Annual programme implementation plan 2011-12 department of women & child development government of Gujarat contents
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| ANNUAL PROGRAMME IMPLEMENTATION PLAN
2011-12 
 
DEPARTMENT OF WOMEN & CHILD DEVELOPMENT Government of Gujarat CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF ANNEXURES
ACRONYMS
CHAPTER 1 CONTEXT AND OBJECTIVES The Integrated Child Development Services (ICDS) Programme is India’s flagship programme for the integrated development of children from prenatal to six years of age, pregnant women and nursing mothers. It represents one of the world’s largest and most unique programmes for early childhood development, adopting a multi-sectoral approach to child development, incorporating health, early education and nutrition interventions. It is implemented through a network of over one million village-level Anganwadi Centres (AWCs), staffed by Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs). It currently reaches to around 7.28 crore children (beneficiaries of supplementary nutrition, 6 months to 6 years of age) and about 1.6 crore pregnant women and nursing mothers (March 2010). One of the major objectives of the scheme is to improve the nutritional and health status of children in the age group of 0-6 years. This objective is sought to be achieved by providing a package of six services comprising of supplementary nutrition, early childhood education (pre-school education), nutrition and health education, immunization, health check-up and referral services to the children below six years and pregnant women and nursing mothers. 1.2 The ICDS Programme has remained in the forefront of the efforts of the Government of India (GoI) and the State Government to achieve the child nutrition related Millennium Development Goal (MDGI)1. The Government of India has committed to achieve the nutrition MDG of halving underweight rates from 54% to 27% between 1990 and 2015, and to achieving the education MDG of universal primary education (MDG2) and the Education For All goal of expanding and improving comprehensive early childhood care and education, especially for the most vulnerable and disadvantaged children. GoI is also committed to reducing infant and child mortality and improving maternal health outcomes (MDGs 4 and 5). Since malnutrition is closely linked to all of these MDGs, the interventions under the ICDS programme are expected to contribute towards achievement of each of these longer-term goals. 1.3 Despite several achievements that the ICDS scheme has witnessed during its three decades of implementation, there remain some major challenges with regard to high burden of child malnutrition in the State. The NFHS -3 (2005-06) reveals that about 44.6 percent children below five years in the State are still underweight against the national average of 43 percent (as per the WHO New Growth Standards; <-2SD). Of these, about 18.7 percent are severely malnourished (<-3SD) against the national average of 16 percent. 1.4 During the 11th Five Year Plan, the GoI has taken several measures to strengthen the implementation of ICDS Programme. The framework is restructured in such a way so as to suit the current needs which would not only hasten the Universalization of the ICDS programme with quality to reach out to all under six children in the State/Country, but also intensify decrease in child malnutrition, IMR and early child development. In order to increase the accessibility of the ICDS services to all households in the country, especially those belonging to disadvantaged and weaker sections in the community, the GoI has embarked upon massive expansion of the programme since 2006-07. In the year 2010-11, the GoG has sanctioned 1150 AWCs and 459 mini AWCs. The programme has been nearly universalized across the villages and habitations in the State. Provision was also made for sanction of AWCs on demand basis by the State. The population norms for opening up of the AWCs in rural, urban and tribal areas, as well as, the financial norms for various interventions under the scheme including that for training and capacity building of the ICDS functionaries, have been revised with effect from April 1, 2009.Honorariums of AWWs and AWHs have been revised since April 2008. In the year 2010, on the occasion of ‘Swarnim Gujarat- Celebrating 50 years of Gujarat State’, there was an additional increment in the honorarium of AWWs and AWHs since May 2010, from the State budget. Even the nutritional (calorific) norms for the supplementary food to the children below six years and pregnant women and nursing mothers have been revised. The challenge now is to harmonize the geographical expansion along with an improved implementation strategy in order to accelerate better and visible programme outcomes. 1.5 The 11th Five Year Plan has envisaged increased coverage in ICDS to ensure rapid universalization; changing the design; and planning the implementation in sufficient details that the programme objectives are not deviated by the design of implementation. Besides, all its original six services have to be delivered fully for the programme to be effective: (i) supplementary nutrition, (ii) immunization, (iii) health check-ups,
1.6 Despite several efforts, the level of child malnutrition remains acute in Gujarat. Every second child under five years of age is underweight in Gujarat. It is well known that malnutrition is a multi-dimensional problem and various determinants affect the nutritional status of children including food security, educational level of parents, water and sanitation, diseases, and many other socio and demographic factors. The ICDS programme follows an integrated approach for the holistic development of children below six years as well as health and nutritional needs of the pregnant women and nursing mothers. It is imperative to know how effective is the existing implementation strategy in addressing the varying needs of children and women. Hence, a detailed implementation plan at the State level would be useful to capture the programme effectiveness against the set targets or track expenditures against the physical achievements. Though ICDS is a ‘centrally sponsored scheme’ wherein the GoI provides 90 percent of the total programme cost to the States/UTs with effect from April 2009 (except the cost for supplementary nutrition, which is 50;50 between the GoI and States, and 90:10 in NE States), the basic responsibility for implementing the programme rests with the State Government. The role of State Government in monitoring the programme implementation is, therefore, very crucial. Till now, the practice followed by the GoI for releasing funds to the States/UTs under ICDS was based on the utilization certificates and monthly/quarterly progress reports. Fig 1: CONCEPTUAL FRAMEWORK OF NUTRITION 
1.7 In view of the growing concern over the programme not being able to achieve its core objectives, it has been felt that there needs to be a paradigm shift in the ICDS programme’s implementation framework / planning in order to improve and strengthen the existing implementation mechanisms. Hence, the existing annual planning process in ICDS being currently followed by the States needs re-structuring and standardization, to bring in clear focus on the programme ‘outcomes’ rather than on ‘outlays’, as was envisioned by the then Finance Minister of India during his annual budget speech on 28 February 2005.2 1.8 The Ministry of Women & Child Development has now introduced a comprehensive annual planning process through the development of an Annual Programme Implementation Plan (APIP) by each State/UT every year. The APIP will have all the details of activities with their physical and financial targets planned by the State. It is envisaged that the APIPs will help both MWCD and the State Governments to monitor the programme performance more effectively and to take mid-course corrections, if any. 1.9 The planning process is very critical to translating the vision of the Prime Minister of India, articulated in his letter to the State Chief Ministers, dated 9 January 2007. Urging that the ICDS programme be closely monitored, he stated that “proper implementation of the programme critically depends on political will, decentralized monitoring and meticulous attention to day-to-day operational issues. Otherwise, problems like irregular functioning of Anganwadi centres (AWCs), inability to provide hot, cooked food and leakage of food material meant for infants, will persist……. We are in the process of universalizing ICDS. But I am afraid, unless we take stock of the present position and remove the lacunae; universalization will mostly remain on paper and will not help our children secure a brighter future. The core objective of the ICDS Scheme in the 11th Plan should be universalization with quality.” 1.10 This document is based on the broad structure of the annual programme implementation plan provided by the GoI, and provides requisite information under various components of the programme.
