Huntiful : Humanity to Health: A New Phase of Learning Huntiful Lyngdoh Marshillong CHLP Bangalore 2014-
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- Huntiful : Humanity to Health: A New Phase of Learning Huntiful Lyngdoh Marshillong CHLP Bangalore 2014-
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2014-2015
2015
Community Health Learning Programme
A Report on the Community Health Learning
Experience
Huntiful Lyngdoh Marshillong
Marshillon
COMPANY
555-543-5432
5432
www.yourwebsitehere.com
SOPHEA
Humanity to Health: A New Phase of
Learning
Huntiful Lyngdoh Marshillong
CHLP Bangalore
2014-15
Contents
ACKNOWLEDGEMENT
II
ABOUT ME AND MY JOURNEY BEFORE I JOIN CHLP
1
MY PASSION
2
WHY I JOINED COMMUNITY HEALTH LEARNING PROGRAM
2
LEARNING OBJECTIVES
2
MY INSIDE LEARNING
3
LEARNING FROM COLLECTIVE SESSIONS
4
LEARNING FROM COMMUNITY
13
FIELD LEARNING
15
HEALTH STATUS IN MEGHALAYA
28
NATIONAL BIO-ETHICS CONFERENCE REPORTS
30
MY READING
36
RESEARCH STUDY
37
PHOTO GALLERY
57
i
Acknowledgement
I give my thanks and glory to God for being with me in each and everything I do in life
I deeply paid my sincere thanks to Dr.Thelma Narayan the Director of SOCHARA,
Bangalore and Dr. Ravi Narayan.
I express my gratitude to my Mentors in SOCHARA Dr.Ravi D Souza and Dr. Rahul who
help me to carry out my learning successfully during this one year of my fellowship program
in Bangalore. I am very thankful to all my SOCHARA Facilitators who has dedicated
themselves in giving us the knowledge, time and lending me a helping hand in time I need.
I am thankful to my field mentors Smriti Sukhla from Sathiya Welfare Society
Organisation, Bhopal and Gary Nengnong from Bethany Society, Shillong who supported
me a lot during my fieldworks which I learn a lot with their help.
My thanks goes to all the community people in Indra Nagar slum, Mira Nagar and Gautam
Nagar which have support and been with me during my learning process in Bhopal and to the
respondents for taking part in giving information for my research study.
Last but not the least I sincerely give my thanks to my parents, sister and brother and to all
my friends who always have encouraged and helped me in whatever I have done during this
whole
year
of
my
fellowship
ii
here
in
Bangalore.
About me and my journey before I join CHLP
My name is Huntiful Lyngdoh Marshillong from Nongstoin, West Khasi Hills District,
Meghalaya. I was born and brought up there in a Christian family, where I am the eldest
sibling among six of us with one younger sister and four younger brothers. My parents are
doing their own business work.
My background before I join SOCHARA
I did my graduation in the Arts stream (BA). After I completed my graduation I wanted to do
my post-graduation so I took admission in Martin Luther Christian University, Shillong
choosing Master Social of Work (MSW). In my MSW I have been taught about community
and other subjects that relate to the society, and how to work with it though at that time I had
an understanding about the community in my heart I wanted something more where I can
learn and get more insight about the community. When I completed my MSW I was in search
for a job and in the mean time I did voluntary work for four months with the Social Services
Centre, Shillong to gain more knowledge about working with the community. In Social
Service Centre, Shillong I got to do social audit on the MGNREGS (Mahatma Gandhi
National Rural Employment Guarantee Scheme) in Ribhoi district, Meghalaya. The audit was
a nice experience for me because for the first time I got involved with the people of the
different villages, and audited the work in their villages and went to the field to see the work
done by them. After this I had to write a report which I found a little difficult in the beginning
but later it went well. I was happy that I got a chance to be involved in this audit and where I
could talk and listen to the people. I got more involved with the people in the community and
at the system level I had to submit my reports to the block office for the public hearing about
the audit. It was during this time that I went to our University to meet the Head of
Department and she told me about this fellowship program on community health learning.
This struck to my mind and at the same I am very happy as I want to learn more about
community so without any delay or second thoughts in my mind I wrote to SOCHARA that I
want to join this course. I thank God that I got the privilege to be in SOCHARA learning
about community health.
1
My Passion
My passion since the time I was doing my MSW was to work with the community in doing
social action and prevention and to put into practice what I have learnt from this course.
Why Humanity to Health a New Phase of Learning
The topic I chose, humanity to health, was because I did my graduation in BA with the
elective subjects as economics, sociology and political science which are humanities subjects
and later for my post-graduation I joined MSW. From here it has been a turning point for me
where I got myself to do community health learning program for one year at SOCHRA,
Bangalore. This community health learning was like a light to me because if I would not have
joined this program I would not be able to understand about health in its wider perspective
and now I realised that those subjects that I have learnt during my BA and MSW are
correlated with health and health system.
Why I joined Community Health Learning
Program
Why I wanted to join the community health learning program is because I am interested and
wanted to get more knowledge and experience from this course so that I can help, create
awareness and make the people understand on how health is important for each one of us. I
want to understand more about what community health is all about and by getting exposure in
this field I would be able to work and give the best of my knowledge to the people in the
community.
Learning objectives
To understand about community health
To explore different fields during my fellowship program
To get an in depth knowledge on how to deal with the problems in the community
To build my confident level of understanding
2
My Inside Learning
Communitcation
Equity not
Equality
Report
writing
Team work
Understand
Community
Health
Learning by
Doing
Reflection
Inside
Learning
3
Build up my
confident
level
Learning from collective sessions
The community health learning program was an insightful learning for me. One of the most
important part which I like the most is when they tell that we are all learners and we need to
learn from each other throughout this fellowship and there is no teacher here but there are
facilitators to facilitate fellows in the journey of community health learning. The sessions that
facilitators give were creative, make the fellows get involved in many activities and to relate
what that has been taught in the class we were able to practice in the community. It is like a
platform for me to see myself where I am and what I can do for the community.
In the four collective sessions that we had during our community health learning program I
have learnt and understood community health more clearly. Apart from the sessions that we
had in class we got to go for visits to different organisations and community. My learning and
reflection about the collective session are:
What is community health?
Health
About health I learnt that health is not only being healthy in the body or the absence of
disease. From the WHO definition and explanation I learnt that health is the wellbeing where
a person has to be physically, socially, mentally and spiritually healthy and not merely the
absence of diseases.
Community
I learnt that community means to bring people together and to build a community with them
where we can have a common understanding and common goal. In community we can have
different structures and denominations but they still share togetherness. We have to build
community in spite of the differences into a positive change.
Community health
I learnt that it is the process of enabling and empowering people to identify their own health
problems and prioritise them, and what action they want to take to solve the problem. People
have to demand health as their right.
4
Community development
From the session and group discussion I understand that development is not only the
development in terms of having big buildings, pucca roads and having many institutions but
development can be called development when all the facilities and services that are available
to people in the community can be used, everyone has access to it and reach to the people
who are unreached. People need to have their right to food, right to education, right to health,
right to employment and other resources in the community.
From here I understand clearly about health, community, community health and community
development and how all these have a link with each other.
Ten Axioms of community health
An effort to
Build a
System To
Achieve
Health for All
A new
vision of
Health and
Health care
not a
professional
Package of
Actions
It is the Right
and
responsibility
Autonomy
over Health
Integrate of
Health and
development
Ten Axioms
of Community
Health
Confronting
the Super
Structure
Confronting Biomedical with
new Attitudes
and Approach
Promoting and
Enhancing
sense of
Community
5
Building
Decentraliz
ed
Democracy
Building
Equity and
Empowering
Community
About these ten axioms of community health I understood and learnt that they are the tools
for community health that we need to follow to improve our work with the community. From
the axioms I learnt that in community health rights and responsibilities are important so we
have to give awareness to the people about their own rights and responsibilities, like right to
food and shelter and they have their own responsibilities to take care of entitlements when
they get them. Autonomy over health is where the people have the right and power to control
and make decision regarding their health. I learnt that how health has to be connected with
development in the community. People’s participation, reaching the unreached, strengthening
and empowering the community people are also a part of community health. To see the
common interest of the community, help to promote and enhance the sense of oneness, build
capacity for confronting any problems or cause of ill-health, bio medical problems and super
structure of health services are also a part of axioms. In community health it is not that we
have to go with a package of professionalism but with the attitude of being with the
community and create new ideas and orientation for health action and from the last axiom I
learnt that we need to reached the people who are unreached to achieve health for all. From
this I learnt that we need to go to the people talk with them and understand them. These
axioms are very helpful for me to see that if we work for the community is it from our point
of view or from the community point of view.
Paradigm shift
Medical Model
Social Model
Individual
Community
Patient
People
Diseases
Health
Providing
Enabling
Drug Technology
Knowlegde/ Social
issues
Professional
Control
Demystification
6
This paradigm shift session has been a great learning since in the beginning when I joined the
fellowship I thought that health is only the medical part and I hadn’t thought that it can be
done in the social part. But after the session I understood that health doesn’t need or mean
only the medical model but can be shift to the social model. Like I mentioned in the above
diagram where we can work and help the community understand the different social
determinants of health at the grass root level.
From my observation during the time when I was doing my voluntary work they used to go to
the community and give services and medicines to the people but I have noticed that they do
not teach the people about the diseases how it caused, how it spreads. So the paradigm shift is
like shifting my mind to think in a different way when we go to the community we have to
know the root cause of the problem and give awareness to the people on how it is caused and
how it can be prevented and how to promote health.
From the diagram I learnt and understand that in medical model treatment and services they
are given to the people but in the social model we focus on people of the whole community to
identify health problems of the people within the community and try to find out the solution
for that problem with the people itself. It was a very nice and interesting session for me.
Determinants of health
When I first heard about social determinants of health I understood to an extent but
sometimes got confused about them. When we were in the field I got to interact with the
people in the community and when they shared about their problems I realised and got a clear
understanding following discussions with my mentor. I learnt that social determinants of
health are social, economic, political, cultural and ecological and all these can be a
determinants in some way or the other. For one problem there are many determinants which
influence that problem- education, unemployment, no proper, no safe drinking water, no
proper health care facilities among others.
