Integrated Child Development Services Research Articles

Improving primary health care delivery in Bihar, India: Learning from piloting and statewide scale-up of Ananya

In 2010, the Bill and Melinda Gates Foundation (BMGF) partnered with the Government of Bihar (GoB), India to launch the Ananya program to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) outcomes. The program sought to address supply- and demand-side barriers to the adoption, coverage, quality, equity and health impact of select RMNCHN interventions. Approaches included strengthening frontline worker service delivery; social and behavior change communications; layering of health, nutrition and sanitation into women's self-help groups (SHGs); and quality improvement in maternal and newborn care at primary health care facilities. Ananya program interventions were piloted in approximately 28 million population in eight innovation districts from 2011-2013, and then beginning in 2014, were scaled up by the GoB across the rest of the state's population of 104 million. A Bihar Technical Support Program provided techno-managerial support to governmental Health as well as Integrated Child Development Services, and the JEEViKA Technical Support Program supported health layering and scale-up of the GoB's SHG program. The level of support at the block level during statewide scale-up in 2014 onwards was approximately one-fourth that provided in the pilot phase of Ananya in 2011-2013. This paper - the first manuscript in an 11-manuscript and 2-viewpoint collection on Learning from Ananya: Lessons for primary health care performance improvement - seeks to provide a broad description of Ananya and subsequent statewide adaptation and scale-up, and capture the background and context, key objectives, interventions, delivery approaches and evaluation methods of this expansive program. Subsequent papers in this collection focus on specific intervention delivery platforms. For the analyses in this series, Stanford University held key informant interviews and worked with the technical support and evaluation grantees of the Ananya program, as well as leadership from the India Country Office of the BMGF, to analyse and synthesise data from multiple sources. Capturing lessons from the Ananya pilot program and statewide scale-up will assist program managers and policymakers to more effectively design and implement RMNCHN programs at scale through technical assistance to governments.

Improving primary health care delivery in Bihar, India: Learning from piloting and statewide scale-up of Ananya.

In 2010, the Bill and Melinda Gates Foundation (BMGF) partnered with the Government of Bihar (GoB), India to launch the Ananya program to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) outcomes. The program sought to address supply- and demand-side barriers to the adoption, coverage, quality, equity and health impact of select RMNCHN interventions. Approaches included strengthening frontline worker service delivery; social and behavior change communications; layering of health, nutrition and sanitation into women’s self-help groups (SHGs); and quality improvement in maternal and newborn care at primary health care facilities. Ananya program interventions were piloted in approximately 28 million population in eight innovation districts from 2011-2013, and then beginning in 2014, were scaled up by the GoB across the rest of the state’s population of 104 million. A Bihar Technical Support Program provided techno-managerial support to governmental Health as well as Integrated Child Development Services, and the JEEViKA Technical Support Program supported health layering and scale-up of the GoB’s SHG program. The level of support at the block level during statewide scale-up in 2014 onwards was approximately one-fourth that provided in the pilot phase of Ananya in 2011-2013. This paper – the first manuscript in an 11-manuscript and 2-viewpoint collection on Learning from Ananya: Lessons for primary health care performance improvement – seeks to provide a broad description of Ananya and subsequent statewide adaptation and scale-up, and capture the background and context, key objectives, interventions, delivery approaches and evaluation methods of this expansive program. Subsequent papers in this collection focus on specific intervention delivery platforms. For the analyses in this series, Stanford University held key informant interviews and worked with the technical support and evaluation grantees of the Ananya program, as well as leadership from the India Country Office of the BMGF, to analyse and synthesise data from multiple sources. Capturing lessons from the Ananya pilot program and statewide scale-up will assist program managers and policymakers to more effectively design and implement RMNCHN programs at scale through technical assistance to governments.

