POVPERSPECTIVES ON VOLUNTEERING Vol 4 - Issue 2: February 2013

Nourishing The Future

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CRY supported project Adhar in Orrisa

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“We all have an obligation as citizens of this earth to leave the world a healthier, cleaner, and better place for our children and future generations.”- Blythe Danner

The word ‘child’ conjures images of happiness, memories of innocence and the promise of a better future. It is that critical stage of development of a human being which leads to intensive brain and biological growth ensuring health, economic and education participation of the child for the rest of his/ her life. Every child has a fundamental right to nutrition, health and education -the essentials that are needed to grow and develop fully. We are fortunate to receive the benefits of a healthy and safe childhood, yet every year, more than 200 million children under five around the world endure dire consequences like retarded physical growth, increased vulnerability to diseases that get carried on to adulthood, attain limited educational opportunities and thus have limited productivity that perpetuates an entire generation living in poverty. The risk factors affecting early childhood development of at least 20–25% of infants are chronic and severe malnutrition that can cause growth stunting and inadequate stimulation or learning opportunities. It is in this context that we bring you a glimpse of the government initiated Integrated Child Development Services (ICDS) program that is meant to ensure that children in India get a caring, responsive and healthy environment. Though early childhood development is closely linked and inseparable from women’s health, we have limited the scope of this bulletin to understanding the functioning of the ICDS and its potential to addressing the issues of early childhood development in an integrated manner We hope that this information will enable you to take concrete steps to address the health and education of the children who need it the most. The Editorial Team

CRY supported project Adhar in Orrisa

INSIDE THIS POV�Figuring out Facts

ICDS: Panacea for Early Childhood development: Services provided at he ICDS and the main players at the ICDS

Critique of the ICDS

Helping children towards a healthy future

CRY Volunteers support the revival of an Aanganwadi

Your Say, Your Idea, Your Bit

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Figuring out facts

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58 million children in India are under the age of 6

1 in 10 Indian children suffer from diarrhea

½ of under 3's are deprived of full immunization.

(Source:http://www.forces.org.in/publications/Startingstrongfinal.pdf).

Percentage of children under the age of 3 who are stunted, wasted or underweight

0

20

40

60

80

100

Stunted (too short

for age)

Wasted (too thin

for height)

Underweight (too

thin for age

NFHS 1

NFHS 2

NFHS 3

· 46% of all children in India below the age of three are too small for their age, 47% are underweight and at least 16% are wasted. In addition to the 46 per cent who are underweight, 39% are stunted, 20% severely malnourished and 80 per cent anemic. Child malnutrition is responsible for 22% of the India’s burden of disease Three-fourths of children age 0-71 months in areas covered by an aanganwadi centre did not receive any supplementary food from the centre in the 12 months preceding the survey. · Only a small proportion (12percent) received supplementary food almost daily. The youngest children (age 0-12 months) are least likely to have received any supplementary food from an AWC in the past 12 months. · More than 6,000 Indian children below the age of five die every day due to malnourishment or lack of basic micronutrients such as vitamin A, iron, iodine, zinc or folic acid.

(Source NFHS -3 2005-2006)

I.C.D.S: Panacea for Early Childhood Development

Human rights are commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being. Human rights are universal (applicable everywhere) and egalitarian (the same for everyone) and exist as natural rights or as legal rights, in both national and international law. After the second world war some countries felt that the United Nations Charter did not sufficiently define human rights. The Universal Declaration of Human Rights came into being to give effect to the Charter's provisions on human rights. Gradually provisions were made for other conventions like the Convention on the Rights of the Child which is a human rights treaty setting out the civil, political, economic, social, health and cultural rights of children.

According to the UNCRC, the right-to-life article (Article 6) includes formulations about the right to survival and to development, which should be ensured "to the maximum extent possible". The term 'development' in this context is interpreted in a broad sense, adding a qualitative dimension: not only physical health, but also mental, emotional, cognitive, social and cultural development

India through constitutional efforts and the National Policy for Children (1974) recognized children as an important asset to the country. The goal of the policy was to take steps to ensure that constitutional provisions for children are implemented. It outlined services that the state should provide for the complete development of a child before and after birth and throughout a child's period of growth which included free and compulsory education until the age of fourteen including physical education and recreational time, access to a comprehensive health and nutrition program, special attention given to children from the marginalized backgrounds and protection from abuse, neglect, cruelty and exploitation.

