Directorate of Integrated Child Development Services Madhya Pradesh
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CONTENTS
S.No. Subject Page no. List of annexure III List of Tables IV Abbreviations V Section 1: Situation and Gap Analysis a) Socio-economic and demographic profile of Madhya Pradesh i. Administrative divisions ii. Demography iii. Vital Statistics in M.P. iv. Socio-economic profile v. Human development in MP 1-5 vi. Literacy rates vii. Health profile viii. Access to safe drinking water and sanitation ix. Nutritional status of women and children x. Road connectivity b) Nutrition Policy of Madhya Pradesh 5 c) Inter-sectoral convergence for program implementation 6 d) Nutrition and health status of women and children 7 e) History of ICDS in Madhya Pradesh - Total number of ICDS 10 projects in the state f) State’s financial contribution to ICDS implementation 11 g) Infrastructure status of operational AWC buildings 11 h) Status of operationalization of projects, AWCs and Mini-AWCs 13 i) Trends in coverage of beneficiaries for supplementary nutrition 15 and pre-school education j) Training infrastructure –AWTCs, MLTCs 17 k) Major gaps/ constraints in program implementation 17 l) Initiatives taken by government of Madhya Pradesh for ICDS 19 programme Section 2: VISION STATEMENT 26 Section 3: ORGANISATIONAL STRUCTURE OF ICDS PROGRAM 27 MANAGEMENT- STATE & DISTRICT LEVEL Section 4: ANNUAL ACTION PLAN- PROGRAM COMPONENTS 4A Human Resources 32 4B Procurement of Materials and Equipment 36 4C Delivery of Services at AWCs 39 C1 Supplementary Nutrition (SN) 39 C2 Preschool Education (PSE) 46 C3 Nutrition and Health Education 50 C4 Immunization 52 C5 Health check-ups 52 C6 Referral Services 55 ii 4D Observation of Nutrition and Health Days 56 4E Information Education and Communication 57 4F Monitoring and Evaluation 61 4G Training and capacity building 63 4H Convergence with Line departments 64 4I Community Participation and Involvement of PRIs a) Existing mechanism for community participation b) Percent of AWCs participated in Gram Sabha meeting c) AWC received any support from Panchayat 65 d) Gram Panchayat meetings attended by AWW e) Percent of Panchayat Samiti meetings attended by AWWs f) No. of districts where the Zila Parishads reviewed ICDS program 4J Financial Management and Fund Flow Mechanism 67 4K New Initiatives to Strengthen ICDS Program during 2011-12 68 Summary of Action Plan (2012-13) 73 Budget Annual PIP (2012-13) Time line of Activities (2012-13) 70 Section 5 : ADDITIONAL INFORMATION 74-82 Annexures 83-98
List of Annexure 1. Nutritional status of children in 50 districts (NIN 2010) 2. District-wise Rural, Tribal and Urban projects and AWCs 3. New government population norms for establishing AWCs 4. AWTCs and MLTCs in the state 5. District-wise number of NRCs 6. Training Calendar (2012-13) 7. Proposal for Annual Training Activity (2012-13) 8. Statement of Expenditure
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Abbreviations Used
AACP Adolescent Anemia Control Programme ABM Atal Bal Mission ACCTO Assistant Accounts Officers ACDPO Assistant Child Development Project Officer ANC Antenatal Care ANM Auxiliary Nurse Midwife AO Accounts Officer ASO Assistant Statistical Officer APIP Annual Programme Implementation Plan ASHA Accredited Social Health Activist AWTC Anganwadi Training Centres AWCs Anganwadi Centres AWWs Anganwadi Worker AWH Anganwadi helper AYUSH Ayurved Unani Siddha Homeopathy BALA Building As Learning Aid BCC Behavior Change Communication BPL Below Poverty Line BPNI Breast Feeding Network of sIndia BRGF Backward Region Grant Fund CARE Cooperation for American Relief Everywhere CBO Community Based Organizations CDPO Child Development Project Officer CHC Community Health Centre CM Chief Minister CMHO Chief Medical & Health Officer DAP District Action Plan DFID Department For International Development DPHFW Department of Public Health and Family Welfare Dept P&T Department of Post & Telegraph DLHS District Level Health Survey DPC Departmental Promotion Committee DPM District Program Manager DPO District Program Officer DWCD Department of Women and Child Development EBF Exclusive Breast Feeding ECE Early Childhood Education FY Financial Year GOI Government of India GoMP Government of Madhya Pradesh
iv Abbreviations Used
HFW Health & Family Welfare HR Human Resources IAP Indian Association of Pediatrics IAS Indian Administrative Service ICDS Integrated Child Development Services IDD Iodine Deficiency Disorder ICMR Indian Council of Medical Research IEC Information Education Communication IFA Iron Folic Acid IGMSY Indira Gandhi Matritva Sahogi Yojna IPC Inter Personal Communication IYCF Infant and Young Child Feeding IYCN Infant & Young Child Nutrition KSY Kishori Shakti Yojna LBW Low Birth Weight LDC Lower Divisional Clerk LHV Lady Health Visitor LIC Life Insurance Corporation MCPC Mother & Child Protection Card MHFW Ministry of Health & Family Welfare MIS Monitoring Information System MLTC Middle Level Training Centre MMR Maternal Mortality Rate MO Medical Officer MOU Memorandum of Understanding MP Madhya Pradesh MP HSRP Madhya Pradesh Health Sector Reform Programme MPLAD Member of Parliament Local Area Development MPR Monthly Progress Report MWCD Ministry of Women and Child Development NGO Non Government Organization NFHS National Family Health Survey NHE Nutrition & Health Education NHED Nutrition & Health Education NIN National Institute of Nutrition NIPCCD National Institute of Public Cooperation and Child NIPI Development NRC Norway India Partnership Initiative NRHM Nutrition Rehabilitation Centre OBC National Rural Health Mission ORS Other Backward Caste
v Abbreviations Used
PHC Oral Dehydration Salt PHFW Primary Health Centre PIP Public Health & Family Welfare PRI Project Implementation Plan PSE Panchayati Raj Institutions QPR Pre-school Education RCH Quarterly Progress Report RUTF Reproductive Child Health SABLA Ready to Use Therapeutic Food SAM Rajiv Gandhi Scheme for Empowerment of Adolescent Girls SC Severe Acute Malnutrition SHG Scheduled castes SMS Self Help Groups SN Sahyogini Matru Samiti SNP Supplementary Nutrition SPIP Supplementary Nutrition Programme SRC State Programme Implementation Plan SRS State Resource Centre SSA Sample Registration Survey ST Sarva Shiksha Abhiyan STRAP Scheduled Tribes TFR State Training Action Plan THR Total Fertility Rate TLM Take Home Ration TNA Teaching Learning Material TSC Training Need Assessment TV Total Sanitation Caimpaign U 5 Television UDC Under five U 5 MR Upper Divisional Clerk UNICEF Under Five Mortality Rate UT United Nations Children Fund USI Union Territories UN MDG Universal Salt Iodization VAS United Nations Millennium Development Goals VHND Vitamin A Supplementation VHSC Village Health & Nutrition Day WCD Village Health & Sanitation Committee WHO Women and Child Development World Health Organization
vi SECTION- 1 SITUATION AND GAP ANALYSIS a) Socio-economic and demographic profile of Madhya Pradesh Madhya Pradesh, as the name indicates, is geographical heart of the Republic of India. It is surrounded on the south by Maharastra, on the west by Gujarat, on the northwest by Rajasthan, on the north by Uttar Pradesh, and on the east by Chattisgarh.
Madhya Pradesh, with total area of 308,245 sq. km, is the second largest state of India. It has five distinct cultural regions – Bundelkhand, Baghelkhand, Rewanchal, Malwa and Mahakoshal. The state, therefore, presents a fascinating mosaic of culture and regional languages. i. Administrative units in the state The state comprises ten revenue divisions, 50 districts and 313 community development blocks, including 89 tribal development blocks. The state’s 55,391, villages are covered by 22,029 Gram Panchayats. On an average a Gram Panchayat covers 2.5 revenue villages, each village having an average population of 1090. A revenue village may consist of a number of separate habitations known as tola, falia or majra, especially in tribal areas. ii. Demography The 2011 Census of India has recorded the State’s population as 72.6 million, out of this, the rural population stands at 52.5million and the urban population 20.1 million. In absolute numbers, the rural population has increased by 8.2million and the urban population by 4.1 million in the last decade. With about 6 percent of the total population of India, it is the seventh most populous state in the country. The decadal growth of population during the period 2001-2011 was 20.3%, which was significantly higher than the national average of 17.6%. The growth rate of population in rural and urban areas was 18.45 and 25.6% respectively. The sex ratio in the state which was 919 in 2001 has risen by 11 points to 930 in 2011. The increase in rural areas has been 9 points from 927 to 936. The same in urban areas has been 18 points from 898 to 916. The sex ratio in the state is comparatively lower than that of India, 930 females per 1000 males in the state Vs. 940 at all India level
Out of the child population of 10.5 million in the age group of 0-6 in the state the rural child population stands at 8.1 million and urban at 2.4 million in 2011. The child population has declined by 0.2 million in the state – decline of 0.3 million in rural areas and increase of 0.1 million in urban areas. In Madhya Pradesh, fall in child sex ratio in the age group of 0-6 years has reached 912. The fall has been 20 points (932-912) for the state during 2001-2011.In rural areas the fall is significant - 22 points (939-917) and in urban areas it is 12 points (907-895) over the last decade.
The literacy rate of Madhya Pradesh as per 2011 Census is 70.6. In rural areas the literacy rate is 65.3 and in urban areas it is 84.1. The male literacy rate which is 80.5 (Rual-76.6; Urban-90.2) is higher than the female literacy rate of 60.0 (Rural-53.2; Urban-77.4).The gap in literacy rate among males and females is 20.5 points in the state.
1 Table A. Demographic Profile of Madhya Pradesh Madhya Pradesh India (Census 2011) (Census, 2011) Population Census (2011) 72,597,565* 1, 210,193,422 Male 37,612,920 (51.8%) 623,724,248 Female 34,984,645 (48.2%) 586,469,174 Sex Ratio( female / 1000 male) 930 940 Sex ratio (0-6 year) 912 914 Decadal growth rate of population 20.3 17.6 (%) Density of population (per sq. km) 196 313 Scheduled caste population (%) 15.4 16.2 Scheduled tribe population (%) 20.3 8.2 Child Population 0-6years 10,548,295 (14.5%) 158,789,287(13.1%) Child Population 0-6years ICDS# 9039076 (2010 - population) Child Population (Rural) ICDS 1160608 (2010 - population) Child Population (Urban) ICDS 5842939 (2010 - population) Child Population (Tribal) ICDS 2035529 (2010 - population) Literacy Rate Total 70.6 74.0 Rural 65.3 68.9 Urban 84.2 84.9 Demographic data are from the Office of Census Commissioner and Registrar General of India, New Delhi. # projected population by Directorate, WCD . iii. Vital Statistics of Madhya Pradesh Vital statistics of Madhya Pradesh are typical of a developing state with high burden of mortality indicating poor state of health of the population. The state has the highest Infant Mortality Rate, second highest Crude Death Rate and the third highest Maternal Mortality Ratio in the country.
Table B. Vital Statistics Rates in Madhya Pradesh Vital statistics rates (2007) Madhya Pradesh India Crude Birth rate per 1000 25.0 23.8 population # Crude Death rate per 1000 8.0 7.5 population # IMR per1000 live births $ 67 50 IMR (Rural)$ 72 55 IMR (Urban)$ 45 34 IMR (Male)$ 66 49 IMR (Female)$ 68 52 Under 5 mortality rate (per 1000 live 89 98
2 birth)-( 2011) Maternal mortality ratio ( 2011) # 310 301 Total fertility rate (2003) 3.12 2.68 # Annual Health Survey, RGI, New Delhi, 2011. $ = Sample Registration System, Registrar General of India, New Delhi, January 2011. U 5 mortality rate and MMR for India are from SRS for the period indicated. While for M.P. these are from AHS, RGI, New Delhi. TFR from NFHS-3, IIPS, Mumbai, 2005-06. iv. Socio- economic profile of Madhya Pradesh Economically, Madhya Pradesh is one of the poor states in India. The State economy has grown at 3.7% per annum during the ten year period from 1993-94 to 2002-03 as against the national growth rate of 6.1% in the same period. The per capita income of Madhya Pradesh (at constant prices 1993-94) is Rs. 7366, which is lower than the national per capita income of Rs. 12416. The gap between national per capita income and M.P has increased over the years. From 1993 to 1999-2000, at constant prices, the per capita income was an average about 81 per cent of national average; from 200-01 to 2004-05 this fell to an average of 68 per cent. In this period of last four years, the per capita income at constant prices in M.P. grew at a modest 3.2 per cent per annum, as against national average of 4.8 per cent during the same period. ((Madhya Pradesh Human Development Report, 2007 p.1333-4). Roughly speaking, one in every three persons in the state lives below the poverty line. There are about 5.3 million families below poverty line.
Table C. Literacy Rates and Per Capita Income in Madhya Pradesh Madhya Pradesh India Literacy (total) (Census, 2001) 63.7% 64.8% Literacy Tribal 41.2 % - Literacy Tribal M/ F 53.5 / 28.4 % Literacy (male) (Census 2001) 76.1% 75.3% Literacy (female) (Census 2001) 50.3% 53.7% Per capita income (at current Rs.15012 Rs.23241 prices) # Per capita income (at constant Rs. 8583 Rs. 12416 prices- 1993-94) # Population below poverty line 37.4% 26.1% # Economic Survey of Madhya Pradesh, Directorate of Economics and Statistics, M.P
Overall literacy rate in the State recorded by 2011 Census is 70.6% (Male 82%, Female 65%). The gap of 21.6% points recorded between male and female literacy rates in 2001 Census has fallen to 16.7 percent point in 2011. v. Human development in Madhya Pradesh The general state of human development in the state, leaving some backward areas, is progressive. Within M.P. rural areas and the areas in its southwest, southeast, northwest, and central belts are more backward than other parts of the state. These are also regions which are forested, have a large Scheduled Tribe population, have an undulating terrain and agriculture is not as advanced as in other areas. Because of their topography and forests these areas have poor access to services like health and nutrition.
3 vi. Literacy The nineties was the defining decade in Madhya Pradesh in reduction of illiteracy. The literacy rate in the state in 2011 was 70.63% (male 80.53 %, female 60.023%). The decadal growth in literacy rate in the state was 6.93% (Census 2001), vii. Health Profile Prevalence of communicable diseses like malaria, T.B. and diarrhoea is high. Diarrhoea is an important cause of high infant mortality in the state, accounting for about 28% of all infant deaths (Rajiv Gandhi Mission for Control of Diarrheal Diseases, Dept. of Health and Family Welfare, GoMP, 2000). High prevalence of communicable diseases like malaria and diarrhea among children and low level of immunization against vaccine preventable diseases (reported later) are important etiological factors, among others, of malnutrition among children.
IMR in the State has shown a continuous decline in recent years. But IMR of 67 per 1000 live births (SRS, Oct. 2009) is still ten percent point higher than the national rate of 57. The NFHS III recorded the U5 mortality rate in MP as 94. Maternal Mortality Ratio, a sensitive index of health of women in the reproductive age group, is 335 as against MMR of 254 at national level.
Access of health services by women and children is poor. NFHS-3 reported low primary immunization coverage among children. As per CES 2009 data, 43% of children below 23 months were fully immunized. Antenatal coverage, however, has increased from 61% to 81% between NFHS-2 and NFHS-3. The institutional delivery rate has also increased from 22 to 30 per cent during the same period.
The state government has taken a number of initiatives to increase institutional delivery, which is expected to reduce maternal mortality ratio in the state in coming years. Institutional delivery and immunization coverage (children fully immunized) rates in the state are 81.1 % and 42.97 % respectively. (CES, 2009).
Table D. Some key indicators of health service delivery in respect of pregnant women and infants in MP
Some Before Befor Covera Institutional Breast Excl. Infants fully Key 12 e 16 ge of delivery feeding BF up immunized Health weeks of weeks Pregna < 1hr to 6 indicator gestation of nt months s (in %) gestat women ion for IFA Tablet Distribu tion 28.2 49.2 78.0 74 26.4 71.0 84.2
Source: NIN 2010-11
4 viii. Access to safe water supply and sanitation One in four persons in the state has access to safe drinking water supply (NFHS-3, 2006). This ratio is less than 10 per cent (8.1%) in rural areas. Similarly, one in every 10 persons (9.6%) has access to toilet facilities in rural areas.
The state has identified 126.2 thousand habitations for safe drinking water (40 liters per day per person). Out of these, 96.30 thousand habitations have been provided safe drinking water while another 22.10 thousand habitations have been partially covered under the government program. To increase public participation in drinking water scheme (10% public contribution) the government has initiated Swajal Dhara scheme. Under the total Sanitation Program 5.38 lakhs personal toilets have been provided to the BPL families till August 2006. (Economic Survey of Madhya Pradesh –2006-07) x. Road connectivity in Madhya Pradesh
Roads:
The length of roads of all categories put together is about 72 thousand km in Madhya Pradesh. Work of improvement and upgradation of over 12050 km roads has been taken up in last one and half years. These include 1400 km National Highways, 2300 km State Highways, 3650 km important district roads and 4700 km rural roads. Over three-fourth of the work has already been completed. The performance of Madhya Pradesh in rural road construction has been lauded by the central government. So far, 10600 villages having upto one thousand population have already been connected to all weather roads and now only 3400 villages remain to be covered. The length of national highway in the state is 3700 kms while State highway extends to 7300 kms.(www.mpinfo.org- Dept of Public Relatio s, GoMP)
Railways:
The main rail route linking Northern India with Southern India passes through Madhya Pradesh. Main junctions in the state are Bhopal, Bina, Gwalior, Indore, Itarsi, Jabalpur, Katni, Ratlam and Ujjain. The divisional railways headquarters are at Bhopal, Ratlam and Jabalpur. (Website of Dept. of Public Relations, GoMP.) b) Nutrition Policy of Madhya Pradesh Madhya Pradesh has developed and adopted a Nutrition Policy. The main objectives of the Policy are to reduce cases of malnutrition in the state, which would be achieved by developing a district-level work plan. The State Nutrition Policy aimed at achieving the following objectives (by the end of year 2003):
To decrease moderate malnutrition by 15 percent and severe malnutrition by 10 percent in children less than five years of age To decrease cases of low weight at birth by 10 percent To eliminate blindness due to Vitamin ‘A’ deficiency To decrease anemia among pregnant women by 20 percent
The major strategies for achieving the objectives were: inter-sectoral coordination, targeting female adolescents for health care delivery, nutritional awareness and targeting the family as the focal points for nutrition related programs.
5 c) Inter-sectoral convergence for program implementation
Department of Women & Child Development (DWCD) and Public Health & Family Welfare (DPHFW) are the key departments for convergent actions at all the level. However other departments such as: Department of Rural Development and Panchayat: for Sanitation & Hygine, livelihood programmes and local governenace Department of Public Health Engineering: Providing safe water at village as well as at AWC level Department of Education: Adolescent anaemia and preschool componenet Department of Tribal Welfare: For better services in vulnerable pockets of the state Department of Food & Civil supplies: Privisioning of essentials commodity ( Wheat & Rice) for SNP in AWCs Department of P&T and Banks
The convergent actions with other departments play an important role for reaching out to the most vulnerable and margilanilized community and ensuring timely availability of ICDS services. The key points of convergence with various departments are as follows:
Implementation of ABM: A state specific Mission mode approach for improving Nutrition services and addressing Malnutrition Holding Regular VHNDs: A convergent forum between ICDS & Health. Use of Mother and Child Protection Card (MCP): For better Recording & Tracking Health Camps: For better outreach of essential services such as, Immunization, ANC/PNC and other health Check ups. Observation of Bal Suraksha Maah (BSM): To deliver package of Essential Nutrition services such as VAS, Deworming, Salt testing etc. Observing Mangal Diwas: A theme based dedicated day for providing various services to the community in participation with PRI, SHGs, Adolescent groups and other stakeholders SABLA & KSY: A scheme for adolescent girls in close partnership with Health, Education and Labour department. The programme address the life skill approach, Nutrition component and vocational trainings Nutrition Rehabilitation Center: The Facility based care of Severely Acute Malnourished Children is provided by DPHFW/NRHM with active support from ICDS for case identification, referrals and follow-ups. Nutrition Resource Centres at State and Divisional Level: Six NRCs Established in all the Govt. Medical Colleges to support ICDS/ABM and NRHM for regular capacity building, planning and data utilization. Total Sanitation Campaign (TSC): Provisioning of sanitary toilets in AWCs in collaboration with Panchayat and Rural Development Department. IGMSY: In close participatrion with department of P&T and Banks to facilitate disbursement of cash benefits. Strengthening Pre-Schools Component: following the SSA Pattern on Preschool education as well as for child friendly buildings. d) Nutrition and health status of women and children in MP Health status of the people in MP has been discussed earlier (Section a.vii, page 4). The nutritional status of women and children has been reviewed in this section.
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A recently concluded survey on nutritional status of under five children in rural Madhya Pradesh by the National Institute of Nutrition (NIN), Hyderabad revealed that about 52% of the rural children below five years of age are underweight in Madhya Pradesh, with a low of 34.8% in Vidisha District and a high of 67.1% in Satna District. Similarly, 49% of them were stunted (ranging from 34.1% in Indore and 71% in Morena) and 26% were wasted (ranging from 15.1% in Morena and 40.2% in the district of Rajgarh). However, it is encouraging to note that these figures are lower than those reported in the National Family Health Survey (NFHS-3) of 2006 (underweight 62.7%; stunting 51.7%; and wasting 36%).
Trends in Children's Nutritional Status (% below -2 SD)
A similar pattern was also observed among severe acute malnourished (SAM) children as shown in the graph below. The SAM children (having nutritional status as % below -3 SD) shows that it is at the level of 19.8% in the state. The proportion of SAM children has registered a decline of about 10 points from 29.3% during NFHS-3 (2006) to 19.8% as per NIN survey (2010).
7 Trends in Children's Nutritional Status (% below -3 SD)
The NIN survey also provides prevalence of undernutrition among children by age group. It was found that undernutrition was high among children in the age group of 1-3 years (both underweight and stunting).
