Comprehensive Master Action Plan Report on

PrREViENIION Of MAILNUTRI110N OF CHI~DREN IN lrNE STrATE OF ~ARNA~AK~

The Core Committee

by

COMPREHENSIVE MASTER ACTION PLAN REPORT

PREVENTION OF MALNUTRITION OF CHILDREN IN THE STATE OF KARNATAKA

BY THE CORE COMMITTEE

HON'BLE SRI JUSTICE N. K. PATIL JUDGE, HIGH COURT OF KARNATAKA CHAIRMAN OF COMMITTEE

SUBMITTED TO HIGH COURT OF KARNATAKA ON 23-8-2012

Comprehensive Master Action Plan Report on Prevention of Malnutrition of Children in the State Of Karnataka submitted to High Court of Karnataka on 23-8-2012

Chairman Hon'ble Sri. Justice N.K. Patil Judge, High Court of Karnataka
--A -

MEMBERS ---Director Health and Family Welfare Services Government of Karnataka Joint Director ICDS, Department of Women and Child Development Government of Karnataka

Chairperson Karnataka State Commission for Protection of Child Rights Bengaluru

Dr.Smt. Maya Olga Mascren has MYRADA Bengaluru

Sri. Mariswamy Representative of SamajikaParivarthanaJanandolana Bengaluru

Sri. Clifton D'Rozario Advocate Bengaluru

Director Indira Gandhi Institute of Child Health Bengaluru

Sri.Vishwanath V.Angadi District and Sessions Judge Member Secretary Karnataka State Legal Services Authority Convenor of the

Justice N.K. Patil

Judge, High Court of Karnataka Chairman of Committee Bengaluru

23rdAugust, 20 12

FOREWORD
The child population constitutes one of the most important sections of society, which being vulnerable, needs a very careful nurturance. Their growth and development is a strong reflection on the future of a country. A wise investment in the health care of children, nutrition and education is the foundation stone for allround development of a nation. Neglect of addressing to the needs of children will condemn the children and the society which would eventually accelerate poverty and deprivation of legitimate fundamental right to life of the children and of all concerned. Children are the greatest gift to humanity. They are the supreme asset of the nation. Children are the future citizens and hopes of the nation. They have the right to freedom of various types and are entitled for justice which gives them the platform to have an all-round development. A child must be groomed well in the tender age which would enable the child to become a vibrant person in the near future. The child must receive, in time, nutritious foodldiet, medical care and a very congenial atmosphere for overall development. Malnutrition is one of the most concerning health and development issues in India as in other parts of the world. The National Family Health Survey - I11 revealed that 42.5% children under the age of 5 years are under weight (low weight for age), 48% children are stunted (low height for age) and 19.8% children are wasted (low weight for height). Malnutrition is a general term. It most often refers to under-nutrition caused by inadequate consumption of foodlnutrients and poor absorption or excessive nutrients. The term also encompasses over-nutrition resulting from excessive intake of a specific nutrient. Malnutrition increases the risk of infection and infectious diseases. The causes of malnutrition are multifarious and are multidimensional.
A Non-Governmental Organisation named VimochanaSangh, Athani, Belgaum District, represented by its President, wrote a letter to Hon'ble the Chief Justice of High Court of Karnataka requesting the intervention of the Judiciary to tackle the issue of death of children on account of malnutrition in some parts of State of Karnataka. Hon'ble the Chief Justice, upon perusal of the letter directed the Registrar (Judicial), High Court of Karnataka to treat the said letter as a Public Interest Litigation. Accordingly, Writ Petition No.3815712011 (PIL) came to be registered.

The Division Bench of High Court of Karnataka, as per order dated 4-10-201 1 directed Karnataka State Legal Services Authority to investigate the matter in question and submit the report. Accordingly Sri.Vishwanath V.Angadi, District & Sessions Judge, Member Secretary, Karnataka State Legal Services Authority visited Markaldinni, Taluk Deodurg, District Raicliur and inquired into the matter and submitted a detailed report with recommendations before the High Court on 28-1 1201 1. After hearing the counsel for the parties, Division Bench headed by Hon'ble Shri Justice Vikramajit Sen, Hon'ble the Chief Justice of High Court of Karnataka and Hon'ble Mrs.Justice B.V. Nagarathna passed order on 12-4-2012 constituting a nine member Committee under my Chairmanship, with a direction to submit Plan of Action and suggest the ways and means of addressing the problem of death of children on account of malnutrition in the State of Karnataka. The first meeting of the Committee under my Chairmanship was convened on 18-4-2012 at Bengaluru wherein it was resolved to constitute District level SubCommittees under the Chairmanship of the respective Deputy Commissloners of the Districts, for the effective study of the issues pertaining to death of children on account of malnutrition and health care of malnourished children in the State of Karnataka. Accordingly, on 19.4.2012, Government of Karnataka issued Government Order. To identify the causes and back drop of children suffering from malnutrition in various parts of our State, meetings at Regional Levels were convened by me at Gulbarga, Bengaluru, Belgaum and Mysore on 26-4-20 12, 30-4-20 12, 3-5-201 2 and 5-5-2012, respectively. To know the ground realities of not only the children suffering from malnutrition but also with regard to health care needs of adolescent girls, pregnant women, nursing mothers and to have a personal knowledge of the infrastructure facilities provided to Anganwadi Centres in the State, I visited as many as 81 Anganwadi Centres covering 14 Districts in the State. Added to the above, Press Conferences were convened by me at District headquarters which I visited, wherein members of public in general, office-bearers & members of NGOs, experts in the field of child health and nutrition, members of print and electronic media etc., were requested to tender their valuable suggestions so as to enable me to prepare Action Plan. The television channels telecasted the deliberations of the press meets. Newspapers, both national and regional of wide circulation in the country published the deliberations of the regional meetings. Apart from the above exercise, on 14-052012, 1 interacted with Deputy Commissioners, Chief Executive Officers of Zilla Panchayat, District Health Officers and Deputy Directors of Department of Women and Child Development of all the Districts in the State through Video Conference from Bengaluru to keep myself informed of the ground reality and to impress upon the above Officers of all the Districts in the State to take appropriate steps with regard to the issue in question.

