Seva Mandir’s Balwadi Programme

Growth Monitoring

Seva Mandir’s zonal worker or any other monitor at block level carries out the six-monthly exercise of monitoring growth through weight for age method. For majority of the children, age was estimated with the help of local calendar, TBA, jyotish, etc. since the practice of birth registration is poor in the area.

As shown in the table, 66.4% of the sample children were malnourished out of which about 5% were very malnourished and needed immediate attention. The table also shows very significant differences between villages and between blocks. The percentage of malnourished (including very malnourished) ranged from 100% to 27%. Highest proportion of malnutrition (75%) was observed in Badgaon block. This is consistent with project level data where Badgaon shows total malnutrition of 64.26%. The Balwadi at Dama fala showed strikingly less proportion of malnourished. The socio-economic conditions of Dama fala, has undergone substantial improvement in the wake of a successful lift irrigation project, which has led to improved food security and nutrition of children (see Annexure 3).

Category	Benchmark (2004)	2009 (March)	2009 (August)
Normal	37.18	49.77	33.6
Mild Malnutrition	27.63	-	-
Moderate Malnutrition	17.52	45.13	61.4
Severe Malnutrition	17.66	5.11	5.0
Total Malnutrition	62.82	50.24	66.4

Even if we consider the March 2009 results to be representative of the nutritional status among balwadi children the fact remains that about 45% are still reporting moderately malnourished. The reasons for this relatively high figure, needs to be understood in more detail.

1. 
   The present diet provided is only supplementary in nature and cannot substitute for the entire nutrition of the child. In an internal study described later, majority of parents reported the main reason for sending the child to balwadi as the availability of food. Most parents provide a small piece of chapatti (usually maize, which is deficient in protein) and some tea to the children as breakfast before sending them to the Balwadi. It is not known what dinner they get to eat given the stark poverty in the area. As long as parents look upon the Balwadi as a substitute rather than supplementary source of nutrition, half the children are likely to continue remain malnourished.
   
2. 
   The situation can only improve if livelihood options improve and local diet is supplemented through better horticulture and animal husbandry. This is a long-term solution. The fact that one Balwadi (Dama fala) in the sample shows very good performance (>70% healthy) compared to the rest bears testimony to this conclusion.
   
3. 
   In the mean time perhaps there is a need to re-consider the design of Balwadi program itself. Unlike the Anganwadi programme, which covers 0-6 age group as well as lactating and pregnant mothers, Balwadi covers children only from 1-5 yrs. Hence many children who come to the Balwadi are already in a severe state of malnutrition from which it takes a long time to come out. Although Seva Mandir has adopted a holistic approach to child care, and has various projects covering all aspects starting from care of pregnant mothers, pre and post natal care, immunization, home based care of 0-1 age group, right up to balwadi and beyond, the fact remains that all these services do not converge in a given fala or even village (see Table 5 Annexure 1)
   
4. 
   The average age of children at the entry point should be one year. In actual practice it is much higher (see Table 7 Annexure 1) since children join the programme at any age and at any time as long as they are under-five. This means that most children are not going through the entire five years of care that is designed for them. It is not surprising that the status of nutrition and development is compromised.
   
5. 
   This can also be surmised by the age-wise classification of project data (Table .8 Annexure 1) which shows that less than 16% of the children coming to the Balwadi are below 2.5 yrs. Significantly, the number of students of age >5 is 23%. This shows that the demand for Balwadi is for older children and parents for various reasons are less comfortable sending very small children. Sanchalikas also find it easier to deal with older children and can handle more no of children if they are of the same age group.
   
6. 
   Although the attendance per Balwadi has increased on an average from 12 to 18, what needs to be seen is the average number of days/ month that a child actually attends the Balwadi. If the attendance is irregular then again the outputs are sub-optimal. Table 9. Annexure1 shows that the average attendance per month for a sample of four Balwadis (94 children) over a period of 17 months was 15.40.
   
7. 
   Due to the above-mentioned reasons, the average figure of malnutrition per balwadi is not a good indicator of the performance of the Balwadi. What is needed is to look at the entry and exit point status as this will show up the number of children coming out of malnutrition after attending the programme for a specified minimum period of time. That would be a better indicator of performance.
   
8. 
   Also, given the inherent limitations of the design where what happens to children before they come to the Balwadi is critical for their health during 1-5 yrs age, and the fact that what children eat during their hours spent at home is not in the control of the programme, one cannot expect to get results of near normal health.