Prevalence (%) of Undernutrition among <5 yrs Children According to SD Classification ( The prevalence of undernutrition was found to be higher among boys than girls. The graph below depicts that undernutrition among boys is comparatively higher than girls in all the three categories expressed as underweight, stunting and wasting. 8 Prevalence (%) of Undernutrition among <5 yrs Children according to SD Classification ( This survey was conducted by NIN at the request of the Department of Women and Child Development (DWCD), Government of Madhya Pradesh during March – August 2010. The survey aimed to estimate the prevalence of undernutrition among under- five year rural children and infant & young child feeding (IYCF) practices for the development of district specific nutrition intervention strategies. The survey also revealed that over three fourths (78.5%) of pregnant women had undergone antenatal check-up (ANC) at least once during their pregnancy, while one third of them had at least three ANCs (36.4%). It is encouraging to note that the proportion of newborns that were given pre-lacteals in the current survey was only 16.1% as against 58.7% reported in NFHS-3 survey during 2005- 2006. Although 78.4% of pregnant women received Iron Folic Acid (IFA) tablets during pregnancy, only 20% consumed the required number of at least 90 tablets during pregnancy. About 79% deliveries were institutional and a majority was conducted by the Medical Officers. Birth weights were recorded for 69% infants and the prevalence of low birth weight (less than 2.5 kg at birth) was 19% which is lower than the overall State (23.4%) and National (21.5%) prevalence rates reported in NFHS-3. Other encouraging results of the survey were that almost all mothers fed colostrum (first milk) to their newborns, a fourth of the mothers initiated breastfeeding within 1 hour and another half (49%) within 1-3 hours of delivery. However, only about one fourth of the mothers had initiated complementary feeding at 6 months of age, which included mostly homemade semisolids/solids. Only one third of mothers gave complementary feeds to their children at least 3 times a day. 9 About 84% of children in the age group of 1-2 years were completely immunized during the first year of life and three quarters of children below 5 years received at least one dose of Vitamin A during the preceding year. The survey highlights the need to impart health and nutrition education to the pregnant and lactating mothers through effective communication strategies. The existing national nutrition intervention programmes such as supplementary feeding under ICDS have to be strengthened further alongside poverty alleviation and income generating activities to improve household food and nutrition security status. Anemia among children and women In NFHS-3 a very high proportion (82.6%) of children between 6-35 months were found suffering from anemia. Prevalence of anemia was higher among rural as compared to urban children (85% and 65% respectively). In the NIN survey total 25.0 % of children between the age group of 12-59 months were distributed IFA Tablet/Liquid In the study conducted by National Instititute of Nutrition, Hyderabad (NIN) 2010-11, Out of the total population surveyed 28.2% of women were registered their pregnancy before 12 weeks of gestation and 36.4% of women recived three ANC visits in comparision to 40.2 % in NFHS -3 (2005-06), this area needs improvement. 92.8 % of women recived IFA tablets during their pregnancy and out of which only 19.7% pregnant women consumed more than 90 IFA tablets, in comparision to 11.8 % reported NFHS -3 (2005-06). There is an increase in 8 points but still needs improvement and its an areas of action in the present APIP. e) History of ICDS in MP – geographical and population coverage Launched on October 2, 1975 in thirty districts of India, ICDS program has grown as the world’s largest early childhood development program. The program approaches child health holistically and comprises health, nutrition, and education components for children less than six years of age; pregnant women and lactating mothers; and adolescent girls. ICDS Program in Madhya Pradesh ICDS scheme was first launched in MP in 1975-76 in Baidhan, a rural block of Singrauli in Sidhi district (Singarauli is an independent district now), and Tokpal, a tribal block of Jagadalpur district (now in Chattisgarh state). The program was gradually expanded to cover the entire state. Year-wise expansion of the ICDS program is shown in table E. Currently, the ICDS scheme covers all the rural blocks and urban areas in the state. There are 453 ICDS projects in the state. Of these, 281 are rural, 99 are tribal and 73 are urban projects. (Annual Report, 2009-2010, Women and Child Development Department, GoMP). In the 453 Projects, 78,929 AWCs and 12070 Mini AWCs have been sanctioned. 10 Table E. Year-wise establishment of ICDS projects and AWCs Year ICDS Cumulative AWCs Cumulative total AWCs Project total Projects 2004-05 - 336 - 49,258 2005-06 31 - 549 49,787 2006-07 - 367 9,537 59,324 2007-08 - - 9,914 69,238 2008-09 86 453 9,691 78,929 2009-10 There are no new projects and AWCS sanctioned in this period 2010- 11 2012-13 - - 1231 81391 Note: Mini AWCs sanctioned by GOI to MP are 12070 (including 9691 sanctioned in Phase III) All the AWCs, including newly sanctioned 9691 addditional AWCs and 9820 Mini AWCs are operational. In the year 2012-13, 1231 AWCs are sanctioned by GoI. With this, the ICDS scheme has been almost universalized throughout the state. f) State’s financial contribution to ICDS implementation (including on supplementary nutrition) ICDS is a centrally sponsored scheme of GOI. The program is, however, implemented by the state government. In MP the ICDS program is implemented under the umbrella of the Department of Women and Child Development. The funds for the implementation of the program are provided by GOI on a cost sharing basis. For additional initiatives, other than covered under the GOI program, the state government provides the required funds. For example, under the Project Shaktiman initiative of the government, the cost of third meal and related expenses was being borne by the state government. The state has launched in 2010 Atal Bal Mission (details are given at page 21). Under this Mission Department of Women and Child development has been provided funds for the welfare of women and children. Part of the funds will be made available to the ICDS program. The state has also provided additional honorarium to AWWs & AW helpers and Mini AWCs workers, at the rate of Rs. 1500/- per month (AWWs), Rs. 750/- per month (AWHS) and Rs. 750/- (Min AWWs) respectively. The State also paid Rs. 631.43 lakhs towards cost of uniform (saree) for AWWs and AWHs from its budget (sanction vide letter No.F3-3/09-50-2 PF dt.28 Feb.2009 of GOMP). g) Infrastructure status of AWC buildings The Department of Women and Child Development is committed to provide adequate and suitable accommodation for smooth functioning of the AWCs in the state. Government of India does not give grant for construction of AWC building. The state’s own resources are limited in this respect. But the government has made efforts to construct AWC building with funds from BRGF and 13th Finance Commission. . Efforts are also being made to get AWCs building constructed tapping other resources e.g. MPLAD, funds from Department of Rural Development and Tribal Development, etc. 11 Details of AWCs sanctioned, buildings approved for construction and AWCs working in their own building is shown in table F. Table F: Status of AWC Building in State District-wise number of AWCs with & without own buildings (as on 31 March 2012) Total Total AWC Total S. Sanctione Buildings without Division District sanctioned No d constructe own AWC Buildings d building 1 Indore Alirajpur 1121 502 378 743 2 Shahdol Anuppur 1030 627 426 604 3 Gwalior Ashok Nagar 876 146 131 745 4 Jabalpur Balaghat 2294 1097 753 1541 5 Indore Barwani 1501 1050 861 640 6 Bhopal Betul 2065 1353 947 1118 7 Chambal Bhind 2022 485 242 1780 8 Bhopal Bhopal 1618 563 251 1367 9 Indore Burhanpur 725 347 169 556 10 Sagar Chattarpur 1728 1146 573 1155 11 Jabalpur Chhindwara 2636 604 442 2194 12 Sagar Damoh 1309 405 281 1028 13 Gwalior Datia 766 366 175 591 14 Ujjain Dewas 1493 339 176 1317 15 Indore Dhar 3248 1662 1128 2120 16 Jabalpur Dindori 1671 1087 999 672 17 Gwalior Guna 1125 312 258 867 18 Gwalior Gwalior 1239 311 198 1041 Narmadapura 19 m Harda 574 214 139 435 Narmadapura Hoshangaba 20 m d 1540 500 383 1157 21 Indore Indore 1582 296 192 1390 22 Jabalpur Jabalpur 2101 377 311 1790 23 Indore Jhabua 1606 923 430 1176 24 Jabalpur Katni 1509 687 327 1182 12 25 Indore Khandwa 1468 673 518 950 26 Indore Khargone 1857 981 684 1173 27 Jabalpur Mandla 1821 1018 771 1050 28 Ujjain Mandsaur 1499 276 210 1289 29 Chambal Morena 2058 1162 482 1576 30 Jabalpur Narsinghpur 1004 281 164 840 31 Ujjain Neemuch 880 254 158 722 32 Sagar Panna 1170 307 256 914 33 Bhopal Raisen 1379 390 290 1089 34 Bhopal Rajgarh 2010 579 420 1590 35 Ujjain Ratlam 1620 376 144 1476 36 Rewa Rewa 2791 376 265 2526 37 Sagar Sagar 2199 517 488 1711 38 Rewa Satna 2591 897 663 1928 39 Bhopal Sehore 1109 585 359 750 40 Jabalpur Seoni 1810 1182 737 1073 41 Shahdol Shahdol 1340 571 284 1056 42 Ujjain Shahjapur 1301 467 318 983 43 Chambal Sheopur 894 486 130 764 44 Gwalior Shivpuri 1850 833 492 1358 45 Rewa Sidhi 1772 886 547 1225 46 Rewa Singroli 1335 608 535 800 47 Sagar Tikamgarh 1406 951 710 696 48 Ujjain Ujjain 1888 462 328 1560 49 Shahdol Umaria 643 548 546 97 50 Bhopal Vidisha 1855 797 283 1572 TOTAL 78929 31862 20952 57977 Presently out of 78929 AWC only 20952 AWCs have their own buildings and rest 57977 AWCs are not having their own buildings. They are either functional in rented buildings or in some other Government buildings like Panchayat Bhavan, Schools etc. Efforts were made for construction of AWC building through PPP. In the last financial year, Ratlam recived funds from local resources for construction of 9 AWCS and 1 in Ujjain district. 13 h) Status of operationalization of Projects, AWCs and Mini-AWCs Total number of ICDS projects and AWCs in Madhya Pradesh ICDS program in MP operates through 453 Projects and 78,929.Anganwadi centers. District -wise rural, tribal and urban projects and the AWCs are presented in Annexure 2. (MPR, Nov. 2010, Directorate of Women and Child Development). With the sanction of additional AWCs by GOI, the ICDS program has been almost universalized in the state. But, on the State’s request for establishment of AWCs on demand, GoI has recently sanctioned 1231 AWCs but still approval of 79 projects (from 35 Districts) and 1909 AWCs is still pending with GOI. The state has followed the population norms given by GOI from time to time for establishment of AWCs. The new norms of GOI (issued vide its letter No. F.14-1/2008-CDI dt. 18 Dec.2008) in this respect are given in Annexure 3. i) Trends in coverage of beneficiaries for supplementary nutrition and pre-school education Coverage under supplementary nutrition program The beneficiaries of ICDS services are children 0-6 years, pregnant women, lactating mothers and adolescent girls. Number of beneficiaries as per MPR March 2012 data of ICDS project in the state were 5975000 children of 0-6 year age and 1268686 pregnant & lactating Mothers. Coverage under pre-school education As per MPR March 2012 a total of 2734819 pre-school education beneficiaries were registered at AWCs. Of them 1388423 were boys and 1346396 were girls. The children of 3- 6yrs attending AWCs are offered informal learning through games, story telling, use of pictures, etc. AWWs are trained to conduct PSE sessions during their job training and refresher training courses. Both under SNP and Pre-school education program the number of beneficiaries has increased over the years as can be seen from the following table (Table G). Table G. Increase in SNP and PSE beneficiaries during the last five year (MPR data) Sr. Repo Pregnant Lactating SNP Coverage PSE Coverage No rt-ing Women Mother 6mth - 3yrs 3 – 6yrs 3 – 6yrs . year Numb Numb Numbe Numbe er % er % r % r % Number % 1 2008 44276 65.7 47411 64.2 210643 60.9 211743 65.4 80.6 5 4 9 3 2 1 5 1 2206506 2 2 2009 52328 70.1 55988 69.8 264482 71.3 249893 71.2 1 7 7 5 6 3 2 5 2594743 82 3 2010 64771 81.7 69031 80.7 321699 79.4 297748 77.9 84.8 8 1 0 9 5 4 9 1 3070725 7 14 4 2011 62821 94.1 64047 93.1 309661 88.8 287838 84.4 2734819 80.2 2 1 4 2 2 3 8 2 1 Proportion of women benefited from Supplementary nutrition program in year 2008 was 65.74 that increased to 70.17 in year 2009. Another increase of 11 % has been reported in 2010. In the year 2011 around 94.11 % women has been benefited by the supplementary nutrition program. Overall a positive change of 43.15 %* increase from baseline year of 2008 to 2011. * %x 100[(x1 x0 ) / x0 ] x0= % of 2008 x 1 = % of 2011 Proportion of Lactating mothers benefitted from supplementary nutrition program in the year 2008 was 64.23% that increased to 69.85 in 2009. In 2010 it increased by 11percent points and has been reported 80.79% and in the year 2011 93.12 % lactating mothers were benefitted from SNP. 44.97%* positive change was reported in the SNP coverage of Lactating Mothers from 2008 to 2011. * %x 100[(x1 x0 ) / x0 ] x0= % of 2008 x = % of 2011 15 Proportion of SNP coverage for children from 6 months to 3 years was 60.91 % in the year 2008, which increased by 10 % and was reported 71.33 % in 2009. In 2010, 79.44 % children out of total enrolled children were benefitted with Supplementary Nutrition Program. 88.83 % children were benefitted from SNP program in 2011. 45.83 % positive change was reported in the SNP coverage of children 6 months to 3 years 2008 to 2011. Proportion of SNP coverage for children from 3 years to 6 years was 65.41 % in the year 2008 and was reported 71.25 % in 2009. In 2010, 77.91 % children were benefitted from SNP program showing an increase of more than 12 % from2008. In 2011 84.42 % children were benefitted from SNP program in 2011. 29.02 % positive change was reported in the SNP coverage of children 3 years to 6 years 2008 to 2011. 16 Proportion of Pre- school coverage for j) children from 3 years to 6 years was reported 80.62 % in the year 2008 and was reported 82 % in 2009. In 2010, 84.87% % children were benefitted from SNP program showing an increase of more than approximately 5% from 2008. In 2011 80.21 % children were benefitted from Pre- school education in 2011. Training infrastructure Department of Woman and Child Development, Government of MP has established a resource center (called Bal Bhawan) at Bhopal. The resource center serves as a center for dissemination of information about ICDS program in the state. It also serves as a library for IEC material for nutrition and health communication. Initial training (known as job training) and refresher training of AWWs and Supervisors are conducted by Anganwadi Training Centres (AWTCs) and Middle Level Training Centers (MLTCs).Training of senior level officers is carried out by NIPCCD, New Delhi which is the apex training center at national level. A Regional Centre of NIPCCD is located at Indore in MP. There are 25 AWTCs in Madhya Pradesh. Ten of these centres are run by government, 9 by MP Council of Child Welfare and remaining 6 by other NGOs. The two MLTCs in the state are located one each at Indore and Jabalpur. The AWTC run by non-government centers are provided financial and technical support by GoMP. Approval for opening one new AWTC at Rewa is received by GoI during financial year 2012-13. Thus after operationalization of this AWTCs there will be total 26 AWTC s operational in the state. Names of training Centers are given in Annexure 3 k) Major gaps in program implementation and programmatic strategies There are a number of problems in the ICDS program operation. These have been briefly discussed hereunder with proposed activities to address them. Geographical and population coverage by AWCs There are geographical and population pockets which still remain uncovered due to number of factors. This is a major challenge and DWCD is working to address this challenge through opening of AWCs on demand, community mobilization etc. The GOMP has submitted a proposal to GOI for sanction of AWCs on demand by the community. In the financial year 17 2011-12, a proposal of 3140 was sent to GoI to open AWCs on demand out of those 1231 AWCs has been sancioned. Space constraints at AWCs A major obstacle in the proper functioning of AWCs is space problem. A large number of AWCs (about 75 percent) are still operating from improvised buildings namely rented buildings, panchayat/ school/government buildings etc. These buildings do not provide sufficient/suitable space for storage of supplies and equipments, organization of different activities including pre-school education and NHED activities. . In the state out of total 78929, 20942 AWC are running in their own building, 37392 AWCs are running in rented building and 20555 AWCs are operational in school /panchayat and other buildings. During the financial year 2011-12 a total of 1715 AWC buildings were sanctioned for contruction under 13th Finance Commission. The State is constatntly trying to arrange funds from different sources e.g. BRGF, Department of Panchayat and Rural Development, etc. for construction of new AWC buildings. Old buildings are also being renovated to make them child friendly. This has been discussed in the next section. This has been discussed in the next section. Proposal has sent to GoI for increasing rent of AWCs in Urban and Rural areas, so that spacious buildings can be rented. Staff vacancies It was observed in earlier section (staffing and infrastructure) that availability of AWWs is as high as 98.1% but staff vacancies in supervisory cadres (CDPOs and Supervisors) do exist which adversely affects the program quality. The state has taken steps, including contract appointments, to fill up the vacancies expeditiously. Present Status of Staff as on 31 March 2012 CADRE SANCTIONED FILLED POST % OF VACANT POST POST CDPOs 453 314 30 ACDPOs 108 66 39 Supervisor 3164 2842 11 AWW 78929 77086 2.34 AWH 78929 76188 4.48 Competency of grass root level staff The horizontal expanse of ICDS had an implication to ensure the quality of all the staff at appropriate level. Although provision of trainings are there however the training loads are limitation to achive 100% trained staff at village level. To address the same it is planned to conduct statewide competency assessment drive and the findings will guide the state to pay attention to the workers with low level of grades achived. ( under Section 4K). Infant and young child feeding practices An important etiological factor responsible for poor nutritional status of children under six in the State is low level of knowledge among / Family members about infant and young child feeding. The Annual PIP 2012-13 proposes to improve IYC feeding practices by strengthening inter- personal communication skill of AWWs. ( under Section 4K) Pre-School Education 18 Low enrolment of children in Pre-school Education (PSE) program is one of the major challenges facing ICDS. It is realized that Right to Education cannot be achieved unless PSE is strengthened. During 2009-10 the department of WCD carried out refresher training of all grass root level workers (Supervisors and AWWs) in carrying out PSE. Guidance of experts in the field was taken to design the training module. Steps have also been taken to ensure regular supply of PSE kits to the AWCs. Behavior Change Communication activities & resource material Behaviour change communication is the key to improve IYC feeding and utilization of health services by the mothers. The conventional IEC approaches (printing and distributing posters, radio/TV jingles, wall writings, hoardings, etc) have only limited impact on bringing about behavior change. The Annual PIP of the State proposes to strengthen inter-personal communication skills of ICDS functionaries through training and equipping them with suitable IEC material. (under Section 4K) Linkages with community based organizations Following the 73rd Constitution Amendment Madhya Pradesh was one of the first states in the country to frame rules (Madhya Pradesh Panchayati Raj evam Gram Swaraj Adhiniyam, 1993) for implementation of Panchayati Raj system. Accordingly PRIs were created at District, Block and Village level. Presently 21,999 Gram Panchayats are functioning in the state. Gram Panchayats are peoples’ institutions at village level and can be potent instruments for strengthening ICDS activities. The department of WCD proposes to orient PRI functionaries and other opinion leaders (SHGs, Mahila Mandals, SMS, ASHA, etc) about ICDS program. ( under Section 4K) Monitoring and evaluation system The department of Women and Child Development, GOMP collects a large amount of data through monthly progress reports (Format I and II). It has developed a web enabled system for data transfer from the field. To effectively use the data for program management the Annual PIP has proposed staff training in MIS. ( under Section 4K) Inter-departmental coordination/ convergence NRHM of Department of H&FW, and Department of Women and Child Development serve the same segment of population (women and children). Although there is some degree of inter-departmental coordination, stillthere is scope of greater convergence for their activities as well as other line departments have also stakes in the health and nutrition activities for women and children. The Annual PIP, 2012-13 proposes to take initiative for convergence of activities of line departments through conducting special workshops for the purpose. ( under Section 4K) l) Initiatives of the GOMP for ICDS program Madhya Pradesh government is committed to improve the health and nutritional status of women and children in the state. In recent years the state has taken some special initiatives towards achieving this objective. These initiatives are briefly outlined in this section. A. Organization of "Mangal Diwas" 19 Mangal Diwas, a unique community-based, culturally appropriate initiative has been conceived and is being implemented by GoMP. On every Tuesday of a month a special program is organized at AWCs in the state. a)"Goad Bharai" is a cultural practice in many communities. It is celebrated to falicitate pregnant women by offering them coconut fruit and other auspicious articles like bangles, vermilion, bindi, etc. and gifts from relatives. Under ICDS initiative of GoMP Goad Bharai celebration is performed at AWC on 1st Tuesday of every month. All newly identified pregnant women are invited to this function. The occasion is utilized for registration of pregnant women for antenatal care (a mother-child card is prepared), health and nutrition education, and IFA supplementation. BPL (below poverty line) women are also provided one time financial assistance of Rs. 500. (b)“Anna Prashan” is also a cultural function which is observed by families to initiate the child on semi-solid food (e.g. rice cooked in milk, porridge, etc) on attaining six months age. Anna Prasan function is held at all AWCs on 2nd Tuesday of every month. All pregnant and lactating women are invited to AWC to attend the function. Eligible children are given their first solid/mushy food and offered a feeding bowl and spoon as gift. This cultural occasion is utilized to educate mothers about infant and young child feeding and to check immunization status of children. (c) “Janam Diwas” program is organized at AWCs on 3rd Tuesday of every month to celebrate birth-day of all children who were born during the month. Weight of the children are taken and recorded on a register. Immunization status of children is checked. Children who have not completed primary vaccination (BCG, three doses of DPT and Polio, and Measles) are referred to NHD camps or to the nearest health institution for scheduled immunization doses. Children whose birth day falls during the month are offered birthday gifts. (d). “Kishori Balika Diwas” is scheduled on the fourth Tuesday of every month. All adolescent girls who are registered under Kishori Shakti program are invited to AWC on Kishori Balika Diwas or Adolescent girls' day where they are educated about balanced diet, health care and are told about economic and home making skills. Health checkup and treatment of minor ailments, games, etc. is also organized. Adolescent girls are administered IFA tablet for prevention of anemia. Development Partners have extended support to the program by organizing state level training for MLTC and AWTC staff on Mangal Diwas to build their capacity and through them of the ICDS staff. Mangal Diwas activities are culturally in tune with the community practices and have high acceptability. They have been successful in disseminating information, modifying practices and eliciting community participation in different activities of AWCs. It has provided a platform to women and adolescent girls to talk about health and welfare of women and children. The number of beneficiaries of AWCs has shown an improvement through these innovative programs. 