7
Sanitation
Gender
Food, shelter & clothing
Community
support
Inequality
Social determinants
Nutrition
Economic
Determinants
of Health
Health System
Political
Cultural
Malnutrition is one of the determinants of health from what I seen in my field work where
women are anaemic and children are malnourished. Causes which leads to less nutrition are:
Don’t have enough food proper
No safe drinking water
No money to buy good and nutritious food
Lack of access to proper health care
Unclean environment
No proper sanitation
Poverty
This can relates from one cause and it is based on where I observe and talking with the people
in the community.
Social stratification
Social stratification in the society is a structure that divides or categories the people in terms
of power and status like caste, class, gender and an unequal distribution of resources.
I learnt that social stratification which exists in our society is one of the social determinants
of health as people cannot have an equal access to the services which are there in the
community as they have been divided into different status where the lower caste cannot mix
with the upper caste and also there is inequality distribution. Stratification affects the life of
the people, the opportunities that they are supposed to get but do not get, and it continues
from generation to generation.
8
Gender inequality and social exclusion is another social problem in the community and are
also one social determinants of health as people are looked upon and treated according to the
gender and also the exclusion of people from the society. From the movies that I saw during
various sessions people with low caste and class have been excluded in the community
Globalisation
Source: www.bized.co.uk
The class on globalisation was a very interesting; I understood and learnt that globalisation is
seamless or borderless. From the picture we can see there is capitalism and monopoly of
power. Due to globalisation the people who are rich are becoming richer and the poor are
becoming poorer. It also affects the environment (global warming), privatisation, equality,
exploitation and urbanisation. In today’s world though everything is becoming more and
more technical and scientific by the use of technology people who are supposed to get the
basic necessities are not able to access to them. Globalisation can affect the environment and
the people’s health like in my place, West Khasi Hills District of Meghalaya, where UCIL
Company and government want to mine uranium in spite of opposition from the people but
they want to do the mining and this can be one of the examples of exploitation as a result of
9
globalisation and instead of Aid they want only the trade. Globalisation has only one goal and
that is profit.
Primary Health Care
The term primary health care was introduced in the Alma Ata declaration. There are four
pillars of primary health care that is equity, appropriate technology, intersectoral approach
and community participation. These four pillars were designed too reach health to all by
using the resources which is available in the community, which are appropriate and to
involve people through participation and intersectoral coordination with other systems of the
government. Primary health care is for promoting health, for preventing ill health and for
people take the responsibility over their own health.
Communitisation in National Rural Health Mission (NRHM)
NRHM is one of the national initiatives of the government that provides health care facilities
to addresses the health needs and follows a bottom up approach in order to reached people in
every community in the country. Introducing NRHM, I can say that, has been a great work
done by the government to help in improving the health status of the country and to
strengthen the systems where people can have access to health. In NRHM communitisation
was one of the components, this includes the ASHA’s worker, VHND and Village health
sanitation and nutrition committee (VHSNC), where they were working with the people at the
community level to promote health within the community.
Health as a Human Right
Health is a state subject. Health as a human right, from this I learnt that, health is a process
and our part and responsibility is that we need to take care of it, it is not a commodity. It is
our right to get health care that we need to be healthy and we should also have the access to
health care that is available, accessible, acceptable and affordable, and to have a quality of
service. I understand that we the people can exercise our right to health and better health
system. It is our responsibility to take care as health itself is a part of life and we need to
make the system work. Health is a fundamental right.
Occupational health
Occupational was one of the interesting sessions to know and learnt about. I learnt and
understand that occupational is one of the major health problems as workers do not have any
safety measures and they are exposed to an unhealthy workplace and environment where they
10
are working. I used to observe and see people in my community working in mines, crèche,
constructions and other occupation and due to the job that they are doing they are facing a lot
of health problems, for which they will go and take medicine from the private doctors and
hospitals and as soon as they recover they will go and continue the same work. Hence it
affects their health a lot on but they will not change their job because of the money that they
get. From the movie which was shown I saw women and even children working in mines
which was affecting their health but due to poverty they have to do whatever work they get to
survive that too without any safety measures. Here I can say that right to health has not been
to make people aware that they have the right to have safety measures in their work place and
to have access to better health.
Quantitative and qualitative research
Research is to find out or to enquire about a problem. It is only a means not an end. Research
was one of the main topics which we had in our collective session. Through this session I got
more in depth knowledge of research and how to do it. It was a great learning for me as I got
a clear understanding about qualitative research and did my study using mixed method to
improve my knowledge about research.
Medical pluralism / Alternatives
From medical pluralism I understood that we do not have to depend only on the allopathic
medicine but we also have the traditional medicine like home remedies where it is easily
available at home and for which we don’t have to go and spend a lot of money, and also
different healers exists in the community. AYUSH (ayurveda, yoga, unani, siddha and
homeopathy) are few of the alternatives.
Health management
From the session I understand that health management is where we identify the health
problem and understand the social, economic, political, cultural and environmental factors in
the community and also find out the local resources. In health management we need to have
good planning between physical and human resources. It is a very important for us to know
what resources are required and how we can implement programmes.
Guest lecture
We not only got sessions from the facilitators but also had guest speakers who gave sessions
on various topics. From their sharing and classes I got inspired and also felt the need to
11
realise the realities. Communication class was one of the classes which I found very
interesting as from this class I gained a lot to build up my confidence levels and how to
communicate well with people. System thinking was one of the classes where I got to
understand how I can go and build the community and how to identify the problems and
prioritise them with the people in the community by using the different methods. It was very
useful and informative classes I got from all guests who came and gave session during this
fellowship.
12
Learning from Community
Field visits
SEVA in Action
Rajendra Nagar
Slum
Vimochna
Shanti Pain and
Palliative Care
Society
Kannur Association for
Integrated Rural
Organization and Support
(KAIROS)
FIELD
VISITS
Snehadaan
Association of People
with Disability (APD)
Foundation for Revitalisation
of Local Health Tradition
(FRLHT)
Apart from the sessions in the class, along with other co-fellows and the facilitators, we got
the chance to go for field visits to different NGOs which work in different areas and deal with
different issues. From these visits I got to explore and learnt many things about the work
done by the NGOs, community based organizations where in each of these organization
worked in the community and how they help and tackle the problems. Each of them has
played a very important role in the community to try and bring a change in the society by
giving awareness, doing social action, promoting health and strengthening people. It was a
nice experience going and visiting these organizations which gave me insights into how much
they have done and worked for the people and with the people in the community.
Protest
Other activities that we got to take part in this one year course of community health learning
program is to be a part of protests along with fellows and facilitators.
1 billion Women’s Voice- this was a protest against women’s violence and harassment and
to demand their rights to stop violence against women and need to be treated equally.
13
Green Peace protest against Genetic Modified Organism and genetic modified foods. From
this protest I learnt that there was a need to raise our voice for our own rights.
We all, the fellows, participated in the blind walk rally where many students had come and
took part in the blind walk to show concern towards those people who are blind by joining
with them in the rally. The blind walk was like practicing empathy and how much we could
feel when our eyes has been blindfolded and walk with those who are blind. It was really a
nice experience for me and I can understand how important it is for us when we do something
we need to put ourselves into their shoes and help them in the way we can.
We also went for solidarity of the Bhopal tragedy to show our solidarity and remembrance
for those people who have been affected by the gas tragedy.
14
Field Learning
1st and 2nd Field Learning
SATHIYA WELFARE SOCIETY, BHOPAL, MADHYA PRADESH
About the organization
Sathiya welfare society came into existence
in 2003 and has got its legal status on 28th
April 2006 under the Society Registration
Act, 1973. It started with ten youngsters
with a focus on empowering the people in
the community, fight for their rights and
take new challenges in their hands. The area
of focus is mainly development and
capacity building, providing training on
livelihood skill enhancement, developing strategic and short term planning of organization.
The approaches are mainly community mobilization, people sensitization and involving the
community through participatory approaches and build their consciousness through
developing a democratic set up. The organization is not only fighting for the rights of the
people but also prepare the community to take their rights by involving them in process of
ensuring rights for their brothers and sisters irrespective of belongingness of caste, culture
and creed.
Sathiya welfare organization works in five district of Madhya Pradesh that is Rajgarh,
Sehore, Betul, Shajapur, Agar and five slums in Bhopal that is Indranagar, Mira Nagar,
Krishna Nagar, Ichwar Nagar and P.C Nagar.
Sathiya welfare organization has the non-hierarchal organogram, the head office is located in
Bhopal and in the team they have a State and District co-coordinator, each staff has their own
responsibility for the work and if any problem or difficulties arise they consult together as a
team.
Sathiya welfare organization works with different disadvantaged groups like tribal, rural and
urban poor by providing them skills based on training and linking them with the market
directly. It also attaches them with various self-employment schemes which are run by the
15
government. It is also campaigning to the people on Panchayati Raj Institution. The focus
areas at present are Malnutrition, Mother and Child health as these are the major issues which
they have found while working with the community. In the slums now they are focusing on
the Adolescent and Women health. The organization has networked with NABARD in which
they coordinate with banks to ensure credits flows among its members and forge better bank
borrower relationships through forming SHG’s (Self Help Groups) and farmers clubs. It also
as a bridge helping communities reach health facilities, it also working on strengthening the
local health facilities/providers like Aganwadi worker and helpers, ASHA, ANM, VHSC and
the community as well by strengthening their knowledge, capacity building through trainings
and providing them information on various health schemes and facilities which are available
from the government.
Their Vision is to access rights for all by ensuring active
participation of women and men from the marginalized
sections of society by involving them in a process of
decision making on the basis of informed choices and
strengthening local self-governance system in reality. Their
aim is to strengthen and empower the community to
demand their rights and community participation.
Reflection
I was happy that the organisation was very helpful in
explaining how to do the logical frame work analysis so that we can do accordingly when we
are in the field. When I reached the slum seeing adolescence girls and women who are in the
centre with the organisation field staffs listening to them while they explain about
malnutrition makes me happy as I can see their willingness to learn and know more about it.
The adolescent’s girls who shows a great interest to continue their studies if they have a
chance and the approach done by Sathiya organisation to educate them in the centre was a
very helpful to them.
Understanding and learning about the community
Socio-economic status of slum in context of urban health
Brief History of the Slum (Indra Nagar Slum, Bhopal
- Ward No.-50)
Indra Nagar slum is a notified slum which situated in the southeast Bhopal near the 12 No
16
bus stop. This slum has been there for more than thirty years but does not have the exact date
and year of when it came up.
