

o IMR - Infant Mortality Rate

o IRB - Institutional Review Board

o ITDP - Integrated Tribal Development Project

o KII - Key Informant Interview

o MMR - Maternal Mortality Rate

o MO - Medical Officer

o NA - Not Applicable

o NCHS - National Centre for Health Statistics

o NFHS - National Family and Health Survey

o NSS - National Sample Survey

o OPD - Out Patient Department

o PHC - Primary Health Centre

o PO - Project Office

o RBSK - Rashtriya Bal Swasthya Karyakram

o RH - Rural Hospital

o RKSK - Rashtriya Kishor Swasthya Karyakram

o RO - Reverse Osmosis

o SC - Sub-Centre

o SC - Scheduled Caste

o SDH - Sub-District Hospital

o SPSS - Statistical Package for Social Sciences

o ST - Scheduled Tribes

o TSB - Treatment Seeking Behaviour

o TRTI - Tribal Research and Training Institute

o U5MR - Under five Mortality Rate

o WHO - World Health Organisation

Tata Institute of Social Sciences, Mumbai | CONTENTS 4

CONTENTS

ACKNOWLEDGEMENTS .............................................................................................................. 1

ABBREVIATIONS ............................................................................................................................ 3

CONTENTS ....................................................................................................................................... 4

LIST OF TABLES ............................................................................................................................. 7

EXECUTIVE SUMMARY ............................................................................................................... 9

CHAPTER ONE .............................................................................................................................. 19

INTRODUCTION ............................................................................................................................ 19

1.1. HISTORY AND EVOLUTION OF ASHRAM SCHOOLS ...................................................... 20

1.2. CONCEPT OF ASHRAM SCHOOL ......................................................................................... 21

1.3. STUDY CONTEXT AND CONSIDERATION ........................................................................ 24

1.4. ADOLESCENT HEALTH FROM A LIFE COURSE PERSPECTIVE: STUDY

FRAMEWORK ......................................................................................................................... 26

1.5. SPECIFIC OBJECTIVES: .......................................................................................................... 29

1.6. OPERATIONAL DEFINITION: ................................................................................................ 29

1.7. METHODOLOGY ..................................................................................................................... 30

1.8 DATA ANALYSIS ..................................................................................................................... 32

1.9 ETHICAL CONSIDERATION ................................................................................................... 32

1.10 LIMITATIONS.......................................................................................................................... 32

1.11. CHAPTERISATION ................................................................................................................ 33

CHAPTER TWO ............................................................................................................................. 35

ASHRAM SCHOOLS: INFRASTRUCTURE AND SERVICES ................................................... 35

2.1 INTRODUCTION ....................................................................................................................... 35

2.2 ADMINISTRATION AND GENERAL INFRASTRUCTURE ................................................. 35

2.3 STAFFING PATTERN ............................................................................................................... 37

2.4 BUILDING AND INFRASTRUCTURE .................................................................................... 42

2.5 ELECTRICITY SUPPLY ............................................................................................................ 44

2.6 WATER SUPPLY AND MANAGEMENT ................................................................................ 46

2.7 SEWERAGE DISPOSAL ........................................................................................................... 47

2.8 TOILET AND WASHROOM FACILITIES ............................................................................... 49

2.9 SPACE PROVISIONS ................................................................................................................ 51

2.10 PROVISION OF CONSUMABLES ......................................................................................... 54

2.11 EDUCATIONAL FACILITY.................................................................................................... 58

2.12 HEALTH INFRASTRUCTURE ............................................................................................... 59

2.13. SUMMARY .............................................................................................................................. 67


CHAPTER THREE ......................................................................................................................... 69

SOCIO-ECONOMIC AND DEMOGRAPHIC CHARACTERISTICS OF ASHRAM SCHOOL

GIRLS ............................................................................................................................................... 69

3.1 INTRODUCTION ....................................................................................................................... 69

3.2 BLOCK AND DISTRICT OF STUDY ....................................................................................... 69

3.3 TYPE OF ASHRAM SCHOOLS INCLUDED IN THE STUDY .............................................. 69

3.4 AGE PROFILE OF THE ADOLESCENT GIRLS ..................................................................... 70

3.5 RELIGION AND CASTE OF THE ADOLESCENT GIRLS ..................................................... 70

3.6 STANDARD-WISE DISTRIBUTION OF ADOLESCENT GIRLS .......................................... 71

3.7 DISABILITY STATUS AMONG ADOLESCENT GIRLS ....................................................... 72

3.8 DISTANCE FROM ASHRAM SCHOOL TO RESIDENCE OF THE GIRLS .......................... 73

3.9 LITERACY LEVEL AND EDUCATIONAL STATUS OF PARENTS .................................... 74

3.10 OCCUPATIONAL STATUS OF THE GIRLS’ PARENTS ..................................................... 75

3.11 APPROXIMATE MONTHLY INCOME OF THEGIRLS' FAMILY FROM MAJOR

SOURCE ................................................................................................................................... 76

3.12 SIZE OF THE HOUSEHOLD ................................................................................................... 77

3.13 SIBLINGS’ EDUCATION STATUS AND VULNERABILITY ............................................. 78

3.14 SUMMARY ............................................................................................................................... 79

CHAPTER FOUR ........................................................................................................................... 81

HEALTH BEHAVIOURS AND ASHRAM SCHOOL ROUTINE ................................................. 81

4.1. INTRODUCTION ...................................................................................................................... 81

4.2. FOOD HABITS IN ASHRAM SCHOOL .................................................................................. 81

4.3 NUTRITIONAL STATUS .......................................................................................................... 92

4.4 GENERAL HYGIENE ................................................................................................................ 97

4.5. MENSTRUAL HYGIENE ......................................................................................................... 98

4.6. SUBSTANCE ABUSE BY GIRLS .......................................................................................... 104

4.7. SUMMARY .............................................................................................................................. 105

CHAPTER FIVE ........................................................................................................................... 107

MORBIDITY PREVALENCE AND PATTERN OF TREATMENT SEEKING ......................... 107

5.1. INTRODUCTION .................................................................................................................... 107

5.2. METHODOLOGY OF CAPTURING SELF-REPORTED MORBIDITY.............................. 107

5.3. MAJOR INFECTIONS ............................................................................................................ 109

5.4. INJURIES AND ACCIDENTS ................................................................................................ 111

5.5. MINOR ILLNESSES ............................................................................................................... 112

5.6 OVERALL MORBIDITY AMONG ASHRAM SCHOOL GIRLS ......................................... 113

5.7. EPISODES OF DISEASES: INDICATOR OF SUSCEPTIBILITY ....................................... 114

5.8. TREATMENT SEEKING BEHAVIOR (TSB) ....................................................................... 114


5.9. HOSPITALIZATION PATTERN OF GIRLS DURING ILLNESS ........................................ 117

5.10. AVAILABILITY AND UTILIZATION OF SICK ROOM DURING SICKNESS ............... 119

5.11. LINKAGE BETWEEN MORBIDITY AND OTHER HEALTH AND NUTRITION

INDICATORS ......................................................................................................................... 121

5.12. SUMMARY ............................................................................................................................ 125

CHAPTER SIX .............................................................................................................................. 127

CONCLUSION .............................................................................................................................. 127

RECOMMENDATIONS .............................................................................................................. 133

REFERENCES .............................................................................................................................. 137

APPENDIX ..................................................................................................................................... 143

TOOL 1- INTERVIEW SCHEDULE FOR GIRLS ....................................................................... 143

TOOL 2- GUIDELINES FOR FOCUS GROUP DISCUSSION ................................................... 155

TOOL 3- GUIDELINES FOR KEY INFORMANT INTERVIEW ............................................... 163

TOOL 4- FACILITY SURVEY FORMAT .................................................................................... 169

TOOL 5- MEDICAL CHECK UP FORMAT ................................................................................ 176

Tata Institute of Social Sciences, Mumbai | LIST OF TABLES 7

LIST OF TABLES Sr

No.

Table

No. Title

Page

No.

1 2.1 Characteristics of selected ashram schools 36

2 2.2 (a) Staffing pattern in selected schools against the ideal expectations according

to the standards in theschools

39

3 2.2 (b) Staffing pattern of three schools with either primary or secondary levels 40

4 2.3 Building facilities of selected schools 42

5 2.4 Infrastructure for power supply in ashram schools 45

6 2.5 Infrastructurefor water supply and frequency of cleaning 46

7 2.6 Sewerage disposal mechanism in ashram schools 48

8 2.7 Toilet and bathroom availability against the number of children 51

9 2.8 Provision of residential and educational facility in ashram schools 53

10 2.9 Consumable provided in ashram schools 55

11 2.10 Number of daily use items received by the respondents based on type of

school management

57

12 2.11 Health care infrastructure and access to health care facilities 61

13 2.12 Data on menstrual status of girls based on self-reported data

and medical check-up data

65

14 2.13 Status of Irregular Menstruation based on self-reported data

and Medical Check-up data

66

15 3.1 District-Block-wise distribution of adolescent girls 69

16 3.2 Age distribution of adolescent girls 70

17 3.3 Sub-tribe of respondents across districts and corresponding blocks 71

18 3.4 Standard-wise distribution of adolescent girls 71

19 3.5 Standard in which girls study according to age group 72

20 3.6 Distance between the school and residence of students across districts 73

21 3.7 Literacy level of parents of respondents 75

22 3.8 Occupational status girls’ parents 76

23 3.9 Approximate monthly family income of the respondents from primary

source

77

24 3.10 Number of siblings not educated or dropped out of school 78

25 4.1 District-wise data on type of breakfast given to the respondents on weekday 83

26 4.2 Type of breakfast provided to the students during weekends across districts 84

27 4.3 Type of lunch provided to the respondents during weekdays across districts 86

28 4.4 Type of lunch provided to the respondents on weekend across districts 86

29 4.5 Type of evening snacks provided to the respondents on weekday across

districts

87

30 4.6 Type of evening snacks provided to the respondents on weekend across

districts

87

31 4.7 Type of dinner provided to the respondents on weekday across districts 88

32 4.8 Type of dinner provided to the respondents on weekend across districts 88

33 4.9 Under-nutrition status of Ashram School girls based on BMI 92

34 4.10 Body mass index of the respondents across districts 93

35 4.11 Anaemia status of ashram school adolescent girls 93

36 4.12 Haemoglobin (Hb) level of the respondents across districts 95

37 4.13 Proportion of wasting among ashram school girls 96

38 4.14 Proportion of stunting among ashram school girls 96

Tata Institute of Social Sciences, Mumbai | LIST OF TABLES 8

39 4.15 Frequency of brushing and bathing daily based on the type of school 97

40 4.16 Frequency of hair wash and nail cutting by respondents based on type of

school

97

41 4.17 Awareness about the ideal age at which girls attain menarche across districts 98

42 4.18 Age at which girls attained menarche across districts 99

43 4.19 Absorbent used by the respondents during menstruation across districts 100

44 4.20 Absorbent used by the respondents during menstruation in type of school 100

45 4.21 Absorbent actually used during menstruation by the respondents against the

preferred absorbents

101

46 4.22 Provision of sanitary napkin or cloth to the respondents by schools across

districts

101

47 4.23 Bodily discomfort experienced by the respondents during

menstruationacross districts

103

48 4.24 Whether the respondent takes treatment for bodily discomfort during

menstruation across districts

103

49 4.25 Change in daily routine due to menstruation experienced by the respondents

across districts

104

50 4.26 Common substance used by friends as per respondents based on type of

school management

105

51 5.1 Types of chronic diseases self-reported by ashram school respondents 109

52 5.2 Major infections reported in last 6 months among respondents across

districts

110

53 5.3 Type of major infections reported among the respondents across districts 110

54 5.4 Injuries or accidents among ashram school girls in last 6 months across

districts

111

55 5.5 Type of injury/accident reported by the respondents across districts 112

56 5.6 Type of minor illnesses reported across districts 113

57 5.7 Total morbidity prevalence reported among ashram school girls 113

58 5.8 Number of major infections reported by the respondents across districts 114

59 5.9 Place of treatment of diseases based on district and block of the school 116

60 5.10 Place of treatment of diseases based on district and block of the school

management

117

61 5.11 Total number of hospitalization in the last one year across districts 118

62 5.11 (a) Purpose of hospitalization based on district and block of the school 118

63 5.12 Duration of hospitalization across districts 119

64 5.13 Availability of sick room in the school based on type and management of

school

119

65 5.14 Utilization of sick room by the respondents during sickness across districts. 120

66 5.15 Reason for sending students home when they are sick as per respondents

across districts

120

67 5.16 Major and minor illness reported against girls' age at menarche 121

68 5.17 Haemoglobin level in gm% based on body mass index of the respondents 122

69 5.18 Age at menarche and Hb level 124

70 5.19 Age at menarche and BMI level 124

Tata Institute of Social Sciences, Mumbai | EXECUTIVE SUMMARY 9

EXECUTIVE SUMMARY

Adolescents, in today’s world, are an important resource who contribute significantly

towards a better tomorrow. The adolescent population in India is 253 million amounting to

20.9% of the total population. Maharashtra is among the top five states with highest number

of adolescents constituting 21.3 million (Census, 2011). Although adolescence is widely

considered as an idyllic phase of one’s life, its volatile nature is something which is usually

overlooked. An adolescent has to deal with a myriad of issues pertaining to their health –

mental and physical; hitting of puberty; cultural and social context followed by the fast pace

of modernism all have a bearing on their health and wellbeing. These vulnerabilities are often

severe when it comes to the adolescents who hail from tribal regions in India.

Given the historical deprivation, social and geographical isolation, distinctiveness of culture,

the tribals, especially the children and women, are more prone to deprivation. About 72% of

the total adolescents live in the rural areas in India, wherein, the Schedule Tribe (ST)

adolescent population amounts to 23 million constituting to 9% share who are socially,

economically and geographically deprived. Taking into consideration the significant

contribution of adolescents and the historical vulnerability manifested among ST

communities, several welfare schemes, programmes and activities have been initiated by the

governments with an objective of overall development and growth of such underprivileged

communities, especially adolescent girls. Even with these schemes, there has only been

marginal improvement in their situation over the years.

One such measure taken by the government to keep a check on the overall growth of the

tribal children was setting up of ashram schools. Ashram schools (residential schools) are

designed to provide them education, shelter, food and a conducive environment for overall

growth, freeing them of the age-old barriers. Primarily focussed on educational upliftment,

ashram schools are developed as a response to ensure social stability for vulnerable

population through provision of residential, educational, nutritional and health services to

their children. These services are aimed directly to improve their overall health and well-

being.

For speedy social and economic development of every remotest tribal community, an ashram

school was mandated for every 5,000 to 7,000 population. Initially, ashram schools

functioned with the help of voluntary initiatives. These initiatives were then taken over by the

government in the year 1972-73 by starting its first 40 ashram schools across the country.

Keeping in view of the vulnerability and deprivation of the remotest tribal communities, for

21 most remote tehsils from seven tribal districts, the government mandated a norm to

provide one ashram school for every 2,000 to 3,000 population in the year 1982-83

(Government of Maharashtra 2005).

Today the ashram schools provide education from 1st standard to 12th standard in both Arts

and Science disciplines across the four major tribal divisions (Nasik, Thane, Amaravati,

Nagpur) of the state of Maharashtra. Thus, a total of 1,103 ashram schools are running in


these areas of which almost half of the schools (547) are run directly by the Tribal Ministry

alone; the rest are run with financial aid of the government via private or charitable

institutions. About 398,090 students are taking residential education of which girl students

form 167,234 (42 %). Among these girls, 84484 (50.4 %) girls are studying in government

schools alone (https://tribal.nic.in). In another estimate, the 23 tribal districts and 36 tehsils of

Maharashtra have 1108 ashram schools with 450,000 students studying of which 50% are

girls (Vidhayak Bharti, 2016)

The government has provisioned about 12% of the total budget allocated to the ashram school

for medical check-ups, books and educational materials, laboratory and library for the

students. The other 8% is provisioned for yearly supply of two sets of school dresses, set of

utensils such as plates, glass bowls and bedding materials like blankets, bed-sheets, pillows,

etc. These are supplied once in three years for every student inmate. Moreover, provisions for

medicines, towels, soaps, hair oil, night gowns and suits for girls and boys, tooth pastes, etc.,

are distributed every year. Specific provisions are also made for breakfast (poha/ upma, eggs,

milk), lunch and dinner along with mid-day light meal, weekly fruits, meat (once in two

weeks) and special food is cooked during festivals. Special focus is given to girl students by

ensuring their enrolment in the 1st division of each standard at 50% or at least 33%.

Additionally, there are specific rules for maintaining register by the lady hostel wardens to

record details of the first attainment of menarche and menstrual periods/ cycles along with the

weights of all girls attained puberty on a monthly basis.

However, from several accounts, it is being found that these ashram school children live in

precarious conditions, even as the ashram schools are actually preordained for providing

lodging and boarding facilities, uniforms, books and note books and educational materials to

its inmates, so to meet their educational and minimal needs of food, clothing and health.

Major problems faced by adolescents in ashram schools include physical, psychological and

social dimensions. Physical dimensions include nutritional problems like anaemia,

malnutrition, etc. and reproductive problems like menstrual issues, reproductive tract

infections and a range of morbidities along with sexually transmitted diseases, HIV etc,

which are seen more in the adolescent girls. Psychological or mental health issues like

depression, suicide etc., and social issues, including abuse, exploitation, substance abuse,

relationship issues etc. (Trivedi S.S., 2012 and Sivagurunath C., et. al. 2015).

According to a study, ashram school children of Kalahandi district of Odisha had

conjunctival pallor at 34.3%, vitamin A deficiency at 15.2%, vitamin B deficiency 15.6%,

iron deficiency at 17.4%, scabies 27.2% and dental caries at 20% (Balgir R.S., 2002). While a

cross-section study conducted on 816 students studying in primary schools of rural Uttar

Pradesh found cases of nutritional deficiencies at 56.9%, dental diseases 46%, skin diseases

29.4%, and respiratory diseases 27.6%. The study concluded higher morbidity among

females 86.1% as compared to male students 84.4%. (Kaushik, A. 2014). Thus, health issues

like nutritional deficiencies, dental conditions, respiratory conditions and infectious diseases

are common among children of ashram schools, especially the girls.


The scenario in Maharashtra is very similar to that across the country. According to a study in

ten ashram schools of Wardha district, head lice (18.2%), scabies (6.9%), multiple boils

(11.2%), fungal infection (6.2%), dental caries (12.6%) and worm infestations (15.9%) were

found among children residing in ashram school (Dongre A.R., 2011). As per a cross-

sectional study conducted in Zilla Parishad schools located in village - Durves, tribal area of

District-Palghar some of the morbidities reported through clinical examination were dental

caries (61%), ear wax (38%), upper respiratory tract infection (19%), ear discharge (13.5%)

and vitamin deficiencies (10%) (Gokale et al. 2017). Malaria has been a major cause of

mortality and morbidity in Gadchiroli district (Dhiman R.C., 2005 and Karlekar, S.R., 2012).

Anaemia, undernutrition, worm infestation, menstrual abnormalities, etc., were found as

major issues among (87.8%) of tribal ashram school girls of 8-16 years in Ahmednagar

district (Bhise, R. M. et. al. 2013).

Hence, it is essential to study the health and nutritional needs of adolescent girls. There is a

need to explore a few questions to examine the linkage between ashram schools and the

health and nutritional needs of adolescent girls. Questions which would seek answers to the

ways by which an ashram school and its environment influence the health and wellbeing of

its adolescent girls; the extent of vulnerability from which these students of ashram school

suffer and how far ashram schools have responded to their needs; the ways in which an

ashram school engages with other departments like health to addressing the needs of the

students, etc.

Methodology:

To study the above-mentioned aspects, we have adopted a cross-sectional study with an

exploratory and descriptive purpose. In the exploratory phase, the study tries to explore

various concerns of adolescent girls by examining the living conditions in the ashram schools

based on the facilities provided both in terms of conditions for living and for education

inputs. It would also focus on their illnesses and concerns and the efforts which are made to

improve their condition being under the security and protective shield of the government so

that these children later can emerge as leaders and represent their tribe and community at

various levels.

The second phase of the study focuses on the mechanism arranged by the government

pertaining to ashram schools and the role of Department of Tribal Affairs, Education

Department along with the Public Health Department in moulding health and wellbeing of

tribal children. Not only the individual factors of the children are examined, but also the

institutional factors, which provide the support and care to these children, and also the ashram

schools, which act as an important agent in institutionalising these changes. The study also

inspects the mechanism which goes at school-level where these changes are implemented.

Therefore, we have used both the qualitative and quantitative facility-based assessment to

understand this particular change and the issues faced by the adolescent girls in ashram

schools.


In order to capture the aforesaid broad varied dimensions, the study used multiple data

collection tools, each with specific focus. Following are the tools used for data collection:

1) Structed Interview Schedule for collecting information from adolescent girls.

2) Semi-structured Focus Group Discussion guidelines to conduct FGDs among

adolescent girls.

3) Semi-structured Key Informant Interview Guidelines to conduct interviews of school

authorities like headmasters, teachers, male and female wardens, other staff and

government officials, etc.

4) Structured Facility Survey for recording information on ashram school infrastructure

and facilities based on observation and informal discussion with relevant

stakeholders.

Selection of ashram schools and respondents:

A sample survey was conducted by selecting 800 adolescent girls aged between 10-19 (i.e.

studying in 5th to 10th or 12th standard) from 17 ashram schools (eight government and nine

government-aided (privately-run) schools) located in four blocks of four tribal-intense

districts (Palghar – Dahanu block; Nandurbar – Navapur block; Yavatmal – Kelapur block;

Gadchiroli – Aheri block). These districts fall under the jurisdiction of four different

Additional Tribal Commissioners (ATC) of Tribal Development Department. The district

with highest proportion of Schedule Tribe (ST) population from each ATCs was selected for

the study while the blocks from these districts were selected using simple random method.

This was done to capture the diversity of the tribal communities and population with respect

to their geography and other socio-cultural aspects. We also wanted to gauge the possible

representation of the adolescents in ashram schools in Maharashtra.

Data analysis:

The data analysis was carried out using SPSS Version 20 software. Besides, simple frequency

and crosstabs with univariate and bivariate analysis was done to analyse the data.

Ethical aspects of the study were accomplished at multiple levels as it underwent the

Institutional Review Board (IRB) of TISS for ethical clearance and necessary consent was

obtained from all the respondents across several stakeholders. Anonymity and confidentiality

of respondents and institutions studied was also ensured.

Findings:

The health status of the adolescents, especially girls, is determined and heavily influenced by

the environment in which they live and study. This environment comprises of the school

premises and facilities offered at the school for food, accommodation, toilet and bathing,

which have an important say and a direct bearing on the health of the adolescent girls. So, it

becomes extremely important for us to understand what is the larger environment within

which these adolescent girls live and undergo desired change.


There is a set mechanism of the government for these children to undergo change. There are

certain things which are already provided such as provision made for medical check-ups,

books and educational materials, laboratory and library for the students. Moreover,

medicines, towels, soaps, hair oil, night gowns and suits for girls and boys, tooth pastes, etc.,

are distributed every year. Specific provisions are also made for breakfast (poha/ upma, eggs,

milk), lunch and dinner along with mid-day light meal, fruits on weekly basis, meat (once in

two weeks) and special food is cooked during festivals. We wanted to see that how far these

schools are in a position to offer those services efficiently so that it induces further desirable

improvements.

The study results showthat these children are presently living in precarious condition.

Besides, the study points to the inadequate infrastructure which being the larger social

environment of living, it has a huge influence on the health of the children. However, the

study shows how these factors are inadequate thereby affecting the adolescents’ health. These

factors need to be ensured by the government as there are set provisions. With respect to

educational and health facilities, though they were existing across schools there weren’t

deployed effectively for students.

Among the 17 selected schools, four schools did not have a separate classroom at all, which

implies students’ living arrangements are made in the same classroom where they attend

classes. In most of the ashram schools, students were forced to reside and study in poor and

menial conditions. This leads to issues of privacy, overcrowding, poor lighting and

ventilation to the room increasing the susceptibility to communicable diseases and

reproductive infections among adolescent girls.

Although all the schools had approach roads, they were either not well-maintained or in good

condition. Of the 17, six schools had good and well-maintained tar roads as they were located

in the heart of the village or near the local bus stop, five had fairly maintained tar roads some

of which were constructed a long time ago, while six schools had poor roads. Poor approach

roads have direct effect on access to medical attention during emergencies.

Fifteen out of 17 schools had residential staff quarters available inside the school premises,

but these quarters were few in number which, in most cases, were meant for male and female

wardens or watchman or class four employees of the school. Only two schools had full-

fledged residential quarters for all employees, including teachers and class four employees

which were functional. The average size of the classroom was 408 sq. feet. Most of the

classrooms have adequate space as a classroom to accommodate 50 students, but the facilities

inside the classrooms like ventilation and lighting were poor in majority of the schools.

Congested or poorly-ventilated classrooms or staying arrangements are predisposing factor to

communicable and skin diseases among the inmates.

It was observed that six schools had less than six teachers (including headmaster) appointed

in primary section. While in secondary section most of the schools have at least one teacher

per class i.e. three in total but one of the schools had no teacher appointed even though the

school catered till 10th standard and another school had four teachers when it is expected to


have 11 teachers in total as per the norms since it caters to both secondary and higher

secondary.

Five schools were deficient of cooks (less than 4) of which two schools had none appointed

on permanent basis. Wardens, another important staff member of the school, was found

deficit in five out of the 14 schools. For daily routine activities, the school’s staff crunch

among class four workers was overcome by assigning these jobs to students. Lack of required

cleaning staff like sweepers or helpers forced teachers or warden to instruct students to do

these chores. Girl students were especially assigned with cleanliness duty, while boys were

assigned works like cleaning the water tanks, moving of table and chairs from one place to

another and lifting grocery bags from the unloading truck to store room. Gendered division of

tasks is a common feature in these schools and rural settings which might also maintain the

status quo existing of gender roles. These shortfalls when managed with students have serious

implication on the health, social and educational aspect of students.

This inadequacy of various category staff has larger implications on the quality of services

offered at the ashram schools and also poses great difficulties in appropriately managing it.

However, other studies and committees on ashram schools have pointed out that as much as

4,445 post are vacant in the ashram schools of which 3,469 are in the government schools and

the rest 976 are in the private-aided schools. Studies highlight that more than half of the

sanctioned posts of female warden are vacant in these schools (Jojo, 2015, Salunkhe

Committee, 2016). These findings are reiterated in our study as we too found that the number

of staff in all categories are having shortfall in the schools that has significant impact on the

quality of services and education offered for the children studying and residing there.

Though most of the schools had a fairly functional septic tanks, some of them were in

extremely poor condition rather equivalent to non-functional due to blockage or leakage of

the tank rendering it unsuitable and unhygienic for daily use. The open drains or leaking

tanks are likely sources of infection for these school inmates. Just two schools (Sunflower

and Dahlia) had provision for waste being collected by panchayat waste collector. Food

wastes from some schools are handed over to pig farmers residing within the village. In some

schools, food waste was thrown outside the school premises which was eaten up by the cattle

loitering around in and outside the school premises.

Though food is provided to the students, the focus remains on satisfying hunger rather than

providing essential nutrients, which is a requirement for many of these students and parents

due to their poor socio-economic status. The dietary pattern gives an impression that the food

supply attempts to follow the norms but is not adequate in terms of quantity and variety and

lack nutritional content obvious from the lack of green leafy vegetables and milk in most of

the schools. The stringent supply of chapathi/ bhakri/ roti, which is otherwise the popular

food among students as compared to rice also indicates the restriction imposed by schools on

food items and along with the absence of nutritive foods like non-vegetarian food, milk and

green leafy vegetable raises the question on whether they get balanced diet in their schools.

This failure to ensure essential nutrients takes a toll on their health. Poor anthropometric


indications of stunting and wasting, anaemia and low BMI reveal urgent need to improve

nutritional and health status of these children.

For most students, consumables were a blessing since they would have failed to avail any of

these products at home owing to their socio-economic background. Considering this context,

most schools provided consumables of inferior qualities to students. The underprivileged

students and parents, instead of complaining, considered themselves fortunate to at least avail

these products at school. As per Ashram Samhita (2005), all ashram schools are expected to

provide students with basic necessities required for daily living for example utensils,

beddings, night dress, uniform, toiletries and educational materials. Among these materials,

the study tried to examine five basic essentials for daily living provided to residential students

which included bedding materials, utensils, bathing materials, night dress and uniform.

Majority of the schools provided most of these essential items to students. Among the five

items, night dress was hardly provided in schools; students were expected to bring night dress

from home. While only 42% of the total children shared that they received at least three items

out of the five only 30% said that they received four essential items like beddings, bathing

materials, utensils and uniform. In government schools 59.1% students received at least three

items which usually involved utensils, bedding and bathing materials. While among 18.3% of

the respondents received only two items, included bedding and bathing materials only.

An interesting finding is good general hygiene maintained by girls despite poor

infrastructural facilities suggesting willingness to change in favorable conditions. Although

water is not available in the taps inside the washrooms, they manage to maintain good

personal hygiene on the contrary when a nail cutter is readily available many cut their nails

regularly. Most of the respondents reported that they brush (91.1%) and bathe (92.2%) once

daily, while hair washing was practiced twice in a week by 71.9% of the respondents which

points out to a good personal hygiene practice given the circumstances in which they live

where water supply is scarce, especially inside the washrooms. The frequency of nail cutting

was found to be once a week among 60.1% of the students and 21.5% of the children cut their

nails twice a week as each student in the school has a personal nail cutter.

The above-mentioned larger environment in terms of living, working conditions and

nutritional inadequacies has direct impact on the health of the ashram school girls, which are

evident from the kind of illnesses being reported by these girls during the study.

The types of morbidities – low anaemia, delayed menstrual cycles, infections, poor health –

reported by the girls in the ashram schools is extremely high. It was found that the minor

illness reported showed a tenfold rise than the general population with hospitalisation rates

also showing fourfold rise. This could be due to the poor living conditions, inadequate food

and nutrition requirement and unhygienic living conditions together contributing to their poor

health status.

The respondents were asked about the number of major infections each of them suffered in

the reference period of six months. It was found that majority 80% of those who reported any


major infections have reported only one episode of illness, with only 17.9% reported two

episodes of major infections in a six-month period. Palghar, Gadchiroli, and Yavatmal

reported maximum number of respondents with at least two episodes of illness.

The extent of Anaemia among ashram school girls is shocking as 41.5% reported to have

their Hb level in the 9-11 gm/dl range, with 47.9% in the 7-9 gm/dl category with 10.3%

having even less than 7 gm/dl. Similar results were also found in the weight deficit aspect

which was in the tune of 25% deficit as compared to the normal with an average height

deficit of around 8% than it is for girls of similar age.

The linkage between morbidity and nutrition status is clear and is cyclic in nature. This

linkage between morbidity and nutritional status and nutritional status and BMI indicate the

extent of vulnerability adolescent girls of ashram schools are subjected to. The fact that poor

nutritional status leading to poor BMI along with repeated infections in poor unhygienic

environment reveals the state of growth faltering manifested in severe anaemic status and

increased age at menarche. This is a clear demonstration of the life course situation wherein

how multiple vulnerabilities during growing up gets embodied as biological characteristics of

healthy living.

Medical check-ups were carried out on a routine basis but that which were done as part of the

study indicated several shortcomings and were found to be non-satisfactory due to variety of

factors like shortage of medical officers, inadequate time or non-existence of the medical

team itself. Menstrual information and morbidity reported in medical check-ups were

considerably lower than that of the self-reported data partly due to poor coverage and lack of

meticulous efforts towards the same.

Poor access to health care facilities for ashram school children during illness indicate the

dismal situation, wherein primary-level care facilities are located around 5-10 kms, while

secondary level around 25-50 kms away and tertiary level care located over 100 kms away

from ashram schools. Not only the functional status of these health care facilities is under

question, more so, the failure to have transport limits the access to these facilities during

urgency. In most schools, authorities send children to their homes for treatment, which raises

queries on their attitude to escape from the responsibilities and painstaking process of

standing in queues or long waiting hours in OPD or accompanying them during

hospitalization.

Recommendations:

Considering the magnitude of the vulnerabilities and challenges faced by the ashram school

students, the recommendations are broadly divided in two parts. First one is to improve the

overall living conditions, for instance, infrastructure, improve the health conditions of the

adolescents for their overall development, separating education and living environment; etc.

All schools should have staff appointed as per the Ashram School Samhita (2005). Several

schools were found to have vacancies reported and that too in teaching staff. All the required

posts of ashram school should be filled on a permanent basis and the inadequacies of these


staff over burdens the existing staff which adversely impacts on the services they provide for

the children.

Given the inadequate food supply in ashram schools, especially in Gadchiroli, where

breakfast is not provided but similar item is given as snacks in the evening, whereas other

schools do not provide evening snacks, it is essential to look at the food quality and supply of

these schools with highest priority. The menu at ashram schools should be at par with

Kendriya Vidyalaya or Sainik School. This is because the quality and adequacy of the food

that the children have access to has direct linkage to their health outcomes not only for

shorter or immediate duration but also as they grow to adulthood in future.

It is important to ensure adequate toilet units with running water facilities and space for

drying clothes are provided in all the schools along with better drainage systems. Efforts need

to be made to align the facilities provided with the Swachh Bharat Mission so that additional

focus to the hygiene is given and maintained. Regular monitoring of toilet units and running

water facilities need to be carried out and a register towards the same should be maintained.

Although in most schools, there is an adequate supply of sanitary napkins to girls, the quality

of sanitary pads was found poor in some schools. Minimum quality needs to be ensured for

the sanitary pad supplied considering the fact that most of the ashram schools are situated in

remote locations and access to markets are not there. It is recommended that all items, which

are needed by the girls, should be provided to them physically every month or year rather

than the DBT service, as it may not necessarily ensure that the girls buy these items through

DBT money or use it to incur expenses of the family. Provisions should also be made of clean

hygienic clothes and good place to clean or dry it up if they were to reuse, as an alternative

for napkins to reduce the non-degradable bio-waste. The female hostel warden should be

compulsorily given periodic training on WASH for ensuring menstrual hygiene of adolescent.

The study not only reveals the poor nutritional status of ashram school girls but also points to

its possibility of multiple manifestations like greater infection rate, especially minor illness

and major infections, along with prolonged age at menarche and poor BMI along with

dismally low Haemoglobin status indicating high anaemia rate. Regular and meticulous

health check-ups should be made mandatory for these ashram schools and regular monitoring

and follow-up of necessary and urgent cases. Ashram schools should maintain a functional

vehicle ready for attending any emergencies.

One public health officer (PHO) should be appointed –for every ashram school with class

strength of over 300 – who can take care of range of activities related to ensuring adequate

food and nutrition status, regularly maintaining menstruation register, health register,

monitoring of toilet facilities and liasoning with public health department to regularly

organize health camps and follow-up of those girls who need special care, render counselling

on overall health promotion and psychological health concerns.

Linking several schools with vocational education and opportunity to develop career in

Sports by affiliations with National Skill Development Mission and Sports Authority of India


respectively in addition to the routine educational career paths can boost the career graph of

the children. The availability of playgrounds and open space near ashram schools can be

utilised for activities earmarked for the same.

Although the government is extensively working on providing these facilities and already

there is a set mechanism in place, there is a need for stronger implementation so that the

overall development and health and nutritional needs of the adolescent girls in ashram

schools is ensured.

Limitations encountered during the span of research study:

1) Lack of knowledge of the local names of diseases may have resulted in missing a few

morbidities during data collection, especially during the initial phase of the project.

2) As health check-up data is generated during RBSK screening, it will capture only

those morbidities at the time of check-up and would have missed the illness before

and after the time of medical check-up, a characteristic limitation of medical check-up

over self-reported method.

3) In Gadchiroli district, inability to access a few remote schools by road during data

collection resulted in selecting school with comparatively better performance which

would have affected the level of representation of data for the entire district.

4) In three districts, health check-ups were conducted by ashram school medical officers

who used their own format and only in one district RBSK format was used though

there exist minor difference in the formats (Appendix 5)

Tata Institute of Social Sciences, Mumbai | CHAPTER ONE 19

CHAPTER ONE

INTRODUCTION

The adolescent population in India is 253 million comprising 20.9% of the total population.

The proportion of adolescent population remained around 21% since 1971 in the country,

reason for arguing that the country would have a demographic dividend in future. About

72% of the total adolescents live in the rural areas. About 44 million adolescents belong to

Scheduled Caste (SC) community comprising 17% of the total adolescents, whereas the

Schedule Tribe (ST) population amounts to 23 million constituting 9% share. Maharashtra is

among the top five states with highest proportion of adolescent population constituting 21.3

million (Census, 2011). Taking into consideration the significant contribution of adolescents

and the historical vulnerability manifested among ST communities, ashram schools were

started as an initiative across the nation.

Primarily focussed on educational upliftment, ashram schools are developed as a response to

ensure social stability for vulnerable population through provision of residential, educational,

nutritional and health services to their children. These services are aimed directly to improve

their overall health and well-being. Vulnerability is often internalized among these children

due to their socio-cultural environment and historical context. Ashram schools aim to change

this perception and enable them to stand out as empowered citizens. Adolescent age group is

a period of transition, wherein children experience a change from childhood to adulthood.

This transition period is most vulnerable and can be utilized to shape children into smart and

healthy adults. Early marriage - a common practice among tribal community - may have

untoward consequences on girls especially due to poor nutrition and ill health during

pregnancy. The future offspring inherently succumbs to the risk of prematurity or

malnutrition by virtue of its birth into tribal community.

Children are enrolled at a tender age into the ashram school and come out as grown-ups ready

to venture into the world. For most of the students, ashram schools are their home where they

grow up, learn, play, and mature. It is important to ensure that the socialization and nurturing

of physical, mental, and social wellbeing of the children during this time remains throughout

their entire life. Despite these good intentions, recent reports point to the fact that children in

ashram schools are susceptible to various diseases possibly due to poor nutritional status and

risky environments along with exploitation and abuse which needs urgent attention. The

state’s tribal department is accountable to ensure conducive environment for overall physical,

mental, social and spiritual development of the inhabitants of these ashram schools.

Hence it is essential to explore a few questions to examine the linkage between ashram

schools and the health and nutritional needs of adolescent girls. What are the current health

and nutritional needs of ashram school girls? What are the ways by which an ashram school

and its environment influence the health and wellbeing of its resident adolescent girls? How

safe is the future generation of tribal population which will be born to these adolescent girls?

What is the extent of vulnerability from which the students of ashram school belong and how

far ashram schools have responded to their needs? What kind of environment is provided to

residents of ashram schools to ensure overall growth and development and overcome their


(residents’) inherent vulnerability status in the society? What are the ways in which an

ashram school engages with other departments like health to addressing the needs of the

students?

Therefore, the study attempts to understand the health and nutritional status - foremost

indicators of a healthy living - of adolescent girls living and studying in ashram schools. This

is done by contextualizing the policies of tribal department towards the welfare of adolescent

girls. Furthermore, the contexts in which they are living are examined based on the facility

survey of ashram schools. Various facilities and provisions provided to adolescent girls in

ashram schools have close link to health and nutrition. Hence, it’s essential to understand

these parameters which would provide a mechanism to pave a path for a better tomorrow and

empower the adolescent girls despite their existing vulnerabilities.

1.1. HISTORY AND EVOLUTION OF ASHRAM SCHOOLS

1.1.1. Pre-independence era

During the 16th century, the British administration in its attempt to ‘civilize’ the so-called

primitive and barbaric tribal community identified and recognized them as a separate group

and introduced various laws and regulations (Xaxa, V. 2005). The scheduled tribes were a

weaker section in India, especially in the context of prevailing untouchability. These laws and

regulations resulted in loss of land and livelihood of tribes drawing them to poverty and

deprivation. Adding to the misery was the subsequent famine they faced from 1891-1901,

1911-1921, 1921-1931 (Xaxa, V., 2011). All these occurred in the backdrop of the freedom

movement in India. During the famine of 1921, social worker and activist Thakkar Bapa and

IndulalYagnik reached famine-affected areas of Dahod and Jhalod in Gujarat for relief work

as per the instruction of Mahatma Gandhi. Moved by the miserable condition of people in the

area, Thakkar Bapa dedicated himself to work for their upliftment of the specific

communities of the region (Jojo, B., 2013).

During his community service, Thakkar Baparealised the need for educational reforms.

Educational activities for tribes were carried out mostly by Christian missionaries during the

British rule (Arya, C., 2013). Thus, under the influence of Gandhiji, in 1922, ThakarBapa

initiated the first ashram school in Mirakhedi, a tribal village in Panchamahal in Gujarat and

founded the Bhil Sev Mandal, an organisation for tribal welfare, in 1923 in Dahod. Dedicated

volunteers of this organisation extended ThakarBapa’s activities by motivating workers in

Bihar, Madhya Pradesh, Rajasthan, Maharashtra, and Odisha to work for tribal welfare. This

led to the formation of All India service organisation, AdimjatiSevak Sang, with primary

motive to initiate educational and welfare activities for tribal children and to improve the

condition of tribes (Mishra, B.C., 2005 and Jojo, 2013).

Then onwards ashram schools were started in different tribal areas of the country for the

welfare and upliftment of schedule tribes by providing educational inputs.


1.1.2. Post-independence era

Ashram schools were started in tribal areas with residential facilities to provide education

which was envisioned to improve the social status of tribes thereby empowering them. At the

time of inception, ashram schools were centres of freedom movement as it prepared and

fostered freedom fighters and social workers with the ideology of national liberation. Post-

independence, ashram school gradually lost its ideology, but their existence continued

(Mishra B.C., 2005). Though first Five-Year Plan considered opening of ashram schools, it

gained momentum only in the third Five-Year Plan in 1962 when Dhebar Committee

suggested establishing ashram schools in sparsely populated remote tribal areas where

schools are non-existent (ibid). The committee also suggested a comprehensive model of

education tailormade for tribal population. The fourth Five-Year plan emphasised further on

the need to develop a system of education in accordance with their culture to ensure

economic and social development.

In the year 1953-54, under the able guidance of dedicated and committed teachers, few

ashram schools were started with a prime motive of providing quality education, food,

residential facilities and educational materials free for the tribal communities for their

educational upliftment. It is from the year 1984-85, the ashram schools were brought under

the Tribal Development Department. For speedy social and economic development of every

remotest tribal community, an ashram school was mandated for every 5,000 to 7,000

population. Initially, ashram schools functioned with the help of voluntary initiatives. These

initiatives were then taken over by the government in the year 1972-73 by starting its first 40

ashram schools across the country. Keeping in view of the vulnerability and deprivation of

the remotest tribal communities, for 21 most remote tehsils from seven tribal districts, the

government mandated a norm to provide one ashram school for every 2,000 to 3,000

population in the year 1982-83 (Government of Maharashtra 2005).

1.2. CONCEPT OF ASHRAM SCHOOL

The term ‘ashram’, according to Indian tradition, means ‘residence of the teacher’. Similar to

the concept of ‘Gurukul’ where students resided along with their guru (teacher) and attained

wisdom. The concept of ashram school was derived from traditional Indian Gurukuls and the

Gandhian philosophy of basic education where teachers and students resided together for

close interaction thus imparting complete personality development and enhancing their

capacities (Mishra B.C., 2005). At its inception, ashram schools intended to uplift the tribal

community through means of education. Ashram schools were established as residential

schools which provided primary education, but it was gradually expanded to provide

secondary education. Vocational education was envisaged as part of the scheme too but

wasn’t operationalized. Additionally, ashram schools intend to reduce financial burden

incurred by parents on residential, educational, and nutritional needs of their children as

ashram schools are expected to cater to all these needs in addition to promoting education

among tribal population. These schools were thus conceived as a direct intervention to

address the issue of social inequality in education among the tribal communities (ibid).