20 B. Atal Bal Mission (ABM) Taking note of the high infant mortality and under five mortality rates in the state as well as high prevalence of malnutrition among children under six the state (MP) has decided to launch the Atal Bal Arogya Evam Poshan Mission. The State Assembly approved setting up of the Mission on 14th May 2010 by adopting a set of 70-point resolution The objective of the Mission is to bring about a systematic reduction in child malnutrition and make the State’s children healthy and happy. The dedicated Mission will experiment, pilot, replicate and upscale ideas aimed at improving the health and nutritional status of children across Madhya Pradesh. The goals set out in the Mission document are: Reduce mortality rate for children under five years (U5MR) from 94.2 to 60 per thousand live births by the year 2015 Reduce the percentage of underweight children under five years from 60% to 40% by 2015 and further to 20% by 2020 Reduce prevalence of Severe Acute Malnutrition (SAM) less than 5 years from 12.6 percent to 5 percent by 2015 and to negligible level by 2020. The Mission will oversee the existing nutrition and health services and will ensure that corrective actions are taken to strengthen all components of service delivery, including timely and appropriate utilization of financial resources and mobilization of additional resources to achieve the set goals. Atal Bal Mission will not be a stand alone program. Rather, it will act as an overarching institution, a focal point to fight against child malnutrition, providing additional support- financial and technical- to the existing programs dealing with health and nutritional services for young children. The Mission will specifically support the strengthening of certain specific areas e.g., effective and regular distribution of SNP, improvements in the quality and quantity of SNP, development of model AWCs, convergent planning. preparation of Annual District Plans, capacity building, supportive supervision and monitoring of community based management of moderately malnourished children and SAM children with the express purpose of reducing child malnutrition. The Mission will have strong political backing as its General Body will be chaired by the Hon. Chief Minister of the state with the Ministers of Women and Child Development; Public Health and Family Welfare; Panchayat and Rural Development as Vice-Chairpersons. The Mission will have its own budget. Under the Mission approach specific activities initiated supported by DFID, MP TAST & Unicef such as: Recruitment of ABM staff at district & Block level: By July 2013 all the 503 locations of District & Block will be having ABM staff, and their induction training will be also completed by August 2013 with the support of development partners. Decentralized District Plans: Since the entire district are having different context therefore Nutrition centric decentralized districts plans were prepared under the leadership of each district collector. The plans were reviewed at divisional level and accordingly allocations were made for the implementation of ABM plans 21 Technical Cell: The district staff requires constant support on technical issues, to address the same a group of people were pooloed from International, National and regional level to provide necessary support in the Mission activities. Resource Centre: Further to support districts a Nutrition Resource Centres are envisaged in the Vision document of ABM. Accordingly 6 NRC are made functional in all the 6 Government medical college. Traning module: For consistency of technical specification, a training module is prepared and circulated for regular references. C. Special survey of children through NIN to assess malnutrition Surveys carried out by NFHS 3 recorded high prevalence (over 60%) of malnutrition among children under six in MP. The MPR data and figures obtained from several rounds of Bal Sanjeevani Abhiyan (where weight of children was recorded across the state), on the other hand, reported the prevalence of underweight children to less than 50 percent. To assess the actual prevalence of underweight children, the Department of Women and Child Development has commissioned a study which is being carried out by National Institute of Nutrition, Hyderabad. The study will also find out the causal factors associated with malnutrition among children. The findings of the study will serve as the district level baseline for nutrition prevalence and provide contours for district-level initiative to counter malnutrition in the State. Results from NIN survey that the prevalence of underweight children in the State is lower by 10 percent point than what was reported by NFHS-3. (Details are at Annexure 1). Another round of NIN is proposed in the year 2013 D. Sanjha Chulha (Common Kitchen) Scheme for serving hot cooked meal to beneficiaries Under the Mid-Day meal program of the Panchayat and Rural Development Department school children are served fresh cooked food prepared at school kitchen by the Self Help Group. The Department of Women and Child Development has decided that cooked fresh meal should also be supplied from the school kitchen for 3-6 year age children and pregnant and lactating women covered under SNP of ICDS project. The scheme has been launched with effect from November 1, 2009. While the food for ICDS beneficiaries is cooked and supplied by SHG from school kitchen its distribution is done by Anganwadi Workers. Provision for payment of transportation cost of cooked meal from school kitchen to AWC has been made, if AWC is not located in the school premises and the school kitchen is away from AWC. Recipes and guidelines have been provided to SHGs for preparation of food for ICDS beneficiaries so that the daily recommended 540 calories and 14 gm protein is provided to the beneficiaries. Of the several benefits of the scheme, an important one is releasing the AWWs from the burden of cooking the meals. She can, therefore, now devote more time on growth monitoring and promotion, and ECE activities. E. Renovation of old AWCs into child friendly model AWCs Rajya Shiksha Kendra provided Rs.10, 000/- per AWC for 88 AWCs in each district of MP for developing the centers into Model AWC based on BaLA (Building as Learning Aid) concept. Altogether 4400 AWCs (88 x 50) have been developed as model centers across the state. In Ujjain district during the financial year 2011-12 a sum of Rs. 143599, in Ratlam Rs. 114800, Rs. 37000 in Dewas and Rs. 150350 in Shahjapur has been recieved by donation and was used for painting work in all projects and AWC in the districts. F. Expansion of Nutrition Rehabilitation Centre 22 Since mortality rate among severely malnourished children is high (about 20%) the Department of H&FW decided to develop a strategy to provide them prompt medical treatment and nutritional rehabilitation. The children are admitted to NRC (established in medical college, district and CHC hospitals) which have trained health personnel (doctors and nursing staff) and facilities for management of severely malnourished children. G. Use of new WHO Growth standards Since the inception of ICDS in 1975 the nutritional status of children from birth to 5yrs has been assessed using IAP classification based on Harvard standards (modified). WHO came up with new standards in 2006 after a long study started in 1997 in 6 countries, including India. MWCD organized a National Workshop on New WHO Growth Standards in New Delhi on 8-9th February 2007. Based on the recommendations of the workshop MWCD & MHFW, GOI took a policy decision to use WHO growth standards. Accordingly, in August 2008 Secretary, WCD and Secretary Health and Family Welfare, GOI wrote to all states for adoption of New WHO Growth Standards in NRHM and ICDS programs. In MP, two orientation workshops were organized in July 2009 for all the district and selected block officials of PHFW, and WCD of all 50 districts. On the basis of the material provided to the core trainers during their orientation in Hyderabad and those modified by NIPPCD, state specific modules and training plans were prepared and provided to all the state & divisional level master trainers, and Joint Directors, WCD. This was followed by a series of divisional level & district level trainings for rolling out New WHO Growth standards up to grass root level in all 50 districts of the state. Altogether 75853 grass root workers, majority from DWCD, have been oriented till March 2010 on New Growth standards ans is an ongoing activity for the last financial year. MP is the first state in India to roll out the implementation of new WHO growth standard across the state. This has helped in mapping the nutritional status of the children and made it easier for the AWW to plot the nutritional status of children H) Monitoring & Evaluation: a. Web enabled MIS system DWCD in collaboration with DFID/ TAST developed a web enabled MIS system to reduce the problems associated with manual data transmission and support correct and timely reporting. The software was piloted and tested in the year 2009/10 and in the year 2011 it was upscaled to the entire state, supported by TAST. The MIS greatly supported the MPR system for monitoring of the program of ICDS. There is a provision in the system to get online information about 0-6 year children, pregnant women, adolescent girls, projects and AWC level directory profile, etc. so that necessary monitoring and evaluation can be done. The details of the system have been given under section “Monitoring and Evaluation”. b. Third party Concurrent assessment: Third Party Supportive supervision is a very important for improving existing MIS but needs to be worked out very carefully. This needs involvement of civil society organizations, technical institutes, and experts. Setting up of a technical cell at the state level which has coordinative role, would be necessary for concurrent assessment. However it will be ensured that such supervision is not outsourced to one single organization/institute having commercial interest. Commissioning a State Level Evaluation Study/Social Audit etc. to assess the impact of ICDS on development of Children and women. 23 I) Breast feeding promotion IYCF program in Madhya Pradesh has been scaled up in the past few years. Initially this was initiated by Development partners by creating a pool of state & National level trainers. Later in, a pool of middle level trainers was created across the state. Also a cadre of CDPO and Supervisors were trained on IYCF & other Nutrition intervention starting from High burden district. This activity was supported by DFID / TAST To Support Nutrition intervention and to provide technical inputs to the districts 6 Nutrition Resource Centres are made functional in close collaboration between DWCD, ABM, DME, Medical Colleges and DFID/TAST. ICDS in MP is working through different strategies for the promotion of appropriate breast feeding practices. These include three in one IYCF counseling skills training, radio publicity, periodic release of information magazine , cinema slides, mothers’ meeting and counseling, distribution of IEC material to AWCs , organizing competitions, organizing group meetings and awareness camps, counseling of mothers and service providers for early initiation of Breast feeding within 1hr, colostrums feeding, exclusive breast feeding up to 6 months and optimal feeding up to 2yrs.etc. As a result of joint efforts of DWCD, DH&FW, Medical Colleges, local NGOs and Development partners improvement in IYCF practices is visible as can be seen from the following graph: The above graph on IYCF practices shows an improvement. The data for children breastfed with one hour of birth for rural areas was reported 13.13% in NFHS-3 which increased upto 26.4 % in NIN study 2010. In NFHS-3 the data for children who were exclusively breatfed for 6 months was reported 21.5% which increased by almost 50 % and was reported 71 % in NIN study 2010. J) Universal Salt Iodization Iodine deficiency disorder is most commonly seen among poor, pregnant women and preschool children. It results in stunted physical and mental growth of young children. According to Coverage Evaluation Survey 2005-06 , only 33% households in MP consumed adequately iodized salt which was reported that 48 % families were using iodized salt ≥15 24 ppm as per NIN study. The availability and consumption of un-iodized salt by the masses in tribal and many interior pockets of the state is very high. K) Trainings & Capacity Building: Learning from the initiative supported by DFID/ TAST to train CDPO & Supervisors from High burden district. Similar activitiy will be carried out for all staff in high burden districts. Also upgradation of softskills of all MLTC & AWTC staff based on the available modules on Communications, Training skills and Computer skills. Another approach of regular trainings will start by: (i) Setting up of a training cell at the state level and computerized data base about the training requirements. This cell will be responsible for preparation of Annual Training Plan, implementation of the same, deputing trainees for various programmes. (ii) Upgrading the infrastructure of least 5 AWTCs and 1 MLTC of the State. (iii) Identifying specific training needs of ICDS functionaries and arrange for the training in the same. (iv) Development of theme specific training modules for ICDS functionaries. (v) Cross State Learning Visits of ICDS functionaries at all levels (At least ten such visits during one year can be propsed). 25 SECTION 2: VISION STATEMENT Madhya Pradesh has launched an ambitious project, which will work in a mission mode, to address the problem of malnutrition and poor health status of children. The Atal Bal Aroogya and Poshan Mission (called in short Atal Bal Mission) was endorsed by the State Assembly in May 2010. The Mission will work in an integrated and coordinated manner to bring about an improvement in the nutrition and health status of children in the state. The goal of the Mission is to: Reduce mortality rate for children under five from 94.2 to 60 per thousand live birth Reduce the percentage of underweight children under five years from 60% to 40% by 2915 and further to 20% by 2020 Reduce prevalence of Sever Acute Malnutrition (SAM) under five years from 12.6 percent to 5% by 2015 and to negligible level by 2020 The overall objective of the Mission is to render an enabling environment and mechanism for prevention and reduction of malnutrition and under five mortality rates in the children of the State through coordinated and concerted efforts.The Mission will also oversee the existing nutrition and health services programs and will ensure that corrective actions are taken to strengthen all components of service delivery, including timely and appropriate utilization of financial resources and mobilization of additional resources to achieve the set goals. The Mission will not work as a stand alone organization but will provide additionality. The support of the Mission to the existing programs would be budgetary as well as technical, using the expertise from within and outside the state. The state government has already released the first tranche of the funds to the Mission. The Department of WCD has adapted the Atal Bal Mission priorities, objectives, goals and targets for its ICDS program. 26 SECTION 3: ORGANIZATIONAL STRUCTURE OF ICDS PROGRAM MANAGEMENT IN M.P. a) Organizational structure: - The directorate of Women and Child development Department, GoMP is divided intwo separate directorate. The instructions were laid down by letter no. F1(A)/32/2011/50-1, Bhopal dated 12th March 2012. The Direcorates after division are Integrated Child Development Women Empowerment Directorate Services Directorate ICDS Ladli Laxmi Yojna SABLA Beti Bacho Abhiyan IGMSY Nari Niketan, Vasti Grah, Mahila Udhhar Grah, Silai Kendra ABM Jabali Yojna Other work related to implementation of Usha Kran Yojna ICDS Jawahar Bal bhavan ICPS Scheme Grants to NGOs Work related to State Women Commission Mahila Vitya Vikas Nigam Work related to Child Protection Work related to Social welfare Board Work related to Women policy and Women Other work related to women empowerment which is not assigned to other Direcorate 27 Organizational framework of the both the Directorate is shown in chart below: 28 Division Level Joint Director (10) District Level District Level Block Level District Assistant Chief Child Development & Project Officer Programme Director Bal Instructor (453) Officer Bhavan AWTC (DPO) (50) (6) (10) Assistant Child Development & Project Officer (109) District Instructors Women & (20) Child Development Assistant Statistical Officer (369) Officer (DWCDO) (34) Supervisors (1998 Regular & 1166 Contract appointments) Anganwadi Mini Workers Anganwadi (78,929) Workers +1231 New (12,070 ) ly sanctioned AWC ) Anganwadi Helper (78,929)+ 1231 Newly sanction AWC 29 Table I. Revised Population Norms for establishing AWCs under ICDS program Old Revised CDPO Block 30,000 to 1,00,000 – 1/project For blocks with >2lac population, A unit for sanction of an ICDS state could opt for more than one project in Rural/tribal project on one per 1lac. In the irrespective of villages & later case staff could be suitably population strengthened. Sector Supervisor 20,000 to 30,000 – 1/sector 25,000 – 1/Sector AWC Rural/ urban one AWC on a population of 400 to 800 – 1 AWC 500-1500 800 to 1600 – 2 AWC 1600 to 2400 – 3 AWC In multiples of 800/AWC Mini AWC 150 to 500 – 1 Mini AWC 150 to 400 – 1 Mini AWC AWC tribal 300 to 1500 – 1 AWC 300 to 800 – 1 AWC 150 to 300 – 1 Mini AWC 150 to 300 – 1 Mini AWC In MP, ICDS program functions under the Department of Women and Child Development. It has a separate Directorate headed by a Director/Commissioner. In the district the organization is headed by the District Program Officer (DPO). In larger districts he is supported by DWCDO (District Woman and Child Development Officer). At the block level, the program is managed by Child Development Project Officer (CDPO) assisted by Assistant Statistical Officer and Assistant Project Officer. At the village level each AWW has two honorary workers viz. Anganwadi Worker (AWW) and Anganwadi Helper (AWH). For every 25 AWCs a Supervisor has been provided. The area covered by the Supervisor is known as a sector. b) Office infrastructure at state, district and block level As mentioned earlier the Department of DWC has recently moved in a new building of its own. At the district level, most offices of DPOs are housed in rented buildings with a few exceptions where DPO offices are located in the district collector building or some other government building. Out of 313 Block offices, headed by CDPO, 165 have their own building while the remaining is in rented building. c) ICDS program in MP is headed by a Commissioner who is an IAS officer d) Committee/ Task Force on ICDS The State has constituted a Core Group under the chairmanship of Director, Department of Women and Child Development for preparation of Annual PIP. Joint Directors (ICDS and WCD), District Program Officers of DWCD, representatives from Partner organizations (DEVELOPMENT PARTNERS, DIFD, etc) are members of the Core Group. Representatives from Department of Panchayat and Rural Development, BRGF, Public Health Engineering are also invited to the Core Group meetings. The Core Group provides guidance for preparation of the Annual PIP. GOMP has also constituted a Steering Committee for implementation of Annual PIP. The Steering Committee is chaired by the Principal Secretary, WCD. Principal Secretary/ Secretary of line departments e.g. Department of Planning, Public Health Engineering, Public Health and Family Welfare, Panchayat and Rural Development are members of the Steering Committee. Representatives of GOI, NIPCCD and Collectors of selected districts 30 are other members of the Steering Committee. The Steering Committee will ensure that the activities proposed under Annual PIP of ICDS are implemented effectively. e) Devolution of powers at the state/ district/block levels Government orders have been issued for decentralization of functions and devolution of power for smooth functioning of the ICDS activities. For example, appointment of AWW is done by CDPO with recommendations of the respective Gram Sabhas. Similarly, procurement of Pre- School kits and other supplies, etc. have been entrusted to the district and block level officers. Planning of annual activities of ICDS is carried out in consultation with community at the grass root level. PRI representatives at Panchayat, block and district level are associated with program planning and review. Further details are given in section 4-I. “Community Participation & Involvement of PRIs” (page 66). 31 Section 4 ANNUAL ACTION PLAN- PROGRAM COMPONENTS 4A. HUMAN RESOURCES a. State’s recruitment process The Human Resource Policy of Madhya Pradesh follows the qualifications and other norms prescribed by GOI for recruitment of staff. The process of recruitment and promotion are briefly described below: i) Recruitment of AWWs The minimum qualification prescribed by GOI for selection of AWWs is Matriculation. But few AWWs, recruited earlier, do not possess the minimum prescribed qualification. Classification of AWWs as per their qualifications is as below: Table 4A.1: Classification of AWWs as per their educational qualifications V IX -XII VI- VIII Post – Illiterate standard standard Graduate Total standard graduates or less pass 5959 6790 14709 35461 10946 4991 78856 Majority (44.97%) of AWWs belong to IX to XII education group. About 34.82% AWWs hold less than the recommended educational qualification. This includes 16.17% AWWs who are either illiterate or have education up to fifth standard only. This has implications for programme implementation as well trainability of the workers. In tribal and difficult areas, women with required educational qualifications are often not available for selection. There is a provision of relaxation of educational qualifications’ norms in such cases. Honorarium of AWWs as per their educational qualifications and experience is listed in the table below: Table 4.A.2 Honoraria scale of AWWs in accordance with their education and experience Qualification & experience of Honorarium (Rs) Honorarium (Rs) S.N. AWW (w.e.f. 01.04.08) (w.e.f. 01.04.11) 1 Non-Matriculate 1438 2938 Non-Matriculate with 5 years of 2 1469 2969 work Non-Matriculate with 10 years of 3 1500 3000 work 4 Matriculate 1500 3000 5 Matriculate with 5 yrs honorary work 1531 3031 Matriculate with 10 yrs honorary 6 1563 3063 work 7 Aanganwadi Helper 750 1500 8 AWW of Mini AWC 750 1500 Selection of AWWs is made by CDPO on the recommendation of Gram Sabha. For selection of AWW, it is essential that she should be a resident of the local village. 