The Annual Programme Implementation Plan has been prepared keeping in mind the specific objectives of the proposed annual programme implementation plan in ICDS as below: a) to strengthen the existing programme management, planning and implementation to help accelerate programme outcomes as envisaged in the ICDS objectives; b) to strengthen the existing monitoring of the programme implementation through tracking of expenditures against physical targets; c) to acknowledge and capture the diversity across the State with respect to health, nutritional needs of women and children and pre-school needs of 3-6 year olds and their feasible responses; d) to develop State specific strategies/interventions in respect of various programme components of ICDS in general and to achieve the health, nutritional and early learning outcomes through monitorable indicators; and e) to enhance the quality of programme implementation in order to achieve ICDS universalization with quality. CHAPTER 2 PROCESSES AND TIMELINES Participatory and Micro Planning process has been adopted as the methodology for development of Annual Programme Implementation Plan in Gujarat. Participatory nature of planning process helps in assessment of actual grass root level gaps and needs as well as development of area specific strategies. This also creates a sense of ownership among the stakeholders, generates awareness and helps in the capacity building of personnel at various levels. Another important feature of planning is the use of ‘bottom-up' approach for planning. Planning is done at three levels namely Block, District and State. The entire process is continuously monitored at various levels. The first step was to form a State level Committee, chaired by the Secretary WCD. The committee comprised of other State level officials like the Director ICDS, State Nutrition Programme Officer, State Accounts Officer and a representative from UNICEF. All the team members were actively involved in the planning process for the preparation of the PIP. The second step was to hire an external consultant to prepare the draft of the PIP with inputs from all the key programme officials. This consultant was hired with support from UNICEF. A State level consultation was organized, wherein the State Officials and the District Programme Officers were oriented on the process of preparation of the PIP. A copy of the Framework provided by the Government of India was also shared with them. Following this, all the necessary information of ICDS, based on the framework provided, was collected. The first draft of the document was prepared and shared with the State level Committee on 15th March 2011. The data and other relevant information were verified by the concerned officials of ICDS. Based on the inputs and suggestions from the key programme officials and UNICEF, and approval from the Secretary WCD, the Annual Programme Implementation Plan of ICDS for the year 2011-12 has been developed. Planning focus for 2011-12 As per the guidelines from the Government of India, special focus has been laid on efforts to address the problem of child undernutrition and early childhood education outcomes. Emphasis has also been laid on the need for training and capacity development of staff at all levels to enhance their skills and knowledge in tackling several issues related to child undernutrition, antenatal care, referral etc. CHAPTER 3 ANNUAL PROGRAMME IMPLEMENTATION PLAN (APIP) INTRODUCTION Gujarat is situated in the western part of the Indian sub-continent, bounded by the Arabian Sea to the west and south west and Pakistan in the North. It derives its name from the “Gurjas” who passed through Punjab and settled in some parts of western India. It has the States of Rajasthan and Madhya Pradesh towards the north east and east, Maharashtra and the Union Territories of Daman, Diu and Nagar Haveli, towards the south. Gujarat is a progressive State and is known for its innovations and unique initiatives in governance and socio-economic development. The state of Gujarat is characterized by sea-coastal, tribal, desert and geographically hostile terrain having sparse and scattered population at the periphery. Communities living in the remote and disadvantaged areas especially BPL population and women, are generally unable to access reliable and cost effective nutrition services. Administratively the State has been divided into 26 districts, sub-divided into 336 Blocks, having 18500 villages and 242 Towns. District Tapi has been recently created. The State has 12 Tribal districts having population of 89,96,744 accommodating 70 percent of the Tribal population (Census 2001). Approximately 18% (89,96,744) of the total population of the State is living in these Tribal districts. Fig. 2: Map of Gujarat 
SECTION 1: SITUATION AND GAP ANALYSIS Gujarat often called as ‘The Growth Engine of India’, being one of the most industrialized States in India, has always been at the forefront of all economic activities and continues to spearhead India’s march towards the global economic superpower status. However, there is a developmental paradox in Gujarat, as social indicators including neonatal and infant mortality rates have not reduced concomitantly in the State in comparison to its economic and development growth and undernutrition in children continues to be high. Undernutrition contributes to more than one third of all deaths in children under the age of five. a) Socio-economic and Demographic Profile (as per census 2001) Table 1: Socio-economic and Demographic Profile of Gujarat
Source: Statistical Year Book – 2011 by MoSPI, GoI b) State Nutrition Policy National Nutrition Policy (Background) The United Nations World Summit on Children in 1990 laid down the goal of “Adequate Nutrition for all” to be achieved to improve the quality of life of all nations. Consequently, the Global Plan of Action for Nutrition was adopted in 1992. The GoI adopted the National Nutrition Policy in 1993. The policy aims to identify the causes of malnutrition and formulate and launch effective sustainable inter-sectoral strategies to achieve the nutritional goals and endures nutritional security in the country. This was followed by preparation of the National Plan of Action on Nutrition, which translates the Policy statements into specific action programmes. Based on this, Nutrition Policies have been launched by different States. Gujarat State Nutrition Policy The Government of Gujarat is one of the few initial States in the country to develop a State Nutrition Policy. This policy formulation has been preceded by many planning exercises viz. the State Plan of Action for the Child which also incorporated a plan of action to reduce malnutrition; Inter-sectoral Plan of Action for Health and Nutrition. Simultaneously, another planning exercise was held for the preparation of the Project Proposal for external funding as well as social assessment. These planning exercises aimed to improve the ICDS services, particularly, to reduce malnutrition in women and children under two years. Goals of Gujarat State Nutrition Policy Overall Reduction of malnutrition of all types including underweight and micronutrient deficiencies amongst children, adolescent girls and women in child bearing age. Specific To provide the conceptual framework and broad guidelines for the population with particular emphasis on pregnant and nursing women, children and adolescents (girls) through appropriate programmatic changes in existing Programmes as well as new initiatives To improve the capacity of the communities, families and individuals to understand their own nutrition problems in terms of practical actions and address them at their own level through appropriate behaviour and action. Thus communities would be encouraged and assisted in assessing and analyzing their own nutritional problems and facilitated to take action on their own behalf. To sensitize and involve government Departments, NGOs and academic institutions in operational issues related to malnutrition, gender dimension of malnutrition, and define their specific roles. c) Existing mechanism for inter-sectoral convergence The Department of Women & Child Development is collaborating with various line Departments to provide effective services to the community. The details of the inter-sectoral convergence are as below: Department of Health 1. Mamta Abhiyan Mamta Abhiyan – It is a comprehensive package of preventive, promotive, curative and referral services under the Reproductive and Child Health Programme (RCH II) initiated in 2006. It caters through Mamta Diwas (Village Health & Nutrition Day), Mamta Mulakat (Post Natal care visit), Mamta Sandarbh (Referral Services) and Mamta Nondh (Records and Reports). Mamta Abhiyan is a shining example of integrating the services of the Health and the Women & Child Development Departments where the grassroots level functionaries work together in harmony and provide quality services through community support.
Child Development & Nutrition Centres (CDNCs) (52) have been established at the district hospitals by the Department of Health. ‘Balbhog’ is provided to the severely underweight children at the CDNCs by the ICDS. The AWWs are also involved in bringing the children to the CDNCs. 3. Integrated Management of Neonatal & Childhood Illnesses (IMNCI) Alongwith the health functionaries, AWWs have also been trained on IMNCI for home based care of the sick children. 4. Anemia Control Program: Government of Gujarat has adopted a multi-pronged approach to prevent and control anemia among pregnant and lactating mothers, adolescent girls and children 6-59 months. Iron Folic Acid (IFA) supplements are being provided to pregnant and lactating mothers as per the standard protocol. From June 2009 onwards, under the RCH program, the State has introduced iron syrup for children (6-60 months) in daily regime for 100 days each year. The syrup is dispensed in 100 ml bottles (with a dropper) so designed that only 1 ml can be dispensed each time. Each ml of syrup contains 20 mg elemental iron and 100 mcg folic acid. Mamta Taruni has been launched for out of school adolescent girls.