Inequality in child undernutrition among urban population in India: a decomposition analysis

BackgroundWith increasing urbanization in India, child growth among urban poor has emerged as a paramount public health concern amidst the continuously growing slum population and deteriorating quality of life. This study analyses child undernutrition among urban poor and non-poor and decomposes the contribution of various factors influencing socio-economic inequality. This paper uses data from two recent rounds of National Family Health Survey (NFHS-3&4) conducted during 2005–06 and 2015–16.MethodsThe concentration index (CI) and the concentration curve (CC) measure socio-economic inequality in child growth in terms of stunting, wasting, and underweight. Wagstaff decomposition further analyses key contributors in CI by segregating significant covariates into five groups-mother’s factor, health-seeking factors, environmental factors, child factors, and socio-economic factors.ResultsThe prevalence of child undernutrition was more pronounced among children from poor socio-economic strata. The concentration index decreased for stunting (− 0.186 to − 0.156), underweight (− 0.213 to − 0.162) and wasting (− 0.116 to − 0.045) from 2005 to 06 to 2015–16 respectively. The steepness in growth was more among urban poor than among urban non-poor in every age interval. Maternal education contributed about 19%, 29%, and 33% to the inequality in stunting, underweight and wasting, respectively during 2005–06. During 2005–06 as well as 2015–16, maternal factors (specifically mother’s education) were the highest contributory factors in explaining rich-poor inequality in stunting as well as underweight. More than 85% of the economic inequality in stunting, underweight, and wasting among urban children were explained by maternal factors, environmental factors, and health-seeking factors.ConclusionAll the nutrition-specific and nutrition-sensitive interventions in urban areas should be prioritized, focusing on urban poor, who are often clustered in low-income slums. Rich-poor inequality in child growth calls out for integration and convergence of nutrition interventions with policy interventions aimed at poverty reduction. There is also a need to expand the scope of the Integrated Child Development Services (ICDS) program to provide mass education regarding nutrition and health by making provisions of home visits of workers primarily focusing on pregnant and lactating mothers.

Anganwadi worker time use in Madhya Pradesh, India: a cross-sectional study

BackgroundAnganwadi Workers (AWWs) are a group of 1.4 million community health workers that operate throughout rural India as a part of the Integrated Child Development Services program. AWWs are responsible for disseminating key health information regarding nutrition, family planning, and immunizations to the women and children in their catchment area, while maintaining detailed registers that track key beneficiary data, updates on health status, and supply inventory beneficiaries. There is a need to understand how AWWs spend their time on all of these activities given all of their responsibilities, and the factors that are associated with their time use.MethodsThis cross-sectional study conducted in Madhya Pradesh, collected time use data from AWWs using a standard approach in which we asked participants how much time they spent on various activities. Additionally, we estimated a logistic regression model to elucidate what AWW characteristics are associated with time use.ResultsWe found that AWWs spend substantial amounts of time on administrative tasks, such as filling out their paper registers. Additionally, we explored the associations between various AWW characteristics and their likelihood of spending the expected amount of time on preschool work, filling out their registers, feeding children, and conducting home visits. We found a positive significant association between AWW education and their likelihood of filling out their registers.ConclusionsAWWs spend substantial amounts of time on administrative tasks, which could take away from their ability to spend time on providing direct care. Additionally, future research should explore why AWW characteristics matter and how such factors can be addressed to improve AWWs’ performance and should explore the associations between Anganwadi Center characteristics and AWW time use.

Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India.

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.

A Study to Analyse the Knowledge Level of Women Beneficiaries of Anganwadi Centres (AWC) Regarding Nutrition in District Budgam of Kashmir Region

Mother is a main caretaker of their children particularly during the first three to six years of life when they are at the risk of being undernourished. How well she takes care of her children to keep them healthy will depend upon the level of her knowledge regarding childcare and nutrition and various associated factors. As such this study was planned to assess and enhance the extent of knowledge among women beneficiaries of ICDS (Integrated child development Service Scheme) centers of district Budgam of Kashmir region. With an intension to surpass and facilitate the knowledge of women beneficiaries this study was taken up with a sample of 600 registered women beneficiaries of AWCs (Anganwadi centers) out of which 150 were nursing mothers, (NM) 150 were pregnant women (PW) and 300 were mothers of child beneficiaries (MCB having children in the age group 6 months-3years. The tool used for assessing the knowledge level was a self-devised rating scale designed to measure the nutritional knowledge related to importance of different kinds (variety) of foods for adequate/ optimal growth and development of a child. Further, in order to divide the levels of nutritional knowledge as, low, medium and high, Quartiles were calculated. In this way the mothers having low level of knowledge (Q1) those who scored up to 4, medium (Q2) whereas, sample women who scored between 5-6 and high level of knowledge (Q3) scored as ≥ 7.The statements were so arranged that a positive answer was specified under score of 1, whereas, a negative statement was granted a score of 0 . The scores of positive responses were summed up and the level of knowledge of women beneficiaries was ascertained, a statistically significant variation is observed in levels of nutritional knowledge as per educational qualification and income group among the respondents. It is also seen that respondents from block B.K.Pora and Nagam blocks are having high level of nutritional knowledge in comparison to block Budgam and Chadoora. Among the groups, MCB are having higher level of knowledge in comparison to NM and PW. No significant variation in the levels of nutritional knowledge is seen as per age. It is quite obvious from the study that education of mothers is directly related to knowledge. Educated mother are more knowledgeable than functionally literate mothers.

