Mainstreaming of Creches to reduce Malnutrition in Odisha


APPI and PHRN has joined hands in implementing a community based programme to combat child (0-3 years) malnutrition in Southern Odisha. The programme is aimed at developing a model that will be eventually scaled-up by the Government of Odisha. The proposed programme will be largely based on the learnings from the AAM programme.

Models of Crèches
There are three types of crèches under the programme addressing different ground situations. Each type of model will be restricted to one block per district.
1) Anganwadi cum Crèche: Attempts will be made to co-locate the crèche within existing AWCs and run it with the full involvement of the ICDS functionaries. While the AWC will cater to children from 3-6 years, the crèche will focus on children aged under 3 years. If a sufficient number of villages cannot be found with adequate space within the designated blocks, the district administration will be requested to provide infrastructural inputs. The intention will be to co-locate the crèches within the Anganwadi centre as soon as is feasible.
2) Creches in villages with PVTG communities: These crèches will be located in villages that are inhabited by PVTG communities. These crèches will address the most vulnerable population in the State. Certain innovations might be required in establishing and running crèches among the PVTGs since the capacity building challenge and logistics challenge is likely to be much higher.
3) Creches in remote villages with non-PVTG communities: These crèches will be located in remote areas/villages/ hamlets of designated blocks with non PVTG tribal communities or SC communities.

Project Area and Setting:
The project is being implemented the districts of Raygada, Koraput, Nabrangpur, Kalahandi and Malkangiri which are considered as one of the most backward districts of the country. It is clear from the table below that the intervention districts lag considerably in the critical child development indicators from the state average.

 

State/ District U5 StuntingPrevalence (%) U5 Wasting Prevalence (%)  U5 underweight Prevalence (%)
Odisha 34.1 20.4 34.4
Rayagada 43.5 23.1 42.4
Koraput 40.3 28.5 44.4
Nabarangpur 45.8 36 51
Malkangiri 45.7 32.5 51.8
Kalahandi 36.6 24.8 39.7

Source: NFHS 3,

 

map

The areas shaded in blue represents the districts selected for the intervention.

 

Implementation Strategy:

Using data of remote villages from ORSAC (Orissa Space Application Centre) and PVTG areas, the following clusters have been identified for the implementation of the programme.

 

  PVTG Areas Remote villages Anganwadi(AWC)Cum Creches
Rayagada B.Cuttack K.Singhpur Raygada
Kalahandi Lanjigarh T.Rampur Golamunda
Malkangiri Kudumuluguma Korkunda Malkangiri
Koraput - Narayanpatna/Dasmanthapur Koraput/Semiliguda
Nabarangpur - Jharigaon Paparahandi

 

The idea behind the co-location of creches in the anganawadis is for advocacy purposes wherein, it opens up an opportunity to demonstrate a programme on the premises of an existing child care programme and to support the advocacy on the anganwadi-cum creche programme that is already part of the restructured ICDS programme.

 

The creche will be a day care center (7 – 8 hours) for housing children aged 6 months to 3 years. The feeding programme in the creches is aimed to take care of 75% of calorie requirement of a child per day with the help of three feeds (one full meal and two snacks). The creches will be opened for 6 days in a week. It will follow the holidays as per the guidelines of ICDS, but it will also accommodate the community demands for deciding on holidays and functioning. The creches will aim at universal coverage and will not target.  Admissions to creches will be on a voluntary basis.

The creches will follow the protocols that were developed for the AAM creches. While the creches cater to nutritional needs and care of children, the health care of creche children will be dependent on the existing government health services. An MIS system to track the children, especially growth monitoring will be part of the programme. The MIS system is designed to enable early identification and prevention of malnutrition among creche children. The children who require medical attention will be referred to the appropriate government services (PHC, NRC) for further care and treatment.

The creches are being opened in a phased manner.