Ashram school scheme was originally a centrally-sponsored scheme run by the state, though

in few states some voluntary organisations pitched in. As per the policy guidelines, ashram

schools should be inter-village connected, opened in such areas where normal schools are not

usually opened and hence located in the remotest area for the most backward tribal group.

The main objectives of ashram school as per the Ashram school samhita1 (ibid: 5) were:

1. To impart general and formal education;

2. To encourage tribal traditions like folk songs and dances so that the school are not

only mere learning places but also centres of cultural activities;

3. To reduce the drop-out rates and to improve the retention capacity of the school;

4. To wean the children away from an atmosphere which is generally not conducive for

the development of their personality and outlook;

5. To impart socially useful crafts along with general education; and

6. To provide close interaction between the teacher and the taught through the increased

individual attention (ibid: 5).

Thus, ashram schools were started with the intention to ensure development of the

scheduled tribes in the remote areas by means of education.

1.2.1 Current scenario

The institution of Ashram school has completed several strides in the history of its evolution

and developed into an established network of institutions with the focus on tribal

development through education with a strong mandate of the government.

1.2.1.1. Governmental level

Centrally, the Ministry of Tribal Affairs was set up in 1999 after the bifurcation of Ministry

of Social Justice and Empowerment with the objective of providing more focused approach

on the integrated socio-economic development of the Scheduled Tribes (STs). Each state has

its own Ministry of Tribal Affairs or Tribal Development Department headed by the central

ministry. In Maharashtra, Tribal Welfare Department was established in 1972, under the

Social Welfare Department which implemented tribal welfare schemes. An independent

Tribal Commissionerate was established in 1973. Though an independent Tribal

Development Department was established on 22nd April 1983, the department functioned

independently in 1984 (http://mahatribal.gov.in/1165/About-the-Department)

In order to strengthen the Tribal Development Department, Directorate was merged into

Commissionerate in 1992. Thereafter, four Additional Commissioner Tribal Development

(ATCs) and twenty-nine Integrated Tribal Development Project (ITDP) offices were

established in the state to implement various tribal welfare schemes under state and central

government. Integrated Tribal Development Project (ITDP) office has several sub-sections of

which school section is in-charge of government and government-aided ashram schools.

(ibid). Another branch of Tribal Development Department is Tribal Research and Training

1Ashram shaala samhita – is a rule book for ashram schools provided by Tribal Development Department, Govt

of Maharashtra issued as a guideline for the proper functioning of schools across the state.

http://mahatribal.gov.in/1165/About-the-Department


Institute, Pune. The Institute is responsible for conducting evaluation training, collect data

about tribes, conduct training programmes and verification of tribal certificate. The major

role in ashram schools is played by Tribal Department while Tribal Research and Training

Institute acts as a nodal agency for research and development of tribes and providing in-

service training to the teachers of these ashram schools.

Along with the Ministry of Tribal Affairs, the Education Department and the Public Health

Department are the two other departments which also play a vital role in functioning of

ashram schools. The Education Department is responsible for recognition and registration of

the schools, planning andimplementation of syllabus and academic schedule for the schools.

The Public Health Department conducts regular health check-ups in the schools, diagnose

various health problems among the children, treat them and follow up with the health

condition of the students if necessary In addition to this it is expected to conduct routine visits

by peripheral health staff such as ANM/MPWs and mobile health and RBSK teams to the

ashram schools for meeting the health needs of ashram school inmates.

1.2.1.2 Institutional level

Currently, there are two different types of ashram school, government-run and government-

aided ashram schools run by private or charitable trust. The government-run ashram schools

are within the mandate of the government. The government supplies all the aids required for

functioning of the school, including food, educational materials for students, staff salary,

uniform, books, etc. While the government-aided, ashram schools are run by a private or

charitable trust, which receives a pre-determined grant in aid from the government for the

number of students the school caters to and salaries for teachers appointed by the

government. The rest of the expenses incurred for the students are borne by the trust. Grant in

aid is transferred to the trust account, and then the trust provides various facilities for the

students. Government-aided schools are also expected to provide similar provisions to their

students as in government ashram schools.

Today the ashram schools provide education from 1st standard to 12th standard in both Arts

and Science disciplines across the four major tribal divisions (Nasik, Thane, Amaravati,

Nagpur) of the state of Maharashtra. Thus, a total of 1,103 ashram schools are running in

these areas of which almost half of the schools (547) are run directly by the Tribal Ministry

alone; the rest are run with financial aid of the government via private or charitable

institutions. About 398,090 students are taking residential education of which girl students

form 167,234 (42 %). Among these girls, 84484 (50.4 %) girls are studying in government

schools alone (https://tribal.nic.in). In another estimate, the 23 tribal districts and 36 tehsils of

Maharashtra have 1108 ashram schools with 450,000 students studying of which 50% are

girls (Vidhayak Bharti, 2016).

1.2.2. Support systems in ashram schools


The key focus of the ashram schools is to safeguard young generation from falling prey to

age-old poverty, illiteracy, superstition and addiction by creating a conducive environment

for education, discipline, and personal health among the children to empower the tribal

community to engage in the developmental process actively. The government has provisioned

about 12% of the total budget allocated to the ashram school for medical check-ups, books

and educational materials, laboratory and library for the students. The other 8% is

provisioned for yearly two sets of school dresses, set of utensils such as plates, glass bowls

and bedding materials like blankets, bed-sheets, pillows, etc. These are supplied once in three

years for every student inmate. Moreover, provisions for medicines, towels, soaps, hair oil,

night gowns and suits for girls and boys, tooth pastes, etc., are distributed every year. Specific

provisions are also made for breakfast (poha/ upma, eggs, milk), lunch and dinner along with

mid-day light meal, weekly fruits, meat (once in two weeks) and special food is cooked

during festivals. Special focus is given to girl students by ensuring their enrolment in the 1st

division of each standard at 50% or at least 33%. Additionally, there are specific rules for

maintaining register by the lady hostel wardens of the first attainment of menarche and

menstrual periods/ cycles along with the weights of all girls attained puberty on a monthly

basis.

The health of the children in the ashram schools is given utmost importance; as there are

specific guidelines for hygiene and health (personal and social) of resident girls, their diets,

and provision of safe drinking water, etc. There are mandatory annual physical and medical

check-ups of all inmates. The mobile health units are mandated to conduct health check-ups

at least once in a month in every ashram schools. The information concerned with the

physical and medical check-ups is to be provided to the parents of children within 15 days.

The children diagnosed with illness or health problems during the medical check-ups need to

be provided with necessary diagnostic support and treatment under the competent medical

officer once every month either during ashram school visits or until the illness gets

completely cured. Additionally, there is a provision of complete medical check-up of the

child both at the time of admission and leaving from ashram schools. The ashram schools are

required to maintain health cards of every inmate (Government of Maharashtra 2005: 22).

1.3. STUDY CONTEXT AND CONSIDERATION

1.3.1. Health needs among tribal population

In general, the tribal population is subjected to vulnerability due to various societal factors

like discrimination leading to alienation from their land leading to poverty, difficult terrain in

terms of poor access to resources, illiteracy, poor employment opportunities along with socio-

cultural factors like superstition, traditions, food habits and so on. All these factors result into

a particular lifestyle among this group of population which takes a significant toll on their

health. The major health issues faced by the tribal population are various communicable

diseases like tuberculosis, hepatitis, diarrhoea, viral and fungal infections, HIV, malaria,

sexually transmitted diseases (Basu, S. K. 1993, Dhiman R.C., 2005, and Karlekar, S.R.,

2012 and Naidu, K. V. 2015). Other health problems include micronutrient deficiencies like

iron deficiency anaemia, vitamin deficiencies, iodine deficiencies leading to bitot’s spots,


goitre, malnutrition and night blindness (Balgir R.S., 2002, Bhise, R. M. et. al. 2013,

Kaushik, A. 2014 and Naidu, K. V. 2015). Other common health issues include genetic

conditions like sickle cell anaemia, thalassemia, glucose 6 phosphate deficiency, haemolytic

diseases and substance abuse and alcohol (Kate, S. L. 2001).

1.3.2 Maternal health

In tribal areas, health of women is often ignored. Lack of women’s autonomy and

empowerment in tribal areas can lead to negligence towards women’s or girl’s health.

Women are often vulnerable to malnutrition and anaemia and lack of utilization of health care

services during pregnancy leads to further complications. Inadequate nutrition during

pregnancy leads to deterioration of mother’s health. Prevalence of anaemia in women of ST

population in India is 59.8% while BMI less than 18.5 is 63.4% as per NFHS 4. Again, intake

of alcohol during pregnancy which is a common practice among tribal population further

leads to adverse consequences on maternal and child health (Basu, S. K. 1993). Due to lack

of access to health care services, home deliveries are common among tribal population.

Thirty-four percent of home deliveries were found in Nashik district of Maharashtra of which

15% were conducted by untrained persons. The same study also found only 64% of

utilization of ANC services (Mumbare, S. S., 2011).

Teenage pregnancy is another commonly seen phenomenon in ST population which is about

10.5% in India as per NFHS 4 data. This is mainly due to early marriages, which on an

average, takes place when the girl is19.7 years old (SRS 2014). While in Rajasthan 86% of

the pregnant adolescent in the age group of 13–19 years were anaemic and 85% of them

weighed less than 42 kg with low BMI (Sharma V, 1992). According to NFHS 4, teenage

pregnancy in Maharashtra is 11.8% among ST population as compared to 8% in general

population. Despite various health programmes focusing on maternal health its uptake in

various tribal areas have been inadequate and is attributed to unawareness among the

population, unsatisfactory or unacceptable hospital services and lack of transport facilities to

the health facilities (Sharma V, 1992). Thus, improper nutrition, alcohol intake, lack of

utilization of health care services, and teenage pregnancies jeopardise the health of tribal

women.

Maternal health is a real time indicator which reflects the disparity in health services provided

to its population. Health of the mother is directly proportional to the health of the family,

especially of new born infants and children. Undernutrition of mothers during pregnancy is

the main reason for an undernourished baby; and protraction of this state during breastfeeding

leads to further malnutrition of the infant making it susceptible to various diseases thus

endangering the further generation.

1.3.3 Child health

Good nutrition is vital for survival and physical, mental and social development from an early

age to adolescent age to adulthood and is the foundation of a healthy life ahead. Many a times

lack of these essential components undermines the growth and development of children

which is a common phenomenon seen across tribal areas. According to NFHS 4, 27% of


children belonging to ST population are underweight while 10.3% are severely underweight

leading to health issues like nutritional deficiencies, protein energy malnutrition, infections

and death (Pelletier, D. L, 1995 and Engle, P. L, 2007). Grag S. (2006), found 73% of

children malnourished in Manendragarh block of Chhattisgarh of which 14% had grade three

malnutrition (50-60% of weight as per Indian Academy of Paediatric standards) and 5% had

grade four malnutrition (<50% of weight as per IAP standards). Another study done in

Kannur, Kerala, highlights 17.3% children of age 3-6 years attending anganwadi were

undernourished (Anita, S.S., 2017). While in Wayanad, Kerala 58.7% children from

anganwadis were found undernourished (Philip, R. R., 2015). This scenario is seen in Kerala

which has a good public health system and where people are wellaware and highly literate.

While in Maharashtra, prevalence of undernutrition in anganwadis were 72% among under

five children (Gondikar, A. 2017). Similarly, full immunization coverage among ST is 55.8%

in India as per NFHS 4.

Thus, it is obvious that children from tribal areas irrespective of the state public health

infrastructure are prone to undernutrition, nutritional deficiencies, and inadequate

immunization coverage resulting in an underdeveloped growth and development and falling

prey to various diseases since childhood itself. Though various government policies through

ICDS exist to cater these situations but most of them fall short to tackle this crisis due to poor

functioning of these agencies and lack of awareness among mothers (Ratanwali, 2010).

1.4. ADOLESCENT HEALTH FROM A LIFE COURSE PERSPECTIVE: STUDY

FRAMEWORK

Early marriage has been a serious social problem in developing countries. About one eighth

of mothers give birth at the age of 15-19 in developing countries (UN 2009 cf Saywer, S.M;

Afifi, R A; Bearinger, L H; et al 2012). Mean age of marriage of girls in ST population is

19.7 years (SRS 2014). Various biological conditions like nutritional anaemia and nutritional

deficiencies, which are persistent in pregnant mothers of these tribes, have a serious impact

on the health of their newborn. Poor health status of mothers account for significant maternal

mortality and infant mortality in this population. IMR in ST population is 43.8 and U5MR is

53.8 and MMR is 16.3 (Ministry of tribal affairs, 2013). The MMR and IMR being

significant health indicators of the country, utmost efforts must be taken to focus on the

health of adolescents especially girls; as health of pregnant mothers can be improved by

focussing on the vulnerable adolescent population. Hence, focusing and addressing issues of

adolescent health in various health programmes especially maternal and child health program

is the need of the hour (Pies, C., 2011). Government programmes like RMNCH also added a

component of Adolescents lately into the programme, reiterating the need for additional focus

(http://nhm.gov.in/nrhm-components/rmnch-a.html).

Adolescent age group among tribal communities thus becomes an intermediary stage between

poor child health and vulnerable maternal health. Hence it can be a threat to ensure healthy

adolescents, who are otherwise sandwiched between an undernourished child and anaemic

mother. On the contrary, this can be an excellent opportunity to correct the historical

deprivation due to child undernutrition thereby preparing for healthy motherhood by taking

http://nhm.gov.in/nrhm-components/rmnch-a.html


advantage of the adolescent stage as it is an important stage of overall growth of a human

being. Adolescent period, the transition from childhood to adulthood has a significant impact

on a person’s adult life. The serious interplay between biological, psychological,

environmental and social protective and risk factors contribute to the well-being of adult life

(Pies, C., 2011). From a life course approach, this provides a temporal understanding to

prevent various communicable, non-communicable and mental health conditions in adulthood

from adolescent life itself (Saywer, S.M., 2012).

1.4.1 Studies on Ashram Schools in India

From several accounts, it is being found that these ashram school children live in precarious

conditions, even as the ashram schools are actually preordained for providing lodging and

boarding facilities, uniforms, books and note books and educational materials to its inmates,

so to meet their educational and minimal needs of food, clothing and health. A study

conducted by Dongare et al (2011), highlights the health needs of students in ashram schools.

It reveals the poor personal hygiene and related morbidities such as lice and worm

infestations, multiple boils, scabies and fungal infestations both in girls and boys. Notably,

76.8 % children had iron deficiency anaemia, more significantly among the girls 81.9% than

the boys 72.8%. Significant number of children is found to be having addictions of tobacco

chewing (Dongare, et al, 2011). It is apparent that the adolescent girls in ashram schools

report high prevalence of anaemia, low BMI for age, early marriages and early pregnancies,

and lack awareness about their health and poor access to health services.

Major problems faced by adolescents in ashram schools include physical, psychological and

social dimensions. Physical dimensions include nutritional problems like anaemia,

malnutrition, etc. and reproductive problems like menstrual issues, reproductive tract

infections and a range of morbidities along with sexually transmitted diseases, HIV etc.

Psychological or mental health issues like depression, suicide etc., and social issues,

including abuse, exploitation, substance abuse, relationship issues etc. (Trivedi S.S., 2012 and

Sivagurunath C., et. al. 2015).

According to a study, ashram school children of Kalahandi district of Odisha had

conjunctival pallor at 34.3%, vitamin A deficiency at 15.2%, vitamin B deficiency 15.6%,

iron deficiency at 17.4%, scabies 27.2% and dental caries at 20% (Balgir R.S., 2002). While a

cross-section study conducted on 816 students studying in primary schools of rural Uttar

Pradesh found cases of nutritional deficiencies at 56.9%, dental diseases 46%, skin diseases

29.4%, and respiratory diseases 27.6%. The study concluded higher morbidity among

females 86.1% as compared to male students 84.4%. (Kaushik, A. 2014). Thus, health issues

like nutritional deficiencies, dental conditions, respiratory conditions and infectious diseases

are common among children of ashram schools.

A six-year follow-up study in Chandigarh showed the incidence rate of psychiatric disorder

to be 0.18 % per year among the 10 to 17-year old-adolescents (Malhotra, S. 2009). The

prevalence rate of psychiatric disorders in Bangalore among 4 to 16year-old children was

12.0 % (Srinath, S., 2005). Depression among school going adolescents of 13 to 19 years in

Kerala was around 2.8% among girls and 1.8% among boys (Nair, M. K. C, 2004).


Systematic review of 15 studies across India aged between 13 and 15 years showed a median

prevalence of tobacco use (ever users) to be 18.2%; 14% among males and 6.3% among

females (Pal, R 2009). Global Youth Tobacco Survey (GYTS) 2006 and 2009 across India

covering 13 to 15-year-old adolescents in 180 schools highlighted an increase in the current

users of any form of tobacco from 13.7 to 14.6 % and current users of cigarette from 3.8 to

4.4 % from 2006 to 2009 (Gajalakshmi V, 2009), while 4% adolescents are prey to tobacco

use in India as per Global Adult and Tobacco Survey, 2017.

1.4.2 Maharashtra Scenario

The scenario in Maharashtra is very similar to that across the country. According to a study in

ten ashram schools of Wardha district, head lice (18.2%), scabies (6.9%), multiple boils

(11.2%), fungal infection (6.2%), dental caries (12.6%) and worm infestations (15.9%) were

found among children residing in ashram school (Dongre A.R., 2011). As per a cross-

sectional study conducted in Zilla Parishad schools located in village - Durves, tribal area of

District-Palghar some of the morbidities reported through clinical examination were dental

caries (61%), ear wax (38%), upper respiratory tract infection (19%), ear discharge (13.5%)

and vitamin deficiencies (10%) (Gokale et al. 2017). Malaria has been a major cause of

mortality and morbidity in Gadchiroli district (Dhiman R.C., 2005 and Karlekar, S.R., 2012).

Anaemia, undernutrition, worm infestation, menstrual abnormalities, etc., were found as

major issues among (87.8%) of tribal ashram school girls of 8-16 years in Ahmednagar

district (Bhise, R. M. et. al. 2013).

Crowding in ashram schools resulted in psychosomatic symptoms such as aches, depressions,

restlessness, aggressiveness, frustration etc. leading to aggressive behaviour, more negative

relationship and low cooperation among themselves (among children) in ashram schools

(Upadhyay, B. K.,2005). Most students of the ashram schools belong to poor socio-economic

status adding on to the vulnerability of the students (Das A.R., 2003).

In another study among tribal students in selected schools of Nagpur district, it was found

that 2.8% students smoked, 41.7% consumed tobacco and 4% consumed alcohol (Gunjal

S.S., 2012). A study conducted in 11 villages of Wardha district among rural adolescents of

15-19 years of age found 63.3% boys and 12.4% girls consumed tobacco (Dhongre, A.R.

2008). A study conducted on adolescents in Shriur block showed 10% adolescent males were

sexually active (Mutatkar, R. K., 1999).

In tribes, migratory pattern among parents to earn a living further precipitates the social

isolation among children who are left to be taken care either in residential schools or with

their relatives. Many a times, this isolation and lack of parental supervision leads to

exploitation, rape and sexual abuse which in turn effects their psychological state. (Thadathil,

A. 2017). Overcrowding, which is another common factor in these tribal ashram schools,

leads to various psychological problems like depression, frustration, restlessness etc. among

the students (Upadhyay, B. K. 2005). Lack of sanitation facilities in the residential schools

further adds on to the agony as girls are often forced to go out to attend the nature’s call due

to lack of toilet facilities (Thadathil, A. 2017). All these lead to perpetuating adverse effects

on health of the residential students, especially girls.


Poorly-maintained surroundings at the schools are breeding grounds for mosquitoes, insects,

rodents and reptiles making it vulnerable for children as easy prey of malaria, insects and

animal bites etc. The Salunkhe Committee records 1,077 deaths of children in government

ashram schools in 15 years’ time (2001-2016) i.e. average 72 deaths in a year and almost 5

deaths in a month, which is very alarming. In case of aided ashram schools, the number of

deaths was 386 students in 13 years’ time i.e. average 30 deaths in a year and 2-3 deaths in a

month, though the number of deaths is relatively less it is an equally serious concern. It is

interesting to note that committee states that about 5% deaths are due to snake bites and 7%

deaths are due to fever and malaria. This is evident that poor surroundings and lack of

adequate safety walls is disastrous for the children in the schools (Salunkhe, 2016).

It is evident that health conditions leading to various diseases, psychological problems and

substance abuse in the adolescent period and undernutrition since childhood ruins the entire

foundation for a healthy adult life. Poor socio-economic conditions along with poor health

add on to the misery among these tribal children. Thus, the present study attempts to examine

the health and nutritional needs of adolescent girls of ashram schools of Maharashtra by

situating the life of girls within the ashram school environment. Thus, the broad objective of

the study was to understand the health and nutritional needs of adolescent girls (AGs) in

ashram schools in Maharashtra within their living context of the school environment.

1.5. SPECIFIC OBJECTIVES:

1. To determine the health and nutritional needs of the adolescent girls in ashram

schools.

2. To study various determinants of their health and nutritional status with special focus

on the institutional infrastructure and facilities of ashram schools.

3. To understand the health seeking behaviours of the adolescent girls with special

emphasis on their treatment seeking behaviour.

4. To understand the welfare interventions of the ashram schools and its contribution to

the overall development of tribal community.

5. To suggest policy recommendations for improving healthy and conducive

environment for the adolescent girls necessary to enable study in the ashram schools.

1.6. OPERATIONAL DEFINITION:

Health and Nutritional Needs: Health needs are assessed mainly based on the self-reported

morbidities of the adolescent girls using different reference periods, namely minor illnesses

with 15 days recall, major infections with 6 months recall, accidents and injury with 6 months

recall and chronic diseases with at least one-year history. This was captured through

systematic survey using a pretested interview schedule. Additionally, data was collected

during routine medical check-up carried out by the health department, which covered

information of various diseases reported during medical check-up along with the height and

weight against their age was recorded for anthropometric analysis along with the anaemia

status of all the girls were checked. Nutritional information collected was further analysed to


identify proportionate prevalence of BMI, height for age to understand stunting and weight

for age to estimate underweight against the ideal values recommended as per the NCHS

criteria.

Adolescent girls: The WHO and United Nations define adolescent as age group as falling in

the 10 – 19-year-old children. Hence, girls residing in ashram schools of Maharashtra aged

10-19 years were selected for the study.

Health Seeking Behaviour: Health Seeking Behaviours are those behaviours that directly or

indirectly contribute to health at the time of illness as well as during its absence. This

comprises of health behaviours, which in this study, include general hygiene behaviour and

menstrual hygiene behaviour and treatment seeking behavior as those seeking treatment

during illness, which are those treatment choices made during illness.

1.7. METHODOLOGY

1.7.1. Research design

The study is a cross-sectional one with an exploratory and descriptive purpose. In the

exploratory phase, the study tries to explore various concerns of adolescent girls by

examining the living conditions in the ashram schools. This was analysed based on the

facilities provided at ashram schools both in terms of conditions for living and for education

inputs. This was analysed based on the expectations of ashram schools and the role of

Department of Tribal Affairs, Education Department along with the Public Health

Department in moulding health and wellbeing of tribal children. The study also captures the

opinion and concerns of various officials from the above departments in order to understand

an insider’s perspective of the services provided at ashram schools.

The second phase of the study is more in-depth focussing on the living conditions of these

adolescent girls, their food intake, and general and menstrual hygiene along with the current

health status captured using self-reported morbidity data and nutritional indicators.

Additionally, the health and nutritional status of adolescent girls were captured using the data

generated through medical check-ups by the public health department using a descriptive

design.

1.7.2. Sources of data collection

The primary sources of data collection were based on survey method using interview

schedule that collected information from selected adolescent girls aged 10-19 from chosen

schools in selected districts of Maharashtra. Focus Group Discussions (FGD) were also

conducted among adolescent girls to get group perception of their living conditions. Key

Informant Interviews (KII) of school authorities like headmaster/ mistress, male and/or

female warden, senior teacher from their respective schools were also done which helped

understand the provider perspective. Apart from the school faculty, officials from Project

Office like Additional Project Officer (APO) of the tribal department, Section officers

looking after ashram school budget and officials from Public Health Department like Civil

Surgeon of the district, Medical Superintendent of Sub District Hospital (SDH), ashram


school Medical Officer and RBSK Medical Officer of selected districts were interviewed.

Facility survey was also conducted for all the selected schools whose information gives a

representation of the functioning of ashram schools of the state.

1.7.3. Selection of respondents / ashram school girls

The study was conducted with an aim to understand health and nutritional needs among

adolescent girls in ashram schools of Maharashtra, hence multi-stage sampling approach was

used to identify respondents. As the entire state project office of Tribal Department is divided

under four additional tribal commissioners (ATCs), this administrative division was used as

the starting point. One district with proportionately highest Schedule Tribe (ST) population

from each of the four Additional Tribal Commissioner (ATC) was selected. Thus, four

districts in Maharashtra was selected. Further, one block from each of the four selected

districts were selected using simple random sampling method. Thus, four blocks were

selected from the entire state.

The total number of public and private schools from each of the selected blocks were

categorised based on the list of schools provided by the respective Project Office of each

district and from each group two schools were randomly selected. Thus, four schools were

selected from each block, two were Government-aided (Private) schools and two were

Government schools

The respondents for the study in each of the schools thus included adolescent girls, teachers,

staff and other personnel associated with ashram schools. Fifty adolescent girls were selected

from each school. Selection of adolescent girls was done by listing of total girls aged 10-19

years i.e. studying in 5th to 10th or 12th standard in the school. In school with more than 50

students, 50 girls were selected based on systematic random sampling method from the list by

picking every nth 2. In schools with less than 50 girl students, all the students were selected

for the study and another school from the same block was selected to suffice the remaining

number of girls. If the same block did not have another government or private school, then

the same was selected from the nearest block. Thus, 50 students from each school, which

makes 200 students from each district and a total of 800 students were selected from all the

four districts together.

1.7.4. Tools of data collection

The tools used for data collection included structured interview schedule for adolescent girls

which included open and close-ended questions on sections like food and other materials

provided by the school, along with information pertaining to general hygiene, menstrual

hygiene, abuse, sexual health, self-reported morbidities (including chronic, major & minor

illness and injuries & accidents) and mental health. The data generated during Health check-

ups were systematically collected for those selected students as per the RBSK’s health

2Total number of students were divided by 50 and arrived at a number ‘n’ which was used as the interval. Thus,

after the first girl in the list every ‘nth’ girl was selected as respondent for the study.


assessment format. Semi-structured FGD guidelines were also used to conduct FGDs on

living arrangement and facilities provided, educational environment at school and related

health issues. Semi structured Key Informant Interview guidelines were used to conduct Key

Informant Interviews with school authorities like headmasters, teachers, male and female

wardens, officials from respective project office of the selected district and officials from

public health departments of the selected districts.

Structured Facility Survey was used for capturing information on the ashram school facility

in terms of its infrastructure and functioning for each school selected. The schedule included

details on physical infrastructure of the school, educational facilities and staff available in the

school, residential facilities available in the school, daily routine of the school, health

facilities available for the school, illness reported in the school etc.

1.8 DATA ANALYSIS

Data collected was entered and analysed using SPSS version 18. Simple frequency and

crosstabs with univariate and bivariate analysis was done to analyse the data.

1.9 ETHICAL CONSIDERATION

Data was collected in the selected four districts of Maharashtra. In each district, the project

office was informed regarding the study. On arrival of the research team in the district, the

Project Officer was contacted and informed about the study. The Public Health Department

of the district was intimated through the Civil Surgeon and the Medical Superintendent of

Sub District Hospital. The Project Office staff would facilitate the study in the schools while

the Public Health Department would facilitate the health check-ups. Necessary sanction was

taken from TRTI, ATC (PO)

Institute Review Board (IRB) of Tata Institute of Social Sciences granted ethical approval for

the study. All the suggestions from the IRB were incorporated into the study tools. In the

field, consent of officials in the ashram school team and each individual respondent was

obtained before data collection. The respondent was explained about the study and the

voluntary nature of their participation. Confidentiality of the data and anonymity of the

school and the respondents were maintained throughout the study. Each school was assigned

the names of flowers to identify and is used for subsequent analysis and is continued in this

report to ensure anonymity of ashram schools (see table 2.1).

1.10 LIMITATIONS

1. Lack of knowledge of the local names of diseases may have resulted in missing a few

morbidities during data collection, especially during the initial phase of the project.

2. As health check-up data is generated during RBSK screening, it will capture only

those morbidities at the time of check-up and would have missed the illness before

and after the time of medical check-up, a characteristic limitation of medical check-up

over self-reported method.


3. In Gadchiroli district, inability to access a few remote schools by road during data

collection resulted in selecting school with comparatively better performance which

would have affected the level of representation of data for the entire district.

4. In three districts, health check-ups were conducted by ashram school medical officers

who used their own format and only in one district RBSK format was used though

there exist minor difference in the formats (Appendix 5)

1.11. CHAPTERISATION

The first chapter introduces the topic with the review of literature that helps in engaging with

ashram school context along with the conceptual framework followed by the methodology

used for the study that captures the objectives, tools and process of data collection. The

second chapter describes the facilities and provisioning as it exists in the ashram school for

its inmates mostly based on facility survey and key informant interviews. The third chapter

on ‘sample characteristics’ provides understanding of the background characteristics of the

selected adolescent girls in the study based on their socio-demographic and household

characteristics. Furthermore, the fourth chapter examines the living conditions of girls in

ashram schools, which can be viewed as health promotion behaviours, including hygiene

behaviours and fifth chapter gives the extent of morbidity prevalent among ashram school

girls and also its linkages between BMI, anaemia status and other important health

parameters. The final chapter entails the concluding remarks of the study results with a few

recommendations to be implemented in future for the welfare of the girls of ashram schools.


Tata Institute of Social Sciences, Mumbai | CHAPTER TWO 35

CHAPTER TWO

ASHRAM SCHOOLS: INFRASTRUCTURE AND SERVICES

2.1 INTRODUCTION

As mentioned in the methodology chapter, data was collected from four blocks of those

districts with highest ST population as per 2011 census. Thus, the blocks and districts

selected for the study were Dahanu block of Palghar district, Navapur block of Nandurbar

district, Kelapur block of Yavatmal district and Aheri block of Gadchiroli district. Four

schools each from all these blocks were selected, of which two were private-aided and two

government schools. In Kelapur block of Yavatmal district, due to inadequate number of

students in one of the government schools, an extra school (Carnations 2) was taken from the

nearest block.

For overall development of the tribal children enrolled in ashram schools, government has

mandated to provide them several services. Ashram School Samhita states very clearly the

details of infrastructural provisions, facilities and services for the day-to-day functioning and

administration of the government and private-aided ashram schools. The study refers to

Ashram Samhita (2005) for policy guidelines pertaining to the expected functioning of

ashram school. This has direct impact on the health of the inmates in the ashram schools,

especially the adolescent girls. It is in this context, a specific tool – facility survey was

employed during the study to understand the kind of services being offered at the ashram

schools, its quality and adequacy for the number of inmates in the schools.

The present chapter covers the administrative, staffing and general infrastructure of each of

the selected schools. This will be done by giving special reference to those facilities and its

provisioning necessary for ensuring quality education and living conditions of the students of

ashram schools. Towards the end, the chapter deals with health infrastructure in the schools

and medical facilities provided to inmates on a routine basis. Finally, an analysis is carried

out by comparing the extent of illness reported based on self-reported morbidity as against

those identified using medical check-ups.

2.2 ADMINISTRATION AND GENERAL INFRASTRUCTURE

The study covered information pertaining to 17 ashram schools in total, eight private-aided

ashram schools and nine government ashram schools. According to table 2.1, most of the

schools were established at least 36 years ago except in case of Dahlia of Aheri block of

Gadchiroli district which was established 101 years ago in 1917; while Lily in Dahanu-

Palghar block was established just 11 years ago in 2007. Majority of the schools had primary

and secondary sections i.e. from 1st to 10th standard except in Rose where there was only

primary section. In another one (Hibiscus), primary section was non-functional due to lack of

students. Yet another school (Dahlia) had only secondary and higher secondary or junior

college only with their primary section was separately situated nearby the secondary school.

Three schools (Hibiscus, Dahlia and Lavender) out of 17 had junior college section and cater

to Arts and Science disciplines. Among all the 17 schools, only one school (Lavender) in

Aheri-Gadchiroli was exclusively meant for girls from 5th standard onwards, it enrols boys


only up to 4th standard. Among the 17 selected schools one school (Rose) was registered as a

primary school, three schools (Hibiscus, Dahlia and Lavender) were registered with primary

secondary and higher secondary or junior college and the rest 13 schools were registered as

primary and secondary schools.

Table: 2.1 Characteristics of selected ashram schools

District -

Block of the

school

Name of the

School

Type of

School

(Government/

Private-aided)

Year of

establishment

(actual years)

Standards in

the School

(number of

standards)

Total no

of students

(As per

roll

register)

Palghar -

Dahanu

Rose @ Private-aided 1982 (36) 1-8 std (8) 451

Lily Private-aided 2007 (11) 1-10 std (10) 519

Jasmine Government 1978 (40) 1-10 std (10) 418

Mogra Government 1973 (45) 1-10 std (10) 785

Nandurbar -

Navapur

Sunflower * Private-aided 1989 (29) 1-10 std (10) 655

Orchid Government 1979 (39) 1-10 std (10) 310

Daisy # Private-aided 1999 (19) 1-10 std (10) 680

Lotus Government 1989 (29) 1-10 std (10) 436

Yavatmal -

Kelapur

Tulips Private-aided 1991 (27) 1-10 std (10) 297

Marigold Private-aided 1987 (31) 1-10 std (10) 388

Carnations 1 Government 1976 (42) 1-10 std (10) 149

Carnations 2 Government 1972 (46) 1-10 std (10) 96

Hibiscus Government 1973 (45) 6 - 12 std (7) 294

Gadchiroli -

Aheri

Dahlia $ Private-aided 1917 (101) 7-12th std (6) 512

Periwinkle Private-aided 1994 (24) 1-10th std (10) 391

Lavender Government 1990 (28) 1-12th std (12) 394

Daffodils Government 1990 (28) 1-10th std (10) 239

@ Eighth standard of this school is not recognised.

* Three classes have two divisions approved

# Five classes have two divisions approved

$ Four classes have two divisions approved

According to Ashram School Samhita (2005), every school is permitted to enrol 50 students

in one division of a class in an academic year. Ideally, it includes 40 residential and 10day

scholars; among these residential and day scholar students, the proportion of girls and boys

are half in each of the category i.e. 20 girls and boys each as residential and 5 girls and boys

each as dayscholars. This was also shared by one of the headmasters from one of the selected

ashram schools, but in case the number of girls or boys are lesser than the specified norm, the

school can enrol either girl or boy student into the remaining vacancy to ensure enrolment of

50 students in a division of a class. Based on this stated norm it is evident from table 2.1, that

except three schools (Rose, Lily and Mogra) in Palghar district and one school (Sunflower) in

Nandurbar district none of the schools have requisite number of students against the number

of standards they teach. The increase in the number of students in these four schools is


probably due to remote location of the school in addition to migratory occupational pattern

which was commonly seen in Palghar district. While the dropout rates of students from these

schools vary from nil to as much as 11%. Among the 17 schools, five school reported 0%

drop outs which is dubious considering the vulnerability and socioeconomic scenario of these

students. The highest dropout rate was found in Yavatmal district (10%) while the lowest

(0.9%) was seen in Gadchiroli district. Among different types of schools, higher number of

dropouts were seen in government schools as compared to private schools.

Although all the schools had approachroads, they were either not well-maintained or in good

condition. Six schools (jasmine, mogra, orchid, tulips, hibiscus and daffodils) had good and

well-maintained tar roads as they were located in the heart of the village or near by the local

bus stop, five (sunflower, daisy, lotus, marigold and periwinkle) had fairly maintained tar

roads some of which were constructed a long time ago, while six schools (rose, lily,

carnations1, carnations 2, dahlia and lavender) had poor roads. Roads in poor conditions were

either kuccha or narrow or steep roads going downhill or uphill, while pucca roads had worn

out due to lack of maintenance leading to puddle formation during rainy season rendering the

road non-functional to use and some were repaired with gravels. Most of the schools had

compound walls, but among those with compound walls, only six schools (orchid, lotus,

marigold, hibiscus, dahlia and daffodils) had a fully-functional wall in good condition, while

the rest were partially available or broken.

Approach roads to schools in poor condition

2.3 STAFFING PATTERN

One of the primary objectives of the ashram schools is to reach to most remote and

disadvantaged children for offering them the educational and development opportunities. It is

also important to state that quite a few of these schools are actually in one of the remotest and

most inaccessible areas. The Ashram School Samhita (2005) too has clearly stipulated the

norms for human resource keeping in view the above-mentioned goal. Adequate, efficient

and qualified staff therefore becomes one of the most necessary requirements for running and

managing these school.


The working staff forms an integral part of any institution. In ashram schools, the policy

norms as per Ashram Samhita (2005) for number of staff members differ from primary to

secondary to higher secondary schools. The norms are further different for government and

private-run ashram schools. Overall, the allotted posts for a private-run ashram school are

less as compared to government run ashram school. The number of teachers is same across

schools but there is a difference with respect to the support staff. For private schools, a

female warden was not a requisite criterion as per the policy. For cooks, including primary,

secondary and higher secondary taken together, private schools are expected to have only six

instead of eight cooks in government schools. Similarly, private schools do not have

provision for a librarian or a lab helper. Whereas allotment of kamathi, who acts as domestic

help in the school, are two in private school as compared to eight in government schools.

Most of the government schools with shortfall of essential staff members like teachers,

wardens and cooks were filled either on temporary or daily wage basis.

Most of the vacant support services were compensated by appointment of local employees on

daily wages as and when required as appointment in none of the posts were done since 2012,

according to the same headmaster. This mechanism usually ensured smooth functioning of

the school despite being short-staffed. Among the 17 selected schools, one school was

registered as a primary school, two schools were registered with secondary and higher

secondary level and the rest 14 schools were registered as primary and secondary schools.

A headmaster from a government school shares about ways of managing vacant positions of

teachers in his school, he says, “Atta je reekth pada ahet, tya reekth padaath prakalpa

adikariyani tathpurtya svaroopath tasika padavarthi shikshyak namelella aheth. Tar thyacha

madhe madhyamik shikshyakana Rs 140 and primary shikshyakanana Rs 125 dile jathe…

Hya shikshakanna atta vadyathil 22.5 tasika jyasthit jyasth shyasanani manjurr keleli aheth.”

(Now, for those post which are vacant, project office has provisioned to appoint temporary

teachers on an hourly basis, wherein the secondary teachers are paid Rs 140 and primary

teachers are paid Rs 125 per hour. And for these teachers, weekly maximum 22.5 hours are

fixed by the government.)

The table 2.2 is divided into two parts (2.2 a and 2.2 b), the first part is based on similar 14

schools and the second part is on the remaining three schools. In the first table, the first row

of ideal expectation for school is the ideal staff allocations required for first 14 schools listed

below which has only primary and secondary sections. While in the second part of the table

the ideal expectations for staff are mentioned separately for each school due to their

individual differences like no secondary section as in case of Rose, no primary section in

Hibiscus and Dahlia.

Of all the 17 schools, except three schools (Rose, hibiscus and Dahlia), all others have

primary and secondary schools (table 2.2 a) with Lavender school of Gadchiroli having

higher secondary level. Of the three schools, Rose doesn’t have secondary (9-10) and other

two (Hibiscus, Dahlia) don’t have primaryclasses (table 2.2 b).


Table 2.2 (a): Staffing pattern in selected schools against the ideal expectations

according to the standards in the schools.

District -

Block of the

school N

am

e of

the

Sch

ool

Sta

nd

ard

s in

the

Sch

ool

Pri

mary

tea

cher

(in

clu

din

g H

M)

Sec

on

dary

teach

er

(in

clu

din

g H

M)

Ward

en

Cook

Ass

ista

nt

(kam

ath

i)

Att

end

an

t

Cle

rk

Oth

ers!

Ideal

expectations

fromSchool

Standard @ 1-10 8 5 1-2 4-5 1-6 1 1 4-6

Palghar -

Dahanu

Lily 1-10 8 5 0 5 1 1 0 0

Jasmine 1-10 3 3 2 1 3 1 1 1

Mogra 1-10 4 3 0 0 0 1 0 1

Nandurbar -

Navapur

Sunflower 1-10 7 4 2 6 2 1 1 3

Orchid 1-10 1 3 1 0 2 0 1 1

Daisy 1-10 10 7 2 6 2 1 1 3

Lotus 1-10 6 0 2 5 4 1 0 2

Yavatmal -

Kelapur

Tulips 1-10 9 4 0 6 2 1 1 3

Marigold 1-10 8 4 0 5 2 1 1 3

Carnations 1 1-10 5 3 2 2 2 0 0 2

Carnations 2 1-10 2 7 2 3 2 0 1 1

Gadchiroli -

Aheri

Periwinkle 1-10 4 8 2 5 3 1 1 3

Daffodils 1-10 6 4 2 8 7 0 0 3

Lavender 1-12 7 4 1 6 2 1 0 2

@ Ideal expectation of staff for first 14 schools listed below is projected as per the Ashram

Samhita (2005).

Teachers are the pillars of educational development in any school. The stipulated norm for

teachers as per Ashram Samhita (2005) for primary section is seven i.e. one teacher for each

class (1-7th standard) of 50 students (one division) and similarly that of secondary section is 4,

while for junior college or higher secondary section is 4 in arts and 3 in science discipline

irrespective of the number of students in a class. Each school is expected to have two separate

headmasters for primary (1-7th standard) and secondary (8-10th standard) sections. Of the 14

schools it was observed that six schools had less than six teachers (including headmaster)

appointment in primary section. While in secondary section most of the schools have at least

one teacher per class i.e. three in total but one of the school (Lotus) had no teacher appointed

even though the school catered till 10th standard and another school (Lavender) had four

teachers when it is expected to have 11 teachers in total as per the norms since it caters to

both secondary and higher secondary (Table 2.2 a). In the second table, all three schools did

not have a major shortfall in teachers.

Wardens, another important staff member of the school, was found deficit in five schools

(Lily, Mogra, Tulip, and Marigold) out of the 14 schools. Where the ideal norm remains two

wardens in government schools, i.e., a male and a female warden for schools till secondary


section and one male warden in primary section (Ashram Samhita, 2005). While among three

other schools, one school (Dahlia) did not have any appointment, another had just one

warden. Though the above five schools did not have permanent wardens they were appointed

either on temporary or daily wages basis by the school. The policy for cooks (Ashram

Samhita, 2005), are extremely biased for government and private schools. In government

schools, only the primary section is expected to have five cooks while with the secondary

should have two and higher secondary must have an additional cook making a total of eight

cooks. This norm with respect to private schools with higher secondary section is relaxed and

they require only a total of six cooks i.e., four in primary and two in secondary section and

none in higher secondary section. While among the 14 schools surveyed, five schools

(Jasmine, Mogra, Orchid, Carnations 1 and Carnations 2) were deficient of cooks (less than

4) of which two schools (Mogra and Orchid) had none appointed on permanent basis. While

in the other three schools had adequate cooks appointed. Thus, essential positions like

teachers, warden and cooks are often ensured appointment on temporary or daily wage basis

to ensure the basic functioning of the school is not disrupted but the situation with the support

staff is different (table 2b).

