We’re three days into the Poshan Pakhwada, 2020 celebrations as I settle into a circle with 15 Anganwadi Sevikas of Mandangad, in the Ratnagiri district of Maharashtra. Some of them have traveled more than 50 kilometers from villages of Veshvi, Tulashi, and Bankot to share their experiences as frontline workers to combat the tough fight against malnutrition in Maharashtra.
The primary goal of Poshan Abhiyan is to achieve improvement in the nutritional status of children from 0-6 years through a holistic approach. The ultimate target of the effort is to reduce stunting of children in the age group of 0-6 years from 38.4% to 25% by the year 2022. In India, the Abhiyan targets adolescent girls, pregnant and lactating mothers, children between the age group of 0-6 and their parents. The Poshan Pakhwada is a fortnight dedicated especially for raising community-level awareness to create an enabling environment for beating malnutrition. The central vein of this nationwide gigantic effort is the Anganwadi Sevika.
While the Poshan Pakhwada is a fortnight aimed at creating public awareness and participation, an Anganwadi Sevika has to deliver consistent work throughout the year. Some Sevikas have been working for more than 30 years in the same community. One of them being Shalaka Pawar from Veshvi. She walks almost four kilometers uphill every day to serve the Katkari community – an Adivasi group that lives in remote areas of the Ratnagiri district.
Often carrying dry snacks for infants, vaccinations for mothers, and several registers for data entry, Shalaka’s work is challenging. “It’s heartening to celebrate the half-yearly birthdays with newborns when they turn six-months old” she shares.
“When a child completes the first six-months of a healthy life, we feel that all our hard work to keep the mother and family informed about benefits of breastfeeding, hygiene, and nurturing has reaped results. These birthdays are also platforms to prepare parents about complementary food – we talk about new foods to introduce to the baby, budget-friendly intakes, quantity of the food and remind them about ensuring they continue to breastfeed for the coming one and a half years as well,” shares Anganwadi Sevika.
During Poshan Pakhwada, Anganwadi Centers celebrate events such as Haat Bazaars, where they host small fairs and sell nutritional garden vegetables, jaggery, peanuts, fruits and local cereals.
Even in a small taluka like Mandangad, geographies are varied, and one idea doesn’t fit all. While Shalaka’s area is a remote tribal hamlet, Sunaina Manoj Sotekar’s area is a densely populated fishermen’s hamlet. “I have close to 35 children coming daily to my Anganwadi while others have 5 to 8,” she smiles rather helplessly. “The fisher community has a very occupation-bound timetable, with most fathers out at sea for most part of the mornings. I have to then work with male parents only during the afternoon or when it’s not fishing season. My Anganwadi center faces severe space constraints when there’s full attendance, but work has to go on every day.”
Poshan Pakhwada also calls for meetings with local community leaders and influencers to get them to invest in every child’s health. Delivering messages regarding behavior and attitudinal change requires consistency and innovation. Suhasini Santosh Chajare, who serves the Anganwadi Centre in Nargoli in Mandangad, has been working as a Sevika for 25 years now.
“We have to leverage as many platforms as possible to repeatedly deliver key messages about breastfeeding, handwashing, nutritional food, talking to their child and so on. The messaging starts at the level of home visits covering with about 800 households. Then, we start conversations with parents who come to our Anganwadi Centres. Over the years, we’ve managed to build a rapport with other message delivery platforms as well – like the Self-Help Group meetings and Gram Panchayat meetings. We also try to target as many public gatherings as possible while celebrating festivals like Haldi-Kumkum,” shares Suhasini.
Through consistent message delivery, Sevikas have managed to build a rapport with their communities strong enough to ensure that any new pregnancy or new community member now self-reports to the Anganwadi, seeking assistance and advice. Suhasini adds, “You have to ensure that a child’s health and nutrition is viewed as a community responsibility. When every single person feels involved in a child’s health then everyone right from the Sarpanch, Gram Sevak, Gram Sabha Members to School Management Committees, community influencers and every single parent works on their individual responsibility – whether it is to disburse funds meant for women and children’s welfare, or to provide a space for meetings, or to even pass along messages. Ensuring a child defeats malnutrition then becomes everyone’s job.”
Nutrition and two full meals a day still remains aspirational in several tribal families in Ratnagiri. “While we do talk about a balanced diet to pregnant and lactating mothers, adolescent girls and parents, some families find it hard to make ends meet even for two meals a day. Malnutrition is then passed onto the next generation. In that case, we have to provide low-cost nutrition ideas to these families. Peanuts and jaggery, leaves of cauliflower and radish, the soupier part of cooked dal are some alternatives that these families adapt to in extremely tight budgets. This is how balanced meals become a part of everyday life,” shares Shalaka.
Targeting new parents and families isn’t enough to break the cycle of malnutrition. Meera Pandirkar, who works in the Gandhi Chowk Anganwadi Centre in Mandangad shares, “Almost 7 out of 10 adolescent girls in my community are anaemic. That’s apparent when we have health camps with ASHA workers. While we do provide folic acid and zinc tablets to adolescent girls, most girls don’t take them – the compliance rate is very low. Bad nutritional intakes such as chips, biscuits, Chinese Bhel are fairly common. Even as an Anganwadi Sevika who’s a mother to a fifteen-year-old, I would say, young girls don’t follow balanced diets and we’ve been creating awareness about this for several years now.”
The average health of young girls in a community is also indicative of the possibilities of malnutrition the community might face when the girls will get to a childbearing age, and if they choose to have children. “I’ve been an advocate for catching up with new times in food preparation for a long time, even as a mother. We talk to parents about how they need to make food interesting, innovative and pack the same old nutrition in a more appealing form. My daughter likes eating cauliflower rice, chapati rolls, and egg sandwiches better than everyday chapati-bhaji.” During Poshan Pakhwada, Meera and other Anganwadi Sevikas host live recipe demonstrations for mothers to become familiar with novel varieties of food preparation.
After an hour and a half of discussions, it’s apparent to me that Anganwadi Sevikas form the first line of defense in our preventive public health system. Going beyond implementing nutrition and early childhood development programmes, they’re the main key to building a robust healthcare system.