The ICDS collaborates with Departments of Health and Food & Civil Supplies for the provision of iodized salt at the AWCs on Mamta Diwas, free of cost, to pregnant and lactating mothers. The indent of requirement is prepared by the ICDS and handed over to the Department of Food & Civil Supplies. The financial support for this is provided by the Department of Health. 6. State Nutrition Cell The Liaison Officer (ICDS-Health) of the State Nutrition Cell, established under NRHM, participates in monthly meetings of ICDS. This provides a platform to discuss field level problems and also facilitates on-the-spot problem-solving. 7. Synchronization between Health and ICDS programs Unique to Gujarat is the geographical and functional synchronization between Health and ICDS Departments at the level of supervisors in the field. Initially it was implemented as a pilot exercise in Valsad district in 2007 with UNICEF support. Currently, synchronization has been scaled across the State. All Health and ICDS supervisory sectors have now been synchronized for effective joint service delivery, training, planning and review. Detailed report is given in Annexure 1.
The ICDS is carrying out the ‘Doodh Sanjeevani Yojana’ in collaboration with the Tribal department in 10 selected Blocks of 6 Tribal districts in the State. The Districts and the selected Blocks are- Banaskantha – Danta, Amirgarh Tapi – Nizar Narmada – Dediapada 1 and 2 Vadodara – Kwant Dahod – Jhalod 1, Jhalod 2 Panchmahal – Santrampur 1 and 2 Under this scheme, double fortified milk (100 ml) is provided to each child twice a week. The budget allowance is Rs. 2.45 per beneficiary for 1 time supply of 100 ml milk. This scheme is implemented with the help of local dairies. Total Sanitation Campaign (TSC) and Water Supply Department TSC: The Total Sanitation Campaign (TSC) programme of GoI concentrates on providing toilets to all Households, Schools and Anganwadi Centres. Under this programme, District Rural Development Agency at the District level receives a proposal from ICDS regarding the village wise requirement of toilets. The requirement is then included in the annual implementation plan of the district. Based on the requirement District funds allocated under TSC for AWCs are transferred to ICDS for implementation/construction of the toilets. WASMO: Water and Sanitation Management Organization (WASMO) is a registered autonomous body under Bombay Charitable Trust Act by Government of Gujarat. This organization primarily facilitates provision of drinking water facility in villages through “Paani Samiti” constituted under Gram Panchayat. In this process, WASMO ensures that all public amenities and households are provided with tap connections. Anganwadi centres are also covered under this programme for making the toilets functional.
The Department provides fortified wheat flour (130 gm per child) and fortified oil at the AWCs. The fortified wheat flour comprises of wheat, chana, defated soyabean, oil and sugar. The 130 g fortified flour provides 500 Kcal, 12-15 gm protein and 6 mg iron, besides other nutrients. The Department also provides iodized salt at subsidized rate (Rs. 1.00 per kg) through Public Distribution System (PDS) to BPL families and those living in tribal areas. Nutri-candy, manufactured by SWAN Pvt. Ltd., is supplied by the Food & Civil Supplies Department. The grant for this is provided by ICDS. Cottonseed Oil is supplied by the Department at Taluka level. From there, the CDPOs take charge and distribute it at the AWC level. Gram Panchayat and Cooperatives Kitchen Gardens have been developed in the campus of AWCs in many Districts with support from the Gram Panchayats and village level Cooperatives. A Village Health & Sanitation Committee (VHSC) has been formed at village level, wherein Anganwadi Workers (AWWs) of the ICDS department are also active members of this committee. Rural Development Department Sakhi Mandal: Economically weak women of our community have come together to work towards their self empowerment. For the empowerment and improvement of their economic and social status, creation of Sakhi Mandals has been undertaken since 2nd February 2007. Under this initiative, in order to promote economic self dependence and habit of saving some money for future, women members of Self Help Groups are motivated and engaged in income generation activities. The scheme is effectively implemented by the Department of Women and Child Development in convergence with the Department of Rural Development. With an aim of providing Revolving Fund grants along with loans, Government of Gujarat provides Rs. 1500 per Sakhi Mandal group as a motivation. In the Swarnim Gujarat year, with an objective of women empowerment and improving the Human Development Index especially among the poor through self economic generation activities; formation of Mission Mangalam has been undertaken. In the fifth submit of Vibrant Gujarat 2011 ‘Gujarat Livelihood Promotion Company’ has signed a 57 Memorandum of Understanding with 32 corporate companies. On execution of these MOUs, within 3 – 5 years more than 15 lakhs women will receive employment. Statistically more than 2 lakh Sakhi Mandals are functional wherein 25 lakhs women have a saving of total Rs. 161.54 crore in banks proving success of the collective and teamwork efforts. d) Nutrition and Health status of Women and Children in Gujarat Gujarat is home to 51 million people3 and often called India’s growth engine. Undoubtedly, it is better positioned compared to many other States in terms of economy, infrastructure, industrialization and governance. However, the status of undernutrition remains high and staggering in the State. Government of Gujarat (GoG) has accorded highest priority to address this formidable challenge and has been undertaking notable initiatives in this regard in the recent past. Fig 3: Nutrition Situation in Gujarat  
A
ccording to DLHS -2 data, 16 out of 26 districts have 45-64% children underweight and 9 of the 12 Tribal districts have 45% or more underweight children. While, the NFHS 3 data shows that 45% children under 5 years are underweight. According to the CES 2009, only half of the children are breastfed within 1 hour of birth while less than half (45%) are exclusively breastfed. A little more than half of the children (56%) 6-9 months initiate timely complementary foods. According to the NFHS 3, 80% of the children 6-35 months are anaemic while only 56% households consume iodized salt. The DLHS 3, 2008, shows that 56% of children received vitamin A supplements. Fig 4: Reasons for Undernutrition in Gujarat 
In Gujarat, the coverage for the 8 of the 10 proven interventions which can reduce undernutrition is less than 50%. Fig 5: Status of adoption of IYCF interventions in Gujarat 
The figure above shows that the adoption of the 3 most critical IYCF interventions (Breastfeeding within 1 hour or birth, Exclusive Breastfeeding for 6 months and Timely initiation of Complementary Feeding) is very poor. The State average is only 19.5%. Fig 6: Infant Mortality in Gujarat - High & Static 
> 13 lakh births annually > 65,000 deaths among under-ones annually > 71% infant deaths during neonatal period
MDG Goal Infant Mortality Rate is very high and stagnated in the recent past in Gujarat, in spite of very good economic and infrastructure growth in the State. There is a wide Rural Urban disparity. Most Infants (i.e. 71 %) die in Gujarat during neonatal period and Gujarat contributes to 5 % of neonatal deaths in India. Factors associated with neonatal deaths are (1) Mothers age-Lower the age, higher is the risk eg < 20yrs 54.2/1000 live births Vs 20-29 yrs 34.2/1000 live births (2.) Neonatal deaths directly related to birth interval (< 2 yrs birth interval NMR 57.9 /1000 live births Vs >3 yrs of birth interval it is 19.2/1000 live births (3) Poor & (4) rural population have higher neonatal deaths Fig 7: Infant Mortality Rat Fig 8: IMR and U5MR -Disparity 
Ref: SRS 2009 Infant Mortality Rate is much lower in other developed states. Infant Mortality Rate in Gujarat is higher than other developed states. Fig 8: IMR and U5MR -Disparity SC, ST & Others: Gujarat and India: 2005-2006 
Scheduled Tribes in Gujarat have higher mortality compared to national level IMR and U5MR. Fig 9: Coverage along the continuum of care: Scheduled Tribes Vs Others: Gujarat 2005-2006 
Scheduled Tribes have poor coverage compared to others except for initiation of breast feeding. Fig 10: Nutritional status of children below 3 years in Gujarat NFHS-3 (2005-06) 