Table 2.2 (b): Staffing pattern of three schools with either primary or secondary levels.

District -

Block of the

school Sch

ool

Nam

e of

the

Sta

nd

ard

s in

th

e sc

hool

Pri

mary

tea

cher

(in

clu

din

g H

M)

Sec

on

dary

an

d H

igh

er

Sec

on

dary

tea

cher

(in

clu

din

g H

M)

Ward

en

Cook

Ass

ista

nt

(kam

ath

i)

Att

end

an

t

Cle

rk

Oth

ers!

Ideal

expectation

Lower

Primary and

Primary+

1-8 8 1 1 5 6 0 0 1

Palghar-

Dahanu Rose 1-8 7 1 1 4 0 0 0 1

Ideal

expectation Secondary+ 6-12 2 12 1-2 2-3 2-3 1 1 1-2

Yavtamal-

Kelapur Hibiscus 6-12 6 9 2 5 6 1 1 2

Gadchiroli-

Aheri Dahlia$ 8-12 - 11 0 5 1 0 1 1

+ Ideal expectation of staff for schools in the subsequent row is projected as per the Ashram

Samhita (2005).

!- others include librarian, lab assistant, sweeper, helper and watchman

$-Schools with two divisions

In case of kamathi (assistant) among the 14 schools, one school (Mogra) did not have any

permanent appointment at all while among the three schools, all had serious shortage of

kamathi as per the ideal expectations (Ashram Samhita, 2005). While in case of attendant, the


expected number is one in schools with secondary section (ibid), while four among 14

schools and one among four schools did not have attendant appointed. Five schools (Orchid,

Carnations 1, Carnations 2, Dahlia and Daffodils) did not appoint an attendant at all. Every

school with a secondary section is supposed to have at least one clerk appointed, while

among 17 schools six schools (Lily, Mogra, Lotus, Carnations 1, Lavender and Daffodils) did

not have clerk appointed.

Similarly, sweeper which is an essential post for maintaining sanitation and hygiene in the

school, while one post is allocated in government schools with a secondary section only as

per Ashram Samhita, 2005; Three government schools (Jasmine, Lotus and Daffodils) among

the nine selected government schools had a sweeper. This points on to the focus on sanitation

and hygiene in the schools. One helper which is a mandatory post in private school with

primary sections was appointed in all eight private schools. While government schools are

expected to appoint one watchman instead of helper as per norms, four schools (Carnations 1,

Carnations 2, Hibiscus and Daffodils) of the nine government schools had appointed

watchman. It is interesting to note that three private schools had appointed watchman, which

is actually not allotted as per the policy norm (table 2b).

The post of one lab assistant is meant for secondary section of government and private

schools was vacant in four schools (Lily, Jasmine, Mogra and Carnations 2), and one

librarian is expected in higher secondary government school was not appointed in any

government school with higher secondary section, while one private school (Lavender)

without higher secondary had appointed librarian. Thus, it is evident from table 2.2 a, with

respect to support services, school often had deficiency in stipulated number of staff, but it

was observed during the study that the school managed to function using the existing number

of staff only; in rare instances, they would hire a daily wage labourer for gardening or for

assistance in functions like annual day celebrations. Largely, appointments in the posts of

librarian, sweeper and helper was found vacant in most of the schools. Many female wardens

highlighted the inconvenience they faced due to lack of another female helping hand

especially in situations when a girl student requires to be taken to hospital at night or was

hospitalized. In such situations, most of the wardens took help from any female teachers or

cooks staying in or nearby the school premises.

For daily routine activities, the school’s staff crunch among class four workers was overcome

by assigning these jobs to students. Lack of required cleaning staff like sweepers or helpers

forced teachers or warden to instruct students to do these chores. Girl students were

especially assigned with cleanliness duty, while boys were assigned works like cleaning the

water tanks, moving of table and chairs from one place to another and lifting grocery bags

from the unloading truck to store room. Gendered division of tasks is a common feature in

these schools and rural settings which might also maintain the status quo existing of gender

roles. Cleaning of hostels and toilets were done by girls and boys respectively. In a particular

private school (Periwinkle) in Gadchiroli, students were also seen cutting vegetables and

helping the kitchen staff during their school hours. Similarly, in another private school (Rose)


in Palghar students were assigned with the duty of preparing and distributing evening milk3 to

students and cleaning the utensils used thereafter. While, entrusting students the

responsibility of food distribution was a common phenomenon observed across most of the

government and private schools. Involving students in many of these activities or chores do

not provide them with sufficient play time or study time or at times force them to miss their

regular classes.

In all the selected ashram schools, it was noted that teachers from government schools in

Palghar and Nandurbar were fewer in numbers as Yavatmal and Gadchiroli districts. One of

the reasons for this trend could be that many staff members, especially teachers in Yavatmal

and Gadchiroli belonged to local area or had their families based in the nearby locality unlike

the situation in Palghar and Nandurbar where the staff belong to faraway places. It must also

be noted that in private schools apart from the government appointed staff, trust also appoints

teachers or staff and pays them from the trust funds. Hence, comparatively shortage of staff

was higher in government schools as compared to private schools. This inadequacy of various

category staff has larger implications on the quality of services offered at the ashram schools

and also poses great difficulties in appropriately managing it. However, other studies and

committees on ashram schools have pointed out that as much as 4,445 post are vacant in the

ashram schools of which 3,469 are in the government schools and the rest 976 are in the

private-aided schools. Studies highlight that more than half of the sanctioned posts of female

warden are vacant in these schools (Jojo, 2015, Salunkhe Committee, 2016). These findings

are reiterated in our study as we too found that the number of staff in all categories are having

short fall in the schools that has significant impact on the quality of services and education

offered for the children studying and residing there.

2.4 BUILDING AND INFRASTRUCTURE

Table 2.3: Building facilities of selected schools

District – Block

of the school School Name

Availability-

Condition

of separate

education

wing

Condition

of

residential

wing for

students

Availability

of

residential

wing for

staff *

Average

area of

the

classroom

in sq. ft.

Palghar –

Dahanu

Rose No Fair Yes (1) 400

Lily Yes – Good Good Yes (2) 440

Jasmine No Poor Yes (2) 240

Mogra No Poor No 300

Nandurbar –

Navapur

Sunflower Yes – Fair Poor Yes (2) 600

Orchid Yes – Fair Fair Yes (4-5) 378

Daisy Yes – Poor Poor Yes (2) 180

Lotus Yes – Fair Good Yes (20) 300

Yavatmal – Tulips Yes – Fair Fair Yes (7) 200

3 Milk in the school was prepared by mixing milk powder with boiled water.


Kelapur Marigold Yes – Good Good Yes (13) 300

Carnations 1 Yes – Fair Fair Yes (3) 225

Carnations 2 Yes – Fair Fair Yes (3) 120

Hibiscus Yes - Fair Fair Yes (2) 900

Gadchiroli –

Aheri

Dahlia Yes - Fair Fair Yes (2) 450

Periwinkle No Poor No 500

Lavender Yes - Poor Poor Yes (6) 800

Daffodils Yes - Fair Fair Yes (18) 600

* Parentheses indicate the number of staff quarters within the school premises.

Among all the 17 selected schools, four schools did not have a separate education wing at all

(Table 2.3), which implies students living arrangements are made in the same classroom

where they attend classes. In such schools, classrooms have a table, chair and blackboard for

instructional purpose meant for teacher. The trunks in which students store their personal

belongings like clothes and books and bed sheets are kept along the corners one above the

other in the classrooms leading to lack of space in the classroom while sleeping. The washed

clothes are hung on top of the classroom under the fan on ropes for drying. This mechanism

of drying clothes inside the classroom blocks passage of light into the room, where already

there is inadequate light due to non-functional tube lights or bulbs inside the classroom.

Those schools where classrooms are also used for residential purposes, creates a non-

conducive environment for learning. Many a times the clothes are stacked on one corner of

the rope by the students studying in that particular class for better light and ventilation. This

will lead to a situation where the clothes are dried improperly and since the students usually

have only 2-3 pairs of clothes to wear; they wear partially-dried clothes and undergarments

which are not adequately exposed to sunlight and this has sort of become a habit for majority

of them. In some government schools where students were provided with mattress to sleep,

they stack their mattress one on top of each other at a corner in the classroom.


Clothes stacked on the rope for drying in a classroom verandah

Fifteen out of 17 schools had residential staff quarters available inside the school premises,

but these quarters were few in number (Table 2.3) which, in most cases, were meant for male

and female wardens or watchman or class four employees of the school. Only two schools

(Lotus and Daffodils) had full-fledged residential quarters for all employees, including

teachers and class four employees which were functional. The average size of the classroom

was 408 sq. feet. Most of the classrooms have adequate space as a classroom to accommodate

50 students, but the facilities inside the classrooms like ventilation and lighting were poor in

majority of the schools. Congested or poorly-ventilated classrooms or staying arrangements

are predisposing factor to communicable and skin diseases among the inmates.

2.5 ELECTRICITY SUPPLY

Electric supply in rural areas is yet another crisis. Majority of the ashram schools face regular

power cuts which means they experience power cuts every day either for a fixed period of

time as in case of some schools or any random time during the day. This is a common

phenomenon across the schools. Two schools (Lotus and Hibiscus) had independent

transformers despite which one school faces power cuts while the transformer of another

wasn’t functional during the period of data collection. Many of the schools face regular

power cuts and due to non-functional generators resulting in situations of not having

electricity throughout the day. During the data collection, it was found that lack of electric

supply makes it difficult for students and teachers from some of these schools to stay inside

the classrooms which are extremely warm as they were roofed with metal sheet. A

headmaster mentioned of students sleeping on verandah (open air porch or gallery outside a

house) at times due to extreme warm environment inside the room, which poses greater risk

of snake and scorpion bites.


Table 2.4 Infrastructure for power supply in ashram schools D

istr

ict

– B

lock

of

the

sch

ool

Sch

ool

Nam

e

Pow

er s

up

ply

Fu

nct

ion

ali

ty

of

gen

erato

r

(Nu

mb

er)

Con

dit

ion

of

gen

erato

r

Nu

mb

er o

f F

ire

exti

ngu

ish

ers

Fu

nct

ion

ali

ty

of

fire

exti

ngu

ish

er

Pal

ghar

–D

ahan

u Rose Regular failure Functional (1) Fair 3 Functional

Lily Continuous Functional (2) Good 6 Functional

Jasmine Regular failure Non-Functional (1) Poor 5 Non -functional

Mogra Continuous Functional (2) Good 6 Functional

Nan

durb

ar

– N

avap

ur Sunflower Regular failure Functional (2) Good 1 Functional

Orchid Regular failure 1-Non-Functional

and 1-Functional (2)

Poor 1 Functional

Daisy Regular failure Functional (1) Fair 1 Functional

Lotus Regular failure Non-functional (1) Poor 0 NA

Yav

atm

al –

Kel

apur

Tulips Occasional failure (0) NA 0 NA

Marigold Occasional failure Functional (2) Good 1 Functional

Carnations 1 Continuous Functional (1) Fair 1 Functional

Carnations 2 Regular failure Non-functional (1) Poor 2 Non-Functional

Hibiscus Occasional failure (0) NA 2 Functional

Gad

chir

oli

–

Aher

i

Dahlia Regular failure Functional (1) Good 3 Functional

Periwinkle Occasional failure (0) NA 2 Functional

Lavender Regular failure Non-functional (1) NA 2 Functional

Daffodils Regular failure Non-functional (1) NA 3 Non-Functional

# - Functionality is doubtful NA- Not Applicable

According to the policy mentioned in Ashram Samhita (2005), every school must have a

generator. But it is interesting to note that many of the schools had regular power failure. In

most of these schools, regular power failure was experienced without any fixed period like

thrice a day i.e. morning, afternoon and night for at least 2-3 hours each, or 8-10 hours

continuously throughout the day. School with occasional power failure had power cuts once

or twice a week or only during summer and those with continuous power supply had no

power cuts at all. Most of the government schools did not have a functional generator. From

the table 2.4, it can be seen, among the 17 schools three schools did not have a generator or

invertor in their school. At times the functional generators are poorly maintained due to

which it was equivalent to non-functional. Among all the 17 schools, 15 schools had at least

one fire extinguisher in their school premises, however its functionality were doubtful

according to most of the headmasters due to lack of periodic inspections. It was observed that

some headmasters were unaware of the number of fire extinguishers or the place where it was

located in their school. It was observed that regular servicing and refilling of the machine was

not followed in many schools. None of the staff members, especially the headmaster and

wardens, were aware of how to operate the fire extinguisher, which is a threat to the safety of

the inmates in the school. Thus, poor supply of electricity and lack of awareness and


preparedness for any fire-related mishap is a common feature found across most of these

schools.

2.6 WATER SUPPLY AND MANAGEMENT

The major source of water for most of the schools primarily were Well or Borewell. Few

schools located in the heart of the main village in the block used water supplied by panchayat

as their primary water source. Water has been available all-round the year in all the schools

except in two schools (Orchid and Daisy) which faced water shortage during summer months,

but this problem never had a significant impact on them yet as during summer months the

school is on summer vacation as shared by male wardens of these school.If the situation

occurred when students were in the school, the water needs were met with tanker water. A

government ashram school headmaster shares, “Sadhya att (8) mahine pani asthe. Unhalyath

kamtarata vatte. Mag tanker dwara pani puravatat. Tarihi divsala 3-4 tanker lagte (Currently

water is available throughout eight months. Shortage (of water) exists during summer. Water

is then made available through tankers. At least 3-4 tankers are required per day).” Most of

the schools had sufficient water storage capacity within the school premises.

Table 2.5: Infrastructure for water supply and frequency of cleaning

Dis

tric

t –

Blo

ck

of

the

sch

oo

l

Sch

oo

l N

ame

Cap

acit

y o

f to

tal

wat

er

sto

rag

e (i

n L

itre

s)

Wat

er

pu

rifi

cati

on

/ tr

eatm

ent

syst

em

Fre

qu

ency

of

Wat

er p

uri

fica

tio

n

Pal

gh

ar –

Dah

anu Rose 9000 Sodium Hypochlorite Solution Once in a month

Lily 26000 Sodium Hypochlorite Solution Twice in a month

Jasmine 10000 Sodium Hypochlorite Solution Twice in a month

Mogra 12000 T Cell Powder Once in a month

Nan

du

rbar

–N

avap

ur Sunflower 40000 Mediclor And T Cell Powder twice in a month

Orchid 9000 None NA

Daisy 18000 None NA

Lotus 50000 T Cell Powder Once a week

Yav

atm

al

–K

elap

ur

Tulips 28000 Bleaching Powder 2-3 times in a day

Marigold 30000 Bleaching Powder 2 times in a day

Carnations 1 10000 Bleaching Powder NA

Carnations 2 12000 Mediclore 2-3times a day

Hibiscus 25000 RO Plant * NA

Gad

chir

oli

–

Aher

i

Dahlia 20000 Bleaching Powder Rarely-purified as panchayat

water is used mostly

Periwinkle 10000 None NA

Lavender 11000 RO Plant NA

Daffodils 25000 Bleaching Powder 2-3 times in a day

* RO- Reverse Osmosis


It should be noted that despite adequate water supply, none of the schools had piped water

supply inside bathrooms or toilets. Some tanks were overhead tanks while others were large

tanks kept on the ground which had a pipe connected at about two feet above ground level.

Water is stored in these tanks and collected in bucket and were used for daily activities like

washing, bathing, toilet, etc., and for drinking purposes, water is collected in their bottles or

poured in a glass or in their plate itself. Many school authorities mentioned to have a separate

drinking water tank but most of the students drank water from any tank in the premises or

even from the hand pump at times. Hence, it was impossible to distinguish tanks supplying

water for drinking and domestic purposes, though as per school authorities the distinction

existed.

Purification of drinking water was mentioned by many schools. The common purification

agent used included chlorine-based products like sodium hypochlorite, medichlor, T-cell

powder and bleaching powder (Table 2.5). Sodium hypochlorite powder and medichlor are

directly added into the water tanks while T-cell and bleaching powder are added into the well

for purification. Two schools (Hibiscus and Lavender) reported to have RO filter plant for

purification of drinking water, but its functionality and its usage of this purified water by

students were doubtful as students are used to drinking water from any water sources as

mentioned above. All the schools mentioned of cleaning their water tanks once fortnightly,

which according to the school authorities is the job of class four staff. However, during

informal discussion with students it was found that this job was done by boys as schools

mostly lack cleaning staff which is evident from the above description on staffing pattern.

Thus, clean and portable water is major concern in almost all schools, no adequate efforts are

made at the schools under study for the purification of drinking water for the children posing

an additional risk for waterborne diseases for the children.

2.7 SEWERAGE DISPOSAL

Waste disposal is a major challenge in ashram schools. Waste includes dry waste like paper

and plastics, wet waste of vegetables and fruits and food waste along with sewerage waste,

which include refuse waste from bathroom and toilets. The major sewerage waste disposal

mechanism for ashram schools are through septic tanks. A few schools located in the heart of

the main village in the block were connected to the gram panchayat drainage system. One

school had no mechanism of sewerage disposal at all. The waste was let out into the nearby

empty farm land.


Open drain in one of the schools

Though most of the schools had a fairly functional septic tanks, some of them were in

extremely poor conditions or equivalent to non-functional due to blockage or leakage of the

tank rendering it unsuitable and unhygienic for daily use.The open drains or leakaged tanks

are likely sources of infection for these school inmates.

Table 2.6: Sewerage disposal mechanism in ashram schools

Dis

tric

t -

Blo

ck

School Name Sewerage disposal

system

Condition

of sewerage

disposal

Wet Waste

disposal

Food waste

disposal

Pa

lgh

ar –

Da

ha

nu

Rose Septic tank and gram

panchayat drain Good Compost pit Compost pit

Lily Septic tank and gram

panchayat drain Good

Thrown in

school premises

Handed over

to pig farmers

Jasmine Septic tank Fair Compost pit Handed over

to pig farmers

Mogra Septic tank Fair Buried Buried

Nan

du

rb

ar –

Navap

ur Sunflower Septic tank Fair

Collected by

Gram panchayat

waste collector

Collected by

gram panchayat

waste collector

Orchid Septic tank Fair Compost pit Compost pit

Daisy Septic tank Fair Compost pit Compost pit

Yavatm

al-

Kela

pu

r

Tulips Goes into nearby farm NA Compost pit Compost pit

Marigold Septic tank Fair Compost pit Compost pit

Carnations 1 Septic tank Fair Thrown outside

the school

Thrown outside

the school

Carnations 2 Septic tank Fair Compost pit Compost pit

Hibiscus Septic tank Fair Compost pit Compost pit


Ga

dch

iroli

– A

her

i Dahlia Gram panchayat

drain Good

Collected by

gram panchayat

waste collector

Collected by

gram panchayat

waste collector

Periwinkle Septic tank Poor Thrown outside

the school

Thrown outside

the school

Lavender Septic tank Poor Burnt Thrown inside

the school

Daffodils Septic tank Poor Thrown outside

the school

Thrown outside

the school

Burning was the major mode of dry waste disposal commonly followed across all the

schools. Mode of wet and food waste disposal was mainly compost pit, which was located at

an isolated corner within the school. While in schools without a compost pit, the waste was

thrown outside the school premises or burnt or buried in a pit inside or outside the school

premises. Just two schools (Sunflower and Dahlia) had provision for waste being collected by

panchayat waste collector. Food wastes from some schools are handed over to pig farmers

residing within the village. In some schools, food waste was thrown outside the school

premises which was eaten up by the cattle loitering around in and outside the school

premises. According to a headmaster, government instructs the school to spray a mixture of

phenyl and thymed every day in areas which are potential mosquito breeding sites. According

to him, this practice also keeps away reptiles like snake or scorpion. Several headmasters

have mentioned that they are following this practice daily and this practice was also observed

in one private school during field work.

Though, clean and hygienic surrounding is one of the important requisites for ashram schools

as per Ashram School Samhita, 2005, this has been substantially ignored by majority of the

schools observed under the study.

2.8 TOILET AND WASHROOM FACILITIES

Toilets and washroom facilities are the most important determinant of health and hygiene in a

residential school context and so are in ashram schools. This is all the more important for

adolescent girls who attain menarche during this phase of life, where toilet and washroom

facility become a necessity. It was found that most of the ashram schools had functional

toilets and washrooms existing in the school premises except in case of Aheri-Gadchiroli,

where two schools (Periwinkle and Lavender) one government and another private as shown

in the table 2.7, did not have functional toilet and bathroom facilities for girls and boys. This

force students to go out in open for nature’s call. It must be noted that though most of the

schools had functional toilets and bathrooms they were poorly maintained. None of the

bathrooms or toilets had piped water connection inside, students usually carry water in

buckets from the nearest water tank or hand pump.

The bathrooms and toilets were usually adjacent to each other and located just besides the

hostel buildings at about 10-100 meters away from their place of residence. Only one school

each in Nandurbar and Gadchiroli (Lotus and Daffodils) had toilets and bathrooms attached

inside the hostel rooms.


Poorly-maintained functional toilets in one of the schools

From the table 2.7, it is evident that among 17 selected schools eight schools (Rose, Tulips,

Carnations 2, Hibiscus, Dahlia, Periwinkle, Lavender and Daffodils) had separate washing

area for boys and girls. While those schools without this facility, students washed their

clothes inside the bathroom or place near the bathroom where handpumps are located. One

school (Jasmine) in Palghar was located on the banks of the river hence students preferred

washing clothes on the river bank and is a practice though the authorities claim that they use

bathrooms for washing. In one of the schools (Daisy) in Nandurbar, washing area was

allotted for boys and not for girls and hence girls use bathrooms for washing. Further when

one examines the adequacy of toilets and bathrooms according to the number of children in

the schools, it is important to note that in some schools one toilet and one bathroom is shared

by 30 or more students in most of the schools (Lily, Jasmine, Mogra and so on). While a few

of them (Lotus, daffodils, carnations 1&2, and so on) have less than 30 students using one

toilet and one washroom. There are also schools like Lavender whose number of girls using a

single washroom and toilet can be more than 100 (table 2.7).


Table 2.7 Toilet and Bathroom availability against the number of children D

istr

ict

– B

lock

Sch

oo

l N

am

e

To

tal

nu

mb

er

of

bo

ys

No

. o

f fu

ncti

on

al

ba

thro

om

s f

or b

oy

s

No

. o

f fu

ncti

on

al

toil

ets

for b

oy

s

To

tal

nu

mb

er

of

gir

ls

No

. o

f fu

ncti

on

al

ba

thro

om

s fo

r g

irls

No

. o

f fu

ncti

on

al

toil

ets

for g

irls

Dis

tan

ce o

f th

e t

oil

et/

wa

shro

om

fro

m p

lace

of

resi

den

ce (

mete

rs)

Sep

ara

te f

acil

ity

for

wa

shin

g c

loth

es

for

bo

ys

an

d g

irls

ex

ist

an

d w

here?

Pal

gh

ar

-Dah

anu Rose 254 4 4 197 4 4 50- 100 Yes

Lily 294 7 7 225 6 15 100 No

Jasmine 253 5 5 235 3 4 20-25 No

Mogra 391 3 4 394 5 7 50-100 No

Nan

du

rbar

- N

avap

ur

Sunflower 340 5 8 315 6 10 50-100 No

Orchid 150 5 5 165 12 12 100-150 No

Daisy 374 7 9 306 7 14 30-40 Yes (B),

No (G)

Lotus 217 18-

20 15-18 219 18-20 12-15

Attached toilets

and bathrooms No

Yav

atm

al

- K

elap

ur

Tulips 163 6 8 134 4 7 30-40 Yes

Marigold 195 9 11 193 9 6 30-40 No

Carnations 1 82 5 5 67 8 10 30-40 No

Carnations 2 46 1* 4 50 9 10 10 Yes

Hibiscus 140 7 9 154 9 9 10 Yes

Gad

chir

oli

- A

her

i

Dahlia 345 4 4 167 5 5 10 Yes

Periwinkle 237 0 0 154 4 0 Non-functional

toilet Yes

Lavender 28 1 1 366 2 3 Non-functional

toilet Yes

Daffodils 129 8 5 110 8 8 Attached toilets

and bathrooms

Yes

* common bathroom which accommodates 5-7 boys at a time

2.9 SPACE PROVISIONS

Most of the ashram schools reported to have separate residential wing with four schools

(Rose, Jasmine, Mogra and Periwinkle) reported that they don't have a separate residential

wing as it is obvious from the table 2.8. Three out of the four schools are from Dahanu block

of Palghar district with the remaining one from Aheri block of Palghar district and students

from four such ashram schools stayed in their classrooms itself. Whereas in those where

separate residential wings were identified, space available wasn’t adequate due to which

many students were housed in classrooms itself.

According to a headmaster, this unavailability of separate residential and school/educational

wing creates confusion in the minds of children, he says “Mulanna rahayla swatantra nivas


sthan ani swatantra shala asavi. Me rahatohe mahanje maje nivas sthan ani me jithe

shikayala jato ti shala. Mahanje he asla ki tyala pharak kallala asta. Jya thikani

vasthighruha ani shala ekatra aaste tyana ek prashna yetho ki, ‘Shala mahanje nemka

kay?’Hi mule jevha ghari jatat thevha thanche ghar pan tasech ani shala pan tasech.”

(Students should have an independent residential wing to stay and an independent

school/educational wing. The place where I stay is my residential space and the place where I

study is my school. If the distinction existed (the student) would have been able to

differentiate between the two. In schools where school and residential wings are the same,

those students usually question ‘What does school really mean?’ For these students, their

house and school lookthe same.)

Additionally, during rainy season, classrooms are wet due to water entering from window or

due to leakage from roof, in such situations, students are unable to sit or lay bed unless the

floor dries off. This situation is further worsened when the school faces power failure which

is common during rainy season. Due to which students, especially the younger ones, normally

sleep late and get up late next day which leads to skipping either of their morning activities

which is usually breakfast or bath.

This is emerging as one of the serious challenges in several of the ashram schools as on the

major infrastructure inadequacy is to ensure separate educational and residential space, which

is a prerequisite to evoke enthusiasm to learn and imagine education as a formal activity

distinct from routine lived life, which is absent currently among them.

The size of each classroom ranged from 180-600 sq.ft, while that of the residential wing

ranged from 200-800 sq feet. It was usually seen that students stayed either in their own

classrooms or in a hall or in rooms which are provided by the school. Most of the schools had

congested accommodation facilities for students due to lack of adequate residential space in

the school. It must be noted that this scenario exists in context where ashram school do not

have requisite intake of 50 students i.e. 40 residential students in each class as mentioned

earlier in general infrastructure facilities.

Despite lack of separate residential space, the school authorities ensured that girls and boys

had separate residential classrooms. According to a male warden, this process of rigid

separation of girls and boys, especially of the adolescent age group, is quite different from

their original tribal culture where girls and boys are allowed to stay and mingle together at a

very early age. This differential practice at school and at home many a times confuses these

adolescents forcing them to be rebellious against authorities in school. In such schools it was

found that girls usually reside in classrooms meant for primary students. While boys reside in

classrooms meant for secondary students. A female warden from one of these schools

highlighted this arrangement for girls and boys residing in primary and secondary section of

the schools were to ensure privacy of girl students as their undergarments are put up for

drying inside the classrooms and boys from secondary section would tease girls. Most of the

schools with separate educational wing for students are also the ones with non-satisfactory

quality of residential space as the space earmarked exclusively for residential purpose is

overcrowded leading to congestion.


Majority of the schools had playground except in case of two schools in Palghar and one

school in Nandurbar. These schools without playground used empty spaces in between the

school building or nearby the school as playground. It was noted that all the schools had at

least five to six different sports equipment like cricket set, badminton, lagori, skipping rope,

football, chess, snake and ladder, shot put, discus and javelin in the school. Many of these

schools did not even appoint a sports teacher, which is also not an allotted post in ashram

schools as per Ashram School Samhita (2005).

Thus, space provisions in most of these school were inadequate leading to congestion to

accommodate personal and educational items of all students in one classroom resulting in

lack of privacy as well.

Table 2.8: Provision of residential and educational facility in ashram schools

Dis

tric

t –

Blo

ck

Sch

oo

l N

am

e

Sep

ara

te p

rov

isio

n

of

resi

den

ce f

or

bo

ys

an

d g

irls

Av

ail

ab

ilit

y-

of

sep

ara

te

resi

den

tia

l w

ing

Av

era

ge

are

a o

f

resi

den

tia

l sp

ace

(sq

. fe

et)

No

. o

f g

irl

stu

den

ts

sta

yin

g i

n o

ne

roo

m.

No

. o

f b

oy

stu

den

ts

sta

yin

g i

n o

ne

roo

m.

Siz

e/a

rea

of

pla

yg

rou

nd

in s

q.

feet

Pal

gh

ar –

Dah

anu Rose Yes,congested No 400 25-30 25-30 1600

Lily Yes,congested Yes 600 40 40 87120

Jasmine Yes,congested No 240 35-40 35-40 No playground

Mogra Yes,congested No 300 40 40 No playground

Nan

du

rbar

–N

avap

ur Sunflower Yes,congested Yes 600 30-35 120-130 26136

Orchid Yes,congested Yes 300 40-50 40-50 45000

Daisy Yes,congested Yes 800 50-55 20-25 3315

Lotus Yes,spacious Yes 600 - hall

200 - room

16 per hall and

5-6 per room

16 per hall and

5-6 per room

No playground

Yav

atm

al–

Kel

apu

r

Tulips Yes,congested Yes 600-hall

200 - room

20-25 in hall

and 8-10

per room

20-25 per hall

8-10 per room

43560

Marigold Yes,spacious Yes 400 65-75 65-75 174240

Carnations 1 Yes,congested Yes 600 60 in one hall 20-25 in one classroom 10000

Carnations 2 Yes,spacious Yes 600 46 girls in one

hall

10-15 each in a room 10000

Hibiscus Yes,congested Yes 300 Around 25-30

girlsstay in one

room

Approximately 40-50

boys stayin one hall

10000


Gad

chir

oli

–A

her

i

Dahlia Yes, congested Yes 300 -

rooms

600 - hall

20-25 girls in a

roomand 50-60

girlsin hall

20-25 in room

and 70-80 inhall

10000

Periwinkle Yes, congested No 500 40-45 students

stayin one room

40-45 students stay

in one room

6400

Lavender Yes, congested Yes 200 -small

room400 -

large rooms

10 to 12 girls per

small room, 40-

50girls per large

room

28 boys per

class room

30000

Daffodils Yes, congested Yes

Fair

1800- hall

Rooms:

600,

300, 200

80-85 students

perHall, 20-25,

5-6 and

3-4 per room

80-85 students

per hall20-25,

5-6 and 3-4 per room

6400

2.10 PROVISION OF CONSUMABLES

As per Ashram Samhita (2005), all ashram schools are expected to provide students with

basic necessities required for daily living for example utensils, beddings, night dress,

uniform, toiletries and educational materials. Among these materials, the study tried to

examine five basic essentials for daily living provided to residential students which included

bedding materials, utensils, bathing materials, night dress and uniform. Bedding included cot,

mattress, bed spread, bed sheet and blankets, utensils like plate, bowl and glass, bathing

materials like bathing soap, washing soap and hair oil, a pair of night dress for girls and boys

a pair of uniform and sanitary pads for menstruating girls. Beddings and utensils are expected

to be replaced every three years, night dress and uniform are provided every year while

bathing materials are supplied every month. Majority of the schools provided most of these

essential items to students.

In general, utensils like plate, bowl and glass were provided one each to all students. At the

end of every academic year students were expected to return these utensils to the school

before leaving for summer vacation and the utensils were given back to students when they

returned after vacation in the next academic year. Due to this mechanism, it was unable for

the students make out whether their utensils were replaced every three yearly as per the

norms. School authorities mentioned that they generally are compliant to this norm. Similar

was the situation for bedding materials as well. In many private and government schools, the

students were not provided with mattress instead was given satranji (a thick rug used instead

of mattress). Some school did not provide blankets as well. While none of the schools

provided cots to the students.

According to a headmaster, non-provision of cot or mattress leads to a common problem

complained by students during assembly, which is especially in rainy season when the floor

is wet. He says, “Zamin khalli zari ladhi asthe tari thi olli aste, tyani (mullani) jo bichana

kella ahe te olla hou shaktho. Rathri thyala zopthana avgadlyasarka vatu shakthe.” (Even

though there is tile on the floor it is still wet, hence their (the students) beddings may get wet.

This would disrupt their sleep at night.)

Hence, according to him provision of cot and mattress to students is essential to ensure sound

sleep and safety of students in areas with high risk of snake and scorpion bite. At times,


though the mattress and cot are supplied to the school, they are unable to provide it to the

students as lesser students would accommodate in a classroom if mattress and cot are

provided due to space constraints. This provision of cot and mattress was only for

government school. Private school is expected to provide cot and mattress from their own

fund hence they are deprived from this facility. While government school students are

deprived owing to lack of space.

Table 2.9: Consumable provided in ashram schools

District – Block School

Name

Soap (bathing and

washing) received

per month

Number of sanitary pads

received per month

Palghar –

Dahanu

Rose One bathing and

washing soap each

3 packets in a month

Lily One bathing and

washing soap each


Jasmine Money transferred

through DBT*


Mogra Money transferred

through DBT*

2 packets are provided

Nandurbar –

Navapur

Sunflower One bathing and

washing soap each

2 cloths per girl is provided every

month.

Orchid Money transferred

through DBT*

1 packet pad per month and cloth

Daisy One bathing and

washing soap each

Not given as this year no stock

Lotus Money transferred

through DBT*

Money transferred through DBT*

Yavatmal –

Kelapur

Tulips One bathing and

washing soap each

1-2 packets per student is given

Marigold One bathing and

washing soap each

No

Carnations 1 Money transferred

through DBT*

2 packets per student

Carnations 2 Money transferred

through DBT*

2-3 packets per student

Hibiscus Money transferred

through DBT*

2-3 packets per student, per month

and given as per need

Gadchiroli –

Aheri

Dahlia One bathing and

washing soap each

2 packets per student

Periwinkle One bathing and

washing soap each

1-2 packets per student

Lavender Money transferred

through DBT*

Money transferred through DBT*

Daffodils Money transferred

through DBT*

1-2 packet per student

*In school where money is transferred through DBT to the students account, the school does not provide any

consumables to the students. They are expected to purchase the necessary items from the DBT amount.


None of the school provided night dress to their students though one government school

authority mentioned receiving night dress once a couple of years ago as part of their regular

supplies4. Uniforms were almost regularly provided to students. A pair of uniform was given

to each student, one each on the occasion of 26th January, Republic day and another on 15th

August, Independence Day; this was the usual pattern seen in most schools. On these days the

students were expected to wear the new uniforms as most of the schools had cultural

programs organised by students on this day which would also be attended by chief guest or

parents. In government schools, cloth required for uniform is supplied by the government to

the school. Tailor is appointed through project office. The representatives of the tailor’s union

meet with the representatives of project office and select their member within locality of the

school. The assigned tailor is expected to stitch uniform for each student within the school

premises. The tailor’s bill is then sent to the project office by the school and is later paid from

project office itself. In areas where tailor’s union doesn’t exist, a tender is called from local

tailors and a suitable tailor is assigned by the project office themselves. Though a pair of

uniforms were given every year, some students from schools in Nandurbar, Yavatmal and

Gadchiroli were seen not wearing uniforms during school hours. On enquiring with the

school staff, it was found that many students keep their new pair of uniform home and wear

normal dress to school.

Hair oil, washing soap and bathing soap were provided on monthly basis in those schools

where students did not receive money through direct benefit transfer (DBT). In majority of

the schools 100 ml of coconut oil, one washing soap and one bathing soap were provided

every month. In case of soaps both washing and bathing, many school authorities mentioned

providing more than one to students as one may not be sufficient and also in case of younger

children who tend to lose or misplace their belongings very often. Sanitary pads are provided

monthly to girls who attained menarche. In most of the schools two packets were provided

when the girl reports to the female warden about the initiation of menstruation on the first day

(Table 2.9). Sanitary pad packets are provided further as per the girl’s requirement. Only in

one private school (Sunflower) in Nandurbar, authorities reported providing two clothes per

month instead of sanitary pads to menstruating girls while another private school (Marigold)

in Yavatmal did not provide either cloth or sanitary pads to menstruating girls. While on

enquiry with the menstruating girls some of them mentioned not receiving sanitary pads from

schools though the authorities insisted on the supply. Students of private schools from

Palghar district shared in FGD, that the pads provided were of substantially poor quality, a

girl with normal flow required minimum eight such pads per day to prevent leakage. This

caused serious inconvenience routinely such as staining of clothes, undergarments and bed

sheet at night, hence they preferred using cloth instead of pads. Whereas in government

schools, students shared that they receive sanitary pads of better quality. In schools where

4 Government school receive supplies from agencies allotted by government. The supplies provided usually

include food items, books and stationaries, bed and bedding materials and other materials provisioned for

inmates of ashram school as per Ashram Samhita (2005). Though all materials mentioned in the Ashram shaala

Samhita (2005) are not received regularly by the school authorities.


money was transferred through DBT into the students account, the school did not provide

sanitary pads, hair oil, washing soap and bathing soap.

Among the five items, night dress was hardly provided in schools; students were expected to

bring night dress from home. While only 42 % of the total children shared that they received

at least three items out of the five only 30 % said that they received four essential items like

beddings, bathing materials, utensils and uniform. According to the table 2.10, in government

schools 59.1% students received at least three items which usually involved utensils, bedding

and bathing materials. While among 18.3% of the respondents received only two items,

included bedding and bathing materials only. Direct Benefit Transfer (DBT) was received by

9.5% of the respondents of which majority (89.4%) belonged to Gadchiroli district. This

possibility could be because students started receiving DBT money for all the items during

the start of academic year 2017-18 and since Gadchiroli was the last district for data

collection (i.e. in the month of November) and the process of depositing DBT had already

overcome its initial hitches during the period of data collection in Gadchiroli.

In private-aided schools, only 5.8% received all five items, while 54.5% received all four

items (excluding night dress). While 26.3% received all three items like utensils, bedding an

bathing materials, 11.6% received two items which mainly included bedding and bathing

materials. One student had received none as she was newly admitted for the current academic

year. According to a headmaster from a private school, they are allotted grant of Rs 900 per

students monthly which is extremely inadequate to ensure provision of essential items to

students similar to government school. The above analysis also needs to be looked it in the

backdrop of DBT, a new initiative which is only meant for government schools.

Table 2.10: Number of daily use items received by the respondents based on type of

school management

Type of

School

Management

Number of daily use items* received by the respondents

Total All five

Items

At least

four

items

At least

three

items

Only two

Items

Only

one

Item

None

Received

DBT

Received

Government 3

(0.80%)

18

(4.50%)

236

(59.10%)

73

(18.30%)

31

(7.80%)

0

(0%)

38

(9.50%)

399

(100%)

Private-aided 23

(5.80%)

217

(54.50%)

105

(26.40%)

46

(11.60%)

6

(1.50%)

1

(0.30%)

0

(0%)

398

(100%)

Total 26

(3.3%)

235

(29.5%)

341

(42.8%)

119

(14.9%)

37

(4.6%)

1

(0.1%)

38

(4.8%)

797

(100%)

* Daily use items included in the analysis were - night dress, bedding materials, bathing materials,

utensils and uniform.

2.10.1. DBT and non DBT

Since 2017-18 academic year, students in ashram school were provided with Direct Bank

Transfer (DBT) wherein a stipulated amount of money is deposited into the beneficiary’s

bank account in order to avoid any foul play by middle men. According to a headmaster from

government school, suppliers would show samples of superior quality during tender while the

ones supplied to school were inferior in nature, this led to introduction of DBT system in

ashram schools. Thus, government deposits money required directly in the bank account

which enables the student themselves to utilize the money to buy essentials required for daily


living. The money is transferred twice a year into the student’s bank account. The bank

accounts are joint accounts with their parents. The amount is transferred to residential as well

as day scholar students. Yearly amount of Rs 4,400 is deposited into the student’s account to

purchase 17 items listed by the government for 10 instructional months. First instalment of

Rs 2,740 was deposited into students account during the period of data collection. The 17

items include 10 bathing soap, 30 washing soap, 10 bottles of 200 gm coconut oil, 10

toothpastes of 100gm, four toothbrushes, two combs, two nail cutters, four pairs of ribbons

for girls, a night dress, two undergarments, a woollen sweater, a sandal, a white canvas shoes,

a towel, two pairs of socks, a slipper and an umbrella.

During the study, only the students from government ashram schools were found to be

beneficiaries of DBT while none of the students from private-aided schools from any of the

districts had received DBT. However, since the study included only residential students, it is

uncertain whether day scholars received any amount through DBT.Since the bank accounts

are joint accounts along with students and parents, it is doubtful whether the amount is

utilized for the student purpose or it is utilized for their household needs as most of these

students belong to economically deprived families. The school authorities mentioned

inspecting items brought by students from DBT money as a mechanism to avoid utilisation of

this money for household purpose; though the diligence of this process is uncertain.

2.11 EDUCATIONAL FACILITY

In all the 17 ashram schools, there exists a provision for science laboratory, computer room

and library. It was observed that in all schools there was either a separate room for science

laboratory, computer room and library or at times science laboratory and computer room

were in the same room or all three were in the same room. All schools had library books

stored in cupboards which was placed either in the library room or either in school office or

headmaster’s room. While none of the schools had library hours. The science and computer

laboratory seemed unused in majority of the schools. Computer teacher was not appointed in

any of the selected schools and none of the students in the schools were equipped to operate a

computer according to the students themselves.

The school office, which consisted of the headmaster’s room, school office room and staff

room, were either three separate rooms or one large room. Some schools had headmaster’s

office and school office in one room while the staff room was separate. Almost half the

selected schools had all three rooms separate. Half of the selected schools had all the three

rooms in one large spacious room partitioned into two or three sections by temporary barriers

or cupboards. In almost all the schools, headmaster’s office consisted of a table with chairs

on either side; one chair for headmaster and 3-4 chairs on the other side of the table and a few

cupboards on one side of the room. On the other side of the cupboard was usually the staff

room or school office. The staff room had a few chairs placed around 2-3 tables arranged

together and the school office had a table with computer and printer for official purpose and a

chair for clerk/accountant. Among all the 17 schools, only one government school did not

have computers, whereas printers in most of the schools were non-functional.


2.12 HEALTH INFRASTRUCTURE

Health care related infrastructure available in ashram schools can be divided at four levels,

also depending on the severity of illness:

First Aid Box: basic care or first aid care available in ashram schools for treatment of minor

ailments, Second-level at the nearest PHC/Sub centre for treatment of minor or major

ailments Third-level at the nearest CHC/RH/SDH for treatment of minor and major infections

Fourth-level at any tertiary reference centres like DH/Civil hospital/Medical college for

treatment of major infections.