In pursuance of my request, Hon'ble Judges of the High Court, individuals, office-bearerslmembers of NGOs, experts in the field of child welfare, Heads of various Departments of Government of Karnataka & many others submitted their valuable suggestions, in writing, before the Committee. As there were urgent issues which needed to be addressed quickly, and since there was no ample time to prepare Master Action Plan Report on 23.05.2012, a meeting of the Committee was convened at Bengaluru wherein it was resolved to submit Interim Report to the High Court. Accordingly, the Committee submitted Interim Report before High Court of Karnataka on 12-6-20 12, suggesting reconlmendations inlnlediately to be addressed by the Government. Division Bench of High Court headed by Hon'ble the Chief Justice heard both sides on 15-06-2012. Government of Karnataka accepted the reconlmendations made by the Committee in the Interim Report and gave undertaking before the High Court that the recomnlendations of the Committee made in the Interim Report before the High Court of Karnataka would be implemented. As per order dated 26-6-2012, High Court permitted the Committee to file final report before it on 30-9-20 12. The Committee examined in detail the suggestions made by individuals, representatives of NGOs, experts, heads of the Departments of Government of Karnataka etc., That apart, I interacted with the members of the Committee, Special Invitees, Heads of the various Departments of Government of Karnataka, Paediatricians, Specialists in nutrition, Anganawadi workers, Anganawadi helpers and members of public in general. The Committee viewed the problem of child malnutrition from various angles and has prepared this Master Action Plan Report. Master Action Plan Report in question shall be read in conjunction with the recommendations made by the Committee in its Interim Report submitted to High Court of Karnataka on 12.6.2012.

I am grateful to Hon'ble the Chief Justice of High Court of Karnataka Shri. Vikramajit Sen and his companion Judge for giving me an opportunity to study the issue regarding child malnutrition in the State of Karnataka and to submit Comprehensive Master Action Plan Report which would benei-it not only the children suffering from malnourishment, but also adolescent girls, pregnant women and nursing mothers in the State of Karnataka.
I acknowledge the valuable suggestions given by Hon'ble Judges of High Court of Karnataka in preparing this report. I acknowledge the valuable assistance rendered by members of the Committee and Shri. Vishwanath V. Angadi, District and Sessions Judge, Member Secretary, Karnataka State Legal Services Authority, who is the Convenor of the Committee. I

also

Shri. A.V. Chandrashekar, District and Sessions Judge, Director, Bengaluru Mediation Centre, Shri H.K. Jagadeesh, District Judge (Ad-hoe), Leave Reserve, High Court of Karnataka, who is the Special Officer of the Committee, Shri. Syed Mustafa Hussain Azeez, Senior Civil Judge and CJM, Hassan (The then Member Secretary, High Court Legal Services Committee), Sri N.Sunilkumar Singh, Deputy Secretary, K.S.L.S.A., Officers & members of staff of K.S.L.S.A. and Dr.H.C.Sridhara Channakeshava Ranga Reddy, State Programme Coordinator - UNICEF, Department of Women and Child Development, Government of Karnataka.

acknowlebge t!c -abS\bva.nce .rendered by

I acknowledge the co-operation and contribution of Shri K.M. Nataraj, Addl. Advocate General, Government of Karnataka, Mr. Ramesh B. Zalki, Prl. Secretary, Dept. of Women and Child Development and Dr. E.V. Raman Reddy, Secretary, Dept. of Health and Family Welfare, Government of Karnataka.
I express my thanks to Prl. Secretaries of Departments of Medical Education, Food and Civil Supplies, Primary and Secondary Education and Rural Development and Panchayat Raj, Urban Development, Government of Karnataka.

I acknowledge the valuable assistance rendered by Shri. M.K.Shankarlinge Gowda, Commissioner, BBMP, Bengaluru. I also acknowledge timely and valuable assistance rendered by the Deputy Commissioners of the Districts and Members of District level Committees, who ably assisted me during my visits to Anganwadi Centres in their respective Districts and in furnishing necessary informa~ionldata to the Committee, well in time.
1 express my thanks to the members of print and electronic media, Anganwadi workers, Anganwadi Helpers, members of public and all concerned who subnlitted their suggestions in writing before the Committee and thereby enabled the Committee to prepare Master Action Plan Report. also express my thanks to Shri M. Ravishankar, Director, Sri.K.M.Bhuvanesh, Joint Director and members of staff of Government Printing, Stationary & ~ubl'kcations, Vikasa Soudha, Bengaluru, in printing the report in a fine manner and at a very short notice.
1

(Justice N.K. PATIL) Judge, High Court of Karnataka Chairman of Conlnlittee

ABBREVIATIONS
AAY ACDPO AFHS AG ANC ANM ARSH ASHA AWC AWH AWS AWW BBNIP BEE BPL CDPO CEO CHC DC DDK Dept. DHC DHO DLHS DOTS DWCD FRU GMP GOK GP H&FW HIV ICDS IEC IFA Anthyodaya Card : Assistant Child Development Project Officer : Adolescent Friendly Health Services : Adolescent Girls : Ante Natal Check-up : Auxiliary Nurse Midwife : Adolescent Reproductive and Sexual Health
: Accredited Social Health Activists : Anganwadi Centre : Anganwadi Helper
: :

: :
:

:
: :

: : : : :
: :

Anganwadi Supervisor Anganwadi Worker Bhruhath Bengaluru Mahanagara Palike Basal Energy Expenditure Below Poverty Line Child Development Project Officer Chief Executive Officer Community Health Centre Deputy Commissioner Disposable Delivery Kits Department District Health Centre District Health Officers District Level Household Survey Directly Observed Treatment Short-course Department of Women and Child Development

: First Referral Unit : Growth Monitoring and Promotion : Government of Karnataka : Grama Panchayat : Health and Family Welfare Services : Human Immune Deficiency Virus
: Integrated Child Development Services

: Information, Education and Communication :

Iron Folic Acid

IYCF KSLSA KSY MAM MGNAREGA MNC MNRC MO NFHS NGO NPAG NRC NRHM ORS OTC PDS PI-IC PIL PNC PPI RCH RDPR RTI SAM SNP SRH ST1 THC THR TP VHND VHNSC WHO ZP

Infant Young Child Feeding Karnataka State Legal Services Authority Kishori Shakti Yojana Moderate Acute Malnutrition : Mahatma Gandhi National Rural Employment Guarantee Act Ma1 Nutrition Children Mini Nutritional Rehabilitation Centre Medical Officer National Family Health Survey Non Government Organization Nutrition Programme for Adolescent Girls Nutritional Rehabilitation Centre National Rural Health Mission Oral Rehydration Therapy Over the Counter Public Distribution System Primary Health Centre Public Interest Litigation Post Natal Check-up Pulse Polio Immunization Reproductive and Child Health Rural Development and Panchyat Raj Reproductive Tract infection Severe Acute Malnutrition Supplementary Nutrition Product Sexual & Reproductive Health Sexually Transmitted Infection Taluk Health Centre Take Home Ration Taluk Panchayat Village Health Nutrition Day Village Health Nutrition and Sanitation Committee World Health Organization Zilla Panchayat

CONTENTS:
Page

Chapter
lntroaucdon

Title
-

No
"

poncept & Causes of Malnutrition , ]

; --

,,

...
,-,I = :
8 .