The above graph shows that the percent children underweight and stunted in Gujarat are higher than the national average. Whereas, the percent children wasted are a little less than the national average. The data shows that inspite of quick development in the State, the improvement in the nutritional status of the children still remains a challenge despite no food insecurity and ample wage opportunities. Fig 11: Status of feeding practices for children below 3 years NFHS-3 (2005-06) 
According to the NHFS-3, a little more than one fourth (27.1%) of the total children below 3 years were breastfed within 1 hour of birth, while almost half of the total children 0-5 months were exclusively breastfed. About two thirds of the children 6-9 months received solid or semi-solid food and breast milk. All the figures are above national average, but need urgent attention. Fig 12: Nutritional status of Women in Gujarat NFHS-3 (2005-06) 
The nutritional status of women in Gujarat is also quite alarming, as shown in the graph above. One third of the women 15-49 years have Body Mass Index below normal levels. About two thirds of the ever-married women 15-49 years are anemic (55.5%), while the percent increases to 80.8% in pregnant women 15-49 years. Fig 13: Status of pregnant women utilizing services at Anganwadi Centres NFHS-3 (2005-06) 
The percent pregnant women receiving at least 3 ANC visits in Gujarat is 64.9% against the national average of only 50.7%. However, the percent women who consumed IFA for 90 days or more is much less at 35.7%. Fig 14: Status of Institutional Deliveries in Gujarat NFHS-3 (2005-06) 
More than half of the women delivered at the institution (54.6%) according to the NFHS-3, while, 64.7% of the births were assisted by health personnel in Gujarat. The percent women receiving postnatal care within 2 days of delivery was 54%. F  ig 15: Routine Immunization coverage in Gujarat
Tracking children for adequate coverage is weak as reflected by 42 % OPV booster and 44 % DPT booster coverages. (CES 2009, UNICEF). Fact Sheet on Maternal and Child Nutrition and Health (NFHS 3) as Annexure 2. e) ICDS in Gujarat Department of Women and Child Development, under the guidance of Hon’ble Minister Mrs. Anandiben Patel and Mrs. (Prof) Vasuben Trivedi, is the Nodal Department for implementation of the Integrated Child Development Services (ICDS) scheme in Gujarat. Integrated Child Development Services (ICDS) scheme was launched in Gujarat in the year 1975 in Chhota Udaipur Block of Baroda District as a part of the State Health Department. After successful piloting, each subsequent year, new blocks were added under the ICDS programme. Considering the interrelated and complementary nature of activities of ICDS and Health programmes, there was always a good coordinated implementation of the two programmes at all levels. It worked quite well because responsibility for implementation of both the programmes was with Health Department. However in 2003 ICDS, was separated from Health department and started functioning separately under Department of Women and Child Development (Annexure 3). Anganwadi centers (AWCs) are the basic infrastructure identified and developed in every target village for delivery of the services and deliverables to target beneficiaries of the ICDS programme. As an attempt towards addressing the issue of maternal and child undernutrition, ICDS has undertaken various initiatives at state and district level besides the schemes and efforts of Government of India. ICDS i.e. Integrated Child Development Services in Gujarat presently covers over 5.2 million beneficiaries (children under 6 years, pregnant women, lactating mothers and adolescent girls) through 49,338 operational Anganwadi centres (as on March, 2011). In addition, the State has introduced mobile Anganwadi vans in difficult to access areas and for beneficiaries working at construction sites, railway tracks etc. Additionally, there are 1,125 mini Anganwadi centres. Based on the efforts undertaken to universalize ICDS programme, recently, 1150 AWCs and 459 mini-AWCs have been sanctioned additionally. Of these, about 50% of the AWCs (22,504) have been built in partnership with Reliance, Tribal Sub-plan, Red Cross, Ayojan Mandals etc. f) State’s financial contribution to ICDS implementation including on supplementary nutrition food, in addition to Central Government’s support (provide last two years data) Supplementary Nutrition Supplementary Nutrition is provided at the Anganwadi Centres in the State as per the Government of India guidelines. The details are as under: Energy dense Micronutrient Fortified Extruded Blended Food (Bal Bhog) is provided as Take Home Ration (THR) to children 6 months to 3 years (7 packets per month) and underweight children 3-6 years (4 packets per month) on Mamta Diwas. Each packet weighs 500 gms. The shelf life of EFBF is 4 months. It can be easily prepared by mixing it with hot milk or water. Calorie dense Take Home Ration (THR) like Sukhdi (1 packet of 1 kg per month), Sheera (3 packets of 500 gm each) and Upma (2 packets of 500 gm each) are provided to pregnant women, nursing mothers and adolescent girls. Hot cooked food is provided through Matru Mandals and Sakhi Mandals in 18543 AWCs covering 2086521 children in the age group of 3 – 6 years. Matru Mandals and Sakhi Mandals are involved in the Supplementary Nutrition Programme to promote community participation and to maintain the quality of food. Currently, 7.2 lakhs beneficiaries (pregnant women, lactating mothers and adolescent girls) from 9591 AWCs are being covered through these Mandals. They prepare the supplementary food and provide to the beneficiaries at the AWCs twice a week. Additionally, the State Government is also providing fruits (seasonal) as morning breakfast to children 3-6 years, twice a week (Monday and Thursday) at the AWCs. Currently, 3579651 children are being covered from 28594 AWCs. There is a provision of Rs. 16.20 crores for the year 2010-11 for this initiative. The State has also initiated ‘Doodh Sanjeevani Yojana’ in selected 10 Blocks of 6 Tribal districts, wherein, 100 ml fortified, flavoured, double toned pasteurized milk is provided to children 3-6 years, twice a week. Around 1.77 lakhs children are benefiting from this scheme from 784 AWCs. This initiative is being implemented with the help of local dairies. Another innovative scheme initiated by the State of Gujarat is the ‘Mobile Anganwadis’. Thirty Six Mobile Anganwadis have been started in all districts of Gujarat State – wide wherein, beneficiaries of NREGA scheme, children of Agariya workers from Balmadir - creches facilities (6 months to 6 years), pregnant women, nursing mothers and adolescent girls are provided supplementary nutrition under this Mobile Anganwadi scheme. Nutri-Candy with micronutrients and vitamins ( Iron – 7 mg, Vitamin A – 300 IU, Ascorbic Acid – 10 mg, Folic Acid – 15 mcg) is given to children in the age group of 3 to 6 years in addition to regular food supplement in Anganwadis. Nutri-candy has a weight of 3 grams and is processed by a manufacturing unit and procured and supplied through Gujarat State Civil Supply Corporation. The cost of one Nutri-candy is 23 paise. Milk and Sukhdi through community support – As per the instructions by the Hon. Chief Minister, a special effort to promote community participation has been started since June 2008. The community has been involved to provide Milk and Sukhadi to the ICDS beneficiaries (children) during the School Admission Drive and Anganwadi Admission Drive. Tithi Bhojan – Through this initiative, the community provides various foods like fruits, sweets, snacks etc. to the children at AWCs on several occasions like birthdays, marriage, religious ceremonies, fair etc. The provision for supplementary nutrition for year 2011 – 12 is Rs. 588.68 crores. Physical target for the financial year 2010-11 and 2011 – 12 is as follows (based on survey by AWWs):
The beneficiaries under SNP have already been universalized in the State. Thus all categories of children (6 months to 6 years) irrespective of their caste/tribal status etc. are being covered under the programme. The recipes of the supplementary nutrition provided are given in Annexure 4. The revised cost norm for Supplementary Nutrition Programme provided by the Ministry of Women and Child Development vide letter nos. No.F.14-1/2008-CD-I dated 18 November 2008 has been implemented in the State w.e.f. September 2009. Directives have been sent to District Collectors and District Programme Officers of all the 26 districts in this regard (Annexure 5). The cost sharing ratio between Centre and States with regards to Supplementary Nutrition Programme is 50:50 and has been effective from the year 2009-10.