32 ii) Recruitment of Supervisors and senior level staff Recruitment and promotion process of Supervisors and senior level staff of ICDS is summarised in table below. Table 4A.3 Process of Selection and Promotion of staff of ICDS Designation of Recruitment by S.N. Direct recruitment posts promotion Selected by CDPO on the Aanganwadi 1 recommendation of Gram - Worker Sabha By selection, but 50% posts 2 Supervisor are reserved for AWWs who - have to qualify by examination 50% by promotion of 3 CDPO 50% Supervisors DWCD / 50% by promotion of 4 Assistant 50% CDPOs Director 100% by promotion of 5 DPO - DWCD/Assistant Director 100% by promotion of 6 Joint Directors - DPOs Additional 100% by promotion of 7 - Director Joint Directors a. Specific cadre for CDPOs Specific cadres of Supervisors and CDPOs exist in the State. b. State’s promotional policy for field level functionaries This has been outlined in table 12. c. Human resource in ICDS programme Human resource status is given in table 4.A.4. It depicts number of posts – sanctioned and vacant, timeline to fill-in the vacant posts, salaries of the staff members and honoraria to AWWs and AWHs. Calculations for salaries of vacant positions have been made by taking into the account, the expected time-period it will take for the positions to be filled in. The State periodically reviews staff status of ICDS programme at different levels. Vacancies against sanctioned post(s) in the field are communicated by the districts in their MPRs. 33 Table 4 A.4: Human resource status in ICDS programme Estimated Timeline budgetary for requireme Sanctione In Salary/Honoraria Designation filling-up nt for the d Posts Position per month vacancie FY 12-13 s (Rs.; Lakhs) State Level Commissioner / 37400+67000+1000 Director 1 1 0= 98276 11.79 Additional Director/Joint 37400-67000+8700= Director 2 2 96222 23.09 Joint Director/ 37400- Finance Advisor 12 12 67000+7600=94484 136.06 Deputy Director 4 4 15600-39100+ 6600 25.75 Assistant Director 8 8 15600-39100+ 5400 49.68 Account Officer 1 1 15600-39100+ 5400 6.21 Superindendent 1 1 9300-34800+3600 4.86 Senior Auditor 1 1 9300-34800+3600 4.86 Astt. Supdtt. 1 1 9300-34800+3200 4.79 ASO 6 6 9300-34800+3600 2.92 Stenographer grade 1 2 2 9300-34800+4200 9.95 Stenographer grade 2 2 2 9300-34800+3600 9.73 Stenographer grade 3 6 6 5200-20200+2800 17.63 Asstt. Grade 1 6 6 5200-20200+2800 17.63 Data Entry Operator 4 4 5200-20200+2400 11.45 Assistant Grade 2/ accountant 7 7 5200-20200+2400 20.04 Assistant Grade 3 / Steno Typist 14 14 5200-20200+1900 38.76 Peon/Watchman/S weeper/Cleaner 10 10 4440-7440+1300 13.73 Driver 10 10 5200-20200+1900 27.68 TOTAL 98 98 436.62 34 District Level Position Estimated Timeline budgetary Sanctioned In for filling- Salary/Honoraria requirement Designation Posts Position up per month for the FY vacancies 12-13 (Rs.; Lakhs) DPO 48 30 3rd Qtr 55300.00 258.80 ASO 20 09 3rd Qtr 53641.00 93.34 Office Superintendent 14 03 3rd Qtr 39500.00 40.29 UDC 32 21 3rd Qtr 23700.00 75.37 LDC/Typist 41 30 3rd Qtr 23700.00 100.96 Peon 41 30 3rd Qtr 9480.00 40.38 Driver 30 30 - 23384.00 84.18 Chowkidar 5 5 - 27492.00 16.50 Total 231 158 709.82 Block level CDPO 453 269 QIII 41080.00 1779.59 ACDPO 108 103 Dying cadre 39500.00 488.22 Assitant/Statistical QIII 39500.00 Assitant 258 153 974.07 Q III 23700.00 Supervisor 3157 2728 2012-13 8368.47 Clerk/typist 380 363 2012-13 23700.00 1056.55 Asstt. Grade I 241 153 2012-13 23700.00 435.13 Asstt. Grade II 296 143 2012-13 23700.00 406.69 Dieying 9480.00 Peon 562 503 cadre 605.77 Dieying 23384.00 Driver 375 282 cadre 791.31 Total Block level 5830 4697 - 14905.80 AWC Level AWW* 80160 77086 2012-13 3000.00 28580.94 AWW (Mini) 80160 76188 2012-13 1500.00 14250.06 AWH* 12070 12070 2012-13 1500.00 2172.6 Total 172390 165344 - 45003.6 35 State’s additional contribution for honoraria of AWWs and AWHs The State’s HR policy is worker oriented. The AWWs and AWHs are paid additional honoraria by the State Government from its own budget. The AWWs are paid additional Rs 1000 per month; thus, raising their total honorarium to Rs. 2500 from Rs. 1500 paid under ICDS norms. Similarly, the AWHs are paid additional honoraria of Rs. 500 per month. Time for filling of different vacant posts has been shown in the table 14: Time Line of Activities (2012-13) at page 73. Detailed calculation of the salary/ honorarium has been given in Annexure 9. a. LIC coverage for AWWs and other welfare measures Government of India introduced ‘Social Group Insurance Scheme of LIC of India for AWWs’, with effect from October 1, 2004. The scheme covers all AWWs and AWHs, on voluntary basis on their part. The name of the scheme is ‘AWWs Group Insurance Scheme’. The Government of MP accepted to implement the scheme and issued instructions to all District Collectors to implement the scheme (vide letter no. WCD/2004/F-3-18/04/50-2 dated 23.09.2004) with immediate effect. f) LIC coverage for AWWs and any other welfare measures Government of India introduced Social Group Insurance Scheme of LIC of India for AWWs with effect from 1st Oct 2004. The scheme covers all AWWs and Anganwadi Helpers on a voluntary basis. The name of the scheme is AWWs Group Insurance Scheme. The government of MP accepted to implement the scheme. It issued instructions to all the District Collectors to implement the scheme vide letter no. WCD/2004/F-3-18/04/50-2 dated 23.09.2004 with immediate effect. 2010-2011 2011-2012 Lodged Settled Amount Lodged Settled Amount disbursed disbursed No. of claims by AWWs and Helpers Natural death 48 48 1400000.00 62 62 1860000.00 Accidental death 6 6 45000.00 7 7 525000.00 Critical illness 1 1 20000.00 1 1 20000.00 Scholarship 532 532 324000.00 1273 1273 763800.00 4B: Procurement of Materials and Equipments a) Status of supply of equipments No. and percentage of blocks with functional computers and printers There are 453 Projects in the state. In the financial year 2012-13, budget is being allotted to all the projects (453), DPOs(50), JDs office (07) and Government owned Aaganwadi workers Training Centres (10), to procure computer and accessiories that includes Desktop, CPU, Printer, UPS, Inverter and Borad band connections (Rs. 1000 per month / per office is allotted. No. and percentage of District offices having functional computers/ printers 36 Functional computers are available at all the fifty District cells. In the financial year budget is allotted to all the DPOs to make replacement of computers and accessaries. Functional vehicles at state, district and block level Out of 453 CDPO offices 272 have vehicles in running condition. Remaining 181 offices hire vehicles for program activities. Further, out of 50 District cells 36 have vehicles in working condition while the remaining 14 district cells are using hired vehicles. At the state level there are 30 owned vechiles and 11 Private Vechiles. No .of functional AWCs having baby and adult weighing machines- Out of 78,929 AWCs in the state 33226 AWCs had baby weighing scales out of which 28373 machines are in working condition (for newborns) and 60422 Salter scales are vailable at AWCs out of which 56593 in working condition and 42022 Adult weighing machines are available at AWCs out of which 34675 are in working condction. (MPR, March, 2012.). The requirement of baby weighing scale is 51787 and Salter scale is 23537 and adult weighing machine 45485 is required during current financial year which included weighing machines for newly sanctioned 1231 AWCs too and demnd for 19729 MUAC tape is being placed by district to the state for financial year 2012-13. Table 4.B.1: List of material and equipment, and their costs, to be procured No. Timeline of No. to be Estimated available supply Means of procured budgetary Items in during FY Verification during requirement(Rs. working (Tentative (MPRs/UCs) the year ) condition date) State level Computer with 5.0 lakhs 12 10 3rd Quarter 5.00 lakhs Printer+UPS @ Rs. 50,000 2.0 lakhs Photocopier - 2 3rd Quarter 2.00 lakhs @ Rs. 1,00,000 0.2 lakhs Scanner 3 1 3rd Quarter 0.2 lakhs @ Rs. 20,000 2.4 lakhs Laptops 8 4 4th Quarter 2.4 lakhs @ Rs. 60,000 Water Cooler 0.75 lakh - 3 2nd Quarter 0.75 lakhs with RO @ Rs. 25,000 0.70 lakhs AC Split 1 2 2nd Quarter 0.70 lakhs @ Rs. 35,000 1. 5 lakh AC Window - 6 2nd Quarter 1.5 lakhs @ Rs. 25,000 1.0 lakh Steel Almirah 15 10 2nd Quarter 1.0 lakhs @ Rs. 10,000 Total procurement for state cell 13.55 lakhs 37 No. Timeline No. to be available Estimated of supply Means of procured Items in budgetary during FY Verification during the working requirement(Rs.) (Tentative (MPRs/UCs) year condition date) District Level (total 50 districts) 10 need Computer cum 5.0 lakhs 3rd 50 replaceme 5.0 lakhs Printer @ Rs. 50,000 Quarter nt Equipment / 25.0 lakhs 2nd 50 Districts 25.00 lakhs Furniture, etc. @ Rs. 50,000 Quarter Total procurement at district level 30.0 lakh Block Level (total 453 Projects) 200 need Computer cum 100.0 lakhs 3rd 253 replaceme 100.0 lakh Printer/ UPS @ Rs. 50,000 Quarter nt Other 453 226.5 lakhs 3rd/ 4th equipment, 226.50 lakh Projects @ Rs. 20,000/project Quarter furniture, etc. Total procurement at Blocks level 326.50 lakh AWC Level 801.6 lakhs 2nd PSE Kit 80160 @ Rs. 801.6 lakhs Quarter 1000/AWC/year PSE Kit mini @ Rs 12070 2nd Qtr 60.35 lakhs AWC 500.00/AWC/Year 480.96 lakhs 2nd Medicine Kit 80160 480.96 lakhs @ Rs. 600/AWC/year Quarter Medicine Kit @ Rs 300.00 2nd Qtr 36.21 lakhs Mini AWc /AWC/Year Weighing Scales Baby Weighing 28373 51787 @Rs.10000.00 2nd 517.87 lakh Scales Quarter Salter Weighing 56593 23537 @ 750 176.52 lakh scales Adult weighing 29849 45485 2nd @ Rs. 1000/AWC 454.85 lakh scales available required Quarter No. Timeline No. to be available Estimated of supply Means of procured Items in budgetary during FY Verification during the working requirement(Rs.) (Tentative (MPRs/UCs) year condition date) Storage boxes, For 51231 2nd & 3rd 2561.55 other - @ Rs. 5000/ AWC AWCs quarter lakhs equipments Total for AWCs 508.91 lakhs Total procurements at state, district, block & AWC level 5419.05 lacs i. Requirement during the FY (2011-12) 38 Total requirement for equipment and furniture; computers, weighing scales, medicine kits, PSE kits etc.for the F/Y 2011-12 is Rs. 5419.00 lakhs 4C DELIVERY OF SERVICES AT AWCS 4C 1Supplementary Nutrition (SN) i. Existing Mechanism for Procurement & distribution of Supplementary Nutrition ICDS provides supplementary nutrition to its beneficiaries in two forms – Hot Cooked Meal & Take-Home Ration (THR). Hot Cooked Meal: There are two arrangements to provide hot cooked food to the beneficiaries. One that is practiced in urban areas is that the food is cooked and supplied to AWCs by SHGs. Other that is practiced in rural and tribal areas is that the Mid-Day Meal programme of Deaprtment of Rural Development has been linked with ICDS in the form of Sanjha Chulha. Hot cooked meals to AWCs are proived through the SHGs which provide MDM to schools. Take-Home Ration: Take-home ration is supplied by M.P. State Agro Industries Corporation, a Public sector undertaking. THR is also fortified with essential micronutrients by highly mechanised method. ii. Basic Information about supplementary food Type of Supplementary Nutrition Provided Following tables provide information about the menu followed in SNP, its cost and its nutritional value. Table 4.C.1: Menu of Supplementary Nutrition Food Pregnant & Type of Food 6mths to 3yrs 3yrs to 6yrs Lactating Women Gehu-Soya Barfi, Take Home Halwa, Bal Aahar, - Aata-Besan Ration (THR) Khichdi laddu, Khichdi 1st Meal: Poshtik Khichdi, Hot cooked food Hot cooked food is Daliya (Sweet/Namkeen) Morning Snacks is provided on provided on every Lapsi (Sweet/ Namkeen) (Hot Cooked every VHND day/ VHND day/ Tuesday 2nd Meal: Sabji-Roti, Meal) Tuesday (Mangal (Mangal Diwas) Kheer-Puri, Dal-Roti, Dal- Diwas) Rice Third meal for Chawal soya ka laddu, Mithi Mathari, Mungphali Underweight - chana chikki children Table 4.C.2: Nutrient content of the menu provided under SNP Hot Cooked Meal (2nd Protein Calorie Day Snack 1st Meal) Meal) (g) (kcal) Monday Daliya Sabjee Roti 13.48 507.75 Tuesday Meethi Laapsi Kheer Puri 12.62 659.65 Wednesday Khichadi Daal Roti 15.54 503.55 Thursday Daliya Daal chawal 12.83 514.05 39 Friday Meethi Laapsi Daal Roti 15.51 541.20 Saturday Khichadi Sabjee Roti 13.48 507.75 Table 4.C.3: Third meal, and its nutrient content, for children between 6 months and 6 years Day Recipe Protein Calorie Monday Chawal soya ka laddu 13.48 507.75 Tuesday Mithi Mathari 12.62 659.65 Wednesday Mungphali chana chikki 15.54 503.55 Thursday Mithi Mathari 12.83 514.05 Friday Mungphali chana chikki 15.51 541.20 Saturday Chawal soya ka laddu 13.48 507.75 iii. Cost (per unit) of supplementary nutrition Table 4.C.4: Per unit cost of supplementary nutrition Rates per beneficiary (in Rs.) (Per beneficiary Target Group per day) Pre – revised Revised Children 6 months to 6 yrs 2.00 4.00 Severely undernourished 2.70 6.00 children Pregnant women and Nursing 2.30 5.00 mothers Note: Fifty percent of the cost of supplementary nutrition is met by the state government iv. Adherence to calorific norms as prescribed by GOI and quantity per child/women per day The rates and calorie and protein content of the SNP provided to pregnant, lactating mothers & children 6 months to 6 years by ICDS were revised in 2009 (State Government’s circular number F 3-2/09/50-2, dated 28.2.2009). The revised norms are mentioned in the table below: Table 4.C.5: Revised nutrient content of SNP food Pre-revised (per Revised (per beneficiary per beneficiary per day) day) Target Group Calories Calories Protein (g) Protein (g) (kcal) (kcal) 40 Children (6months to 6 300 8-10 500 12-15 years) Severely Malnourished Children (6months to 600 20 800 20-25 6years) Pregnant Women and 500 15-20 600 18-20 Lactating Mothers Amount of THR, per day per beneficiary, is given in the following table. While amount of THR per day is 120 g for children between 6 months and 6 years, it is the 150 g for pregnant & lactating mothers. Table 4.C.6: Quantity of THR per child/women per day Daily Protein Calories THR Target Group Quantity (in g) (in kcal) Pregnant women and Gehu-Soya barfi (premix) 150 g 18.47 631.80 Nursing mothers Aata Besan Laddu Pregnant women and 150 g 18.14 626.93 (premix) Nursing mothers Children (6months – Halua (premix) 120 g 12.28 503.04 3years) Children (6months – Weaning food (premix) 120 g 14.61 500.11 3years) Children (6months – Khichdi 125 g 20.44 500.75 3years) v. No. of AWCs with feeding interruption for more than 1 month during the last year There were no AWCs which had any feeding interruption for more than one month during the last year. vi. Coverage of total & average beneficiary per AWC by rural-urban-tribal category as on 31st March 2011 & gaps in coverage Table 4.C.7: Total beneficiaries under SNP and percent beneficiaries covered Target Total Total Gap in Population Beneficiary Beneficiary Eligible Gap in (as per & Enrolled & Target Group survey) Enrolled Covered Enrolled Covered Children (6 months to 3 4583363 3485941 3096612 1097422 389329 years) Children (3 years to 6 3952132 3409665 2878388 542467 531277 years) 41 Pregnant 671818 667541 628212 4277 39329 women Lactating 741367 687816 640474 53551 47342 women i. Special strategy for cut off area planning during monsoon In Madhya Pradesh, THR is supplied from MP Agro. On the basis of demands received from districts, MP Agro supplies THR from Bhopal and Indore, maintaining rotation cycle of one month. During rainy season, several villages in the State get cut-off from the district headquarter, mainly because of affected roads. Approximately, 8-10% of total AWCs get affected during monsoons. Districts know of these villages by experience. To ensure there is no disruption in the supply of SNP in such villages, districts sanction stock of SNP for two to three months in advance. ii. Differential strategy for tribal & rural areas in collaboration with department of Tribal development Since the inception of ICDS programme, different mechanisms for preparation & distribution of supplementary nutrition have been adopted for effective implementation of the programme. After the introduction of new Nutrition Policy in February 2007, a standard reference list of menu and revised cost along with revised calorie-protein values has been provided to all the districts (vide letter number F3-1/07/50-2of dated 15.2.2007). Earlier, preparation of supplementary nutrition at Anganwadi centers required a lot of preparation and consumed considerable time of AWWs. The AWWs are supposed to provide six services including daily organization of preschool education for children aging 3- 6years, In view of this constraint, ICDS linked supplementary nutrition program with MDM program of department of tribal development. This arrangement is named as Sanjha Chulha. It is effective from 1st November 2009. As per the Sanjha Chulha initiative the SHG who was preparing food for school children prepares supplementary nutrition in the same kitchen for anganwadis as well. The SHG provides the food to the AWCs as per the fixed weekly Menu & cost following the revised norms of ICDS. Distribution of food to the beneficiaries is done by the AWW. The AWWs collects the cooked food from the Sanjha Chulha kitchen. Where Sanjha Chulha kitchen is at a distance from AWC, SHG delvers the food to the centre. In this case transportation cost is paid from administrative budget head by the CDPO. The norms for the transportation cost are: if the distance of AWC from the MDM kitchen is within 100mts then no transportation cost is paid. On the other hand, for distance between 101 to 500mts Rs. 250/month and for distance between 501 to 1000mts Rs. 500/month is paid as transportation cost to SHG. The SHG prepares food daily for all the children aged 3-6years. But on Tuesdays the pregnant & lactating mothers and 6months to 3years children coming to AWC are also served nutrition supplement. Revised guidelines were issued by the department on 27.8.2009 for implementation of Sanjha Chulha scheme. Along with the regular supplementary nutrition to all the beneficiaries, a special provision of third meal has been introduced by the State for all severely underweight children. As per the guidelines provided wide letter no.F3-2/09/50-2 dt. 10th November 2009, all the severely underweight children of age 6months to 6years are provided food with 800 kcal and 20- 25gms of protein. The following table explains the third meal cost & nutritive value recommended & currently in practice for children 6 months to 3 years who are getting THR. 42 Table 4.C.9: Comparison of Average received from Take Home Ration(THR) & Average received Total Average including cooked from Third Meal meal provided on ( Pre-mix) Tuesday Protei Calori Rate Protei Ca Rat Protei Calori Rate n e n lor e n e ie Recommended 15.25 527.6 3.99 6.91 27 2.01 22.16 800.04 6.00 9 2. 35 Third Meal (Hot cooked) (average value) Temporary 15.2 527.69 3.99 8.8 311.9 2.08 24.05 839.62 6.07 arrangement 5 0 3 For the children aged 3-6years the third meal cost and nutritive value of food provided to the beneficiaries is given in table 24. Table. V. Nutritive value and cost of Third Meal and food supplied under Sanjha Chulha to children 3-6 years. Average received by Average received from Total Average Sanjha Chulha Third Meal arrangement ( Sanjha chulha) Protein Calorie Rate Protein Calorie Rate Protein Calorie Rate (Rs.) 13.91 538.99 3.94 6.91 272.35 2.01 20.82 811.34 5.95 Under the time bound action plan as per directives issued by DWCD (vide letter no. WCD/SN/09/10243, dated 8th September 2009) severely underweight children of 6 months to 3 yrs are given THR while 3-6yrs children are fed hot cooked meals 3 times a day at the AWCs between 9 to 10am, 12 to 1pm & 2.30 to 3pm. iii. Differential strategy for urban areas The guidelines with revised rates and nutritive value were provided to all the districts through various directives issued by the Department of Women and Child Development, MP (vide letter number F3-1/07/50-2, dated, 15.2.2007; letter number F3-21/07/50-2, dated 27.3.08; and letter number WCD/SN/10346, dated 31.5.08 and 25.10.08). The guidelines for urban areas are the same as for the rural & tribal areas with the exception of the food preparation & distribution mechanism. As per the guidelines, arrangement of hot cooked meals to AWCs in urban area has to be made at district level by local institutions like SHGs/Mahila Mandals/Matru Sahyogini Samiti. These institutions should be compulsorily local. The selection of institutions is done by a committee chaired by the District Collector, or his nominated representative, along with 43 DPO/DWCDO, Treasury Officer and CDPO(s) of the related projects. After the selection of the institutions MOU is signed among all the parties. One institution covers a minimum of 50 AWCs in the urban area. The institution provides food to AWCs with no extra cost of transportation. Matru Sahyogini Samiti (MSS), Supervisors and Health committees are involved in the arrangement, wherein MSS provides food and other two institutions monitor the programme. It is a mandate under the programme that the services of contractors will not be taken at any given point of time & selected institutions cannot outsource the work to any other institution. iv. Expenditure on supplementary nutrition during previous two years The following tables show budgetary allocation and actual expenditure in the FYs 2010-11 and 2011-12. IT also differentiates between State and Central shares. Table 4.C.11: Budgetary allocation and expenditure on SNP during FY 2010-11 and 2011-12 Funds Financial Budget Actual Expenditure received Year allocation from GoI State Share Central Share 2010-11 92697.77 32137.63 44868.20 44868.20 2011-12 90200.00 52322.73 44682.88 44682.88 v. Quantum of food commodity approved for Wheat based Nutrition Program (WBNP) and lifted and requirement for this year The following table shows the quantity of wheat-based food which was requisitioned and received from GOI. Table 4.C.12: Quantity of food grains requisitioned and received from GOI for WBNP Qty. of food requisitioned Qty. of food received from from GOI GOI S.N. Year Wheat Rice Wheat Rice (Metric ton) (Metric ton) Metric ton) (Metric ton) 1 2010-11 162000 65000 162000 65000 2 2011.12 162000 65000 162000 65000 Information regarding quantity of food received from GOI and quantity picked up from FCI during the current year (till Dec. 2010) is given in the following table. Table 4.C.13: Information regarding BPL wheat/rice received during 2010-11 from GOI Qty. of food received from Qty. of food picked up from GOI FCI S.N. Quarter Wheat Rice Wheat Rice (Metric ton) (Metric ton) (Metric ton) (Metric ton) 1. First 40500 16250 34581.700 14243.000 2 Second 40500 16250 33636.100 14396.500 44 3 Third 40500 16250 38181.500 14477.028 4 Fourth 40500 16250 33170.000 14215.000 Total 162000 65000 139569.300 57331.528 The Department of WCD has submitted to GOI a demand of 162000 metric tonnes of wheat and 65000 metric tonnes of rice for WBNP scheme for the FY 2011-12. vi. Estimated budgetary requirements for the FY (2011-12) The table given below summarises the budgetary requirement for the year 2012-13. Table 4.C.14: Budgetary requirement for FY 2012-13 Populatio n as per Budgetary AWW’s requireme survey No. of Target nt for register beneficiaries for Unit current FY Means of (March (as on current cost (Rs.; verification Beneficiaries 2012) March 2012) year (Rs.) Lakh) (MPRs/UCs) Children (6m-3y) 4583363 3096612 4500000 4 54000 MPR Mar 13 Children (3y-6y) 3952132 2878388 4000000 4 48000 MPR Mar 13 Pregnant Women 671818 628212 670000 5 10050 MPR Mar 13 Lactating Mothers 741367 640474 740000 5 11100 MPR Mar 13 Severe Underweight children 187599 187599 187599 6 3376.78 MPR Mar 13 Total 126526.78 - xii) Growth Monitoring & Promotion: No. and percentage of AWCs using WHO New Growth Charts: After March 2010 most of the AWCs started using New WHO Growth Standards for growth monitoring of children. But proper recording and reporting to Directorate of WCD could start from December 2010 onwards only. Grading of nutritional status of children as per the new standards will be reflected in MPR from next F/Y. Percentage of AWCs using New Mother & Child Health Cards/any other tools for counseling: New MCP Card was launched by the Hon. Chief Minister of MP in 2007. The card was jointly printed by the DWCD and Department of Health and Family Welfare. DEVELOPMENT PARTNERS state office of MP also shared the printing expenses of MCP cards. Growth monitoring/ Promotion and Children’s Nutritional status: The state has started using WHO New Growth Standards since 2010 onward. Distribution of nutritional status of children using weight for age criteria (MPR March 2012) is shown in the following graph. 