An assessment of nutritional status of pre-school children enrolled under Anganwadi centre: An analytical approach and report

Every child has the right to get affection, love and understanding, adequate nutrition and medical care free education and full opportunity for play and recreation, as the constitution of India upholds these rights and provides guarantee to protect the children from any sort of exploitation. The government of India launched the scheme of “Integrated Child Development Services” popularly knows as ICDS on October 2, 1975 with the assistances of UNICEF to tackle the problem in an integrated manner and to meet the challenge. The grass level of ICDS is Anganwadi and centre, is run by the Anganwadi workers. An angnawadi worker is the main functional unit and head of the center. Food in adequate quantity and quality is probably the most important factor affecting health and nutritional status. Due to the insufficient supply of diet majority of infants are suffering from protein energy and, thus have been associated with malnutrition. A statistical approach has been made to assess the nutritional status of pre-school children with the age group of 0-6 years of urban slum and rural of Samastipur district under ICDS scheme.

The Impact of a National Early Childhood Development Program on Future Schooling Attainment: Evidence from Integrated Child Development Services in India

AbstractEvidence on the long-term benefits of early-life interventions remains inadequate in developing countries. In this paper, we evaluate the effect of India’s Integrated Child Development Serv...

ICDS and supplementary nutrition programme to children in rural areas of Kasargod, Kerala

ICDS and supplementary nutrition programme to children in rural areas of Kasargod, Kerala - JMRA- Print ISSN No: - 2394-2762 Online ISSN No:- 2394-2770 Article DOI No:- 10.18231/j.jmra.2020.026, Journal of Management Research and Analysis-J Manag Res Anal

Distress migration and employment in indigenous Odisha, India: Evidence from migrant-sending households.

We convey responses from migrant-sending households in western Odisha from interviews on migration conducted during the lockdown. The majority of migrants are indigenous (referred to as Scheduled Tribes or STs in India), come from very poor households and have little or no education. Prior to the lockdown, the majority of migrants engaged in seasonal, temporary migration—working in dangerous, informal, low-skilled odd jobs for low wages for a few months to supplement incomes at home the rest of the year. Lack of local employment alternatives is cited as the primary reason behind migration. After the lockdown, in the absence of income from migration, households with former migrants hope to earn a livelihood locally—with assistance from National Rural Employment Guarantee Act (NREGA), India’s public works program. Besides providing employment, NREGA works can include physical and health infrastructure which improve connectivity of health workers. NREGA works can also include community assets, such as facilities for irrigation, rainwater harvesting and plantations as well as child-care centers under India’s Integrated Child Development Services (ICDS) program. We posit that in the long run, this can improve health, education levels and livelihoods of the local communities, addressing not only the immediate need for local employment but also distress migration in the future.

School-readiness Among the Underprivileged: The Neglected Dimension

In the Indian context, the problem of the high proportion of out-of-school underprivileged children as well as the learning deficits in many such children in primary schools have raised concerns. Preparing these children for their journey through schooling has therefore been under the spotlight. The national Early Childhood Care and Education (ECCE) policy recognises pre-school education (PSE) of these children as one priority area. Given that the increased privatisation of pre-schooling marginalises a large section of underprivileged children in rural India, the role of public pre-schools always remains significant. Although many pre-primaries in government and aided schools contribute to the PSE of these children, the public pre-school system at community level in the form of anganwadi centres (AWCs) under the national Integrated Child Development Services (ICDS) programme remains the most viable and cost-effective opportunity for a high proportion of these children. This article examines the state of the PSE at AWCs through the lens of coverage, mechanisms of service delivery, quality of learning opportunities and inclusiveness. The paper draws evidence largely from a sample survey covering 4,800 households and over 200 AWCs spread across 192 villages in three sample states, besides other macro-level data and relevant literature on PSE. The findings show that the implementation of PSE through AWCs does not comply with many ECCE norms. There is a lack of targeted PSE interventions for learning opportunities and developing socio-emotional skills. Among other factors, functioning of AWCs for less than the stipulated duration in a day, inadequate earnestness among AWC workers and unequal opportunities even in scarce PSE services adversely affect the PSE of underprivileged children. The article calls for increasing the efficiency of this largest public pre-school system through professional development of service providers and setting up monitoring mechanisms to ensure school-readiness of underprivileged children.