Quality Control Mechanism Regular testing of various food samples is being done. The random samples collected from the field are sent to the NABL labs every month for testing by the State Commissionerate Office. Table 3: Budget Provision & Expenditure position under SNP for 2010-11 and 2009-10
g) Infrastructure status of all operational AWC Buildings (own/rented; pucca/kuccha etc) - State's plan for construction of AWC buildings using funds from RIF/NABARD, MPLAD/BRGF and other development partner sources etc.; potable water supply and child friendly toilets at the AWCs; smokeless chulhas, medicine supply in health sub centres, renewable energy sources etc. Gujarat State envisions that by 2012, all Anganwadi Centres would have their own infrastructure building with electricity facility, fan, water and toilet facility, for which continuous efforts are being made. Table 4: Status of Anganwadi Centres in the State:
*As on March, 2011 Table 5: Facilities at the AWCs
Construction of new Anganwadi Centres Gujarat state visions that by 2012, every Anganwadi should have their own infrastructure building with facilities like electricity, fan, water and toilet; for which continuous efforts are undertaken. During 2008 – 09, State spent Rs. 50 crores and during 2009-10, State has spent Rs. 100 crores for construction of 3333 Anganwadi Centers at a unit cost of Rs. 3 lakhs.
In the year 2010-11, the unit cost of AWC was raised from Rs. 3 lakhs to Rs. 3.23 lakhs with a provision of Rs. 100 crores to construct 3095 AWCs as per the new rate. For the year 2011-12, there is a provision of Rs. 100 crores for AWC construction. Repair and Electrification at Anganwadi Centres In the years 2009-10 and 2010-11, Rs. 10 crores each were allocated for the repair and maintenance of the AWCs. Since the year 2009-10, the State Government is paying Rs 200 per AWC towards electricity bills. The total expense incurred towards the electricity bills in the year 2009-10 was Rs. 7.04 crores. The budget provision for electrification for the year 2010-11 was Rs. 34.37 lakhs, while the budget approved for the year 2011-12 is Rs. 247.17 lakhs.
The State Government has provided Vans for Mobile Anganwadi Centres to address the needs of the socially exluded population, mostly residing in the interior areas of the State. In the year 2009-10, an expenditure of Rs. 24.72 lakhs was incurred for purchasing Mobile Vans. In the year 2010-11, provision of Rs. 1.71 crores was made for purchasing additional 26 Mobile Vans. Thus in total we have 36 Mobile Anganwadi Vans for improved coverage of the eligible beneficiaries. Gas Connection, Stoves and Cooker for Anganwadi Centres As per the Hon’ble Supreme Court’s order freshly prepared supplementary nutrition needs to be provided every day at the Anganwadi Center and in order save the AWW and AWH from harmful exposure of the smoke from chulha, Gujarat Government is providing gas connection along with Stove and a cooker at each AWC. First time in India, in 2009 -10 Gujarat State spent Rs. 33.34 crores for providing Gas connection to all 49,000 operational AWCs along with stove and Idli Cooker. h) Status of operationalization of blocks/AWCs/mini-AWCs against sanctioned Table 6: District- wise allocation of AWCs - February 2011.
Source: ICDS – MPR – March, 2011 and Anganwadi allotment letter no. Yojana-2-ICDS-mehkam-navi AWC-manjooree-11-2026 dated 14-2-2011 by Director, ICDS office to all DPOs The above table shows that across the State, 98% of the coverage of beneficiaries is done through Anganwadi Centres, while the percent share of Mini Anganwadi Centres is only 2%. In the year June 2006, out of the sanctioned 37961 AWCs, 37608 AWCs were functional. By March, 2011, the number of AWCs increased to a great extent in Gujarat, with 49,338 AWCs functional out of the 50226 sanctioned AWCs. Fig 16: Trends in coverage of beneficiaries (6 – 36 months) for supplementary nutrition (5 years) 
Amongst the children in the age group of 6-36 months, the number of children receiving Supplementary Nutrition has gradually increased. In June 2006, 669878 children had received SN. While, in March, 2011, the number increased to 1695658. However, in February 2010, there was a sudden drop in the number of children due to interruption in food supply at AWCs. Fig 17: Trend analysis of children in the age group of 3-6 years received Supplementary Nutrition (Jun 2006 - March 2011) 
The above graph shows that the number of children in the age group of 3-6 years has increased from 765417 in June 2006 to 1389178 in March, 2011. Fig 18: Trend analysis of pregnant and lactating mothers received SNP (Jun 2006 – March 2011) 
This graph shows the extent of supplementary nutrition provided to pregnant and lactating women through the AWCs. In June 2006, 252569 women were covered, while in March 2011, the number of women increased to 732328. j) Training infrastructure – AWTCs, MLTCs Training of functionaries for effective programme implementation is an integral component of the Integrated Child Development Services (ICDS) scheme. A set curriculum developed by National Institute of Public Cooperation and Child Development (NIPCCD), New Delhi, is used for the training. The trainings are divided into three components – Health and Nutrition; Pre-school Education and Community Participation (home visits). Based on the set curriculum, the training centres decide upon the topics to be given more emphasis and the types of training aids to be used, as per the local situation and need. Two types of training centres have been recognized by the Government to provide job, induction and refresher trainings to the ICDS staff - Mid-level Training Centres (MLTCs) and Anganwadi Training Centres (AWTCs). Child Development Project Officers (CDPOs), Assistant Child Development Project Officers (ACDPOs), ICDS Supervisors and Instructors of AWTCs are trained at the Mid-level Training Centres (MLTCs). At the district level, the Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs) are trained at the AWTCs. CDPOs, ACDPOs, ICDS Supervisors and AWWs receive a job training of 32 days. Additionally, they also receive one week induction training and one week refresher training. Each AWH receives a one week orientation training and five day refresher training. The Instructors of Training Centres receive an orientation training of 11 days and a one week refresher. In Gujarat, there is one MLTC, located in Gandhinagar and 17 AWTCs across the State. The MLTC and the AWTCs are functioning in partnership with the non-government organizations. State officials and officials appointed by NIPCCD monitor these training centres. A needs assessment study was carried out for the MLTC and AWTCs of Gujarat from April-May 2010 to identify the existing gaps. The study was conducted using the standard questionnaires developed by NIPCCD. The study revealed gaps in manpower, equipments and infrastructure. Need to enhance skills and knowledge of the instructors has also been identified. Fig 19: Mid-Level and Anganwadi Training Centres in Gujarat 
