Ground Zero | How dearth of data killed a healthy diet

Ground Zero | How dearth of data killed a healthy diet

The monitoring and monitoring of vitamin companies to the poorest of the poor in India have been hampered by the dearth of on-line data. Jagriti Chandra experiences how this has affected pregnant girls in a pandemic yr when starvation and poverty have worsened

Twenty-year-old Afsana’s child is due in a month. Afsana conceived simply 10 days after the nationwide lockdown was imposed to curb the unfold of the novel coronavirus. Afsana and her household of 9 reside a hand to mouth existence and the pandemic has solely worsened their woes. The expectant mom is anaemic, having survived alongside together with her household on simply chapatis and crimson chilli paste on most days.

Afsana’s husband, brother-in-law and father-in-law, the three breadwinners of the household, work on the native stone quarries in Derwala village in Jhunjhunu district of Rajasthan, the place they reside. They had no work for practically three months, from April to June. Though work has picked up slowly since then, their every day earnings are as little as ₹150 on a good day. They survive on the wheat provide from the general public distribution system. “Only if we go out in the day to work can we buy pulses, sugar and milk for our evenings. There is barely enough to last us a day,” says Mohammad Rafiq Bhati, Afsana’s brother-in-law.

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Afsana has already undergone blood transfusion 4 instances. Her eyes are listless. She has been known as once more to the first healthcare centre on December 9 for a check-up. The Pradhan Mantri Surakshit Matritva Abhiyan, a scheme of the Union Health Ministry, goals to offer high quality antenatal care, free of price, to all pregnant girls within the nation on the ninth of each month and likewise a minimal package deal of antenatal care companies to girls of their second/ third trimesters of being pregnant at designated authorities well being services. However, Afsana’s take-home rations as half of anganwadi companies have been irregular. Of the eight months of her being pregnant, she has acquired 6 kg value of month-to-month entitlement (1.5 kg wheat, 1.5 kg rice and 3kg pulses) just for 4 months. The provide of these, too, has been erratic as anganwadi staff have to attend for the inventory to build up sufficiently earlier than disbursing it. Though the intention of the programme is to make sure ample vitamin for expectant moms, this meals has been utilized by all of the members of Afsana’s impoverished and hungry household.

While Afsana, because the expectant mom of her first little one, can also be entitled to obtain a complete of ₹5,000 in a number of tranches beneath the Pradhan Mantri Matru Vandana Yojana, a scheme of the Ministry of Women and Child Development, she has nonetheless not obtained any advantages. Her sister Ruqsar Bano says nobody has come to gather paperwork and even requested them to submit the papers on the anganwadi centre. “We have completed the paper work. We are waiting for the government to release her claim,” says Rekha Sharma, a native ASHA employee. Afsana, shy and reticent, needs she had the cash to purchase greens and fruits.

The supply of vitamin companies to the poor in India has been delivered to a halt or slowed down as a result of lack of on-line data, a drawback attributable to poor Internet and server points. This has not solely affected the beneficiaries, but additionally the anganwadi staff. It has additionally induced frustration amongst these working in the direction of addressing India’s malnutrition, poverty and well being points. The lack of publicly accessible vitamin data is just not solely affecting India’s vitamin objectives however can also be pushing States into considering of methods of organising their very own techniques to deal with the issue.

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In Jhunjhunu, a imprecise reminiscence

An IT-based vitamin monitoring system known as the Integrated Child Development Services-Common Application Software (ICDS-CAS) was inaugurated by Prime Minister Narendra Modi in Jhunjhunu on March 8, International Women’s Day, in 2018. Under this method, anganwadi staff log the main points of the beneficiaries and every day actions to allow monitoring on the district, State and Central ranges for enchancment within the high quality of supply of companies. However, on this village, ICDS-CAS is barely a imprecise reminiscence for many.

Ground Zero | How dearth of data killed a healthy diet


“Two years ago, we were given tablets and smartphones. But when we had Internet issues, those were taken away,” says Rekha. She and her crew of one anganwadi employee and one anganwadi helper have been working extra time, about eight to 10 hours a day, conducting surveys on COVID-19 sufferers and making certain social distancing at Panchayat elections, amongst different duties. A telephone might have helped groups like hers on the block and district ranges fill the gaps in programme implementation.

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The ICDS-CAS was the mainstay of Poshan Abhiyaan, accepted by the Union Cabinet in December 2017 at a funds outlay of ₹9,000 crore. Half of this was to be funded by the Indian authorities and the opposite half via a mortgage from the World Bank. Poshan Abhiyaan strives to enhance dietary outcomes for youngsters, pregnant girls and lactating moms by decreasing undernutrition, bringing down anaemia, and rising beginning weight. As the intention of Poshan Abhiyaan is to succeed in 10 crore beneficiaries at 14 lakh anganwadis, the federal government arrange the ICDS-CAS to make sure swift monitoring and efficient implementation.

