Seva Mandir’s Balwadi Programme

Practice of Health Care at Balwadi

1. 
   Sanchalikas should be trained to record health problems in children and extra precautions be taken during seasonal infections.
   
2. 
   Additional training should be given to them in the use of medicines. In addition to the medicines given to them, a first-aid kit should also be included.
   
3. 
   Linkage with TBA needs to be established. Possibility of organizing monthly health check-ups with the help of local doctors on contract may be explored. If this is not an available option to consider, then perhaps Seva Mandir could initiate virtual OPD with doctors sitting at Udaipur. The technology for e-medicine is now available and helps to reduce transaction costs for rural people dramatically, reducing the cost of primary health care.
   
4. 
   Referral services can be improved further by improving the network of doctors and hospitals as well as through virtual consultation.
   

During the field visit the review team made the following observations:

• 
  The children were aware of the play and educational material available in the centre and were confident of using it. The children were seen playing with all the play and learning materials. At one center a four year old completed a jigsaw puzzle within seconds. Such activities are known to build cognitive capacities among children. These toys and other activities such as listening to stories told by the sanchalika, learning poems and songs from her and group games etc. help to give the children an enjoyable experience and they are therefore eager to come to the centers.
  
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  The children were divided into different groups (usually two) as per their age and then led by the sanchalika to take on different learning activities. Some Sanchalikas had experienced the difficulty of younger children wanting to join the group of older children. One A-grade sanchalika found that putting the older children outside in the courtyard and the younger inside the house was an effective way to overcome this problem.
  
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  The children were also given space to select the activity of their own choice if they were not interested in a particular activity. Some toys were within their reach while others were kept out of reach on high racks and provided to them only when the sanchalika felt it fit. This is because those toys were delicate and needed supervision during play. Sanchalikas reported that some toys were more popular than others. Cars were the most popular and children had to wait for their turn to play with cars. The same was the case with the plastic slide and rockers provided to each Balwadi by Seva Mandir. In the process the children learnt discipline and the value of sharing with others. In case of pucca houses, walls were painted black upto three feet from floor level so that the children could use them as a blackboard.
  
• 
  The charts, drawings and artwork by children were visibly displayed in the center. Though the children were not allowed to take it home these were shown to parents during the meetings with them. The use of local materials like leaves, sand, etc. was put to good use and was helpful in teaching them about local bio-diversity. Children learnt to identify fruit trees through craft in one center. The most popular fruit among children in the area is ber.
  
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  The available physical space and infrastructure varied from center to center. In a few cases where the community hall was available for use the facility was good because the building was pucca and children suffering from iron deficiency did not get an opportunity to eat mud. It was also easier to maintain hygiene. The centres were clean and there was provision of drinking water. Most of the centres had space for outdoor activities. The centres do not have toilet facilities except in case of community hall. This is problematic as it can create problems of hygiene and/or safety of children if they have to be sent out to relieve themselves. The issue of making a protective fence in cases where the center was located on the main road was pointed out by one of the sanchalikas in the meeting with sanchalikas of Badgaon. In the kuccha houses the problem of inadequate light was addressed by putting plastic tiles since the local culture is not in favour of houses with large windows. If the tile is not inserted in the right place (as was noticed during the field visit) the problem remains unsolved.
  

The technical resource agencies like Mobile Crèches, ASAG and Shrujan have played a key role in building the capacities of the sanchalikas and Seva Mandir staff. The training has focused on concepts and activities of Early Childhood Care and Development.

• 
  Adverse Sanchalika to child ratio: One sanchalika is responsible for multiple activities for all children (age range 1-5 years) and hence cannot focus on the pre-school elements completely. The ideal situation would be to have two sanchalikas per center with one in charge of 1-3 yrs and the other looking after 3-5 yrs age groups.
  
• 
  All Sanchalikas are not gifted in all the activities. Some are extremely gifted in activities like arts and crafts, singing, puppetry etc. A few such sanchalikas with such expertise could be sent to different centers once a month to perform and teach those activities. During the visit they could guide the sanchalika and provide useful practical tips. The youth who have been trained in puppetry could also likewise be sent to the centers to entertain the kids on special occasions such as Independence Day, Foundation day of the center, or local festival days etc.
  
• 
  As far as possible convergence should be brought between Balwadi and NFE centers so that the child gets uninterrupted cognitive development services till the age of 8 yrs.
  
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  Regarding assessment of cognitive development, it is suggested that Seva Mandir try out an instrument recently developed by World Bank as part of the evaluation package for its ECD programme (hard-copy to be provided by Nirali Mehta). If for some reason this does not work out, it could monitor the inputs:
  
  • 
    3-4 hours of play and educational activities per day
    
  • 
    Mix of physical and mental activities
    
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    Balance between gross and fine motor development
    
  • 
    Ability of sanchalika to stimulate the children and give them a joyful experience while learning
    
  • 
    Inputs to cultivate feeling of brotherhood and sisterhood through sharing, community identity and culture, curiosity and creativity, emotional well being etc.
    

The IRM study found that majority of mothers interviewed (62.1%) sent their children to Balwadis primarily because their economic condition was weak and food was being provided for their children there. Only 20.1% stated that it freed them to do house hold and fieldwork while 17.3% mentioned child development as the main reason for sending their children to the Balwadi. The findings are some-what misleading since these reasons are not mutually exclusive. A ranking of the reasons would have given a clearer picture of the benefits derived by the mothers. In another question, all women in the sample agreed that the Balwadi had reduced their work pressure in one way or the other. Only 17% stated that their economic condition had improved on account of the Balwadi service. This is consistent with the fact that only 17% was dependent on labour for their livelihood. For these people the inflow of cash would be tangible while for the rest the benefits may not be visible because these are in terms of savings in labour cost, time, or benefits in kind harvested from the forests and village commons. The study did not attempt to impute and quantify these benefits.