Proposed interventions: Upgradation of six ICDS training centres into regional model ICDS training centres with State-of-the-Art facilities (training aids, accommodation, training facilities) under Nutrition Mission Provision of equipments and other materials required as per the needs assessment study carried out in the year 2010. Capacity building of instructors on issues identified during the needs assessment study AWTC Needs Assessment Study Report as Annexure 6. k) Major gaps in programme implementation Discussed in section “Issues” on page 111-113. SECTION 2: Strategies proposed to address child undernutrition and early childhood education issues Universalizing AWC coverage & track all children Universalization of ICDS Scheme and Implementation of Supreme Court’s Orders dated 22.4.2009: The status of operationalization and action plan is given in section 1h. The AWCs have been sanctioned by Government of India vide its Ministry of Women & Child Development letter dated 31st March, 2010, No. 14-1/2008-CD-I Vol.-II. This letter has been received on 15/4/2010. By GOI letter dated 29th May, 2009 No. F-No-1-1/2007-CD-I, a proposal for on- demand Anganwadis was asked to be submitted. Accordingly, by this office letter dated 2/12/2009, a request for total 2500 on-demand Anganwadi Centres was submitted. Subsequently, a GOI letter dated 5/10/2009, No.35 (i) followed by a fax dated 27/1/2010 was received with information to be submitted in the prescribed format. Accordingly, consolidated information collected from all Districts in the prescribed format was submitted by letter dated 3/5/2010, No.N-2/ICDS/On-Demand /A'wadi- Approval/09 in the form of both hard and soft copy. Further response is awaited. Universalization with Quality: Under the ICDS Universalization plan, calorie and protein content of supplementary food provided has been revised under the new feeding norms (2009). New Anganwadi centres have also been sanctioned under the revised norms. Take Home Ration is being provided to the pregnant and lactating mothers and adolescent girls. ICDS growth registers have been developed in Gujarati using the WHO New Growth Standards (2006). ICDS growth registers and charts have been rolled out in the entire State and the staff has been sensitized on how to use these charts. Adherence to population norms Table 7: Population norms for the AWCs
In 2009, All District Program Officers have conducted a detailed survey of each district population to assess adherence of the population norms for AWCs. On the basis of which, new AWCs and Mini- AWCs were demanded from GoI. Certification of the fact that all habitations are covered after ground verification As per the office letter dated 21/4/2007 and 20/6/2009, all District Development Officers were requested to send demand under 3rd phase for Anganwadi Centres/Mini Anganwadi Centres ensuring no SC/ST/SEBC/Minorities /urban slums or other areas left uncovered of ICDS services with certification of the fact that all villages, areas, Nagarpalikas, Corporations or slums have been fully covered. A proposal for 2433 On-Demand Anganwadi Centres and 814 Mini-Anganwadi Centres has been submitted on 3/5/2010. We have received a certification from all the District Program Officer confirming that no SC/ST/SEBC projects are left uncovered. GIS mapping of AWCs to ensure that no pocket/area remains without ICDS coverage An extensive exercise by Department of Women and Child Development, Government of Gujarat is undertaken to map each and every Anganwadi through GIS. Total 11 districts out of the 26 districts of Gujarat have been mapped and by June, 2011 mapping of rest 15 districts will also be completed. Fig 20: Snapshot of GIS mapping of AWCs of Pilot District in Gujarat 
Details in Chapter 3, Section 4F. Exhibition of list of AWC locations at their website By GOI letter dated 30/4/2010, information regarding location of Anganwadi Centres as on 31/3/2010 was sought by E-mail. Accordingly, as per the official letter dated 7/5/2010, all District Development Officers and Programme Officers have sent information by E-mail. The State has created a line listing of all the AWCs which has been updated on the website – http://wcd.gujarat.gov.in Full coverage of urban slums/urban areas with the required local innovation Total 3785 AWCs were operationalized in Nagar Palika areas. From 17/12/2009, 401 new Anganwadi Centres have been sanctioned by reallocation. In this way, 4186 AWCs have been operationalized in slum areas of Nagarpalikas, while 4233 AWCs were sanctioned in Municipal Corporation areas. Out of them, 362 new AWCs have been sanctioned to cover the slum areas. Innovation With coordination with Health Department, all the areas of Female Health Supervisors were geographically synchronized with the area of the Anganwadi Supervisors. Thus, the attempt facilitated the delivery of both the services of ICDS as well as of the Health department to achieve full coverage. (Annexure 1). Addressing issue of social inclusion To address the issue of social inclusion, there are Anganwadi Centres (including mini AWCs) functional in the State for SC/ST and minority areas.
Thus, by covering all the above mentioned areas, the State has made an attempt to universalize ICDS services along with quality. Additionally, to address the needs of socially excluded population like migrants, NREGA workers etc., earlier there were 10 Mobile Anganwadi Vans in 6 districts (Ahmedabad, Surat, Rajkot, Vadodara Valsad, Navsari). An expenditure of Rs. 24.71 lakhs was incurred for Mobile Anganwadi vans. Further, in 2011- 11, provision of Rs. 1.71 crores was made for purchasing additional 26 mobile AW vans. Thus, in total there are now 36 mobile Anganwadi vans for improved coverage of the socially excluded population. Efforts are made to cover all eligible beneficiaries by improving the quality of service delivery By Women & Child Development Department GR No.ICD/102006/1970/B, dated 26/3/2007, Balmandirs/Balwadis run by Departments other than ICDS like Tribal Development department, Rural Development Department, Department of Social Welfare etc. or run by private agencies have been converted to Anganwadi Centers for providing supplementary nutrition. In this way, delivery of services has been improved through extension of coverage of beneficiaries. Focus on children under 2 years of age All these years ICDS has been focusing on children in the age group of 3-6 years. But recent studies reveal that most undernutrition sets in the first two years of life. Much of this early damage is irreversible and any interventions after this would be too late. The cost of treating undernutrition is 27 times more than the investment required for its prevention (UNICEF, 1997). Hence, early identification of undernutrition and timely corrective action (counseling/referral) is even more pertinent. The Gujarat Nutrition Mission stresses special focus on children below 2 years of age (for details see pages 48-49) Focus on mothers and out of school adolescent girls Gujarat is the only state in India where Pregnant and lactating women and out of school adolescent girls are provided with Energy dense extruded blended fortified ‘Ready to Cook’ Take Home Ration premix packets being given following the revised feeding norms (2009) - Sheera (3 packets of 500 gm each), Upma (2 packets of 500 gm each) and Sukhadi (1 packet of 1 kg) per month from the AWC free of cost. Earlier 10 Adolescent girls from each AWC were provided, supplementary nutrition which was later increased to coverage of 20 adolescent girls per AWC. Under the newly launched SABLA scheme (being piloted in 9 selected districts of Gujarat) all the eligible adolescent girls (School going and out of school going) are provided with ICDS – Take Home Ration (Sheera, Sukhadi, Upma) as supplementary nutrition. Increase in coverage of beneficiaries because of THR: The highest coverage observed for the time period Jan’09 - May’10 was 36,89,243 beneficiaries. But with the launch of new THR scheme by the State Government, the coverage has increased to 50,43,391 beneficiaries, marking solid growth of 36.71% of ICDS services.
