The Tata Trusts have been working with the Andhra Pradesh government to ensure that young mothers and children get their daily recommended nutritional inputs
It’s a hot May morning at the Penumaka anganwadi centre in Guntur, Andhra Pradesh, where over a dozen children play happily on the colourful swings and slides in the garden. Play time is soon followed by study time — the children come indoors to learn numbers, alphabets and simple rhymes.
This anganwadi centre is special — unlike the typical dull-looking ones elsewhere, the Penumaka unit has been completely refurbished by the Tata Trusts, with colourful walls, new furniture, special tables for the children and play equipment. The centre now acts like a child magnet after the makeover, helping it to better perform its primary role as a place where children and young mothers receive counselling and support for the first few years of a child’s life.
“The services are the same but the new look makes a lot of difference. Children are willing to come, and mothers are motivated to send them too,” says anganwadi supervisor Y Sreelatha, who oversees around 20 centres in the area.
Refurbishing anganwadi centres is just one of the roles undertaken by the Trusts in their engagement with the state government of Andhra Pradesh. The organisation, which has worked in the region since March 2017, has adopted an integrated approach to improve nutritional levels of children and mothers in three districts in the state (Nellore, Krishna and Guntur), where over 400,000 children are attached to 11,900+ anganwadi centres.
Our focus is nutrition, not making the centres look nice. But when we did one, it received such a positive response from the government and the children that we are being asked to do this for more centres.”
Good food is the focus
“Our focus is nutrition, not making the centres look nice,” says Sandesh Kotte, programme officer, Tata Trusts. “But when we did one, it received such a positive response from the government and the children that we are doing this for more centres. We have completed the makeover of three anganwadis and there will be more.”
Nutrition, a key component of the Integrated Child Development Services (ICDS) platform, is also the primary focus of the anganwadi centres. The Andhra Pradesh government has reinforced this by launching the State Nutrition Mission to ensure that young children and mothers get the nutrients they need to stay healthy.
At the Penumaka anganwadi centre, the children get a full meal of rice, dal, an egg and milk. A few young mothers sit to feed their toddlers with a nutritional food called Balamruthum — a thick gruel made from wheat flour, milk powder, groundnut and sugar with added vitamins and minerals.
There’s a pregnant mother who has come in for her daily nutritional input, and she gets a hot meal as well. Jacinta, the anganwadi worker for the Penumaka centre, says she looks after 20 children every day. She also has a dozen pregnant and lactating mothers on her books, and goes on home visits regularly.
The Trusts’ core objective is to ensure that children and mothers get the nutritional inputs they desperately need. One important route has been convincing the government to introduce fortified foods into two delivery platforms that touch large number of children and mothers — the ICDS network of anganwadi centres and the midday meals served in schools.
With the Trusts’ advocacy, the Women Development and Child Welfare Department in Andhra Pradesh has now introduced two fortified foods — double fortified salt (with iodine and iron) and fortified milk (enhanced with vitamin A and D) — for its anganwadi centres.
The Trusts are now working with the state government to set up a factory to manufacture fortified food, known in the ICDS system as ‘take home ration’ (THR), for mothers of young children. THR is based on a formula that combines multi-grain flours such as wheat, corn, or soybean, fortified with micronutrients.
The Andhra Pradesh government has branded this as Balamruthum, and has been sourcing it from the neighbouring state of Telangana. The Tata Trusts are providing technical support to build a new 100,000 tonne plant that will supply Balamruthum to Andhra’s 54,000 anganwadi centres.
The Trusts are also working with rice mills in Odisha and Karnataka to produce fortified rice kernels. These kernels, fortified with iron, folic acid and vitamin B, and mixed with regular rice in a specified proportion, will soon be introduced in the Andhra Pradesh ICDS system and the school midday meal scheme in the three districts.
Communicating health
At the Penumaka centre, another anganwadi worker, Sarla Kumari, counsels mothers on the importance of a proper diet for their toddlers. “It will make them strong and help them walk early,” she says. An anganwadi worker for 15 years now, Sarla recently attended a training module on preventing anaemia in pregnant mothers through an iron-rich diet.
This is yet another component of the Trusts’ engagement, ensuring that the communication around nutrition is strong and meaningful. For this, it has started a series of training programmes to strengthen the knowledge and capabilities of anganwadi workers and supervisors.
Anusha Krishnapuram is a new member of the 23-member Tata Trusts team based in Vijayawada. She serves as the district manager for Guntur and is in charge of monitoring capability strengthening. “We use the incremental learning approach (ILA) — there are 21 modules, and we take up one module a month over three days, to make sure that the trainees fully grasp all the points,” says Ms Krishnapuram.
The Trusts have helped create new, more colourful communication material for the modules, which come with illustrations. These deal with several topics related to child health that anganwadi workers in rural areas regularly find themselves dealing with — handling sick newborn babies, counselling new mothers on breast feeding, steps to be taken for home visits, diet counselling for pregnant mothers, and so on. In Andhra Pradesh, the Tata Trusts plan to train over 11,000 workers through the ILA method.
“It’s all about the first 1,000 days of a child’s life, counting from conception onward to pre-school. We also do community-based events that promote health and nutrition,” says Farida Sultana, who handles the anganwadi refurbishment initiative for the Trusts.
Apart from pregnant and young mothers, the Trusts work with one more important segment — adolescent girls. They partner the state Kishori Vikasam Scheme which offers adolescent girls counseling on matters related to health and nutrition.
Delivering impact
Measurement and monitoring are key when it comes to health, and technology plays a big role in the Trusts’ nutritional engagement in Andhra Pradesh. To make the ICDS system more robust and effective, the Trusts have been piloting a biometric authentication system in the state’s Prakasam district.
“Anganwadi workers in Prakasam have all been given mobile phones by the government. By linking the biometric devices to their mobiles, we will be able to get accurate beneficiary data and also eliminate false beneficiaries from the system,” Mr Kotte explains.
The Trusts are also in discussions with the State Ministry of Panchayati Raj to source and distribute health data cards, called mother-child protection cards, to all mothers enrolled in the ICDS scheme.
What could give the nutrition programme a more significant boost, though, is the launch of the Swasth Bharat Prerak Programme, a joint initiative of the Tata Trusts and the Union Ministry of Women and Child Development.
Under this programme, around 500 young men and women trained by the Trusts will be stationed in various districts across India, where they will support the district collector’s office in driving the government’s health and nutrition programme. More than 110 such preraks have been trained as of now, and one each assigned to Andhra Pradesh’s 13 districts.
The Trusts’ work with nutrition in Andhra Pradesh is one of their most intensive engagements in the country. This multipronged drive against malnutrition combines a highly interactive on-ground approach with focused interventions in the areas of support, supply, services and communication.
The expectation is that all this will lead to a sustainable impact on the health and nutrition of young children at the most tender stage of their lives.