Primary screening and diagnosis of any illness or diseases occur within the ashram schools

during routine school health camps which is conducted mainly by the public health

department by their medical team consisting of a male and female Medical Officer, a nurse, a

pharmacist, a driver and a vehicle for travel. According to an ashram school medical officer,

the team is expected to conduct medical check-ups immediately after the school reopens from

summer vacation, Diwali vacation, before the end of the academic year and once in between

the academic year. In majority of the schools the ashram school medical officer visits at least

twice in six months. While in some other schools they have not visited even once in the last

six months. This data was obtained from the school’s visit book or remark book, were

medical officer is expected to enter the details of their visit.

Screening of illness outside the ashram schools occurs either in primary health centres (PHC),

community Health Centres (CHC), Rural hospital (RH), Sub-divisional hospital (SDH),

District Hospital (DH) and Medical Colleges. An ashram school is affiliated to a particular

PHC nearby the school which provides all health care provisioning to the students. The ANM

at the nearby sub-centre visits the school once or twice in a week to check the health status of

the children in terms of any epidemics, for malaria testing, to provide health education and to

provide medications for first aid box.

From the table 2.11 it is evident that most of the ashram schools have at least one well

maintained first aid box5. Some schools (Jasmine, Orchid, Daisy and Periwinkle) which did

not have a well-stocked first aid box were the ones located in the interior villages of the

block. Its remoteness could be one reason for lack of sufficient stock in the first aid box as

the stock is provided to the school from the PHC or by the ANM in the sub-centre who

themselves may not have sufficient stock.

The table 2.11 shows 11 schools out of 17 had a separate sick room for students who fall sick,

but none of these rooms were actually utilized by sick students. In Gadchiroli and Yavatmal

districts, all the selected government schools had full-fledged and well-equipped sick room

and an examination room which was used only by the medical team during health check-up.

5 The first aid box varied in different school but commonly found items in first aid box included gauze roll and

pad, cotton, band aid, savlon, soframycin, betadine and medicines to treat common ailments like cough, cold,

fever, stomach ache, menstrual pain, scabies, loose motion, acidity etc. These medicines were provided from the

nearest medical facility to wardens. The ANM during her visit would usually check the box to ensure it was

fully stocked and provide necessary medications as and when required.


While in Palghar and Nandurbar districts, the sick room was normally a store room with a cot

and mattress available in it and sometimes was used by teachers staying outside the school

premises to stay back at night. Despite the existence of physical structure of a sick room in

many schools, it was not utilized for the said purpose in all schools. The mean distance from

school to tertiary health care facility was 182.7 kms and mean time was 3.6 hours. Tertiary

health care included either District Hospital or Medical College Hospital, as preferred by the

ashram school authorities. While the nearest tertiary health care centre was located 20 -25

kms and takes one hour to reach there from the school (Sunflower and Orchid). While the

farthest tertiary health care centre was located 800kms and 15-16 hours away from the school

(Rose and Lilly). The farthest tertiary health care centre was in Palghar district, as they

preferred Medical College Silvassa in comparison to their district hospital. As per informal

discussion with school authorities in Palghar, it was found that most schools in the district

preferred Medical College Silvassa than any tertiary facilities in Mumbai due to better

services, transportation services to Silvassa, less crowd and ease in clearing administrative

formalities. Fourteen of the schools had basic health care facility, either primary or secondary

facility, within 15-20 km radius or within 15-20 minutes away from the school.

The major problem most of the schools faced with respect to health care was lack of any

transportation facility during medical emergency. Many schools relied on private vehicles

like two or four wheelers or auto rickshaws owned by a villager residing near the school.

Some schools referred to 108 ambulances as another source in case of emergency but

according to a female warden, it is the most unreliable mode of transportation in case of

emergency as it reaches the school 2-3 hours after it is called. During informal discussion,

most of the headmasters and wardens and especially those from remote areas mentioned need

for an independent vehicle for ashram school or an ambulance for 3-4 nearby schools to

ensure timely and safe transportation of students from school to the health facility which is

often a tough task for the school authorities. This is a valid request considering the number of

schools and the risk of illness.

This shows the agony faced by many school authorities ensuring provision of health care to

the inmates, who are prone to diseases due to their vulnerability. Lack of transportation

facilities often led to delayed visits to health facilities, especially secondary and tertiary

facilities, by school authorities. Further lack of transportation facilities in remote areas

coupled with lack of staff, especially female warden or a support staff, to accompany female

warden could lead to delay or inability to avail secondary and tertiary health care by inmates,

especially girls in ashram schools. At times children are sent home when they fall sick, this

is also a practice in some of the schools thereby transferring the responsibility for referral and

treatment from the school to the families. This is possibly due to lack of access to health care

provisions at the school level which is evident from table 2.10.

A headmaster from one such remote school, who himself studied in the same ashram school,

says “Pratyek ashram shale madhe 400 mule hostel madheasthat 1st the 10thparynth ani

12thparyanthasale tar 500 mule asthat. Tar hya mulansathi ek swatantra nurse nemayala

pahije… Kahi ajar udbhavala tar tabadtob upchar shaletach milto. Nahi tar hya parisarat

shalesathi, kivha 12km madle shale satthi ek doctor asava. He changla asel.” (Each ashram


school with 1st to 10th standard will have 400 students and those with 12th standard will have

500 students in hostel, an independent nurse must be appointed for these students. Or else a

doctor should be appointed for at least nearby schools within 12 kms radius. This would be a

good strategy).

Table: 2. 11 Health care infrastructure and access to health care facilities

Dis

tric

t –

Blo

ck

Na

me o

f th

e S

cho

ol

Co

nd

itio

n o

f fi

rst

aid

bo

x

av

ail

ab

le i

n s

cho

ol

Av

ail

ab

ilit

y o

f S

ick

roo

m

Nu

mb

er o

f h

ealt

h c

hec

k-

up

cam

ps

hel

d i

n l

ast

six

mo

nth

s*

Dis

tan

ce t

o N

eare

st P

HC

fro

m t

he

sch

oo

l (k

ms)

Nea

rest

RH

/SD

H i

n k

ms)

an

d t

rav

el t

ime

Ter

tia

ry h

ealt

h c

are

fa

cili

ty

stu

den

ts a

re r

efe

rre

d

Tra

nsp

ort

fa

cili

ty i

n c

ase

of

emer

gen

cy

Pal

gh

ar –

Dah

anu

Rose Well

maintained

Yes

(1)

Once PHC

20kms- 30-

40

mins

SDH8-10

kms- 20-

25

mins

Medical college

Silvassa 800Km -

15-16hours

Auto rickshaw

Lily Well

maintained

No Once PHC

20kms-

25-30 mins

SDH 8-10

kms- 25-

30

mins

Medical college

Silvassa 800Km -15-

16hours or

JJHospital,Mumbai

-150-180kms-4-

5hours

Auto rickshaw

Jasmine Poorly

maintained

Yes

(1)

3-4

times

PHC 8-

10kms -

30 mins

SDH

25-30 kms

- 1.5

hours

Valsad Medical

college-71 kms-2

hours or Medical

college Silvassa 47

Kms -2-3 hours or JJ

Hospital, Mumbai-

180-200 kms- 5-6

hours

Auto rickshaw

Mogra Well

maintained

Yes

(1)

None PHC 2

kms- 5-10

mins

SDH

40 kms-

1.5 hours

Medical college

Silvasa- 40 kms- 1

hour or DH Palghar

80-90 kms- 4 hours

Private vehicle

Nan

du

rbar

– N

avap

ur

Sun-flower Well

maintained

No 3

times

PHC 15-

17 kms-

45 mins

SDH 8

kms- 15-

20 mins

Civil hospital

Nandhurbar- 20-25

kms - 1hr

Auto rickshaw

or two-wheeler

Orchid Poorly

maintained

No 2

times

PHC 2-

3kms-

5 mins

RH

20 kms-

45 mins

Civil hospital

Nandhurbar-20-25

kms - 1hr

Auto rickshaw

or two-wheeler

Daisy Poorly

maintained

No 3

times

PHC 4-

5kms -

20 mins

RH

10kms-

45 mins

Civil hospital

Nandhurbhar 45-50

kms- 2.5 hours

Auto rickshaw

or two-wheeler

Lotus Well

maintained

Yes

(1)

2

times

PHC 10

kms-

30 mins

RH

4kms-

15 mins

Civil hospital

Nandhurbhar

40-50 kms- 2 hours

Auto rickshaw


Yav

atm

al –

Kel

apu

r Tulips Well

maintained

No 4

times

PHC 3km-

15mins

SDH

10kms-

30mins

Civil hospital

Yavatmal-

150-200- 2-3 hours

Two-wheeler

Marigold Well

maintained

Yes

(1)

3

times

PHC

18kms-

30 mins

SDH

8kms-

15 mins

Civil hospital

Yavatmal 150-200

Kms -2-3 hours

Auto rickshaw

or Car

Carnations

1

Well

maintained

Yes

(1)

_ PHC

5kms-

10mins

SDH

15kms-

30 mins

Civil hospital

Yatamal 180 kms

-3 hours

Auto rickshaw

or Jeep

Carnations

2

Well

maintained

Yes

(1)

2

times,

PHC

10 kms-

30 mins

RH

5kms-

15 mins

Civil hospital

Yavatmal-100 kms -

2-3 hours

Car or Auto

rickshaw or

108 ambulance

(unreliable)

Hibiscus Well

maintained

Yes

(1)

4

times

PHC

0.5 kms-

5mins

SDH

18 kms-

40 min

Civil hospital

Yatamal-200kms -

3.5 hours

Private jeep or

108 ambulance

(unreliable)

Gad

chir

oli

– A

her

i

Dahlia Well

maintained

Yes

(2)

_ PHC

-5kms-

15min

SDH

0.5 kms-

5 mins

Civil hospital

Gadchiroli-

120 kms- 2.5hours

Private vehicle

from village

or108

ambulance

(unreliable)

Periwinkle Poorly

maintained

No 3

times

PHC

21kms- 45

mins or

PHC -0.5

kms-

10mins

SDH

12 kms-

30 mins

Civil hospital

Gadchiroli

150 kms- 3 hours

Private vehicle

or 108

ambulance

(unreliable)

Lavender Well

maintained

Yes

(1)

3

times

PHC 3km-

5 mins

SDH

6km-10

mins

Civil hospital

Gadchiroli- 100 kms

- 2 hours

Private

vehicleor 108

ambulance

(unreliable)

Daffodils Well

maintained

Yes

(1)

2

times

PHC

12kms-

20-30mins

SDH

25kms-

30-40

mins

Civil hospital

Gadchiroli- 120

kms- 2 hours

Private vehicle

from village

* Six months is considered as per the month of data collection in specific district

All schools reported that 108 ambulances were unreliable.

PHC- Primary Health Centre, CHC- Community Health Centre, RH- Rural Hospital,

SDH- Sub-district Hospital and DH is District Hospital

2.12.1. Maintenance of Menstruation Register

The female warden in the ashram school is expected to maintain a series of registers,

including the one on menstrual details of the girls who have attained menarche. Each girl who

has attained menarche reports to the female warden about the first and last date of her

menstruation every month. The female warden is expected to enter these details in a register

and report the menstruation status of girls to the headmaster every month. This practice

helpsto track the girls who attain periods regularly and to treat those girls who have

irregularity related to menstruation at the earliest.

According to a female warden, every girl would religiously report to the female warden on

the initiation of their menstrual cycle every month as she had to collect sanitary pads from the

warden for that particular month. But now with the arrival of DBT, which allows to purchase

sanitary pads on their own by the girls, resulted in gradual dilution of their earlier practice


thus making it not only difficult for wardens to maintain the register but also to ascertain the

usage of pads by girls instead of cloths as absorbents.

When respondents were asked whether they are aware that female warden maintains this

register, 49.7% of the respondents reported it to be maintained and few of the respondents

reported about non-maintenance of the register and another few said they didn’t know. On

further inquiry based on the data maintained in the register, there were discrepancy in the data

and the actual scenario, which points out that the registers are not maintained using real-time

data. In some schools it was found that the registers are filled once in a while in one go

irrespective of the menstrual status of the students and hence could have possibly resulted in

discrepancy. This makes difficult to track any delay in menstruation among girls.

2.12.2. Routine Medical check-up by Public Health Department

As mentioned earlier, routine medical check-ups carried out by the public health department

is a characteristic feature of inter-sectoral coordination with the health department with an

aim to regularly monitor and respond to the health and nutritional needs of ashram school

children. The students of the ashram schools are expected to undergo health check-ups

regularly as per the policy norms. An ashram school medical team is constituted solely to

conduct medical check-ups on a regular basis. The team comprises a medical officer (male

and/or female), a nurse, a pharmacist and a driver with an independent vehicle allotted to

them. The team is allotted with specific number of blocks in a district. The team conducts

regular health check-ups of inmates of ashram schools and tribal hostels. The team reports

daily to the Medical superintendent of Sub-District Hospital (SDH) and to the Project Officer

of the Integrated Tribal Development Project (ITDP).

The team is ideally expected to conduct health check-ups of ashram school students once

every month to capture any illness at the initial stage and to ensure maintenance of their good

health. It was observed during the field visits that ideal norms were not followed as one team

was allotted around 20-25 ashram schools; and health check of each school required around

2-3 days due to which it was ideally impossible to cover every school every month.

Additionally, there was shortage of staff, especially medical officer, due to which the medical

check-up often prolonged for 2-3 days in districts when check-ups were conducted

systematically; while in other districts where the check-ups were completed in a day the

quality of the check-ups was compromised. It was observed that none of the selected districts

had two medical officers in the team due to which the medical officer appointed currently

was often overloaded with work, thus making it unable for the team to conduct health check-

ups in all the allotted schools every month or are forced to compromise the quality of health

check-ups done.

In one of the selected districts, ashram school’s medical team didn’t exist, check-ups were

conducted by RBSK team. Apart from the ashram school team, RBSK team also conducts

health check-ups in ashram school once in a year. The major focus of this team is 4Ds based

on the RBSK screening format viz. Defects at birth, Deficiencies, Diseases and

Developmental delays. Once a disease is diagnosed, they refer the child to the respective

health facility i.e. PHC/RH/SDH/DH for treatment. After diagnosis, this team is responsible


to ensure complete cure of the child. There is no predefined criterion on the type of diseases

they (RBSK) look for. Under the 3rd D- ‘Diseases’, any disease can be diagnosed and referred

to the respective health facility for treatment.

The quality of medical check-up and the constraints in organising medical check-up as part of

the study helps understand the difficult situation existing currently among ashram schools as

it is no longer an effective mechanism either to monitor the situation nor to follow up as the

data itself is never consolidated and is grossly underreported.

2.12.3. Limitations of Medical Check-ups

In all the selected districts, the public health department was notified in advance on the date

and days of visit to a particular ashram school. Thus, on the pre-determined day the ashram

school medical team was requested to conduct medical check-up for the school as part of

their routine check-up with priority to all the respondents included in the study.

But in all the four districts the team was deficient. For the medical check-up during data

collection, the public health department was requested for some extra health personnel to

ensure thorough data collection like a dentist for dental examination, an ophthalmologist for

ophthalmic examination, a gynaecologist for reproductive and menstrual related illness and a

lab technician to monitor haemoglobin count and preliminary sickle cell anaemia test. In

Gadchiroli district, the RKSK counsellor also accompanied with the medical check-up team,

who volunteered to collect and enter details on ‘Developmental delay’ which was the final

section in the format. The counsellor accompanied with the team in three schools to complete

official visits to these schools and gave routine health talk in these schools as well.

In none of the selected four districts, all the additional health personnel were available in all

the selected schools together. Due to which many parameters to be monitored and entered by

these additional health personnel were left blank in the health check-up format as other health

personnel’s were reluctant to step into the missing person’s shoe and play their role.

In Palghar’s Dahanu block ashram school, medical team did not exist at all, hence the RBSK

team was assigned with additional responsibility of the ashram schools as well. Therefore, the

quality of medical check-ups was mediocre. In Nandurbar, the ashram school team was a full-

fledged team with one male and two female medical officers, a nurse, a pharmacist and a

driver. The team had a senior doctor, who has been working there for more than 5-8 years,

hence was well-aware of the students’ conditions and hence quality of medical check-up was

better. In Yavatmal’sKelapur block, the ashram school team did not have a female medical

officer due to which a lady medical officer from the neighbouring block was allotted for

health check-up. Since the medical officer did not belong to Kelapur block and conducting

medical check-up in this block was forced upon her in addition to her block, the quality of

medical check-up was poor. In Gadchiroli’sAheri block, the ashram school team did not have

a female medical officer. Since the block already had shortfall of doctors, a lady medical

officer was available on request for only two schools, while in the rest of the schools the male

medical officer conducted the medical check-up due to which proper physical examination

and collecting data on reproductive or menstrual issues of adolescent girls was difficult.


The format used for health check-up was the RSBK health assessment format. The pilot study

was conducted in Palghar district, during the pilot it was conveyed that RBSK format was the

only health assessment format which existed for ashram schools. Since this format was

already standardized, it was incorporated in the study. Since RBSK format specifically

focused on the 4Ds as mentioned above, the ashram school medical officers, who were not

used to this format found it cumbersome to enter details into this format. During data

collection, none of the medical officers had a specific format for medical examination by

ashram school team, except in Gadchiroli district. Since, the RBSK format was used in all the

other districts, the same was followed in Gadchiroli as well to ensure a standardised format

across the districts.

From table 2.12 and 2.13, the data generated by medical check up was compared with the

data based on self reported survey. It was found that there is substantial underreporting of

information on menstrual status. Two possibilites exist: first, there could be absenteeism in

schools which then result in missing the data of girls during medical check up. Second and

more serious one, the fact that 20-30% forms are left blank in the medical check up data

indicating poor recording of data during routine activity, a serious limitation of institutional

data. Thus, from the tables 2.12 & 2.13 it can be seen, the data on medical check-up was

thoroughly underreported as compared to self-reported data. This raised further queries on the

authenticity of data provided by the public health department. No mechanism currently exists

to regularly consolidate the data generated in medical check-up in schools or to follow up

those children who need regular nutritional supplement of with other illnesses. Given this

fact, it is unclear on the condition of medical check-ups which are regularly conducted

monthly in the ashram school for these children.

Table 2.12 Data on menstrual status of girls based on self-reported data

and medical check-up data

Information on menstrual status of girls

Medical check up Self-reported Total

Yes No

Yes 294 (36) 11 (1.4) 305 (38.2)

No 19 (2.4) 281 (35.3) 300 (37.6)

Absent 29 (3.6) 22 (2.8) 51 (6.4)

Blank 66 (8.3) 75 (9.4) 141 (17.7)

Total 408 (51.2) 389 (48.8) 797 (100)

( ) indicate total percentage


Table 2.13: Status of Irregular Menstruation based on self-reported data

and Medical Check-up data

Information on Regularity of Periods

Medical check up

Self-reported data Total

Regular Irregular NA

Regular 190 (23.8) 21 (2.6) 3 (0.38) 214 (26.9)

Irregular 35 (4.4) 11 (1.4) 253 (31.7) 299 (37.5)

Absent 27 (3.4) 2 (0.25) 22 (2.8) 51 (6.4)

Blank 105 (13.2) 17 (2.1) 111 (13.9) 233 (29.2)

Total 357 (44.8) 51 (6.4) 389 (48.8) 797 (100)

( ) indicate percentage

2.12.3 Other forms of Engagement with Public Health Department/ Avenues of Inter-

sectoral Coordination

Additionally, mobile medical unit from the SDH also conducts health check-ups in the

government schools, including ashram schools though the catchment area of this team, the

frequency of health check-ups and the team members of this team are not known. According

to the school authorities in the sickle cell prevalent areas, the team is responsible for

conducting sickle cell testing of the entire students and regular follow-ups with the students

detected positive. The PHC Medical Officer is also expected to conduct biannual medical

check of the students as part of School Health Program for screening and early management

of diseases which too was found deficient in some selected districts.

Apart from these health check-ups, the ANM from the sub centre are also expected to visit

the school once in two weeks to keep stock of medicines in the first aid box and supply them

if necessary, to provide health education to students on menstrual hygiene, environmental

sanitation etc., monitor immunization status, monitor communicable diseases, check for

environmental hygiene of the school and to monitor the general health condition of all the

students especially the sick ones. The Rashtriya Kishor SurakhyaKaryakram (RKSK)

counsellor also visits the ashram school to monitor the growth and development of the

children by monitoring health and weight and to counsel the adolescent aged children on

issues pertaining to them like sexual abuse, menstruation etc.

Apart from all these, health personnel visiting the ashram schoolsprovide treatment to the

students during minor illness in the school premises itself and in cases where the illness is

unresolved, they are then taken to the nearby health facility either SC/PHC/CHC/RH/SDH as

per the urgency. All of the health personnel are expected to monitor growth and development

of the children, by monitoring health and weight during their visits. Thus, ideal attempts are

made to integrate the functions of health department, make them relevant, and appropriate to

the needs of ashram school inmates at multiple levels.


2.13. SUMMARY

To summarise, the present chapter provides an overview of the ashram schools in terms of its

infrastructure facilities, staff pattern and the provision of basic amenities provided.

All the 17 schools included in the study varied drastically with respect to infrastructure

facilities but were almost the same in case of provisioning of facilities to the students; though

provisioning at government schools were found better than private schools. With respect to

infrastructure, some schools had separate buildings for education and residential purposes and

other structures as compared to others with poor facilities. Staffing showed essential

shortfalls in permanent appointments while major lacuna was seen across class IV workers

which were already provisioned less according to the student strength. These shortfalls when

managed with students have serious implication on the health, social and educational aspect

of students.

Another issue being the inadequate and improper building and infrastructure as in most of the

ashram schools, students were forced to reside and study in poor and menial conditions. This

led to issues of privacy, overcrowding, poor lighting and ventilation to the room leading to

increase susceptibility to communicable diseases and reproductive infections among

adolescent girls. Frequent power disruptions, unpreparedness to tackle fire-related

emergencies and provision of safe drinking water in all the schools needs to be catered with

utmost importance.

Furthermore, septic tanks being non-functional, and sewage spilled out into the nearby land

by schools rendered surroundings unhygienic and breeding sites for mosquitoes leading to

potential source of several diseases. In case of toilets and bathrooms, though physical

structures existed in most schools, many of them were non-usable due to poor maintenance. It

is disheartening to see that such conditions prevail in the backdrop of Swachh Bharat Mission

taking of in full swing across the country.

Consumables form an important requirement to most students in context of their

socioeconomic background. For most students, consumables were a blessing since they

would have failed to avail any of these products at home. Considering this context, most

schools provided consumables of inferior qualities to students. The underprivileged students

and parents, instead of complaining, considered themselves fortunate to at least avail these

products at school. In this backdrop, successful utilization of money transferred to joint

account of the student and parent through DBT is doubtful even though schools claim to have

a mechanism to monitor utilization of this money.

With respect to educational facilities and health facilities, though it was existing across

schools it wasn’t deployed effectively for students. Medical check-ups were carried out on a

routine basis but that which was done as part of the study indicate several shortcomings and

are found to be non-satisfactory due to variety of factors like shortage of medical officers,

inadequate time or non-existence of the medical team itself. Menstrual information and

morbidity reported in medical check-up was considerably lower than that of the self-reported

data partly due to poor coverage and lack of meticulous efforts towards the same.Further, the

access to health care facilities for ashram school children during illness indicate the dismal


situation, wherein primary level care facilities is located around 5-10 kms, with secondary

level around 25-50 kms away and tertiary level care located more than 100 kms away from

the ashram schools. Not only the functional status of these health facilities is under question,

more so the failure to have transport facility limits the access to these facilities during need.

Hence, it is essential to focus on further improvement of existing facilities to ensure healthy

growth and development of these children who are admitted to these schools at a tender age.

Roads lacked maintenance making it difficult for vehicular access especially in case of an

emergency. Similarly, the compound walls were intact only in six schools rest were either

partially available or broken. In most of the schools, boys were assigned mundane activities

like cleaning the water tanks, moving of table and chairs from one place to another and lifting

grocery bags from the unloading truck to store room due to shortage of staff. In Gadchiroli

and Palghar, students were also seen helping in kitchen and distributing food. This many a

times led to loss of instructional hours and play time for the students.

The average size of the classrooms that accommodate 50 students was 408 sq ft. Among the

17 schools, four schools did not have separate educational facility which forced students to

reside and study in menial and congested environment. This led to issues of privacy,

overcrowding, poor lighting and ventilation to the room leading to increase susceptibility to

communicable diseases and reproductive infections among adolescent girls from wearing

partially-dried clothes and undergarments inadequately exposed to sunlight.

While the second chapter focussed on the lack or absence of essential infrastructure and

services in ashram schools which play one of the most essential roles in education of the

underprivileged children, the third chapter would highlight the socioeconomic, demographic

and cultural characteristics of the adolescent girls in these ashram schools.

Tata Institute of Social Sciences, Mumbai | CHAPTER THREE 69

CHAPTER THREE

SOCIO-ECONOMIC AND DEMOGRAPHIC

CHARACTERISTICS OF ASHRAM SCHOOL GIRLS

3.1 INTRODUCTION

This chapter deals with socioeconomic, demographic and cultural characteristics of those

selected adolescent girls, namely their age, standard in which they are currently studying,

religion, caste, sub tribe, disability status and basic information on their family and

household. This profile of the respondents helps situate the social and cultural characteristics

and the extent of vulnerability in which they live that calls for examining the infrastructure

facilities and services in the given context. The chapter gives an overview of the general

background of the selected adolescent girls, their parents and household environment along

with their siblings’ education status - a proxy indicator to evaluate their purpose of being in

ashram schools.

3.2 BLOCK AND DISTRICT OF STUDY

As mentioned earlier, the study covered four selected districts of Maharashtra based on the

highest proportion of Schedule Tribe population as per census 2011 data. The study was

carried out in Dahanu block of Palghar district, Kelapur block of Yavatmal district, Aheri

block of Gadchiroli district and Navapur block of Nandurbar district. The table 3.1 shows the

distribution of adolescent girls in each block and its proportionate contribution to the total

sample. Palghar and Yavatmal districts each represented 25.1%, Gadchiroli with 25%, and

Nandurbar district representing 24.8% of the total adolescent girls selected for the study.

Table 3.1: District-Block-wise distribution of adolescent girls

District-Block Frequency Percent

Palghar-Dahanu 200 25.1

Yavatmal-Kelapur 200 25.1

Gadchiroli-Aheri 199 25

Nandurbar-Navapur 198 24.8

Total 797 100

3.3 TYPE OF ASHRAM SCHOOLS INCLUDED IN THE STUDY

There are two types of ashram schools based on the ownership or management; namely,

government ashram school and private-aided ashram school. The government ashram schools

are entirely funded, run and managed by the government and each school gets Rs 7000 per

student per year studying in 1st to 4th standard, Rs 8500 for those in the 5th to 8th standard and

Rs 9500 for 9th to 10th standard. This amount goes to directly to the students through DBT.

This money is used for school dress, shoes, stationary and other essential materials such as

soap, oil etc., while the private-aided ashram schools are owned by individuals or run by a

charitable or private trust. These private ashram schools are run and managed by the private

agencies and is aided by government; though 100% aid is not received but they get some

proportion of funds from the government as aid. For these schools, government grants Rs 900


per student per month and the amount is transferred on a quarterly basis. In addition to these,

the society can claim in the prescribed format any additional expenditure they incur for

student related purposes within the stipulated guidelines. Both these types of schools abide

the same set of governmental rules and regulations, staff requirements, syllabus, structure and

facilities for students. Among the ashram school selected in the study, about 50% of the

schools were government-aided, while the rest half (50%) were government ashram schools

which are run by government staff. Another type of classification of ashram schools is based

on the type of children studying. There are co-educated (co-ed) ashram schools and girls only

ashram schools. The study had only one school (Lavender) from Aheri, Gadchiroli, which

was a girl only school. Most (94%) of the respondents hence belonged to co-ed school, while

only 6% of the respondents were from girls-only school. The school which was only for girls

was co-ed till primary section i.e. till 4th standard and from secondary and junior college

section onwards the school admitted only girl students.

3.4 AGE PROFILE OF THE ADOLESCENT GIRLS

As the study is confined only to adolescent girls, only adolescent girls were selected as

respondents. Girls aged 9 to 19 years were the age group included in the study. The mean age

group of respondents were 13.5 years (SD=2.1). Table 3.2 shows that the largest (33%)

proportion of the age group represented was belonged to age category 13-15 years while 29%

belonged to 11-13 years of age. Around 19.4 % of the total sample were from 9-11 years age

group. As only three ashram schools selected in the study had junior colleges attached to the

ashram schools, only 2.8% of the samples were from those above 17 years age.

Table 3.2: Age distribution of Adolescent girls

Age of respondents Frequency Percent

9-11 years 155 19.4

11-13 years 226 28.4

13-15 years 259 32.5

15-17 years 135 16.9

17 years and above 22 2.8

Total 797 100

3.5 RELIGION AND CASTE OF THE ADOLESCENT GIRLS

All the respondents included in the study were Hindus (100%) belonging to the Scheduled

Tribe (100%) category. One of the major eligibility criteria for admission in ashram school is

that the girls should belong to Scheduled Tribe category. The respondents represented a range

of tribal communities that are prevalent in Maharashtra. From the table 3.3 it is clear that

around 25% belonged to Gonds, while 22% were from Warlicommunity, 11% belonged to

the Kolam and 10% were Mandiyaclan. Additionally, the proportion of girls representing

Bhila, Gavith, Kokani and Mavchi communities were 7.4%, 5.5%, 4.5% and 3.6%

respectively with 7.6 % girls categorised as others which included MalharKoli, Oraon, Padvi,

Valvi, Tadvi, Raut, Athodi, Gaouli, Vasvi, Katkari, Valde, Pradhan, Mana, Pardhi, Andh,

Naik, Diva kolhi, Vavadi, and Kilbhi. A few girls (29%) among the respondents, especially

those in the younger age group 9 -10 years, were unable to give information about their sub-

tribe details.


Table 3.3: Sub-tribe of respondents across districts and corresponding blocks

Sub-tribe

ofthe

Respondent

District and block of the school

Total Palghar-

Dahanu

Nandurbar-

Navapur

Yavatmal-

Kelapur

Gadchiroli-

Aheri

Warli 172 (86) 0 (0) 0 (0) 0 (0) 172 (21.6)

Gond 0 (0) 0 (0) 94 (47) 102 (51) 196 (24.6)

Kolam 0 (0) 0 (0) 91 (46.5) 0 (0) 91 (11.4)

Madia 0 (0) 0 (0) 0 (0) 80 (40) 80 (10)

Kokani 23 (11.5) 13 (6.6) 0 (0) 0 (0) 36 (4.5)

Gavith 0 (0) 44 (22.2) 0 (0) 0 (0) 44 (5.5)

Mavchi 0 (0) 29 (14.6) 0 (0) 0 (0) 29 (3.6)

Bhila 0 (0) 59 (29.8) 0 (0) 0 (0) 59 (7.4)

Others 5 (2.5) 27 (13.6) 14 (7) 15 (7.5) 61 (7.6)

Don't know 0 (0) 26 (13.1) 1 (0.5) 2 (1) 29 (3.6)

Total 200 (100) 198 (100) 200 (100) 199 (100) 797 (100)

( ) Parentheses indicate column percentage

District-wise distribution shows that Warli tribe were the predominant (86%) group from

Palghar district with Gond (51%) and Madia (40%) being the dominant sub-tribe in

Gadchiroli district. In Yavatmal district, too, Gond (47%) was the most represented group

with Kolam (46.5%) tribe having almost equal representation. Bhila (29.8%) and Gavith

(22.2%) were the one represented more in Nandurbar district with Mavchi around 14.6% in

this district and also present here were the larger proportion who could not tell about their

sub-tribe.

3.6 STANDARD-WISE DISTRIBUTION OF ADOLESCENT GIRLS

As seen in the age distribution earlier, the standard in which the respondents were studying at

the time of survey also indicate that majority (20%) of the respondents were studying in 8th

standard, while around 15% of the respondents were from 5th, 7th and 9th standard (table 3.4).

The representation from 11th standard (4%) and 12th standard (3%) were the least as those

ashram schools with junior college were only three in number.

Table 3.4: Standard-wise distribution of adolescent girls

Standard Frequency Percent

5 123 15.4

6 109 13.7

7 123 15.4

8 160 20.1

9 117 14.7

10 108 13.6

11 30 3.8

12 27 3.4

Total 797 100


3.6.1 Age and standard of ashram school girls

To understand the standard in which the students are studying against the age of the child,

analysis was done. This will help understand whether the students are studying in lower

standards against the ideal age, a possibility in situations when there are dropouts or in situations

when students need to repeatedly study in same class due to failure in exams and so on.

Table 3.5: Standard in which girls study according to age group

Age of girls in

years

Standard in which the respondent is currently

studying Total

5-7 std 7-9 std 10-12 std

9-11 years 154 (43.4) 1 (0.4) 0 (0) 155 (19.4)

11-13 years 175 (49.3) 51 (18.4) 0 (0) 226 (28.4)

13-15 years 22 (6.2) 195 (70.4) 42 (25.5) 259 (32.5)

15-17 years 4 (1.1) 29 (10.5) 102 (61.8) 135 (16.9)

17 years and above 0 (0) 1 (0.4) 21 (12.7) 22 (2.8)

Total 355 (100)

[44.54]

277 (100)

[34.7]

165

(100)[20.7]

797 (100)

[100]

( ) parenthesis indicate column percentage

[ ] indicate row percentage

From the table 3.5, it is clear that the major proportion of students belonged to the 5-7 standard

constituting around 44.5%, with 34.7% studying in 7-9 standard, and 20.7% studying in 10-12

standard. When examining against their age pattern, it was found that around 7% of those

studying in 5-7 standard have crossed 13 years, indicating the chances of drop out or failure in

classes. Similarly, about 10% in the 7-9 standard have crossed 15 years, ideal age by which 9th

standard will be completed in normal situations. The same trend could be observed among the

10-12 standard girls where around 12% of the girls were 17 years and above. This trend only

points to a possibility that by increasing standards, more and more students will be studying with

ages more than their 'normal' and 'expected' age. In other words, it is a difficult situation to

complete studies in school according to the ideal ages and there are around 7-12% children who

always have a chance of dropout or delay in completing their studies.

3.7 DISABILITY STATUS AMONG ADOLESCENT GIRLS

Among the total respondents, 99.7% had not reported any form of disability. Only two girl

students reported any form of disability with one girl reported locomotive impairment and

another had visual impairment. The student with locomotive impairment used to limp while

walking since childhood and was a 9th standard student. Further details were not available as

disability certificate of the student with locomotor impairment was at her residence and the copy

of the same was not available at the ashram school. The ashram school authorities were unaware

of the medical diagnosis. While the 10th standard student with visual impairment reported to have

decreased vision due to cataract. The student was diagnosed by ashram school medical officer

during medical check-up and is scheduled for a corrective surgery, but the process is delayed due

to pending official formalities.


3.8 DISTANCE FROM ASHRAM SCHOOL TO RESIDENCE OF THE GIRLS

In the interview schedule, the distance from the girl’s house to school was asked during data

collection, but many of them were unable to calculate the distance from home to school,

especially the younger girls, as they visited home only during vacations. Most students knew the

time taken to reach their home from school and the name of their village. Hence, the name of

their village was noted down in the interview schedule and the approximate distance of their

village from school was later obtained from the school officials.

According to the Ashram School Samhita (2005), students belonging to schedule tribe category

and residing within 10 km radius of the ashram school are expected to be enrolled into nearest

government and private-aided ashram schools. In case of vacancy, then students from other

villages may be enrolled after necessary approval from officials at respective Project Office (PO).

Based on the data collected from the respondents, it is interesting to note that in Palghar, only

47% of the respondents resided within 10 km radius of the school. Certain areas in Palghar

district were fortunate to receive public bus facilities twice a day, once in the morning and once

in the evening at a fixed time.

In Nandurbar, the proportion is 58.6% and in Yavatmal it is 43.5% with only 12% in Gadchiroli.

On the other hand, it is significant to note that in Palghar and Nandurbar, the proportion of

children whose residence is more than 50 kms are 7.5% and 8.1% respectively. While for

Yavatmal it is only 2% and Gadchiroli it’s 27.6%, partly due to the difficult terrain of these

regions. The distance to their residence is possibly an indication of the access to ashram school

education and its location within the districts. This could also be due to lack of schools in

Gadchiroli as those available were located in geographically remote villages and lacked

transportation and connectivity. In addition to this, poor transportation facilities to the interior

regions further pose challenges to their regular travel to their homes.

Table 3.6: Distance between the school and residence of students across districts

District and

block of the

schools

Distance from the house to school

Total

less

than

5 km

5-10

km

10-20

km

20-30

km

30-40

km

40-50

km

50 km

and

above

Don't

Know

Palghar-

Dahanu

82

(41)

13

(6.5)

5

(2.5)

28

(14)

46

(23)

3

(1.5)

15

(7.5) 8 (4)

200

(100)

Nandurbar-

Navapur

55

(27.8)

61

(30.8)

42

(21.2)

12

(6.1) 4 (2) 4 (2)

16

(8.1) 4 (2)

198

(100)

Yavatmal-

Kelapur

40

(20)

47

(23.5)

58

(29)

31

(15.5)

7

(3.5)

5

(2.5) 4 (2) 8 (4)

200

(100)

Gadchiroli-

Aheri 10 (5) 14 (7) 16 (8)

21

(10.6)

22

(10.6)

40

(20.1)

55

(27.6)

22

(11)

199

(100)

Total 187

(23.5)

135

(16.9)

121

(15.2)

92

(11.5)

78

(9.8)

52

(6.5)

90

(11.3

42

(5.3)

797

(100) ( ) parenthesis indicate row percentage


In general, the distance from the girl’s village to school as shown in table 3.6 reveals that

around 24% of the students resides at a distance of less than 5 km away from the school, 17%

resided 5-10 kms away from the school and 15% resided 10-20 kms away from the school,

while 11.5% resided 20-30 kms far from the school. While only 6.5% stayed 40-50 kms

away from the school a significant proportion of 11.3% came from a distance of over 50 kms

from the school.

According to an ashram school headmaster, ashram schools admit about 80% of the students

from villages located at 3-5 km radius from the school and these students must be hostel

residents. However, this rule is relaxed in some inaccessible or hilly areas. Considering the

fact that ashram schools are generally located within the interior regions of the districts,

students admitted from distances as far as 30 kms indicate that they are able to reach the

needy students staying in the interior areas. Another possibility is that there is a tendency

which was observed among students that some of them prefer those ashram schools located

far from their village as that will allow them to stay away from the home environment

especially in situations where the home environment is not good/ happy.

3.9 LITERACY LEVEL AND EDUCATIONAL STATUS OF PARENTS

Educational status and occupation of parents of those children studying in ashram schools

were collected to use it as a proxy indicator to understand the household characteristics of the

students of ashram schools. It was found that most of the parents’ education levels were poor,

possibly due to the historical vulnerability and poor access to education among tribal

communities during earlier generations.

Considering the poor educational background, categories were made with either of the

parents and both the parents education status was considered (table 3.7), which included

parents who are illiterate, at least one studied till 5th, 7th or till 10th standard. It is significant to

note that almost half (47.4%) of the parents of those respondents are either illiterate or either

of the parent must have studied till 5th Standard indicating lack of education of the parents.

Further, around 12.3% and 13.3% had at least one of their parents studied till 7th and 10th

standard together constituting another quarter of the total respondents. A few respondents

were unaware of their parent’s educational level and there were few whose parents were

dead.

The proportion being small is categorised as others category. It was found that around 62% of

respondents had literate parents, while only 29% had illiterate parents. Few (7.4%) of the

girls said they are not aware of their parents’ literacy status. Another characteristic feature

noted is that there is a stark difference between their father’s and mother’s education status

when the education status of both and at least one parent is examined. Here, it was found that

mothers are less educated than fathers another characteristic of poor women’s educational

status among tribal communities. This shows the dire need for education among these girls as

one of the potential ways of upliftment of their social status. The lower education status

among tribal women was also a feature found in other studies as well (Ministry of tribal

affairs (2013)


Table 3.7: Literacy level of parents of respondents

Literacylevel of parents Frequency Percent

Both are illiterate 231 29

At least one studied till 5th std 147 18.4

Both studied till 5th std 42 5.3




Both studied till 10th std 16 2



Others 81 10.2

Total 797 100

3.10 OCCUPATIONAL STATUS OF THE GIRLS’ PARENTS

Further, the types of occupation the parents of girls are engaged in were examined to

understand their socioeconomic characteristics. The categories used for analysis were

seasonal agricultural labourers, regular agricultural or other labourer, seasonal labourer other

than agriculture, family-based agriculture or animal husbandry, family shop or trade, those

who are in service/profession which implied mostly regular jobs other than labourers and

unemployed. The same occupation pattern was examined for both father and mother of the

girls.

Among fathers, seasonal agricultural labourers constituted the majority (67%) of the

occupation groups as most of them were engaged in seasonal agricultural labour as their

major occupation (table 3.8). They either owned their own land where they cultivated

seasonal crops and during the remaining period they worked as helpers in shops or gathering

leaves or wood or as labourers in construction site or were involved in family-based poultry

or animal husbandry. While 12% of fathers were involved in regular agricultural or other

labours, others were involved working as construction workers or helper in shops or as

workers in factory. Seasonal or migrant labourers (other than agriculture) included those

working in brick kilns, those with regular job were 4% which included those girls whose

fathers were working as peon or supervisor in factories. Fathers engaged in family-based

shop or trade like tea stall, tailor, rickshaw driver, vegetable vendor, mechanic etc. included a

meagre 3%.


Table 3.8: Occupational status girls’ parents

Type of Occupation Number of

fathers

Number of

mothers

Seasonal agricultural labour 535 (67.1) 608 (76.3)

Regular agricultural/Other labourer 96 (12) 58 (7.3)

Seasonal/Migrant Labourer other than agricultural 35 (4.4) 31 (3.9)

Family based agriculture/animal husbandry 31(3.9) 24 (3)

Family shop/trade 23 (2.9) 18 (2.3)

Service/Profession 34 (4.3) 18 (2.3)

Unemployed 2 (0.3) 27 (3.4)

Don't know 41 (5.1) 13 (1.7)

Total 797 (100) 797 (100)

( ) parenthesis indicate column percentage

Though similar pattern exists among mothers’ occupation status, it was observed that

majority (76.3 %) of the mothers worked as seasonal agricultural labourers either in their own

farm where they cultivated seasonal crops or workers as labourer in other’s farms. During

rest of the period, they worked as helper in shops, bidi rollers or cotton plucking or labourers

in construction site or were involved in family-based poultry or animal husbandry. Regular

agricultural or other labourers formed 7.3% of the total mothers. Labours other than

agriculture involved working as construction workers or helper in shops or worker in factory.

The category of service or professionals which formed 2.3% included mothers working as

peon or supervisor in factories. While mother engaged in family shop or trade like tailoring,

vegetable vendor, food vendors (like samosa, pani-puri, snacks, tea), ration shop etc. included

2.3%. From table 3.8, it is obvious that seasonal agricultural labourers constitute the major

occupation groups both among fathers and mothers indicating the difficulty and vulnerability

in which the tribal girls are, both socially and economically. It is in this context their access

to ashram schools and the residential facilities offered become a great relief for both the

children and their parents and the education and safety (especially of girls) that the child can

acquire during this period is an added advantage.