The people who reside here are mostly those who come from Maharashtra known as Marathi
people, the Nimadi people who come from Khandwa district of Madhya Pradesh and others
parts of Madhya Pradesh. These people migrated from different parts of Madhya Pradesh and
from the neighbouring states with the purpose of better earning for livelihood.
Demographic
The demographic population of this slum according to the data from “A glimpse of slums in
Bhopal” the total number of house Hold was 800 and the total population was 8000. Here
Scheduled Caste (SC) population was more than Scheduled Tribes (ST), Other Backward
Castes (OBC) and General.
Community
SC
70%
ST
1%
OBC
20%
General
9%
Religion
Hindu
85%
Muslims
5%
Christians
10%
Sikhs
0%
Others
0%
This information was through our interaction with the people and observation
The major livelihood of the people here is domestic work, house painting, daily wage work
and others kind of works. Both men and women are going for work to earn their livelihood.
17
Living Conditions
The living conditions of the people here in Indra Nagar slum are not good and the
environment that they are in is not good as they don’t have a proper sanitation, drainage
system, proper place for dumping waste and housing. The type of houses where the people
here lived was in semi-kutcha and kutcha houses. The place is very congested and there is no
place for the children to play.
Sanitation status
The people in this slum mostly they do not have their own toilet and only few houses that
have got their own toilet at home and use it. The sanitation status of the people living in this
slum was not good as many of the people went for an open defecation and some went to the
public toilet.
Water Sources/Supply
For water they get tanker supply and the source of water that the people get here was from
Kolar. They have the water tank and from here it supplied by pipeline connection and people
get water from the pipe only without a proper connection like water tap. There was no handpump, well or tap connection in this slum.
Electricity
The people have accessibility of electricity and street lights. There are houses which got
electricity connection with a meter at home. There are some houses which they do not have a
proper connection and they are connecting illegally from the main wire. Those people who
have got the connection at home told that they find it difficult to go and pay the bill because
they did not get it for each and every month and found it difficult to pay the bills one time all
the bills that they got.
Type of Clusters
People in the slum are likely to settle with their own people who belong from their same
place and same state. They like to settle in groups who are from their own clans and those
who are belong to their same customs and traditions, beliefs and those who are from the same
caste. This pattern of settlement which they followed where the Marathi people stay in one
area, the Nimadi people in another area and the others who are from different community like
Christian and Muslim they stay in different areas.
18
Status of Institutions/Infrastructures
Here the institutions which exist in the community are two primary schools one is private and
one is government school. There were no health care facilities there is only one DOT centre
and a nearby private hospital. There are small temples in the community where the people
used to go and worship and celebrate and there is no community hall available. There are also
two Anganwadi centres within the community.
The infrastructure was not good as the place where people lived was so congested and the
houses that they build are kutcha and semi kutcha, they have access to roads, electricity and
water but they do not have a proper place for dumping the waste and also no proper drainage
system.
Anganwadi Centres in the Basti
There are two Anganwadi centres within the community.
The first Anganwadi started in the year 1985
The second Anganwadi started in the year 2007
These Anganwadi building centres was rented and they got a small room to use and there
was no water facility and toilet available as it was a rented house where people stay in that
Anganwadi. No proper place and the room are small. They use to distribute the cook food to
the children’s and for the adolescence girls they give iron folic acid tablet.
Table No 1: Weighing of children in one Anganwadi
Age
Total
Boys
Girls
SC
ST
General
OBC
0-3 years
49
22
27
22
0
4
14
3-6 years
23
8
15
12
2
3
6
According to the data given by the Anganwadi worker the total number of children who came
to the first Anganwadi was seventy two and from the second Anganwadi we are not able to
get the information.
Table No 2: Grades of malnutrition children as per their weight for age
Age
Normal
Moderate
19
Severe
Boys
Girls
Boys
Girls
Boys
Girls
0-3 years
8
7
3
7
3
6
3-5 years
8
3
2
2
2
2
Through the weighing that we did on the 8th May, 2014 out of 62 children nine of the children
are above five years so we did not include. This data we plotted on the growth chart and 13
children were severe malnourished, 14 are moderate and 26 of them are normal. This
weighing was only from one that is the first Anganwadi.
Schools in the Basti (Slum)
There are two schools in this slum one is private and one is government and both the schools
are primary schools.
Health institutions/Clinics in Basti (Slum)
No government health institutions exist in the community; there was only one nearby private
hospital and one DOT centre which used as a clinic. The health care services which the
people get are only from the private clinics that are available in the community and from the
private hospital which was near to their place or went to the district hospital, and the distance
to go to district hospital was about eight kilometres from the slum.
Public Distribution System
The people they use to get the ration every month where they used to get rice, sugar and
kerosene and the distance is not far as they use to go and take from 12No stop which is near
to the community. The amount that the people get was according to the size of the family
members. They get the ration at a very reasonable price where most of them are able to afford
it.
Problems identified
List of Problems
priority bases
Housing
on Reasons
Poor people cannot afford to go and stay in the buildings
provide by the as they to pay so much of money and the
rooms are small in which the family having five or six
members cannot be easily fit in along with their household
20
things
Sanitation
Mostly people do not have their own toilet so they used to
go for an open defecate which they sometime feeling shy
sitting and facing with the other person but there was no
space to construct toilet
Livelihood
Livelihood was one of the main important parts of the
people in the community where they consider it as one of
the top priority apart from education and health. If people
did not get a proper job or wages they are very worried of
how to feed themselves and the family.
Health
Health was one of the priority where the community
people are not access to any government health care
facilities.
Education
Education was one of the important parts but the people
choose livelihood and health first and education last. There
are who understand about the important of education and
those who can afford to let their children to study they do
that but there are some who cannot afford to make their
children to study they have to make them involve with any
job they get to survive.
Detailing of problems as on priority basis
Here the people like to settle with their own community and with their own people who
belong from the same state or same places; they are not likely to stay or mixed with different
groups from different communities and denominations. Their socio-economic are also
different as mostly the Marathi people men are going for house painting and women are
domestic worker and the other community also doing the same work for but there are others
who are involve in other works. The response from the community people was good. Here
the government stake holder function are not in proper as for electricity the connection they
are delaying in giving the electric bill which the people have to pay three or four months bills
where the people are find it difficult to go and pay and the BPL card which they did not issue
in the right time and make the people to wait for months. There are government health care
facilities
Intersectoral approach
21
In the field when I was placed for field learning the intersectoral approach is there as the
NGOs people are working together with Anganwadi centre and with the community people to
work in health. The ARSH is one which in the community they are collaborate with the
ASHA, USHA, Anganwadi workers and schools where they use to provide the iron folic
acid. Adolescents get iron folic acid, calcium and vitamins for free. They used to have
discussion on different topics on adolescents health in schools, colleges, the teens groups. Per
day four to five adolescents come for counselling. ARSH also networks with NGO’s to work
in the community and here in Bhopal they network with Agan Trust NGO and Bachpan NGO
Social determinants of health
In the community which I was placed social determinants was the main problem were people
do not have proper housing, unsafe drinking water, poor sanitation, no proper drainage
system, no health care facilities in the community, no proper electricity and unclean
environment where all these can affect the health of the people because most of them they
were struggle to earn their living by doing any kind of job they got. Therefore from the
community I learnt the social determinant here includes the social, political, economical,
cultural and ecological.
Health care providers and medical pluralism
I also learnt from the community about the health care providers where they have the Dais,
general practitioners, and the private hospitals which they have nearby and the people of the
community they will go to the general practitioners to take medicines rather going to the
government because it is far. Medical pluralism was also there where the people are
practicing home remedy when they are getting sick and they also go for allopathic medicines
for quick recovery.
Health care systems
Health system was not seen in the community as there were no health care facilities and
services but there are only Anganwadi worker and USHA who give health education to the
people whereas from the government there was no health care institution. People can have
access to health care facilities in the government hospitals but it was far from their place that
is why it makes the people to choose the other option to go to the private doctors and general
practitioners and no going to the government hospitals.
22
Through the visits to districts hospital, Hamedia hospital, PHC and the Gauravi centre I gain
a lot of information and understand that what services and facilities it was good and they are
functioning well but sometimes people in the community even though they know that all the
services they can get from here but they are not going to use it properly as they said that it
was crowded and have to spend a lot of time to be there in the hospital and it is far.
Problems faced by the adolescents
Outside the family
The adolescence girls who have to go for work sometimes if they have to go by themselves
all alone they are not comfortable because on the way there are some boys who use to pass
comments on them and teasing them on the way and if they ask someone from home to
accompany them they did not get. They also have problem with the timing in their work place
because if they want to shift the timing for their work the house owner did not allow them
and they have to stick with it. The works that they did include in the house are washing
clothes, cleaning utensils and cleaning the house but the payment which they get is less.
Inside the family
In the family these adolescence girls did not get the support from their parents, no trust and
getting scolding from their parents if they did not for work and they feel like their parents are
not given proper attention and love to them. Gender discrimination at home where their
brothers will go and roam but for them they have to go for work and during eating time the
parents will give more and for them later and the quality of food they did not get the same
like their brothers get.
These problems makes them to think that they are not worth and they said that they even feel
depressed and sometime even think about suicide and low self-esteem as no one is there to
support them if they need. When they are in the community they are not allowed to talk and
make friends with boys they have to be at home and talk only with girls. Mostly if they have
any problems they use to share with their friends.
Discrimination and gender inequality
The parents treat the boys differently from the girls as mostly for them but for girls they have
to study and doing household works after they came back from schools coming from school
but for the boys they are not allow to even wash their own clothes which shows some
23
inequality. When they go to school for their brothers they will give more money but for them
they will give only ten rupees and when they are at home they are not allowed to make
friends or talking with any boys. For dresses also they have to dress with fully covered with
dupatta. They do not have freedom like the boys has. For girls during their menstruation they
are not allowed to go anywhere apart from school and not allowed to go to temple which is a
part of their culture. These adolescence girls they did not get any information from the school
about health education and when they reach the puberty stage their sister or mother has to
help in explaining them about the menstrual period. Due to this inequality at home some of
the girls think “why I was born as a girl not as a boy”. One of the adolescent girls who face
sexual harassment from her father is not able to speak to any one because her father would
not allowed her to go out with anybody.