Under the ICDS-CAS, anganwadi staff are supplied cell phones, and anganwadi supervisors, tablets. Anganwadi staff enter particulars of every day actions, together with photograph proof of the opening of anganwadis; attendance of youngsters; particulars of meals, weight and peak; and many others. These are then monitored at 5 ranges — first by the anganwadi supervisor after which on the block, district, State and Central ranges. The assessments and suggestions from these ranges are supplied to the employees. Service supply is thus tracked and knowledgeable choices taken primarily based on the assessments.

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Plugging gaps in Churu

Churu, a district positioned three hours from Jhunjhunu, paints a completely different image. It is among the many 9 districts the place the ICDS-CAS has been carried out. The use of know-how and the monitoring of actions via cell phones permit block-level supervisors to increase assist to anganwadi staff and plug gaps once in a while.

Sunita is full of reward for the native anganwadi in Gajsar village in Churu. “Food was being delivered regularly. We often ask when they will open the anganwadi so that the children get hot meals and remain busy,”” she says. Before the lockdown, the Rajasthan authorities additionally tried weekly menus which included milk, fruits, and a combination of rice and lentil, however this was discontinued in the course of the lockdown.

Sunita’s instant neighbour Amina Bano, who has a six-year-old grandson Shoaib, says, “We are happy with the anganwadi as children get to learn some numbers and alphabets.”

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Here, the environment friendly monitoring system ensures that if there’s a lag in ration provide on the anganwadis, programme supervisors at block ranges are alerted and provide is restored. Smartphones distributed to anganwadi workers additionally assist to alert them when vaccinations are due. They are additionally capable of preserve a record of the malnourishment ranges of the complete village inhabitants. The telephone helps them determine youngsters in danger of being malnourished in addition to these already stunted or wasted. Those in danger of being malnourished are highlighted on the app in yellow and people already stunted/wasted are marked in crimson after the anganwadi staff log within the peak and weight particulars of the kids. Sanju Devi, the native anganwadi employee, exhibits her telephone: two of the 20 youngsters registered with the anganwadi the place she works are within the crimson class and want particular interventions.

Internet points

However, server points and Internet issues plague the system right here, too. Also, smartphones which got to the employees to simplify their duties have doubled their work. Workers at the moment are anticipated to notice down particulars not solely of their telephones but additionally in registers.

In Churu, the server has been down for over two months. Since the ICDS-CAS platform is widespread for the entire nation, which means monitoring actions throughout greater than 26 States the place the ICDS-CAS is working have been hampered.

“For the past two months, they have been logging details in their phones as well as in registers, so there is duplication,” says Mohammed Mushtaqeem Khan, District Co-ordinator, National Nutrition Mission. “They usually use the phone to upload photos of children attending the anganwadi. Photos can’t be misused as they are uploaded directly on the app and can’t be saved in the phone’s gallery. This avoids a situation where an anganwadi worker clicks photos for the entire week on the same day. We also use the photos to do surprise checks and contact the beneficiaries and their parents to receive feedback. The technology has helped the parents become more aware too. They often use these occasions to tell us if they have been receiving less than what they are entitled to get.”

An anganwadi worker visits a household to deliver essentials and gather details about the children’s health at a village in Rajasthan’s Jhunjhunu district.

An anganwadi employee visits a family to ship necessities and collect particulars concerning the youngsters’s well being at a village in Rajasthan’s Jhunjhunu district.  
| Photo Credit:
V.V. Krishnan


The collapse of the system additionally signifies that the anganwadi staff are the toughest hit. “The anganwadi workers’ incentives have been delayed at a time when the pandemic has resulted in their work increasing manifold. The system helps automatically calculate an anganwadi worker’s incentives through the activities logged in by her. But since that is not possible now, they haven’t received their incentives for the past two months. The State government is devising a new parameter to overcome this problem,” he says.

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Experts say on the situation of anonymity that the server crash is a end result of the federal government’s lack of preparedness to take care of a large quantity of data (practically seven lakh out of 14 lakh anganwadis the place the ICDS-CAS have already been carried out) and cloud storage and managing the complete structure together with {hardware} and software program. The know-how assist has alternated between the National Informatics Centre and Tata Consultancy Services within the latest previous, whereas it was earlier dealt with by the U.S.-based Dimagi.

Lack of data

Even earlier than the server drawback, unavailability of data from an costly know-how system arrange primarily to enhance service supply induced anger amongst implementation companions, researchers, vitamin advocates and public well being consultants. This occurred at a time when warnings have been issued concerning the probability of a further 10,000 under-five deaths per 30 days globally and of 6.7 million extra youngsters affected by losing, a sturdy predictor of mortality, because of the pandemic.

“The strength of India’s future will be determined by the health and nutrition of its babies today. The government deploys significant resources and hundreds of thousands of front-line anganwadi workers across the country, who work every day, including through the pandemic, to reach some of India’s more vulnerable citizens. As an example, Poshan Abhiyaan disseminates over 10 nutrition-related messages across more than 20 platforms. But what is the reach of platforms and messages? Have pregnant and lactating women’s nutrition behaviours changed over time? How has all of this been changing during the pandemic? It is very important to track progress, understand gaps, and acknowledge and reward heroic efforts. Without live information systems like the CAS, many key decisions will be made without robust evidence,” says Divya Nair, Director, IDinsight.