3.11 APPROXIMATE MONTHLY INCOME OF THEGIRLS' FAMILY FROM

MAJOR SOURCE

The exact income of the respondent’s family was unable to obtain as almost half of the

respondents could not give the information as 38% were unaware of their family’s income

and another 19% don’t want to share the information. Hence the data was available only of

42% (N=338). This could be because many respondents were 9 to 12-year-olds and since

these children spend most of their childhood in ashram schools, they were unaware of the

income earned by their parents. Hence, the study tried to obtain approximate income of the

family by enquiring on the major occupation of parents and the approximate income earned

daily through it on a monthly basis.


Based on the major occupation, the wages earned daily were estimated from the labour

charges offered to men and women on a daily basis in that particular block of the district.

Since most of the parents were daily wage workers, the estimation was easy. At times the

team asked for father’s and mother’s occupation separately and the number of days both

parents worked to obtain the data. Thus, the approximate income of the family from primary

occupation was calculated. The income from other means of living or secondary occupation

were not considered in calculating the approximate income as it was not a regular affair and

girls were unable to estimate the money obtained in this process. Hence, it was decided to

include income data obtained from primary occupation only. Hence the data presented in the

table gives an approximate monthly income of the girl’s family from their primary source of

income.

In order to capture variations among those earning Rs 10,000 and less, they were further

categorized into those earning less than Rs 5,000 and those earning less than Rs 2,500.

Among those who gave information (N=388) on income, majority (62.7%) of those were

earning less than Rs 5,000 per month among which around 22% earn only less than Rs 2,500.

A quarter of the remaining (23.4%) were earning in the range of Rs 5,000 to Rs 10,000, with

only 13% earn above Rs 10,000 of which those earn above Rs 20,000 is only a meagre 2.9%.

Table 3.9: Approximate monthly family income of the respondents from primary source

Approximate income

from major source

Frequency Percent

<2500 74 21.9

2500-5000 138 40.8

5000-10000 79 23.4

10000-20000 37 10.9

20000< 10 2.9

Total 338 100

3.12 SIZE OF THE HOUSEHOLD

In the interview schedule, data on family size was captured by enquiring about details of the

member in the family, including parents, grandparents, and siblings (excluding the girl).

Among the girls, most of them stayed in nuclear family due to the migratory nature of their

parents’ employment while those who stayed in joint family or extended family mostly had

parents with non-migratory employment. Some girls’ parents with migratory employment

stayed in extended family by leaving children under grandparent’s supervision.

The mean family size of the respondents’ household was 5.2 (SD: 1.4). According to the

figure 3.1, 54% of the girls had 4-6 members in their family, while only 3% of the girls had

more than 8 members in their family. In some cases, increased number of members in the

family was due to more than 3-4 siblings in the girl’s family. On an average the number of

siblings was 2.3.


3.13 SIBLINGS’ EDUCATION STATUS AND VULNERABILITY

In order to understand the vulnerability of the girls, the ones living in poor conditions and

their socioeconomic constraints leading to drop out their sibling’s education status was

examined. This data was examined at two levels, first for the total respondents to understand

the overall trend of drop outs or non-education among siblings and second is whether there is

any linkage it has with income. Overall, it was found most (87.5%) of the respondents

reported to have at least one dropout or uneducated sibling at their homes, with 9.5%

mentioned 2 siblings have dropped out or not educated while only 2.3% respondents shared

that they don’t have any siblings dropped out or not educated in schools.

The intensity of poor access to education among tribal communities is obvious from this data.

Further it was examined whether there is any linkage with income of the household and

sibling’s education status, it was found that of those for which income data is available

(N=338), 54.1% of those reported that one of their siblings has dropped out belonged to the

less than Rs 5,000 per month income category, with 21% belonging to Rs 5,000 to 10,000

category. In other words, dropout rate or non-education of siblings reported by ashram school

girls is a characteristic that is skewed towards the lower socioeconomic category.

Table 3.10: Number of siblings not educated or dropped out of school

Approximate monthly

income from major

source

Number of siblings not

educated or dropped out of

school

Not any

drop outs Total

1 2 3< NA

<2500 62 (18.3) 9 (2.7) 0 3 (0.9) 74 (21.9)

2500-5000 121 (35.8) 13 (3.8) 0 4 (1.2) 138 (40.8)

5000-10000 71 (21) 8 (2.4) 0 0 79 (23.4)

10000-20000 32 (9.5) 5 (1.5) 0 0 37 (10.9)

20000< 3 (0.9) 4 (1.2) 3 (0.9) 0 10 (2.9)

Total 289 (85.5) 39 (11.5) 3 (0.89) 7 (2.1) 338 (100)

Not available 408 37 2 12 459

Total 697 [87.5] 76 [9.5] 5 [0.63] 19 [2.3] 797 [100] ( ) parenthesis shows total percentage for income based analysis

[] indicate the extent of drop outs in overall sample.


3.14 SUMMARY

From the above sample characteristics, it is clear that ashram schools for tribal children is

much needed opportunity to make a difference in their lives, especially in tribal communities,

in terms of education which need to be supported with improved residential provisions. The

education status of their parents indicate clearly that their parents could not get this

opportunity during their time. Further, the location of ashram schools is mostly in the interior

regions of the districts which might be favouring more admission and representation from

tribal communities. But the facility survey on the other hand shows the poor infrastructure

situation at the school in terms of water supply, sanitation and basic facilities like power

supply and so on, becomes the stumbling block to the basic motive of ashram schools.

Finally, the situation with respect to the occupation status of the girls’ parents also indicate

that poor employment opportunities existing in tribal areas and more so the opportunities

available are mostly seasonal and migratory in nature which demand that both the parents

need to be working for the survival of the family. The vulnerable context of these tribal girls

in terms of accessing education and continuing their education without dropping out itself is a

challenge. This was obvious when it was found that 87.5 % of the total respondents said that

at least one of their siblings either dropped out or uneducated in their homes whose intensity

was increasing by decreasing income category.

Moving over to important aspects which shape the behavioural pattern in the adolescent girls,

chapter four will discuss the health, hygiene and food habits among the girls living in the

ashram schools.


Tata Institute of Social Sciences, Mumbai| CHAPTER FOUR 81

CHAPTER FOUR

HEALTH BEHAVIOURS AND ASHRAM SCHOOL ROUTINE

4.1. INTRODUCTION

Ashram schools become primary homes for several of its inmates since they join these

schools at an early age, grow, socialize. Thus, they also become the site and space for

socialization by developing several of their health behaviours, some of it may stay with them

throughout their lives. Hence, it is important to understand the routine school activities,

which include food items served as it has an important bearing on their nutritional status,

their current nutritional status, general and menstrual hygiene of the girls, as all of which

have an influence on their overall growth and development.

This will then help understand the potential linkages between food intake, nutritional status

and hygiene behaviours which will offer scope for intervening in modifying health

behaviours and improve dietary pattern, if necessary, as these are the opportunities through

which their inherent vulnerability can be responded to. This chapter describes the actual food

intake of the inmates based on real time data of their diet pattern during weekdays and

weekends along with the actual nutritional status of the girls using anthropometric data and

generating information on them being underweight, stunting and wasting. Additionally, the

data on general hygiene and menstrual hygiene practiced by inmates in their daily routine

helps understand their current hygiene behaviours and the role of infrastructure facilities

towards the same.

4.2. FOOD HABITS IN ASHRAM SCHOOL

Considering the fact that tribal adolescent girls are generally deprived of nutritious food

during their early years of life, ashram schools and the food provided there are expected to

respond to the nutritional needs of their students. Hence, it is expected to provide a well-

balanced and nutritious provision of food to suffice the nutrient needs during their growth

period. The specific time period and possible menu that needs to be provided in the ashram

schools are mentioned in the Ashram Samhita (2005).

As per the guidelines of the Samhita, the government has to provide 100 gms of rice, 400

gms of wheat/jowar/bhajra, 50 gms of other items for poha/ pav (bread)/ upma, 75 gms of

pulses, 125 gms of green leafy vegetables, 75 gms of vegetables, 75 gms of roots, 200 ml of

milk, 35 gms of oil, 20 gms of masala, 10 gms peanuts, 15 gms of salt and 15 gms of sugar to

the respective government schools for one student on per day basis. Though this appears to be

a meticulously calculated nutrition requirements with adequate flexibility for regional

preferences, there is no mechanism to ensure that this quantity, or for that matter, whether

adequate food is reaching the students at any point of time. For all practical purposes, the

above per day requirement per student will be used to purchase the items for cooking

depending on the total strength in a school.

To ensure optimal growth, children are fed with breakfast, lunch, evening snacks and dinner.

Breakfast is expected to be provided between 8-9 am, lunch between 12-1 pm, evening


snacks between 2-3 pm and dinner by 6.30 pm. Additionally, it is expected to provide

additional fruits and egg daily, non-vegetarian food twice a month and special feast and

sweets on special occasions (Government of Maharashtra (2005). Thus, ashram schools are

expected to ensure overall growth and development of its inmates by ensuring adequate diet.

While at times the quantity and the items specified by the government as per norms may not

be received by the schools on time due to which the schools may be forced to provide

whatever is available in their stock at that time. This is especially true for items like green

leafy vegetables, eggs, fruits and milk which show seasonal variations in adequacy of supply.

Considering the vital importance of food in determining health status of adolescent girls, the

present study has collected real time data on food intake. The data on the type and number of

meals per day was collected for one weekday and weekend as it was found in the preliminary

understanding that there is a slight difference in the diet pattern during weekdays and

weekends across schools. Data was collected by asking the students to share the details of one

weekday and weekend immediately preceding the survey week in terms of the breakfast,

lunch, evening snacks and dinner.

Similar strategy was used to collect weekend data wherein the previous weekend was

considered in case the interview was conducted on a weekday. The questions directed were

“What did you have for breakfast/lunch/evening snacks/ dinner today or the previous day?”

During data collection, it wasn’t possible to measure and estimate the exact quantity of food

provided per student. Even the ashram school authorities were unaware of the exact quantity

to be provided, most of them mentioned to provide as much as the student required. This was

found to be true, but only with respect to items like rice and dal and at times in case of items

like poha, chanavatana and sprouts. On the other hand, students also said that there were

restrictions on the number of chapattis and sabji per student in some schools which is also the

more ‘liked’ food item and the number of eggs and other special foods.

4.2.1. Breakfast

Breakfast forms the most important meal of the day as this is the meal that is expected to

break 8-10 hours of fast and hence has greater contribution to the overall nutritional status.

An adequate breakfast is a necessity to kick start an energetic day ahead. In most of the

schools, breakfast included legumes like chanavatana,- a combination of boiled chickpea and

green peas or poha (rice flakes) together with either eggs or fruits. Alternatively, there were

other combinations like sprouted cereals and khichidi, - a form of boiled rice and dal, peanuts

and sugar, upma along with either fruits or eggs. There are regional differences as food items

across the states have so much variation and hence food intake will be analysed across four

districts and their corresponding blocks. Thus, three main combined categories were found

across the four districts which is used to interpret the breakfast intake. They are poha, or

chanavatana or both along with either fruits or eggs. Additionally, there were also categories

like sprouts and others category, the latter included khichdi, upma, peanuts and sugar.

As per table 4.1, the usual weekday breakfast included across all the four districts shows that

21.8% said that they received poha and chanavatana along with any fruit or egg, with 19.7%

received poha with fruits or eggs and 12.5% received chanavatana with fruits or eggs. It is

important to note that there were around 15.6% who have received only sprouts with 10.6 %


said they received breakfast other than those mentioned above, together constituting around

24% who have not received adequate breakfast as they are not getting fruits or eggs along

with the cereals. The more shocking was that around 19.8 % of the total respondents said that

they are not given any breakfast, which on further analysis was identified that all these

respondents belonged to Gadchiroli region, and the idea of breakfast is not followed here as

in other places as an early morning item, rather they have lunch at around 10.30 to 11 am

instead of eating breakfast before 9 am.

Further, when examined the distribution of the type of breakfast across blocks from table 4.1,

the most (53.5%) common breakfast item during weekdays in Dahanu block of Palghar

district was Poha with eggs or fruits, whereas it was poha and chanavatana with fruits or

eggs (66.7%) in Nandurbar district. For Yavatmal, the most (40%) common breakfast being

sprouts with 20.5% said they generally have chanavatana with fruits and eggs for their

breakfast. As mentioned earlier, in Gadchiroli district, 78.4% reported that they have not

received any breakfast. On further inquiry, it was found that in this district the practices are

such that instead of breakfast people in this district normally prefer food (usually rice and

roti) at about 10.30 or 11 am in the morning. People in this district referred it as lunch hence

the same is followed in the study.

Ideally, as per the Ashram Samhita (2005), ashram school children are given lunch during 12-

1 pm, evening snacks at 2-3 pm and dinner by 6-6.30pm. However, it is noteworthy that

among the 78.4% of those in Gadchiroli, who mentioned that they have not received

breakfast during weekdays, almost half (35.7%) of them said that they got breakfast on

weekends. Further, it was found that the children from Gadchiroli said that they are provided

with fruits and egg only during weekends and students consider this as breakfast since it is

given in the morning. This arrangement is because the school starts early at 8 am as it works

half day i.e. till 12 pm on Saturday and hence lunch is usually after school hours. Thus, to

ensure students are not hungry they are given breakfast on weekend.

Table 4.1: District-wise data on type of breakfast given to the respondents on weekday

District

and block

of the

schools

Type of breakfast during weekdays

Total Chanavatana

with egg or

fruits

Poha

with

egg or

fruits

Poha and

chanavatana

with fruit or

egg

Sprouts No

breakfast Others

Palghar-

Dahanu

33

(16.5%)

107

(53.5%)

25

(12.5%)

13

(6.5%)

0

(0%)

22

(11%)

200

(100%)

Nandurbar-

Navapur

21

(10.6%)

7

(3.5%)

132

(66.7%)

31

(15.7%)

2

(1%)

5

(2.5%)

198

(100%)

Yavatmal-

Kelapur

41

(20.5%)

34

(17%)

12

(6%)

80

(40%)

0

(0%)

33

(16.5%)

200

(100%)

Gadchiroli-

Aheri

5

(2.5%)

9

(4.5%)

5

(2.5%)

0

(0%)

156

(78.4%)

24

(12%)

199

(100%)

Total 100

(12.5%)

157

(19.7%)

174

(21.8%)

124

(15.6%)

158

(19.8%)

84

(10.6%)

797

(100%)


During weekends, too, the food items were mostly similar as per table 4.2, children said their

breakfast mainly include poha with either eggs or fruits, poha&chanavatanawith either eggs

or fruits and sprouts alone. Alternative breakfasts include chanavatana with egg or fruits and

others which included khichidi, chivda and peanuts, upma and only fruit and egg. In all the

four districts together 19.7% children said they received poha&chanavatana with either eggs

or fruits, 18.9% received poha with either eggs or fruits and 18.8% received sprouts only.

While it is interesting to note that in Gadchiroli the proportion of those who had no breakfast

has halved from 78.4 % to 35.7%. Thus, in Gadchiroli almost 60% of the total children

mentioned to have received breakfast on weekend which included items like sprouts only,

poha, chanavata, chivda, with either eggs or fruits and at times only exclusively fruits. In

Yavatmal, it was found that during weekends there were 15% who have said that they have

not received breakfast during weekends. In Palghar district, children mainly receive poha

with either eggs or fruits (35.5%), with Sprouts only given for 27.5% students. In Nandurbar,

the trend is similar as that of weekdays as most (58.1%) of them received poha&chanavatana

with either egg or fruits.

Table 4.2: Type of breakfast provided to the students during weekends acrossdistricts

District

and block

of the

school

Type of breakfast during weekends

Total Chanavatana

with egg or

fruits

Poha

with

egg or

fruits

Poha and

chanavatana

with fruits

Sprouts No

breakfast Others

Palghar-

Dahanu

25

(12.5%)

71

(35.5%)

21

(10.5%)

55

(27.5%)

2

(1%)

26

(13%)

200

(100%)

Nandurbar-

Navapur

12

(6.1%)

31

(15.7%)

115

(58.1%)

22

(11.1%)

10

(5.1%)

8

(4%)

198

(100%)

Yavatmal-

Kelapur

46

(23%)

26

(13%)

10

(5%)

37

(18.5%)

30

(15%)

51

(25.5%)

200

(100%)

Gadchiroli-

Aheri

21

(10.6%)

23

(11.6%)

11

(5.5%)

36

(18.1%)

71

(35.7%)

37

(18.6%)

199

(100%)

Total 104

(13%)

151

(18.9%)

157

(19.7%)

150

(18.8%)

113

(14.2%)

112

(15.3%)

797

(100%)

Overall, the breakfast pattern across schools indicate that eggs are given predominantly

during weekdays and not so regular in weekends and during weekends breakfast is usually

diluted by managing it with either fruits only or predominantly sprouts, a characteristics

feature found in Palghar district. Eggs and fruits along with other breakfast items like poha or

chanavatana are normally given during weekdays than on weekends. This pattern is seen in

all the other districts except Gadchiroli, where breakfast is more systematically provided

during weekends. Therefore, the table evidently shows weekend breakfast are not up to the

mark as compared to weekdays.

Another aspect observed was, many government ashram schools provided either eggs or

fruits alone or in combination with a main breakfast item on weekends and weekdays as

breakfast while private ashram schools provided only the main breakfast item without

necessarily eggs or fruits. None of the private ashram schools were seen offering eggs


whereas fruits like banana were offered intermittently as compared to apple and banana

served to children from government ashram school, the diet pattern prescribed as per the

Ashram Samhita, 2005.

The authorities of the private Ashram school during informal discussion mentioned lack of

funds to ensure adequate provision on nutrition to children as per the Ashram Samhita, 2005.

Further, it was added that government-aided ashram schools and private ashram schools are

expected to provide breakfast based on this menu from their own funds. As per Ashram

Samhita (2005), schools are supposed to provide milk which none of the schools were found

to serve milk except one school in Palghar which was using milk powder for the same.

4.2.2. Lunch

While in case of lunch, the schools provided mainly rice and chapati/bhakri with dal (a thick

gravy made of pulses). In some schools along with the above sabji and/or amti(a form of

watery gravy made of pulses) is given. During weekends non-vegetarian food like chicken or

egg will be provided instead of sabji. Thus, it can be seen rice, dal, sabji and amti is common

items across schools. Chapati /bhakari was an additional dish provided intermittently. Hence

the table is categorized into three categories as rice and chapati/bhakri with dal and/or sabji

and/or amti, rice with dal and/or sabji and/or amti. While in the table on weekend ‘others’

include rice along with non-vegetarian food.

On weekdays, majority (86.1%) of the schools provided rice and dal with either

bhakri/chapati with either sabji or amti. Similar is the case on weekends were 78.8% of the

students were provided with rice and dal with either bhakri/chapati with either sabji or amti.

But when looked at district-wise data, it is obvious that Palghar and Gadchiroli districts are

the ones where around 17% and 26% said that they are not getting chappathi/ bhakri for

Lunch during weekdays (table 4.3). Although similar pattern is observed during weekends, it

is interesting to note that only 8.7% of the total students were provided with non-vegetarian

food, with the same districts of Palghar (17%) and Gadchiroli (14.6%) have greater

proportion. While in Nandurbar and Yavatmal, the proportion of students reported to have

received non-vegetarian food during weekends is almost nil (table 4.4).

As per the norm, children are expected to provide better food, including non-vegetarian food

on weekends. Non-vegetarian food was reported by only 6.6% of respondents during the

survey. Further, it was found that generally non-vegetarian food was offered only on alternate

Sundays which got confirmed as per the school authorities. Among the food served, majority

of the school authorities reported surplus supply of rice, dal and sabji/amti, but limited supply

of chapati and bhakri to the students. The younger students (usually till 5th standard) were

generally provided one bhakri/chapati, while older ones (above 5th standard) were provided

with two bhakri/chapati. In case where the bhakri/chapati is larger in size, half was given to

younger children and one full was given to older ones. Another observation was among sabji,

green leafy vegetables were not provided in any schools despite recommended in Ashram

Samhita. Inadequate allocation of funds for food is given as the major reason by school

authorities for stringent and compromised diet pattern, which when examined with the per

student amount allocated for food shows.


Table 4.3: Type of lunch provided to the respondents during weekdays across districts

District and block of

the school

Type of lunch weekday

Total

Rice and

chapati/bhakri with

dal and/or subji

and/or amti

Rice with

dal and/or

sabji and/or

amti

No Lunch

Palghar-Dahanu 158 (79%) 34 (17%) 8 (4%) 200 (100%)

Nandurbar-Navapur 187 (94.4%) 10 (5.1%) 1 (0.5%) 198 (100%)

Yavatmal-Kelapur 195 (97.5%) 3 (1.5%) 2 (1%) 200 (100%)

Gadchiroli-Aheri 146 (73.4%) 53 (26.6%) 0 (0%) 199 (100%)

Total 686 (86.1%) 100 (12.5%) 11 (1.4%) 797 (100%)

Table 4.4: Type of lunch provided to the respondents during weekend across districts

District and block

of the school

Type of lunch weekend

Total

Rice and

chapati/bhakri

with dal and/or

subji and/or amti

Rice with dal

and/or subji

and/or amti

Others

(includes non-

vegetarianfood)

Palghar-Dahanu 132 (66%) 34 (17%) 34 (17%) 200 (100%)

Nandurbar-

Navapur 184 (92.9%) 12 (6.10%) 2 (1%) 198 (100%)

Yavatmal-Kelapur 194 (97%) 1 (0.5%) 5 (2.5%) 200 (100%)

Gadchiroli-Aheri 118 (59.3%) 52 (26.1%) 29 (14.6%) 199 (100%)

Total 628 (78.8%) 99 (12.4%) 70 (8.7%) 797 (100%)

4.2.3. Evening snacks

As per the Ashram Samhita (2005), every student is to be given some evening snacks in

ashram schools. On the contrary, it was astonishing to find that 52.9% of the total

respondents reported that evening snacks are not provided in their ashram schools. This was

83% and 78% in Yavatmal and Nandurbar districts, whereas it was around 50% for Palghar

district. The proportion of girls reported to have not received evening snacks from Gadchiroli

was only 0.5% (table 4.5). Furthermore, around half the population from Gadchiroli district

shared that they were served either chanvatana or sprouts as evening snacks. Here, this could

be possible due to the fact that instead of breakfast provided in other districts, Gadchiroli

could be providing the same as evening snacks to their children. On the contrary to other diet

pattern, it was found that evening snacks are found more regular during weekdays than

during weekends possibly due to the fact that it is linked with school timings and might get

skipped on holidays.

Among evening snacks, sprouts and chanavatanawas included as the major snack provided to

children across districts on weekdays and weekends. The proportion of children reported that

they had sprouts and chanavatana as evening snacks were 20.6% and 17.7% during weekdays

and 16.2% and 10.5% respectively during weekends. Milk was reported to have given only in

one school in Palghar district. The milk provided here was milk powder based. The category

others in the table includes upma, poha, peanuts and sugar and chivda. While almost half

(52.7%) of the children from ashram school did not receive evening snacks on weekdays


(table 4.5), while on weekends 65.1% of children did not receive evening snacks at all (table

4.6).

Table 4.5: Type of evening snacks provided to the respondents

on weekday acrossdistricts

District and

blockof the

school

Type of evening snacks weekday Total

Chanavatana Milk Sprouts Nothing Others

Palghar-Dahanu 36 (18%) 49 (24.5%) 13 (6.5%) 99 (49.5%) 3 (1.5%) 200 (100%)

Nandurbar-

Navapur 1 (0.5%) 0 (0%) 41 (20.7%) 154 (77.8%) 2 (1%) 198 (100%)

Yavatmal-Kelapur 6 (3%) 0 (0%) 22 (11%) 166 (83%) 6 (3%) 200 (100%)

Gadchiroli-Aheri 98 (49.2%) 0 (0%) 88 (44.2%) 1 (0.5%) 12 (6%) 199 (100%)

Total 141 (17.7%) 49 (6.1%) 164 (20.6%) 420 (52.7%) 23 (2.9%) 797 (100%)

Table 4.6: Type of evening snacks provided to the respondents

on weekend acrossdistricts

District

and block

ofthe

school

Type of evening snacks weekend

Total Chanavatana Milk Sprouts Nothing Others

Palghar-

Dahanu 28 (14%) 12 (6%) 4 (2%) 152 (76%) 4 (2%) 200 (100%)

Nandurbar-

Navapur 0 (0%) 0 (0%) 39 (19.7%) 158 (79.8%) 1 (0.5%) 198 (100%)

Yavatmal-

Kelapur 5 (2.5%) 0 (0%) 31 (15.5%) 147 (73.5%) 17 (8.5%) 200 (100%)

Gadchiroli-

Aheri 51 (25.6%) 1 (0.5%) 55 (27.6%) 62 (31.2%) 30 (15.1%) 199 (100%)

Total 84 (10.5%) 13 (1.6%) 129 (16.2%) 519 (65.1%) 52 (6.4%) 797 (100%)

4.2.4. Dinner

Dinner in most of the ashram schools follow similar patterns to that of lunch which include

rice and chapati/ bhakri and dal with either sabji or amti and rice and dal and/or sabji and/or

amti hence the categorization was kept the same in the table. While a third category others in

the table 4.7 included dal and bhakri only on weekdays and non-vegetarian food like eggs

and chicken provided on weekends (table 4.8). Rice and chapati/bhakri and dal and/or sabji

and/or amti for dinner on weekdays was provided by 69.4% of schools. Across the districts,

this pattern is seen similar except in case of Gadchiroli where chapati/ bhakri is not provided

in most (88.9%) of the schools (table 4.7). This could be attributed to the regional difference

as rice forms their staple food.

On weekends, overall only 9.2% girls were provided with non-vegetarian food like egg or

chicken. Though there are huge variation of this across districts with Palghar district reported

to have given 26%, with Gadchiroli giving non-vegetarian diet to 8% whereas Nandurbar and


Yavatmal districts reported to have given non-vegetarian during weekend only to 2% and 1%

respectively. This during weekdays was meager 1.7% across districts taken together (table

4.7).

Table 4.7: Type of dinner provided to the respondents on weekday across districts

District and block

of the school

Type of dinner weekday

Total Rice and chapati/bhakri

and dal and/or sabji

and/or amti

Rice and dal and

/or sabji and/or

amti

Others

Palghar-Dahanu 152 (76%) 38 (19%) 10 (5%) 200 (100%)

Nandurbar-Navapur 187 (94.4%) 10 (5.1%) 1 (0.5%) 198 (100%)

Yavatmal-Kelapur 193 (96.5%) 5 (2.5%) 2 (1%) 200 (100%)

Gadchiroli-Aheri 21 (10.6%) 177 (88.9%) 1 (0.5%) 199 (100%)

Total 553 (69.4%) 230 (28.9) 14 (1.7%) 797 (100%)

Table 4.8: Type of dinner provided to the respondents on weekend across districts

District

and block

of the

school

Type of dinner weekend

Total Rice and

chapati/bhakri and

dal and/or subji

and/or amti

Rice and dal

and/or subji

and/or amti

Others

(includes non-

vegetarian

food)

Palghar-

Dahanu 122 (61%) 26 (13%) 52 (26%) 200 (100%)

Nandurbar-

Navapur 165 (83.3%) 29 (14.6%) 4 (2%) 198 (100%)

Yavatmal-

Kelapur 195 (97.5%) 3 (1.5%) 2 (1%) 200 (100%)

Gadchiroli-

Aheri 16 (8%) 167 (83.9%) 16 (8%) 199 (100%)

Total 498 (62.5%) 225 (28.2%) 74 (9.2%) 797 (100%)

Overall, it is noteworthy that ashram schools, which are expected to suffice nutritional needs

of its students, provide lunch and dinner regularly on weekdays and weekends. Although

provision of non-vegetarian food on weekends, which is mandatory for the schools, is

uncertain as very few students reported it according to tables 4.4 and 4.8. While provision of

evening snacks to all the students is perhaps disputable as more than half of the total

respondents received nothing on both weekdays and weekends. Considering the Gadchiroli

context, it is highly possible that breakfast in Gadchiroli schools are given as evening snacks

after their lunch. Breakfast was quite regular and as per the respondents except in Gadchiroli

due to their unique cultural factors. Thus, it can be drawn that students in the ashram schools

are generally provided food regularly on weekdays, while on weekends the food served is cut

down as compared to weekdays especially evening snacks.


The provisioning of non-veg food is found poor in Yavatmal and Nandurbar regions and is

comparatively better in Palghar and Gadchiroli regions. This scenario could be due to lack of

supervision on weekends as teachers and headmasters may not often visit the school as they

don’t stay within the school premises; though in many schools, headmasters are given a

residential space which is in poor condition. Hence it remains unused or is utilized by class 4

employees of the school. In nutshell, the dietary pattern gives an impression that the food

supply attempts to follow the norms but is not adequate in terms of quantity and variety and

lack nutritional content obvious from the lack of green leafy vegetables and milk in most of

the schools. The stringent supply of chapathi/ bhakri/ roti, which is otherwise the popular

food among students as compared to rice also indicates the restriction imposed by schools on

food items and along with the absence of nutritive foods like non-vegetarian food, milk and

green leafy vegetable raises the question on whether they get balanced diet in their schools.

Poor state of kitchen in the schools



Hand and Kitchen wash area

Dining Hall of the school


4.3 NUTRITIONAL STATUS

4.3.1. Nutritional status based on BMI

As mentioned in the methodology, height and weight of the girls were captured during the

medical check-up carried out by the public health department. Based on this information

along with the age several nutritional indicators were measured. Body mass index (BMI) is

an important indicator used to determine the nutritional status among various age groups. It is

a good indicator among adolescents as it is the growing phase of the child so that one can

easily identify growth lag if any.

The BMI is defined as the weight divided by the square of the body height and is universally

expressed in units of kg/m2, resulting from mass in kilograms and height in metres. The ideal

value for BMI is 23, which is considered normal, though 18-25 is treated as that falling in the

normal range. The mean BMI for the girl respondents calculated was 16.9 (SD= 3.9) with a

mean age of 13.5 (SD=2.2). In the study, the categories used were underweight (< 18.50),

normal (18.50-25.00), over weight (25.00-30.00) and obese (>30.00). There were few

students from each school who were not available at the time of medical check-up and hence

their values are missed in the table as they had gone to their home. Table 4.9 shows the

nutritional status based on BMI among the girls of ashram schools. It is shocking to find that

77.2% of the total respondents fall in the underweight category, with only 17.6% reporting

normal BMI with around 5% falling in the above normal category. It is obvious from the

above data that the adolescent girls of ashram schools represent a group with poor nutritional

status attributable to the inherent vulnerability during childhood due to poor living conditions

along with bare minimum food intake within the facilities that is only sufficient for their

survival without improving their health status.

Table 4.9: Under-nutrition status of Ashram School girls based on BMI

BMI

Classification Percentage N

Standard BMI

Underweight 77.2 537 Less than 18.5

Normal 17.8 124 18.5 to 25

Overweight 3.5 24 25 to 30

Obese 1.4 10 30 and above

Total 100 695

Lower or higher BMI is an indication of having risk of several health hazards depending on

the population from which it is reported. In this context, low BMI is an indication of poor diet

or poor nutritional intake supplemented with historical vulnerabilities that has hampered their

health status. Here it is a clear indication of underweight as the major characteristics. The

underweight status can decrease the ability of the human body to absorb essential nutrients

like amino acids, vitamins and minerals etc. Improper absorption of vitamin D and calcium

can invite a risk of developing osteoporosis or iron deficiency anaemia. In case of girls, such

early anaemic status during adolescent age can invite high chance of complications later

during their time of delivery, such as low birth weight babies, preterm babies. It is also a fact

that there are practices among the tribal communities to have early marriages. Hence it is

important to note that the undernourished status can have severe consequences on not only at

adolescent age but in the post adolescent or post married life of these girls.


BMI was calculated for the selected girls across districts. Among the total respondents

selected, 77.8% belonged to the underweight category with only 17.8% reported to have

normal weight. Across the districts, the proportion of underweight was highest (90.1%) in

Nandurbar, with Palghar (85.8%) coming next with Yavatmal (68.5%) and Gadchiroli (65%)

reporting better than others. Gadchiroli (33.5%) and Yavatmal (15.9%) was found to have

better nutritional status as compared to other two as correspondingly proportional increase

was found for normal category in these two districts (table 4.10).

Table 4.10: Body mass index of the respondents across districts


the school

BMI Total

<18.50 18.50 - 25.00 25.00 - 30.00 >30.00

Palghar-Dahanu 157 (85.8) 21 (11.5) 3 (1.6) 2 (1.1) 183 (100)

Nandurbar-Navapur 146 (90.1) 15 (9.3) 1 (0.6) 0 (0) 162 (100)

Yavatmal-Kelapur 113 (68.9) 26 (15.9) 18 (10.9) 7 (4.3) 164 (100)

Gadchiroli-Aheri 121 (65) 62 (33.3) 2 (1.1) 1 (0.5) 186 (100)

Total 537 (77.2) 124 (17.8) 24 (3.5) 10 (1.4) 695 (100)

4.3.2 Nutritional Status based on Haemoglobin level (Sahil’s Haemoglobin meter)

Nutritional status of the girls was also measured using physiological parameters like the level

of haemoglobin level in their blood or Hb level, also known as iron deficiency anaemia

status. Haemoglobin a protein is required to transport oxygen to various parts of the body

from lungs. Lack of haemoglobin in blood is responsible for nutritional anaemia causing

shortness of breath, palpitation, dizziness, fatigue and paleness among individual. Adolescent

girls and their anaemia status are an important indicator of their health status as life events

like age at menstruation is also linked to the nutritional status and loss of iron also occurs

during menstruation. Anaemia could be due to nutritional deficiency called iron deficiency

anaemia or due to certain genetic conditions like sickle cell anaemia, a common disease

among tribal communities. Normal haemoglobin range for adolescents aged 12-14 years as

per WHO is above 12 gm%, 10-11.99 gm% suggest mild anaemia, 7-9.99 indicated moderate

anaemia while less than 7 indicated severe anaemia.

Table 4.11 Anaemia status of ashram school adolescent girls

Anaemia Percentage N Normal range WHO

Severe 10.3 74 Less than 7

Moderate 67.9 489 7 to 9.99

Mild 21.3 153 10 to 11.99

Normal 0.6 4 12 and above

Total 100 720


The mean average Hb for the ashram school girls were 8.9 gm/dl%.From the table 4.11, it is

shocking to find that around 10.3% of the total respondents’ haemoglobin level falls under

the severe category with 67.9% falling in the moderate category. In other words, 78.2% of the

total adolescent girls fall in the severe or moderate anaemia status. This further reiterates the

earlier finding which is based on BMI that the anaemic status among the ashram schools is

also severe as per the haemoglobin status. Further, a different categorisation other than the

WHO cut off value was used in this context as studies have shown that anaemic status among

Indian adolescents is a general pattern that across population haemoglobin value hovers in the

range of 10-12 in normal population for Indian population (YandamuriAyyanna, 2013).

Additionally, it was found that the public health department and therefore ashram school

authorities mostly consider Hb status of less than 9 gm/dl as ‘anaemic’ for practical purposes.

This is a feature of changing ‘normality’ by routine, wherein after repeated exposure of low

anaemia status among tribal populations result in setting new ‘normality’ for defining the

problem. Hence a revised category was used to understand the anaemic status and its

variance.

From the table 4.12, it is shocking to find that only 45.9% of the total respondents fall within

the Hb level of 9 and above, despite the health department consider this as the revised normal

range. Thus, those with the Hb value of less than 9 gm/dl was reported by 58.2% of the total

adolescent girls of ashram schools with 47.9% belonging to the range of 7-9 gm/dl (table

4.12). An astonishing 10.3 % have Hb level of less than 7 gm/dl indicating the extent of

vulnerability among these populations, which indicate the extremely severe anaemic status.

The anaemic status across districts indicate that Yavatmal and Palghar fares better as

compared to other districts, as 52% from each district fall in the 9-11gm/dl category, with

only 30.5% and 42% belonging to the 7-9gm/dl category. On the other extreme is the case of

Gadchiroli and Nandurbar, where 59.7% and 55.7% fall in the 7-9 gm/dl Hb category with

only 31.6% of the total girls of Nandurbar falling in the 9-11 gm/dl category. Gadchiroli

shows extreme vulnerability as more than 39.9% of the total girls from the district fall in the

less than 7 gm/dl% indicating an emergency situation that need immediate attention. This

when examined with the food pattern and nutritional status based on BMI indicate a strong

linkage.

Considering haemoglobin as an indicator to health of these children, we canconclude that

almost all the respondents in the ashram schools reported high anaemic status, which indicate

poor health status. This poor health status is unacceptable, especially in a situation where

children are subjected to routine medical check-ups. The purpose of a medical check-up is

not served when it is not responded upon by health personnel from the health department

when the results indicate low performance.

It was also observed that during medical check-up, most of these health personnel considered

haemoglobin below 9 gm/dl as mild anaemia and only below 7 gm/dl as severe anaemia, the

latter requiring attention and treatment. On further inquiry it was told that usually among

tribal population, it is expected that their anaemia status will be low than the normal among

tribal population - an obvious discrimination that is rooted among health professionals. Given

this ‘understanding’, it becomes ‘routine’ for these health personnel to consider haemoglobin


levels of 9 gm/dl even among girls as normal. Hence, as per the medical team all the

respondents were categorised within the range of normal haemoglobin level. When linked

with the nutritional status and diet intake, it is interesting to note that Gadchiroli is the worst

affected in terms of BMI and nutritional anaemia, followed by Nandurbar. This could be due

to the failure to ensure adequate breakfast in Gadchiroli and non-vegetarian food being a

rarity in the Nandurbar region.

Table 4.12: Haemoglobin (Hb) level of the respondents across districts

District and block

of the school

Haemoglobin level in gm Total

< 7 gm 7-9 gm 9-11 gm > 11 gm

Palghar-Dahanu 0 (0) 79 (42) 98 (52.1) 11 (5.9) 188 (100)

Nandurbar-Navapur 5 (2.6) 117 (59.7) 62 (31.6) 12 (6.1) 196 (100)

Yavatmal-Kelapur 6 (3%) 61 (30.5%) 104 (52%) 7 (3.5%) 178 (100)

Gadchiroli-Aheri 6 3 (39.9) 88 (55.7) 5 (3.2) 2 (1.3) 158 (100)

Total 74 (10.3) 345 (47.9) 299 (41.5) 32 (4.4) 720 (100)

4.3.3 Nutritional status based on Nutritional Indicators

Under-nutrition: Weight for Age

In order to supplement the data generated based on BMI and hemoglobin status of adolescent

girls, nutritional indicators using anthropometric status was analyzed. The height and weight

of adolescent girls collected were compared with the standard heights and weights of girls

belonging to similar age group. To compare the heights and weights of girls ICMR’s (2002)

NCHS values were used as standard value.

The average weight deficit of the ashram school girls belonging to age group of 10-19 years

were around 25%, (Mean 24.66; Median 25.82) with a mean average age of 13.5 (SD=2.1)

years. As the proportion of underweight based on BMI was high along with the fact that Hb

level also indicate a higher proportion of anemic status, it was expected that there will be

several girls whose weight falling far below the normal value. Thus, WHO recommendation

of weight for age –Z score will cover a larger proportion of the sample falling within it,

which will actually mask the severity of the problem.

In order to understand the extent of underweight in this population merely categorizing as

underweight or not is insufficient but it is important to understand the extent of

undernutrition, represented in terms of the extent of deficit in the weight from the normal

weight for a given age group. This was shown in the table 4.13 as the proportion of

population falling in the decennial deficit of weight against the expected normal weight for a

given age group. Thus, it is important to note that only 2.4 % of the girls had normal weight

for their age whereas 9.3% of girls have around 10% deficit in weight against the normal.

Those with 10-20% deficit from normal was 9.7% girls with the maximum number of girls

were having 34.3% deficit with significant proportion (26.3%) having more than 30-40%


deficit than the normal weight. In other words, those girls with more than 20% deficit than

their expected weight for age was found among 68.7% of the total girls surveyed.

Table 4.13 Proportion of wasting among ashram school girls

Proportion of weight deficit among girls

Percentage deficit of weight for age Percent N

Normal 2.4 16

0-10 9.3 62

10-20 19.7 132

20-30 34.3 230

30-40 26.3 176

40 and above 8.1 54

Total 100 670

Stunting: Height for Age

In order to understand the extent of stunting, height of the ashram school girls was also

examined against their ideal height. It was found that the average height deficit of those girls

belonging to 10-19 age group with an average age of 13.5 yrs (SD=2.1) was 8 % (mean 8.45,

median 7.45). To understand the extent of stunting, the height deficit was categorised into

categories of less than 5 %, those with 5-10 %, with 10-15 % and with 15 % and above

deficit (table 4.14). Here, too, it was found that around 70% of the total ashram school girls

reported height deficit of more than 5 %. This was distributed with 40.5% reporting a deficit

of 5-10%, with 20.3% reporting 10-15% deficit with around 10% reporting more than 15 %

height deficit against their normal height for their age group.

Table 4.14: Proportion of Stunting among ashram school girls

Proportion of height deficit among girls

Percentage deficit of height for age Percent N

Normal 4.5 30

0-5 25.2 170

5-10 40.5 273

10-15 20.3 137

15 and above 9.5 64

Total 100 674

The height for age data also indicates that the overall height among adolescent girls also has

faltered further indicating their vulnerability manifested in their nutritional status. Overall the

anthropometric indicators reveal the extent of growth faltering that has happened among

adolescent girls of ashram schools, which can be attributed to multiple factors like the

progression of vulnerability during childhood to the adolescent along with the inadequate

nutrient intake and supplements becoming insufficient to overcome the health vulnerabilities.


4.4 GENERAL HYGIENE

The daily routine and the general hygiene behaviours could be understood by their responses

on their daily brushing, bathing, hair washing and nail cutting habits. The results are shown in

table 4.15. Most of the respondents reported that they brush (91.1%) and bathe (92.2%) once

daily, while hair washing was practiced twice in a week by 71.9% of the respondents which

points out to a good personal hygiene practice given the circumstances in which they live

where water supply is scarce, especially inside the washrooms. The frequency of nail cutting

was found to be once a week among 60.1% of the students and 21.5% of the children cut their

nails twice a week as each student in the school has a personal nail cutter.

Although water is not available in the taps inside the washrooms, they manage to maintain

good personal hygiene on the contrary when a nail cutter is readily available many cut their

nails regularly. The above behaviour points to the fact that children in ashram schools are

quite aware and would prefer to follow good hygiene practices to the extent they can practice.

This is also dependent on the facilities available which in most of the situations become a

prerequisite for good behaviours. The same behaviour was not very different across districts.