I-1u

11-20

Care & Protection of Adolescent Girls, Pregnant Women & Nursinv Mnthers
-

Identification, Medical Assessment & Treatment of ICDS and Non ICDS Children Nature of Nutrition, Procurement and Distribution

... ... ...

25-31 32-33 34-36 37-59 60-67

I Awareness Through Information, Education and

Communication (IEC) Basic Infrastructures to Anganwadi Centres
-

--

... , ...
...

Qualifications/ Eligibility, Duties & Responsibilities of Anganwadi Workers, Anganwadi Helpers, Auxiliary Nurse Midwives and ASHA Workers Co-ordination in Between Different Departments of Government of Karnataka and Effective Monitoring of Working of Anganwadi Centres

68-70

Chapter: I

Introduction

Children are the future citizens and hopes of the nation. They are the greatest gift to humanity. They are the supreme asset of the nation, irrespective of their nationality, religion, caste, creed and sex. They have an inborn right to freedom and to get justice which gives them an opportunity for an all-round development. A child must be groomed well in the tender age to enable to become a vibrant person in future. The children must receive timely nutritious food and utmost medical care and a very congenial atmosphere so that they become good human beings with a clear vision and mission. The children must be strong, both physically and mentally as also knowledgeable and only such children are capable of making their country great and strong. The child population is one of the most important sections of the society which besides being vulnerable needs a very careful nurturance. Their growth and development is a strong reflection on the future of a country. In any effort for development, the starting point should be to have children who are physiologically, socially and economically strong. A wise investment in childrens' health, nutrition and education is the foundation stone for development of a nation. Neglecting childrens' needs will, by contrast, condemn them and push the society to a vicious cycle of poverty and deprivation. A healthy generation of children will lead to a healthy generation of productive young people and adults. Nutrition plays a very important role in the physical, mental, social and emotional development of a child. The infants and preschool children are most vulnerable to retardation in growth as a result of malnutrition, particularly, under nutrition. Childhood under nutrition is an important public health and development challenge in India. Undernourished children have significantly higher risk of mortality and morbidity. Besides increasing the risk of death and diseases, under nutrition also leads to growth retardation and impaired psychosocial and cognitive development. Children with Severe Acute Malnutrition (SAM) have nine times higher risk of dying than well-nourished children.

In India, the prevalence of Sever Acute Malnutrition in children remains high despite overall economic growth. The National Family Health Survey-3 revealed that 6.4% of children less than 5 years of age are severely wasted. Malnutrition is widespread among the disadvantaged in our State. The consequences of malnutrition are severe and long lasting. Children who are inalnourished have a longer and more severe illness and have a higher risk of dying coinpared to better nourished children. Malnutrition children have delayed motor developn~ent. Malnutrition can have negative effect not only on those affected but also on their offsprirlg. Causes of malnutrition are numerous. These causes are intertwined with each other and are hierachially related. The most immediate determinants of malnutrition are poor diet and illness. Poor diet and illness are themselves caused by a set of underlying factors that include access of family to food and maternal care-taking practices. Finally, these underlying factors are influenced by basic socioeconomic and political conditions within which poor families are attempting to raise well the nourished children. An accurate understanding of the relationships among these various causes of malnutrition and the relative contribution of each is essential for the design of efficient and effective programmes to reduce malnutrition and its consequences.

SCENARIO IN KARNATAKA
Karnataka is a State in South West India. It came into existence on lst November, 1956, with the passing of the States Re-organisation Act. The said day, annually is celebrated as "Karnataka Rajyotsava Day" (Formation Day). Originally known as the State of Mysore, our State is named as Karnataka in 1973. Karnataka is the land of Kannadigas, Tuluvas, Konkanis, Kodavas, etc., . The capital and largest city in Karnataka is Bangalore. Karnataka has 30 districts. They are namely, 1) Bagalkot 2) Bangalore Rural 3) Bangalore Urban 4) Belgauin 5) Bellary 6) Bidar 7) Bijapur 8) Chamarajnagar 9) Chikkaballapur 10) Chickrnagalur I 1) Chitradurg 12) Dakshina Kannada (Mangalore) 13) Davanagere 14) Dharwad 15) Gadag 16) Gulbarga 17) Hassan 18) Haveri 19) Kodagu 20) Kolar 21) Koppal 22) Mandya 23) Mysore 24) Raichur 25) Ramanagaram 26) Shimoga 28) Udupi 29) Uttar Kannada (Kanvar) 30) Yadagir. 27) Tun~kur
- 7 -

INTRODUCTION

Relevant statistical information of Karnataka is indicated in the following table:

Census - 201 1 Male Population Female Total Density of population (per sq.km) Sex ratio (females per 1000 males) Male Population in the age Female group of 0-6 years Total Male Female Literacy rate Percentage of above two
Male Proportion of child population in the age group 0-6 sex-wise Female Percentage of above two

India 62,37,24,248 58,64,69,174 1,21, O 1,93,422 382 940 8,29,52,135 7,58,37,152 15,87,89,287 82.14 65.46 74.04 13.3 12.93 13.12

Karnataka 3,10,57,742 3,00,72,962 6,11,30,704 319 968 35,27,844 33,27,957 68,55,80 1 82.85 68.13 75.6 11.36 11.07 11.21

The health scenario in the State of Karnataka is a combination of achievements and challenges. NFHS-I11 report indicates the following facts and figures with regard to the health and nutrition status of children in the State of Karnataka: Infant mortality rate in Karnataka is estimated at 43 deaths before the age of one year per 1,000 births. Under-five mortality rate is 55 deaths per 1,000 births in Karnataka. Infant mortality rate in rural areas (471 1,000) is higher compared to urban areas (3711,000). Infant mortality is 74 per 1,000 for teenage mothers compared to 47 per 1,000 for mothers in the group of age 20-29.

