Programme inputs

Balwadi Building

At each CPWPC site a balwadi building is constructed with financial assistance from Mahila Samajams, CARE, and the Government of Kerala. The cost of construction at present is Rs 12,000 (US$1,500). Nearly 30-40 per cent of the funds for land, building material, and construction are generated by the Mahila Samajams, who have legal ownership of the building. The balwadi is the venue for distribution of the nutrition supplement, dispensing of preventive and curative medical services, and imparting child-care education to mothers and non-formal education to children. In short, these structures are the focal point of integrated maternal child health activities in the village. This building has imparted a real sense of performance to the existing ill-housed programmes that were conducted under the shadow of trees or in someone's house.

 

Food Supplement

The programme is designed to provide an enrolled child a cooked meal of 312 calories and 12 grams of protein for 300 days per year. Children attending the balwadi classes receive an additional meal of 100 calories and 3 grams of protein.

The data suggest that the food is distributed regularly at the centre. The response of mothers to questions on the adequacy and taste of the centre meal, and the purpose of the feeding programme indicates a positive attitude towards the programme (table 4). The vast majority of mothers agreed that the taste of the meal was acceptable to the children. Also, the mothers felt that the food given at the balwadi was adequate. More than 90 per cent of the mothers regarded the objective of providing a meal as "improvement of health" of the children.

TABLE 4 Attitudes of Mothers towards the Programme

Attitude	Mothers
	(%)
Quantum of food
Adequate	93 4
Not adequate	5.9
Do not know	0 9
Regularity of the programme
Yes	99.0
No	1.0
Taste of food
Like	98 4
Not liked	1 5
Justification for the programme
Poverty	1 7
Hunger	2.2
Health	91.1
Incentive for attending balwadi	1.4
Do not know	4.3

In analysing the data it was found that a child attending the balwadi received a meal of 404 calories and 22 grams of protein. A meal of 320 calories and 17 grams of protein is given to non-balwadi participants. The entire quantity of food, according to 73 per cent of the mothers, is fed to the enrolled child (table 5). Another 24 per cent reported feeding between "half" and "most" of the food the participant child.

TABLE 5. Quantity of Centre-food Reported to be Fed to the Programme Child

Quantity of centre-food	Children
	(%)
All	73.1
Most	15 7
Half	8.8
Less than half	1.9
Other	0.2
TOTAL	99 7

 

Medical Services

Both preventive and curative medical care is to be provided to programme beneficiaries by a medical doctor once a month and an auxiliary nurse mid-wife (ANM) once a week. Evidence collected suggests that on an average a child received protection against two-three childhood diseases such as diphtheria, whooping cough, pertusis, polio, and tuberculosis (table 6). More than half the mothers recalled receiving prophylactic doses of vitamin A for their enrolled child. Also, mothers of one-fifth of the children mentioned receiving preventive doses against worms for the participant child. Although the majority of children experienced two-three episodes of illness in a year, less than 10 per cent of the children were treated for illness at the balwadi centre.

TABLE 6. Utilization of Health Services

Type of service	Mothers
	(%)
Medicine for illness	7.8
Vitamin A	52.0
Multi-vitamins	41.0
Deworming medicine	20.0
Immunization:
DPT	52.5
BCG	38.9
Polio	49.0

 

Child-care Education

Important concepts concerning certain practices that contribute to child malnutrition, morbidity, and mortality are communicated to mothers of the enrolled children through fortnightly sessions at the balwadi centre, home visits to participants homes, and six monthly camps of two days' duration. The balwadi teacher, trained for a period of one month, has the responsibility of imparting child-care education. For effective communication, posters and pamphlets have been developed. As a tool for personal instructions to the mothers about the health and nutritional requirement of the young child, a coloured growth chart is provided for each programme child.

TABLE 7. Frequency of Attendance at Child-care Sessions

	Mothers
Frequency	(%)
Never	26.9
Once a week	2.6
Once a fortnight	2.0
Once a month	16.6
Once in 2 months	4.7
Once in 3 months	16.5
Whenever they have time	31.4

About 73 per cent of the interviewed mothers reported participating in the fortnightly education sessions (table 7). Nearly 22 per cent of the mothers attended the sessions once a month. Another 40 per cent participated in the educational activity whenever they found time. The majority of the 27 per cent of mothers who never attended the education sessions mentioned "time" as a constraint for their participation. Nutrition camps were attended by about 80 per cent of the mothers (table 8), and about 74 per cent attended more than once.

TABLE 8 Frequency of Attendance in Child-care Camps

Number of camps	Mothers (%)
0	18.2
1-2	38.2
3-4	35.0
4 and more	7.5
Do not know	2.0

The growth chart used for monitoring the body weight of the child was seen by 72 per cent of the mothers, and 70 per cent of them understood what it conveyed. in a similar programme in Pondicherry, although the children were weighed regularly, the growth charts were seen by less than one-fourth of the participants' mothers. Data on awareness and knowledge of selected child-care practices indicated that a large number of mothers grasped the messages that were being conveyed in the education sessions.

Economic Activities

Mahila Samajams are encouraged to organize economic activities to increase the income of mothers. Assistance is planned for 20 mothers per balwadi in a year to develop a kitchen/backyard garden. Ten families of the participant children are given 10 chickens each on the condition that they provide 100 eggs to the Mahila Samajam. These eggs in turn are supplied to 5 families for hatching and rearing. Provision is made for supplying goats to 10 families. These families are to return a female lamb to the Mahila Samajam for supply to other mothers.

Evidently 30 per cent of the families have established a garden in their backyard (table 9). Goats and poultry units have been received by 26 and 30 per cent of the families respectively.

TABLE 9. Economic Activities Undertaken by Mahila Samajams

	Families reported/Receiving assistance
Type of activity	(%)
Kitchen garden	30
Poultry units	30
Goats	26

TABLE 10. Comparison of Perceived Advantages by Mothers and the Purpose of Their Visit to the Balwadi

	Mothers
Services	Purpose of visit (%)	Perceived advantages (%)
Collection of food	79.4	95.0
Immunization	17.0	31.4
Medical relief services	9.1	12.4
Medicine	10.6	22.8
Vitamin A drops	5.3	12.8
Iron and folic acid	2 7	7.3
Deworming medicine	2.5	4.7
Education	49.7	46.0

Besides these three types of activity, some of the Mahila Samajams are organizing radio assembly units. tailoring classes, and dairy units.