Table 4.15: Frequency of brushing and bathing daily based on the type of school

Type of

School

Number of times respondents

brushes teeth daily

Number of times respondents bathes

daily

Once Twice Total Once Twice Total

Government 345 (86.5) 54 (13.5) 399 (100) 361 (90.5) 38 (9.5) 399 (100)

Private-aided 381 (95.7) 17 (4.3) 398 (100) 374 (94) 24 (6) 398 (100)

Total 726 (91.1) 71 (8.9) 797 (100) 735 (92.2) 62 (7.8) 797 (100)

Table 4.16: Frequency of hair wash and nail cutting by respondents based

on type of school

Frequency of hygiene

behaviours

Type of School Total

Government Private-aided

Hai

r w

ash Daily 17 (4.3%) 18 (4.5%) 35 (4.4%)

once in a week 77 (19.3%) 102 (25.6%) 179 (22.5%)

Twice in a week 300 (75.2%) 273 (68.6%) 573 (71.9%)

Others 5 (1.3%) 5 (1.3%) 10 (1.2%)

Total 399 (100%) 398 (100%) 797 (100%)

Nai

l cu

ttin

g

Once a week 238 (59.6%) 241 (60.6%) 479 (60.1%)

Once in 2 weeks 7 (1.8%) 3 (0.8%) 10 (1.3%)

Once in a month 4 (1%) 7 (1.8%) 11 (1.4%)

Does not cut

nails 3 (0.8%) 2 (0.5%) 5 (0.6%)

Twice in week 86 (21.6%) 85 (21.4%) 171 (21.5%)

Others 61 (15.3%) 60 (15.1%) 121 (15.2%)

Total 399 (100%) 398 (100%) 797 (100%)


4.5. MENSTRUAL HYGIENE

4.5.1. Awareness on ideal age at menarche among respondents

Awareness on menstruation among adolescent girls in the ashram schools attains significance

as their knowledge about menstruation is a precondition to follow good menstrual behavior in

future. Girls were asked about their understanding about the normal age at which girls attain

menstruation. From the table 4.17, it is clear that 38.6% of the total respondents don’t know

the normal age at which girls generally attain menstruation with the maximum (49%) from

the Nandurbar district with the lowest (25%) from the Yavatmal district. The proportion of

girls who could not tell about the normal age at menarche was lowest from Yavatmal district

indicating that the awareness level is more in this district as compared to others. Those who

said that the ideal age at menarche should be between 10 and 12 years were 33.8% whereas

those who shared that the average age at which girls attain menarche to be between 12 years

and 14 years is 21.3%. While 4.6% of the girls felt 14-16 years as the ideal age at which girls

attained menarche. Awareness on age at menarche can be seen as an expression based on

their experience in their schools. This could be because they observed elder siblings or girls

in their school who attained menarche at these age groups.

Table 4.17: Awareness about the ideal age at which girls attain

menarche across districts

District and block

of the school

Awareness on age at which girls attain menarche

Total Don't

know

<10

years

10-12

years

12-14

years

14<

years

Palghar-Dahanu 93 (46.5) 8 (4) 75 (37.5) 22 (11) 2 (1) 200 (100)

Nandurbar-

Navapur 97 (49) 5 (2.5) 63 (31.8) 28 (14.1) 5 (2.5) 198 (100)

Yavatmal-Kelapur 50 (25) 3 (1.5) 75 (37.5) 56 (28) 16 (8) 200 (100)

Gadchiroli-Aheri 68 (34.2) 1 (0.5) 56 (28.1) 64 (32.2) 10 (5) 199 (100)

Total 308 (38.6) 17 (2.1) 269 (33.8) 170 (21.3) 33 (4.6) 797 (100)

4.5.2. Actual age at which ashram school girls attain menarche

Age at which a girl attains menarche is associated with a variety of internal and external

factors. Age at menarche is seen as an indicator of embodiment, wherein bodily processes are

seen as an outcome of the social, political, economic and cultural context of the adolescent

girls. Hence, age at menarche as an indicator has a significant role in determining the health

status of girls. There is no ideal/standard age at menarche in any societies, but it can be seen

as an indicator of development. This is because societies in advanced stage of development

have found that the age at menarche is reducing. This is true when comparing urban and rural

age at menarche.

The average age at menarche in Indian society is 12-14 (Bagga 2014 and Phatak 2014). This

is 13.51 + 1.04 years and 13.67 + 0.8 years for urban and rural adolescent girls respectively.

Of the total 797 respondents, only 408 girls (52%) have reported that they have attained

menarche at the time of survey. Among those who have not attained menarche the average


age was 12 years (median =12; mean 11.97). From the table 4.18, of the total 408

respondents who attained menarche, 154 (37.7%) girls have attained menarche at the age of

14-16 years, with 134 (32.8%) attaining menarche between the age 12-14 years with only

25.5 % (104) reporting menarche between the age of 10-12 years (table 4.18).

If we consider 12-14 as the ‘ideal’ age at menarche, those proportion of girls reporting

menarche above 14 years have to be a concern. Across districts, the proportion of those

falling in the 14-16 age groups indicates the proportion of girls who had delayed their

menstruation. The highest proportion who reported menarche after they completed their 14

years were from Gadchiroli (49.6%) district, followed by Yavatmal with 41% and Nandurbar

with 33.8% with the lowest (16.7%) proportion in this category reported from Palghar

district. Earlier studies have reported that the average age of attaining menarche is between

12-14 years in rural Maharashtra (Jena, P. 2017, Dambhare, D.G., 2012 and Bagga A. 2000).

According to study by Sharma, M.B. (2017), girls belonging to Gond tribe of Maharashtra

attained menarche at a mean age of 13 years of age. This is one of the tribal groups dominant

in the Gadchiroli district. Thus, one can infer that the overall age at menarche in these sample

of adolescent girls of ashram schools are higher than the normal pattern reported in other

parts of Maharashtra and even higher than the Gond tribes, mostly reported from Gadchiroli

and Yavatmal district of the study sample.

Table 4.18: Age at which girls attained menarche across districts

District and block

of the school

Age at which girls attain menarche

Total <10

years 10-12 years

12-14

years

14 and

above

Palghar-Dahanu 7 (8.3) 41 (48.8) 22 (26.2) 14 (16.7) 84 (100)

Nandurbar-Navapur 5 (6.8) 13 (17.6) 31 (41.9) 25 (33.8) 74 (100)

Yavatmal-Kelapur 2 (1.7) 22 (18.8) 45 (38.5) 48 (41) 117(100)

Gadchiroli-Aheri 2 (1.5) 28 (21.1) 36 (27.1) 66 (49.6) 133 (100)

Total 16 (3.9) 104 (25.5) 134 (32.8) 154 (37.7) 408 (100)

4.5.3. Absorbent use among girls of ashram schools

To understand the practice related to use of absorbent among tribal communities, questions

were asked about the type of absorbent used by school girls during menstruation. As

expected, sanitary pads were the first choice for most (78.7 %) of the respondents. Similar

trend was seen across Gadchiroli (76.7%), whereas higher proportion were found in Palghar

(92.8%) and Yavatmal (89.1%) districts except for Nandurbar where only 50% said they use

sanitary pads with 23% reported that they use cloth and another 27% said that they use both.

In Gadchiroli district, too, significant (22.6%) number of girls said that they use both sanitary

pads and cloth (table 4.19).


Table 4.19: Absorbent used by the respondents during menstruation across districts


the school

Absorbent used during menstruation

Total Sanitary pad Cloth

Both sanitary pad and

cloth

Palghar-Dahanu 77 (92.8) 0 (0%) 6 (7.2) 83 (100)

Nandurbar-Navapur 37 (50) 17 (22.9) 20 (27) 74 (100)

Yavatmal-Kelapur 106 (89.1) 6 (5) 7 (5.9) 119 (100)

Gadchiroli-Aheri 102 (76.7) 1 (0.8) 30 (22.6) 133 (100)

Total 322 (78.7) 24 (5.9) 63 (15.4) 409 (100)

Based on the type of school, it is interesting to note that majority (92.8%) of the respondents

from government schools used sanitary pads with 11.7 % shared that they use both pads and

cloth as per convenience as compared to only 70% of the respondents from private or aided

schools who shared that they use only sanitary pads. Here the proportion of those who use

both pad and cloth were 19 %, whereas 10% shared that they use exclusively cloth as an

absorbent during menstruation (table 4.20). This difference could be due to fund crunch in

private-aided schools, whereas in government schools’ supplies are often in ample as it is

centrally provisioned.

Table 4.20: Absorbent used by the respondents during menstruation in type of school

Type of school

management


Total Sanitary

pad Cloth

Both sanitary pad

and cloth

Government 178 (86.8) 3 (1.5) 24 (11.7) 205 (100)

Private-aided 144 (70.6) 21 (10.3) 39 (19.1) 204 (100)

Total 322 (78.7) 24 (5.9) 63 (15.4) 409 (100)

4.5.4 Type of absorbents preferred by respondents against the actual one used

In order to understand the unmet need for absorbents among the Ashram school girls, they

were asked about their preferred choice of absorbent. Though schools differ in provision of

sanitary pads or cloth, respondents mentioned their preference during menstruation.

Questions were asked to find out the preference girls have towards absorbent during

menstruation. This was intended to understand the felt need of the girls for absorbents.

Among those who preferred sanitary pads during menstruation, only 89.7% were using

sanitary pads indicating that around 10% of their need for sanitary pad is not met. For those

who preferred sanitary pad and cloth together as their first choice, about 96.3% of the

respondents’ need is fulfilled. Among those who preferred cloth as the absorbent during

menstruation almost 95% need was fulfilled (table 4.21). The above section on the use and

preference of absorbent material indicate that the need for absorbent among ashram school

girls are fulfilled to a large extent, with around 10% need for sanitary pad is yet to be

responded to.


Table 4.21: Absorbent actually used during menstruation by the respondents

against the preferred absorbents

Preferred absorbent

by respondent


Total Sanitary

pad Cloth

Both sanitary pad

and cloth

Sanitary pad 321 (89.7) 1 (0.3) 36 (10.1) 358 (100)

Cloth 0 (0%) 23 (95.9%) 1 (4.2) 24 (100)

Both sanitary pad

and cloth 1 (3.7) 0 (0%) 26 (96.3) 27 (100)

Total 322 (78.7) 24 (5.9) 63 (15.4) 409 (100)

4.5.5. Provision of sanitary napkins

According to the norm in ashram schools, sanitary napkins are provided by the schools.

Whereas some schools provided cloth to their students, instead of pads and some others

provided neither pad nor cloth to their students. Recently due to direct benefit transfer (DBT)

facilities, students who receive the amount are expected to buy sanitary napkins from using

the DBT money. To understand the distribution pattern, questions were asked to the girls

about their receipt of sanitary pads and its frequency. Among the students who received

sanitary pads in the school 73% of the total respondents mentioned to have received one

packet per month, while 12.9% said they have received two packets per month. Each pack

consists of six to eight pads, which is the type of pack commonly followed across schools.

Quality of pads varied across districts and was found that in some schools the quality of

sanitary pads where so poor that students shared that they had to use even eight pads in a

single day during the peak days of menstruation.

When looked at the district-wise provisioning, it was interesting to find out that except

Nandurbar, all other districts have good supply of pads with at least one pack per month

ensured to almost 90% of the girls. In Nandurbar, almost 30% reported that they don't get any

supply of sanitary pads with 10.9% said they are supplied with cloth from the school (table

4.22)

Table 4.22: Provision of sanitary napkin or cloth to the respondents

byschools across districts

District and block

of the school

Number of sanitary napkin packs received from school in

a month

Total One

pack Two pack

As per

need

Don't

get

Gets cloth

from

school

Palghar-Dahanu 58 (70.7) 22 (26.8) 2 (1.2) 0 (0) 0 (0) 82 (100)

Nandurbar-

Navapur 33 (51.6) 1 (1.6) 4 (6.3) 19 (29.7) 7 (10.9) 64 (100)

Yavatmal-Kelapur 74 (63.8) 23 (19.8) 9 (7.8) 10 (5%) 0 (0%) 116 (100)

Gadchiroli-Aheri 100 (99) 1 (1) 0 (0%) 0 (0%) 0 (0%) 101 (100)

Total 265 (73) 47 (12.9) 15 (4.1) 29 (7.9) 7 (1.9) 363 (100)


4.5.6. Access to water and usage of cloth during menstruation across districts

As per the table 4.21, the proportion of respondents using exclusively cloth during

menstruation is very less (5.9%) though in combination with sanitary pads together will be

around 21.3%. It was observed that most of the girls used sanitary pads during periods as it

was provided by the school, but while at home during vacations, girls used cloth as sanitary

pads were not provided during vacations. A few who could afford sanitary pads used them

during vacation as well. On examining the cloth use pattern, it was revealed that several of

those respondents who used cloth used it once and some of them use the cloth more than

thrice.

Those who used cloth during menstruation reported that they washed the cloth in bathroom as

none reported to wash the cloth in the common washing area, partly due to the fact that in

several of the schools a separate washing area is absent. Some of those respondents reported

that they dry washed clothes under the sun - an outcome of the knowledge shared by female

wardens and RKSK counsellors on menstrual hygiene. Few of them also said that they dry

their washed clothes in bathroom or in the hall or room they stay.

As mentioned in the earlier chapter, water supply in tribal areas is minimal and so is the case

with ashram schools. As per the data shared by school, none of the schools had water scarcity

during academic period. Among the few who reported water scarcity, it was during summer

when the children were on vacation. On inquiring about adequate water supply to maintain

menstrual hygiene, very few respondents felt they did not have adequate water to take care of

their menstrual hygiene. This situation was seen across all the districts though in Gadchiroli

the proportion was higher. In all the schools, the taps in the washrooms are not equipped with

water supply as was revealed from the facility survey. Children carry water in buckets from a

common water source which is normally a water tank nearby the washrooms.

4.5.7. Bodily discomfort during menstruation

Menstruation is always known to have associated with multiple bodily discomforts and it is

important to understand how the girls manage these discomforts in a residential environment

like ashram schools. Among the respondents, the major discomforts reported were included

like abdominal pain, backache, foul smell, itching and there were few who reported that there

was no discomfort at all. There were other discomforts as well though its intensity was not

reported as severe as the major ones and was found to be ‘manageable’. For the purpose of

analysis, categories were made with the most severe discomfort as the primary category.

Among all these discomforts, abdominal pain with other minor complaints was found to be

the most commonly faced discomfort among all the respondents which formed 44.4% when

taken as aggregate which was reported highest in Palghar and lowest in Gadchiroli. Whereas

30% of the total respondents did not report any discomfort at all, whose proportion was

highest in Yavatmal with Gadchiroli reporting the lowest though the variation is only

minimum across districts.

When asked how they manage their discomfort during menstruation, about 37% of the

respondents stated that they mainly reported the discomfort to the female warden, while 20%

of the respondents never reported any of these discomforts to anyone. It is noteworthy that


15% of the total respondents reported to the senior students and relatives despite the fact that

they stay in ashram schools. This shows that many girls rely on their senior students and

relatives during any menstrual related discomfort, which could be due to lack of

approachability to the female warden or non-availability of a female warden in the school

itself.

Table 4.23: Bodily discomfort experienced by the respondents

during menstruation across districts

District

and block

of the

school

Major bodily discomfort reported during

menstruation

Others

No

discom-

fort

Total Abdominal

pain

Back

pain

Foul

smell Itching

Abdominal

pain and

back pain

Palghar-

Dahanu 45 (53.6) 2 3 1 7 (8.3) 1 25 (29.8) 84 (100)

Nandurbar-

Navapur 37 (51.4) 7 (9.7) 1 0 4 1 22 (30.6) 72 (100)

Yavatmal-

Kelapur 47 (40.9) 7 (6.1) 5 (4.3) 0 8 (6.9) 5 (4.3) 43 (37.4) 115(100)

Gadchiroli-

Aheri 50 (37.9) 19(14.4) 4 3 16 (12.1) 8 (6.1) 32 (24.2) 132(100)

Total 179 (44.4) 35(8.7) 13(3.2) 4 35(8.7) 15(3.7) 122(30.3) 403(100)

Among the 281 (35%) respondents of the total sample who reported discomfort during

menstruation, only 56.6% sought treatment for these discomforts. The proportion was highest

in Palghar and Gadchiroli districts and lowest in Nandurbar district, indicating the need for

greater focus in the latter. It is quite possible that the discomfort was not very severe among

some of the respondents or they consider it quite normal as most of them face these

discomforts every month during menstruation or because they don’t have any female help to

alleviate their issues and offer help. If latter is the case, then it points out to the lack of

sufficient attention to the girls residing in ashram schools by the authorities as they may not

have a female warden appointed in the school or she may not be staying in the school

premises at an accessible distance.

From the above description it is clear that there is scope for better response by female

wardens towards the menstrual discomfort among girls as whenever girls face difficulty due

to menstruation it is necessary that the ashram schools take responsibility to attend it

immediately as they are staying away from their families and need emotional and social

support during adolescent period.

Table 4.24: Whether the respondent takes treatment for bodily discomfort

duringmenstruation across districts

District and block of the

school

Is treatment taken for bodily discomfort

during menstruation Total

Yes No

Palghar-Dahanu 42 (71.2) 17 (28.8) 59 (100)

Nandurbar-Navapur 16 (32) 34 (68) 50 (100)

Yavatmal-Kelapur 34 (47.2) 38 (52.8) 72 (100)

Gadchiroli-Aheri 67 (67) 33 (33) 100 (100)

Total 159 (56.6) 122 (43.4) 281 (100)


4.5.8. Change in daily routine due to menstruation

When asked about the major changes in daily routine leading to disturbances they faced

during their daily life during their period, the respondents complained primarily of the need

for prolonged resting hours, sleep disturbances and decreased appetite as major changes. As

per the table 4.25, combinations of the above three primary disturbances along with other

disturbances was reported by the respondents. The ‘others’ category included in the table

implies feeling of giddiness and excess hunger. From the table, it is obvious that majority

(38.8%) reported to have to spent prolonged resting hours.

Yavatmal district reported the highest (43.2%) proportion in this category with Nandurbar

reporting the lowest (26.8%). Decreased appetite was reported by 23% of the total

respondents, which was reported highest (43.9%) in Nandurbar and lowest (17.3%) in

Yavatmal. Sleep disturbances alone was reported by only 11%. However, prolonged resting

hours, decreased appetite, and sleep disturbances together were reported by 13.6% as a

combined category. It was reported highest in Yavatmal (20.9%) with Nandurbar (9.8%)

reporting the lowest proportion.

Table 4.25: Change in daily routine due to menstruation experienced

by the respondents across districts

District and

block of the

school

Change in daily routine due to menstruation

Total Prolonged

resting

hour

Sleep

disturbances

Decreased

appetite

Prolonged

resting hours,

sleep

disturbances

and decreased

appetite

Sleep

disturbances

and

decreased

appetite

Others

Palghar-Dahanu 25 (39.7) 5 (7.9) 17 (26.9) 7 (11.1) 1 (1.6) 8

(12.7) 63 (100)

Nandurbar-

Navapur 11 (26.8) 7 (17.1) 18 (43.9) 4 (9.8) 1 (2.4) 0 (0) 41 (100)

Yavatmal-

Kelapur 35 (43.2) 10 (12.3) 14 (17.3) 17 (20.9) 1 (1.2) 4 (4.9) 81 (100)

Gadchiroli-

Aheri 43 (39.4) 11 (10.1) 19 (17.4) 12 (11) 7 (6.4)

17

(15.6)

109

(100)

Total 114 (38.8) 33 (11.2) 68 (23.1) 40 (13.6) 10 (3.4) 29(9.9) 294(100)

4.6. SUBSTANCE ABUSE BY GIRLS

Substance abuse was common practice among children in ashram schools, especially from

Nandurbar, Yavatmal and Gadchiroli districts, where tobacco consumption is developed as a

habit in home as part of the cultural influencesor could also be due to peer pressure. Common

substances used by respondents were tobacco, kharra, gutka, and toddy. Others included pan

masala and pan (betel leaf).

In order to reduce hesitancy in answering questions related to tobacco use, questions were

asked to find out whether there exist any tobacco consumption habits among their friends.

This information was tabulated across government and private schools separately. Though

majority (79.5%) of the respondents reported that their friends don’t use any substances,


about 11.2% agreed that their friends consume tobacco and 8.4% mentioned the use of kharra

(a form of tobacco) by their friends. Toddy was the least reported 0.1%. A similar pattern was

seen among government and private-aided ashram schools as there is no significant

difference in the pattern of use. Despite this, there was denial of use of any substances but on

informal discussions it was found that several of the students agreed which was even

reiterated as a possibility during dental check-up, especially in Yavatmal and Gadchiroli

districts. It is possible that they may have not revealed the right information in the survey due

to the stigma attached to the information.

Table 4.26: Common substance used by friends as per respondents

based on type of school management

Type of

School

management

Common substance used by friends

Total Tobacco Kharra Gutka Toddy Others None

Government 45

(11.3%)

34

(8.5%) 0 (0%)

1

(0.3%) 2 (0.6%)

317

(79.4%) 399 (100%)

Private-aided 44

(11.1%)

33

(8.3%)

3

(0.8%) 0 (0%) 1 (0.3%)

317

(79.5%) 398 (100%)

Total 89

(11.2%)

67

(8.4%)

3

(0.4%)

1

(0.1%)

3

(0.3%)

634

(79.5%)

797

(100%)

4.7. SUMMARY

Food intake, a vital aspect for growth and development of children to ensure their adequate

nutrition and improved health status, is an important determinant. Food intake becomes

crucial not only in terms of overall growth but also in terms of nutritive value. It was found

that rice and dal is the major food that is provided to children, whereas roti, chapati is

restricted in quantity. No adequate nutrients are provided through the current practice

wherein green leafy vegetables and non-vegetarian diet is a rarity. Eggs and fruits are not on

a regular supply but a luxury. The linkages between nutrition and health doesn't need any

explanation. Healthy nourishment is essential especially in the early stage of human life i.e.

childhood and adolescents as poor nourishment can lead to undernutrition leading to greater

susceptibility to infections. From the above data it is very clear that despite mandated

provisions food is not adequately served to the school children as a result there could be high

implications on the health outcomes of these children. This is evident from the nutritional

data showing high levels of anaemia and very low BMI as the 'normality' among children in

ashram schools, especially due to their vulnerability. The extent of Anaemia is shocking as

41.5% reported to have their Hb level in the 9-11 gm/dl range, with 47.9% in the 7-9 gm/dl

category with 10.3% having even less than 7 gm/dl. Similar results were also found in the

weight deficit which was in the tune of 25% deficit as compared to the normal with an

average height deficit of around 8% than it is for girls of similar age. Furthermore, poor

anthropometric indications of undernutrition and stunting reveal the severity of the situation

and the urgent need to respond to the high levels of undernutrition among adolescent girls.

With respect to general hygiene, most of the respondents reported good personal hygiene. It

was interesting to note nail cutting was practised twice a week by the respondents. This

shows, the respondents’ eagerness in maintaining personal hygiene when necessary

Tata Institute of Social Sciences, Mumbai| 106

resources, like nail cutter in this case, are available. Another indicator pointing towards the

poor nutritional status of girls is their age at menarche. It was also observed that a

significantly higher proportion (37.7) of the respondents attained menarche at the age of 14-

16 years as compared to those (32.8) within their 12-14 years, which is the general pattern for

rural Maharashtra. Whereas in case of menstrual hygiene, respondents preferred using

sanitary napkins, but due to non-availability of adequate quantity or poor-quality force them

to use cloth instead. Bodily discomfort related to menstruation like abdominal pain, back

pain, itching and foul smell were prevalent among respondents which was usually reported to

either the female warden or friends. And due to these bodily discomforts, the major

disturbance in their daily routine was prolonged resting hours and sleep disturbances.

Tata Institute of Social Sciences, Mumbai| CHAPTER FIVE 107

CHAPTER FIVE

MORBIDITY PREVALENCE AND PATTERN OF

TREATMENT SEEKING

5.1. INTRODUCTION

Morbidity patterns among adolescent mark as an essential indicator in determining their

current health status and a pointer towards their future health. This is because in

understanding under-nutrition status among adolescents, the exposure to repeated infections

becomes detrimental to their nutritional status as it is understood that the growth of human

being falters when infected with diseases. More so, it is the fact that illness of a community

also represents their conditions of living, especially in a residential school environment like

Ashram school that lack adequate infrastructure facilities like drinking water, toilet and

bathroom facilities with some schools recorded lack of a separate residential infrastructure.

Identification and treatment of these morbidities thus becomes an essential prerequisite.

Capturing morbidity in health studies has always fraught with multiple challenges. There are

arguments that self-reported morbidity is not a good representation of morbidity as greater

morbidity will be reported in situations where there is greater access to health care, which is

attributed to perception factor (Sen, 2002). On the other hand, there are several studies that

have shown that despite differences in self-reported morbidity with or without good access to

health care, it was found that a cross-sectional self-reported data with different reference

period can get a much better overall picture (Dilip, 2002; NSSO 2015). Medically diagnosed

diseases is not only cost intensive but also fail to capture the history of illness retrospectively

unless the patient reports.

This chapter is based on the self-reported morbidities captured from the ashram school

adolescent girls and their response to the same by tracking their treatment seeking behaviour.

The second part of the chapter analyses possible linkages between nutritional indicators and

health status along with morbidity among adolescent girls.

5.2. METHODOLOGY OF CAPTURING SELF-REPORTED MORBIDITY

One of the ways by which health needs of a population is examined is based on the

prevalence of morbidity reported using self-reported morbidity using survey technique.

Questions were asked about the various types of illnesses respondents were suffering within a

given reference period. This reference period is used differently according to different type of

illness. For instance, in NSSO survey on morbidity, 15-day recall period was used to capture

minor illness and one-year period was used to capture chronic diseases (NSSO 71st round). In

addition to this, major infections, accidents and injuries were captured based on the reference

period of six months. Thus, in this study, morbidities were categorized into four types:

chronic diseases, major infections, minor illness and injuries & accidents were captured. The

lists of potential diseases in each of the above category were prepared based on the categories

identified in NSSO survey and RBSK programme. Self-reporting was used to capture the data

on morbidity for the last one year.


A limitation of this method could be recall bias among respondents especially due to their

younger age and lack of awareness about the various types of diseases. As recall bias depends

upon the extent of severity of the disease, it is possible to forget those minor illnesses which

are older. On the other hand, most frequent diseases and those with repeated episodes can

also get missed while collecting the information. Keeping this in mind, minor illnesses were

used a recall period of 15 days, major infections with a recall period of six months, accidents

and injuries also with a recall period of six months. Chronic diseases with at least a history of

one year was the criterion used for capturing data along with hospitalization. Information for

last one year was also captured though the proportion of the latter two among adolescent age

group was very less as expected.

As mentioned in the methodology, in addition to the self-reported morbidity captured through

survey method, data generated during routine medical check-ups of the same respondents

were also captured. Medical check-ups are regularly conducted by the public health

departments among ashram school students. One of the limitations of this data source is that

it will capture only those illnesses that the students are suffering at the time of medical check-

up and was based on the discussion with the student with minimal laboratory support.

Additionally, the format used was hugely underreported in terms of illnesses, also mentioned

in the earlier chapter while using data related to anthropometric information and haemoglobin

test. The regular medical check-up conducted by the ashram school medical officer was

conducted in each of the schools to capture morbidities which the respondents may not be

able to identify due to lack of awareness.

As mentioned earlier, each category of morbidity was captured based on the reference period.

Chronic diseases were categorized as any diseases or illnesses which the respondent suffered

since the last one year and which are non-communicable. Major infections are those diseases

or illnesses which the respondent suffered within the last six months and has reached a

diagnosis with a longer duration. Minor illness was all those diseases or illness the

respondent suffered in the last 15 days with short duration. Any injury or accident the

respondent had in last 6 months was considered in the category injuries and accidents. There

were overlaps in the categories captured under minor illness and major infections category

initially. In order to separate these two related categories, the duration of illness, severity and

recall period were used as crucial criteria to distinguish between the two.

Additionally, primary distinction was whether the illness was at a symptom level (minor) or

whether it has progressed to a disease with a valid diagnosis (major infections). Hence, illness

reported at the level of symptom with shorter duration was taken as minor illness and those

with a disease diagnosis with a longer duration was taken as major infection. In order to

avoid the overlapping of illness due to chronic disease, or any other category of illness

getting reported twice in the category of minor illnesses of 15-day recall period, questions

related to minor illness were asked last, and when asked about minor illness it was

emphasised to share about illness in last 15 days by excluding all other illnesses already

reported.


5.2.1 Chronic Diseases

Of the various categories of diseases reported among adolescent girls, chronic disease was

reported by lowest proportion (6.3%) of the respondents. The lowest proportion could be due

to the adolescent age group in which the respondents belong, where they are not prone to

many chronic diseases. Among the chronic diseases which were reported by the respondents,

sickle cell anaemia (2%) and chest pain (1.3%) were the most reported, with iron deficiency,

anaemia, and chronic headaches were reported (table 5.1). The category ‘Others’ included

respondents suffering from chronic dizziness, cataract, chronic ear discharge, chronic rhinitis

(cough and cold) and allergies.

Table 5.1: Types of chronic diseases self-reported by ashram school respondents

Type of chronic diseases No of cases

Diabetes 1 (0.1)

Hypertension 3 (0.4)

Anemia 5 (0.6)

Sickle cell anemia 16 (2)

Epilepsy/Seizures 2 (0.3)

Chest pain 10 (1.3)

Chronic headaches 4 (0.5)

Cancer 2 (0.2)

Others 7 (0.9)

No chronic disease reported 747 (93.7)

Total 797 (100)

5.3. MAJOR INFECTIONS

From the table 5.2, it is clear that over half of the total respondents (56.2%) reported major

infections during the last six months preceding the survey. This proportion was highest across

Nandurbar (61.6%), Yavatmal (60.5%) and Gadchiroli (69.8%) districts with the latter

reporting the maximum. Proportion of girls reported major infections was lowest in Palghar

district with only 33% of the total respondents reported to have had episodes of major

diseases in the last six months. The lowest number of cases reported in Palghar could be a

limitation of the data collection method which got strengthened in capturing information on

major infections, which was done only towards the end of first district, which was Palghar.


Table 5.2: Major infections reported in last 6 months among

respondents across districts


the school

Whether any major infections

reported in last six months Total

Yes No

Palghar-Dahanu 66 (33) 134 (67) 200 (100)

Nandurbar-Navapur 122 (61.6) 76 (38.4) 198 (100)

Yavatmal-Kelapur 121 (60.5) 79 (39.5) 200 (100)

Gadchiroli-Aheri 139 (69.8) 60 (30.2) 199 (100)

Total 448 (56.2) 349 (43.5) 797 (100)

From the table 5.3 it is clear that the major infections reported are Malaria, typhoid, measles,

Mumps, jaundice, scabies, fevers and so on. Additionally, there were cases of excessive

bleeding during menstruation requiring hospitalization for 15 days, giddiness, appendicitis,

urinary tract infection, convulsions, diarrhoea, ulcer in the mouth and vomiting which was

categorised as ‘others’ category as they were few in numbers.

Among the total respondents, 157 (34.8) cases of malaria was reported in the last six months.

Gadchiroli reported the highest (56.4) proportion of Malaria cases with Yavatmal (31.7)

having second highest with Nandurbar (23.8) reported a quarter of the total major infections

reported with Palghar reporting the lowest (15.2) proportion of malaria cases among the

major infections. This could be because Gadchiroli being one of the Malaria endemic districts

of the state.

On the contrary, Palghar reported the maximum proportion (50%) of Jaundice cases

indicating the possibility of more water borne infections as compared to the others. Fever

(11.9) and mumps (10.6) cases are significant across the respondents and is reported in

similar proportions across all districts except Palghar. Another important aspect to note is that

measles, chickenpox, scabies and mumps were reported highest in Nandurbar district

indicating that there is a greater chance of airborne infections are reported in this district

which raises a possibility of overcrowding and poor hygiene in this district as compared to

other districts.

Table 5.3: Type of major infections reported among the respondents across districts

Type of Major

infections

Name of districts Total

Palghar-

Dahanu

Nandurbar-

Navapur

Yavatmal-

Kelapur

Gadchiroli-

Aheri

Malaria 10 (15.2) 29 (23.8) 39 (31.7) 79 (56.4) 157 (34.8)

Typhoid 0 1 2 4 7 (1.6)

Jaundice 33 (50) 7 (5.8) 2 2 44 (9.8)

Measles 6 (9.1) 12 (9.8) 5 (4.1) 8 (5.7) 31 (6.9)

Scabies 2 18 (14.8) 5 (4.1) 6 31 (6.9)


Chicken pox 0 13 (10.7) 7 (5.7) 3 23 (5.1)

Mumps 6 (9.1) 18 (14.8) 13 (10.6) 11 (7.9) 48 (10.6)

Stomach pain 2 4 3 2 11 (2.4)

Rash or boil on skin 3 (4.5) 6 (4.9) 3 1 13 (2.9)

Fever 2 10 (8.2) 25 (20.3) 17 (12.1) 54 (11.9)

Others 2 4 19 (15.4) 7 (5) 32 (7.1)

Total 66 (100) 122 (100) 123 (100) 140 (100) 451 (100)

No major infections 134 [67] 76 [38.4] 77 [38.5] 59 [29.6] 346 [43.4]

Grand Total 200 [100] 198 [100] 200 [100] 199 [100] 797 [100]

5.4. INJURIES AND ACCIDENTS

As per table 5.4, there were only 30% of the total respondents who reported any type of

injuries and accidents in six months preceding the survey. Injuries and accidents were

classified into fall at school, road traffic accidents, scorpion bite, snake bite and cut with

sharp objects. The ‘others’ category included honey bee sting, fall at river, dog bite, cut on

the finger, hit by stone, finger stuck in between the door hinges and insect bite (Gaikeeda-

name of an insect in Marathi). While in case of injuries and accidents higher proportion were

reported from Yavatmal (50.5%) and Gadchiroli (56.3%) districts as compared to 5% in

Palghar and 8.10% in Nandurbar.

Table 5.4: Injuries or accidents among ashram school girls

in last 6 months across districts

District and block

of the school

Whether any Injuries or accidents

reported in last 6 months Total

Yes No

Palghar-Dahanu 10 (5%) 190 (95) 200 (100%)

Nandurbar-Navapur 16 (8.10%) 182 (91.9%) 198 (100%)

Yavatmal-Kelapur 101 (50.5%) 99 (49.5) 200 (100%)

Gadchiroli-Aheri 112 (56.3%) 87 (43.7) 199 (100%)

Total 239 (30%) 558 (70) 797 (100%)

As per the table 5.5, injuries by falling in the school was found mainly with 127 (52.9%) girls

and was mostly reported from Gadchiroli (69 cases) and Yavatmal (50 cases) districts.

Scorpion bite was another common event reported by 55 (22.9%) girls. This too was found

mostly reported from Gadchiroli (24 cases) and Yavatmal reporting (19 cases). Overall across

the districts, Gadchiroli and Yavatmal reported highest proportion of injuries and accidents

possibly could be attributed to the geography of these areas with steep slopes resulting in fall

and dense forest cover leading to higher cases of scorpion and snake bites.


Table 5.5: Type of injury/accident reported by the respondents across districts

Type of Injuries

Name of Districts

Total Palghar-

Dahanu

Nandurbar-

Navapur

Yavatmal-

Kelapur

Gadchiroli-

Aheri

Fall at school 2 6 (40) 50 (49.5) 69 (60.5) 127 (52.9)

Road accident 0 1 0 1 2

Scorpion bite 8 (80) 4 (26.6) 19 (18.8) 24 (21.1) 55 (22.9)

Snake bite 0 1 2 2 5 (2.1)

Cut with sharp

objects 0 0 16 (15.8) 17 (14.9) 33 (13.8)

Others 0 3 14 (13.9) 1 18 (7.5)

Total 10 (100) 15 (100) 101 (100) 114 (100) 240 (100)

5.5. MINOR ILLNESSES

Minor illnesses reported were fever, cough and cold, skin diseases, chicken pox, diarrhoea,

stomach pain, headache, pain in joint or muscles and so on. In addition to these, there were

reported cases of giddiness, pain while urinating, vomiting, which were very few, and

included in the category of others.

Among all the minor illnesses reported cough and/or cold were reported highest with 260

(54.5%) cases of the total (477) minor illness cases. Across the districts, Gadchiroli 80

(57.6%) and Yavatmal 72 (58.5%) had highest number of cough and cold cases with

Nandurbar (51.4%) and Palghar (49%) reporting almost half of the total minor illness cases

from the districts. Fever cases reported the next highest across all the districts whose

proportion was 21.4% (102 cases). This was highest in Nandurbar 32 (29.9%) with all other

districts reporting almost quarter of their total minor illnesses (table 5.6). Diarrhoea was the

third highest reported minor illness contributing to 9% of the total minor illness cases

reported. Among the districts, the highest proportion of cases where reported from Palghar

and Nandurbar, further reiterating the possibility of water contamination in these districts as

compared to others.

From the type of illness reported, it is interesting to note that Palghar has highest proportion

of waterborne diseases like diarrhoea and jaundice. Nandurbar reported highest proportion of

fever and other airborne infections with Gadchiroli reporting highest number of Malaria,

sickle cell anaemia and fever along with highest number of injuries due to falls and scorpion

bites, where the latter two were also a feature of Yavtmal.


Table 5.6: Type of minor illnesses reported across districts

Type of minor

illnesses

Palghar-

Dahanu

Nandurbar–

Navapur

Yavatmal-

Kelapur

Gadchiroli-

Aheri Total

Cough and/or cold 53 (49.5) 55 (51.4) 72 (58.1) 80 (57.6) 260 (54.5)

Fever 23 (21.5) 32 (29.9) 23 (18.5) 24 (17.3) 102 (21.4)

Diarrhea 15 (14) 13 (12.1) 7 (5.6) 9 (6.5) 44 (9.2)

Skin Diseases 5 (4.7) 2 9 (7.3) 5 21 (4.4)

Stomach pain 6 (5.6) 2 4 6 (4.3) 18 (3.8)

Headache 4 1 4 7 (5) 16 (3.4)

Diseases of eye 0 0 1 3 4

Chicken pox 0 1 1 0 2

Others 1 1 3 5 10 (2.1)

Total minor illness 107 (100) 107 (100) 124 (100) 139 (100) 477 (100)

No minor illness 93 [46.5] 91 [46] 76 [38] 60 [30.2] 320 [40.2]

Grand Total 200 [100] 198 [100] 200 [100] 199 [100] 797 [100]

5.6 OVERALL MORBIDITY AMONG ASHRAM SCHOOL GIRLS

Based on the data on morbidity, the overall morbidity of the adolescent girls is as shown in

the table 5.7. This pattern of morbidity reveals the real burden due to disease in a given tribal

population. This when compared with the existing data sources on morbidity reveals that the

prevalence of diseases among the ashram school girls is quite high, except for chronic

diseases, possibly due to the young age group. The reason for hospitalization also reveals that

most of it was due to the major infections (table 5.11) that they get more often than usual,

another indicator of greater susceptibility to diseases. This when compared with age wise

NSSO (2014) data among females that collect information on proportion of ailing persons

(PAP) per 1000 population with a 15 day recall it was found to be 47 and 57 in the 10-15 and

15-29 age group. The similar data for the current survey reveals tenfold rise of minor illness

among these populations.

5.7 Total morbidity prevalence reported among ashram school girls

Type of diseases (10-19-year-old girls) Proportion of illness per 1000 girls

Minor illness (15-day recall) 598

Major infections (6-month recall) 576

Injuries and accidents (6-month recall) 300

Chronic disease (persisting for more than 1-year) 63

Hospitalization rate (1-year period) 190


5.7. EPISODES OF DISEASES: INDICATOR OF SUSCEPTIBILITY

In order to understand the frequency of onset of diseases in a population number of episode

of diseases in a given time period is used. Further, it has to be noted that more the number of

disease episodes in a population, the more time the girls will remain sick and hence will halt

their growth as they are ill. Thus, it is significant to understand the number of episodes of

diseases, especially among tribal population which is vulnerable to diseases due to under-

nutrition. The respondents were asked about the number of major infections each of them

suffered in the reference period of six months. It was found that majority (80%) of those who

reported any major infections have reported only one episode of illness, with only 17.9%

reported two episodes of major infections in a six-month period. Palghar, Gadchiroli, and

Yavatmal reported maximum number of respondents with at least two episodes of illness.

Table 5.8: Number of major infections reported by the respondents across districts

District and block

of the school

Number of major infections

reported in last six months Total

1 2 3

Palghar-Dahanu 45 (67.2) 20 (29.9) 2 (2.9) 67 (100%)

Nandurbar-Navapur 104 (85.2) 15 (12.3) 3 (2.5) 122 (100%)

Yavatmal-Kelapur 101 (82.1) 21 (17.1) 1 (0.8) 123 (100%)

Gadchiroli-Aheri 115 (82.1) 25 (17.9) 0 140 (100%)

Total 365 (80.8) 81 (17.9) 6 (1.3) 452 (100%)

5.8. TREATMENT SEEKING BEHAVIOR (TSB)

Treatment seeking behaviour is defined as any behaviour carried out by people when they are

ill with a view to get rid of the illness. Thus, treatment seeking behaviour is used to

understand not only the choice of health care facility utilized but also can be interpreted as a

way by which the illnesses among adolescent girls in ashram schools are responded upon by

the authorities. Further, scholars have argued that utilisation of health services are determined

by the extent of access they have to existing health services.

The range of health care facilities available for the girls of ashram schools are the sub-centres

(SC), primary health centres (PHCs) and community health centres (CHC) together treated as

the primary level providers and sub district hospital (SDH) and District hospital (DH),

usually located at the district headquarters. Further, some of the school authorities prefer

private sector health facility, especially when public sector is not functioning or when the

type of school is a private school as it is mandatory for public sector schools to first report to

the public health care facility and are referred to higher centres if needed.

Another factor that was considered in deciding the health facility was the proximity to health

facility- wherein nearest (2-3kms) and farthest (18-21 kms) are the two categories used. Thus,

the places of treatment sought during illness were categorised into nearby primary level

public health care facility like SC/PHC/CHC, far away tertiary health care facility like

SDH/DH, usually located at the district headquarters. Additionally, there were situations

when the girls are treated back at their home, at times treated in ashram school itself, resort to


folk treatment and not taking any treatment. In the category treated back at the girl’s home,

the respondent may have utilized either public or private facility or folk treatment available in

their own villages.

5.8.1 Treatment seeking behaviour across districts

In case of chronic diseases, the most common place of seeking treatment by the respondents

were usually tertiary level public facilities like SDH or DH few of the respondents took

treatment back home. As the number of respondents reported chronic diseases were less

(6.3%) there is no scope for further analysis. As mentioned earlier, only 56.2% (N=452) of

the total respondents have reported any major infections during the reference period. Among

those, the most common place (43.6%) of seeking treatment by the respondents were nearby

public facility which is either a SC, PHC or CHCs.

The second prominent practice when girls get any major infection was to send them back to

their respective homes (23%) with 16% reporting that they went to faraway public health

facilities like sub-district hospital (SDH) or district hospital (DH). It is important to note that

only 8.6% took treatment at ashram schools, whereas around 3.5% resort to folk treatment

(table 5.9). Similar trend was found across districts except for Nandurbar district where more

proportion of girls opted for faraway public facility, possibly due to poor performing public

facilities nearby.

Unlike major infections, in case of injuries and accidents, it is important to note that a quarter

of the total cases are sent back to girl’s home and another quarter is treated at the ashram

schools. Around 21% of the total cases were treated in public facilities with 13% using the

nearby facility with 9% using the far away facility. Interestingly here, too, 12% of the cases

were treated using folk treatment (table 5.9). In case of minor illness, larger (34%)

proportion is treated at the Ashram school itself with 28% choosing the nearby public facility

and 11.5% seeking treatment at faraway public health facility. Here too around 11% children

are sent back home due to the illness. Similar trend was found across districts

What is revealing from the treatment seeking behavior is that ashram schools provide

treatment when they are affected with minor illness and during injuries and accidents. On the

other hand, public health care facility is the dominant choice for treatment whether they

choose to nearby or faraway public health care facility depending on the level of performance

of the health facility.

