Refurbishment of Anganwadi Centres (AWCs), capacity building and training of frontline workers, and community mobilisation activities helps increase footfall in AWCs by over 30% and advance nutrition indicators in Maharashtra

Integrated Child Development Services (ICDS) and National Health Mission (NHM) platforms across rural India have an unmatched reach and are intended at delivering health and nutritional inputs to the most vulnerable populations. ICDS is India’s response to malnutrition. It is a comprehensive nutrition programme that includes nutrition specific and nutrition sensitive interventions which has the potential to bring about sustained improvements in nutritional status of the population and contribute significantly to reduce stunting. Augmenting existing well spread and well invested platforms, are the way forward.

In 2017, Tata Trusts set out with the goal to demonstrate sustainable improvement in the nutritional status of the population with a special focus on reducing stunting and anaemia. To achieve this, it was important to improve the quality and coverage of services in ICDS and NHM, with a special focus on training, demand generation and monitoring management information system, and mobilise communities to bring about an improvement in nutritional practises and seeking behaviour change in the communities. The programme adopted a multi-pronged approach for execution, and identified Palghar, Chandrapur and Gadchirolli districts of Maharashtra, covering 4114 Anganwadi Centres and 4.45 lakh children under 6 years, and 16 lakh women of reproductive age.

I. System Strengthening

a. Developing model Anganwadis: Upgradation and repair of roof, walls, flooring, kitchen, entrance, toilet, wall paintings with specially designed IEC messages.

3200 Anganwadi Centres were upgraded with need based equipment’s across Palghar district by providing weighing machines, stadiometers, infantometers, water purifiers, early child education toys, nutrition and early child education posters, plastic mats and nutrition booklets each. These items were provisioned to each AWC in consultation with the Principal Secretary, DWCD and CEO, Zila Parishad, Palghar. This was ably carried out through a publication detailing standard operating procedures (SOPs) on Anganwadi Refurbishment.

Refurbishment of 102 dilapidated Anganwadi Centres in Palghar and Gadchirolli by civil upgradation viz. upgradation and repair of roof, protection from seepage of walls, ensuring even flooring, kitchen upgradation, doors and windows repair, pivoting of building, securing entrance, upgradation of toilets wherever applicable, water proof painting of walls with specially designed IEC messages etc. Centres for refurbishment meeting the criteria were jointly identified with the recommendation of the District Administration (DA).

b. Capacity Building: 

With the objective of enabling convergence of services under ICDS and NHM, the programme organised joint capacity building training of 6352 frontline workers (AWWs, ASHAs, and ANMs) – triple A (AAA) convergence. This was facilitate working in convergence as per the GR as well as on submission of joint monitoring report on the status of convergence at the last mile. Mother Infant and Young Child Feeding Training – Capacity building of 2700 frontline workers was pursued on Infant and Young Child Feeding practices with the use of demonstrable breastfeeding techniques and local nutrient rich foods for complementary feeding. Panchayati Raj Institute and ICDS convergence Training – Joint capacity building of 620 Sarpanch, 121 Gram Sevaks, Child Development Project Officer, Lady Supervisors, through PRI training Institute, on working in convergence has been completed in all blocks of Palghar and is currently on going in Chandrapur and Gadchirolli districts, virtually. Community Based Events Training – Capacity building of 2255 Anganwadi workers was actioned on conducting Community Based Events in Palghar before Poshan Abhiyaan was subsumed in the district. 

II. Community Mobilization Initiatives

a. Community Based Events: More than 11,000 Community Based Events celebrated in three districts on various topics including dietary diversity, breastfeeding techniques, complementary feeding, antenatal and postnatal services.

b. Jan Andolan Events: 1027 Jan andolan events were conducted on themes like T3 anaemia, dietary diversity, complementary feeding, community based strategies to address Severe Acute Malnourished (SAM) and Severe Underweight (SUW) children with a special focus on involving Panchayati Raj members

c. Regular AAA Household visits: Need based counselling for a woman who is expecting or has a young child goes a long way in child health and nutrition outcomes. It is altogether on a different level when all three frontline workers’ pay household visits to the vulnerable mother. More than 3000 household visits were made along with AAAs (ASHA-AWW-ANM) which had seen the maximum impact in mobilising a family and a community.

d. Tracking High Risk Beneficiaries: Closely following up with high risk beneficiaries and referring them to relevant departments, not only helps in gaining confidence of the communities on existing systems, it also spreads awareness on the services available to the beneficiaries. The programme tracked close to 300 Severe Acute Malnutrition (SAM) children and high risk pregnant mothers until March 2020 to ensure they received services as mandated.

III. Multi-Level Advocacy

The programme promoted the importance of convergence within ICDS and NHM as well as ICDS and Panchayati Raj Institution at the village level, followed by block and project level officials, to district and the State level officials until the lockdown. 

Resumption of work during COVID-19

Understanding that mothers and young children need these interventions more than ever during the lockdown, the programme made use of ICT to resume work on ground. Starting with the understanding that Anganwadi workers have a smartphone under the Poshan Abhiyaan scheme, the programme calibrated the situation on ground. Over a period of time, after necessary approvals from the district administrations, the programme formed Whatsapp groups with Anganwadi workers, along with their beneficiaries and, eventually, resumed all possible activities on ground, virtually.

So far, through 467 Whatsapp Groups, the programme has trained 5137 Anganwadi, ASHA and ANM workers. With the support of frontline workers, the programme was able to counsel and provide support to 2834 pregnant and lactating women. By virtually monitoring and supporting 573 Village Health Sanitation and Nutrition Days, the programme has been able to track and follow up with 440 high risk pregnant mothers and 361 high risk young children, and 355 SAM children, who are being provided with energy dense nutritious food from Maharashtra government. 

A convergence of all the initiatives have resulted in an increase in footfall at AWCs by over 30%, with children, and young mothers, taking active interest in knowing more about nutritious food, pursuing pre-school education, primary healthcare, immunisation, health check-up, community participation on locally-sourced food products, as envisioned under ICDS. 

Findings

Fig 1. Total number of children attending Anganwadis before and after refurbishment in 30 Anganwadi Centres in Palghar, Maharashtra

Fig 2. Per cent increase in attendance over thirty Anganwadi Centtres in Palghar

Fig 4. Impact evaluation of interventions on coverage of services in Palghar before and after

Fig. Knowledge of importance of Iron Folic Acid supplementation during pregnancy

NoFig. Consumption of Iron Folic Acid supplementation during pregnancy