Inferences and suggestions

Inferences and suggestions

1. 
   There is a need therefore to explore the apparent lack of participation of parents. It may be a combination of lack of appreciation of the real worth of Balwadi for their children as well as the preoccupation of the parents with the issue of food security and employment that may make them averse to discussing shulk and attendance all the time. This again may explain lack of participation in meetings. It is suggested that parents be given a more intensive training of say three days twice a year covering various aspects of ECCD and the role of parents at home.
   
2. 
   Shulk may be collected once or twice a year depending on the convenience of the community and at a time when parents have a cash inflow on account of harvest, payment of NREGS labour etc. having put this issue aside, the meetings should concentrate on more important issues of providing feedback to the parents of the progress made by individual children on various fronts including malnutrition, cognitive development, creativity etc. Meetings could also be used to plan certain events together such as Bal Melas etc. Occasionally videos and other multi-media material may be used to communicate specific messages – such as the issue of iron deficiency in the region, best practices in ECC, how to meet the nutritional requirement with local resources etc. Seva Mandir’s staff rather than the sanchalika should facilitate the meetings, until such time that parents reach a critical level of understanding. The meetings could be made less frequent if necessary, but proper facilitation and planning of the meetings would be key to their success.
   
3. 
   There is also a lack of appreciation among parents of the hard work put in by the sanchalikas. In some cases there may be jealousy involved since sanchalikas get a fixed salary for work, which is seemingly easy. It is significant that although shulk money is sometimes unutilized fully, no one ever thought of buying a sari for the sanchalika. (However, some mothers were also reported to say that the sanchalika probably took better care of the child than even herself). Parents meetings could be used to sensitise the parents in this regard. Parents once sensitized may on their own come out with ways to express their gratitude to sincere and hardworking sanchalikas. Each parent may be asked to contribute one day a year to help the sanchilaka in her work. When the mother participates for the whole day she would get an idea of what goes into running a Balwadi properly. This would increase her participation as well as appreciation of the sanchalika’s work. These are just a few suggestions. A brainstorming meeting with the sanchalikas would be useful in generating more creative and effective suggestions for improving participation of parents.
   
4. 
   Shulk may not be a good indicator of participation because parents know that the Balwadi would not close down if shulk were not paid. In the present arrangement, shulk is only a token and the money is used to give a bonus benefit to children. Perhaps the best indicator would be regular attendance of children.
   
5. 
   Regular attendance (participation) may be hampered by certain constraints such as location of Balwadi, unavailability of any person at home to take the young child to the center, lack of awareness about the benefits of Balwadi etc. The GVS and parents can come together to find solutions to these problems so as to ease the constraints.
   

Participation of the GVC is limited by its understanding of ECCD process. If and when this improves, the quality of supervision and participation would improve. Convergence with other activities of Seva Mandir would also improve the scope of decision-making by the committee and give it more experience in managing community services such as Balwadi.

• 
  Monitoring the Balwadis
  
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  Facilitating timely supply of food material
  
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  Facilitating supply of educational and other materials
  
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  On-going capacity building of sanchalikas
  
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  Motivating parents and GVCs
  
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  Monitoring growth, development and health of the children
  
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  Developing and enriching the activities for cognitive development
  
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  Organising monthly meetings at zone level and bi-monthly meetings at block level to facilitate planning and capacity building
  
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  Writing proposals, raising funds for the programme
  
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  Exploring collaboration with government and other stakeholders.
  
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  Advocacy at all levels.
  

Seva Mandir has over the years tried to improve the programme through trial and error. Concerned about the lack of participation of the community three years ago, it initiated an action research project through its Participatory M & E cell. The action research did a perception study of stakeholder groups and initiated various steps including training, bringing up Balwadi issues in different village level and project related forums etc. These measures had the desired effect and participation of both parents and GVC was reported to have improved significantly. The action research project has now been scaled up in all the five blocks.

1. 
   The review team was impressed by the dedication and commitment of the Balwadi programme team. It was felt that perhaps the services of a doctor could greatly improve the linkage with health and immunization programme. However, it is rare to find competent doctors interested in this kind of work, so part-time involvement on voluntary or consultancy basis of interested doctors could be sought.
   
2. 
   The action research initiative has shown how to bring attention of the community to the importance of Balwadi at various forums at the same time. The learning from the project could be institutionalised.
   