45 Graph showing overall nutritional status of children from birth to 5yrs (Using WHO New Growth Standards) 4 C2. Pre-school Education (PSE) a) State Policy/guidelines/curricula for Pre-school Education & Pre-School Kits in ICDS: The pre-school education component under ICDS Scheme is an important component of the package of services envisaged under the scheme. It aims at school readiness and development of positive attitudes towards education. Strengthening of pre-school education would also supplement the effort in achieving the national goal of universal primary education. It is to be noted that right to education, which has been accepted by the government as a national policy cannot succeed without PSE. The Pre-School Education in Anganwadi centers is provided through non-formal and play way methods by joyful learning. The age group of 3-6 years can be termed as school preparatory stage where the emphasis should be on development of cognitive processes along with motor & muscular development: The child can be guided to develop pre-number concepts such as differences between more & less, thick & thin, far & near etc. During this age concept formation and language development also need to be facilitated by organizing activities like pre-conversation, story telling, rhyming songs, vocabulary building etc. Emotional and social developments are other areas which need careful intervention. As per the guidelines issued wide letter no. 4-4/2008-CD-II dated 11th May 2009 by Ministry of Women & Child Development, GOI Pre-School Kits are provided each year for all operational Anganwadi Centers in the State @ Rs.1000/-, per AWC per annum. M.P. opted for providing more than one kit having age appropriate TLM (Teaching & Learning Material).Two kits were designed one each for less than 3years, and more than 3 years children. The items in the kit were multiple in terms of possible play activities & concepts, durable, safe for children (non-toxic & without sharp edges), culturally and environmentally 46 relevant, cost-effective, easy to maintain, handle and store, conducive to creativity and problem solving. The Pre-school Education program in terms of content, curriculum, duration, etc follows MOWCD, GOI guidelines. In the past, PSE program had not received adequate attention under the ICDS program due to a number of reasons. The scene has changed considerably in recent years. There is now greater awareness among the community to enroll children for pre-school education. The recent initiative of the state to increase the working hours of AWC by offering additional honoraria to AWW and AWH as well supply of pre cooked food under its Sanjha Chulha initiative has resulted into sufficient time to AWW to devote to joyful learning activities. b) Number & percentage of AWCs (against total operational) having received PSE kits during the previous year: AWCs have been supplied Pre-school Education kits for teaching learning of children between 3-6 years attending AWCs. Each AWC is supplied one kit on annual basis. Since 2000, procurement of the kits has been done by the state government as per the decision of MOWCD, GOI. Guidelines provided by the Ministry for procurement of PSE kits are followed by MP. The cost of the kit has been raised from Rs 500 to Rs 1000 by GOI. The State government has now decentralized procurement of PSE kits to the districts thus ensuring timely supply to the AWCs. The directives for procurement of the PSE kits for the year 2010- 11 were issued to all the districts vide letter no. WCD/ICDS/2010/3611 dated 3.05.2010. The Directorate of WCD has also printed and supplied to the AWCs calendars which outline the subjects and pictorial material for training of the pre-school children. Total number of PSE kits issued to AWCs during the last financial year was 78929 which is 100 percent of the total operational AWCs. Procurement of PSE kits have been decentralized during the current financial year. Districts have been authorized to procure the kit at their level, following the GOI guidelines. c) Specific interventions on preschool education made during recent years Rajya Shiksha Kendra, DWCD & DEVELOPMENT PARTNERS jointly organized 5 days training on pre-school education component in 2010 for all WCD supervisors. To start with 75 Master Trainers were trained. The Master Trainers trained 2500 ICDS Supervisors in PSE and training technique at state level as resource persons. The Supervisors in turn conducted training of AWWs. MLTC Indore and MLTC Jabalpur were used as training centres for Supervisors’ training. The Supervisors were also supplied training modules for training of AWWs. In the first phase in each district 200 villages were identified where enrolment of children in primary school was low. To develop AWCs in these villages as model centres funds were released to procure teaching learning material. The state, with the technical and financial support from State Education Centre (Rajya Shiksha Kendra), trained 69,240 AWWs. With effect from November 2009 pre-school education has been developed into Anganwadi Nursery Centers. Along with this the department has also taken steps to develop 88 model anganwadi centers in each district of MP. These AWC will be made child friendly based on BaLA concept. Under the guidance of national experts curriculum for pre-school education has been designed and provided to AWCs. The curriculum includes games, story telling, song and drama, language, cognitive and creative skills. On last Saturday of every month Children’s 47 Meet (Bal Sabha) is organized at AWCs. The children present different skill learnt by them. The parents of the children are also invited to these meetings. d). Strategy for children 6months to 3years for early childhood development stimulus: Currently there is no specific activity practiced for children 6months to 3yrs for early childhood development stimulus. However, under Atal Bal Mission special attention to this aspect is proposed. Strategy for preparing 3-6children for school readiness: For school readiness the program aims at providing exposure with activities for language development like singing rhymes, reciting poems, story telling, discussion etc. Under the cognitive development component the program provides activities like identification of shapes, color, texture, difference between small & big/large, hot & cold, rough & smooth, up & down, in & out, under & above, preparation for writing like joining dots, scribbling, small muscle development activities (as sorting grains & cereals, garland making, making toys from clay, paper craft, hand painting, drawing, sorting pebbles etc,) activities for mathematics readiness like front & back, few & more, numbers, making identical pairs, odd one out etc. It is proposed to try out Activity Based Learning Approach in selected AWCs. e). Specific interventions for tribal/rural/urban AWCs in conjunction with Tribal/Rural/Urban development departments It is proposed to strengthen PSE in tribal and rural areas. Identification of 200 villages in each district where enrolment of children in primary school was low and developing AWCs in these villages as model centers was part of state’s initiative in this direction. These AWCs have been given grant for purchase of teaching learning material for Pre-school Education with support from Rajiv Gandhi Shiksha Mission. f). Contents of PSE kits & supply positions during previous two years Information on number of kits provided has been given under b) above. Contents of PSE kits have been provided in table Z. Table Z.-1 Contents of PSE kits for AWCs Sr. No. Content Quantity 1 Skipping Rope 1 no. 2 Shapes & Colors (set of hollow plastic shapes in different colors) 1 set 3 Set of cut borads for learning & puzzle aptitude 2 sets 4 Toddler Ring (7rings of seven bright colors of different sizes) 1 set 5 Play Football (Foam leather) 2 No 6 Plastic Bat, Ball & 3 Stumps 1 set 7 Hindi Alphabets Chart (chart printed with multicolor print of Hindi 1 no. alphabets with picture illustration) 8 Rubber Ball (Set of 4) 4 Set 9 Abacus – Counting beads 1 no. 10 Learning Story Set 1 set 11 Dafli with Jhanjhri 1 no. 12 Magic Clay with Pakaging containers 1no. 13 Building beaker 1 set 48 Table Z.-1 Contents of PSE kits for Mini AWCs Sr. No. Content Quantity 1 Skipping Rope 1 no. 2 Shapes & Colors (set of hollow plastic shapes in different colors) 1 set 3 Set of cut borads for learning & puzzle aptitude 2 sets 4 Play Football foam leather 1 no 5 Charts (Hindi Alphabet) 1 each 6 Abacus – Counting beads 1 no g). Number of children who graduated from AWCs to formal Primary Schools Number of children who graduated from AWCs to formal primary schools during the last FY is shown in table AA below. The data pertains to (July 2010 figures of Sarva Shiksha Abhiyan). Table AA. Number of children graduating from AWCs to formal Primary School Boys Girls Total Children 3-6yrs ICDS 1388423 1346396 2734819 Children 5-6 as per 1006066 897002 1903068 VER Enrolled in class 1 254148 224000 478148 Table 5. Pre-school Education No. of No. of No. of 3- Target for Estimated budget Means of AWCs Children 6yrs the FY requirement for verification Providing 3-6yrs as Children PSE Kits (@Rs. (MPRs/ASRs/Ucs) pre-school per attended 1000/kit/AWC/year) education AWW’s PSE for in Lakhs (as on survey at least March register 16 days 2012) (as on in the March previous 2012) month (as on March 2012) 78929 3952132 2734819 40,00,000 80160 x 1000= MPR March.2013 Rs. 801.6 PSE for 12070 mini AWC @ Rs 500.00/AWC 60.35 Note: Currently 78929 AWCs are functional. During FY 2012-13 all 80160 sanctioned AWCs will become operational & budget has been calculated accordingly. As per MPR of March 2012 a total of 3422951 pre-school education beneficiaries were registered at AWCs. Of them 1388423 were boys and 1346396 were girls. The children of 3- 6yrs age attending AWCs are offered informal learning through games, story telling, use of pictures, etc. AWWs are trained to conduct PSE sessions during their job training and refresher training courses. In terms of total eligible population the current coverage under the PSE activity is about 80 49 % ( March data). To increase enrolment of 3-6 year children to the Pre-school Education activity is a major programmatic challenge for ICDS program. Table AB. No. of 3-6 years children enrolled with AWCs for PSE Program Indicators Boys Girls Total Eligible population 2033994 1925093 3959087 Enrolled under PSE 1749397 1673554 3422951 % enrollment 86.01 86.93 86.46 PSE beneficiaries 1388423 1346396 2734819 % beneficiaries out 79.37 80.45 79.90 of enrolled children 4C3. Nutrition and health education i. Strategy on Nutrition and Health Education Community education on nutrition issues has received high priority in MP. Every year breast-feeding week is observed to promote breast feeding. The activities are organised in collaboration with the Department of Public Health and Family Welfare, professional bodies like Indian Association of Paediatrics, Family Planning Association of India, Voluntary Health Association, BFPNI, etc. Education for breast feeding is also imparted to mothers of new- borns who come for institutional delivery. Norway India Partnership Initiative (NIPI) also promotes breast-feeding by its volunteers who are posted at the health institutions. An important initiative of the State to promote breast-feeding is appointment of trained counsellors in the hospitals for educating women delivering at health institutions under Janani Suraksha Yojana. Nutrition and health education of the mothers is carried out through Mangal Diwas events as well. These have already been described earlier in section 1 (page 20). SABLA programme which has been launched in 15 districts further strengthens this community, through adolescent girls. ii. Status of implementation of national guidelines on Infant & Young Child Feeding Practices National guidelines on Infant and Young Child feeding are being followed in the state. Breast-feeding is almost universal in MP; the challenge is to promote correct breast-feeding (i.e. feeding colostrums, exclusive breast feeding up to six months and introduction of semi- solids at age 6 months). The activities to promote breast feeding have been outlined in the section above. Because of the efforts made in this direction level of knowledge about early breast feeding, exclusive breast feeding, weaning at six months and breast feeding during sickness has shown an upward trend as reported by NFHS 3 and DLHS 3 data. Also refer to graph at page 24. Existing mechanism for counselling of mothers on nutrition and health issues by AWW/Supervisor during home visit: Pregnant and lactating women are given counselling on nutrition and health issues by AWWs, Supervisors, ANMs, LHVs during home visits. Members of Matri Sahayogini Samiti have also been trained to provide counselling to mothers. NHED kits for counselling are not available but IEC material developed by DWCD and DHFW on different health and nutrition issues is used during home visits. Efforts made under NHED have paid results as can be seen by improved health behaviour of women. For example, the prevalence of breast feeding within one hour and exclusive breast feeding for six months have almost doubled from DLHS II to III; the respective figures being 43% and 21% for breast feeding within one hour and 52% and 29% for exclusive breast feeding. 50 NHED sessions during VHND/NHD: Nutrition and Health Education Days (NHED) are observed on regular basis at AWCs. The NHEDs are synchronized with the Mangal Diwas activities. Behaviour change communication activities for improving health and nutritional status of women and children are carried out using charts, posters and other educational material obtained from the department of Public Health and Family Welfare, Development partners and other sources. Mothers attending the sessions are told about care of mother during pregnancy, care of newborn, breast-feeding, weaning, immunisation, giving ORS to children suffering from diarrhoea, personal hygiene, etc. Monitoring mechanism: Local ANM and ASHA, women from Mahila Mandal, Matri Sahayogini Samiti and other community based organisations attend VHND camps. Members of Matru Sahayogini Samiti also make home visits with AWWs. There is, however, scope for strengthening home visits by the stake holders. iii. Any specific intervention for tribal/ rural/urban AWCs in conjunction with line departments Specific intervention on health and nutrition education in conjunction with the line departments has not been formalised. But field functionaries of different departments cooperate with each other in carrying out specific activities like Kishori Balika Camps, NHED sessions for pregnant and lactating women and during community awareness camps. 4C 4. Immunisation i. Current immunization coverage rates DLHS 3 survey (2007-08) found out that complete primary immunisation (BCG, three doses of DPT and Polio, and Measles) coverage of children was low (36.2%). Coverage rates for immunisation from the Department of Public Health and Family Welfare for the last year are presented in the table below. Table 4.C.17: Coverage of immunisation of children for the years 2011-12 DPT Polio BCG Measles Achieve Achieve Achieve Achieve Target Target Target Target d d d d 172145 172145 172145 172145 1572480 1429934 1537695 1544001 4 4 4 4 Source: Directorate of Public Health and Family Welfare\ A total of 1620942 women received booster TT dose last year against an expected number of 2012633, out of whom 1941144 were registered for ANC check-up. Coverage for vitamin A in the last round (December, 2011) was 76% and for albendazole was 71% for children in the age-group of 9 months and 5 years. ii. Existing mechanism for immunisation services Immunisation for children and pregnant women is provided by the Department of Public Health and Family Welfare under its National Immunisation Programme. Immunisation sessions are held at AWC by ANM during her monthly visit to villages. The sessions are held on different Tuesdays, and Fridays if need be, of a month as per the micro-plan developed by district authorities. Tuesdays also happen to be Mangal Diwas Days at AWCs. This helps in convergence of services and provides platform for nutrition and health education activities. iii. Any specific intervention for tribal/rural/urban AWCs in conjunction with line departments 51 The districts and blocks where immunisation coverage is low will be identified in conjunction with DHFW. Special drives to improve immunisation coverage in these districts/blocks will be organised to improve immunisation coverage during 2012-13. Help of line departments will be taken in this special initiative. In the year 2011-12, “Supplementary Immunisation activity” was organised in Gwalior division (except Shivpuri) and Ujjain Division, a total of 13 districts. Children in the age- group of 9 months and 10 years were provided measles vaccine, wherein three departments DWCD, DPHFW and Education department converged. 4C5. Health check-ups i. Health check-ups of pregnant women and children Antenatal check-up of pregnant women is provided at the AWCs during the VHND sessions which are held by ANM during her visit to the village. These clinics are held once a month by rotation at AWC on Tuesdays, coinciding with Mangal Diwas activities (Goad Bharai, Anna Prasan and Birth Day events). Mangal Diwas are used as a platform to impart education to mothers on care during pregnancy (minimum three ANC, IFA supplementation of minimum 100 tablets, and TT injection), post-natal care and institutional delivery. Mothers are educated about diet during pregnancy and lactation. Family planning advice and contraceptives are also given to eligible couple. ii. Supply and composition of medicine kit during last F/Y All Anganwadi centres are supplied Medicine kits for management of minor ailments of mothers and children. The cost of medicine kit as per the guideline of MOWCD is Rs. 600/- per kit which is supplied to each AWC annually; for min-AWCs, it is Rs. 300/- per kit. The contents of the medicine kits are given in table below. During the last financial year, medicine kits to all AWCs (78929) were provided, including 12070 mini-AWCs. Table 4.C.18: Specification of Medicine Kits supplied to AWWs. Sr. Name of the Drug Packing Quantity No. 10x10 strip/blisters in 04 Pack 1 Paracetamol Tab. IP 500mg. cartoon (400 tabs) 10x10 strip/blisters in 2 Albandazole 15- Tabs cartoon Paracetamol Syrup IP each 3 5ml contains paracetamol IP 60ml bottle 04 bottles 125mg. Chloramphenicol eye 100 4 Coloured glass bottle ointment IP 1% W/W applicaps Providone Iodine ointment 5 5% USP (Available Iodine 15gm tube with cartoon 5 tubes 0.5%) Gama Benegene 6 100 ML bottle 4 Bottles Hexacholoride Oral Rehydration Salt IP 7 (WHO citrate formulae with 20.5 gms Sachet/Pouch 20 sachet anhydrous dextrose) Antiseptic Solutions contains Cholorohexidine GluconateIP 100 ML Elliptical Shape 8 02 bottle 1.5% v/v strong certrimide BP transparent PVC bottle soln, equilavelent to 52 centrimide IP 3% w/v 9 Absorbent cotton wool IP 400 Gms Roll 01 roll Rolled Bandage as per 10 schedule F-11 drug & 5 cms X 4 mtr Roll 01 Dozen Cosmetic Act Medicated Pad contains Bezalkonium Chloride One Strip Size App/19 11 Solution IP Equilavelent to 20 strips mm X 70 mm in glassine Benzalkonium Chloride 0.5% w/w Table 4.C.18-1: Specification of Medicine Kits supplied to Mini AWWs. Sr. Name of the Drug Packing Quantity No. 10x10 strip/blisters in 02 Pack 1 Paracetamol Tab. IP 500mg. cartoon (200 tabs) 10x10 strip/blisters in 2 Albandazole 70 Tabs cartoon Paracetamol Syrup IP each 3 5ml contains paracetamol IP 60ml bottle 02 bottles 125mg. Chloramphenicol eye 50 4 Coloured glass bottle ointment IP 1% W/W applicaps Providone Iodine ointment 5 5% USP (Available Iodine 15gm tube with cartoon 5 tubes 0.5%) Gama Benegene 6 100 ML bottle 1 Bottle Hexacholoride Oral Rehydration Salt IP 7 (WHO citrate formulae with 20.5 gms Sachet/Pouch 10 sachet anhydrous dextrose) Antiseptic Solutions contains Cholorohexidine GluconateIP 100 ML Elliptical Shape 8 1.5% v/v strong certrimide BP 01 bottle transparent PVC bottle soln, equilavelent to centrimide IP 3% w/v 9 Absorbent cotton wool IP 200 Gms Roll 01 roll Rolled Bandage as per Half Dozen 10 schedule F-11 drug & 5 cms X 4 mtr Roll (06 rolls) Cosmetic Act Medicated Pad contains Bezalkonium Chloride One Strip Size App/19 11 Solution IP Equilavelent to 10 strips mm X 70 mm in glassine Benzalkonium Chloride 0.5% w/w 53 iii. Status of three antenatal coverage of pregnant women during last year ANC services are provided by ANM during the monthly visits to AWCs by rotation. The ANC checkups are generally done at the AWCs. The AWWS assist the ANM in mobilising the mothers and in conducting ANC clinic. According to data of DHFW, ANC registration in MP was 96%, while 3 ANC visits were paid to 77% pregnant women in FY 2011-12. iv. Supply of IFA tablets to pregnant women through RCH IFA tablets, large and small, are supplied to all Sub-Health Centres by the DHFW under the RCH II program. The ANMs, in turn, supply IFA tablets to the AWCs for distribution to women and children. IFA tablets were distributed to 80% of pregnant women in the State during April 2010 to Jan 2011 (www.mp.gov.in. health bulletin). During the period under reference, all AWCs were supplied IFA tablets. There is provision for purchase of IFA tablets by DWCD, in case there is supply break down from DHFW. Control of adolescent anaemia is also a component under SABLA program. v. Strategy to improve health check up during the FY Coordination between the departments of WCD and HFW will be further strengthened to improve health checkup of mothers and children during the financial year. Greater role of PRI to motivate the community and community monitoring of the program will be attempted. Emphasis on inter-personal communication will be given in IEC activities . vi. Specific intervention for tribal/ rural/urban AWCs in conjunction with Tribal/ Rural/Urban development department No specific intervention for tribal/rural and urban groups to improve health check-up in coordination with the line departments was planned during the last financial year. The possibility of improved inter-sectoral coordination between the concerned departments will be explored during the next financial year. vii. Linkage with AYUSH : No linkage can be done with AYUSH 4C 6. Referral services i. Existing mechanism for referral services AWWs refer pregnant women and children requiring medical advice/care to local ANM during her monthly village visit or to Sub Health Centre. But women/children who need special advice are referred to Primary Health Centre/Community Health Centre and District Hospital in the area. As per MPR data March 2012 21599 pregnant and lactating women were referred to higher health facilities that includes PHC/CHC/DH ( out of 21599, 18673 were referred for normal delivery, 1564 were referred due to complication and 1362 were reffered for other services from AWCs). During the same reference period 54036 children were referred by AWWs to various helath facilities, out of which 27452 children were referred for Pheumonia, Dirrehea and Fever, 17221 severely underweight children were also referred. ii. Constraints in effective referral There is no effective system of referral of clients between AWCs and the health facilities. This is a great constraint in the referral system. Absence of a referral card in the Anganwadi Centres is also a constraint. iii. Strategy to improve this component during the F/Y It is proposed to develop and supply referral cards to the AWCs for referral of clients to higher centres. Efforts will also be made to discuss the problem with the local ANM/Block 54 MO to evolve a robust referral system so that the clients referred are received at the referred centre promptly and given appropriate services. Allocation for printing of referral cards @ Rs. 10 per AWW = Rs 10 x 80,000 = 8, 00,000 it is proposed to include this under ABM. 4D Observance of Village Health and Nutrition Day a) Mechanism for observance of monthly Village Health and Nutrition Day MOHFW guidelines describes the importance of conducting monthly Village Health Nutrition Days, which defines the required relevant procedures and logistics; the role of each cadre of health worker including supervisors; and the various activities that should be conducted on the day. Under NRHM the Village Health and Nutrition Day is planned to provide comprehensive Maternal and Child health and nutrition services, ensure early registration, identification and referral of high risk children and pregnant women. The department of WCD actively participates in Village Health and Nutrition Days organized by the department of HFW. VHNDs held once a month in the villages covered under sub health centre area by rotation. Women and children, particularly pregnant and lactating women, in the village are mobilized for attending the meeting. Village Health and Sanitation Committee members, members of Matri Sahayogini Samiti, Mahila Mandals, SHG, and other community based organizations are also contacted to extend support for VHNDs. a) Summary of activities that are taken up during the Village health and Nutrition day VHND activities are jointly carried out by health staff (ANM/LHV), AWWs and ASHA. AWWs play important role in community mobilization besides helping in organizing the activities. VHNDs are generally held at sub health centre or AWCs. Pregnant women are registered for antenatal care, and health check up of women is done. Two doses of tetanus toxoid vaccine are administered and IFA tablets (total 100 tablets) are given. Children who attend VHND are given health check up. Primary immunization (BCG, 3 doses of DPT and Polio each, and Measles) is administered to children and Vitamin A supplement is also given. Mother and Child card is used to record the services provided to the beneficiaries. IEC activities on nutrition of pregnant/ lactating women and children, importance of immunization, family welfare methods, and personal hygiene form important aspect of VHND activities The different activities are organized at VHND like Health and Nutrition Education, immunization, PNC, Exhibitions etc. The MIS reveals that AWW imparted Health and Nutrition Education in 98 % sessions and organized exhibitions in 89% of session out of total they attended. b) Support received from community/ PRIs for observance of NHD Support is sought from community/ PRIs for observance of Nutrition and Health days. The support is extended by way of participation in the event, community mobilization, publicity, use of PRI resources including Panchayat Bhavan) to organize the events. PRI members were present in 91% of VHNDs organized in the state. 