Pregnant and Lactating women 1. MAMTA Abhiyan Mamta Abhiyan, a joint four-pronged health and nutrition service delivery strategy has been initiated by the State of Gujarat in early 2007. The four components include: Mamta Divas (Village Health and Nutrition Day) Mamta Mulakat (Post Natal Care Home Visit) Mamta Sandarbh (Referral and Services) Mamta Nondh (Record and Reports) Purpose To provide preventive and promotive health and nutrition services at village level To operationalize service with convergence among health and ICDS departments Goal To enhance reach, access, and utilization of the integrated health and nutrition services The components of Mamta Abhiyan are: Mamta Divas (Health and Nutrition Day) - This is a monthly fixed day fixed site joint nutrition and health delivery strategy implemented in each village. Along with routine immunization, other services delivered are micronutrient supplementation (IFA, Calcium, Vitamin A and iodine through free 1.5 kg of iodized salt for all pregnant and lactating mothers), Hemoglobin test for the pregnant woman at the time of registration and also in the 6th and the 8th month, urine test of pregnant women for albumin and sugar with Uristix and counseling by health and Anganwadi workers. Additionally growth monitoring for children under-three is carried out by Health/ICDS supervisors on quarterly basis. Mamta Sandarbh (Referral Services) - One Mamta Referral Centre has been developed in each Block. Services of a Pediatrician who has been commissioned on call basis are available on a definite day (Thursday) at the Referral Centre to provide medical care to the childrenfound with acute and chronic illnesses, through screening on Mamta day. Mamta Mulakaat (postnatal home visit) - Three postnatal visits are conducted by the ICDS/Health worker on Days 1, 3 and 7 after birth of the child. Mothers are supplemented with postnatal vitamin A (2 lakh I.U.) on the first visit and provided counseling on child care and exclusive breastfeeding in all visits. Mamta Nondh (Records and Reports) - are records/reports of all above-mentioned activities. Using these reports, data is compiled and block-wise data is used to review and identify poor performing blocks. 2. Indira Gandhi Matritva Sahyog Yojana (IGMSY) A new scheme for pregnant and lactating women called Indira Gandhi Matritva Sahyog Yojana (IGMSY) has been initiated by the Government of India, initially on pilot basis, in 52 selected districts across the country. The scheme would be a centrally sponsored scheme, wherein grant-in aid would be released by the GoI to the States/UTs, and would be implemented through the ICDS department (Annexure 7). In Gujarat, Bharuch and Patan districts have been selected for the implementation of the IGMSY scheme.
To improve the health and nutrition status of pregnant and lactating women and infants by: Promoting appropriate practices, care and service utilization during pregnancy, safe delivery and lactation Encouraging the women to follow (optimal) IYCF practices including early and exclusive breastfeeding for the first six months Contributing to better enabling environment by providing cash incentives for improved health and nutrition of pregnant and lactating women Target Group – Pregnant women of 19 years of age and above for first two live births Each pregnant and lactating mother would receive a total cash incentive of Rs. 4000/- between second Trimesters till the child attains the age of 6 months subject to fulfilling of the set conditions. Table 8: Conditions for Cash Transfer
The milestones for cash transfer are: First – at the end of second trimester Second – 3 months after delivery Third – 6 months after delivery Cash incentive to AWWs and AWHs – AWWs would receive a cash incentive of Rs. 200/- per pregnant and lactating women after all the due cash transfers have been completed. AWHs would be provided Rs. 100/- per beneficiary as cash incentive. Activities Formation of ICDS Cell at State, District and Block levels Fund flow mechanism Training and Capacity Building of ICDS functionaries Monitoring and supervision plan Recording and Reporting Roles and responsibilities of ICDS functionaries at various levels Roles and responsibilities of health functionaries Out of school Adolescent Girls 1. Kishori Shakti Yojana and NPAG In the year 2000, the MWCD, GoI, came up with a scheme called Kishori Shakti Yojana (KSY), which was implemented using the infrastructure of the ICDS. The objectives of this scheme was to improve the nutrition and health status of girls in the age group of 11 to 18 years, to equip them to improve and upgrade their home-based and vocational skills, and to promote their overall development, including awareness about their health, personal hygiene, nutrition and family welfare and management. Thereafter, the Nutrition Programme for Adolescent Girls (NPAG) was initiated as pilot project in the year 2002-03 in 51 identified districts across the country to address the problem of under-nutrition among adolescent girls. Under this programme, 6 kg of free food grain per beneficiary per month was given to the undernourished adolescent girls. 2. Mamta Taruni Under the Kishori Shakti Yojana, the Government of India was providing Rs 10,000 per block annually. However, no separate budget for supplementary nutrition was given. Both the above mentioned schemes have influenced the lives of the adolescent girls to some extent, but have not been able to achieve the desired results. In the year 2006-07, Government of Gujarat initiated provision of supplementary nutrition to 10 out of school adolescent girls per AWC across the State. Looking at the increasing demand, the number of adolescent girls was increased to 20 per AWC in 2009-10. Gujarat is the first state in the country to carry out this initiative. In March 2010, 336,410 adolescent girls were provided supplementary nutrition, while in February 2011, the number increased to 746,445 girls. The entire expenditure is borne by the State Government. Under the RCH II programme, adolescent health is an important component. In Gujarat, a special programme called “Mamta Taruni” has been launched for adolescent girls in the age group of 10-19 years. It is a convergent scheme of Health and ICDS departments across the State. The services provided include: weighing once every four months, weekly distribution of iron and folic acid (IFA) tablets, nutrition supplementation to those weighing less than 35 kg, de-worming, biannual vitamin A supplementation, tetanus toxoid vaccination, and counselling. Peer educators have been identified and trained as mobilizers. 3. SABLA A comprehensive scheme called Rajiv Gandhi Scheme for Empowerment of Adolescent Girls or SABLA has been launched by the Government of India to address the multi-dimensional problems of adolescent girls. The KSY and NPAG schemes have been merged into this. SABLA would be implemented initially in selected 200 districts across the country, using the platform of ICDS. In these districts, RGSEAG will replace the KSY and NPAG schemes (Annexure 8). In the remaining districts, KSY would continue as before. The Scheme has 2 major components: Nutrition component: wherein energy dense food would be provided at the AWC. The beneficiaries would be 11-14 years out of school adolescent girls and all girls in the age group of 15-18 years. Non – nutrition component: Here, the focus would be on out of school girls only. For out of school adolescent girls: a) 11-18 years Nutrition provision IFA supplementation Health checkup and referral services Nutrition & Health Education (NHE) Counselling/Guidance on family welfare, ARSH, child care practices Life Skill Education and accessing public services b) 16-18 years Vocational training under National Skill Development Programme (NSDP) For school going adolescent girls 11-18 years, the services under ii) a) will be provided twice a month in school days and four times a month in vacations.