3. 
   Regarding kawad, the review team felt that while the utility of the method of communication had been established, in the next stage, it could be leveraged to communicate more specific messages to parents rather than general awareness.
   

3. 
   Influencing the Larger System
   

1. 
   Community monitoring of AWCs: Seva Mandir has been in dialogue with the ICDS unit at Udaipur for quite some time. To address the issue of high rate of absenteeism among Anganwadi workers, Seva Mandir came up with the idea of camera based monitoring of the centers. In January 2009, and MoU was signed with ICDS, Udaipur to monitor the regularity of AWWs and quality of services provided in 20 Anganwadi Centers of Jhadol block. In the experiment, these were called treatment centers while 17 other centers were used as control centers. The monitoring mechanisms included the use of cameras with date and time stamps to check the regularity of attendance and random visits by community members to monitor the centers. Community members were trained to do the monitoring work with the help of checklists provided to them. After six months, the results were not very conclusive as there was a discrepancy between the results of the two methods. Since then a system of verification of the random checks has been made. The final results are awaited.
   
2. 
   Incentive scheme for immunization:
   

The programme dramatically increased child immunization rates from 6% to 38%. An increase of 11% was attributed to reliability f the immunization camps. The remaining 21% was attributed to the incentives. Seva Mandir is interested in testing ths idea in a few more locations in different states of India before advocating its large scale replication.

1. 
   Participated in a Policy committee Meeting organized by the National FORCES Secretariat at Patna on 20-21^st Nov, 2008.
   
2. 
   A study on the status of childcare services being provided under the NREGS. The study was conducted in four blocks of two districts viz. Udaipur and Alwar. The findings of the study show that 95% of the women workers want childcare facilities at the work site where as only 22% of the respondents were brining their children to the work site. 35% of these were given crèche facilities, which was largely a shade under a tree. Not surprisingly only 11% were satisfied with the childcare services provided at site. The study will be useful in advocating with the government for providing quality childcare services under NREGS and exploring convergence with AWWs under ICDS.
   
3. 
   CWDS was involved in developing an Alternate Report on the Status of Young Child for the United Nations Convention on the Rights of the Child. As part of this initiative Seva Mandir in collaboration with CWDS and Plan International organized a regional consultation in Jaipur to delibrate on the “Status of the Young Child in Rajasthan.” The state level consultation was held on 26^th May ’09 at the State Institute of Health and Family Welfare, Jaipur. Representatives from 19 NGOs apart from donor agencies, medical professionals, academicians, government officials, activists and media persons attended the consultation. A workshop report has since been brought out and disseminated among all stakeholders. The report concluded with a number of observations on the shortcomings of the ICDS in its present form. Various suggestions were proposed for better implementation as well as for redesigning of the programme. Members also resolved to improve the membership of the network and meet again soon.
   
4. 
   On invitation from FORCES, a status paper on “the state of the young child in Rajasthan,” with focus on policies and programmes of the government was prepared by Dr. Kanchan Mathur of Institute of Development Studies, Jaipur. The paper was presented at the above-mentioned workshop.
   

3. 
   Sustainability of Balwadis
   

The programme has been running since the past 23 years. Paul Hamlyn Foundation has supported it for the past 9 years. Since this is a well-being activity, it would have to continue until such time that the economic condition of the local communities improves and they are able to support these services on their own. The present economic situation of the local communities indicates that they are caught in the vicious cycle of poverty and it would take a long time and huge investments in local natural resources before they can emerge from it. Therein lies the problem of sustainability of the Balwadis.

1. 
   Influence the Government model through demonstration
   
2. 
   Mobilize local communities to make the government machinery more responsive and accountable
   
3. 
   Work out alternative models of delivery through public-private-community partnership
   

Seva Mandir has made considerable progress with the first step. It has also now been granted a project to demonstrate its model in the context of NREGA where day care center is a felt need, but is not being provided anywhere. It is like-wise doing a similar demonstration of incentive based immunization programme, which is also producing the desired results. For 0-1 age groups the Bal Sakhi initiative is being experimented with. Camera based monitoring of Anganwadis by local monitors has been another interesting idea initiated in collaboration with ICDS. Testing new ideas and demonstrating their utility is what Seva Mandir is good at and should continue doing. However, it also needs to go beyond that through active policy advocacy and capacity building of the government on one hand and mobilizing people on the other.