65% of the deliveries occur in health care institutions. Remaining 35%

occur in homes with the assistance of relatives or other untrained persons. Amongst women in the age group of 15-19 years, 17% bear children a little higher than the national average (lbO/o). Young women in rural areas are almost twice (21%) as likely to have begun child bearing as young women in urban areas (1 1%).
a

Birth gap: The median interval between births in Kamataka is 30

months, 1 month shorter than the national average. Il0/0 of non-first births take place within 18 months of the previous birth and 28 9' 0 occur within 24 months. A little less than two-thirds (63%) of births occur within three years.
59% of the children less than 6 months old are exclusively breastfed as recommended by the World Health Organization and only 750h are breastfed within the first day of life of the child, including 36% who

start breastfeeding in the first hour of life of the child. Mothers in Karnataka breastfeed for an average of 21 months which is shorter than the minimum of 24 months, recommended by the WHO. Article 39 (f) of the Constitution of India postulates that the children are to be given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity. Childhood and youth are protected against exploitation as against moral and material abandonment. It is useful to refer to Articles 15 (3) and 39 (e) of the Constitution of India which provides for making suitable legislations for the welfare of the children. As per the constitutional mandate and provisions contained in various statutes, it is our obligation, responsibility and duty to look after and groom well the children with great human touch and concern. The Central and State Governments cannot neglect and fail to provide basic healthcare needs such as shelter, clothing. nutritious food, pure drinking water and timely medical treatment. It is the constitutional duty of the State to create a very good and congenial atmosphere for overall development of children. Children are to be nurtured, loved and protected by providing basic necessities. Nutrition is the most
-3-

INTRODUCTION

important factor which has its effect, both on mental & physical development of the child. Optimal nutrition like proteins, vitamins, carbohydrates, micronutrients, iron and trace elements are integral parts of nutritious diet which is required for the overall development of the child. Food which consists of the above is the wholesome food. Deficiency of even one of the above would hamper the overall development of the child. When proper nutrition is denied, the child becomes virtually handicapped.

BACKGROUND OF THE COMMITTEE:-

On 22.05.201 1, TV-9 Kannada News Channel telecasted on item of news of the children not only suffering from starvation but also death of a few children on account of starvation and lack of timely medical treatment in the State of Karnataka, especially, in Markaldinni village of Deodurg Taluk of Raichur District. After watching the said news item, NGO by name Vimochana Sangha, Athani, Belgaum District, through its President addressed a letter to Hon'ble the Chief Justice, High Court of Karnataka to intervene in the matter. Hon'ble the Chief Justice, High Court of Karnataka, after perusing the letter directed Registrar (Judicial), High Court of Karnataka, to treat the said letter as a Public Interest Litigation and to list the same before the Division Bench. Accordingly, Writ Petition No.38 1571201 1 (PIL) came to be registered. It was posted before the Division Bench on 4.10.201 1. The Division Bench, as per order dated 4.10.201 1, directed Karnataka State Legal Services Authority to conduct investigation through its District Legal Services Authority, Raichur, to get the truth of the matter investigated and submit report. Accordingly, the Member Secretary, Karnataka State Legal Services Authority conducted the investigation and submitted report before the High Court on 28.11.201 1. The matter came for consideration before the Division Bench consisting of Hon'ble the Chief Justice Hon'ble Mr. Vikramajit Sen and Hon'ble Mrs. Justice B.V.Nagarathna. After hearing the counsels for the parties, the Division Bench, as per order dated 12.04.2012, constituted a nine members Committee under the Chairmanship of Hon'ble Mr. Justice N.K.Pati1, Judge, High Court of Karnataka, to look into various aspects of children suffering from malnutrition in the State of Karnataka and to prepare an Action Plan and submit the Report to High Court within 15-06-2012.

Nine members Committee constituted under the Chairmanship of Hon'ble Mr.Justice N.K.Pati1 are as follows:

Chairman : Members :

Hon'ble Sri.Justice N.K.Pati1, Judge, High Court of Karnataka 1 . Director, Health and Family Welfare Services, Government of Karnataka 2. Joint Director, ICDS, Department of Women and Child Development, Government of Karnataka 3. Chairperson, Karnataka State Commission for Protection of Child Rights 4. Dr. Smt.Maya Olga Mascrenhas, MYRADA (NGO) 5. Sri. Mariswamy, Representative Parivarthana Janandolana (NGO) of Samajika

6. Sri. Clifton D'Rozario, Advocate, Bangalore

7. Director or Paediatric Nutritionist/Dietician, Indira Gandhi Institute of Child Health, Bangalore
8. Member Secretary, Karnataka State Legal Services Authority - Convenor of the Committee

APPROACH OF THE COMMITTEE FOR PREPARING MASTER ACTION PLAN:The first meeting of the Committee was held on 18-04-2012. The meeting was chaired by Hon'ble Mr. Justice N.K. Patil, Judge, High Court of Karnataka. Members of the Committee, Special Invitees, namely, Addl. Advocate General of Karnataka, Prl. Secretary, Department of Women and Child Development, Prl. Secretary, Department of Health and Family Welfare, Govt. of Karnataka attended the meeting. After due deliberations, the Committee resolved to constitute District Level Sub-committees under the chairmanship of respective Deputy Commissioners of the Districts, for the effective study of the issues pertaining to malnutrition of children in the State of Karnataka.

INTRODUCTION

In pursuance of the resolution adopted in the first meeting, the Government of Karnataka issued order No. WCD 303/ICD/20 1 1(B) dated 19-04-20 12, constituting District level Sub-Committees consisting of the following Members, as detailed below :-

1 Deputy Commissioner

: Chairperson : Member
: Member : Member

2 Chief Executive Officer, Zilla Panchayat

3
District Health Officer

4 PrincipalIDirector, Medical College, Government1 Private: Nominated by Deputy Commissioner

5 Deputy Director, Department of Women and Child Development

Member Secretary

i
c

In the four Regions of the State, i.e., Gulbarga, Bangalore, Belgaum and Mysore, Regional Meetings were convened by the Chairman of the Committee to identify the causes and reasons for malnutrition in the children. The meetings were convened also with an intention to give opportunity to individuals, representatives of NGOs working in the field, experts in the field of child welfare and all concerned to put forth their suggestions/ recommendations. In the above Regional Level Meetings, the participants gave valuable suggestions to prepare Action Plan and as to how to tackle the issue of children suffering from malnutrition in their respective Regions. The Committee directed Department of Women and Child Development, Government of Karnataka to launch Toll Free Helpline to enable the public and all concerned to interact with the Department with regard to the treatment of malnourished children and other health care issues. Accordingly, on 26.04.2012, Toll Free Helpline number 1800-425-25250 was launched in the Regional Meeting of the Committee convened at Gulbarga. To know the ground reality of not only the children suffering from malnutrition but also adolescent girls, pregnant women and lactating mothers and with an intention to get first-hand information regarding the infrastructure provided by the Department to the Anganawadi Centres in the State. Hon'ble Chairman of the Committee visited 81 Anganawadi Centres covering 14 Districts in the State. The chairman was accompanied by Senior Officers of the Department of Women and Child Development, Health and Family Welfare, Deputy Commissioners, Chief Executive