About ARSH clinic
From the visit to the district hospital I learn about the ARSH program and the helpline which
is also one of the counselling centres for the adolescents which is running by the state
government for the adolescent health. It is one of the centres where the adolescent can get
medicine like IFA tablet and counselling. They also the help line which
use to give
counselling through phone as well as face to face counselling for both adolescent boys and
girls
Reflection
Through the discussion and interaction with the people in the community was that mostly
teenage boys and girls faced their different problems at home as well as outside. Peer
pressure, family problems to earn the living and other problems like relationship problems
which leads them to substances abuses when they don’t anything to do. From the interaction
with some girls was that the food that they take was very less as they don’t have a good
appetite to eat which can leads them to anemia. They never go to the Anganwadi to get the
IFA tablets and this seems that most of them do not like to go to the Anganwadi and they
don’t know that IFA helps them in case they are anemic. Lack of awareness on the need of
nutrition and health education can affect their growth as for them nutritious food is important
due to lack of appetite to eat. Therefore awareness for both boys and girls is needed and life
skills education is very important.
Other social issues in the community
24
Here mostly men are engage in gambling, taking alcohol which leads to domestic violence
and even the younger children start to imitate the habits that they see in the family. The
unhealthy lifestyle practices by the elders within their home as well as outside the family
affects the children and adolescence where adolescence boys are eating khutka, pooch which
it is not good and which affect their health.
Overall Reflection
From these two fieldwork my reflection was that the living condition of the people in the
urban slum are not good and we can say that what the people in rural areas are getting like
MNEREGA schemes the people here in urban poor did not get any scheme, no primary
health care available for them. People have to struggle to go and search for job so that they
will be able to meet the needs of the family. They have to face a problem to meet their needs
like sanitation, unsafe drinking water, no proper electricity and place to throw the garbage are
not available in the community and due to this the surrounding are unclean. Many children's
who are supposed to go to school they did not go and some they have to drop their schooling
as no one was there to look after their siblings as parents are going out for work. Malnutrition
among children are high and from the interaction with some mothers the food or milk that
they give to the children they mixed with water and give the child and there are mothers who
are suppose to breast feed the child but want to give something like cerelac this it was due to
lack of awareness and education among them. What I like from the people who stay in this
slum was that even they are come from different places and settle here they still have that
love and to be proud about their own culture and tradition where they use to celebrate it
which shows the uniqueness in them. Adolescents in this community faced a lot of the
problems either with the community, at home they also faced gender discrimination, not
equally treated and harassment. It is their time to get a lot of support either socially, mentally,
physically, spiritually but they didn’t get they have to strive and search for their living and
help the family. Through the visits to the different hospitals and PHC it was very helpful for
me to see the different services that give and how the government services provide to the
people but human resources are still less. Through these four months of my community
learning in Bhopal has been a very useful, informative and has made me understand more
about the community in urban.
3rd Field Learning
Bethany Society Shillong, Meghalaya
25
About the organisation Bethany Society it is a non-profit organisation and it was established
in the year 1981 and it was a charitable society. Bethany Society dream ‘Of an earth fully
alive, where everyone can enjoys fullness of being’.
Bethany Society work towards this by “Forming partnerships with people, communities and
resources so as to create opportunities which empower enhance dignity and lead to security of
health, food, livelihoods, and shelter in a sustainable manner”.
Bethany Society works with “People’s in vulnerable situations such as persons with
disabilities, children, youth and women living in extreme poverty, particularly in remote rural
areas”
Bethany works with many different projects and some of those project are
Hostel for people with disability in Shillong and Tura
Jyoti Sroat School, school it is an inclusive education
Community based rehabilitation program (CBR) in Mawkyrwat
Promoting mental health across Meghalaya
Learning
In the third field learning I was placed in Bethany society, Shillong, Meghalaya where I have
to do my research study in one of their working district that is in Mawkyrwat, South West
Khasi Hills District. In this two months of my third field learning it was a great experience
for me to do my study and also to participate in different programs which has been conducted
by Bethany Society, Mawkyrwat.
ASHA profile in Meghalaya
In Meghalaya there are 6258 ASHAs where in each districts they have ASHAs. From the
interaction with the ASHA in the field they tell that they have to do a lot of things to be done
where sometimes she said it is difficult for her because the incentives was less but they have
to do it. The activities of the ASHA was
Mobilizing pregnant mothers for ANC and escorting them for Institutional delivery.
Mobilizing Children & mothers for immunization
Conducting home visits & surveys
DOTS Provider
26
Collecting blood slides
Salt testing & water testing
Conducting VHSC meetings
Organizing VHND & other health activities in the village
Motivator of family planning
Depot holder of basic drugs
Promoter of healthy lifestyle
Assisting ANM in Home Deliveries
The ASHAs that I met and interact with them was working very hard to promote health along
with the VHND and VHSC. They are doing her work with responsibility.
27
Health status in Meghalaya
Meghalaya as per census of 2011 it has a population of 26.59lakhs. Health status of
Meghalaya was
Table
1.
Demographic,
Socio-economic
of Meghalaya State as compared to India figures
and
Health
profile
Indicator
Meghalaya
India
Total population (in crores) (Census 2011)
Decadal Growth (%) (Census 2011)
Crude Birth Rate ( SRS 2013)
Crude Death Rate ( SRS 2013)
Natural Growth Rate ( SRS 2013)
Infant Mortality Rate ( SRS 2013)
Maternal Mortality Rate (SRS 2010-12)
Total Fertility Rate (SRS 2012)
Sex Ratio (Census 2011)
Child Sex Ratio (Census 2011)
Schedule Caste population (in crore) (Census 2001)
Schedule Tribe population (in crore) (Census 2001)
Total Literacy Rate (%) (Census 2011)
Male Literacy Rate (%) (Census 2011)
Female Literacy Rate (%) (Census 2011)
0.30
27.82
23.9
7.6
16.4
47
NA
NA
986
970
0.001
0.2
75.48
77.17
73.78
121.01
17.64
21.4
7
14.4
40
178
2.4
940
914
16.67
8.43
74.04
82.14
65.46
Table 2. Health Infrastructure in Meghalaya
Particulars
Required
In position
Shortfall
Sub-centre
789
397
392
Primary Health Centre
118
109
9
Community Health Centre
29
29
0
Health worker (Female)/ANM at Sub Centres &
PHCs
506
787
*
Health Worker (Male) at Sub Centres
397
133
264
Health Assistant (Female)/LHV at PHCs
109
79
30
Health Assistant (Male) at PHCs
109
69
40
Doctor at PHCs
109
104
5
Obstetricians & Gynecologists at CHCs
29
5
24
28
Particulars
Required
In position
Shortfall
Pediatricians at CHCs
29
1
28
Total specialists at CHCs
116
9
107
Radiographers at CHCs
29
22
7
Pharmacist at PHCs & CHCs
138
142
*
Laboratory Technicians at PHCs & CHCs
138
134
4
Nursing Staff at PHCs & CHCs
312
414
*
29
National Bio-ethics Conference Reports
The 5th national bio-ethics conference was held on 11th -13th December, 2014 in St.John’s.
The theme of this conference was Integrity in Health Care, and Research.
This was my first experience in attending the national conference which gives an insight to
understand the integrity in health care and research. As has been said by Prof. Shiv
Visvanathan in the first plenary session is that ethics is cognitive. Ethics is not only what we
think that it is what we feel from our heart but it should also be cognitive by using our mind
to think.
From the talk given on the dualism of bio-medicine by Prof. Farhat Mozoam I learnt that in a
person we have the dualism that is the good and the bad. The two realms that is physical
which it is biological machine which can be studied and the mental realm of mind studied
through philosophical and religion. The physician’s world is about the body based on facts,
biology and about diseases but the patient’s world is with the living body which they
experience emotions and illness and it is subjective reality.
Parallel workshops session
Public Ethics -1
A critique of extractive capitalism: The role of public health ethics which
presented by Agnus Dawson
In this workshop Agnus Dawson give his presentation on ‘an extractive capitalist economy’
where he explain about the development in Odisha in practice of mining of metal ores and
aluminium. Explicit focussed on top-down economic development. The mining companies
are foreign own and are perceived which involve corruption in the state. Extractive industries
often fail to deliver on the promises of employment and other economic benefits to the people
of the state. Here the critique is about how development can have a major impact on integrity
of the community people, their health and the environment. Here Public health ethics has
brought to discuss on the concept such as solidarity, equity and the common good of the
people
30
Learning
Through the discussion I got to understand that how the people or the community has to face
the difficulties just because of the development that the mining industries try to extract the
resources from their land. The impact of development which leads to migration of the tribal
population and getting false promised on land, money and employment.
Reflection
From the session my reflection was how can public health ethics can be practice and help the
people as the aims of preventing, promote health and reduces inequities. Public health has the
values of equity, solidarity, trust and community common goods but these are missing instead
of giving the community the harmonious idea of development instead their environment,
health status and livelihood has been affected, whose rights has been protected.
US funded measurements of cervical cancer death rates in India: Scientific
and ethical concerns
Scientific studies had established cervical cancer screening for preventive health intervention.
Starting 1998 three separate randomized trials in India funded by the US National Cancer
Institute and the Bill & Melinda Gates foundation. To date, at least 254 women is unscreened
control groups have died from cervical cancer. Eric J Suba was talking about scientific and
ethical concerns about US funded death rates measurement which has been published in peerreviewed journals.
Reflection
Through the presentation my reflection was how much the US funded has been given to in
India for cervical cancer screening but the death rate measurements continued even after
mortality benefit from screening has been confirmed. Scientific design required for ethical
misconduct and an informed consent should be taken before screening.
31
Learning
Ethical concerns among women who do screening were that its subjects have not provided
inform consents. Manipulate to benefits the academic industrial complex.
Occupational health in India
In the session three presentations has been presented on occupational health in India where
the presenter presents their topics in which the first speaker was Dr.Naveen which talks about
the key points from the code of occupational health ethics as prescribed by the International
Commission of Occupational Health. The second speaker Mr Jagdish Patel shared his
interesting work experience in which he himself went with the workers to visit the doctors for
treatment. The third speaker, Amulya Nidhi, showed a short movie of silicosis patient
discussing about their problems and situation they faced and where they took up the case
study of workers from tribal population in Madhya Pradesh who migrated for work.