Although Seva Mandir has asked its GVCs to monitor the functioning of Anganwadis and demand for better services, the GVCs have not taken to the idea. They have taken a stand that Anganwadis are part of an entire system, which is corrupt and unaccountable. Even some of the trained sanchalikas who joined as AWWs have been co-opted into the system. Hence they do not believe that they can make any difference on the functioning of Anganwadis. A certain amount of apathy towards government and its systems has set in.

In the past two NGOs have tried to implement Anganwadis on behalf of the government. Both the experiences have proved negative, since the NGOs had to work within a system, which was not appreciative of their efforts and tried to sabotage the work at every opportunity. Private companies with CSR budgets have also been seen to “adopt” certain number of Anganwadis. During the field visit we encountered one such Anganwadi adopted by Hindustan Zinc Ltd. According to the people, this one was functioning relatively well. Experiences of such private companies need to be gathered.

There is a need to share information with the local communities about the cost of running the Balwadi programme. Each GVC could then be challenged to come up with innovative suggestions for reducing the cost of running their Balwadi without compromising on the quality of services. Various models of mothers, talented siblings etc who volunteer their time either to help in the administration or the teaching of children could be explored. If the people want the service badly enough they are bound to come up with suggestions. Once such suggestions are made, the GVC could be challenged to implement at least a few of them. Thus would begin the journey towards self-supported programmes.

Paul Hamlyn Foundation should take the lead in identifying other donor agencies, which would be interested in picking up various expenditure components, especially for software. Provisions should be made for experimenting and innovation of delivery systems in partnership with the state. The projects of supplying materials to the Balwadis could be supported under livelihood programmes thus reducing the burden on present donors under ECCD. Mobilising funds for material inputs from government could also be explored.

8. 
   Conclusions and Recommendations
   

• 
  Proportion of severe malnutrition among the Balwadi children, has come down by more than 70% from a level of >17.5% to about 5.0%
  
• 
  The percentage of normal children has increased by about 33.8% making almost half the children free from any form of malnutrition.
  
• 
  Cognitive development of the children, including learning of secular values, local culture, hygiene etc. has been taking place to satisfaction of all.
  
• 
  Although iron deficiency could not be monitored properly, there is anecdotal evidence to show that the problem is being arrested, although magnitude is not certain.
  
• 
  Linkage of out-going Balwadi children with various schools / NFEs has taken place giving a boost to education of the children. Retention in these schools of Balwadi children has also been reported to be as high as 87%.
  
• 
  Balwadis have enable more than half the mothers to pursue livelihood activities and/or domestic work as per a study, which is indicative. A more rigorous and representative study would provide a better understanding of impacts on both parents and siblings.
  

On the other hand there is evidence that moderate malnutrition continues to be rather high at about 45%. The causes could be traced both to limitations in the present design of the Balwadi as well as implementation. A major long-term limitation is the acute poverty in the region, which prevents parents from giving the necessary nutrition and care at home. The other limitation is the failure of parents to get their children immunized in time either due to lack of awareness or due to lack of facilities. Suggestions have been made to address these issues and fine-tune the model.

• 
  Growth monitoring should be done for all children and at greater frequency
  
• 
  For malnutrition, comparison of entry and exit data may be more meaningful than looking at mere averages
  
• 
  Performance card for each child should be prepared graphically and shared with sanchalika and parents
  
• 
  Sanchalikas and parents should be give special training to deal with malnurished and severely malnourished children
  
• 
  Monitoring of iron deficiency to be done on a regular and scientific basis. If taking blood samples is not practical, sanchalikas may be trained to carry out clinical examination.
  

• 
  Sanchalikas can take a proactive role in ensuring immunisation of at least children attending the Balwadi.
  
• 
  They can be trained to maintain immunisation record of each child and inform parents in advance especially on MCHS day.
  
• 
  Sanchalikas may be encouraged and trained to seek out ASHA, TBA, Bal Sakhi and other health workers and forge better linkages for ensuring immunisation.
  