Officers of Zilla Panchayat, District Health Officers, Deputy Directors of Women and Child Development Department of the respective Districts, Mernbers of the Committee, Convenor of the Committee, Special Officer of the Committee and others. During the visits, Hon'ble Chairman had interaction with Anganawadi workers, Anganawadi helpers, Anganawadi children, their parents, adolescent girls, nursing mothers, public in general etc., to know the problems faced by them in managing the Anganawadi Centres in their respective regions.

Hon'ble Chairman of Conlnlittee interacting \tith a Anganwadi worker during the visit to one of the Angannadi Centres in Bidar District

In addition to the above referred methodology, due publicity was given to the public, NGOs and experts working in the field soliciting valuable suggestions in identifying causes relating to malnutrition and on related issues. In the above regard, Press Conferences were convened by Hon'ble Chainnarl of the Committee in all the Districts the Comnlittee visited. In the Press Conferences, Hon'ble Chainnan requested the journalists, members of print and electrollic media and others to submit their valuable suggestions in the above regard. Pursuant to the same, good number of suggestions were received. Apart from the above, on 14.05.2012, Hon'ble Chairman of Committee convened a brain stonning session at Bangalore with Prl. Secretaries of Departments of Women and Child Development, Health and Family Welfare, Pri11lar-y and Secondary Education. Food and Civil Supplies, Agriculture, Rural Development and Panchayat Raj and Urban Development of Government of Karnataka to impress upon them of inter departmental co-ordination for the effective implementation of various

INTRODUCTION

issues concerning adolescent girls, pregnant women, nursing mothers, severely malnourished children and the children attending Anganawadi Centres in the State.

Hon'ble C'l~,~isma~i of Comm~ttcc ~ c r ~ f y tllc ~ n I-eslbtcr\ g rna~ntalneciIn one of the , A n g r ~ l ~ \ \ a d ~ Ccntres 111 C'hlhh;lballnpu~D14tric.t

After visiting many Anganawadi Centres in Bangalore, many towns, villages, tribal settlement areas, SC and ST colonies, localities where minority sections of the society reside and slums in towns and cities and after holding Regional Meetings and press conferences, voluminous information, in writing, were received by the Committee from various quarters. Hon'ble Judges of the High Court of Karnataka, Secretaries of Department of Women and Child Development, Health and Family Welfare, Food and Civil Supplies, members of District level sub committees, experts in the field, members of NGOs and general public submitted their valuable suggestions. As it was not possible for the committee to collate the information and suggestions so received within a short time to submit a comprehensive report to Hon'ble High Court, in the meeting convened by the Committee on 23.05.2012 at Bangalore under the Chairmanship of Hon'ble Mr. Justice N.K.Pati1, Judge, High Court of Karnataka, it was resolved to submit Interim Report as certain urgent issues needed to be addressed to, urgently, with regard to the children suffering from malnutrition in the State of Karnataka.

INTRODUCTION

Accordingly, the Committee submitted its Interim Report to High court of Karnataka on 12.6.2012. Division Bench of High Court of Kamataka heard the matter on 15.6.2012. It perused the Interim Report of the Committee. On 26.6.20 12, Additional Advocate General of Karnataka submitted to the Division Bench that Government of Kamataka have accepted in toto the recommendations made by the Committee in its Interim Report. As per order dated 26.06.2012, High Court of Karnataka extended the time to the Committee to file final report by the end of September, 20 12. The Committee examined the suggestions submitted to it by Hon'ble Judges of the High Court of Karnataka, various NGOs, individuals, experts in the field heads of the various departments of the Government of Karnataka etc., Chairman of the Committee had frequent meetings of the Committee and studied the problems pertaining to child malnutrition in the State of Kamataka from all angles. Thereafter, the Comprehensive Master Action Plan Report containing recommendations for doing the needful by Government of Karnataka is prepared by the Committee. Hence, the Comprehensive Master Action Plan Report.

Photograph of Hon'ble Chai~man, Members of the Committee, Special Invitees, Deputy Commissioner and other officers of Government of Karnataka with anganwadi children, adolescent girls and villegers in front of an Anganwadi Centre situated in a Tribal Colony in Yellapura Taluk, Uttar Kannada District

Chapter: II

Concept & Causes of Malnutrition

Conct t and Causes of Malnutrition

te consumption, poor absorption or excessive loss of nutrients, but the so encompass over-nutrition resulting from excessive intake of specific

growth and if he is unable to digest the food he consumes. Acute malnutrition, also known as 'wasting' is characterized by a rapid on in nutritional status over a short period of time.

In children, it can be measured using the weight-for-height nutritional index or er arm circumference.
acute malnutrition (MAM) and (2) severe acute malnutrition (SAM). Severe acute malnutrition is a result of recent I - - h7 (short-term) deficiency of protein, energy,

r minerals and vitamins leading to loss of body

k
fats and muscle tissues.

I
I

Acute malnutrition presents with wasting (low weight-for-height) andl the presence of oedema (i.e., retention of water in body tissues).

urgent medical @are

nic malnutrition'Wso known as 'stunting" is a form of growth failure

s over a long period of time. hadequate nutsition ova. long periods of g poor maternal nutrition and poor infant and young child f&

- 11 -

CONCEPT AND CAUSES OF MALNUTHTZON

practices) and/ repeated infections can lead to stunting. In children, it can be measured using the height-for-age nutritional index. . b : .- ,, . -v

As per WHO growth standards, birth weight of an infant less wan 2,F"3 grams is considered as low birth weight infant.
An individual will experience malnutrition if the appropnate m a -1, or quality of nutrients comprising for a healthy diet are not consumed fur an extended period of time.
i4

f&l

Malnutrition increases the risk of infection and infectious diseases. Moderate malnutrition weakens every part of the immune system. It is a major risk factor in the onset of active tuberculosis. Protein and energy malnutrition and deficiencies of specific micronutrients (including iron, zinc, and vitamins) increase suscqtibility to infection. Malnutrition affects HIV transmission by increasing the risk of ~ s s i o n from mother to child and also increasing replication of the virus. In w m m e t i e s or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represents the downward spiral of malnutrition as victims are less able to perform tZle tasks they need, namely, to get food, earn livelihood and benefit fiom education.