Learning
Through this workshop about occupational health that I attend was very helpful for me to
understand more and a clear understand on what is silicosis how it affects people and what
are the result of it
I learnt about the code of occupational health ethics in which the code raised issues on
prevention for the welfare of the worker in their work place and follow up of remedial action.
Workers are not informed and being misled by the doctor if they are diagnoses as silicosis
where they have been told that it was a TB and keep the reports confidentiality. 93% of
occupational health was in unorganized sectors.
There is Ethical dilemmas in which inform consent is not given to the workers and also the
safety. Doctors are not sitting and discuss with the patient and how the patient who have been
affected by silicosis and they have been informed that ‘coal dust is not harmful’.
Through the discussion after the presentation what I learnt was that awareness for the people,
safety in the work place and trained doctors is needed to address the problem.
32
Reflection
Through this workshop it makes me understand that occupational health was one of the main
health problems where people do not understand. People being mislead by the doctors in
diagnose the diseases that they got and the untrained doctors or medical students who give
treatment. In this ethics has not been practice as the workers are not given any consent about
the hazards and unhealthy of the work that they are going to face and keeping confidential
about their health status report. If the government did not approved that the patient who got
silicosis has been told and treated as a TB patient this makes people think that it was TB only
because they do not have any awareness about silicosis and not a proper support from the
system people are helpless.
2nd Day parallel workshop
Public Health Ethics -2
In this workshop on public ethics-2 in which the first presenter present on the Ethics of
Dental Health Screening in communities in India where screening was done among the
school going children which it is easier to implement and this was done to promote regular
screening of the dental diseases. The second presenter presents on the topic of polio
eradication in India: a national mission? Exploring some ethical issues through a case study
in Odisha which has been talk on how polio eradication has been one of the main goals to
achieve. The third presenter present on financial inclusion is an ethical imperative to reduce
health inequities and strengthen integrity in health schemes in which Sridevi Seetharam
explain about their study which has been conducted in the tribal hamlets of a rural district in
Southern India.
Learning
From the whole session my learning was that the increase in numbers of dental teachings
hospitals has an impact where the schools as an institution where children’s in school has
been one of the target point which they find it easier to do dental screening and even the
community people with their intention to promote awareness on dental diseases but this is
one way to create the demand for the dental care and capitalised for enhancing their clinical
activity. No involvements of parents, no informed consent which is their rights and no follow
up after screening.
33
About polio eradication what I learnt is that people think it as a government medicine where
some people who followed their traditional medicine didn’t want their children to take the
polio drops. It is a top-down structure and politics where the ground level problems are not
able to understand and to negotiate for roads, water and electricity taken place.
From the presentation on financial inclusion I learnt that among the 56 tribal hamlets out 177
pregnant women only 59% received JSY schemes and that too after many weeks of delivery.
Most of the tribal women didn’t understand the guidelines and they also find it difficult to
maintain their documentary requirements as most they will migrate from one place to
another.
Reflection
From this whole workshop on public ethics I feel like mostly there are system errors and not
been able to understand the problems at the ground level. Ethics and integrity was not seen in
some cases where inform consent are not given properly. In giving any schemes to the
beneficiaries financial literacy has to be given to get a proper implementation about the
schemes. Health has sometimes been negotiate with the other developments in the states and
as medical institutions increased people will be like women and children has become
vulnerable to screenings and trial of drugs.
3rd parallel workshop
Clinical Ethics Consultation
From this workshop on clinical ethics consultation which has been presented by Dr. Robyna
Ershad Khan I learnt that in good clinical practice they have informed consent and truth
telling that is the between the physician and patient or family member of the patient. Cases
arise when it comes to financial aspect as it differ from one patient to another, facility of care,
end of life care and when it comes to decision making who will the decision on behalf of the
patient whether the family member, the patient himself or the doctors. Ethical consultation
can have 2 or 3 people.
34
Reflection
Through this reflects me was that ethics in clinical practice can be practice but there are
cases when it come decision making and financial aspect for the patient. The need of building
trust and respect the person and quality of life care is also needed for the patient.
Over all reflection
The first time of getting like this opportunity to get and attend like this type of conference it
was interesting and helpful for me to get to know about bio-ethics what is it all about wand
what does it mean. The sessions and workshops was mostly in line to the medical term which
is quite difficult for me to understand but as I attend the workshops I get an understanding
that all the sessions can relate to our community and health system.
Conclusion
This fellowship program was a great time and learning to me I got to understand more and in
depth about community health from all the sessions that I got in the class, field visits to
different organisations that I have learnt from the visits and other activities that we as fellows
we went and take part in the protest which the organisation conducted and the guest lecture
that we got from the people who are really committed with their work in the community. This
whole learning program which I got from the class and the field it was really precious and
insightful where now I got a lot of knowledge and understanding about community health.
The learning process which I got from here was very good, innovative and creative which I
can say that I am lucky to be here and learnt about community health in one year of my
community health learning program.
35
My Reading
1. Public Health Resource Book
2. Main Streaming Women’s Health
3. Reproductive & Child Health module for health worker female (ANM)
4. Where There Is No Doctor
5. Taking Sides by Doctor C Sathya Mala Et.al
6. Articles on adolescent health
36
RESEARCH STUDY
A study on the functioning of the Anganwadi centres and the
people’s perception regarding the services in Mawkyrwat, South
West Khasi Hills District
Background
ICDS was one of the national programmes under the Women and Child Development
Ministry. This programme has been initiated for over 38 years by the government of India in
every State to uplift the health and nutrition status of the child, pregnant women, adolescents
and the lactating mothers in the country. The main objective of the programme is to improve
the nutritional and health status of the children 0-6years. In India according to the NFHS 3
44.9% children under 3years are stunted, 22.9% are wasted and 40.4% are underweight and
children 12-23 months who get fully immunized were only 43.5%. According to the NFHS 3
in Meghalaya children who are underweight are 43%, 32% are wasted and 48% are stunted
and only 35% of children below six years of age are in the areas covered by an Anganwadi
and only 33% children of 12-23 months get fully immunized. In West Khasi Hills District
according to DHLS-4 data children 12-23months who get full vaccination were only 47.3%
from all the North East State Meghalaya was highest in having malnutrition children.
Anganwadi has been implement and function for over 38 years but through the studies that
has been conducted in different States in India the function was still need to be improve.
From the other studies that has been studied the health check-up and growth monitoring are
still poor because the weighing machine in some Anganwadi is not available and have to
borrow from the other Anganwadi centre and the non-availability of the new growth chart
booklets, no toilets facilities and small centre. The referral services was record in the registers
which is a part of documentation and the pre-school education that is supposed to be given to
the children of 0-5years but the Anganwadi worker do not have time to give proper education
to them. The supplementary nutrition and immunization are mostly done and there is lack in
providing nutrition and health education.
According to the Research on ICDS an Overview Vol.3 a study on the function of the
Anganwadi in Meghalaya which has been conducted in East Khasi Hills has been found that
the Anganwadi centre in the district on an average every centre had 96 beneficiaries and
enrolment of children of 0-3years was 37.53%. About 52.5% they give services to the
37
pregnant women, 87.5% for lactating mothers but records has not update and kept to justify
that the services has been provide. No proper maintaining of record by the Anganwadi
worker for the malnourished children of Grade I and Grade II where nearly 90% AWCs had
between 1-9 children who are in grade I malnutrition.
Rationale
The study has taken up to assess the function of the Anganwadi centres and to get the
people’s perception on Anganwadi as this is one of the national program which has been
running for 38 years to improve the nutrition level among children but malnutrition was still
high and according to the NHFS3 data children under 3years were 44.9% are stunted, 22.9%
are wasted and 40.4% are underweight. From the DHLS-4 data children who get full
vaccination in West Khasi Hills District was only 47.3%. From the other study it shows that
the there is less community participation, they have scarcity of water, unavailability of toilets,
poor attendance of children, less motivation from the supervisor, no proper weighing of
children, not maintaining of registers properly and nutrition and health services lacking in
most of the Anganwadi centres this is from the Delhi report visit on 8th July 2011 and ICDS
study article in Munger District.
Despite of the good services provided by the government through the ICDS programme
which runs through the Anganwadi centres in every State but still malnutrition among the
children is high. In Meghalaya malnutrition among the children is high as we can see from
the figures given by NFHS3. Therefore the study has taken up as less study has been
conducted in the state and to assess the functioning of the Anganwadi centres and the
people’s perception about the services provided by ICDS through the Anganwadi centres.
Research question
How was the functioning of Anganwadi centres in line with ICDS programme and what are
the people’s perceptions regarding the services provided to children 0-6years
Specific Objective
1. To assess the functioning of the Anganwadi centres in Mawkyrwat, South West Khasi
Hills with reference to nutritional services provided to 0-6
2. To assess on the nutritional status of children 0-6years
3. To understand the people’s perception about the services being provided by the
Anganwadi centres
38
Methodology
Study design
Descriptive study using a mixed method for data collection
Study Duration
September – November 2015
Study Area
In three villages which fall under Mawkyrwat Block, South West Khasi Hills District,
Meghalaya
Sampling design
Purposive sampling
Sampling unit
Village with Anganwadi centres
Study unit
Anganwadi workers, mothers of registered children 0-6years in the Anganwadi
Data Collection
Tools
o Questionnaires
o Interview guide
o Using recorder for in depth interview
Methods
o In depth interviews with the mothers of the children who are registered in the
Anganwadi centres
o Observation, review of registers and interview of data
Data Analysis
In the study the researcher used an audio recorder and also hand written notes which were
used for transcription. The transcripts were translated from Khasi into English. Data entry
and analysis was done on Microsoft Excel for the quantitative section and on Atlas-ti for
qualitative section.
Ethical Considerations
In the study participants were provided with a written consent sheet which explained about
the title, objectives of the study and the rights of the participants including voluntarily
participation and information of using an audio recording or written record, taking pictures
and also mentioned that in case of any inconvenience the participants can withdraw
39
themselves from taking part in the study. The risk for the participants was minimal as
confidentiality is of the most priority and the researcher maintained the rights of the
participants throughout the study.