55 c) Specific intervention for tribal/rural/urban AWCs in conjunction with line departments Currently no specific intervention for tribal, rural and urban tAWCs with line departments exists. But the department of WCD proposes to conduct one day orientation program for all PRI members on ICDS services and the contribution that can be made by them. All the line department representatives will be involved in the orientation program. The activity will be proposed under the auspices of Atal Bal Mission. Following this, the involvement of the line departments in NHD activities would increase. Table 8. Village Health and Nutrition Days No. of Average No. Average Average Average Target for Means of AWCs of AWCs No. of No. of No. of FY verificatio operational reported VHNDs VHNDs VHNDs (2012-13 n (MPR) (2011-12) conducting attended attended attende AWCs to monthly by AWCs by d by be VHNDs (2011-12) Supervis PRI covered (2011-12) ors (2011- for (2011-12) 12) monthly NHDs) 78929 62776 66713 62248 56865 80160 MPR Source: MIS DWCD Is has been observed that the percentage of AWW attended VHND during 2011-12 was 106 it is because they provide their services at different venues where ever VHND is organized viz. Panchayat Bhawan, Sub Centre etc. 4 E Information Education and Communication a) Activities carried out under IEC component during last year; The ICDS programme under the aegis of Department of WCD aims to improve the nutrition status of children and mothers. In order to attain the programme objectives Behaviour Change Communication is an important driver to improve health and service 56 seeking behaviour alongside the service delivery. The key focus areas of the ICDS programme are- Infant and Young Child Feeding (IYCF) practices Immunization Growth monitoring Pre-school education The department uses a mix of traditional and modern media to reach out to the target audiences. There is a lot of focus on inter personal communication activities through AWWs. In order to create mass awareness on schemes, issues and to connect with the AWWs a number of publications are published. Last year (on October 6, 2011) Chief Minister of Madhya Pradesh launched “Beti Bachao Abhiyan”, for which the DWCD is the nodal department. A summary of the IEC activities carried out are as follows: Publications Radio Observatio Inter Community Other n of special Personal platforms channel days Communicati s on AnaganwadiSamac Radio has Focused AWWs are the Engage To harika been used disseminatio primary Community enhance A monthly news effectively last n of channel of Based reach letter to disseminate year to messages IPC ensuring Organization and information to generate around maximum s to conduct impact a AWWs about new awareness on specific reach to the community mix of guidelines and ICDS program themes beneficiaries mobilization mid activities and specific through (Mahila media issues. observance Mandal, channels of special Matri have days Sahayogini also Samiti, Self been Help Group) used last year Calendar Channels Women Area of -Nutrition - Depict success Use of 12 focused concern Health and Exhibitio stories on women centers of All International Lack of job Education ns empowerment and India Radio Women’s aids for Day -Street prevention of female and Vividh Day-March effective IPC -Village shows foeticide Bharti 8 and Health and -Cinema program in MP Safe counseling Nutrition slides Motherhood sessions Day (with -Rallies Day- April NRHM) - 11 Worksho World ps Breastfeedin - g week-1- Seminar 7August s Adolescent -Painting focused competiti National on Girl’s Day- -Mangal January 24 Diwas 57 Adolescent Girls week- July 25-31 Stop Child Marriage campaign- throughout the week with focus around Akshay Tritya Others ICDS day- October 2 Children’s day- November 14 Nutrition week September 1-7 Badhte Kadam Programmes Behtar Kal Stories (marching towards Radio drama better tomorrow) Songs Talks and Discussions Jingles Radio spots Phone in facility Information booklet Key focus on Ladli Laxmi and areas IGMSY Breast feeding Immunization Complementar y feeding Folders, booklets, pamphlets, posters Increase awareness on nutrition, health, immunization, breast feeding b) List of IEC materials that have been developed IEC material developed by the department has been outlined in the previous section. Posters have been supplied to AWCs. During last financial year Public Address systems were procured and supplied to all 453 Projects and 7 Divisional Bal Bhavans. 58 c) Details of campaign organized on nutrition and pre-school education No.of No. of No. of Allocation Estimated Means of operational AWCs AWCs and budgetary verification AWCs supplied carried out expenditure requirement (UCs) (2010-11 IEC any IEC during last for the F/Y) material campaign year financial year during during last last year year 78929 All AWCs IEC is Allocation Activity-wise: IEC activities were carried out 789.29 lakhs 1.IEC material will be supplied during home Exp. @ 1000/- per reported IEC visits and 744.30 AWC (for 80160 through MPR material Mangal lakhs AWCs)= Diwas. Rs. 801.60 Occasionally lakhs IEC campaigns are carried out during special occasions as outlined above. d) Activities that are planned during the current year As mentioned in the sections above, there are a number of activities that have been conducted by the department last year ranging from publications, radio programmes, IPC through AWWs, special events around specific days and producing IEC materials. This year the ICDS programme will aim at identifying thematic focus more specifically and enhancing reach through a 360 degree communication approach. The 360 degree communication approach involves the use of multiple channels of communication (mass media, information communication technology such as mobile phones, IPC and community mobilization) to create a diverse, yet synergized, communication environment that supports social and behavioural change. In Madhya Pradesh only about 30-40% of the population has access to mass media, therefore, the adoption of a 360 degree approach, is seen as a necessity. This year the department will leverage effectively on the activities conducted and platforms used last year with defined focus areas along with a multi-channel approach to bring about behaviour change. A detailed communication implementation plan will be developed to ensure proper implementation of the planned activities. This will be coupled with an evidence based media plan to maximize reach and impact. Alongwith this a monitoring and evaluation system will also be put in place to track changes in the key indicators around priority thematic areas. In order to implement the BCC activities following are the pre-requisites- 59 Capacity strengthening of IEC officials across various levels (Technical Assistance to be provided by BBC-World Service Trust through DFID support) IPC skill strengthening of Aanganwadi Workers (Technical Assistance to be provided by BBC-World Service Trust through DFID support) Details are provided in the capacity building section Creating communication outputs (Technical Assistance to be provided by BBC- World Service Trust through DFID support) 4F. Monitoring and evaluation a) Existing monitoring and supervision mechanism at different level The main tool of monitoring of ICDS program in the State is monthly progress report data received from the field starting at AWCs and reaching the state monitoring cell. Although huge amount of data is collected through this system, currently it is not put to effective use for management purposes. It is realized that the data is neither complete (because of different number of AWCs reporting in a given month), nor accurate. Accuracy of data is not ensured because the AWWs are not fully trained (particularly those whose literacy levels are low) to maintain records and fill up the MPR forms. They also are not aware of the importance of the MPR for program management. The supervisors also do not check the data for its accuracy and completeness. At the state level the team handling the data is not trained for its collation, analysis and interpretation for management purposes. The department has recently put in place a web enabled system for data collection from the periphery to the state headquarter and, once fully operational, is expected to improve monitoring of the ICDS program activities more effectively. Training of the staff will be undertaken in use of new web enabled monitoring system at all levels. The state proposes to introduce and establish a system of data verification through independent third party audit. This will be done on a regular basis so that all the 50 districts and 313 blocks are covered in a year. The Department with the support of MPTAST has recently completed a data verification study on routine MIS. The findings and recommendations suggested by the study would be adopted for improving the quality of data. In addition, concurrent monitoring system would be implemented to evaluate and assess the performance of various activities at regular intervals. This concurrent monitoring system will provide ifnromation on key parameters of the program and will serve as guide for taking mid- course corrections to improve the programme activities for achieving the desired outcomes. b) Constraints in monitoring and supervision (human resources, capacity building and mobility of functionaries) Supervision of the program is undertaken by supervisory level functionaries/ officers at different levels i.e. sector level, project level and district level. A unique, initiative was taken last year by the Hon. Minister of WCD and the Commissioner / Director of the department by personally visiting the AWCs and checking the program implementation including SNP. .However, the need for a strong and formal system of supervision and monitoring cannot be over-emphasized. Capacity building of staff for monitoring has already been highlighted in the above paragraph. Lack of mobility of supervisory staff at different levels is also an important constraint 60 d) Assessment/ evaluation studies undertaken No assessment or evaluation study has been undertaken by the department in the last two years. But the study by National Institute of Nutrition (ICMR), Hyderabad which has been commissioned by the state to assess the level of malnutrition among children and the underlying factors will provide district-wise baseline information and epidemiological determinants of malnutrition. The data will be used for district-level planning of activities to control malnutrition e) State has rolled out revised MIS as prepared by MWCD The State has not yet rolled out revised MIS system prepared by MWCD. But it will be incorporated in the web enable monitoring system early next financial year. f) State’s strategy to improve the existing MIS State proposes to introduce revised MIS developed by MWCD on the web enabled platform to improve MIS for ICDS program activities. Along with the introduction of the new MIS system, training of staff at different level will also be undertaken to develop capacity of staff to use the new information system. In addition, it is proposed that a nutrition surveillance system will be designed and developed in the state to identify high risk pockets and also to understand the causal factors along with social-cultural attributes associated with prevalence of malnutrition in the state. The nutrition surveillance system will be interfaced with the existing web-enabled MIS so that data synchronization can take place in a systematic manner. The nutrition surveillance system will provide regular information at micro and macro level on issues of malnutrition and its level. The information would be helpful in identifying the SAM children and would be utilized in tracking malnourished children at micro level. This will be further supplemented by innovative use of mobile phone technology for improving the MIS system and tracking of SAM children. The use of mobile phone technology will also be used for supportive supervision and improving feedback mechanisms at field level. The state propose to pilot such innovations using ICT tools (such as mobile phone/PDA technology) for improving the MIS system as well as in better management of SAM children through real time data analysis and tracking of children and other beneficiaries. g) Community monitoring mechanism DEVELOPMENT PARTNERS is running a community monitoring system in one of the districts (Guna) of the state. Based on the experiences gained, community monitoring system will be gradually scaled up in other districts as well. h) Structured feedback mechanism Although some feed back is provided to the functionaries at the ground and middle level by the supervisory staff there is as yet no structured feedback system in place. Supervisors do provide feedback to the AWWs during their supervisory visits. A structured feed back format and system will be incorporated in the training of staff at all levels which is being proposed as part of introduction of new MIS of MWCD and web enabled reporting system. 61 Table 10. Monitoring and Evaluation No. of No of No. of No. of Allocation & Estimated Means of operational AWCs blocks review Expenditure budgetary verification AWCs as having using IT meetings during last requirement in March revised for MIS held at the year for FY 2012 records state level (Rs. 500 and during per AWC registers past year 78929 Currently All 453 Review Allocation 80160 MPR using old Blocks are meetings 200.00 AWCx Rs. records using IT held as lakhs 500/ AWC and for MIS part of ------=400.8 registers piloting Exp. lakhs web- 173.42 enabled lakhs reporting system 4G Training and capacity building a) State Training Action Plan State Training Action Plan is prepared by the State annually and submitted to the MOHFW. The training cycle of the workers is fixed. The annual training load is calculated on the basis of new recruits requiring training (induction training) and the number of workers who need refresher and job training during the year under reference. Training backlog of the workers is calculated on the basis of number of staff undergone training during the previous year. Induction training of new AWWs sanctioned by MWCD is currently under progress. Training of AWWs and supervisor is carried out by AWTCs and MLTCs. Training of senior level staff is undertaken by NIPCCD for which programs are designed and communicated to the State. As yet, there is no computerized record of workers undergone training and requiring training. But this will be achieved by developing a suitable software and linking it to the web of ICDS program. b) Training needs assessment ICDS functionaries No formal TNA has been carried out by the state. But training needs assessment is informally assessed by discussion with the supervisory staff and communicated to the higher level. Additionally, results of evaluation of ICDS program which has been conducted under ODISHA project is taken into account while conducting training of workers by AWTC and MLTC. c) Available training resources in the state (AWTCs, MLTC and SRCs) There are 10 AWTCs run by DWCD while another 15 are run by NGOs. During the financial year 2012-13 a new AWTC has been sanctioned by GoI at Rewa. The AWTCs run by the NGOs are financed by the government. The two MLTCs in the State are run by the government. The list of AWTC and MLTC is given in annexure 3. The State Resource Centre is located at Bhopal. 62 d) Detailed training calendar Detailed training calendar for all the training institutions is prepared annually. A copy of the training calendar is placed at annexure 5. The state training calendar is based on the training calendars submitted by different training institutions. e) Monitoring and supervision mechanism The training activities are monitored through the information submitted by the training institution after completion of each training conducted by them. Information is also collected from the training institutions as and when required. f) Review of the performance during the last two years as per QPR Review of the capacity of the training centers has not been undertaken during the current financial year. But performance review is carried out during annual planning meeting of the Principals of the AWTCs and MLTCs. The last meeting of the Principals of training centers was held on 19th March 2012 where training activities were reviewed and the Annual Training Plan was discussed and finalized. . Information from the centers is also collected periodically as per the need. g) Proposal for other training activity Training programs have been proposed under different program heads, besides the regular training activities conducted by AWTCs and MLTC. State has developed web based MIS system and proposes Rs 1753.95 lacs for training all the functionaries ( AWW, Supervisor, CDPOs’ DPOs, DWCDPOs’, DDs, etc) on online MPR. For the year 2012-13 State has proposed two study tour one each at Maharashtra and Andhra Pradesh which will amount to Rs. 10.00 Lacs h) Financial requirements (details on Annexure5) i) Induction training, Job training and refresher training by AWTC/MLTC DWCD vide its letter No. WCD/583/Trg/2012 dated 25 April 2012 has submitted a proposal to MWCD, GOI for annual training activity for the F/Y 2012-13. (Details are placed at annexure 5). A budget of Rs. 947.54 lakhs has been proposed by the state for carrying out induction training, job training, refresher training and establishing new Aganawdi Training Centre in Rewa, MP. during the financial year 2012-13. The state also prosposes to train 12070 mini AWH which will cost Rs. 162.81 Lacs 4 H. Convergence with line departments a) Existing mechanism for convergence and coordination with line departments Core committee for Annual PIP for ICDS has been constituted. A Steering Committee under the chairmanship of the Principal Secretary, DWCD has also been constituted. The Core Committee and Steering Committee will not only provide guidelines for preparation of Annual PIP but would review its progress and of the ICDS annual program. Several activities of the Department of WCD and HFW e. g holding of VHND, NHD, antenatal, immunization sessions, Mangal Diwas at the village level are held jointly by the 63 functionaries of the two departments. Sanjha Chulha program is an example of coordination between departments of WCD, Education and Panchayat & Rural Development. Training of AWWs in PSE with financial and technical support of District Education Centre is yet another example of the interdepartmental coordination. Construction of AWCs with BRGF funds of department of Panchayat and Rural Development has been similarly undertaken as joint effort between the two departments to promote health and nutritional status of women and children. Consultations are also held between different line departments, particularly Public Health and Family Welfare, for implementation of ICDS activities. Area and activities of convergence between the WCD and HFW departments have been detailed under section on situation analysis (page 6) of this document. The inter-department convergence will be further strengthened with the launch of Atal Bal Mission which will serve as the umbrella organization for reviewing and supporting activities of the two departments for the purpose of promotion of health and nutrition in their various dimensions. The new SABLA program creates platform for interdepartmental coordination and convergence for improving health and nutrition of adolescent girls. a) Status of joint planning with health at district, block and village level The Department of WCD has been participating in the preparation of Annual Plan of Action for National Rural Health Mission at State and district levels. Similarly, for the preparation of Annual PIP of the Department of WCD consultations were held with the department of health and other line departments at village, block and district level for decentralized planning. b) Joint visits /review with health and other departments Joint visits, as per program requirement are made by the officers at the district and block level to the AWCs in connection with program activities and occasionally for supervisory purpose. The number of joint visits undertaken by the middle level and grass root functionaries of the DWCD and DHFW during the last year is shown below. Table 11. Convergence No. of blocks that No. of districts/blocks Average No. of Means of have developed having integrated ICDS AWCs reported verification micro plans for plans with conducting (Review reports/ VHNDs with NRHM/TSC/NRDWP/SSA monthly VHND Field visit reports) health plans with participation of ANMs during previous year All Done All 78929 AWCs MPR (March 2013) conducted monthly VHND meetings with ANMs No. of sector No. of blocks that have No. of districts that MPR (March 2013) meetings attended organized convergence have organized by health staff meeting of ICDS, health, convergence PRI and other line meeting of ICDS, departments. health, PRI and 64 other line departments 13564 sector Information not available Information not MPR (March 2013) meetings were available attended by health staff Budget: An amount of Rs. 50 lakhs (Rs. 1 lakh per district) has been proposed for convergence meetings and workshops for all line departments. 