Clinical signs/symptoms of malnutrition:

.

i-

Face
Eye
Mouth

Moon face (kwashiorkor, simian facies (marasmw)

Dry eye;, pale conjunctiva, Bitot's spots (vitamin A), perirabital edema
Angular stomatitis, cheilitis, glossitis, spongy blw(vitamin C), parotid enlargement
-

gbms

Teeth
Hair

Enamel mottling, delayed eruption

.%

---

Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper and hypopigmentation, erosions, poor wound healing Koilonychia, thin and soft nail plates, fissures or ridges

Skin

Nail

CONCEPT r L N D CAUSES OF MALNUTRITION

Musculature Skeletal
t
C1

Muscles wasting, particularly in the buttocks and thighs Deformities usually a result of calcium, vitamin D or vitamin C deficiencies Distended - hepatomegaly with fatty liver, ascites may be present

Abdomen

g,

Cardiovascular Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy Global development delay, loss of knee and ankle reflexes, impaired memory Hematological Behavior Pallor, petechiae, bleeding diathesis Lethargic, apathetic

SOURCE: "Protein Energy Malnutrition" Grover, Zubin: Ee, Looi (2009)

In India, 46% of children below the age of three are too short for their age. 47% children are underweight. 16% of the children are wasted. Many of these children severely malnourished.
Malnutrition in children is not affected by food intake alone. It is also uenced by access to health services, quality of care for the child health of pregnant er and the following of good hygiene practices. Girls of tender age are more at k of malnutrition than boys because of their lower social status. Malnutrition in early childhood has serious long-term consequences because it impedes motor, sensory, cognitive, social and emotional development of the Child. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults at greater risk of disease and early death. Around onethird of adult women are underweight. Inadequate care of women and girls, especially, during the pregnancy results in low- birth weight babies.

Vitamin and mineral deficiencies also affect the survival of children and - development. Anaemia affects 74% of children under the age of three, more than 90% ~f adolescent girls and 50% of women. Iodine deficiency which reduces learning . capacity up to 13% is widespread. Vitamin A deficiency which causes blindness and

IF

Nearly 30% of new-borns have a low birth weight making them vulnerable to er malnutrition and diseases.

CONCEPT AND CAUSES OF M A L N U T R I ~ O N

increases morbidity and mortality among pre-schoolers also remains a public-health problem. .. . - Under nutrition in children under 5 years of age is associated with high rate of mortality and morbidity and is an underlying factor in almost one third to one half of the children under the age of five years who die each year of preventable causes. Strong evidence exists on synergism between under nutrition and child mortality due to common childhood illnesses including diarrhoea, acute respiratory infections, malaria and measles.
Photo of a malnourished child requiring urgent medical care

Causes for malnutrition :

The causes for malnutrition are multifarious and are multidimensional. In the course of study, it came to the light of the Committee that the causes for malnutrition among children in the State of Karnataka differ from one region to another region. The causes for malnutrition that we find in Hyderabad-Karnataka and BombayKarnataka regions of State of Karnataka are not the same for Coastal and Malnad regions in our State. #{&: 2 .- 2 '.:-+ - -The causes for malnutrition may broadly be classified as follows: Social factors 1 1 . Health factors III. Economic factors and IV. Other factors Social Factors:-

I.

a t - Household food insecurity:

Lack of food security in the family is one of the main reasons for malnutrition in children. The study conducted by the Committee revealed that several families in the State do not have either BPL or AAY cards though such families are eligible to get the same. It is also noticed by the Committee that BPL or AAY card holders are not

CONCEPT AND CAUSES OF MALNUTRITION

getting timely and quality ration through public distribution system (PDS). Thus, lack of household food security has also contributed to the cause of malnutrition of children in the State of Karnataka.
&-

Lack of education 1 Female literacy rate: In Karnataka, educating the general population on benefits of nutrition is necessary to ensure that people take balanced diet. Good education on nutritional aspects should start from the school level. Required curriculum on the importance of consumption of nutritional food/food supplements should find place in text books of children.

Many a parents lack the requisite knowledge of providing healthy and adequate Jiet to their children.

In Karnataka, female literacy rate is very low.' They lack knowledge regarding nutrition and child care.
Female literacy rate of Karnataka State indicated in the following table:
Ranking of Districts by Famale Literacy Rate
Yadgiri Raichur Chamarajnagar Gulburga Koppal Bijapur Bellary Bagalkot Ramanagar Chickballapur Bidar Mandya Belguam Gadag Chitradurga Districts Tumkur Kolar Mysore Hassan Davangere Haveri Bengaluru R Chickmaglur Dharwad Shimoga kodagu Uttara Kannada Udupi Dakshina Kannada Bengaluru U

.
I I
I I

I I I

141.31 49.56 54.32 55.87 56.22 56.54 I 58-28 58.55 61.30 61.55 61.66

62.10 64.74 55.29 66.05 66.45 66.56 66.59 I 68.30 9.39 r0.65 r0.73 72.88 73.57 1 74.89 1 77.91 78.21 81.41 84.04 84.80
80.00

1 -

--

0.00

20.00

40.00

60.00

1 0 0 . 0 0

Female Literacy Rate in Percentage

According to the census of 201 1, the female literacy rate in Karnataka is 68% Dakshina Kannada, Bengaluru, Udupi and Uttara Kannada districts have high literacy rate. Yadgiri, Raichur, Gulburga and Bijapur have low literacy rate. Bengaluru Urban district has the highest female literacy rate (85%). Yadgiri has the lowest female literacy (41.31%). Out of 30 districts in the State, only in 11 districts, the female literacy is more than the State's average and in rest of the districts, it is less than State's average.

iti

Gender discrimination: Gender discrimination especially in India is high. According to NFHS - 111, in Karnataka, 12% of women and 13% of men want more sons than daughters. Only 3-5 % wants more daughters than sons. In rural area, if women give birth to healthy female child, the member of family will not be happy. Even the elders in the family are not ready to provide proper care to such girl child and her mother. Lack of proper care, at initial stage, to the newly born female child and her mother many a times leads to malnutrition of the child.