Analysis
Table No 1: Details of the Anganwadi worker in four Anganwadi centre
Details about
the
Anganwadi
worker
Age
Qualification
Years
of
working
Complete any
training
Are you from
this village
Anganwadi 1
Anganwadi2
Anganwadi3
Anganwadi4
39
8th
7
27
12th
2years
27
10th
2years
44
8th
5½
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
The above table shows about the details of the Anganwadi workers working in different
Anganwadi centre where the Anganwadi worker age ranges from 27 to 44 years of age, their
qualification was from 8th standard to 12th standard, the years of experience as an Anganwadi
worker ranges from 2-7 years. All the Anganwadi workers have been selected from the
village itself and of the four Anganwadi workers, three of them have completed their training.
Table No 2: Anganwadi infrastructure
Details about
Anganwadi
centre
Anganwadi
building
Anganwadi
centre
Do you have a
kitchen
for
preparing food
Do you have a
toilet
Functioning or
not
Sources
of
cooking
Your
main
source of water
Anganwadi 1
Anganwadi2
Anganwadi3
Anganwadi4
Pucca
Pucca
Pucca
Pucca
Primary school
Own house
Own house
Community hall
No
Yes but not Not proper
regularly used it
No
Yes
Yes
Yes
Yes
Functioning
Functioning
Functioning
Functioning
Firewood
Firewood
Firewood
Firewood
Water tap
Pond
Pond
Pond
40
Table no 2 shows that all four Anganwadi centre were having a pucca building and two of the
centres were in their own building where as the other two are located in the community hall
and in primary school respectively. From the four Anganwadi centre only one has their own
kitchen but is not used regularly whereas the other three they do not have their own kitchen.
For cooking they use firewood and the main source of water use for cooking are ponds and
water tap. All Anganwadi centres had a toilet and it was functioning.
Table No 3: Equipment received by the Anganwadi centre from the ICDS office
Equipments
provide
by
ICDS
Registers
Weighing
machine
Growth chart
Utensils
Charts
Carpets
Are they being
used
Anganwadi 1
Anganwadi2
Anganwadi3
Anganwadi4
Yes
No
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Yes
Yes
Yes
Only one
Yes
Yes
No
Yes
Yes
Yes
Yes
Table no3 shows that all Anganwadi centres got the registers whereas only two Anganwadi
centre received weighing machines and the other two did not have as it as they were mini
Anganwadis. Growth chart were available in two Anganwadi centres. Three Anganwadi
centre had cooking utensils. One Anganwadi had one only chart whereas others had more and
one did not get the carpet. These resources are being utilised by all the Anganwadis.
Table no4 gives details of food availability both cooked food as well as raw food and food
supply that they get from the ICDS. All the Anganwadi centres get food supplies once in
three months. Delays in food supply from the ICDS happened in two Anganwadi centres and
sometimes due to weather condition during rainy season they got spoiled food.
41
Table No 4: Food availability in the Anganwadi centres
Availability of Anganwadi1
food supplies
Anganwadi2
Anganwadi3
Anganwadi4
Type of food Both ready to eat
supplement
and
raw
and
kutcha
Do
you
get No, once in three
supplementary
months
facilities
every
month
Is
there
any No
interruption
of
supplementary
nutrition
Ready to eat
and raw and
kuthcha
No, once in
three months
Both ready to Ready to eat
eat and raw
and kutcha
No, once in No, once in three
three months months
No
Yes, delaying
sometimes
due to
Weather
conditions
Spoiled food
during rainy
season
Yes, only once
during
rainy
season we got
spoiled food
Table No 5: Services provided by the Anganwadi centre
Services
Anganwadi1
provided in the
Anganwadi
centre
Supplementary
Yes
nutrition
Immunization
Yes given by the
ANM
Health check up Yes
by the
ANM
Referral services Yes
Pre-school
Yes
education
Nutrition
and Yes but once in
health education a month
Anganwadi2
Anganwadi3
Anganwadi4
Yes
Yes
Yes
Yes given by the
ANM
Yes
by the
ANM
Yes
Yes
Yes given by the
ANM
Yes they came
from the CHC
No
No
Yes given by the
ANM
No
Yes
Yes
Yes once a
month
for
women
No
No
Of six services provided by the ICDS only supplementary nutrition, immunization by the
ANM and nutrition and health education (once in a month) were being provide at all the
Anganwadi centres. Health check-ups were done in three Anganwadi centre by ANM. As for
referral services two Anganwadi centre said yes. Preschool education was given by two
Anganwadi centres. (Table 5)
42
Table No 6: Other services provided deworming and IFA tablet
Other services
provided in the
Anganwadi
centre
Is
deworming
done
for
children
Do you provide
Iron Folic Acid
in the centre?
Anganwadi1
Anganwadi2
Anganwadi3
Anganwadi4
Yes
Yes
Yes
Yes
Yes, but not Yes
regular
only
sometime
Yes
No
To whom do Pregnant
you provide?
women,
adolescent girls
Pregnant
Adolescent girls
women,
three
uneducated
adolescent girls
No
Deworming tablet was provided at all Anganwadi centre to children; IFA tables at two
Anganwadi centre were providing, at one Anganwadi centre they are not given regularly
whereas the other anganwadi did not give IFA tablets. The three Anganwadi centre which
give IFA tablet do so to adolescent girls and pregnant women where in Anganwadi2 they IFA
to those adolescent girls which are uneducated in the village.
Table No 7: Services on education and health education
Education on Anganwadi1
nutrition
Provision
of Yes
nutritional
health education
Methods used
Demonstrations
Dance and songs
sometimes
Anganwadi2
Anganwadi3
Anganwadi4
Yes
Yes
Yes
Discussion
Demonstration
Discussion
Discussion
Dance and songs Demonstration
In table no7 shows that all Anganwadi centres give nutritional and health education and the
methods they used includes discussion, demonstration and dance and songs.
Table No 8: Home visits by the Anganwadi worker
Home
Anganwadi1
visits
Do you Yes
do home
visits
How
3-4
many you
visits in a
week
Anganwadi2
Anganwadi3
Anganwadi4
Yes
Yes
Yes
3-4
3
2-3
43
For what
purpose
Educating
parents
of
malnourished
children
Advising
pregnant
and
lactating
mothers
Advice of sick
children
Motivating
parents to send
children
to
Anganwadi
regularly
Educating
Advising
Advising
parents
of
pregnant
and
pregnant
and
malnourished
lactating
lactating
children
mothers
mothers
Advising
Advice of sick Advice of sick
pregnant
and
children
children
lactating
Motivating
Motivating
mothers
parents to send
parents to send
Advice of sick
children
to
children
to
children
Anganwadi
Anganwadi
regularly
regularly
Motivating
parents to send
children
to
Anganwadi
regularly
In the above table talks about home visits done by the Anganwadi worker where all the four
Anganwadi workers used to go for home visits and the house visits per week ranged from 2-4
houses. The purpose of doing house visits was to give advice to the pregnant and lactating
mothers and motivating parents to send their children to the Anganwadi centre, where only
two Anganwadi worker went and give education for the parents of malnourished children and
two Anganwadi worker wgo and give advice for sick children.
Below table shows about availability and updating of registers. Not all registers were
available at the Anganwadi centres and not all of them were up to date.
Table No 10: Availability and updating the registers
Availability
Anganwadi1
and updating A
U
registers
Survey
Yes Not
register
yet
update
Anganwadi2
A
U
Anganwadi3
A
U
Anganwadi4
A
U
Yes
Not
yet
update
Yes
Not
seen
SNP register
Mother
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Child
Attendance
Delivery
Growth chart
Food stock
Yes
Yes
Yes
No
Not
seen
Yes
Yes
Yes
No
Not
seen
Yes
Not
available
during the
interview
Yes
Yes
Yes
Yes
Not seen
Yes
Yes
Yes
No
Not
seen
Yes
Yes
Yes
Yes
Not
seen
Yes
Yes
Yes
No
Not
seen
Not
available
during the
interview
Yes
Not
available
during the
interview
Yes
Yes
Yes
No
Not seen
44
Yes
Yes
Yes
Yes
No
Not
seen
Mothers
meeting
Child weight
Yes
Yes
Yes
Yes
Yes
Yes
Not seen
No
No
Yes
No
No
No
No
Not
seen
No
Table No 11: Supervision visits in the Anganwadi centre
Supervision
Anganwadi1
Anganwadi2
Anganwadi3
Anganwadi4
ANM visits in Yes, once a Yes, once a Yes, once in 2 or Yes, once in 2 or
the last 30days, month
month
3 months
3 months
90days,6 months
ICDS supervisor No, once in No, once in No, but in a year No, in 6 months
visits in the last three months
three months
nearly 8 times
1 or 2 times
30days, 90days,
6 months?
CDPO/ ACDPO No, once a year No, once a year No
No
visits in the last
30days, 90days,
6 months?
Medical Officer No,
last
8 No
No
No
visits in the last months back
30 days, 90days,
6 months?
In table 11 about supervision the ANM visits used to visits every 30 days in anganwadi1 and
anganwadi2 whereas in the other two Anganwadi only once in two or three months. No visits
in the last 30 days from the ICDS supervisor (they visit once in three months in two
Anganwadi centres, eight times a year in the anganwadi3 and in the anganwadi4 one or two
times in 6months). There was no visits from the CDPO/ACDPO for the anganwadi3
anganwadi4 and in the Anganwadi1 and anganwadi2 it was once a year whereas there was no
visits from the medical doctor in the last 30 days in all Anganwadi centres and the last visit
was 8months back in anganwadi1.
Table No 12: Beneficiaries 6months- 3years
Beneficiaries
Children (6months -3 years)
No. of children identified
during survey
No. of children registered
No. of children received IFA
No. of children for whom
deworming was done
No. of children for whom
growth monitoring was done
No. of children weighed in
previous months
B-Boys, G-Girls, T-Total
Anganwadi1 Anganwadi2 Anganwadi3 Anganwadi4
B G T B G T B G T B G T
26 21 47 44 28 72 11 23 34 14 15 29
26
0
2
21
0
1
47
0
3
44
0
10
28
0
10
72
0
20
11
0
0
23
0
0
34
0
0
14
0
0
15
0
0
29
0
0
0
0
0
10
10
20
0
0
0
0
0
0
0
0
0
12
1
13
0
0
0
0
0
0
45
Table 12 shows that the total number of children’s from the four Anganwadi centre was 182
which has been identified during the survey and registered in the Anganwadi centre.