A CASE-CONTROL STUDY OF RISK FACTORS FOR MALNUTRITION AMONG PRESCHOOL CHILDREN IN A SEMI URBAN AREA ADJOINING INDORE (MADHYA PRADESH)

Background: Childhood malnutrition is a multi-dimensional problem. The prevalence of malnutrition among children in developing countries is very high. An increase in household income is not sufficient to reduce childhood malnutrition if children are deprived of food security, education, access to water, sanitation and health services. The aim of this study is to identify the characteristics of malnourished children between 3 to six years of age and to ascertain the risk factors of childhood malnutrition in a semi urban adjoining Indore (Madhya Pradesh, Central India.
 Objective: The objective of this case control study was to determine the risk factors for malnutrition among preschool children in a semi urban area adjoining Indore (Madhya Pradesh).
 Materials and Methods: A case-control study was carried out among preschool children, aged between three to six years, attending the Anganwadi centres and their mothers in a semi urban area of Tehsil & district Indore of Madhya Pradesh, India from 1 st April to 30th June 2019. Case was a child with moderate to severe malnutrition with z-scores < −2SD from the median of WHO reference. Control was a child without malnutrition with z-scores between -2SD and +2SD and the age matched with case’s. Face to face interviews with the respective child’s mother and measurements of the respective child’s weight and height were carried out. Information on socio-economic characteristics, household food security status, child’s dietary intake, caregiver’s practices and resources were enquired. A total of 1140 children (380 cases and 760 controls) were selected by multistage cluster sampling technique. A semi-structured risk factors questionnaire was used to identify the risk factors for malnutrition among children.
 Results: The majorities (45.8 and 45.5%) of the children in the study were in the age group of 3.0 to 4.0 years in case and control groups respectively. There was a slight preponderance of illiterate parents among cases in comparison to the controls. Largely, 87.4% of the children belonged to poor socio-economic status in the case groups compared to 82.4% in the control group. After adjusting for the confounders, underweight status was significantly associated with socio- economic status of the parents (aOR: 2.05, 95% CI: 1.06, 3.96), birth weight < 2000 g (aOR: 25, 95% CI: 0.10, 0.59), recurrent diarrhoea (aOR: 2.74, 95% CI: 1.56, 4.83), recurrent cold and cough (aOR: 3.88, 95% CI: 1.96, 7.67), worm infestation (aOR: 2.0, 95% CI: 1.19, 3.38) and pre-lacteal feed given (aOR: 3.64, 95% CI: 2.27, 5.86).
 Conclusion: Parental education, childhood illness, short birth interval, open defaecation, type of weaning and complimentary food given to children were some of the significant determinants of underweight that were found in the study. Information, Education and Communication (IEC) campaigns alleviating food habits and taboos and promoting birth spacing is the need of the hour for preventing the occurrence of malnutrition among preschool children.
 Keywords: Malnutrition, Anganwadi centres, preschool children, pre-lacteal feed, socio-economic characteristics, Information, Education and Communication (IEC), Adjusted Odds Ratio (aOR), Integrated Child Development Services (ICDS), Statistical Package for Social Sciences (SPSS).

M-Health Intervention Has the Potential to Alleviate Constraints in Using Administrative Data Systems for Improving Service Delivery in India