The Integrated Child Development Scheme (ICDS) was launched in 1975 throughout India in accordance with the National Policy for Children. It was rooted in the concept of Early Childhood Care and Development (ECCD) which advocated the holistic development of children including physical, cognitive, language, social and emotional development from conception to age six. The pace of development in these years is extremely rapid and in the right conditions, children develop normally, laying the foundations for a good life. The right conditions entail good health care and nutrition for children and mothers, clean water and proper sanitation, psychosocial care, opportunities for early learning and emotional security, protection from abuse and exploitation, and equal rights for boys and girls. In the absence of these conditions the consequences are wide-ranging and include a lower IQ, greater susceptibility to illness, lower educational attainment, lower productivity and lower earnings. Scientific evidence proves that irreversible damage tends to occur when young children are exposed to malnutrition and ill health during these formative years from conception to age six. The lack of a stimulating environment results in poor psycho-

social and skills development affecting children's entry into school, their performance and persistence through school, and their eventual success in life.

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The ICDS program adopts a multi-sectoral approach to child well-being, incorporating health, education and nutrition interventions. The program covered the period of adolescence in a girl, women throughout the reproductive period with special services during pregnancy, child birth and lactation. It is implemented through a network of aanganwadi centers at the community level. An aanganwadi means a courtyard, that is, a play center. It is located within a village or a slum. It is the focal point for delivery of all services provided under ICDS. The basic services provided under ICDS fall into three broad headings: Nutrition, Health and Pre-school education

Nutrition services include supplementary nutrition program for young mothers and children, growth monitoring, and nutrition and health counseling to adult women. If a child is below three years of age, s/he will get supplementary nutrition and proper infant and young child feeding advice. The growth of a child is also regularly monitored at the Aanganwadi Centre through growth charts. Accordingly, their mothers are counseled so that their children develop in a healthy and robust manner. In addition, the Aanganwadi Centre takes the responsibility of checking-up her/his health Health services include immunization, basic health care checkups, and referral services to Primary Health Care centre or hospitals. A child is immunized against six killer diseases like Tuberculosis (TB) Diphtheria, Perthussis (whooping cough), Tetanus, Measles and Poliomyelitis by the Auxiliary Nurse Midwife (ANM) at the aanganwadi. Pre-school education involves the holistic development of children (aged 3 to 6 years) that ensures their overall physical, cognitive, language, social and emotional development through various stimulation and learning activities at the Aanganwadi. The aanganwadi also provides stimulating play environment wherein children learn about their surroundings and day-to-day interaction with others. A variety of play material like puppets, dolls, balls, wooden blocks, wet clay, flash cards for story telling, puzzles, etc. are available for children in the Aanganwadi Centre.

CRY supported project Adhar in Orrisa

CRY supported project Adhar in Orrisa

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Many people are involved in the implementation of ICDS. The success of the programme depends on active cooperation between these different “actors”. The Aanganwadi Worker’s (AWW) job is to run the aanganwadi, survey the families in the neighborhood, enroll eligible children into school, ensure that food is served on time every day, conduct the pre-school education activities, organize immunization sessions with the ANM, make home visits to pregnant mothers etc. The Aanganwadi Helper (AWH) is central to the implementation of ICDS. She is supposed to assist the AWW in her tasks. Her main duties are to bring children to the aanganwadi, cook food for them, and help with the maintenance of the AWC. Normally, an ICDS project covers a population of around 100,000, and involves running about 100 aanganwadi’s. Each project is managed by a Child Development Project Officer (CDPO). The CDPO’s office acts as a ‘headquarter’ for the ICDS project. The CDPO is assisted by Supervisors, who make regular visits to the aanganwadi’s. The supervisors are supposed to check the registers, inspect the premises, advise the aanganwadi Worker, enquire about any problems she may have, and so on. The Auxiliary Nurse Midwife (ANM) acts as a crucial link between ICDS and the Health Department. Her main task is to organize immunization sessions, together with the aanganwadi worker. She also provides basic health care services at the aanganwadi. The National Rural Health Mission has created a cadre of women voluntary health workers at the village level called Accredited Social Health Activist (ASHA) who are working with the ANM and AWW to improve the health and nutrition of women and children. Community participation is an important element in the design of ICDS. The community can be mobilized to provide the aanganwadi’s with better facilities, to ensure that they open on time every day, or to encourage mothers to participate in counseling sessions. Community participation can take place through Gram Panchayats, Mahila mandals, self-help groups, youth groups or just spontaneous cooperation sessions with the ANM, make home visits to pregnant mothers etc. NGOs play an active role in the implementation of ICDS. Sometimes entire ICDS ‘projects’ are managed by an NGO. Some international organizations often provide specific support to ICDS like supplying food for the supplementary nutrition programme, and supply of medical kits.