Deworming has been done for children only 23 in Anganwadi1 and anganwadi2. Growth
monitoring was being for 20 children only in Anganwadi2 and the number of children that
has been weight in the previous months was only 13 children.
Table no 13 shows that the total number of beneficiaries in 3-6 years with all those identified
during the survey being registered in the Anganwadi centre. The number of children who got
deworming tablets from the centre was 47 from the three Anganwadi centre and only
Anganwadi4 has not given. Growth monitoring was done only in the Anganwadi2.
Table No 13: Beneficiaries 3-6years
Beneficiaries
Anganwadi1 Anganwadi2 Anganwadi3 Anganwadi4
Children (3years - 6 years)
Number of children identified
during the survey
Number of children registered
Number of children received
IFA
Number of children for whom
deworming was done
Number of children for whom
growth monitoring was done
Number of children weighed
in previous months
B-Boys, G-Girls, T-Total
B
20
G
16
T
36
B
39
G
25
T
64
B
25
G
24
T
49
B
9
G
12
T
21
20
0
16
0
36
0
39
0
25
3
64
3
25
0
24
0
49
0
9
0
12
0
21
0
3
2
5
15
15
30
7
5
12
0
0
0
0
0
0
12
10
22
0
0
0
0
0
0
0
0
0
12
10
22
7
5
12
0
0
0
Table No 14: Pregnant mother’s beneficiaries
Pregnant
Anganwadi1
women
Number of PW 8
during survey
Number of PW 8
registered
Number of PW 2
delivery
registered
Number of PW 0
attending NHE
last month
PW- Pregnant Women
Anganwadi2
Anganwadi3
Anganwadi4
11
7
8
11
7
8
6
0
0
0
0
0
46
Table no14 shows that pregnant women who are the beneficiaries are 34 from the four
Anganwadi centres which registered in the Anganwadi centre but only 8 received supplies.
Table No 15: Lactating mothers beneficiaries
Lactating Mothers
Number identified during the
survey
Number of LM registered
Number of LM delivery
registered
Number of LM
attending
NHE last month
Anganwadi1 Anganwadi2 Anganwadi3 Anganwadi4
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
In the table above only Anganwadi1 has identified and registered one lactating mother where
all the Anganwadi centre have not identified any lactating mothers.
Table No 16: Adolescents girl’s beneficiaries
Adolescent girls
Number of AG identified
during survey
Number of AG registered
Number of AG delivery
Number of AG getting
weighed regularly
Anganwadi1 Anganwadi2 Anganwadi3 Anganwadi4
29
63
37
15
29
2
0
3
2
0
3
0
0
15
0
0
The number of adolescent girls who were identified during the survey ranged from 15 to 63
however only in three Anganwadi centres adolescent girls were registered and only in two
Anganwadi centres were receiving supplies.
Table No 17: Number of malnourished children as per the weighing of the Anganwadi
Number
of
children Anganwadi1 Anganwadi2 Anganwadi3 Anganwadi4
malnourished
Measure
B G T B G T B G T B G T
As per wage for age
0
0
0
1
0
1
0
0
0
0
0
0
As per height for age
0
0
0
0
0
0
0
0
0
0
0
0
As per weight for height
0
0
0
0
0
0
0
0
0
0
0
0
Referred to PHC
0
0
0
0
0
0
0
0
0
0
0
0
From table no 17 from the four Anganwadi centres only one Anganwadi centre has identified
one malnourished child.
Assessment of the nutritional status of children 0-6years
Weighing of children’s in the Anganwadi centre from 0- 6years was done to find out how
many malnourished children are there. This weighing of children has been conducted by the
researcher to find out the level of malnutrition and to see how many malnourished children
47
are there to compare with the data given by the Anganwadi worker where only one child is
malnourished from among the four Anganwadi centres.
Table No 18: Weighing of children in two Anganwadi Centres
Age
0-3years
3-5years
Total
16
14
Boys
6
6
Girls
10
8
In table 18 the number of children that have been weighed by the researcher is 30, the number
of children of 0-3years age is 16 (10 girls and 6 boys), and 3-5years is 14 (6 boys and 8 girls).
Table No 19: Grades of malnutrition of children as per their weight by age
Age
Total
0-3 years 16
3-5 years 14
Normal
Boys
Girls
5
9
4
6
Moderate
Boys
Girls
1
0
2
1
Severe
Boys
0
0
Girls
1
1
The grades of malnutrition of children according to their age is that in 0-3 years age out of 16
children 1 boy is moderately malnourished and 1 girl is severely malnourished. For the
children of age 3-5years 2 boys are moderately malnourished and among girls 1 is moderately
and 1 is severely malnourished.
The researcher has taken a sample of 30 children from the two Anganwadi centre to weight
the children’s to be able to find out the nutritional status of the children and found it is
different from the records that the Anganwadi centres have. From this weighing the
researcher found out that out of the 30 children, 2 children are severely malnourished and 4
are moderately malnourished..
People’s perception about Anganwadi Centres
From the table below all the respondents are female; their age ranges from 22-35 years;
among the ten respondents four of them are housewife, three of them are working as a teacher
in the Lower Primary and other are daily wages workers, agriculture workers and domestic
workers.
The number of children that they have ranges from 1-6, school going children ranges from 25 children, children who has been registered in the Anganwadi centre ranges from 1-4,
children who has been sent to the Anganwadi centre everyday ranges from 1-3. Some
children are not sent regularly to the Anganwadi centre because they have no one to take
them to the centre and the distance of their house to the Anganwadi centre.
48
Table 20. Description of the respondents
S.No Age Sex Occupation
No
of School
children going
children
Children
registered
in
Anganwadi
Children
sent to the
Anganwadi
centre
Children
not send to
Anganwadi
centre
regularly
1
31
F
4
2
4
2
0
2
3
4
5
32
28
22
35
F
F
F
F
4
3
1
6
3
2
0
5
4
3
1
3
3
2
0
3
0
0
1
0
6
34
F
5
4
3
3
0
7
8
26
32
F
F
3
5
2
4
2
2
0
0
2
2
9
10
29
33
F
F
1
4
0
3
1
3
1
3
0
0
Teacher in
LP School
Housewife
Housewife
Housewife
Domestic
work
Teacher in
LP school
Agricultural
Daily
wages
Teacher
Housewife
Perception about timing of the Anganwadi centre
From the ten interviews that have been conducted there is a mixture of responses towards the
timing of the Anganwadi centre. Out of the ten respondents five told that the Anganwadis
open in the morning between 6 or 7 o’clock and 8 or 9o’clock in the morning and four said
that the Anganwadi centre in their village was open in the evening at around 4.30 pm.
“I don’t know the exact timing when they open and when they close because they use to
open in the evening”. (22 year old mother of one child)
About the timing the respondent’s say that it is not a problem, they are satisfied with it and
they are happy about the time that are given by the village committee. There are respondents
which said that evening timing is good as their children after they come back from school
they will just go to the Anganwadi centre.
Opening Days
The respondents told that the Anganwadi centres used to open every day but there are days
when they do not open and they inform the children not to come. They also mention that
Anganwadi worker are not on time in coming to the centre and as has been said by one of the
respondent that in rainy and windy days they close the centres and also during the shortage of
food.
49
P2 “Yes it open every day but only when there is shortage of foods she will open in
alternative days” (32 years old mother of four children)
P6 “Here it use to open every day except Sunday but the Anganwadi worker mostly she is
late to come and give the food” (35 years old mother of six)
P2 “Every day it use to open only rainy season then there are days which it close due to
rain and windy as no one like to go out early in the morning otherwise if she is not open
she use to inform the children not to come”(34 years old mother of five children)
Awareness about the services
All the respondents said that they are not getting any awareness but what they know is that
their children are getting supplementary food and preschool education when they are going to
the Anganwadi centre.
P4“No awareness that we get from the Anganwadi worker about the services” (33 years
old mother of three children)
P5“No..as for now I didn’t get any kind of awareness about the services since they change
the Anganwadi worker but before when it was looking by the another Anganwadi worker I
use to know if there is any meeting or programs but now I don’t know. As from what I
remember only once they have meeting where the supervisor come and give awareness
about health education”. (35 Mother of six children)
Food
The perception of the respondents about the food that the Anganwadi worker provides in the
centre to the children was good. They get cooked food usually and there are days on which
they are given raw food. One of the respondents mentioned that the packet food that her
children got was spoilt. The respondent also said that their children have to take their own
box or bowl to take food.
P2: “Supplementary food that was provided from the centre was good as it was the
nutritious food and she use to give cook food only sometimes they give the raw food like
shira, yummy and milk” (26years old mother of three children)
P4: “They give cook food, for shira and milk they give raw but the milk sometime it was a
spoiled packet that children get and children got loose motion because she didn’t keep it
properly”(33 years old mother of four children)
Activities
The activities that the children use to get and do in the centre was only singing and praying
before they give the food as mention by the respondents.
50
Preschool
Preschool education which is one of the services that the children are supposed to get from
the centre but this is not happening in all the Anganwadi centres. Some respondents said that
their children get preschool education in the centre which helps their children learn their
basics like ABC, how to sing and pray before eating whereas other respondents said that the
children didn’t get preschool education and they only get supplementary food.
P3 “.. preschool it was helpful for the our small children to try to learn the basic things
like singing, writing and being taught on some morals before it’s the right time for them
the go to school and start their schooling”(28 years old mother of three children)
P6 “Now this new Anganwadi worker didn’t give any preschool education she give only
supplementary food and every time she will reached late in the centre”(35 years old
mother of six children)
Weighing
Regarding weighing of the children in the Anganwadi centre only three respondents said that
their children are weighed by the Anganwadi worker when the ANM come to the centre
during the immunization and there are also respondents which said that in their Anganwadi
centre they don’t have the weighing machine so they didn’t get to weigh their children. Some
of the other respondents said that in their Anganwadi centre the weighing machine is there
but the Anganwadi worker haven’t weighed the children till now. Even though the
Anganwadi worker weighed the children the growth chart are not shared with the parents and
kept with them.