4I Community participation and involvement of PRIs a) Existing mechanism for community participation The role of PRI is very important in the implementation of ICDS program. PRIs are involved in a number of ways to support ICDS program activities. For example, AWWs and AWHs are selected by CDPOs on the recommendations of Gram Sabha. Selection of the site for construction of AWC building is also done by Gram Sabha. In fact, Gram Sabha provides land to the department of WCD for construction of the AWC building. Involvement of PRI, however, depends to a large extent on the rapport between the AWW/ Supervisor of the area and the PRI members and, therefore, varies from village to village. The support of PRI may range very widely. In two districts viz. Damoh and Sidhi, Janpad Panchayat (Block Panchayat) are running ICDS projects. This is an example of PRI owning the program. Similarly, two NGOs are managing ICDS projects. The PRIs extend support to AWW for mobilization of community support, motivating mothers to attend health check up, immunization sessions, conducting Mangal Diwas, observing special days e,g. Breast Feeding Day, etc. Village Health and Sanitation Committees have been formed in all the villages of the state. These committees are part of Village Panchayat and are responsible for planning and implementation of health and nutrition related activities. The scope for PRI involvement in a larger and intensive way so that the program is owned by the peoples’ institutions is as yet limited. To increase it, the department of WCD proposes to conduct one day orientation on ICDS for Sarpach, and Mahila members of the Panchayat and members of VHSC. b) Percent of AWCs participated in at least one Gram Sabha meeting during last year Gram Sabha meetings are supposed to be held monthly. But very few Gram Sabhas meet on monthly basis. The Department of Panchayat and Rural Development mandates that Gram Sabhas meet at least four times a year on Republic day (26 Jan), Independence Day (15 Aug.), 2nd October (Gandhi Jayanti) and 14 April (Baba Saheb Ambedkar Jayanti). All the adult members of the village are members of Gram Sabha. AWW of the village, being a resident of the village, is a member of Gram Sabha and participates in the meetings as and when the meetings are held. c) Percent of AWCs received support fom Panchayat/ CBO (SHGs, etc) All AWCs receive support from PRI in different form as discussed under a) above. c) Percent of monthly Gram sabha meetings attended by AWWs Department and Panchayat and Rural Development mandate that AWWs attend meetings of Village Health and Sanitation Committee. This committee is one of the several 65 committees of Village Panchayat and looks after health and nutritional related activities in the village; Data on percent of Gram Sabha meetings attended by AWWs is not available. d) Percent of monthly Panchayat Samiti meetings attended by ICDS staff This information is currently not available. e) Number of districts where Zila Parishads have reviewed ICDS program Swasthya and Mahila Bal Vikas Samiti is a special committee of Zila Parishad. It meets bimonthly and reviews ICDS program implementation in the district. Budget: An amount of Rs. 665.0 lakhs has been proposed for orientation of PRI members in ICDS program ( Key initiatives, page 68) 4 J Financial management and fund flow mechanism a) Fund flow mechanism from State to Districts/ Block Funds are transferred from the state to the district for program implementation. The allocation is given as per the norms of the GOI and is demand base. Funds for honoraria of AWWs and AWH and salary of staff are transferred to the project directly. Funds for SNP are, on the other hand, transferred to District Pancahat. The district Panchayat, in turn makes allocation to the Janpad Panchayat for Sanjha Chulha. (for supply of hot cooked meal through SHGs which are contracted for the purpose). State government has issued detailed guideline about the contents of the meal, its nutritional value and cost. The SNP program is supervised by the department functionaries for food quality and regularity. The POL, contingency funds and rental of AWC building (if they are housed in rented accommodation) are also passed on to the CDPO as per the government of India norms. PSE kit budget has been decentralized as recommended by GOI and given to the districts. The Districts are now authorized to purchase PSE kits as per the standard contents recommended by GOI. b) Steps taken to ensure timely payment of honoraria of AWWs/ AWHs The budget for payment of honoraria has been transferred to the Block level (CDPO office, the lowest office which has accounts assistant to manage budget and accounts). CDPO is the Drawing and Disbursing Officer at Block level for ICDS activities.There is, therefore, no delay in payment of honoraria to AWWs and AWHs. Similarly the SNP funds have been given to Janpad Panchayat (Block Panchayat) for smooth functioning of nutrition supplement program. c) State’s plan for establishing Society structure under ICDS set up Society structure has been set up under Atal Bal Mission. Currently the society has been set up at state level. But district level society structure is envisaged. Once the Society at the district level is established under Atal Bal Mission the government may consider bringing the functioning of ICDS under Atal Bal Mission Society frame work. d) Detailed minor head-wise break-ups of allocation for different program activities Head-wise break up of allocation is detailed in table 13. e) Statement of expenditure (SOE) of previous year Statement of Annaul expenditure of previous year (2-11-12) is enclosed at annexure 8. 66 4 K New Initiatives to Strengthen ICDS Program during 2012-13 Over the last more than four decades, ICDS program in MP has expanded considerably, both in content of services and geographical and population coverage. The progress of the program to achieve its objective of improvement of nutritional and health status of the children under five has been successful to a large extent.. Yet a lot of ground remains to be covered as nearly half of the children in the state are underweight. In the year 2010 the State launched the Atal Bal Mission with the explicit objective of lowering of the mortality rate among children under five and reduction of prevalence of malnutrition, particularly Sever Acute Malnutrition (SAM). The Mission document outlines the strategies and activities to achieve these goals. The DWCD has reviewed the performance of the program while documenting Annual PIP, 2012-13. The document has followed the guidelines provided by GOI while preparing the PIP. Yet the Department (WCD) feels that additional thrust is required to address some state specific problems and to strengthen program activities. The strategy and planned activities to strengthen the program activities have been outlined in the following pages. 1. Orientation for Community Participation in ICDS program Rationale: Programs like ICDS, which has people as its target, cannot succeed without their informed participation. Involvement of community, PRIs, CBOs and village level opinion leaders, in the activities of ICDS and ultimately its ownership of the program is thus essential for its success. At present, community sees, by and large, ICDS as a government program. This has to be changed to people accepting that ICDS is their own program for the benefit of their own children. Activity proposed to improve community participation As a first step the community needs to be informed about the activities of ICDS program (and health) and its importance for the health and nutritional wellbeing of children, and pregnant and lactating women and adolescent girls. The aim of the present initiative is to create awareness about the program and their involvement in micro planning of its activities and community monitoring. It is proposed to organize one day orientation program on ICDS for community leader, PRI, VHSC members, etc. In each of about 55,000 villages in the state five to six persons will be oriented on ICDS program. Outcome- Awareness of community leaders about ICDS and through them the community increased. Indicator No. of villages covered under orientation program and in each village number of persons oriented. Timeline- II, III and IV quarter of 2012-13 67 Budget: i). Training of PRI, CBOs, VHSC members etc- 55,000 villages x 6= 3,30,000 @ Rs. 150, per participant (travel, food, stationery, payment to trainers, etc) = 495.0 lakhs ii) Resource material and information booklet @ Rs 50 per participant & trainer i.e.3, 40,000 x 50 = 170 lakh Total i) and ii) = Rs.665 lakhs 1. Appointment of additional AWWs in selected AWCs Rationale: There are about 11,000 AWWs in the state who are illiterate (4556) or have less than V standard educational status (6394). It is unrealistic to expect that these educationally handicapped women will be able to undertake growth monitoring, maintain records and registers, submit MPR data or carry on PSE activities. Activity It is proposed to appoint additional AWWs in these AWCs and/ or those where the problem is acute because of other reasons. The department of HFW, for example, has appointed additional ANMs under its NRHM program to strengthen the sub health centres where there is a need to do so. The new AWWs will be given honorarium permissible to AWWs of Mini AWC (i.e. Rs. 750/- per month) and will help existing AWWs in performing their duties more effectively. The CDPOs will be asked to appoint the additional AWWs on the recommendations of Gram Sabha. Outcome AWCs strengthened by appointment of additional AWWs in selected AWCs. Indicator No. of additional AWWs appointed, trained and posted at identified AWCs Time line II, II, IV quarters Budget: i) Induction training of 11,000 AWWs at AWTC (20 trainees per batch i.e. total 550 batches. Training cost per batch @ Rs.27,000 per batch as per GOI norm) Total training cost = 27,000 x 550 batches = Rs. 148.5 lakhs ii) Honoraria to additional AWW @ Rs. 750 p.m. / AWW for six months during 2012-13 = Rs 495 lakhs. Total of i) and ii) = Rs. 643.50 lakhs 2. Training of AWWs in Inter-personal communication Rationale: Conventional IEC approach i.e. communication through print or electronic media are not very effective in changing the behavior of mothers about breast feeding, supplementary feeding, health seeking behaviour for immunization and in case of illnesses of the children, additional diet during pregnancy and lactation, iron supplementation etc. These issues are 68 related to their personal knowledge, attitudes and practices. Inter-personal communication is best suited to bring about behaviour change among women and influencers. BBC-World Service Trust through DFID support will be providing Technical Assistance to DWCD for designing the IPC training component along with Job aid and will assist in implementing the training through the proposed model in a phased manner. Activity: It is proposed to hold training of AWWs in inter-personal communication so that they can bring about behavior change in mothers and influencers. The training will be done in a step ladder manner as follows: IPC experts will train 60 selected CDPOs as Master Trainers in the technique of IPC. The CDPOs will be selected from all the CDPOs based on their interest and existing skills. The training will be at State HQ or some other suitable place. The training will be of two day duration. Each team of two CDPOs (Master Trainer) will train Supervisors in batches of 20 Supervisors. Total five batches will be trained by every team. (Thus training load on each CDPO team will be 100 Supervisors in five batches of 2 day each). MT can stagger the training @ one or two training per week so that her own work does no suffer. The Supervisors will act as Trainer of AWWs for their respective clusters, covering 25 AWWs each. The training may be of two sessions of half day each or one full day session. The Supervisor will hold half day refresher training every month to reinforce the skills of AWWs in IPC. (a) Suitable training modules will be developed for use of Master Trainers and Supervisors. (b) Also job aids will be designed and printed for the use of AWWs in the community during home visits, NHED sessions, during visit of women to AWC etc. Hands on training in the use of the flip books will be imparted by Supervisors to AWWs in live situations. (c) The training will be supported by Development Partner working in state and having experience of imparting training on the issue. Outcome- Skill of AWWs and Supervisors in IPC improved Indicator- No. of AWWs and Supervisors trained in IPC technique and no. of them started IPC during different sessions (home visit, AWC visit, NHED sessions, etc).IPC training will also be monitored by number of Supervisors holding refresher training for AWWs every month. Time line- II.II and IV quarter of 2012-13.. Budget- i) Training of 60 Master Trainers (CDPOs) by experts in IPC (Including fee of experts) = Rs. 1.0 lakhs ii) IPC training of Supervisors by Master Trainers CDPOs) 3000 Supervisors x 150 = Rs. 4.5 lakhs iii) Honoraria to CDPO – Rs 150 / batch x 5 batches per Master Trainer = 750.0 69 Total honoraria to 60 Master Trainers= 750 x 60 = Rs 45,000 iv) Training of AWWs in IPC by Supervisors Rs. 100 per AWW/ day 80,000 AWWs x 100 = Rs. 80.0 lakh v) Honoraria to Supervisors for training AWW (Rs. 200) for two trainings Total honoraria to Trainers (Supervisors) – 3000 x 200 = 6.00 lakhs vi) Expenditure on training modules, stationery, etc. (Rs. 20 per participant x 80,000) = 16 lakh vii) Development and printing of job aids for AWWs – 80,000 x 200 = 160 lakhs Total of i) to vii) above= Rs. 267.95 lakhs 3. Mobile tracking system for program activities and malnourished childrenSAM children At present, ICDS programme activities are monitored through MPR. Monitoring by MPR has several shortcomings because apart from incomplete and inconsistent data the information reaches the program management after several weeks. Timely action on the basis of field data is not possible. To monitor the services being provided by AWCs and to track the status of severly malnourished children on real time basis is a challenging task. It is, therefore, proposed to introduce a system of mobile tracking of AWC services. Activity Under the scheme it is proposed to utilize existing private call centres / mobile telephone sevices to receive daily information from the AWWs. The sector supervisors will collect the information about functioning of AWCs, distribution of SNP meals/ THR, attendance of children in PSE program, home visits made, VHND held, etc. A fixed time will be used to contact the AWW who will be available with the required information. The Supercisor, in turn, will pass on the collated information to the Block/ District units. Close monitoring of the activities of AWCs will be possible by this system. Wherever necessary (such as AWCs not opening, SNP not being distributed, etc) prompt action will be possible by the management on receiving information from the field. Outcome Information about the AWC activity and surveillance of malnourished children is strengthened. Indicator Number and percentage of AWWs contacted through mobile tracking system Timeline II, III, IV quarters of 2012-13. Budget: Rs.5.00 per day x 300 days for each AWC=Rs 1500 x 80160 = Rs.1202.4 Lakhs 4I. Special request for better Services 4I.1. Budget for construction of AWC Buildings: 70 There 37392 AWC are running in rented building, 20595 in other building and 1231 AWC are newly sanctioned. Hence state proposes requirement of Rs. 2416.13 Crores for construction of 41231 new Anganwadi Building. 4I.2. Increase in rent of AWC and Project Office The rent for urban AWC is Rs. 750.00 per month and for rural AWC is 200.00 which is quite less for the required space to run all the activities at AWC. Hence we propose increase in rents for urban to 1000.00 and rural to 500.0 . Similarly, the project offices are functioning either from Government building or rented building, in rented building there is a constraint bof space for storing THR in the present rent rate . Hence we propose rent for 268 project office cum godown @ Rs 3000.00 per month. The total budget required for AWC and project office rent will be Rs. 28.12 Crores. 4I.3. Uniform for children Like primary school and private schools have uniform for their children, so to bring uniformity in the children who come to AWC we propose to provide them a set of uniform to chidren between 3 to 6 years of age group. There are 40lakhs children who fall in the age group of 3- 6 years the budget required will be Rs. 100.00 Crores (@Rs.250.00) 4I.4.Transportation of THR from CDPO office to AWCs The unit cost for SNP is Rs. 4 which includes the cost of transportation also, but this amount is not sufficient for providing SNP excluding transportation, Hence we propose addition budget for transportation of SNP from CDPO to AWCs - 80160*2Quintal*50* 12 = Rs 9.61 Crores. 71 SECTION 4: SUMMARY OF ACTION PLAN Table 14: Physical Targets and Financial Estimates S. Program Intervention/ Unit Norm Time Physica Financial N Components Activities Line l (Rs. . Lakhs) 1 2 3 4 5 6 7 8 1 Human Filling of vacancies Targets Resources State level 98 See 100% District level 231 (73 table 100% vacant) AG Block level 2673 (794 at 100% vacnt) page Sector level 3157 (429 76 of 100% (Supervisors) vacant) the AWC level 80160 AWW repo 100% (3074 rt for vacant) time line 100% 80160 AWH (3972 vacant) 100% 12070 AWW (Mini AWC) Salary of ICDS staff (see details at table 4.A.4 Page 32) State 98 436.62 District 231 709.82 Block/Sector 5860 14905.80 AWC 172390 45003.6 SUB- TOTAL-1 61055.85 2. Administrative Rent/ Vehicle/Contingency cost Rent AWC Rural/Tribal Rs. 708.4 AWC 29517 200/m Urban AWC 7875 750/m 708.75 Total 1416.8 Hiring of vehicles State - - - - - District 14 2.15 30.10 Block 188 2.15 404.20 POL 72 State 10 1.2 12.0 District 36 1.2 43.20 Block 265 1.25 331.25 Total 820.75 Contingency State level 1 2.0 2.0 District level 50 1.0 50.0 Block level 453 0.40 181.20 AWC 80160 0.006 480.9 Total 714.1 SUB-TOTAL- 2 2951.65 3. Supplementary Supply of SN to children, P & L Nutrition women and AGs Children 6 85,00,000 Rs. 4 x 102000 .00 months- 6 yrs 300 P & L women 1410000 Rs. 5x 21150.00 300 Severe 1.87,599 Rs. 6 x 3376.78 malnourished 300 children SUB- TOTAL -3 Note: 50% of cost of SNP to be borne by State 126526.78 4. Procurement Supply of material & equipments (see table 4B.1 at page 37) PSE kit 80160 0.01 lakh/ kit 801.60 Medicine kit 80160 0.006 lakh/ kit 480.96 PSE kit (Mini 12070 0.005lakh/kit 60.35 AWC) Medicine kit (Mini 12070 0.003lakh/kit 36.21 AWC) Weighing scales 23537 0.0075 / scale 176.52 Salter scale Baby weighing 51787 0.01 lakh / 517.87 scale scale Adult weighing 45485 0.01 lakh / 454.85 scale scale Computers/ Printers and UPS State level 10 0.50 5.0 District level 10 0.50 5.0 Block level 200 0.50 100.0 Almirah/ Storage See table 4B.1 details box/ Utensils, equipment, etc State level 8.55 District level 50 districts 0.50 25.0 Block level 453 Blocks 0.20 90.6 AWC level@ 0.05 51231 AWC 0.05 2561.55 lakhs for furniture SUB- TOTAL – 4 5324.06 5. Training and Regular training See 1110.35 73 capacity (induction/ job/ annexure 5 building Refresher MPR /MIS training 1753.95 for ICDS staff Exposure Visit 10.0 SUB – TOTAL- 5 2874.3 6. IEC Mangal Diwas 80160 0.025 2004.0 AWCs IEC per AWCs /yr 80160 0.01 801.60 AWCs SUB - TOTAL- 6 2805.6 7. Monitoring & Routine 80160 0.005 400.8 Evaluation monitoring AWCs through MPR Register, records .005 461.15 etc. (80160 +12070 mini AWC) SUB-TOTAL-7 861.95 8 Others Uniform to 80160 Rs. 425 681.36 AWW/AWH AWCs / +80160 worker AWHs+1207 0 Mini AWWs / =172390 Convergent 50 districts 1.0 lakh 50.0 workshops / distric Flexi Fund for the 92230 0.01 922.3 AWCs Travel 2297.0 Office expense 620.0 Special initiatives : See details at item 4 K at page 60 of the report. 1.Orientation workshops for PRI Members 665.0 2.Appointment of additional AWWs at 11000 AWCs 643.50 4. Training of AWWs and Supervisors in Inter-personal 267.95 communication 5. Mobile tracking system for program activities 1202.4 SUB- TOTAL-8 7349.51 GRAND TOTAL 209749.70 74 Summary of Proposed Budget 2012-13 Proposed Budget S.N. Intervention/ Activities (Rs. Lakhs) 1 Human Resource (State to AWC) 61055.85 2 Administrative Cost ( Rent POL, Vehicle hiring, Compuer, 2951.65 Furniture etc. 3 Supplementary Nutrition (Note: 50% of cost of SNP to be 126526.78 borne by State) 4 Procurement 5324.06 5 Training and Capacity Building 2874.3 6 Information ,Education and Communication 2805.6 7 Monitoring and Evaluation 861.95 8 Others 7349.51 GRAND TOTAL 209749.70 1 Table: 14 Time Line of Activities of APIP 2012-13 Activity Sub Activity Output Indicator Time line (Quarterly) I II III IV 1) 1.1) Assessment of Vacant positions at state, List of vacant All Vacancies filled Human district, block, sector & AWC level positions ready Resource 1.2) Issuing directives to CDPOs for filling up the Directives issued s vacant positions of AWW/AWH with recommendations of Gram Sabha. 