Child marriage and early pregnancy: "Child marriage" can be defined

as a "phenomenon where a child is married before he or she attaim adulthood".

According to the Prohibition of Child Marriage Act, 2006, "child marriage" means a marriage to which either of the contracting parties is a child -.-,- . s - z [Section 2 (b) 1. - .Li Section 2 (a) of the above Act defines the word "child" as mazing a person who, if a male, has not completed 21 years of age, and if a female, has not completed 18 years of age.

Child marriage continues to be a w&&xread social evil in India. NFHS-III carried out in 29 States confirmed that 45% of women are married before the age of 18 years. The percentage is much higher in rural areas (58.5) than in the urban areas (27.9%). In Jharkhand, 6 1.2% women are married by the time they are 18 years, 60.3% in Bihar, 57.1% in Rajasthan, and 45% in Karnataka. NFHS -111 findings further reveal that 16% of women aged in between 15-19 are already mothers or pregnant at the time of survey.

4 5 5

Photo of a married couple (Less than the legally marriageable age - an instance of child marriage)

CONCEPT A.VD CA USES OF MA LIVUTRITION

According to the Report of UNICEF titled 'State of the World's Children2009', 47% of the Indian women are married before the legal age of 18 with 56% in rural areas. 15% of girls in rural areas, across the country are married before the age of 13. 52% of girls have their first pregnancy in between the age 15 and 19. In Karnataka, 2 out of 5 girls are married before they attain the age of 18. According to the census of 200 1, in the age group of 10- 1 8 years, there are 52,02,954 adolescent girls. In the age group of 10-21 years, there are 72,00,909 children, teenagers etc., The above two headings constitutes 23% of the total population in the State. According to DLHS-RCH 2007-08, nearly 114"' of the girls in the State are married before attaining the age of 18 years (22%). Similarly 11% of boys, nearly 1110'~ get married before the age of 2 1 years. In Bagalkote, nearly half of the girls are married before the age of 18 years. Least child marriages is recorded in Uttara Kannada District (1.7%). The percentage of child marriages is high in almost all Northern districts (Koppal 44.7%, Belgaum 44.2%, Bijapur 43.1 %, Gulburga 4 1.6% and Raichur 38.7%) when compared to Southern districts in the State. In child marriage, early onset of sexual activity and the persistent pressure on the wife to conceive and have a child can have irreparable and adverse consequences on the health of both the mother as well as the child. 53.5% of neonatal mortality, 20.3% of post neonatal mortalities, 73.8% of infant mortality, 19.7 child mortality and 92.1 % under - five child mortality occur in case of birth of children, the mother in question being below the age of 20 years. Infant mortality is 7411000 for teenage mothers compared to 4711000 for mother in the age group of 20-29. (Source: NFHS-111). Due to these complications, woman may die during child birth. Many women suffering from chronic disabilities die after child birth. When the mother is suffering from chronic diseases, the same will affect the child. Finally, the child becomes unhealthy or malnourished. Teenage pregnancies results in low birth weight of the newborns.
Z P

Social Hierarchy: Often in countries with an inherently patriarchal set up, the males are given precedence when it comes to food. The father and the sons will be fed first. Thereafter, the female members of the family will be served with food. This is evident in countries such as India where it is the role of the woman to cook and serve the male. Consequently, the mother and girl child in the family many-a-times gets less quantity as against their minimum nutritional
- 17-

CONCEPT AND CAUSES OF MALNUTRITION

requirements. As a result, such women and girl children suffer from malnutrition.

Alcoholic Family: Generally, the alcoholic families neglect their children. Lack of proper care, nutritious food, immunization and timely medical treatment to the children born in alcoholic addicted families may many a times . . push the children towards malnutrition.

-.
Health Factors:
a>

Poor breastfeeding practices: Most of the pregnant and nursrng women are not aware of the importance and methodology of breastfeeding. Mmy mothers do not breastfeed immediately after birth of child. The study crmdud ;by the Committee reveled that in some districts of K a r n a ~ - H y b Wma, mothers still believe that bottle feeding is better breastfeeding.
. t ~

Exclusive breastfeeding for the first six months will have direct effect on the growth, development, nutrition and health status of the idimt and the mother. The study revealed that excluive bred* not only prevented infections, pdculaly, diarrhoea1 infections in the child but also help i n panrenting anaemia in child, a s bioavailable iron. Exclusive bne mother's immune system, delays next reduces the insulin needs of among the women folk importance and practice of breastfeeding has also contn"buted, its: maw extent, * for child malnutrition in the State.

rn Poor complementary feeding practices: Most of the pregtumt

women do not know "Infant Young Child Feeding" practices and aakitimd needs of the child. It may also lead to malnutrition. between two children is one of the contributing factors for child malnutrition.

w Inadequate birth spacing: Inadequate and insufficient birth spacing in

a> Genetic problem: Genetic problem of the parents is also a contributing factor for child malnourishrnent.

CONCEPT AND CAUSES OF MALNUTRITION

w Poor access to health services: Lack of access to healthcare at periodic

intervals also contributes for child malnutrition.

w Poor diet: The mother and child should be provided nutritional food during
pregnancy and after birth of child failing which the child will not grow well.
a> Digestive disorders and stomach conditions: Some children consume properly. But their body can't absorb the nutrients. Failure to identify the cause at right point of time and failure to provide required treatment may result in serious health disorders. Ultimately, such children may land in the circle of malnutrition.

Economic Factors:

Poverty: Poverty is one of the important causes of child malnutrition. Poverty is a vicious cycle. This leads to inadequate food intake and under nutrition further leading to physical growth and development of children, impaired functioning and low productivity, again leading to poverty. Poverty imposes restrictions on food intake of poor sections of the society and the worst sufferers are young children, adolescent girls, pregnant and lactating mothers. These groups are nutritionally the most fragile and vulnerable sections.

mpairedfunctioning

Inadequatedls

1.

The information gathered by the Committee revealed that the families of Northern districts of Karnataka consisting of Bidar, Raichur, Gulburga, Yadgir, Koppal etc., have low income and live in worst living conditions. These districts have the highest percentage of poverty and highest incidence of malnutrition as well.