Abstract Objectives Administrative Data (AD) are a key component of nutrition data systems, but little is known about how AD are used or can be reshaped for accountability and action. We studied factors influencing AD use in India's Integrated Child Development Services (ICDS), in two Indian states; and assessed how an m-Health intervention (Common Application Software (CAS)) changes it. ICDS-AD system consolidates data from 11-recording registers updated every month by ∼1.3 million frontline workers (FLW). CAS digitizes these records and creates dashboards for real-time monitoring. Methods We conducted semi-structured interviews (n = 82) with supervisory staff at sub-district [Lady Supervisors (LS); Child Development Project Officer (CDPO)] and district level [District Program Officer (DPO)] to understand AD use patterns, facilitators and barriers. Data were coded, summarized and analysed across levels of supervisory staff. Results LS supervise FLWs, visit villages monthly to monitor data, and collate it to the sub-district level. Due to limited time and pressures to update AD on time, LS focus on data completeness and not on quality or data use. At the next level, CDPOs review and discuss program targets for indicators with LS, and check data completeness. They create monthly reports on targets for the districts, based on LS reports. At the district, DPOs use compiled reports to review subdistrict performance and discuss any gaps with CDPOs. CAS makes the data entry, compilation and report generation easier for all users. LS can monitor data entry daily in CAS and data collation is automated. CDPOs can review the CAS dashboard and use it to discuss issues with LS and DPOs. However, program target indicators dominate use of data. In CAS areas, these include growth monitoring completion, home visits, identification of malnourished children, and their referral. Overall, data use is target-driven, with indicators for monitoring prioritized by program management. Conclusions Focus of data use has been on reporting up on target indicators rather than on local program improvement, due to staff and time constraints. CAS can address some AD use constraints by easing data entry and data compilation but a data culture that focuses on predetermined target indicators can limit use for local program improvement. Funding Sources Bill & Melinda Gates Foundation via grants to IFPRI and UCSF.

Lasting Impact of Early Life Interventions: Evidence from India’s Integrated Child Development Services

In the year 1975, the Indian government initiated the Integrated Child Development Services (ICDS), the largest national programme in the world targeting long-term nutrition and holistic development of children, to be implemented through the Anganwadi Centres (AWC). Combining differences across villages in the year of AWC construction with birth-year of children, we capture the variation in ‘exposure’ to the programme, to estimate the impact of the ICDS exposure through access to AWCs on later life health outcomes of children. Our findings suggest that a 10–13 year old cohort fully exposed to the scheme during first three years of life has higher height (by 2.3 cm) and weight (by 1 kg) as compared to the same cohort, not exposed to the services in initial three years. The Z score of height-for-age (ZHFA) and Z score of weight-for-age ZWFA, although not statistically significant, seem to increase as well. The average impacts seem to be as high as 0.74 cm and 0.33 kg for an extra year of exposure, for measures of height and weight, respectively. Our findings are robust to changing age cohorts and several specifications. The effects seem to be larger among girls and in poor households.

Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016.

The Integrated Child Development Services (ICDS) program launched in India in 1975 is one of the world’s largest flagship programs that aims to improve early childhood care and development via a range of healthcare, nutrition and early education services. The key to success of ICDS is in finding solutions to the historical challenges of geographic and socioeconomic inequalities in access to various services under this umbrella scheme. Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015–2016, this study presents (a) socioeconomic patterning in service uptake across rural and urban India, and (b) continuum in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0–72 months) in India. We used an intersectional approach and ran a series multilevel logistic regression (random effects) models to understand patterning in utilization among mothers across socioeconomic groups. We also computed the area under the receiver operating characteristic curve (ROC-AUC) based on a logistic regression model to examine concordance between service utilization across three different points. The service utilization (any service) by mothers during pregnancy was about 20 percentage points higher for rural areas (60.5 percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4; 39.1). We also found a lower uptake of services related to health and nutrition education during pregnancy (41.9 percent in rural) and early childcare (preschool) (42.4 percent). One in every two mother–child pairs did not avail any benefits from ICDS in urban areas. Estimates from random effects model revealed higher odds of utilization among schedule caste mothers from middle-class households in rural households. AUC estimates suggested a high concordance between service utilization by mothers and their children (AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if service utilization commences at pregnancy.

WORKLOAD AND PROBLEMS OF ANGANWADI WORKERS IN TELANGANA STATE – A STUDY

Integrated Child Development Service (ICDS) scheme is the most important nutritional programme in the field of child welfare. Its effectiveness depends upon the efficiency of its functionaries at grass root level i.e., Anganwadi workers (AWW). AWW assumes a pivotal role due to her close and continuous contact with the beneficiaries children grow and develop amazingly. AWWs play the most dominant role in providing basic education, nutrition and ensuring health in rural and urban areas. AWWs was not able to work as per the activities specified in the recommended time as records maintenance consumed a lot of time i.e. three times more than the recommended time. Low honorarium, register work, meeting out of duty hours, short attendance of children and adolescent girls, not adequate space in Anganwadi centre (AWC), no government building for AWC were some of the problems reported by AWW. AWWs were unable to render services as per the recommended time because considerable time was spent in maintaining records and other activities. The study analyzes the trends and problems faced by AWWs of Warangal Rural District of Telangana State and suggests overcoming their problems. It is quite regrettable and sad to note that despite their social commitment and diligence they are very poorly paid and treated worse than the class fourth employers. That is an urgent need that the Telangana Government should look in the matter with all sympathy and concern.