• 
  Record of health problems should be maintained
  
• 
  Additional training on the use/ application of medicines is desirable
  
• 
  Referral services are highly valued by the parents. There is a need to strengthen the network and explore possibility of providing virtual advise through tele-medicine. Initially the virtual network could be set up to reach block level and parents could bring their children to the block level office. Later as ICT penetration advances into interior areas, virtual OPDs could be organized connecting Balwadis directly to doctors in urban centers.
  

• 
  Adverse sanchalika to child ratio is affecting the overall effectiveness of cognitive development activities. In general smaller children need more attention than 3-6 yrs olds. Sanchalikas will need additional help. In what form this help could be provided is a matter of fine-tuning the design of Balwadi services.
  
• 
  Sanchalikas with special gift/ skill in particular activity could visit other centers to teach on a rotational basis.
  
• 
  Villagers with special skill could volunteer time (with or without compensation) to teach/ entertain children on certain days
  
• 
  Convergence between Balwadi and NFE is highly desirable to continue process of cognitive development upto the age of 8 yrs.
  
• 
  Greater emphasis on local materials and local culture is desirable. Local materials can reduce the cost of running a balwadi and reduce dependence on external agencies. Local songs, poems etc help to impart knowledge about local culture and bio-diversity, which is important for community living and survival in the local context.
  
• 
  Scientific assessment of cognitive development needs to be carried out. A recent tool being used and propagated by World Bank may be tried out with suitable modifications (reference – Nirali Mehta).
  

• 
  Dealing with severely malnourished,
  
• 
  Dealing with physically and mentally challenged
  
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  Communicating with parents and facilitating meetings
  
• 
  Monitoring of iron deficiency
  
• 
  Proper use of certain medicines
  
• 
  Linking parents to referral services
  

• 
  More intensive training for parents is desirable, preferably twice a year. Parents need to understand why certain activities are carried out and how these contribute to ECCD. They also need to be sensitised about the work put in by sanchalikas. One way to achieve this could be for each mother to volunteer at least one day in a year to help the sanchalika at the balwadi.
  
• 
  Seva Mandir staff should facilitate meetings with parents and GVC, perhaps less frequently but with a richer agenda. This should be continued at least for one year until such time that the sanchalikas gain confidence in handling these meetings. The meetings should move beyond collection of shulk and achieving regular attendance of children. Meetings can be used for a variety of purposes such as:
  
  • 
    Identifying constraints and finding solutions together – e.g. reaching small children to center, local food preparation with more nutrition
    
  • 
    Training on specific health issues
    
  • 
    Organising events together e.g. Bal Divas etc.
    
  • 
    Providing feedback on performance of individual children
    
  • 
    Providing guidance /counseling on care of children at home
    
  • 
    Finding ways of helping/ supporting Sanchalika
    
  • 
    Ensuring immunization of all children etc.
    

• 
  The action research initiative has shown how to bring attention of the parents and community to the importance of Balwadi at various forums at the same time. The learning from the project could be institutionalised.
  
• 
  Regarding kawad, the review team felt that while the utility of the method of communication had been established, in the next stage, it could be leveraged to communicate more specific messages to parents rather than general awareness.
  

• 
  There is a need to provide more intensive training on ECCD to all committee members along with parents
  
• 
  Training on how to supervise Balwadi should be imparted especially to the women members of the committee
  
• 
  Convergence with livelihood and NRM activities can help strengthen decision making and governance by the GVC
  

• 
  The demand pattern as indicated in the age wise profile of Balwadi children shows that parents do not prefer to send children less than 2 yrs of age while almost a fifth of the children attending the Balwadis were older than the maximum age of 5 years. Hence the original target age of 2-6 years seems to be more appropriate. However, this can only be adopted if some mechanism is in place to ensure that children in age group 0-2 years get nutrition and other health related inputs at home.
  
• 
  At present the Sanchalikas are under tremendous pressure as they have to look after children of different age groups with different needs. In general children of age group 1-2 require greater attention and fewer such children can be taken care of by one person as compared to 3-6 yr olds.
  

Seva Mandir is in the process of introducing a new health scheme called Bal Sakhi, wherein a trained health worker would provide health and nutrition services at home to children from 0-5 yrs. This is an ideal opportunity to bring these two programmes together in order to gain synergy from both. If the Bal Sakhi and Sanchalika can work together in tandem, the total impact of the two programmes would bring about dramatic improvement in the status of children. The precise changes needed to bring about such synergy need to be worked out by the two teams in a workshop mode.