The last but most important aspect is that there is a regular pattern of sending a quarter of

those girls who fell ill are sent back home for treatment which is only 11% in case of minor

illness. Considering the fact that several of their home villages are far from the school, it also

implies that they need to travel that distance while they are ill and secondly this gives an

impression that ashram school transfer their responsibility of girl’s health to their parents in a

residential school system is not fair.


Table 5.9: Place of treatment of diseases based on district and block of the school T

yp

e o

f d

isea

ses

District and

block of the

school

Place of Treatment

Total

Nearby

Public

facility

(SC /

PHC /

CHC)

Faraway

Public

facility

(SDH /

DH)

Nearby

Private

facility

Treated

back at

Girl’s

home

Treated

in

Ashram

School

Folk

treatment

Not

treated

Ma

jor

infe

ctio

n

Palghar-

Dahanu 20 (30.3) 6 (9.1) 2 (3) 24 (36.4)

10

(15.2) 2 2 66 (100)

Nandurbar-

Navapur 33 (26.8) 31 (25.2) 3 (2.4) 39 (31.7) 9 (7.3) 7 (5.7) 1

123

(100)

Yavatmal-

Kelapur 43 (34.9) 21 (17.1) 6 (4.9) 30 (24.4)

20

(16.3) 2 1

123

(100)

Gadchiroli-

Aheri

101

(72.1) 18 (12.9) 2 () 11 (7.9) 0 5 (3.6) 3

140

(100)

Total 197

(43.6) 76 (16.8) 13 (2.9) 104 (23) 39 (8.6) 16 (3.5) 7 (1.5)

452

(100)

Inju

ries

/acc

iden

ts

TSB 30 (13) 21 (9.1) 7 (3) 63 (27.4) 60

(26.1) 29 (12.6) 20 (8.7)

230

(100)

Min

or

dis

ease

s

Palghar-

Dahanu 24 (22.6) 2 (1.9) 1 (0.9) 12 (11.3)

48

(45.2) 0

19

(17.9)

106

(100)

Nandurbar-

Navapur 21 (19.8) 24 (22.6) 2 (1.9) 16 (15.1)

36

(33.9) 0 7 (6.6)

106

(100)

Yavatmal-

Kelapur 33 (27) 16 (13.1) 2 (1.6) 14 (11.5)

41

(33.6) 0

16

(13.1)

122

(100)

Gadchiroli-

Aheri 54 (39.7) 12 (8.8) 2 (1.5) 13 (9.6)

35

(25.7) 2

18

(13.2)

136

(100)

Total 132(28.1) 54 (11.5) 7 (1.5) 55 (11.7) 160 (34) 2 59(12.6) 470(100)

5.8.2 Treatment Seeking Behaviour based on type of school

Treatment seeking behaviour was also assessed based on the type of school, namely,

government or private-aided in order to find out whether there is any difference across the

schools. As the number of chronic diseases were very less and cases of injuries and accidents

were also less only those with major infections and reported minor illness was examined.

From the table 5.10, almost 60.3% of those affected with major infections used public sector

facility indicating that public sector hospital is the major treatment centre for all illness in

ashram school context. It is important to note that in private schools almost equal proportion

(29.7% and 27%) of those with major diseases sought treatment in nearby and faraway public

facilities which for government schools, majority (57.8%) sought treatment at the nearby

public sector health facility. This difference could be due to better access and trust towards

lower level primary health care facility as compared to private sector, wherein the latter

always prefer higher level public sector for treatment. In both the type of schools it is

interesting to note that 23% of the total who had major infections were send back to their own

homes, which reiterates the earlier point that ashram schools have a tendency to send children

back home when they fall ill.


Another notable feature is that private schools have a better (11.7%) treatment facility than

government schools (5.4%), especially while responding to major infections. The pattern with

respect to minor illness further reveals that private schools have lower preference to nearby

public health facility (lower level) as compared to government schools. Additionally, they

have greater (14.4%) tendency to send them back home even for minor illness as compared to

government schools (8.8%).

Thus, it can be drawn that majority of the government schools preferred nearby

SC/PHC/CHC for treatment of diseases while aided schools preferred far away public health

facility like SDH/DH for treatment of their children possibly due to trust factor. Additionally,

this could also be because most of the private schools were located proximally to the SDH

close to the heart of the district/block, while most of the government schools, selected in the

study, were located far away from the heart of the block in the interior villages where access

to lower level facility is better.

Table 5.10: Place of treatment of diseases based on type of school management

Ty

pe

of

Dis

ease

s

Type of

School

Management

Place of treatment during illness

Total

Nearby

Public

facility

(S/

PHC/)

Far

away

Public

facility

(SDH/

DH)

Nearby

Private

facility

Treated

back

at

Girl’s

home

Treated

in

Ashram

School

Folk

treatment

Not

treated

Maj

or

Infe

ctio

ns Government 129(57.8) 12 (5.4) 4 () 50(22.4) 12 (5.4) 12 () 4 ()

223

(100)

Private-aided 68 (29.7) 64(27.9) 9 (3.9) 54(23.5) 27(11.7) 4 () 3 () 229

(100)

Total 197(43.5) 76(16.8) 13 (2.9) 104 (23) 39 (8.6) 16 (3.5) 7 (1.5) 452

(100)

Min

or

dis

ease

s

Government 94 (41.4) 5 (2.2) 3 20 (8.8) 75 (33) 2 () 28(12.3) 227

(100)

Private-aided 38 (15.6) 49(20.1) 4 35(14.4) 85(34.9) 0 32(13.1) 243

(100)

Total 132 (28) 54(11.4) 7 (1.5) 55(11.7) 160 (34) 2 () 60(12.7) 470

(100)

5.9. HOSPITALIZATION PATTERN OF GIRLS DURING ILLNESS

The respondents were asked about whether they got hospitalised for any illnesses (chronic,

major, minor diseases or injuries and accidents) and if so, how many times to understand the

extent of hospitalization for one year, preceding the survey. Maximum number of

hospitalization reported by any respondent was two. From the table 5.11, it is clear that 155

(19.4%) out of 797 girls have reported hospitalisation in one-year period. This implies a 19%

hospitalisation rate among adolescent age group is quite high by any standards. The current

hospitalisation rate for general population is around five percent, which as per NSSO (2014) t

round for 0-14 age group and 15-19 age group is 14 and 18 per 1000 respectively. Here too a

tenfold increase is found among the ashram school adolescent girls in terms of hospitalisation

rate.

Further, it is significant to note that 20% of those who hospitalised in last one year shows that

they were hospitalised twice indicating their vulnerability to major diseases, possibly due to


poor nutritional status and high susceptibility due to poor environmental factors. This across

districts reveal that Gadchiroli had highest (36.8) number of hospitalization with Nandurbar

reporting 30% hospitalisation with Yavatmal (23.2%) and Palghar reporting the lowest with

(9.7%). Whereas, repeated hospitalisation among those hospitalised was more found in

Yavatmal and Gadchiroli districts.

Table 5.11: Total number of hospitalization in the last one year across districts

District and block

of the school

Number of hospitalization in last one year Total

1 2

Palghar-Dahanu 12 (80) 3 (20) 15 (100)[9.7]

Nandurbar-Navapur 42 (89.3) 5 (10.6) 47 (100)[30.3]

Yavatmal-Kelapur 24 (66.6) 12 (33.3) 36 (100)[23.2]

Gadchiroli-Aheri 46 (80.7) 11 (19.2) 57 (100)[36.8]

Total 124 (80) 31 (20) 155 (100)[100]

5.9.1 Purpose of hospitalization

When examined the purpose of hospitalization, it was found that major infections were the

predominant reason for which most (71.6%) with chronic diseases contributing to 12% of the

total hospitalizations (see Table 5.11 (a)). As expected, minor illness (7.7%) constituted the

lowest number for hospitalization This pattern was consistent across the districts of

Gadchiroli and Nandurbar where chronic diseases were reported and was not the situation

with Palghar and Yavatmal where chronic diseases were few. What is significant is that a

significant proportion of hospitalization cases across districts was due to major infections

which included malaria, jaundice, mumps, measles, chicken pox and so on.

Table 5.11 (a): Purpose of hospitalization based on district and block of the school


the school

Purpose of hospitalization

Total Chronic Major

Illness

Injuries and

accidents

Minor

Illness

Palghar-Dahanu 0 10 (66.6) 1 4 15 (100)

Nandurbar-Navapur 8 (17) 33 (70.2) 1 5 (10.6) 47 (100)

Yavatmal-Kelapur 4 23 (69.8) 8 (22.2) 1 36 (100)

Gadchiroli-Aheri 8 (14) 45 (78.9) 3 1 57(100)

Total 20 (12.9) 111 (71.6) 13 (8.38) 12 (7.7) 155 (100)

5.9.2. Duration of hospitalization

Duration of hospitalization was categorized into less than 3 days, 3-6 days, 6 days and above,

based on the responses (table 5.12). Among the total respondents the highest hospitalization


was seen for less than 3 days in (58.8) with 3-6 days reported (31.4%) with 12.9% have to

spent more than 6 days during hospitalization. Majority belonging to shorter duration of

hospitalization also indicate that the disease for which they got admitted was not severe and

needing long term attention. It again reasserts the possibility of major infections in admission

pattern. The pattern was consistent across four districts with Gadchiroli reporting maximum

proportion in less than 3 days.

Table 5.12: Duration of hospitalization across districts

District and block of the

school

Duration of 1st hospitalization

Total < 3 days 3-6 days

6 days and

above

All districts 73 (58.8) 39 (31.4) 16 (12.9) 124 (100)

5.10. AVAILABILITY AND UTILIZATION OF SICK ROOM DURING SICKNESS

All the ashram schools are expected to have a sick room, which is to be utilized by students,

when they are sick. The room must be equipped with basic infrastructures like cot, mattress,

fan, light, toilet and IV stand as the minimum facilities. Though different ashram school

across districts have different kinds of sick rooms, availability of one in the school is

mandatory mainly to ensure isolation of sick students, especially in case of any

communicable diseases. Based on this information, questions were asked about whether the

students are aware about the sick room availability in the schools. About 7.61% of the total

respondents said that their school did not have a separate sick room. With only 23.9% said

that their school had a sick room. This pattern was mostly similar across districts with not

very significant variation, whereas across public and private schools it was interesting to find

that when 37.3% of the total girls from government schools said that there is a sick room; and

only 10.6% of those girls from private schools have reported availability of sick rooms in

their schools. In other words, the proportion of government schools having a separate sick

room and utilising it is higher than in private, a feature also found in facility survey data.

Table 5.13: Availability of sick room in the school based on type

and management of school

Type of School

management

School has a sick room Total

Yes No

Government 147 (37.3) 247 (62.6) 394 (100)

Private-aided 42 (10.6) 354 (89.3) 396 (100)

Total 189 (23.9) 601 (76.1) 790 (100)

In order to understand the response of the ashram schools during illness, the utilisation of sick

room during illness was examined. Though, majority (67.3%) of the respondents across the

schools mentioned utilization of a sick room in their school with only 36.1% mentioned not

utilizing sick room in the school. Similar pattern was found across the four districts with


Gadchiroli (79.3) and Yavatmal (71.3) districts showing slightly higher proportion possibly

due to better preparedness in responding to frequent illnesses.

Table 5.14: Utilization of sick room by the respondents during sickness across districts.


the school

Respondent is kept in sick room when she is sick Total

Yes No

Palghar-Dahanu 126 (63.9) 71 (36.1) 197 (100)

Nandurbar-Navapur 106 (54.4) 89 (45.6) 195 (100)

Yavatmal-Kelapur 142 (71.3) 57 (28.7) 199(100)

Gadchiroli-Aheri 158 (79.3) 41 (20.7) 199 (100)

Total 532 (67.3) 258 (32.7) 790 (100)

Further, when asked about the proportion of students sent home during sickness, it was found

that consistently 23% of those affected with major infections and 11% of those affected with

minor illness have said that they were sent home during illness (table 5.10). Further, when

asked about their opinion about the reasons for sending them home, highest proportion (42.5)

of respondents said that it was to provide adequate rest to the sick, indicating lack of quality

space needed during sickness, which is absent in most of the schools. Around 20% of the

respondents shared that their parents will take better care of them at their home also pointing

to the kind of support, attention and assurance they get at home than what they get at ashram

schools. Around 25% were unable to give any specific reason for going home during sickness

as they said they don't know with 6.5% shared that they think it was to avoid contagion of the

infection to other students. The category ‘others’ indicate that the students are send during

'extreme' illness (table 5.15).

Table 5.15: Reason for sending students home when they are sick

as per respondents across districts

District and

block of the

school

Reason for sending students home when they are sick

Total To avoid

contamination

of the

infection

To

provide

rest to the

sick

Parents

take

better

care

Others Don't

know

Palghar-Dahanu 10 (5) 104 (52) 48 (24) 14 (7) 24 (12) 200

(100)

Nandurbar-

Navapur 7 (3.5) 57 (28.8) 29 (14.6) 16 (8) 89 (44.9)

198

(100)

Yavatmal-

Kelapur 10 (5) 88 (44) 56 (28) 7 (3.5) 39 (19.5)

200

(100)

Gadchiroli-Aheri 25 (12.6) 90 (45.2) 31 (15.6) 3(1.5) 50 (25.1) 199

(100)

Total 52 (6.5) 339 (42.5) 164 (20.6) 40(5.1) 202(25.3) 797(100)


5.11. LINKAGE BETWEEN MORBIDITY AND OTHER HEALTH AND

NUTRITION INDICATORS

Health and nutritional needs of a population is described using measures of morbidity and

nutritional indicators. The usual morbidity and nutritional indicators used are type of illness

people suffer from, usually categorised into minor, major and chronic diseases along with

occurrence of injuries and accidents. Nutritional indicators among adolescent girls include

height and weight represented by the composite index, body mass index (BMI), weight

against age and height against age with the standard height and weight as per ICMR

standards for Indian adolescent girls (ICMR 2002). This will vary across age groups as there

are age-specific characteristics. Hence, for adolescent girls, age at menarche, BMI status,

their anaemic status, and finally the reported morbidity is analysed against the above

parameters.

5.11.1. Linkage between morbidity and age at menarche

Age at menarche is a significant indicator which reflects the health and nutritional status of

girls. As the proportion of chronic diseases, accidents and injuries being less, the proportion

of those reported major infections and minor illness and its distribution across girls reported

age at menarche was examined. In the table 5.16 age at menarche is analysed against those

reported minor and major infections captured through self-reporting. It is evident that there is

a slight increase in the proportion of those reported minor (60.5%) and major (62.2%) illness

among those girls who reported their age at menarche in their 14-16 age group. As the

relation between illness and age at menarche is reciprocal it is difficult to attribute whether

major infections have contributed to increased age at menarche or vice versa. Though one

cannot draw a cause effect relationship, it can be inferred that those with greater age at

menarche are the ones who have also reported more illness than those with lower age at

menarche. This is obvious in terms of major infections than with minor illness.

Table 5.16: Major and minor illness reported against girls' age at menarche.

Age at menarche

Any major infections in last 6

months by age at menarche

Any Minor illness

with 15-day recall N

Yes No Yes No

<10 years 62.50 37.50 43.80 56.20 16

10-12 years 52.90 47.10 61.50 38.50 104

12-14 years 50.70 49.30 55.60 44.40 133

14-16 years 62.20 37.80 60.50 39.50 147

>16 years 66.70 33.30 50.00 50.00 6

Total 56.10 43.90 58.40 41.60 406


5.11.2. Body Mass Index (BMI) and Haemoglobin (Hb) level

When the haemoglobin status of girls was plotted against their BMI status, it can be seen that

536 (77.2) out of 694 respondents fell under the category of underweight (<18.5). Among

these, around 43% each had reported their Hb level to be between 7-9 and 9-11gm, both

falling in the anaemic category, as per any standards. Thus, an astonishing proportion (53 %)

of those with underweight (<18.5) had haemoglobin less than 9 gm, indicating that they are

severely anaemic. While in case of those with normal BMI (18.5-25.00) also, those with Hb

having less than 9 gm constitute around 59 % of the respondents, with 36% falling in the 9-11

category.

From the table below, it is clear that the sample respondents are skewed towards low BMI

and low Hb indicating the extent of vulnerability of this population as compared to other

adolescent groups. This implies that majority of the girls suffer from low Hb status and are

also having low BMI according to their age. This being the situation of adolescent girls calls

for the need to focus on the nutritional status of these children, which in turn will have a

direct impact on the overall health status of the girls of ashram school.

Table 5.17: Haemoglobin level in gm% based on body mass index of the respondents

Body Mass

Index (BMI)

Proportion of girls against their haemoglobin level

< 7 gm 7-9 gm 9-11 gm > 11 gm N

<18.50 9.90 43.10 42.90 4.10 536 [77.2]

18.50 - 25.00 8.90 50.00 36.30 4.80 124 [17.9]

25.00 - 30.00 16.70 58.30 25.00 0.00 24 [3.5]

>30.00 10.00 70.00 20.00 0.00 10 [1.4]

Total 9.90 45.20 40.80 4.00 694 [100]

[] parenthesis indicate column percentage

5.11.2. Double vulnerability of ashram school girls

In order to understand multiple vulnerabilities of ashram school girls, who are living in

ashram schools with poor food intake, overcrowding and repeated infections due to

unhygienic environment, it is important to understand the extent of vulnerability. As

mentioned earlier in this report, adolescent groups are a cohort which is sandwiched between

undernourished childhood and high-risk maternal health. Hence, to understand the extent of

vulnerability embodied in bodily parameters like BMI status and Haemoglobin level of tribal

adolescents help. A scatter plot graph that represents the overlap of low BMI and low Hb

level segregated to dark spots towards the bottom left. It is clear that majority of the

population is falling far below the normal values and is concentrated in one space.


Figure 5.1 Scatter plot indicating the relationship between BMI and Anaemic status

The relationship between BMI and anaemic status is clear from the above figure. From the

table, it is evident that those girls who reported low BMI are also the ones who have mostly

reported low Hb status. The overlap of these two parameters, an explicit indicator of low

nutritional status of the study population is obvious from the above scatter plot where the

overlap of most of the cases are indicated by the dark spots consolidated towards the left and

is far below the accepted normal values of both the indicators.

5.11.3. Age at menarche

Age at menarche reported was used as an indicator to understand the manifestation of poor

nutritional status among the girls of ashram schools. It was found that majority of those who

had low Hb level (<9 gm/dl) attain menarche after attaining 12 years whose proportion

increases with decreasing Hb status. For instance, those with Hb level less than 7gm/dl %,

48.7% had age at menarche in the 14-16 age groups andwith 23% in the 12-14 age group.

Whereas among those with Hb level 7-9 gm /dl had reported that 71% of them had their age

at menarche after 12 years, whose proportion that crossed 14 years of age were 38.8%.

Additionally, among those with Hb level 9-11 gm/dl, 75% of them have reported that they

have completed 12 years by the time they had their menarche. Among the same group those

who have crossed 14 years to attain menarche was around 36% (table 5.18). Further, it is

important to note that almost half of the total girls from all the categories of Hb status has not

attained menarche despite their mean age was 12 years again reasserts the possibility of poor


health status among the girls. Similar pattern was also found when examined age at menarche

and BMI level of the girls.

Table 5.18: Age at menarche and Hb level

Hb level Proportion of girls and their age at menarche

Total <10 years 10-12 years 12-14 years 14-16 years

< 7 gm 1 10 (25.6) 9 (23.1) 19 (48.7) 39 (100)

7-9 gm 9 (5.3) 40 (23.5) 55 (32.4) 66 (38.8) 170 (100)

9-11 gm 4 34 (21.8) 62 (39.7) 56 (35.9) 156 (100)

> 11 gm 1 8 (44.4) 3 6 (33.3) 18 (100)

Total 15 (3.9) 92 (24) 129 (33.7) 147 (38.4) 383 (100)

Another important linkage that is crucial among the tribal girls will be their BMI status and

Age at menarche. As mentioned in the earlier sections that their BMI status is extremely poor

and have significant undernutrition reported, it is important to examine whether there is any

linkage with their BMI status. Thought it is difficult to establish a direct causal relationship it

is important to understand their interlinkages especially among vulnerable communities.

Table 5.19 shows the relationship between BMI and age at menarche. It is important to note

that those with BMI less than 18.5 more than 70% had reported their age at menarche after 12

years of which 37.6% had reported after attaining their 14th birthday.

Similar trend was also found among those with BMI in the 18-25 age group, wherein the

proportion who attained menarche after their 12th birthday was 71% with 40% reporting their

age at menarche after 14 years (table 5.19). Here it is important to note that as there is

significant weight deficit (25%) and height deficit (8 cms) reported in the sample, it is

possible that BMI could have distorted due to stunting. Thus it can be concluded that majority

respondents in the study had haemoglobin level and BMI rates which were lower than the

normal range and adding to the agony was their deprived and vulnerable status of being tribal

and repeated morbidities owing to ill health along with poor nutritional disorders together

resulted in bodily processes like age at menarche - an outcome of the adolescent girls’ social,

economic, cultural and political embodiment in the midst of multiple vulnerabilities as argued

by (Krieger and Smith, 2004).

Table 5.19: Age at menarche and BMI level

BMI

Age at which respondent attain menarche

<10 years 10-12 years 12-14

years

14-16

years Total

<18.50 11 (4.8) 56 (24.5) 76 (33.2) 86 (37.6) 229 (100)

18 – 25 3 27 (25.5) 33 (31.1) 43 (40.6) 106 (100)

25< 1 5 (25) 7 (35) 7 (35) 20 (100)

Total 15 (4.2) 88 (24.8) 116 (32.7) 136 (38.3) 355 (100)


5.12. SUMMARY

The morbidity data described in this chapter reiterates the fact that ashram school girls and

their extent of vulnerability is much higher than that reported in general population. This was

clear when it was found that the minor illness reported that shows a tenfold rise than the

general population with hospitalisation rates also showing fourfold rise. This could be due to

the poor living conditions, inadequate food and nutrition requirement and unhygienic living

conditions together contributing to their poor health status. The linkage between morbidity

and nutrition status is clear and is cyclic in nature. This linkage between morbidity and

nutritional status and nutritional status and BMI indicate the extent of vulnerability

adolescent girls of ashram schools are subjected to. The fact that poor nutritional status

leading to poor BMI along with repeated infections in poor unhygienic environment reveals

the state of growth faltering manifested in severe anaemic status and increased age at

menarche. This is a clear demonstration of the life course situation wherein how multiple

vulnerabilities during growing up gets embodied as biological characteristics of healthy

living.

Further, there is an inadequacy in terms of access to health care as most of the respondents

reported major and minor illness for which those from government school mainly sought

treatment in the nearby PHCs, while those form private-aided school sought treatment from

tertiary health care facilities like SDH or RH due to its proximity from the school. Even

though sick room was physically available across school it was hardly utilized for the said

purpose. Instead children were sent home during period of sickness which may or may not

have resulted in proper treatment of the diseases due to economic vulnerability of most

parents. The age of attaining menarche, haemoglobin levels and BMI had significant

influence on higher morbidity among these respondents. With the quantum of medical

personnel allotted for ashram school there is urgent need to capture morbidities and growth

deficiencies at the school-level routinely and further ensure proper treatment and follow up

till recovery.


Tata Institute of Social Sciences, Mumbai| CHAPTER SIX 127

CHAPTER SIX

CONCLUSION

The adolescent population in India comprised of 20.9 % (i.e. 253 million) of the total

population. The country is expected to have demographic dividend in the future due to its

adolescent population consistent at 21% since year 1971 onwards. Invariably, 72 % of the

total adolescents live in rural areas. About 44 million adolescents belong to Scheduled Caste

and 23 million consist of Scheduled Tribe community. The significant number of adolescents,

their historical vulnerability manifested in tribal community has given strong base upon

which ashram schools have initiated across country.

With prime focus on educational upliftment, ashram schools are developed as a response to

ensure social stability for the vulnerable tribal population with the provisions of residential,

educational, nutritional and health services to their children. Such vulnerabilities are often

internalized among these children due to their socio-cultural, environmental historical

context; ashram schools are therefore aimed to change this perception and enable them to

stand as empowered citizens in the society. The adolescent being in the transition phase can

be utilized to shape them into smart and healthy adults. This is also to curb the future risk of

prematurity or malnutrition which is otherwise seen common among the offspring of

adolescent girls who likely to be early mother’s tomorrow. As early marriage and early

conception is a common practice among tribal community- may have untoward consequences

on girls’ health, especially due to poor nutrition and ill health during pregnancy.

Though the children are enrolled at a tender age into the ashram schools to meet their

educational and health needs; recent reports point to the fact that children in ashram schools

are susceptible to various diseases possibly due to poor nutritional status and risky

environments along with exploitation and abuse which needs urgent attention. The state’s

tribal department is accountable to ensure environment conducive for overall physical,

mental, social and spiritual development of the inhabitants of these ashram schools.

Thus, it was important to understand i) the current health and nutritional needs of adolescent

girls; ii) the linkage between ashram schools and the health and nutritional needs of these

girls and iii) how ashram schools and its environment influence in ensuring health and

nutritional needs of the girls. The study considered health and nutritional status of the

adolescent girls as utmost important indicator of their healthy living mediating for good

educational status and empowered, responsible citizen for tomorrow. This is done by

contextualizing the policies of tribal department towards the welfare of adolescent girls.

Furthermore, the contexts in which they are living are examined based on the facility survey

of ashram schools.

It is a cross sectional study with exploratory and descriptive designs. In the exploratory phase

it attempts to examine the prevailing living and working conditions of the adolescent girls,

based on the facilities provided by the ashram schools in coordination with Tribal

Development Department and Public Health Department for the overall welfare of these

Tata Institute of Social Sciences, Mumbai| CONCLUSION 128

children. This was accomplished through the facility survey carried out among selected

schools. The opinions of various officials from these departments and ashram schools were

captured as insider perspective, using key informant interviews. In the later phase, study

intensely looked at living and working conditions of adolescent girls in the schools along

with food intake, general and menstrual hygiene and their current health status captured using

their self-reported morbidity and nutritional indicators. This was captured primarily through

survey method using interview schedule and later supported using focus group discussions

with adolescent girls. The data generated through survey was corroborated with data

generated through the routine medical checkups carried out by the public health department

that helped to examine the multiple linkages.

A total of 800 adolescent girls aged between 10-19 (i.e. studying in 5th to 10th or 12th

standard) were selected for the study; from randomly selected 17 government and

government aided (privately run) schools; from 4 blocks of 4 tribal intense districts belonging

to 4 different ATCs of Tribal Development Department. The district with proportionately

highest Schedule Tribe (ST) population from each ATCs were selected for the study while

the blocks from these districts were selected using simple random method. While the schools

too were randomly selected in such a way that 4 schools belonging to each selected block, of

which 2 were government and 2 were government-aided (private schools). Ethical aspects of

the study were accomplished at multiple levels. The study has gone through the Institutional

Review Board (IRB) of TISS for ethical clearance and necessary consent was obtained from

all the respondents across several stakeholders. Anonymity and confidentiality of respondents

and institutions studied was also ensured.

All the 17 schools included in the study varied drastically with respect to infrastructure

facilities but were almost the same in case of provisioning of facilities to the students.

Though provisioning at government schools were found better than private schools. With

respect to infrastructure, some schools had a separate structure built for school, residential

and other structures as compared to others with poor facilities. Staffing showed essential

shortfalls in permanent appointments while major lacuna was seen across class 4 workers,

which was already provisioned less based on the norms. These shortfalls when managed by

deploying students has serious implication on the health, social and educational aspect of

students.

Building and infrastructure being another issue in most of the ashram schools forced students

to reside and study in poor and menial conditions. This led to issues of privacy,

overcrowding, poor lighting, and ventilation to the room leading to increase susceptibility to

communicable diseases and reproductive infections among adolescent girls. Frequent power

disruptions, unpreparedness to tackle fire-related emergencies and provision of safe drinking

water in all the schools needs to be catered with utmost importance.

Furthermore, non-functional septic tanks and sewage let out into the nearby land by schools

rendered surroundings unhygienic and breeding sites for mosquitoes leading to source of

other diseases. In case of toilets and bathrooms though physical structures existed in most

schools, many of them were non-usable. It is disheartening to see that such conditions prevail

in the backdrop of Swachh Bharat Mission taking off in full swing across the country.


Consumables form an important requirement to most students in context of their socio-

economic background. For most students, consumables were a blessing since they would

have failed to avail any of these products at home. Considering this context most schools

provided consumables of inferior qualities to students, as students and parents, instead of

complaining, considered themselves fortunate to avail these products at school. In this

backdrop, successful utilization of money transferred to joint account of student and parent

through DBT is doubtful even though schools claim to have a mechanism to monitor

utilization of this money.

With respect to educational facilities and health facilities, though it was existing across

schools, it wasn’t deployed effectively for students. Medical check-ups done as part of the

study, but routinely carried out by ashram school medical officers and other medical teams

were also found to be non-satisfactory due to variety of factors like shortage of medical

officers, inadequate time, or non-existence of the medical team itself. Hence, it is essential to

focus on further improvement of existing facilities to ensure healthy growth and development

of these children who are admitted to these schools at a tender age.

Moreover, the access to health care facilities for ashram school children during illness

indicate the dismal situation, wherein primary level care facilities is located around 5-10 kms,

with secondary level around 25-50 kms away and tertiary level care located more than 100

kms away from the ashram schools. Not only the functional status of these health facilities is

under question, more so the failure to have transport facility limits the access to these

facilities during need.

Most girls in the study belonged to the age group of 9-19 years and a mean age of 13.5 (SD

2.1) and majority studying in 8th standard. All were Hindu by religion, belonging to

scheduled tribes, predominantly from Gond and Warli tribes. Among the total respondents,

only two girls suffered disability with one reported locomotive impairment, and another had

visual impairment. Many of these girls resided as far as 30-40 kms away from the school and

majority of them were from Gadchiroli district. This distance could be due to the

geographical difference in this region leading to remote location of ashram schools. Most of

these girls belonged to family with 3-4 members while some had 8 members as well.

Majority of the parents were illiterate or had studied till 5th standard signifying lack of

opportunity to education among their parents resulting in most parents working as daily wage

labourers. Most of these respondents belonged to households earning less than Rs 5,000

monthly and had at least one sibling who had dropped out of the school to support the

household. The occupation status of the girls’ parents also indicates that poor employment

opportunities existing in tribal areas and more so the opportunities available are mostly

seasonal and migratory in nature which demand both the parents need to be working for the

survival of the family. The vulnerable context of these tribal girls in terms of accessing

education and continuing their education without dropping out itself is a challenge. This was

obvious when it was found that 87.5 % of the total respondents said that at least one of their

siblings either dropped out or uneducated in their homes whose intensity was increasing by

decreasing income category.


Considering food as a vital factor in determining the health status of adolescent girls,

breakfast predominantly is seen to be provided including items like sprouts, poha and

chanavatana. Government schools additionally provided eggs and fruits in contrast to private

schools. Schools in Gadchiroli did not offer breakfast due to the cultural differences in this

region of Maharashtra which may possibly point to the poor nutritional status of girls in this

district compared to other districts. Lunch and dinner were provided regularly across schools,

dinner lost its focus by providing only rice, dal and subji in most schools where the cooks and

teachers did not reside within the school premises. Lunch on alternate weekend was served

along with non-vegetarian dish. Evening snack consisting of sprouts, chanavatana was

served mainly to students though it was conveniently skipped during weekends and holidays

in most ashram schools. Though food is provided to the students, the focus remains on

satisfying hunger rather than providing essential nutrients, which is a requirement for many

of these students and parents due to their poor socio-economic status. This failure to ensure

essential nutrients takes a toll on their health. Poor anthropometric indications of stunting and

wasting, anaemia and low BMI reveal urgent need to improve nutritional and health status of

these children. It is obvious that the adolescent girls of ashram schools represent a group with

poor nutritional status attributable to the inherent vulnerability during childhood due to poor

living conditions along with bare minimum food intake within the facilities that is only

sufficient for maintaining their existing health conditions.

General hygiene among inmates was good with regular bathing, brushing, and hair washing

habits. They showed a desire to maintain good hygiene when given an opportunity as

evidenced in nail cutting habit where girls surprisingly reported cutting nails twice a week.

Most of the girls used some form of substance, which was seen as a common practice in their

families across Yavatmal and Gadchiroli districts. It was also observed that a significantly

higher proportion (37.7) of the respondents attained menarche at the age of 14-16 years as

compared to those (32.8) who attained within their 12-14 years, which is the general pattern

for rural Maharashtra. Whereas in case of menstrual hygiene, respondents preferred using

sanitary napkins, but due to non-availability of adequate quantity or poor-quality force them

to use cloth instead. The extent of anaemia among ashram school girls is shocking as 41.5%

reported to have their Hb level in the 9-11 gm/dl range, with 47.9% in the 7-9 gm/dl category

with 10.3% having even less than 7 gm/dl. Similar results were also found in the weight

deficit which was in the tune of 25% deficit as compared to the normal with an average

height deficit of around 8% than it is for girls of similar age.

Yavatmal reports highest number of chronic diseases (9%) and while Gadchiroli has highest

proportion of major infections (69.8%), injuries and accidents (56.3%), and minor illness

(65.3%). From the type of illness reported, it is interesting to note that Palghar has highest

proportion of waterborne diseases like diarrhoea and jaundice. Whereas Gadchiroli and

Nandurbar districts reported highest proportion of fevers especially malaria with

Yavatmaland Gadchiroli districts reporting highest proportion of girls suffering injuries due

to falls and scorpion bite. Thus, we see that Gadchiroli district shows higher rates of

morbidity indicating towards poor health status of the children. While it has to be noted that

students from Palghar were unable to report their illness suggesting lack of awareness about

their existing diseases condition. On the other hand, girls from other three districts were


aware of ill-health hence able to report their morbidities. This suggests that overall there is a

higher onset of all forms of illness among adolescent girls of ashram schools. This was clear

when it was found that the minor illness reported in the study shows a tenfold rise than the

general population with hospitalisation rates also showing tenfold rise than the normal

population. This could be due to the poor living conditions, inadequate food and nutrition

requirement and unhygienic living conditions together contributing to their poor health status.

The linkage between morbidity and nutrition status is clear and reveal its cyclic nature. This

is a clear demonstration of the life course situation wherein how multiple vulnerabilities in

growing up gets embodied as biological characteristics of healthy living.

Majority of the government schools preferred SC/PHC/CHC that are nearby for treatment of

diseases while aided (private) schools preferred public health facilities like SDH/DH that are

far away for treatment of their children. It is noteworthy that many a times girls avail

treatment from their homes, which may be public/private/folk treatment. In most schools,

authorities send children to their homes for treatment, which raises queries on their attitude to

escape from the responsibilities and painstaking process of standing in queues or long waiting

hours in OPD or accompanying them during hospitalization. Age of attaining menarche,

haemoglobin levels and BMI had significant influence on higher morbidity among these

respondents. With the quantum of medical personnel allotted for ashram schools, there is an

urgent need to capture morbidities and growth deficiencies at the school level routinely and

further ensure proper treatment and follow up till recovery.

Most schools provided essential items for daily living though many lacked infrastructural

facilities and staff. Strengthening educational and health facilities is the need of the hour.

Deficit food intake among these children points out to their poor nutritional status, requiring

urgent interventions and thorough health screening to prevent deterioration of their health

which in future may add on to country’s maternal and infant mortality. Interestingly, the

study finds that good general hygiene is maintained by girls despite poor infrastructural

facilities suggesting their willingness to change in favorable conditions. Whereas morbidity

patterns show highest diseases reported in Gadchiroli district, which may be due to increase

in health awareness while Palghar has the least reported diseases due to lack of awareness

and poor reporting. Thus, though policies to ensure well-being of students exist, the quality

and adequacy of implementation at school level need urgent attention.


Tata Institute of Social Sciences, Mumbai| RECOMMENDATIONS 133

RECOMMENDATIONS

Below are the recommendations considering the magnitude of the vulnerabilities and

challenges faced by the ashram school students:

1) Given the inadequate food supply in ashram schools, especially in Gadchiroli where

breakfast is not provided but similar item is given as snacks in the evening, while other

schools do not provide evening snacks, it is essential to look at the food quality and supply of

these schools with highest priority. It is important for the adolescents to ensure ashram school

life as an opportunity to substantially improve their health and nutrition status. This is

because it is highly probable that in the current context of unemployment and poor

opportunities for livelihood, the same girls when they acquire child bearing age further can

lead to high risk maternal health. Hence, it is important to improve their health and nutritional

status in these facilities by providing healthy and nutritious food with adequate quantity

which are attractive so that students can enjoy eating. The menu at ashram schools should be

at par with Kendriya Vidyalaya or Sainik School. This is because the quality and adequacy of

the food that the children have access to has direct linkage to their health outcomes not only

for shorter or immediate duration but also as they grow to adulthood in future.

2) As the general hygiene behaviour shows, children have a desire and willingness to

maintain hygiene in situations where adequate facilities are provided. It is important to ensure

adequate toilet units with running water facilities and space for drying clothes are provided in

all the schools along with better drainage systems. Efforts need to be made to align the

facilities provided with the Swachh Bharat Mission so that additional focus to the hygiene is

given and maintained. Regular monitoring of toilet units and running water facilities need to

be carried out and a register towards the same should be maintained. Adequate infrastructure

becomes a prerequisite to improve general hygiene behaviour and considering the inadequacy

of clean potable water, adequate number of facilities like toilets, bathrooms, washrooms,

drinking water places, hygiene at kitchens, dining areas and areas of residences we would like

to recommend that all these facilities has to be adequately made available to the school

children. More so they should be periodically monitored, maintained and improved as per the

need by the authority.

3) On menstrual hygiene, it was found that in most schools, there is an adequate supply of

sanitary napkins to girls except in few situations. The quality of sanitary pads was found poor

in some schools. Minimum quality needs to be ensured for the sanitary pad supplied

considering the fact that most of the ashram schools are situated in remote locations and

access to markets are not there. It is recommended that all items, which are needed by the

girls, should be provided to them physically every month or year rather than the DBT service,

as it may not necessarily ensure that the girls buy these items through DBT money or use it to

incur expenses of the family. Provisions also be made of clean hygienic cloths and good place

to clean or dry it up if they were to reuse, as an alternative for napkins to reduce the non-

degradable bio-waste. The female hostel warden should be compulsorily given periodic

training on WASH for ensuring menstrual hygiene of adolescent.


4) Health and nutritional status have to be the major concern among these ashram school girls

as adolescence is the best time to rectify the ills of the past, especially during childhood and

also prepare them to take on the additional nutritional requirements as a working woman in

future. The study not only reveals the poor nutritional status of ashram school girls but also

points to its possibility of multiple manifestations like greater infection rate, especially minor

illness and major infections, along with prolonged age at menarche and poor BMI along with

dismally low Haemoglobin status indicating high anaemia rate. Though it is a feature of high

anaemia status in Indian context among adolescence, the proportion of cases in the severe

category has to be a concern. Regular and meticulous health check-ups should be made

mandatory for these ashram schools and regular monitoring and follow-up of necessary and

urgent cases.

In the study it was found that due to various systemic and poor inter-sectoral coordination

with public health department, medical check-ups are usually delayed and even if poor

anaemic status is found it gets ‘normalized’ as a feature of tribal societies instead of

responding to it. Additionally, there is a clear inadequacy of health promotion activity in

these schools on a regular basis as most of the time this responsibility is given to the female

warden or head master whose understanding about health needs of adolescent girls and more

importantly proactively engaging/ liasoning with the public health departments are not

adequate. It was also found when the girls fall ill and treatment seeking behaviour of girls’

reveal that in severe situations, they are always sent home to look after themselves.

What is proposed here is that for every school with more than 300 students, one public health

officer (PHO) should be appointed who can take care of range of activities related to ensuring

adequate food and nutrition status, regularly maintaining menstruation register, health

register, monitoring of toilet facilities and liasoning with public health department to

regularly organize health camps and follow-up of those girls who need special care, render

counselling on overall health promotion and psychological health concerns. Above all,

maintenance and regular monitoring of the height and weight of the children of ashram

schools should be maintained, especially in the situations where undernutrition and stunting

are severe. This liasoning with the public sector facilities will also help easy channelizing of

those girls who fall ill for appropriate treatment centres and even referral centres as and when

necessary. In the current context, most of these tasks are carried out as another ‘routine’

without necessary acknowledging the public health dimensions of the problem. The sickroom

should be equipped to meet all the primary level care of the children with at least 4 functional

beds. For the secondary and tertiary care effective referrals should be maintained. Ashram

school should maintain a functional vehicle ready for attending any emergencies. These gaps

in treatment seeking can also be the responsibility of the public health officer to liason with

the public health department as and when necessary.

5) As the original intention of ashram school to empower the underprivileged children with

education and look after their wellbeing, it is assumed that good health and wellbeing is a

prerequisite for effective education. Hence, there is ample scope of improving the educational

needs at various schools. As a preliminary step, education and living environment should be

separated as in many schools the classrooms are also used for living as well as hanging


clothes for drying during ongoing lectures. This explains the quality of education that can

happen in such kind of environment. All schools should have staff appointed as per the

Ashram School Samhita (2005). Several schools were found to have vacancies reported and

that too in teaching staff. All the required posts of ashram school should be filled on a

permanent basis and the inadequacies of these staff overburden the existing staff which

adversely impacts on the services they provide for the children.

Another area which can be focussed for future development is on linking several schools with

vocational education and opportunity to develop careers in sports by affiliations with

National Skill Development Mission and Sports Authority of India respectively in addition to

the routine educational career paths. The availability of playgrounds and open space near to

the ashram schools can be utilised for playgrounds earmarked for the same.

****************


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Tata Institute of Social Sciences, Mumbai| APPENDIX 143

APPENDIX

TOOL 1- INTERVIEW SCHEDULE FOR GIRLS

INTERVIEW SCHEDULE FOR GIRLS

CONSENT AND FORMAT

TATA INSTITUTE OF SOCIAL SCIENCES

DEONAR, MUMBAI – 400088

Girls Informed Assent for Participation in In-depth interview on Health of Adolescent girls in

Ashram Schools

Project Title: Health Issues of Adolescent Girls in Ashram Schools in Maharashtra.

Participant Information Sheet:

Tata Institute of Social Sciences, is doing a research study on Health issues of Adolescent

Girls in Ashram Schools. The study aims to understand the health and nutritional needs of

adolescent girls in Ashram schools. We also wish to understand all the challenges around

meeting health and nutritional needs of these girls and, what solutions are required to

improve the situation. For this reason, we are grateful to hear the views of all you girls in

this school.

Health in any way has less priority in our country, and health of remote tribal girls is on

least priority of the society. Hence, we would like to understand what way health of all you

girls get affected and because of what reasons. What provisions are being made to

ascertain your health? This is very informal interaction; you can talk about anything you

think is important for us to know. I also want to remind you that everything we talk about

today is confidential. No one will hear this tape except the people working on this project.

Whenever we write a report based on the information you have given, we will use numbers

or fake names so no one can identify you. If there are any questions you’d rather not

answer, just let me know - that’s fine.

Your frank responses and discussion will be most helpful to us as we try to really

understand these issues. Remember, your answers to our questions will not be considered

“right” or “wrong”, because we just want to know about what you think. They are merely

information you will provide based on your experiences, observations, or feelings. Your

participation in this study will be voluntary and consisting of an interview lasting

approximately 40-50 minutes. In case you have any queries on the research project you are

free to contact on the phone number given below. If you agree to participate in this study,

then we can discuss in a private setting of your choice, where you will feel comfortable to

talk with me.