1.3) Advertise vacancies for supervisors, conduct Selection held test & hold selection (50% reservation for AWWs & 50% open) 1.4) Advertise vacancies for CDPOs conduct test & Interview Conducted Interview 1.5) Hold DPC for promotion of CDPOs to DPC Held DPOs/DWCDO 1.6) Advertise vacancies for ASO/SA, conduct test Interview Conducted & Interview 1.7.1) Appointment of additional AWWs in selected Appointment made AWCs 1.7.2) Training & Honararium to additional AWWs - Trainings completed 2) 2.1) Conduct Induction training for newly recruited Trainings Completed No. of AWWs & Training AWWs & Helpers AWH trained & 2.2.1) Training needs assessment for Job & Need assessment Capacity Refresher training of AWW/Helper completed Building 2.2.2) Conduct Job & Refresher training of - Trainings completed No. of AWWs/AWHs AWW/Helper as per STRAP as per STRAP trained 2.3.1) Preparation of training module & material on - Module & Material All districts received IPC prepared the material 2 2.3.2) Development & printing of Flip books on IPC - Flip book printed All districts received for AWWs the material 2.3.3) Training of Master trainers on IPC - Master Trainers No. of Master trained trained 2.3.4) Training of trainers (supervisors) on IPC Supervisors trained No. of traines trained 2.3.5) Training of AWW on IPC - AWWs trained No. of AWWs trained on IPC 2.4.1) Training of ICDS functionaries on MPR/MIS Training conducted No.of functionar 2.4.2) Exposure visit Exposure visit Best practices conducted being rolled out 2.4.3) Organize orientation trainings for community Trainings of No. of functionaries opinion leaders(PRI, CBO, SMS, Mahila Mandal, community opinion trained SHG etc.) leaders organized 3) SNP 3.1) Processing procurement of SNP for AWCs SNP Procured No. of districts (THR) received SNP 3.2) Monitoring of SNP quality, quantity, frequency Improvement in Coverage increased & beneficiaries covered ( at different levels) coverage by 10% of current status 3.3) Monitoring of third meal programme for Improvement in 100% SAM children Severely Underweight Children through Mobile coverage receive third meal tracking & routine monitoring system 4) Pre- 4.1) Ensuring 100% children of 3-6yrs are enrolled Improvement in 100% children are School & attend PSE enrollment & enrolled & 10% Educatio attendence increase in n attendance from the current level 4.2) Community Monitoring of PSE Programme for Community No. of villages with quality & regularity monitoring system community established monitoring system established 3 4.3) Organization of Parent-AWW meet every month System of Parent No. of AWCs which for creating awareness about PSE AWWs meet started organizing established regular meeting with parents 5) 5.1) Procurement of PSE kit by DPOs as per Kits procured No. of AWCs Procurem purchase rules received PSE kit ent 5.2) Procurement of Medicine kit by DPOs as per Kits procured No. of AWCs purchase rules received Medicine kit 5.3) Place orders for procurement of Computers & Orders placed No. of districts Printers through LUN after finalizing the /blocks received specifications at DWCD supplies 5.4) Procurement of furniture & office equipments as Procurement done No. of districts per purchase rules /blocks received supplies 5.5) Assessment of requirement of serving utensils, Assessment of No. of districts from boxes, dari, furniture etc for AWCs requirement made where assessment received 5.6) Procurement of serving utensils, boxes, dari, Procurement done No. of AWCs furniture etc for AWCs as per purchase rules received supplies 6) IEC 6.1) Strengthen Mangal Diwas Programme Mandal Diwas No. of AWCs where strengthened all four Mangal Diwas are held regularly 6.2) Assess IEC needs & develop strategies & IEC strategy - material document developed 7) 7.1) Linking of Mobile tracking monitoring system & Monitorin referral of SAM children g & 7.2) Development & Printing of New MPR formats, Material developed No. of districts Evaluatio Checklist, Registers started using new n MPR & formats 4 8) Others 8.1) Procurement of Sarees & badges to AWW & Procurement made No. of AWWs & AWH Helpers received Sarees & badges 8.2) Organizing Convergence workshops for Convergence No. of districts improved interdepartmental coordination with workshops for started organizing health, RD, Education, Tribal departments interdepartmental convergence coordination initiated workshops 8.3) Strengthen NHED sessions in convergence NHED sessions No. of NHED with health department strengthened sessions organized as per the protocols 5 Section 5: Additional Information Support Received from Development Partners in ICDS III) MP Health Sector Reform Programme (MPHSRP) supported by DFID The MPHSRP has been jointly designed by GoMP and DFID within the broader context of MP Health Sector Strategy. The Departments of Public Health and Family Welfare, (DoPH&FW) and Women & Child Development (WCD), Government of Madhya Pradesh (GoMP) have been implementing a DFID supported (2007-15 ) Madhya Pradesh Health Sector Reform Program (MPHSRP). This includes financial and technical assistance of £120m with total fund allocation to DWCD of £35m: of which £16m has been disbursed till 2011-12. The goal of MPHSRP is to improve the health status of people in Madhya Pradesh - especially the poorest, and thereby accelerate the state's progress towards the MDGs. The purpose is to increase use of quality health services especially by the poorest people and in underserved areas. This program provides a unique opportunity for the government to prioritize the use of its limited resources and to help address the critical shortcomings in the public health system. The main objectives of this program are reduction in: infant mortality, maternal mortality, total fertility rate, making health outcomes and utilization of services more equitable, addressing malnutrition among children and reducing morbidity and mortality from common communicable diseases such as malaria, leprosy and tuberculosis. Key Reform Dimensions To achieve these objectives, the program supports the following five dimensions of reforms: 1. Improve availability of quality public and private health, sanitation and nutrition services, particularly in the underserved districts, 2. Improve availability of more and better trained staff, in particular in the underserved districts, 3. Strengthen financial management and procurement systems, 4. Bring about increased demand for nutrition, health and sanitation services; and 5. Strengthen M&E Systems. These outputs are in turn co-related with a host of agreed milestones, the achievement of which is facilitated by the MP TAST under the Technical Cooperation component of the MP HSRP. The MPHSRP support for the DWCD/ICDS over 2007 -2012 includes the following: Design of State nutrition mission (AtalBal Mission) and a PMU set up by MPTAST within AtalBalMissions Implementation of state nutrition mission (ABM) supported in 5 districts of Sagar Divisions. TA team has supported the training of 156 ICDS Supervisors and also trained Block officials (CDPOs) from all the 134 projects in 15 high burden districts for supportive supervision and building correct knowledge about core nutrition interventions. Develop monitoring and Evaluation framework for ICDS Established M&E unit - 2 people placed in the department from TAST support Revised MPR as per needs of the State and GOI and Develop Web enabled MIS –online as well as offline system for data entry.ilot conducted on revised MPR and ONLINE MIS system in 50 blocks (one block from across the state IT enabled MIS for ICDS is now scaled up all over the state, with a dedicated URL created for MIS: mpwcdmis.org. 3409 ICDS functionaries were trained during the process with DFID TA support. Registers have been designed keeping in view the revised on-line MPR format and the needs of the GOI. Number of registers was reduced from 9 to 7. DFID TA also funds the CRISP (web management services) to support A large scale BCC campaign and IPC is being designed under MPHSRP to promote IYCF, hand washing and toilet use 6 DFID TA has supported roll out of SABLA and IGMSY in 2 districts. DFID TA also funds the CRISP (web management services) to maintain web based MIS system for the department. DFID TA support over 2012 onwards will focus on: ABM district and block staff training and supervision Direct implementation support of ABM in 11 districts All district plans will be monitored quarterly at state level. Supervisors & CDPOs training will be continued as well as training of AWW as needed. Facilitate state level convergence with NRLM and Tejaswani and work with community groups/SHGs/Volunteers. Sabla: TAST will support Sabla in 2 districts and develop linkages to strengthen the life skills and vocational/skill development. Behavior Change Communication; the BCC consortium – BBCWST and Care – is now in place and help implement BCC activities. MIS strengthening: Training of CDPOs and Supervisors on use and analysis of MPR data Concurrent monitoring of outcomes and processes to be started (every quarter 8-10 districts to be monitored with quantitative and qualitative surveys) NIN survey to be repeated in 2013 to track progress II) Support by UNICEF Technical support on promotion of infant and young child feeding practices including the use of WHO child growth standards at state, division and district level Technical support in development of vision and strategy document for Atal Arogya and Bal Poshan Mission and development of district level strategy document. Technical support in operationalization of the mission at state, division and district level. Provide technical support for planning, implementation and monitoring of State Government’s initiatives and schemes like SABLA, Streamlining the timely identification, referral of SAM children to NRCs Unicef is also extending financial and technical support Such as Gap filling supply for ICDS quality improvement (Salter Scale, Growth Registers, Monthly weight registers, IYCF Flip book & Flash Cards), Supply to NRCs - Electronic weighing scale, Length Board, Camera, MUAC Tape, Bed sheets, Feeding & Protocol Panels. II) Support by Micronutrient Initiative(MI) MI support mainly for strengthening the vitamin A supplementation in routine immunization & along with deworming during the Bal Suraksha Maah rounds MI provides training & organize workshops for capacity building of officials & staff of different line departments at different levels on vitamin A supplementation. IEC activities & printing of reporting formats for the Bal Suraksha Maah is also one of the major activities supported by MI. 7 Names of Key Officers of DWCD and Their Telephone Numbers Department of Women and Child Development Vijaya Raje Vatsalya Bhavan, Arera Hills, Bhopal, M.P. Names, Addresses and Contact Numbers of Key Officers Name Address Telephone Nos. Office Residence Shri B.R. Naidu, C-2/ 8, Char Imli, 0755- 2550894 0755-2559692, Principal Secretary Bhopal 9425602333 Shri D. D. Agarwal, 0755-2550909 Commissioner Shri H.C. Agrawal, 86-A, Janaki Nagar, 0755-2550940 8109210060, Additional Director Bhopal 9424468226 Shri Akshaya 109/12, Shivaji 0755- 2550928 9424410467 Shrivastava, Jt. Nagar, Bhopal e-mail: Director [email protected] Shri. Pankaj Mohan 0755-2550916 9425155066 Shri R.P. Singh, HIG-3/135, Bag 0755-2550922 9827227727 Joint Director Mugalia, Bhopal Shri R.C. Shukla, G-2/103, 1100 9425026630 Deputy Director Quarters Shri Harish Khare, F-91/ Tulsi Nagar 0755- 2550936 94255614440 Deputy Director ICDS Website URL : www.mpwcd.nic.in Names, Addresses and Contact Numbers of District level Program Officers Indore Division Address Telephone 1 Mr. Vishal Nadkarni Department of Women & Ph: 0731-2366058, District Program Officer Child Development, 9425103731 Room no.107, Collectorate Campus, Moti Tabela, Indore, Dist Indore. 2 Mr. N.S. Tomar Department of Women & Ph: 07292-2235066, District Program Officer Child Development 9425942401 Collectorate Campus, Dhar , District Dhar 3 Ms. Jaywant Verma Department of Women and Ph.07290- 224445 District Program Officer Child Development, Asha 94254 08498 Gram Road, Barwani, 4 Mr. L.N. Kandwal District DistrictWomen Badwani and Child Ph: 0728-2232596, 94251 Program officer Development Office , 91303 Indore Road, Near TAFE Tractors Khargone, Dist. Khargone, 5 Mr. Rajesh Gupta Office of Women and Child Ph: 0733-2223794, District Program Officer Development Department, 9425355652 Khandwa District Khandwa (M.P.) 8 6 Mr. R.S. Jamra Office of Women and Child Ph: 07394-234350, District Program Officer Development Department 9993109030 Tanki Ground, Umrali Road, Alirajpur, District Alirajpur 7 Mrs. Neelu Bhatt, (MP)Office of Women and Child Ph: 07392-244397, District Program Officer Development Department, 9425061658 Jhabua 8 Ms. Shweta Raghav DistrictOffice of Jhabua Women (M.P.) and Child Ph: 07325-251931, 99779 District Program Officer Development Department 19111 Renuka Mata Mandir Road Near Shikarpura Thana, Burhanpur (MP) Ujjain Division District Burhanpur (M.P.) 9 Ms. Nishi Singh Department of Women & Ph: 0734-2511658, District Program Officer Child Development 9827350147 38. Prashasnik Kshetra, Email: [email protected] Sector Wing D, Mahendra Bhatnagar Marg, Near Iskon Temple, Ujjain (MP) 10 Mr. D.S Meena Office of Women and Child Ph:- 07412-270433, Joshi District Program Officer Development Department acct:9424047811 Old Kendriya Vidyalaya Katju Nagar, District Ratlam 11 District Women & Child Office(M.P.) of Women and Child Ph:- 7412- 270433, 267876 Development Officer, Development, Old Kendriya Vidyalaya, Ratlam 12 Mrs. Relam Baghel Department of Women and Ph:- 07422-242543, District Program officer Child Development 9424892032 Women and Child Development Office Nayi Abadi District Mandsaur (M.P) 13 Ms. Sunita Yadav Office of Women and Child Ph: 9425065313, 07364- District Program Officer Development Department 226639 Collectorate Campus Lalghati, District Shajapur 14 Mrs. Sushma Bhadoria (M.P.)Office of Women and Child Ph: 9425980823, 07423- District Program Officer Development Department 231020 Collectorate, District Neemuch (M.P.) 15 Ms. Tripti Tripathi District Department of Women & Ph: 07272-250117, 98931 Program Officer Child Development 21587 Collectorate Campus District Dewas Bhpal Division 16 Ms. NakiJahan Qureshi Office of Women and Child Ph: 9425083175, 0755- District Program Officer Development Department, 2548599 B-Block, Old Secretariat, Collectorate Campus District Bhopal (M.P.) 9 17 Mr. Brajesh Shivhare Office of Women and Child Ph:- 0756-2222752, District Program Officer Development Department 9407273520, 94250 39265 District Sehore (M.P.), 18 Ms. Rama Mukati Office of Women and Child Ph: 9 94258 89970 District Program Officer Development Department 0737-2255083 Collectorate Campus District Rajgarh (M.P.) 19 Mr.D.S. Meena Office of Women and Child Ph:- 07482-222132, District Program Officer Development Department 989375413 Collectorate Campus District Raisen (M.P.), 20 Mr. Sanjay Tripathi Office of Women and Child Ph: 94257 25653, 07574- District Program Officer Development Department 253254 Commissioner Building District Hoshangabad (M.P.) 20 Mr. Devendra Sundaryal Office of Women and Child Ph: 9479879741, 0759- District Program Officer Development Department 2232986 Behind Collectorate Office Collectorate Campus District Vidisha (M.P.) 21 Mr. Lalit Dehariya Office of Women and Child Ph: 94251 75811, 07577- District Program Officer Development Department 225973 Near Sunrays school, Pandey Compound, District Harda 22 Mr. Pradeep Rai (M.P.)Office of Women and Child Ph: 07141-230305, District Program Officer Development Department 9926377522 Near Bus Stand, District Betul (M.P.) Sagar Division 23 Mr. Brijesh Tripathi Department of Women & Ph: 07682- 243590, District Program Officer Child Development 9425362263 Near Police line Road District Chhattarpur 24 Mr. Sanjay Singh Office of Women and Child Ph: 07582-223510; District Program Officer Development Department 9424439925 Tehsili Compound 25 Mr. B.L. Prajapati OfficeDistrict of Sagar Women (M.P.) and Child Ph: 07683-242257; District Program Officer Development Department 9425141901 Collectorate Campus District Tikamgarh (M.P.) 26 Mr. Yogendra Yadav Office of Women and Child Ph: 07812-222473, 94254- District Program Officer Development Department 38991 Old Collectorate Building District Damoh (M.P.) 27 Mr. Nayan Singh Office of Women and Child Ph: 07732-252159, District Program Officer Development Department 9424762973 Collectorate Office, Opposite Ram Jankin Mandir, District Chambal Division Panna (M.P.) 28 Mr. D.K.Sidharth Office of Women and Child Ph: 9425635752, 07532- District Program Officer Development Department 223379 Collectorate Campus District Morena (M.P.) 10 29 Ms. Kalpana Bohre Office of Women and Child Ph: 98263-62417, 07534- District Program Officer Development Department 230427; Collectorate, District Bhind Accountant: Maujiram ji:- (M.P.) 9754517996 30 Mr.Sourabh Singh Office of Women and Child Ph: 07530-222088, District Program Officer Development Department 9425131721 Collectorate Campus District Sheopur (M.P.) Gwalior Division 31 Mrs. Seema Sharma, Office of Women and Child , Ph: 07512-446217, District Program Officer, Development Department 9425114265 Moti Mahal, Gwalior 32 Mr. D.S. Jadon Office of Women and Child Ph: 942540 07197, 07522- District Program Officer Development Department 233724 Collectorate Campus District Datia (M.P.) 33 Mr. R.C. Tripathi Department of Women & Ph: 94254-72915, 07542- District Program Officer Child Development 250168 Cantt Area, District Guna 34 Mr.Sajan Aluna Department(MP) of Women & Ph: 94254 36991, 0749- District Program Officer Child Development 2234704 Collectorate Campus District Shivpuri (MP) 35 Mr. Akhilesh Jain Office of Women and Child Ph: 94250 51653, 07543- District Women & Child Development Department 220306 Development Officer Nehru Degree College, District Ashoknagar (M.P.) Rewa & Shahdol Division 36 Ms. Usha Solanki Office of Women and Child Ph: 07662-256857, 94251- District Program Officer Development Department 84993 Shilpi Plaza, A- Block 3rd Floor, District Rewa (M.P.) 37 Mrs. Saurabh Singh Office of Women and Child Ph: 94251 31721, 07672- District Program Officer Development Department 224182 District Collectorate Campus, District Satna (M.P.) 38 Mr. M.L. Mehra Office of Women and Child Ph: 07652-241538, District Program Officer Development Department 9425184228 Old Collectorate Building District Shahdol (M.P) 39 Ms. Laxmi Dhurve Office of Women and Child Ph: 07659-222672, 222287, District Program Officer Development Department 9407091821 Near Collectorate Campus District Annupur (M.P.) 40 Ms. Leekha Shivedi Office of Women and Child Ph: 9826736833, Ph. 07644- District Program Officer Development Department 234965, 234364 Collectorate Campus District Dindori (M.P) 41 Mr. Gautam Adhikari, District Office of Women and Child Ph. 07822-250302, Program Officer Development Department, 9425472915 District Sidhi, 11 42 Mrs. Subhadra Manikpuri Office of Women and Child Ph: 07653223397, District Women & Child Development Department 9407855295 Development Officer Collectorate Campus District Umaria (M.P.) 43 Ms. Pratibha Pandey, Office of Women and Child Ph:- 9425470883 District Program Officer Development Department, District Singrauli (M.P.) Jabalpur Division 44 Mr. H.K. Sharma Office of Women and Child Ph:, 0761-2609545, 94258- District Program Officer Development Department 49111 Collectorate Campus District Jabalpur (M.P.) 45 Ms. Swarnima Shukla Office of Women and Child Ph: 94250-51420, 07162- District Program Officer Development Department 243421 Collectorate Campus District Chhindwara (M.P.) 46 Ms. Shanti Bele Office of Women and Child Ph: 07792-230512, 94250- P District Program Officer Development Department 40632 Collectorate Campus District Narsinghpur (M.P.) 47 Mrs. Shashi Uike Office of Women and Child Ph: 07642-252373, District Program Officer Development Department 993092532 Near Smarak Chouraha District Mandla (M.P.) 48 Ms. Neelima Tiwari Office of Women and Child Ph:- 07632-241637, 94254- District Program Officer Development Department, 47851 District Balaghat, 49 Mr. Manish Seth Office of Women and Child Ph:- 07622-224623, District Program Officer Development Department, 9425159633 District Katni 50 Mr. Bharat Singh Rajput Office of Women and Child Ph:- 07692-228191, District Program Officer Development Department, 9009220758 District Seoni 12 ANNEXURES Annexure- 1 Nutritional Status Of Children Up to 6 Years By SD Classification Under Nutrition among 0-5 Yr Children (< Median – 2sd) Current survey (2010-11) Districts Underweight Stunting Wasting Alirajpur 60.8 52.9 32.6 Anuppur 55.8 45 28.9 Ashokngar 49.9 55.6 20 Balaghat 48.1 40.7 23.6 Barwani 65.1 58 34.8 Betul 43.2 38.1 21.1 Bhind 55.1 63.5 16.0 Bhopal 55.8 47.7 24.6 Burhanpur 55.4 48.6 26.7 Chhatarpur 48.3 45.9 21.9 Chindwara 48.8 44.3 27.3 Damoh 42.9 39.5 26.6 Datia 59.6 66.7 21.1 Dewas 40.9 38.2 22.5 Dhar 54.4 46.9 33.2 Dindori 61.7 50.3 31.6 Guna 50 48.4 25.3 Gwalior 56.6 65.2 21.1 Harda 53.7 47.6 23.5 Hoshangabad 38.4 37.6 24.8 Indore 34.9 34.1 21.7 Jabalpur 45.7 39.1 24.2 Jhabua 57 50.3 31.5 Katni 55.5 51.5 27.4 Khandwa 56.9 45.1 29.8 Khargone 58 50.6 30.8 Mandla 56.5 47.3 29.6 Mandsaur 52.5 45.1 27 Morena 53.2 15.2 15.2 Narsimhapur 46.1 49 16.9 Neemuch 48.1 36 24.1 Panna 50.3 42.1 29 Raisen 36.3 38.8 19.3 13 Rajgarh 56.5 46.6 40.2 Ratlam 49.1 42.1 29 Rewa 53.7 58.3 22 Sagar 48.3 61.5 19.2 Sathna 67.1 66.3 29.5 Sehore 40.5 41 21.2 Seoni 52.9 40.3 29.8 Shadol 56.5 42.1 32.6 Shajapur 51.7 43.3 30.1 Sheopur 52.3 64.6 17.9 Sidhi 54.5 52 25.4 Singrauli 58.8 51.8 34.3 Shivpuri 55 62 25.7 Tikamgarh 49.7 45.7 23.1 Ujjain 45 39.9 26.7 Umaria 66.6 60.3 32.9 Vidisha 34.7 50.8 16.3 Pooled 51.9 48.9 25.8 14 Annexure – 2 District-wise Number of Projects & AWCs in Madhya Pradesh S.N. District Rural Tribal Urban Total Project AWC Project AWCs Project AWC Project AWCs 1 Betul 3 496 7 1414 2 155 12 2065 2 Bhopal 3 445 0 0 7 1173 10 1618 3 Harda 3 316 1 191 1 67 5 574 4 Hoshangabad 6 1096 1 225 2 219 9 1540 5 Raisen 7 1379 0 0 0 0 7 1379 6 Rajgarh 10 2010 0 0 0 0 10 2010 7 Sehore 8 1009 0 0 1 100 9 1109 8 Vidisha 8 1699 0 0 1 156 9 1855 9 Bhind 9 1851 0 0 1 171 10 2022 10 Morena 10 1802 0 0 1 256 11 2058 11 Sheopur 4 543 1 248 1 103 6 894 12 Ashoknagar 4 783 0 0 1 93 5 876 13 Datia 5 672 0 0 1 74 6 766 14 Guna 5 1015 0 0 1 110 6 1125 15 Gwalior 5 744 0 0 5 495 10 1239 16 Shivpuri 8 1750 0 0 1 100 9 1850 17 Alirajpur 0 0 6 1121 0 0 6 1121 18 Barwani 0 0 8 1501 0 0 8 1501 19 Burhanpur 2 239 2 277 2 209 6 725 20 Dhar 2 297 13 2877 1 74 16 3248 21 Indore 7 895 0 0 8 687 15 1582 22 Jhabua 0 0 6 1606 0 0 6 1606 23 Khandwa 5 710 2 586 1 172 8 1468 24 Khargone 3 460 7 1328 1 69 11 1857 25 Balaghat 7 1427 3 795 1 72 11 2294 26 Chindwara 8 1515 5 1012 1 109 14 2636 27 Jabalpur 6 1375 1 190 6 533 13 2101 28 Katni 5 1035 1 255 1 219 7 1509 29 Mandala 0 0 9 1821 0 0 9 1821 30 Narsinghpur 6 1004 0 0 0 0 6 1004 31 Seoni 4 635 6 1105 1 70 11 1810 32 Rewa 14 2612 0 0 1 179 15 2791 33 Satna 12 2275 0 0 2 316 14 2591 34 Sidhi 6 1547 1 225 0 0 7 1772 35 Singrauli 3 544 2 664 1 127 6 1335 36 Chatarpur 12 1651 0 0 1 77 13 1728 37 Damoh 7 1229 0 0 1 80 8 1309 38 Panna 5 1119 0 0 1 51 6 1170 39 Sagar 13 1941 0 0 3 268 16 2199 40 Tikamgarh 7 1342 0 0 1 64 8 1406 41 Anuppur 0 0 4 1030 0 0 4 1030 42 Dindori 0 0 7 1671 0 0 7 1671 43 Shahdol 1 212 4 1068 1 60 6 1340 44 Umaria 2 328 2 315 0 0 4 643 45 Dewas 6 1087 1 246 2 160 9 1493 46 Mandsaur 8 1363 0 0 1 136 9 1499 47 Neemuch 5 805 0 0 1 75 6 880 48 Ratlam 5 761 2 521 3 338 10 1620 49 Sajapur 10 1301 0 0 0 0 10 1301 50 Ujjain 9 1420 0 0 5 488 14 1888 Total All districts 278 48762 102 22292 73 7875 453 78929 15 Annexure –3 List of Anganwadi Training Centres & Middle Level Training Centres in MP S.N. Name of training Centres District Government training centres 1 Government AWTC , Pawarkheda Hoshangabad 2 Government AWTC, Rajgarh Rajgarh 3 Government AWTC, Obaidullagunj Raisen 4 Government AWTC, Jabalpur-1 Jabalpur 5 Government AWTC, Jabalpur 2 Jabalpur 6 Government AWTC, Satna Satna 7 Government AWTC, Nogaon Chatarpur 8 Government AWTC, Shivpuri Shivpuri 9 Government AWTC, Dhar Dhar 10 Government AWTC, Tikamgarh Tikamgarh Non-Government AWTC 1 AWTC, MP Council of Child Welfare, Bhopal Bhopal 2 AWTC, MP Council of Child Welfare, Gwalior Gwalior 3 AWTC, MP Council of Child Welfare, Seoni Seoni 4 AWTC, MP Council of Child Welfare, Shahdol Shahdol, 5 AWTC, MP Council of Child Welfare, Mandla Mandla 6 AWTC, MP Council of Child Welfare, Ratlam Ratlam 7 AWTC, MP Council of Child Welfare, Jhabua Jhabua 8 AWTC, MP Council of Child Welfare, Ujjain Ujjain 9 AWTC,MP Council of Child Welfare, Chindwara Chindwara 10 AWTC, Indore Indore 11 AWTC, Mahila Chetana Manch, Bhopal Bhopal 12 AWTC, Institute of Regional Analysis, Betul Betul 13 AWTC, Savya Sanchi Centre, Sidhi Sidhi 14 AWTC, Shri Ram Shankar Samiti, Morena Morena 15 AWTC, Matr Shakti Seva Kendra, Guna Guna 16 Annexure-4 District-wise number of NRC established in MP and Children Treated (April 2011- March 2012) Source :- NRHM Sr. District Name Fully Functional Partially Functional Total No. NRCs NRCs NRCs 1 ANOOPPUR 4 - 4 2 ASHOKNAGAR 3 - 3 3 BALAGHAT 2 - 2 4 BARWANI 3 1 4 5 BETUL 5 - 5 6 BHIND 2 2 4 7 BHOPAL 3 1 4 8 BURHANPUR 3 - 3 9 CHHATARPUR 5 - 5 10 CHINDWARA 4 - 4 11 DAMOH 5 - 5 12 DATIA 3 2 5 13 DEWAS 4 - 4 14 DHAR 7 1 8 15 DINDORI 3 - 3 16 GUNA 3 2 5 17 GWALIOR 4 - 4 18 HARDA 3 - 3 19 HOSHANGABAD 5 1 6 20 INDORE 5 2 7 21 JABALPUR 6 - 6 22 JHABUA 4 - 4 23 ALIRAJPUR 2 - 2 24 KATNI 6 - 6 25 KHANDWA 5 - 5 26 KHARGONE 7 1 8 27 MANDLA 3 - 3 28 MANDSAUR 7 - 7 29 MORENA 5 - 5 30 NARSINGHPUR 2 1 3 31 NEEMUCH 3 - 3 32 PANNA 4 2 6 33 RAISEN 3 2 5 34 RAJGARH 2 1 3 35 RATLAM 2 3 5 36 REWA 5 2 7 37 SAGAR 3 3 6 38 SATNA 3 3 6 39 SEHORE 2 3 5 40 SEONI 2 - 2 17 41 SHAHDOL 3 1 4 42 SHAJAPUR 4 - 4 43 SHIVPURI - 3 3 44 SHOEPUR 7 2 9 45 SIDHI 2 - 2 46 SINGRAULI 2 - 2 47 TIKAMGARH 5 2 7 48 UJJAIN 5 - 5 49 UMARIA 2 1 3 50 VIDHISHA 1 5 6 18 Annexure 5 19 20 21 22 23 24 25