* Health services are to be provided by establishing convergence with MoHFW - Other services in coordination/convergence with related sectors/departments - MNGOs include resource persons In Gujarat, 9 districts namely, Banaskantha, Dahod, Kachchh, Panchmahals, Narmada, Ahmedabad, Jamnagar, Junagadh and Navsari, have been selected for implementation of this scheme. Objectives of the scheme are to: Enable self-development and empowerment of adolescent girls Improve their nutrition and health status Spread awareness among them about health, hygiene, nutrition, Adolescent Reproductive and Sexual Health (ARSH), and family and child care Upgrade their home-based skills, life skills and vocational skills Mainstream out-of-school adolescent girls into formal/non-formal education Inform and guide them about existing public services, such as PHC, CHC, Post Office, Band, Police Station etc. Target group – Adolescent girls in the age group of 11-18 years under all ICDS projects in the selected 200 districts across the country Activities Baseline survey of adolescent girls Formation of Kishori Samooh Preparation of training kit Celebration of Kishori Diwas Development of Kishori Card Training and Capacity development Implementation plan Roles and responsibilities of service providers Fund flow mechanism Convergence with other line departments Monitoring and supervision plan Recording and Reporting Counseling and Home visits Strategy for Counseling: On Mamta Diwas, besides health and nutrition services, the pregnant women are counseled on various issues like nutritious diet, care during pregnancy, institutional delivery, early initiation of breastfeeding (within 1 hour), importance of colostrum feeding, exclusive breastfeeding etc. On the day of Annaprashan Diwas, the lactating women gather at the AWCs. They are counseled on optimal feeding practices like continuation of breastfeeding along with complementary feeding upto 2 years, hygienic feeding practices, appropriate feeding for children during and after illness etc. Anganwadi workers go on home visits in the village between 2-3 pm after completing the AWC activities. The details of the home visits are recorded in a separate register called “Gruh Mulakat Register”. SATCOM sessions on various health nutrition topics are conducted to enable AWWs in carrying out the counseling sessions more efficiently. The SATCOM also helps in creating awareness amongst the community members on various health and nutrition issues. Supervisors also sometimes make home visits, especially to houses of severely underweight children or those who need immediate attention. Capacity building of staff Regular trainings – induction and on – job training through MLTC and AWTCs for all cadres For details see Chapter 3, Section 4G. Cascade training on roll out of WHO New Growth Standards With the introduction of the WHO New Growth Standards, there was an urgent need to orient the ICDS staff on its use. A two days orientation was organized in April 2010 with support from UNICEF. The participants included 234 CDPOs, 1608 ICDS Supervisors and Officials from Health Department. The total numbers of participants were 2000. Besides the orientation on the New Growth Standards, issues like Annaprashan Diwas, THR Recipes, Decentralization, Record Registers were also included. Handouts on Breastfeeding principles, How to improve Counseling Skills and Reasons for high undernutrition in Gujarat, were shared with the participants. For orienting selected supervisors and preparing them as Master’s trainers for training all the Anganwadi workers; regional level workshops were organized in all the 26 districts of Gujarat. These master trainers then trained all the AWWs in teams to orient and train them about THR, WHO New Growth Standards
Training on Supportive Supervision during Mamta Day Mamta Day is an important component of the Mamta Abhiyan carried out across the State. The role of Supervisors is very crucial to ensure effective implementation of the activity. A two-days training programme was organized for the ICDS Supervisors on Mamta Day with support from UNICEF. The training was divided into 2 levels: a. State level – A two-day Training of Trainers (TOT) was organized to prepare Master Trainers, who would further train the ICDS Supervisors. The participants included 2 Instructors from MLTC and all the AWTCs, and District Nutrition Programme Associates working under the State Nutrition Cell. The training was held in 2 batches from 19-20 and 21-22 October 2010. The agenda for district level training and training materials were shared with the participants. b. District level – The Master Trainers trained at State level, further trained the ICDS Supervisors at the district level. In all, 47 batches covering 1686 ICDS Supervisors were trained in 8 AWTCs across the State. The training methodology included lectures, group discussions, role plays, audio-visual displays, case studies etc. (Agenda and List of Training batches – Annexure 9).
Extending partnerships – Public and Private Construction of Anganwadi Centres Anganwadi centres are built through Public Private Partnership (PPP). For example, companies like Reliance, Syntex, Atul Industries, Adani group etc, as part of their Corporate Social Responsibility (CSR) initiatives, are providing financial support in building Anganwadi centres in some villages, while the space for construction of Anganwadi Centres has been provided by schools, Panchayati Raj Institutions (PRI) etc in many other villages. Approximately 27,010 Anganwadi centers (as on November 2010) were built through partnership with Reliance, Tribal Department, Red Cross, Ayojan Mandals etc. Table 10: Status of AWCs built through Partnerships
Gas connections at Anganwadi Centres The Government of Gujarat is providing gas connection along with gas stove and cooker to all the Anganwadi centres across the state. For this, the Department of ICDS has collaborated with State Government PSUs under the Corporate Social & Environmental Responsibility (CSER) and about Rs. 33.34 crores have been spent to provide Gas connections in all AWCs with 2 gas bottles, gas stoves and cooker. Gujarat State Nutrition Mission Gujarat State under the mentoring and chairmanship of Hon’ble Chief Minister Mr. Narendra Modi proposes to launch Gujarat State Nutrition Mission (GSNM) to ensure that maternal and child undernutrition reduction is at the centre stage of the State’s priorities and gets highest political sanction/cooperation. The mission is proposed to work with Department of Health and Family Welfare, Department of Women and Child Development, Mid Day Meal of Education Department and other departments with a focused approach to address the issue of child and maternal undernutrition. One of the biggest root causes for high prevailing rates of undernutrition is that the focus of Integrated Child Development Services Scheme (ICDS) has been on 3-6 years; but research evidences prove that maximum undernutrition occurs between pre – natal period of 9 months of pregnancy to 2 years of birth (first 1000 days). The caregivers do not have enough knowledge on infant and young child feeding (early and exclusive breastfeeding, complementary feeding) and hygiene practices while cooking and feeding complementary food. Further, there is low community demand for the existing nutrition services. Research evidences have proved that the universal delivery of the package of ten evidence-based, high impact essential nutrition interventions will lead to an unprecedented reduction in child undernutrition. To address this urgent need, the State plans to intensify interventions and programs, focusing on poor performing far reached areas (especially 61 Vikassheel and Vikasbandhu talukas of Gujarat). A bottom-up equity-focused block-centric approach focusing on poor performing/backward/left out blocks is the focal point of GSNM. Addressing the missing links and promotion of the ten essential interventions require intensive coordinated efforts of Departments of Health, DWCD, Education, Food and Civil Supply and Water and Sanitation/WASMO.
To reduce any undernutrition in adolescent girls, mothers, children under five years of age, with focus on under-twos, through universal coverage and promotion of 10 evidence-based nutrition interventions through coordinated efforts, with special focus on poor performing blocks. Activities to be undertaken by the mission are: Mapping underserved and poor performing blocks and hamlets by use of IT/GIS technology. The Mission would aim at developing an online reporting system for key indicators and longitudinal nutrition surveillance system. Building alliances and networks as a Change Lab, through joint proposals with member organization (government, top-B schools, home science colleges, corporate, NGOs/CBOs, Milk Cooperative Unions, media) for shared understanding of current reality, prototyping initiatives, implementing pilot projects and dissemination of evidence and findings through state consultations. Annual Block – level Nutrition Indicator Cluster Survey to regularly monitor the child and maternal nutritional status in Gujarat. ‘Media Coalition for Nutrition Security’. Partnerships with Media agency for state wide awareness and advocacy purpose. Partnership with Corporate Sector through Corporate Social Responsibility Partnerships with Food Processing industries for manufacturing various food items prepared from the Take Home Ration (THR) being given through DWCD. District level review meetings of progress and reporting of all block activities/indicators through SMS and e – gram network Additional support of coordinators with ICDS at district & block-level and district-level would ensure sufficient coordination between the Departments and implement mission activities. Nutrition Health Counseling by organizing ‘Gyan Chaupals’ through e-gram centers in all villages at fixed time for awareness building among all the village people regarding health and nutrition. Directory: download download -> Performance Tuning Guidelines for Windows Server 2008 May 20, 2009 Abstract download -> Northern England’s set-jetting locations download -> Bbc archives: Beyond the programme download download -> Occupational health and safety download -> Dynatest 3031 lwd light Weight Deflectometer download -> Forth coming competitive exams download -> English Olympiad Tasks: 10 th form Аудіювання, 10 клас. Текст download -> Brush High School Morning Announcements Friday, September 05, 2014 all school download -> Year 9 The Arts — Music download -> Years 7 and 8 standard elaborations — Australian Curriculum: Music draft Download 5.36 Mb. Share with your friends:
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