Contact Details:

Dr Narendra KakadeDr. Mathew George

Principal Investigator, Co- Investigator,

Tata Institute of Social Sciences. Tata Institute of Social Sciences.

Ph: 022 25525514 Ph: 022 25525512


CERTIFICATE OF CONSENT

I__________________________________________________ have read the participant

information sheet for “School Girls” about ongoing research project on “Health Issues of

Adolescent Girls in Ashram Schools in Maharashtra.”

The information contained in the participant information sheet regarding the nature and

purpose of the study, safety, and its potential risks / benefits and expected duration of the

study and other relevant details of the study, including my role as a study participant, have

been explained to me in the language that I understand (Marathi/ Hindi/English). I have had

the opportunity to ask queries, which have been clarified to my satisfaction.

I understand that my participation is voluntary and that I have the right to withdraw

from the study at any time without giving any reasons for the same.

I understand that the information collected during the research study will be kept

confidential. The representatives of sponsor/, government regulatory authorities/ethics

committees may wish to examine my records/study related information at the study site to

verify the information collected. By signing this document, I give permission for these

individuals to have access to my records.

I hereby give my assent willingly to participate in this research study.

Witnessed Assent: Girl’s In-depth Interview

The following will be read to participants and their written assent sought.

1. I have read this information sheet (or have understood the verbal information) that

explains the reason for the study, and the procedures that I will be asked.

2. I understand that I am free to choose whether or not I wish to participate, and that no

pressure has been put on me to participate. I can withdraw from the study at any time.

3. All the questions I had about this study have been answered.

4. I understand that I can request the tape recorder to be switched off at any time.

5. I agree to take part in this study.

6. I agree to quote without my name being published in the study.

Name of location: ______________________________

Name of participant: ______________________________

Date: _____Month______Day_______Year

Participant Signature: ______________________________

Witness Assent:

I have witnessed the consent procedure of the study participant and the individual has had the

opportunity to ask questions. I confirm that the individual has given consent freely.

Name of the consenting person/Guardian: __________________________________

Witness Signature: ____________________________

Name and signature of Person who collected consent: __________________________


Tata Institute of Social Sciences, Mumbai

Health issues of Adolescent Girls in Ashram Schools in Maharashtra

Interview Schedule for Girls

(This will be completed by research staff)

Date of interview

School name

Survey code for School number

Co-ed or Girls only school 1) Co-Ed

2) Girls only

Physical location of school (address)

A. SOCIODEMOGRAPHIC AND HOUSEHOLD CHARACTERISTICS

Sr.

No.

Questions Response

1. Type of the school 1. Government

2.Government Aided (private)

3. Private Unaided

2. Age in completed years

3. In which standard are you currently studying?

4. Religion 1. Hindu

2. Islam

3. Buddhism

4. Other specify ----------

5. Caste 1. SC

2. ST

3. NT

4. OBC

5. Gen

6. Sub tribe/sub caste

7. Which year did you take admission in this school

8. No. years studying in this school

9. How far is your home from the school?

10. How often you go home in a year? Specify the time

period?

------------Times/ years

11. How many days (total) in a year you stay home

when you go home?

Ganpati_______

Diwali________

Holi__________

Summer Vacation__________

Others__________

12. Do you have any disability Yes/No

13. Type and percentage of disability ____________ and

________%

14. Any corrective aids used, if yes what are they?

15. Who provides these corrective aids? Govt/self

16. If self how much was the cost?


B. SOCIO-ECONOMIC AND FAMILY BACKGROUND OF THE CHILDREN

Name of

family

members *

Relation

with

respondent

Age Sex Marital

status

Education Major

Occupation

Income

Monthly#

Remark

*starting with Adolescent girl respondent

# Individual income need to be calculated for a month according to the type of occupation

they are in.

Any other source of household income: Yes/No

If yes, details, of the sources: (this is excluding the income recorded in the table)

Source 1:_________________ Source 2: _________________

Source 3: ________________ Source 4: _________________

___________________________________________________________________________

Approximate annual Family income (in Rs.):____________________________________

Label: Annual Income Code:_______________

C. RESIDENTIAL FACILITY AT THE ASHRAM SCHOOL (living conditions and

provisioning of services)

Sr. No. Particulars Response

i. Are you residing in the hostel? Yes/No

ii. If yes, number of years staying in this hostel

iii. Did you receive the following items from the

school? When?

Items Specifications and number (0, 1, 2,---) When did you last received?

Utensils

Beddings

Gown

Bathing

materials

Clothes

i. What do you think is the quality for these materials provided by the school? (Specify

brand name)

ii. What essential material are required to bring from the home?

iii. Why?


D. FOOD PATTERN (One week preceding the survey/ one weekend and one weekday)

Particulars

Last Weekday Weekend (Sunday) How sufficient is the food

for one time? (Y/N) Timing

Food items

(in quantity)

Timing Food items (in

quantity)

Breakfast

Lunch

Evening

Snacks

Dinner

Type of

festival

Food items served during

festive occasions

Quantity Timing (Breakfast/

Lunch/Dinner)

E. DAILY ACTIVITIES (1-day routine)

What is your daily routine? Time: (from ______to _____ for each activity)

Sr.

No

Questions (actual) Timing

1. At what time you wake up in the morning?

2. Prayer timings

3. Breakfast timings

4. Study time (for home work)

5. School timing (can be in the morning and evening)

6. Lunch timing

7. Evening snacks timing

8. Play Time

9. Dinner timing

10. Night study

11. At what time you go to bed?

12.

F. PERSONAL HYGIENE


Sr.

No

Questions Response

1. Do you brush your teeth daily? I) Yes

II) No

2. If no, then why?

3. How many times do you brush your teeth in a day? I. Once

II. Twice

III. other---------

4. How often do you take bath?

_______/day

_______/week

5. With what do you take bath? I. Shampoo

II. Soap

III. Others----------

6. Do you wash your hair? I) Yes

II) No

7. If no, then why?

8. How frequently do you wash your hair?

I. Daily

II. Once in a week

III. Twice in a week

IV. Others (specify)

9. With what do you wash your hairs? I. Shampoo

II. Soap

III. Others (specify)

10. Do you oil your hair regularly? I) Yes

II) No

If no then why?

11. How often do you comb your hair?

12. How frequently do you oil your hair?

I. Daily

II. Once in a week

III. Twice in a week

IV. Others (specify)

13. Which oil do you use to oil your hairs? (specify brand)

14. How often your hair get infested with lice?

(need a defining criteria)

I. Always

II. Very often

III. Rarely

IV. Never

15. How frequently do you remove lice from your hair?

How do you remove?

I. Once in a week

II. Twice in a week

III. Frequently in a week

IV. In a month or two

V. Never remove

16. How frequently do you cut your nails? (specify)

17. Do you wear fresh washed clothes after taking bath? Yes

No

18. For how many days do you use one cloth? I.One day

II.Two days

III. Three or more days

G. MENSTRUATION AND MENSTRUAL HYGIENE


Information on menstruation:

1. Can you tell us at what age girls attain

menarche?

2. Did you attain menarche? I. Yes

II. No, If no, skip to Q.44

3. At what age did you attain menarche? (actual) -------yrs

4. Do you get your periods regularly? Yes/No

5. If no how often do you get? (Note: interval

between two periods)

6. Did anyone tell you about how to take care of

your menstruation and hygiene? (Tick any that

apply)

I. No one

II. Mother/ father or person who

cares for you

III. Another relative

IV. Friends

V. School teacher (male)

VI. School teacher (female)

VII. Other, specify

7. When were you told about this? (Tick one

answer only)

I. Before start of your first

period

II. at the time of your first period

III. After you had your first period

IV. Never told

Absorbent use:

8. What type of absorbent usually do you use

during menstruation?

I. Sanitary pad

II. New cloth

III. Old washed cloth

IV. Other specify---------------

9. Why do you prefer it?

10. Where do you get the above material? If answer to Q.9 is not 1, skip to Q.17

11. What do you do with used absorbent material

(pad/ cloth)?

I. Throw it

II. Burn it

III. Reuse it

IV. other specify___________

12. If thrown, where do you dispose used pad?

13. Do you change pad during your menses? Yes/No

14. If yes, how many times do you change on each

day? (please mention the number of pads

changed on each day of discharge)

I. On first day_____________

II. On second day____________

III. On third day____________

IV. On remaining days_________

15. If the number of pads used on the first and

second day is less than two then, why is it so?

16. If to reuse, where do you store your used cloth

once it is washed?

17. For how long do you reuse the cloth?

18. Where do you wash the used cloth?

19. What do you use for washing used cloth?

20. Where do you dry the washed cloth?

Menstrual hygiene:


21. Do you take daily bath during menstruation?

If No, then in how many days do you take bath?

Yes/No

22. During menstruation days, do you clean your

external genitalia?

Yes/No

23. If No, Why?

24. If Yes, how many times do you clean external

genitalia during menstruation?

I. Every time you visit toilet

II. Every time you change

absorbent material

III. Others specify ____________

Sanitation facilities available at school:

25. Is there supply of water in toilet for maintaining

menstrual hygiene?

Yes/No

26. Is the supply of water adequate? Yes/No

27. If the water is not available in the toilet what do

you do?

28. In the last week was water there in the toilet? Yes/No

29. If no then why?

Sanitary pad availability

30. With what do you clean your external genitalia


31. How many sanitary pads do you get from school

for a month?

Y/N, If No, skip to Q.6

32. Did you get sanitary pads from the school?

33. Do you get sanitary pads for free from school? Yes/No

34. Do you have to pay for it to school? Yes/No

35. If yes, how much do you pay?

36. If you yourself have to purchase pad, where do

you purchase it from?

Shop

Chemist shop

Others--------------

37. How far is the shop/ chemist/ place from the

school premise?

38. How much is the cost of pad for one cycle?

Tackling menstrual discomfort:

39. Do you have any complaints or health problems

related to menstruation?

Yes/No

40. If yes, what are they? I. Foul smell

II. Itching

III. Abdominal pain

IV. Back pain

V. Cramps

VI. Irregular periods

VII. Not attain menarche (13<yrs

VIII. other specify___________

41. Have you reported it and taken any treatment?

42. If yes, whom was it reported and what was the

treatment?

43. If No, why?


44. Does menstruation cause any disturbances in

your daily routine? (Mention Yes/No)

If yes, then what are they?

I. Sleep disturbances_______

II. Decreased appetite________

III. Prolonged resting hours:

_________________

IV. Missing classes:

_________________

V. Others (specify):_________

45. Does your warden maintain MC register

/records?

Yes/No

46. If yes, what are those details?

47. How often/ regular warden maintain MC

records?

48. Whom do you take help from for the issues

related to menstruation?

Practices followed during menstruation:

49. Do you do anything differently during your

menstruation ?

Yes/No

50. If yes, then what are those practices?

51. Do you have any different sleeping arrangements

when you are menstruating?

Yes/No

52. If yes, why and what are those practices?

53. Do you follow any religious practices differently


Yes/No

54. If yes, what are they (specify):

55. Do you follow any different food related

practices when you are menstruating?

Yes/No

56. If yes, what are they (specify):

57. Do you go to school as usual when you are

menstruating?

Yes/No

58. If no, why?, (specify)

H. ABUSE

1. Have you heard of good touch and bad touch? Y/N

2. If Yes, can you explain?

3. Have you ever faced any form of harassment from anybody in the Ashram

school?

Yes/No

4. Can you explain?

5. Have you ever faced any form of discrimination from anybody in the Ashram

school?

Yes/No

6. Can you describe about it

7. What action was taken by the Ashram school authorities during harassment/

discrimination?

I. SEXUAL HEALTH


Sr.

No

Questions Response

1. Have you ever experienced any abnormal itching or burning sensation in

or around private parts

Yes/No

2. Have noticed any sores on your private parts? Yes/No

3. Did you ever experience any burning sensation associated with

micturition?

Yes/No

4. Have you ever experienced any kind of white/brown thick discharge

from your genital parts?

Yes/No

5. Do you have any associated discomfort with the discharge? Yes/No

6. Are you aware of HIV-AIDS? Yes/No

7. If Yes, what are you aware of? (Symptoms, Mode of transmission etc.)

8. Are you aware of Sexually Transmitted Diseases? Yes/No

9. If yes, what are you aware of? (Symptoms, Mode of transmission etc)

10. Where did you get this information?

J. SELF-REPORTED MORBIDITY AND TREATMENT SEEKING

1. Chronic diseases (person suffering from an illness for past one year and is continuing his

treatment such as diabetic, CHD, hypertension etc)

Sl

No

Type of

Symptoms

First

identified

Diagnosis

(if any)

Place of

treatment*

Required

hospitalization

(Y/N) and number

of days

Who

accompanied

to treatment

place

* Govt hospital, PHC, Ashram School, Home or Others

2. Major infectionss – person suffered or have suffering from major infections such as

TB, malaria, Japanese Encephalitis, Jaundice, measles, mumps etc.

Type of

Symptoms

First

identified

Diagnosis

of the

symptoms

(If any)

Place of

treatment*

Duration

of

illness#

Required

Hospitalization

(Y/N) and

number of

days

Who

accompanied

to treatment

place?


# Duration: From the start of the illness to end of the illness


3. Injuries and accidents – Any reported injury or accidents occurred in the past one

year /six months (including snake , animal or insect bites)

Type of

Injury/

accident

Cause of

injury/

accident

Place of

treatment*

Diagnosis of the

Injury/ accident

Severity

∞

Required

Hospitalization Y/N)

and number of days

Who accompanied

to treatment place


∞Minor, Major or Severe

4. Acute Disease – any minor diseases with short spell occurred (at symptom level only)

in last 15 days such as cough, cold, fever, diarrhoea, dysentery, skin infections etc.

Type of

Symptoms

First

identified

Place of

treatment

Diagnosis of the

symptoms (?)

Type of

Treatment

sought

Required

hospitalization Y/N)

and number of days

Who accompanied

to treatment place

K. ACCESS TO HEALTH SERVICES

1. Is there separate sick room in your hostel/ residence? Yes/No

2. Are you kept along with other students when you are sick Yes/No

3. Were the health check-up camps held in the school? Yes/No

4. Was it held anytime recently? Yes/No

5. Who had conducted health check-up?

6. How often health checkup camps are arranged in the school?

7. What all diseases are diagnosed and treated during camps?

8. How many doctors come for the camps?

9. Are medicines provided in these camps?

10. Can you suggest ways to improve the health checkup camps?

11. What is your opinion about these camps?

12. When you are sick who accompanies you to the hospital?

13. When you were sick did you get treatment for your illness?

14. How promptly did you receive the treatment?

15. How far is the hospital from your school?

16. Where do you go for treatment when you fall sick?

17. Are your parents informed about your illness?

If yes, Are they asked to accompany/ take you home when you are sick?

Yes/No

18. Are you asked to go home with your parents until you get cured? Yes/No /

Others

19. Why?


L. Substance Use:

1. Do your friends use any form of tobacco? Y/N

2. If yes, Which form of tobacco is prominently used by

your friends?

3. How often do they use?

4. Do they have any other habits?

5. Do you consume any form of tobacco or alcohol? Yes/No, If No, skip to

6. If yes, what addiction do you have?

7. How much tobacco or tobacco products ( do you

consume/ in a day

8. Since when you have this addiction

9. What other addictions do you have and since when?

10. How did you develop this addiction?

11. What do you think are the reasons you picked up this

addiction?

12. Any attempt you made to quit the addiction Yes/No

13. When did you attempt to quit the addiction?

14. How many times did you attempt to quit the addiction?

15. Do you plan on quitting the addiction somewhere in the

near future?

M. MENTAL HEALTH

Sr.

No.

Over the last 2 weeks, how often have you

been bothered by any of the following

problems?

Never Occasionally Sometimes Always

1 2 3 4

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling asleep, or sleeping too

much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself - or that you are

a failure or have let yourself or your family

down

7. Trouble concentrating on things, such as

reading the newspaper or watching

television

8. Do you feel safe when your

friends/teachers are around

9. Thoughts that you would be better off dead

or of hurting yourself in some way

10. Moving or speaking so slowly that other

people could have noticed? Or the opposite

— being so fidgety or restless that you

have been moving around a lot more than

usual


TOOL 2- GUIDELINES FOR FOCUS GROUP DISCUSSION

FOCUS GROUP DISCUSSION CONSENT AND GUIDELINES



Girls Informed Assent for Participation in Focus Group Discussion on Health of Adolescent

girls in Ashram Schools






meeting health and nutritional needs of these girls and, what solutions are required to

improve the situation. For this reason, we are grateful to hear the views of girls of your

school.

Health in any way has less priority in our country, and health of remote tribal girls is on

least priority of the society. We would like to understand what way health of you all girls

get affected and because of what reasons. What provisions are being made to ascertain

your health? This is very informal; you can talk about anything you think is important for

us to know. I also want to remind you that everything we talk about today is confidential.

No one will hear this tape except for people working on the project. Whenever we write a

report, we will use numbers or fake names so no one can identify you. If there are any

questions you’d rather not answer, just let me know - that’s fine.




information you will provide based on your experiences, observations, or feelings.

Everyone’s views are equally important. It’s fine to disagree with other people’s views, but

if you do, it’s important to disagree in a respectful and polite manner. It’s important for

you to talk in turns to speak, because if you all speak at once, we will not have a clear

recording. If you disagree with something anyone says, you can say ‘I disagree’ and then

wait for them to finish before you speak.

In case you have any queries on the research project you are free to contact on the phone

number given below.

Contact Details:




Ph: 022 25525514 Ph: 022 25525512




information sheet for “School Girls” about ongoing research project on “Health Issues of





been explained to me in the language that I understand (Marathi/ Hindi/ English). I have had


I understand that my participation is voluntary and that I have the right to withdraw from the

study at any time without giving any reasons for the same.

I understand that the information collected during the research study will be kept confidential.

The representatives of sponsor/, government regulatory authorities/ethics committees may

wish to examine my records/study related information at the study site to verify the

information collected. By signing this document, I give permission for these individuals to

have access to my records.


Witnessed Assent: Girl’s FGD

The following will be read to participants and their written assent sought.

1. I have read this information sheet (or have understood the verbal information) that explains

the reason for the study, and the procedures that I will be asked.

2. I understand that I am free to choose whether or not I wish to participate, and that no pressure

has been put on me to participate. I can withdraw from the study at any time.

3. All the questions I had about this study have been answered.

4. I understand that I can request the tape recorder to be switched off at any time.

5. I agree to take part in this study.

6. I agree to quote without my name being published in the study.

Name of location: ______________________________

Name of participant: ______________________________

Date: _____Month :______Day: _______Year


Witness Assent:

I have witnessed the consent procedure of the study participant and the individual has had the

opportunity to ask questions. I confirm that the individual has given consent freely.

Name of the consenting person/Guardian: __________________________________

Witness Signature: ____________________________

Name and signature of Person who collected consent: ___________________________


Tata Institute of Social Sciences, Mumbai

Health Issues of Adolescent Girls in Ashram School

Focus Group Discussions: Girls

PROFILE OF THE PARTICIPANTS:

MODERATOR: Document required information as appropriate for each FGD using the

formats provided below.

Date: _____/_______/________

Initials: Moderator: ______ Note Taker______ Recorder Number: ____

Folder/File Name (location on recorder): _______________________

Interview location (Venue):

_________________________________________________________

FGD Group: ____________________________________________________

FGD Number: _____

Time Start: _______________ Time stop: ________________

No. Participants at start of FGD: ________

No. Participants at the end of FGD: _________

Demographic information for every FGD participant [to be completed on a one-to-one

basis, immediately after assent is obtained]

Participant

number or Fake

name

Age

(in completed

years)

Menstrual

Experience

(years)

Ethnic group

Education

(present

grade)

Older sisters

1

2

3

4

5

6

7

8

9

10

11

12

COMMENTS – reasons for withdrawal, refusal, ambience of FG, level of interest,

disagreements, etc

Introduction


Thank you so much for your willingness to take part in this group discussion. My name is

[Name].

I am from the Tata Institute of Social Sciences, Mumbai. We are doing a research study on

Health issues of Adolescent Girls in Ashram Schools. The study aims to understand the

health and nutritional needs of adolescent girls in Ashram schools. We also wish to

understand all the challenges around meeting health and nutritional needs of these girls and,

what and solutions are required to improve the situation. For this reason, we are grateful to

hear the views of girls in [Name of community/school]

Health in any way has less priority in our country, that health of remote tribal girls is on

least priority of the society. We would like to understand what way health of you all girls

get affected and because of what reasons. What provisions are being made to ascertain your

health? This is very informal; you can talk about anything you think is important for us to

know. I also want to remind you that everything we talk about today is confidential.

However, you must not discuss anything that has been talked about in this discussion, with

anyone outside of this group after it has finished. Also, you should not discuss issues that

are personal to you. No one will hear this tape except for people working on the project.

Whenever we write a report, we will use numbers or fake names so no one can identify

you. If there are any questions you’d rather not answer, just let me know - that’s fine.




information you will provide based on your experiences, observations, or feelings.

Everyone’s views are equally important. It’s fine to disagree with other people’s views, but

if you do, it’s important to disagree in a respectful and polite manner. It’s important for you

to talk in turns to speak, because if you all speak at once, we will not have a clear

recording. If you disagree with something anyone says, you can say ‘I disagree’ and then

wait for them to finish before you speak.

• Explain the role of note-takers and tape-recorder. Give a few minutes for answering any

questions regarding the FGD

Please note the questions here:

_____________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

MODERATOR: Allow group to decide; assign fake names or use participant numbers.

Make sure to use these fake names or participant numbers in note-taking and transcription.

Make name tags using the fake names or participant numbers.


Areas Questions Probes

SECTION I: EDUCATION ENVIRONMENT AND INPUTS OF SCHOOL

Education environment

1. How do girls

perceive class

learning?

2. How much they

gain out off?

3. How much

school

environment

nurture for

learning?

How is the sitting

arrangement in your class

How comfortable or congested you feel in

the class if not, why?

Are there adequate

bench/chairs to sit?

Are they in good conditions?

Are there separate arrangements to sit for

girls, if not where do they sit? Or they sit

along the boys?

Is there adequate lighting in

the class?

If there is no adequate lighting how does

students manage their learning?

How often lighting was not there in the

preceding week

Education inputs

What are the teaching

learning materials available

in the class?

Are they adequate? Are they in good

conditions or quality? Does teachers use

them for better explanations of subjects?

How regular are your

teachers in class?

If not, how does class manage their

learning?

How often teachers are not there in the

class?

Do you follow what is being taught in the

class?

What efforts does teachers make for your

learning?

Do you enjoy the class learning?

How many teachers stay in

the campus

Do they stay with their family?

How many do not

Why they don’t stay?

What problem/difficulty you face when

your teachers/ staff is not staying in the

campus

How is your daily routine

at school?

What time you get up or sleep?

What are your meal time

Did you get any materials

from the school?

What did you get? when? if you get late

why? Is it adequate? If you don’t how do

you manage?

SECTION II: LIVING CONDITIONS AND FACILITIES OF HOSTEL

Living arrangement

Facilities at the

hostel?

Did you get the material for

bedding and daily use?

What did you get? when? if you get late

why? Is it adequate? If you don’t how do

you manage?

Are there separate

residence for girls

If yes is it adequate, how many girls are in

one room? Are there separate beds for each

girl? Is it congested?

If not how do you manage?

Is their adequate light in the

room?

How frequent electricity goes off? Is the

back up for electricity?

If not how do you manage?

Are there adequate toilets There adequate water available? How clean


in the girls residential area? and hygienic those toilets? Who cleans it?

Do you regularly use?

If not how often you do not use those

toilet?

If you do not use toilet, where do you go

for toilet? How about your safety?

Are there adequate

bathrooms in girl’s

residential area?

There adequate water available? How clean

and hygienic those bathrooms? Who cleans

it? Do you regularly use?


bathrooms?

If you do not use bathrooms, where do you

go for taking bath? How about your safety?

Does you hostel has a

facility for washing

clothes?

There adequate water available? How clean

and hygienic those washrooms? Who

cleans it? Do you regularly use?


bathrooms?

If you do not use washrooms, where do you

go for taking bath? How about your safety?

Is there lady

attendant/warden during

night at the hostel

How often the lady attendant is not there

during night

In the preceding week was there lady

attended / warden present in hostel?

Does the school has play

ground for children to

play?

If they have any specific time? Is it in good

condition?

What type of games they play? Are there

any games? Is it in the school premise? If

not at what distance? What is the condition

of the play ground? If bad condition where

do you play?

Are there any facilities to

store their clothes and other

essentials?

Do they have cupboards/trunks/racks etc.?

are they adequate? What is the condition of

it? If you do not have any of such facility

what do you do to store your cloths

Supplies and provisioning for living

Food and Drinks What is the daily meal

pattern

Timings? Portions? do they get food if they

are late? Do they get extra if they want?

Taste of the food? Quality?

Does the menu change every day or

remains same?

Do you help in cooking? How do you help?

Drinking water Is there enough fresh water for drinking?

Where do they store it? Who does it? How

is it done?

Environmental determinants

Cleanliness and

hygiene in school

premise

Where is garbage being

dumped generated at school

or hostel?

At what distance? Kept open or processed

it? Any foul smell you get due to that?

Problem of flies, on any specific months?


Open drainages? What is arrangement of drainages? How

often they are choked? Who cleans it?

Are there stagnant water around the school

/ hostel area

Is mosquito breading

around the school/ hostel

premise?

Are there mosquito breading grounds?

What difficulties you face due to that?

What does the school administration do

about that?

Grass or bushes in the

surrounding?

Is your school surrounding is covered with

grass or bushes? Insects / snakes

infestations?

Is your kitchen and dining

area clean and hygienic?

How much is your kitchen and dining area?

How often is kitchen being cleaned? If

kitchen and dining is not clean what do you

do?

SECTION III: HEALTH & HYGIENE BEHAVIOR

Wellness

General health

hygiene of girls

How often do you oil your

hairs?

If not why?

How often are your hairs

get infested with lice from

your hair?

How do girls learn about

menstruation?

From whom? What do they tell the girls?

Is it good information? Why / why not?

How girls

perceive

menstruation

What does menstruation

mean to girls like you?

- Positive / Negative

experience

Why?

Are there some local

customs that stop girls from

doing things when

menstruating

What are they – what do girls feel about

this – do girls agree, disagree – do they

‘comply’ or reject some of these?

If girls like you had a

choice what would they use

for their menstrual period?

(If applicable) what would

stop them from using it?

Tell me about using

…….(each product

mentioned)Why do some

girls use …….(each

product)What is good about

using (each product)

What is not good about

using (each product)

Why?

Prompt for each product mentioned

Do girls / your friends go to

school when they are

menstruating? If not: why

If not/ not always – prompt for issues to do

with physical illness / discomfort or

menstrual management issues.


not?

Illness

Illness Acute illnesses

(Which is the general

illness occurring in the

hostel? do not focus on the

illness of one individual

alone)

What kind of health issues most commonly

faced by girls? Is there any specific month/

season of the year?

If someone is sick what is being done? Any

treatment provided?

When the student is taken to the hospital?

Where? Is it immediate?

If they could describe any of their current

experience?

Are they allowed to go home? Or they are

sent home?

If the child has long illness

– more than past six

months (chronic illness)

What treatment being given to such

children? Where? Do they get medicines

on time? Do they face issues in visiting

doctors? Do they face any issues because

of their illness? Probe?

Do they or their parents

have to pay for the

diagnosis or treatment of

the children?

Why? How often?


TOOL 3- GUIDELINES FOR KEY INFORMANT INTERVIEW

KEY INFORMAT INTERVIEW CONSENT AND GUIDELINE



Girls Informed Assent for Participation in stakeholder/ key informant interview on Health of

Adolescent girls in Ashram Schools






meeting health and nutritional needs of these girls and, what solutions are required to improve

the situation. For this reason, we are grateful to hear your views as on behalf of [Name of

community/school]

Health in any way has less priority in our country, and health of remote tribal girls is on least

priority of the society. We indent to understand the root cause affecting the health of girls in

Ashram Schools. What provisions are being made to ascertain health of children especially

adolescent girls? This is very informal; you interview, can talk about anything you think is

important for us to know. I also want to remind you that everything we talk about today is

confidential. No one will hear this tape except for people working on the project. Whenever

we write a report based on the information you have given, we will use numbers or fake names

so no one can identify you. If there are any questions you’d rather not answer, just let me know

- that’s fine.

Your frank responses and discussion will be most helpful to us as we try to really understand

these issues. Remember, your answers to our questions will not be considered “right” or

“wrong”, because we just want to know about what you think. They are merely information

you will provide based on your experiences, observations, or feelings. Your participation in

this study will be voluntary and an interview lasting approximately 50-60 minutes. In case you

have any queries on the research project you are free to contact on the phone number given

below. If you agree to participate in this study, then we can discuss in a private setting of your

choice, where you will feel comfortable to talk with me.

Contact Details:




Ph: 022 25525514 Ph: 022 25525512




information sheet for “School Girls” about the group research project on, “Health Issues of





been explained to me in the language that I understand (Marathi/ Hindi/ English). I have had


I understand that my participation is voluntary and that I have the right to withdraw from the

study at any time without giving any reasons for the same.

I understand that the information collected during the research study will be kept confidential.

The representatives of sponsor/, government regulatory authorities/ethics committees may

wish to examine my records/study related information at the study site to verify the

information collected. By signing this document, I give permission for these individuals to

have access to my records.


Name of location: ______________________________

Name of stakeholder: ______________________________

Date:_____Month______Day_______Year


Name and signature of Person who collected consent: ______________________________


Interview Guideline for health issues of Adolescent Girls in Ashram Schools

For Stake Holders (Head Master, School Teachers, Sarpanch, etc)

Name of the interviewer

Date and time of interview

LOCATION DETAILS

Name of the School

School ID

Co-ed or Girls only school

Physical location of school

(Address)

RESPONDENT DETAILS

Name of the informant/respondent

Age of respondent

Sex

Religion

Marital status

Educational qualification

Occupation

How long been working in this

school?

A. ADMINISTRATION

MANAGEMENT WITH GOVERNMENT

i. What is the coverage area for this school?

ii. How many villages covered?

iii. What is the average family background of the children studying in the school?

iv. When did this school start? (Date/Year/Specific event triggering its started)

v. What was the purpose/need/motivation behind starting this school?

vi. How many children study in this school?

vii. How many standards and divisions does the school have?

viii. Are the policies and protocols directed by government or you are free to customise it

based on your local context? If yes, how is it done?

FUNDING

i. How do you receive funds? Is it regularly received?

ii. What are the facilities expected to be provided free of cost for students?

iii. How do you manage fund shortage?

iv. For private schools (Do you receive any funding from government if yes what are

those?)

STAFF AND ITS MANAGEMENT

i. How are the staff appointed? Temporary or contractual?

ii. What facilities are provided to your staff?

iii. How many staff you do have in total in the school? (No. of temporary and permanent


& teaching and non-teaching staff)

iv. Do you have any staff shortage at present if yes how many? How is it managed

v. How are issues or complains which your staff faces in Ashram schools tackled?

vi. What is the qualification of teacher, required to be appointed in your school?

Do you think that is enough? Does all your teachers fulfil these eligibility criteria?

B. FACILITIES

SOCIODEMOGRAPHIC PROFILE OF GIRLS

i. What are the age group of children enrolled into the school?

ii. What is boy’s vs girl’s ratio in the school?

iii. What is the average family income of your students?

iv. What is the admission criteria?

v. What about students with disability, mental retardation, learning disability etc., are

they admitted in the school? If yes what are the special provisions for them?

GENERAL FACILITIES

i. What are the facilities being provided by the school for children?

ii. How do you ensure quality in the services/ facilities offered?

iii. What constraints/difficulties do you face in providing quality facilities for the

children? (Shortage of manpower, funds etc.)

iv. What complains do you generally receive from the children about the facilities

provided?

v. Do you think the facilities provided by the school for the children are adequate? If

yes/no why?

vi. What are the day to day activities that take place in your school? Can you elaborate?

EDUCATIONAL FACILITIES

i. What educational materials are provided to children in Ashram Schools?

ii. Is there any difference in the provisioning at government and government aided

Ashram Schools?

iii. What teaching aids are available in the schools? Which of them are used by teachers?

iv. Is there any provision are available in the classroom (light, fan, bench, desk etc.)?

Are they sufficient for these a batch?

RESIDENTIAL FACILITIES

i. What are the residential facilities provided to the children?

ii. Are they expected to get anything from home? If yes what are those?

iii. How are children accommodated (rooms or dormitory)? How many children stay in

one room?

iv. How adequate is the residential facilities provided for the children? What is its

quality?

v. What measures do you take to improve the quality of residential facility?

vi. Are there any frequent complains or issues raised by children regarding residential

facilities?


C. CHECKING BASIC AMENITIES

WATER SUPPLY

i. What is the source of water? Where do you get drinking water?

ii. How much water do you receive for drinking and for other uses?

iii. How is drinking water stored? How often is the storage container cleaned? Who

cleansit?

iv. Does the campus have enough supply of water for daily activities like cooking

washing drinking?

v. How do you manage the shortage of water for school?

vi. Is there enough space provided for sanitation for girls?

vii. What problems do you face due to water or sanitation?

ENVIRONMENTAL HYGIENE

i. How is garbage disposed of? (Kitchen and other garbage)

ii. How do you prevent mosquito breeding around your premises?

iii. What measures are taken to prevent insect/snake infestation around the campus?

iv. How do you take care of drainage system within the school premises?

D. MONITORING AND MANAGEMENT OF GIRLS HEALTH

MENSTURAL HYGIENE

i. What is being provisioned to improve the knowledge of the girls regarding their

menstrual care and hygiene?

ii. How specific focus is given to adolescent girl’s health needs in your school?

iii. In your view what complaints and disorders girls face regarding menstruation?

iv. What provisions does the school has to handle such issues? (? Menstruation issues)

v. How many sanitary pads are provided to a girl in a month? Which brand?

vi. How are issues related to menstruation tackled?

RECORD MAINTENANCE

i. What are the records expected to be maintained by Ashram Schools?

ii. Is there any record different from government aided schools that private schools have

to maintained?

iii. How many years are these records maintained for?

ILLNESS REPORTING

i. What kind of health services are provided to the students?

ii. How do you handle emergencies health care?

iii. How far is the medical facility from the school?

iv. How do you ensure the health and hygiene of the student in school?

HEALTH CENTER

i. How regular are the health check-up camps held?

ii. What are the difficulties or constraints in maintaining regularity of the health camps

for students?

iii. Who bears the cost of treatment? Why?

iv. Are there regular health education organised for girls? If yes on what topics and how

is it conducted?

v. How are communicable diseases tackled? What are the isolation measures adopted


during such situations?

vi. Are there any addictions among these children? If yes, How are addictions talked

among students?

vii. Did you have any outbreaks in last 10 years? If yes wat where those and how were

they managed?

ABUSE AND HARASSMENT MANAGEMENT

i. What is the protocol to report abuse or harassment?

ii. Once an abuse is reported, what are the course of action?

iii. Where there any cases reported in the last six months? If yes what was the nature of

those cases?

E. CHALLENGES AND PROSPECTS

i. What you have to say about the current health situation the children of your school?

ii. What kind of changes do you want to bring about in the current health situation of

students?

iii. How do you want to bring those changes in the school system?

iv. Do you have any other suggestions, to improve the services provided to these

adolescent girls?


TOOL 4- FACILITY SURVEY FORMAT

FACILITY SURVEY

Name of surveyor: Date of facility

survey:

Background information: (Administrator/HM)

Sr. No. Particulars Responses

1. District

2. Block /taluk

3. Location and name of the Ashram school

4. Total area/size of land of the Ashram school ---------In acres/ bigha

5. Who’s ownership

6. Is a school on rental premise

7. Since how long

8. On lease for number years

9. Where is the Ashram School located a. Within the village

locality

b. Far from the village

locality

c. If far from the village

locality specify in kms

10. Does the school has designated building / structure

(approx. area of the structure)?

11. Recognized / registered

12. Registration number and date

13. Government / aided / unaided

14. No. of years on government aid

15. Starting date of Ashram School-(DOE)

16. How many standards does the school have?

17. Minimum and maximum distance of the villages

from where children are recruited in for the school

18. Distance to the nearest preferred hospital

19. Distance to the nearest police station

20. Population of village where ashram school is located

21. Population of surrounding 10 villages of the school

22. Percentage of tribal population in the surrounding 10

villages

23. Number of villages covered by the ashram school for

recruiting children


BASIC AMENITIES (Administrator)

Sr.

No.

Particulars Available

(Yes/No)

Functionality

(Full (90% and

above)/ Partial (50-

90%)/ None

<50%))

Conditions

(good/fair/poor)

1. Approach road to school

2. Transportation facilities available

on approach road to school

3. Does the school compound have

wall/ fencing?

4. Source of Water availability for

Ashram School:

(well/ river/ lake/ piped/ bore

well/ hand pump/ tube well/ any

other specify)

5. If no water source, how does

school manage water required for

school?

6. Whether overhead tank and pump

exits inside the Ashram school?

7. If overhead tank exists what is its

capacity?

8. If overhead tank is not within the

school compound then distance at

water source from school?

9. Is water available for the whole year for the school? Yes/No

10. Water purification/ treatment

system for school and hostel?

11. Sewerage – type of sewerage

system – soak pit/connected to

gram panchayat sewerage

12. Waste disposal – how the waste

material is being disposed

(specify)?

Ashram school complex facilities: (HM)

Sr.

No.


(Yes/No)

Functionality

(Full (90% and

above)/ Partial

(50-90%)/

None (<50%))

Conditions

(good/fair/poor)

School related/ Education

1. Separate Education wing

2. Residential wing for students

3. Residential wing for staff

4. No. classrooms


5. Average Space available/ provision

for every student in the class

excluding gallery/ veranda

L: B: H:

(highest)

L: B: H:

(lowest)

6. Laboratory (science and computer

lab)

7. Staff room

8. Head master/ Principal office room

9. School office

10. Is there electric connection in every

section of the school especially

residence that too girls residence

(in all parts/in some parts/ none)

11. Regular power supply a. Continuous power supply

b. Occasional power failure

c. Power cuts in summer only

d. Regular power cuts

e. No power supply

12. Standby facility (generator)

available

13. Approx. Height of classroom from

the plinth

Living Arrangements

1. Average space for every child for

residence

2. Toilet/washroom facility for school

3. Facility for bath

4. Toilet /washroom facility attached

to hostel or room

Attached/Detached

5. If detached, how far and where?

6. Separate provision for girls and

boys for toilet

7. Separate provision for girls and

boys for bathrooms

8. Separate facility for washing

clothes for boys and girls

9. Separate provision of residence for

boys and girls

Residential facility for children

1. No. of students staying in one

room.(whether congested)

2. What facilities has been provided

to sleep at night?

a. Cot only

b. Bed only

c. Bedsheet only

d. Cot & bed

e. Cot, bed and bedsheet

f. Make your own arrangement

3. No. of student on one bed

4. Protection from mosquito/ insects


5. Distance at which the playground is

from the school?

6. Size/area of playground

7. Who owns the playground?

8. Are sports equipment’s/ materials

available?

9. If yes, list them.

Total stock the school has received in this academic year: (Accountant/Administrator)

Sr.

No.

Particulars Since When Number Functional or Non

Functional

1. Tables

2. Chairs

3. Desks

4. Blackboards and duster and

Notice boards

5. Scales

6. Cupboards

Materials provided for residential students: (Headmaster)

Sr.

No.


(Y/N)

Adequate/Inadequate

1. Slates

2. Pencils

3. Pens

4. Ink/Refill

5. Text Books

6. Notebooks

7. Office stationary

8. Bell

9. Photos of national leaders

10. Text books for the use of teachers

11. Maps

12. Geometric materials

13. Educational equipment’s charts

14. Educational equipment’s charts

15. Library

16. Library hours

17. Number of books in the library

18. TV set for students

19. Computers for office

20. Printers for office

21. Projectors for office

22. Internet connections for office

23. Telephones for office

24. What is the transportation facility available in

school?

25. If yes, what vehicle is available


1. Utensils

2. Bedding

3. Gowns

4. Oil

5. Soap

6. Sanitary pads

STUDENT STRENGTH (Based on school records or register last year 2016-17):

(HM and Warden)

Particulars 1st std to 4th 5th to 6th std 7th std

Boys Girls Boys Girls Boys Girls

i. Residential students

ii. Day scholars

iii. Total students (As per roll

register)

iv. No. Approved standards

v. No, Approved divisions

vi. No. of drop outs

Particulars 8th and 9th std 10th std 11th and 12th std

Boys Girls Boys Girls Boys Girls

i. Residential students

ii. Day scholars

iii. Total students

iv. No. Approved divisions

v. No. of drop outs

Staff Details: (Administrator from register)

Staff Qualifications Caste

Category

Approved no. Recruited by

organization

Permanent

Head master

All Teachers

▪ 1-4

▪ 5-6

▪ 7

▪ 8-9

▪ 10

▪ 11-12

Librarian

PT teacher

Attendant

Lab assistant

Accountant

Sweeper

Any other

Hostel staff

Warden

Cook

Helper


Assistant

(kamathi)

Lady attendant

Any other

Total

DAILY ROUTINE (Warden and cross check with chart)

What is daily routine for school and children? (Time- from to)

Sr. No Questions (actual) Response

i. At what time children wake up in the morning?

ii. School Prayer timings

iii. Breakfast timings

iv. school work for children before going school?

v. Library Hours

vi. School hours

vii. Brunch

viii. Lunch timing

ix. Play time

x. Dinner timing

xi. Evening snacks timing

xii. Night study

xiii. At what time children go to bed?

FOOD PATTERN (one week preceding the survey/ one weekend and one weekday)

(Warden)

Particulars Timing Weekday food items Quantity Weekend food items Quantity

Breakfast

Brunch

Lunch

Evening Snacks

Dinner

Food items

served during

festive occasions

i. How often do you have special food for festive occasions?

HEALTH PROTECTIVE MEASURES AT THE SCHOOL (Administrator)

Sr. No. Facility Available Number Functional Conditions

1. First aid box

2. Sickroom

3. Others (Fire extinguisher,

fly catcher))

4.


i. What includes in the sick room?

ii. How often physician/doctor visits the ashram school?

iii. How often health checking happens of the children?

iv. How many health checkup camps held in last six month?

v. How far is the nearest PHC (in kms) from the school premise and travel time for

reaching there?

vi. How far is the nearest CHC/RH (in kms) from the school premise and travel time for

reaching there?

vii. What is the fastest provision of transport in case of medical emergency with the

school?

viii. What is provision if any child falls sick?

ix. Any records of illness, reported, treated and so on?

x. Where are children generally referred if they are ill?

ILLNESS(Based on existing records, fill the following for last one year)

(Administrator/HM)

Type of

illness (In

last 1yr/ 6

months)

No. of

children

fallen

sick

No. of

children

Not treated/

No. of

children

cured

No. of

children

referred

Outbreaks No. of

children died

Cause of

death

EXPENDITURE (FOR LAST FINANCIAL YEAR) (Administrator)

Sr.

No.

Expenditure Actual

expenditure

Sanctioned

expenditure

Un-sanctioned

expenditure

Total


TOOL 5- MEDICAL CHECK UP FORMAT


Health and Nutritional Needs of Ashram Schools - tiss.edu€¦ · Prof. K Anilkumar, Dean, SHSS, for his motivation and support in bringing out this report. Special mention and thanks

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