CRY supported project Sadhana in Maharashtra

CRY supported project Sadhana in Maharashtra

CRY supported project Sadhana in Maharashtra

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On 28 November 2001, the Supreme Court directed the Government of India to universalize ICDS making it a legal obligation. Further orders were issued in 2004 and 2006 ensuring an increase in the coverage of Aanganwadis one for population of 1000 in urban/rural and one for population of 700 in tribal areas. The judgments also directed the State Governments to identify Scheduled Caste and Scheduled Tribe hamlets for establishing the aanganwadi centers on a priority basis.

A child cannot fully realize her right to education unless he/she has access to quality early childhood care, health and education. The ICDS Program is important because it addresses problems, and strengthens the foundations of a child's health and capacity to learn. The universalization of ICDS, with quality improvements, can help to break the vicious cycle of malnutrition and poverty-an essential step towards the realization of children's fundamental right to nutrition, health and education.

References:

· Starting Strong: Early childhood development in India, New Philanthropy Capital, Simon Blake, Tara Chand, Gaurav Gupta, Iona Miller; September 2009

· UN Convention on Child Rights (UNCRC) (http://www2.ohchr.org/english/law/crc.htm)

· *National Policy for Children 1974 (wcd.nic.in/national_policy_for _children_1974.pdf)

· Supreme Court judgments dated 13 December, 2006, 29 April 2004, 7

October 2004 and 13 December 2006

(http://thejusticeandpeace.org/PDF/Rightto%20Food.pdf)

· Aanganwadis for all: Action for Rights of children under six- A Primer, Right To Food Campaign, Secretariat, Delhi, Third Edition, December 2007

CRY supported project Mahita in Andhra Pradesh

Editorial: Economic and political Weekly, March 19th, 2011, vol xlvl no 12

Malnutrition and ICDS: Pronouncements about the ICDS scheme have to be juxtaposed against the grim reality of malnutrition.

In his Union Budget 2009-10 speech soon after the Congress-led United Progressive Alliance-II (UPA-II) government took office, Union Finance Minister Pranab Kumar Mukherjee stated that “Government is committed to universalisation (our emphasis) of the Integrated Child Development Services (ICDS) scheme in the country. By March 2012, all services under ICDS would be extended, with quality (our emphasis), to every child under the age of six.” We are now a year away from March 2012, but with two-fifths of children under five years of age suffering from moderate to severe malnutrition, one-third not getting a full course of diphtheria, tetanus and pertussis (DTP) immunisation, and two-thirds deprived of the oppor tunity of preschool learning, surely the actual outcome next year is going to fall far short of the pronouncement made two years back. Yet, the Union Budget for 2011-12 has stepped up the allocation for the ICDS from Rs 8,430.21 crore in 2010-11 (revised estimate) to just Rs 9,294.19 crore in 2011-12 (budget estimate), which will be an increase of no more than 10.2% and that too in nominal terms. Perhaps the finance minister knew even when he made the pronouncement in 2009 that the ICDS scheme could not deliver the outcome he promised. And he presumed that the pronouncement itself would have been forgotten. But the reality of malnutrition in India is grave. Even if our “India shining” elite have declared India as an economic superpower, the grim reality reflected in the infant, under-five child and maternal mortality rates, and the high incidence of malnutrition, puts the nation in the category of the least developed countries. Certainly though, the increase in honorariums (still grossly inadequate) of the aanganwadi (childcare) worker and helper is for the better. In each aanganwadi a single worker and her helper are expected to deliver many services as part of the ICDS scheme - deliver supplementary nutrition to children under six and to pregnant and nursing mothers, be a link to immunisation and health check-ups, give health and nutrition tips, offer referral services, and provides non-formal, preschool education.The ones that actually do all they can to accomplish their job to the best of their ability would be working harder than most government employees. Surely, they deserve to be absorbed at least as grade III (the aanganwadi worker) and grade IV (the aanganwadi helper) employees of the government. By depriving these workers of their due, successive governments have been practicing gender and class discrimination of a high order, and are yet to be pulled up by the courts

Thirty-six years have passed since the ICDS was launched in 1975. What impact has it had on people's nutritional standing? Of course, one cannot single out a single government scheme for what is a systemic problem. Exploitation is written large on the faces and bodies of the poor in India. You do not have to be a scientist with the right specialization to discern this; the body mass index (BMI) - the ratio of weight in kilograms to height in metres - is a reliable indicator of chronic hunger. In the 1970s, about half the Indian population had a BMI of less than 18.5 (which is the lower end of “normal” nutritional status), this number has come down only to around 40% in 2005-06. The mean weight of babies born to poor women is far below that of those born to rich women. Is the dispensing of vitamins and nutritional supplements, sold by the pharmaceutical companies in bulk to the government, going to change that fact? No, poor women (and their men) have to struggle for decent wages and social security so that they gain “normal” BMIs, and their babies are born with a weight at birth of around 3.2 kg. The fact is that the parents of those babies and the aanganwadi workers and helpers who provide childcare services to them suffer grave deprivations in their lives. They need to be uplifted so that they can give their babies a better start in life. The mothers need the requisite BMI in order to breastfeed their children over the first six months (currently only one in three infants are exclusively breastfed in the first six months). They then need to give the appropriate foods to the infants. But the poor women do not have the requisite BMIs and their families cannot afford such foods. Not surprisingly, the proportion of underweight children rises dramatically between six months and two years of age. And then when diarrhea, fever, and influenza strike, the impact of child malnutrition assumes more serious proportions, and with it, under-five child mortality. What else can one expect when the mothers have to work long hours away from home without any support system, and are unable to afford healthcare? Is it surprising then that India is still one of the four countries with the highest prevalence of under-five children who are underweight.