Assessment of Utilization of Integrated Child Development Services Scheme in Uttarakhand

Background: ICDS scheme has been playing its role effectively since 1975 when it was launched, but still there are some short comings which need to be addressed. Uttarakhand being one of the states with poor health indicators with respect to child and mother there is need to increase research on implementation of programs. Aims & Objectives: The present study was conducted to see utilization of services provided under ICDS scheme in Uttarakhand. Material & Methods: A cross sectional study was conducted in selected areas of Uttarakhand from October 2018 to June 2019. 505 households from 16 Anganwadi centers, from both urban and rural areas of Dehradun and Haridwar districts were included. Assessment of utilization of services was done by household interviews. Data was analyzed using SPSS V 23 software. Results: Availing supplementary nutrition services was the most utilized service (94.5%) followed by health education services (88.3%), health and referral services (83.2%), preschool education services (76.7%) and least utilized service was immunization service (69.3%). Conclusion: Various factors independently affecting utilization of services were identified. Overall utilization of services is highest among pregnant women and least among adolescent girls and women of reproductive age group.

Imparting Educational Intervention on Health Care Practices for Integrated Child Development Service (ICDS) - Beneficiaries

Imparting Educational Intervention on Health Care Practices for Integrated Child Development Service (ICDS) - Beneficiaries

Awareness and Uptake of Maternal and Child Health Benefit Schemes Among the Women Attending a District Hospital in Coastal South India

Introduction: Maternal and child health (MCH) benefit schemes were introduced to increase institutional deliveries, to reduce out of pocket expenditure, to provide quality care and nutrition to mother and baby and thereby reduce maternal mortality rate and infant mortality rate. Objective: To assess the awareness and estimate the uptake of benefits regarding various MCH benefit schemes among study participants. Methodology: A cross-sectional study was conducted at district hospital, Mangaluru, Karnataka, India, among 250 antenatal women and postnatal mothers. They were interviewed using a semi-structured–validated questionnaire. Data were analysed using Statistical Package for Social Science version 11.5. Result: Awareness for scheme varied, ranging from 94 per cent for Integrated Child Development Service and 0.8 per cent for Rashtriya Bal Swasthya Karyakram. Major source of information being accredited social health activist (40.41%), most of the study participants had a favourable opinion regarding the benefits of MCH schemes. Maximum uptake was seen for Janani Shishu Suraksha Karyakram (100%); however, none of them availed Prasoothi Araike. Conclusion: Our study showed that the awareness and uptake for different MCH-related schemes varied. Most of the study participants had a favourable opinion about the benefits of MCH schemes. Since awareness for some schemes were low, efforts should be made to increase awareness regarding all schemes by displaying the information. Uptake can be increased by proper channelising the resources.

Recasting Food

This study is an ethnographic enquiry into the pre-school Supplementary Nutrition Programme (SNP), in India’s western Gujarat state. The broad objective was aimed at understanding the institutional barriers and sociological process that had led to the exclusion of families and children under the age of six from the SNP. This study was undertaken because despite enthusiastic State investment in human resources and food funding, the uptake of SNP was poor. The study method involved multi-sited ethnographies conducted in four rural villages of Gujarat. The research concluded that caste and religious identities shaped dominance and control, restriction of social interactions, and food commensality. The authors situate these compelling findings within the broader discourse of food as a process of ‘othering,’ and stigmatised identities as they relate to consumption of ‘polluting’ food, the symbolic role of food when coupled with caste, and association of religion with food. Observations of SNP delivery sites suggest that spatial and moral dimension of societal caste conflicts directly influence local ‘biologies’ by reproducing and amplifying such tensions in the Anganwadi health centres. Crucial symbolic and cultural markers of food, nutrition, distribution, and consumption are rendered invisible to official health providers resulting in failure of the SNP programme. Current research on global health advocating ‘scaling up of models’ is an ethical violation if it glosses local ecologies that shape poor uptake of SNP by the affected communities.