How the POSHAN app tracks and helps malnourished children

Watching my children struggle with issues of feeding and nutritional support for their grandchildren, it reminds me of the huge contrast between selfless children whose parents struggle to force-feed them and children without access to nutritious food or any food.

A pretty calming thought and I began to explore the extent of malnutrition in children.

According to the National Family Health Survey (NFHS) -4 conducted in 2015-2016, 38.4% of children in the 0-5 age group were “stunted” (low stature for age) and 21% were “emaciated” (low weight / height ratio). The NFHS-5 conducted in 2020-2021 showed some improvement in these ratios to 35.5% and 19.3%.

The Department of Women and Children’s Development (WCD) recently reported that 3,323,322 children were malnourished, of which 1,776,902 were “severely acutely malnourished” (SAM) children and 1,546,420 were “severely malnourished” children. moderately acutely malnourished ”(MAM) as of October 14, 2021.

The World Health Organization defines SAM as very low weight-for-height or MUAC less than 115 mm or the presence of nutritional edema. MAM is defined as moderate cast iron and / or MUAC greater than or equal to 115 mm and less than 125 mm.

How did the Ministry count these children? Were all children counted with appropriate labeling of their nutritional status?

This data is based on the POSHAN tracker mobile application downloaded by Anganwadi workers (AWW) working in Anganwadi centers (AWC) to record the nutritional status of preschool children (0-6 years), pregnant mothers and breastfeeding and adolescent girls.

AWCs provide various services such as immunization, check-up and referrals – and non-formal education / counseling and additional nutrition in the form of hot cooked meals served on site and take-home rations (THR) for children. children with special needs.

An AWC is a common delivery point for health, nutrition, and education services, so a portion of the spending is pooled by the Department of Health, the Department of WCD, and relevant state governments.

At the end of December 2019, there were 1,380,796 operational AWCs with 1,329,138 AWW against a sanctioned workforce of 1,399,697 AWC with 1,399,697 AWW (1 AWW per AWC).

AWCs are a network of service delivery points created under the Integrated Child Development Program (ICDS) launched in 1975, to which the World Bank also provides financial support.

Previously the monitoring and recording of children’s weight / height was manual, but now the data is uploaded to a central database through the app.

Prior to 2005-06, nutritional supplements were provided by the states and the center covered its administrative costs. Then the center started to share 50 percent of the expenditure on the nutrition component. (Changed to 90 percent of central funding for Northeastern states from 2009 to 2010).

In October 2012, the scale of financial assistance (per beneficiary per day) under the ICDS was increased to Rs 6 for children aged 6 to 72 months, Rs 7 for pregnant women and mothers nursing mothers and Rs 9 for severely malnourished children (6-72 months). ).

The cost standards for the Supplemental Nutrition Program were revised in October 2017, and Anganwadi’s services were streamlined with a revised scope, structure and cost-sharing ratio in November 2017.

Anganwadi workers are community volunteers who receive honoraria with additional benefits like insurance coverage. In 1975, an AWW was paid a fee of Rs 100 per month (Non-Registered) and Rs 150 per month (Registered). Aanganwadi Helper (AWH) was paid Rs 35 per month.

As of October 1, 2018, the central government increased AWW fees in AWCs from Rs 3,000 to Rs 4,500 per month; AWW in mini-AWC from Rs 2,250 to Rs 3,500 per month and AWH from Rs 1,500 to Rs 2,250 per month.

The government has also introduced a performance incentive of Rs 250 per month for AWHs. AWWs receive a performance incentive of Rs 500 per month for using ICDS-CAS (Common Application Software) under POSHAN Abhiyaan. Most states / UTs provide additional monetary incentives to these workers from their own resources.

Spending on the ICDS program has varied between Rs 18,000 crore and Rs 20,000 crore over the past five years.

In March 2018, POSHAN Abhiyaan (national nutrition mission) was launched with the aim of reducing stunting in children aged 0 to 6 from 38.4% to 25% by March 2022 with a total budget of 9,046.17 rupees. . (50 percent from government source and 50 percent from IBRD) Rs 2,700 crore was budgeted in BE 2021-22 for this.

The program seeks to use technology for a focused approach and convergence strives to reduce the level of stunting, undernutrition, anemia and low birth weight in children, as well as to focus on adolescent girls, pregnant women and nursing mothers, thus fighting in a holistic way against malnutrition.

The program plans to provide cash incentives directly to the bank, to the postal account of pregnant women and nursing mothers in DBT mode during pregnancy and lactation.

Against this background, it was distressing to note that in the 2021 Global Hunger Index (GHI) report released on October 16, India slipped to 101st out of 116 countries. In 2019, India was ranked 102 out of 117 countries and in 2020 it was 94 out of 107 countries.

Each year’s report is based on the assessment of the previous four years in which the GHI score is calculated for each country using statistics on infant mortality (33%), undernourishment (33%) and 16.5 % each on wasting and stunted children. .

India’s GHI score declined from a GHI 2000 score of 38.8 points considered “alarming” to a GHI 2021 score of 27.5 considered “serious”.

Part of the reason a country’s ranking changes from year to year may be because it is compared to a different group of countries.

The most important parameter negatively affecting India’s ranking is stunting in children. About a sixth of children are believed to continue to be underweight for their age.

The data used in the GHI ranking exercise has been officially challenged by the government and we hope that more robust data will be available for GHI-2022.

Several questions come naturally to mind.

Since AWCs implement multi-ministerial programs with financial support from central and state government, there is no single source of information on the profile of total expenditure on AWCs. Is an adequate budget provided by all governments? Is the budget for the purchase of food sufficient? Are the administrative expenses linked to the operation of the AWCs (Honorarium, etc.) increasing to the detriment of the food budget?

Has the system created perverse incentives to report a high incidence of underweight children? Is it a rural-urban problem? Are far too many healthier children being excluded from the “weight for age” monitoring system?

The data on changes as new data is uploaded. Data captured yesterday (December 16) at 7:40 pm shows that 1,297,865 AWC and 1,362,724 AWW are registered on the POSHAN application; 1,706,016 children attended AWCs and 43,744 children received THRs. Pregnant women, nursing mothers, children 6 to 36 months old and adolescent girls have the right to THA.

According to the 2011 census, there were 15.8 crore of children in the 0-6 age group. The current number is not known but it is clear that many children are not tied to any AWC or do not use its services.

How can the situation be improved? Technology is undoubtedly a great help. Several NGOs are helping to reach needy children. Further assistance can be provided through the supervision of civil society. Can AWCs be linked with local community leaders for enhanced monitoring and support?

This article originally appeared as a post on Subhash Pandey’s Facebook page and has been reproduced here with permission.

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