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What can volunteers do?

· Awareness building: Volunteers can create an interest in ICDS within the local community and make people understand that ICDS is an entitlement of all children under six. Volunteers can update their knowledge about the ICDS and related Supreme Court orders and take the people to the local Aanganwadi to see what is happening on the ground.

· Investigate the on-ground situation: This can be done through formal surveys and informal enquiries on topics like the location of the Aanganwadi, its accessibility to the marginalized children, the state of the building, the availability of basic facilities and equipment, the regularity, diversity and nutritious value of the food provided to children in the age group of 3-6 years, the accuracy of the growth charts, whether growth monitoring is done regularly, the adequacy of health services and preschool education activities, etc.

· Ensuring that every hamlet has an Aanganwadi: If there is no Aanganwadi, it is best to start by contacting the local CDPO or the District authorities. A petition can be sent to the Secretary in charge of ICDS or the local authority. Volunteers can also contact the Commissioners of the Supreme Court or their state advisors.

· Monitoring the local Aanganwadi: Many Aanganwadis are in poor shape. It is useful to organize a meeting along with the Aanganwadi worker to discuss how the Aanganwadi can be improved. Volunteers can also contact the CDPO. In cases of serious irregularities volunteers can talk to the CDPO or even to the District authorities.

· Reviving the aanganwadi: The volunteers can educate mothers about the importance of having a healthy, confident and educated child. They can revive the aanganwadi through renovation, supporting games and activities for children.

· Advocacy: Some problems require policy changes at higher levels. For instance, if the budget allocation for supplementary nutrition is low, the local Aanganwadi worker and even the CDPO may not be able to do anything about it. Achieving policy changes like increased allocation of budgets to an aanganwadi requires organized advocacy and public pressure. This involves activities like lobbying with MLAs, sending petitions to the Chief Minister, writing in the newspapers or through mass media. It requires taking time to write, networking with journalists to conduct ‘newsworthy’ investigations and organize effective media events.

· Research: Facts can be collected in a systematic manner and presented to the concerned authority for taking action.

· Documentation: Writing blogs,and articles on your experiences, reporting case studies, success stories on facebook will also help in highlighting the issues

Helping children towards

a healthy future

CRY supported project Mahita in Andhra Pradesh

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Volunteers revive an Aanganwadi

CRY volunteers of the Yeshwantpur Public Action Group in Bangalore, conducted a door to door campaign in the Mohan nagar slum to enroll children who were out of school into the local municipal school. On this enrollment drive they encountered Manjula who was working in an aanganwadi that was being supported by a local NGO. Due to lack of funds the NGO could not sustain the daily aanganwadi operations and was planning to close it down. Manjula tried approaching the government officials directly in a bid to keep the aanganwadi open by converting it into a government run aanganwadi but her efforts were thwarted. This volunteer Public action group decided to pursue the matter and met the Child Development Project Officer (CDPO) who informed them that an Aanganwadi has already been sanctioned for the area but could not function as there were problems in recruiting a teacher. The people in the community were not aware of any such vacancy in spite of the official’s claim of advertising the position requirement in the local papers. The volunteers decided to support Manjula’s candidature for the post of the aanganwadi worker as she fulfilled the government’s criteria for aanganwadi teachers. This interaction helped build trust with the community and also enabled Manjula to serve the community that she knew so well. Manjula finally won the battle with the government and was selected as the Aanganwadi teacher. The Aanganwadi reopened with 30 children whose parents were relieved that their children could learn and play together again without any fear of closure.

CRY supported project Mahaan in Rajasthan

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Your say, Your Idea, Your bit

Your say, Let us know what you feel about that state of children’s health in India. Write to us on our blog or Facebook @ http://www.childrightsandyou.blogspot.com/http://www.facebook.com/CRYINDIA Your idea, Share your ideas about how we can improve the health of the children in our communities by writing to us @ vol.mum@crymail.org Your bit, Share the information and volunteer to ensure lasting change in the lives of the children