P3 “Weighing machine are there but they haven’t weight the child till now” (29 years old
mother of one)
P5 “..before the old Anganwadi worker use to weight the children nearly every month and
she use plot in the chart but now this new Anganwadi worker I haven’t seen her weighing
the children”(22 years old mother of one)
P3“Yes she use to weight the children every month but the growth chart has not been
given to us to see how much my child improve in the nutrition”(28 years old mother of
three children)
51
Service delivered
The six services that are provided by the ICDS through the Anganwadi centre are
supplementary nutrition, immunization, health check-up, referral services, preschool
education and nutrition and health education. Of these six services according to the
respondents the services which they get regularly are supplementary nutrition, immunization
and weighing of children done once a month when the ANM come to the centre but no proper
records are maintained by the Anganwadi worker after weighing the child. Health education
and home visits was there but not in all the Anganwadi centres it differs as there are
respondents who said they received and there who have not received. Delivering of services
in the Anganwadi centre are not the same for all the respondents and there are respondents
which tells that the Anganwadi worker use to come and deliver the services by herself and
among the respondents there are which says that she was not coming on time to the centre she
will be late and send some relative to come and delivered the services
P4“Only the supplementary food for children, no preschool or tablets like IFA and
deworming which before we use to get and the Anganwadi worker during polio drop she
didn’t inform and we know when they announce in the church and the same for
immunization whereas before the old Anganwadi worker she will inform through children
or she will come home and tell”(33 years old mother of four children)
P2 “They got only the supplementary nutrition” (32 years old mother of five children)
P3 “The services that the Anganwadi worker mostly first that she gives to the children are
the nutritious foods and preschool education where others like immunization and
weighing the children also is there where the ANM from the CHC comes once in a
month”(28 years old mother of three children)
P6 “Yes she use to come but late so the children have to wait and sometimes when she is
not coming she will send someone to come and give the food to the children”(35 years old
mother of six children)
Perception about the functioning of the Anganwadi centre
The respondents’ perception towards the functioning of the Anganwadi centre was a good if
the Anganwadi worker is delivering all the services and has the responsibility to them. There
are respondents who said that it is good having the Anganwadi centre as it help their children
to get nutritious food and learn the basics in the centre but not in the other services.
P1 “Yes it function well only when it comes to food supplementary as they use to give it
every day but not the other services” (26years old mother of three children)
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Perception on Anganwadi worker attitude
Though the perception of the respondents on the attitude of the Anganwadi worker was good,
friendly, responsible and doing her work well there are respondents who are not happy with
her attitude as they were comparing the new Anganwadi worker with the old Anganwadi
worker and say that they like more the old Anganwadi worker rather than the new one as she
is not that much friendly and for any program that they have in the centre she is not giving
any information to them.
P2 “The Anganwadi worker was nice and kind towards the children and also she is very
friendly with all of us and whenever there is any kind of awareness or program in the
centre she will inform to all to come and attend and she has the responsibility towards her
work to try to improve in what she did” (32 years old mother of four children)
P3“Attitude of the old Anganwadi worker is different from this Anganwadi worker now
before that Anganwadi worker she is very polite and friendly with children’s and now this
new Anganwadi worker she will come and give food not that friendly and kind towards
children”(29 years old mother of one son)
Perception on the community participation
The respondents said that the participation of the community people is there by sending their
children to the centre everyday but there are also who can’t send their children to the centre
because they stay far. The participation from the community when the Anganwadi worker tell
them that she need firewood for cooking the community they will bring and give to the
Anganwadi worker.
Benefits of having Anganwadi
The perceptions of the respondents about the benefits of having Anganwadi centres in their
village was that their children get the supplementary food as it is a nutritious food for them
and instead of spending money to buy food from outside as they are getting from the
Anganwadi centre, they got preschool education and also some activities like singing and
praying but there are respondent which says that it is not benefitting them as she never gives
any information on program like immunization.
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P3 “To me personally I feel that by having this Anganwadi centre it was a great benefits
for my children even though they got only the food and preschool but it has help a lot in
trying to build my children health and education where we do not need to pay money but
get it for free and that also every day.”(28 years old mother of three children)
P3 “To me now I didn’t get any benefits because when the old Anganwadi worker is there
then I get benefits as for pregnant women she will come and tell that we have to come and
weight in the Anganwadi and for children also she will do like that she use and give health
education to the adolescent girls, the mothers she will give awareness on health. All this I
use to get because she use to inform but now nothing and no information if they have
program or meeting.”(29 years old Mother of one son)
Discussion
The ICDS programme has been running for 38 years now in every state in the country and it
has been in a great expansion to improve the nutrition health status for the mother and child
care. For better understanding of the progress and performance we need to look on the
functioning and also to get the perception of the people about the services being provided by
the Anganwadi centre. In the study conducted by Sarva Siksha Abhiyan 39% of the
Anganwadi centres are part of the primary school and 44% are built by the panchayat which
similar to my study where two Anganwadi centres got their own building where the other two
Anganwadi centres are part of primary school and using the community hall which is given
by the panchayat. In their study Anganwadi centres have the own kitchen and in my study the
Anganwadi do not have their own kitchen so they cook at home and bring the food to the
centre for distribution. From the study by Meenal M Thakare study on the functioning of
Anganwadi centres in Aurangabad registers and maintaining records are up to date but in my
study though the registers are available but they are not keeping the records properly and also
not all registers are available in the centre which is similar to the study of ICDS Assam and
Meghalaya where the Anganwadi workers said they have the registers but they are not
updated or maintained well.
The supervision from the ICDS centre was less- from the discussion with the Anganwadi
worker the researcher gets to know that the Anganwadi workers have difficulties in updating
the registers and when they have to submit the reports that time they will fill the register.
For the beneficiaries the Anganwadi centres provides the services 6 days a week in all
Anganwadi centres and the number of beneficiaries identified and registered in age group 0-6
years is different from one centre to another. For adolescent girls they give the services only
to those who are uneducated and only three girls can come and register in the centre. The
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services to the beneficiaries in the study by Meenal M Thakare shows adequacy of nearly all
the services is average when compared to my study because from what I observe and discuss
with the people in the community even though the Anganwadi worker said that they give
nearly all the services but the main services which they give was supplementary nutrition in
all the Anganwadi centre and preschool was given only in one Anganwadi among the four
and other services like immunization and health education they give only in the time when
the ANM come for immunization day.
My observation was that the Anganwadi workers were providing regular services of only the
supplementary food and the maintaining of registers was lacking. One of the Anganwadi
worker expressed that she is having difficulties in maintaining the registers and she needs
more training for that.
From the Anganwadi centres they said they give all the services however to the participants it
is not like that even though they get the services not all have been given the information by
the Anganwadi worker. From the study it was discovered that there was lack of awareness on
the six services among the respondents given by the Anganwadi worker and the respondents
send their children to the centre to get supplementary food and no preschool are available in
the centre which shows that there is less of services delivered by the Anganwadi worker to
the people.
It has been identified that growth monitoring was poor as there are Anganwadi worker who
have the growth chart and the machine for weighing but they are not doing it and no records
are maintained, not all beneficiaries can avail the services, no machines in the mini
Anganwadi. The respondents were not that much happy with the Anganwadi worker attitude,
and there are respondents which feels that the Anganwadi not has benefitted them. As from
the observation during the visits in the Anganwadi centre maintaining of register was not
being done properly. It has been express by the respondents that there is less responsibility of
the Anganwadi worker and not punctual in coming to the centre.
Conclusion
The study shows that from the ICDS give six services to the Anganwadi centres services that
have been provided are not running smoothly as from what it has to be as nearly all the
services to all the beneficiaries but through the interviewed with the people the researcher
found that services was mainly for the children 0-6years not all the beneficiaries. Even
though from the study the malnourished that has been identified by the Anganwadi worker
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was only but when the researcher took samples of 30 children and weighed them to check and
from the weighing there were 2 who are severely malnourished and 4 who are moderate
which shows that if the Anganwadi workers keep the proper record and weighing there can
be more than one. The lack of knowledge in documenting was one of the barriers to the
Anganwadi worker who are not able to do by themselves and there is less supervision from
the office. The responsibility of the Anganwadi worker to delivered and give awareness to the
people it would very helpful as from this study there are Anganwadi worker who give the
services just because they have been appointed as an Anganwadi worker. There is negative
and positive perception about the system of the Anganwadi functioning where there are
respondents are happy with this and there are which are not happy with it.
References
International Institute for Population Sciences. India National Family Health Survey (NFHS3), 2005-06. International Institute for Population Sciences; 2007.
Centre for North East Studies and Policy Research. Functioning of Anganwadi Centres in
Assam and Meghalaya. Research on ICDS: An Overview (1996-2008) Volume 3. National
Institute of Public Cooperation and Child Development. 2009: 157-61
Thakare MM, Kuril B, Doible M, Goel NK. A Study of Functioning of Anganwadi Centers
of Urban ICDS Block of Aurangabad City. Indian J Prev Soc Med. 2011;42(3):253–8.
International Institute for Population Sciences. District Fact Sheet East Khasi Hills (2012-13).
District Level Household and Facility survey -4. International Institute for Population
Sciences; 2015.
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Photo Gallery
A place where people throw garbage
Housing in Indra Nagar slum, Bhopal
in Indra Nagar slum
Interaction with women of Indra
No proper sanitation, used open
Nagar Slum
defecation
Interaction with the adolescent girls in
Meera Nagar Slum,Bhopal
Awareness on breast feeding for pregnant
57
women in Indra Nagar slum
Awareness on rights and responsibility to
get the old age pension scheme
Interaction with the Dai in Indra Nagar
Slum
Discussion with field mentor from
Showing documentary movie to adolescent
Sathiya organisation
girls on nutrition in Indra Nagar Slum
58
Home base visit with Bethany staff
Awareness on HIV/AIDS in Bethany
Mawkyrwat
Mawkyrwat
Celebrate mental health day in
Bethany Mawkyrwat
Mental health camp in Mawkyrwat
organised by Bethany Society
59
Visit Bachpan organisation Bhopal
Anganwadi centre in Mawkyrwat
Interview the Anganwadi worker
Class room activities
60
Community Health Learning Programme is the third phase of
the Community Health Fellowship Scheme (2012-2015)
(2012 2015) and is
supported by the Sir Ratan Tata Trust, Mumbai.
School of Public Health, Equity and Action (SOPHEA)
SOCHARA
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Block, Koramangala,
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