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“The less said about ICDS-CAS, the better. The data have not been available, and we can’t use the software tool the way we would like. So, we use our application called Sampark, where we log the data of children, mothers as well as the status of welfare schemes such as PDS, BPL, labour cards accessible to beneficiaries…,” says a consultant of the Madhya Pradesh authorities.

Dr. Vandana Prasad, a public well being knowledgeable, Joint Convenor of the People’s Health Movement-India (Jan Swasthya Abhiyan) and a member of the Steering Committee of the Right to Food Campaign agrees. She says, “ICDS is important because it caters to the entire life cycle of pregnant women and lactating mothers, adolescent girls and children between the age of six months and six years, by making direct interventions. It also provides a platform for delivering health services. Data are critical to any programme, especially nutrition programmes. During a pandemic we need more data, not less. Data are critical as people are at a higher risk now, they are severely vulnerable. All public data need to be made public. Data must be open for evaluation so that there are no cover-ups.”

The drawback of lack of entry to data can also be confronted by State governments. Many States, together with Rajasthan and Andhra Pradesh, are recognized to have written to the Centre elevating their issues about unavailability of data for programme implementation and evaluate.

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“The guidelines for a supplementary nutrition programme allow States to decide what food they would like to distribute, but the ICDS-CAS is a common application for the entire country which doesn’t allow us the flexibility to record and monitor data as per the specifics of our scheme. We have written to the Centre raising this issue and demanded that all data be put in the public domain so that there is transparency and accountability. If we want the data of the past two or three months, for instance, to study the impact of our interventions, we don’t have them,” says Rajasthan’s Women and Child Development Secretary, Krishna Kant Pathak.

“There are no data available. We have requested the Central government for access, but beyond their templated dashboard, nothing is available to us. We haven’t even received a response from the Centre,” says Annapurna Garu, Joint Project Co-ordinator, National Nutrition Mission.

When the scheme was designed and being carried out, it was pushed by a spirit of co-ordination and co-operation, explains one the chief architects of the Poshan Abhiyaan on the Centre, on the situation of anonymity. “We often wrote letters and communicated over the phone to address the problems expressed by the States. Data, too, were always discussed at meetings where different non-government stakeholders were present as well. It is not true that data were meant to be kept under lock and key because of privacy issues. There are enough ways to mask the identity of the beneficiaries,” he says.

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Need for convergence

States demand not solely the Centre’s co-operation but additionally harp on the necessity for convergence between the Ministry of Health and Family Welfare and the Women and Child Development’s ICDS via a widespread data portal. “There is a need for convergence. The Pregnancy, Child Tracking and Health Services Management System, for example, can give us data about a woman becoming pregnant. We can then use this to transfer their entitlements through the Pradhan Mantri Matritva Vandana Yojana, a maternity benefit scheme,” says Pathak.

Since the Centre has failed to do that, the Rajasthan authorities is now planning to launch an AAA app or the ‘Auxiliary Nurse Midwife, Anganwadi and ASHA’ app, to make sure that all three of them are related via the identical software. Andhra Pradesh, too, says that a pre-existing app known as NutriTask, which was put apart after the ICDS-CAS was concieved, might now be revived.

Ironically, a month earlier than the launch of Poshan Abhiyaan, the Union Women and Child Development Ministry had written to the State Chief Secretaries to make sure a “single point of impact for all nutrition-related schemes” via the ICDS-CAS and suggested them to “phase out State-/ UT-level initiatives to enable a synergised approach, avoid replication, and achieve the overall goals of the Mission.” But three years later, issues appear to be shifting in the wrong way as a number of States are eager to develop their very own software program modules.

“The accountability system is enormously centralised and top-down and is focused on surveillance of anganwadi workers. This is risky during a crisis like a pandemic or a flood because it means that the local community is not taught to take ownership of nutrition services and trained to monitor service delivery. To me if you want accountability, you could have a mother’s group that can monitor whether or not an anganwadi is functioning, whether the supplies are there, whether an anganwadi worker is providing those supplies to children or not. Local mothers’ groups and panchayat committees can play not just an inspectorial role, but also a supportive role,” says Jashodhara Dasgupta, social researcher on gender, well being and rights, and convener of the Feminist Policy Collective.

The ICDS-CAS harps on accountability of the particular person on the floor degree as a substitute of addressing different systemic, she says. “Anganwadi workers are treated as voluntary workers as they are considered to be part-time workers, and they live close to the houses they monitor. They are underpaid, overworked and deprived of social protection. So why are we so hooked to their accountability when there are inadequate budgets, delays in disbursal of cash benefits, lack of data, etc.? The entire system is intent on policing her,” Dasgupta says.

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“There is a strong case against centralisation of data systems. The systems must be flexible and in tune with local interventions. They must also be available to the front-line workers as well as at the local level for analyses and execution of corrective measures, and not just to programme developers. After all, it is an anganwadi worker who can take corrective steps immediately. Data systems should also be built with local participation and consensus. The Centre can facilitate setting this up locally and providing a supportive role to ensure capacity building for effective use of data,” Prasad contends.

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