1
k

r(,

Food prices and food distribution

4 Low purchasing power etc

IV. Other factors:

rn Lack ~f availability of safe drinking water

Poor sanitation and environmental conditiam ?S Poor personal hygiene ~ c > Maternal malnutrition w Cultural beliefs (not feeding colostrum to the child, incorrect weanii practices) =i ! m Wrong cooking and developmental stage of ' child ZB Crop failure EO Quali of crops Er, Food and Agricultural
ef,

,. ,--... .7t , . . ; .
>.'-I '?

xL

.. . . -8

Chapter: 1 1 1

Care & Protection of Adolescent Girls, Pregnant Women & Nursing Mothers

Chapter: IZI

Care & Protection of Adolescent Girls, Pregnant Women & Nursing Mothers:
India is the second most populous country in the world with a population of 1.22 billion (as per the data of 1ndianonlinepages.com of 20-08-20 12). Adolescents form a large section of population viz., 243 million, which is about 20 per cent of the population. "Adolescent" is defined by the World Health Organization as "the period of life spanning between 10-19 years". Adolescence is the transition period between childhood and adulthood, a window of opportunity for tJle improvement of nutritional status and correcting poor nutritional practices. Adolescence is characterized by the growth spurt, a period in which growth is very fast. During this 'period, physical changes affect the body's nutritional needs, while changes in one's lifestyle may affect eating habits and food choices. Adolescent nutrition is, therefore, important for supporting the physical growth of the body, cognitive functions and for preventing futwe health problems.

Group photograph of adolescent girls

Adolescents are no longer children, but not yet adults. Adolescents have dmdvantages. They are developing rapidly and having an extreme degree of pressure fiom peers, parents, society and self. They lack knowledge and skill to cope with the pressure.

'

. CARE & PROTECTION OF ADOLESCENT GIRLS, PPRGNANT WOMEN & NURSING MOTHERS

Any nutritional deficiency experienced during this critical period of life can have an effect on the future health of the individual and their off-spring. Rapid physical changes of adolescence has a direct influence on a person's nutritional needs. Nutritional status and physical growth are inter dependent. Optimal nutrition is a requisite for achieving full growth potential. Nutrition of the adolescent girls is particularly important but undernutrition (too little food or food lacking required nutrients) in adolescents frequently goes unnoticed by their families or the young people themselves. Adolescence is the time to prepare for the nutritional demands of pregnancy and lactation that girls may experience in later part of their life. It is a common observation that adolescent girls hide some sexual health issues. Even they are not ready to tell with regard to such issues before their parents. Lack of concern of family regarding the health of the adolescent girls may push the adolescent girls in health problems. Added to this, adolescent girls require complete nutrition, timely medical advice and treatment to rise to the occasion to give birth to a healthy child. Thus, the care and protection of adolescent girls is very important to prevent the problem of malnutrition.

Photo of a severely malnourished child under the care of her mother

The study conducted by the Committee revealed that the adolescent girls are not getting required nutition, timely medical advice and aid. That apart, many adolescent girls are not the beneficiaries under ICDS or other projects launched by the Government for the benefit of adolescent girls. This is on account of various reasons, especially, lack of knowledge regarding the schemes like Sabla, Kishori Shakthi

CARE & PROTECTIOiV OFADOLESCENT GIRLS, PREGNANT WOMEN & NURSI'YG .MOTHERS

Yojana, Sneha Clinic etc., as also on account of lack of support of family. Consequently, adolescent girls are deprived of required nutrition, timely medical advice and treatment and social support which are essential for physical, mental and social development well-being of adolescent girls. Thus, the Committee is of the opinion that unless the adolescent girls are taken care and protected, the Government can't effectively tackle the problem of malnutrition. "A healthy mother gives birth to a healthy child". The role of pregnant women is very important from the point view of child malnutrition. During pregnancy, a woman's energy requirement increases because she expends more energy. That energy is used to:
&

Maintain the woman's essential body functions such as respiration and digestion of food. The energy expended to maintain essential body function is known as Basal Energy Expenditure (BEE) and a woman's BEE increases during pregnancy; Perform physical activity and during pregnancy, the energy cost of performing standardized tasks increases. A woman will expend more energy performing the same task during pregnancy than she was doing before she became pregnant; and Deposit fat and protein as the products of conception(the foetus and placenta tissue and amniotic fluid which surround and protect the foetus) and maternal tissues (including breast and uterine tissue) as the pregnancy progresses. An average woman will add 12.5kg of tissues and fluids to her body and she should consume additional food to account for this.

&

&

During pregnancy, macronutrients provide the energy necessary for foetal growth and maintenance of the woman's weight and essential bodily functions (e.g. respiration). Macronutrient requirements, therefore, increase during pregnancy because growing baby requires energy as well as the woman's body. Ensuring energy intake increases and accordingly is essential for optimal health outcomes for both the pregnant woman and her baby. Macronutrients are nutrients such as protein and carbohydrates which are converted into energy, to be used by the body to fulfil essential functions and perfonn physical tasks. They are obtained from a variety of food sources including cereals and grains, meat and legumes.

CARE & PROTECTION OF ADOLESCENT GIRLS, PREGNANT WOMEN & NURSING MOTHERS

An individual who does not consume enough energy becomes malnourished and malnutrition has a range of health consequences for a pregnant woman and her growing baby. These include a greater risk of low birth weight and infant mortality. Low birth rate is the most important factor which causes illness and death in babies. It is also associated with a variety of infant and childhood development disorders, in particular, poor cognitive (mental) development. Low birth weight also increases an individual's risk of developing chronic health conditions such as diabetes later in life. The study conducted by the Committee revealed that in some parts of the State, especially, in the districts of Hyderabad - Karnataka region and in urban slums, many pregnant women suffer from malnutrition on account of various causes like insufficient nutrition, chronic diseases, lack of timely medical treatment, poor hygiene, want of safe drinking water, lack of family support etc., In many parts of the State, many nursing mothers are malnourished for one or the other reason the pregnant women suffer. As the health status of pregnant women and nursing mothers has a direct bearing on the health of their children, unless health and nutrition status of the pregnant women and nursing mothers improve, we can't curb the problem of malnutrition of the children. During the course of visit of the Committee to various Anganwadi Centres in the State, it was observed that the pregnant women and nursing mothers, though enrolled as beneficiaries under ICDS are not properly provided the services to which they are lawfully entitled. They are not getting Take Home Ration (THR) and IFA tablets regularly. That apart, it has also come to the notice of the Committee that the pregnant and nursing mothers are not subjected to periodic medical check-up and in some cases, required medical treatment is not at all provided. Thus, the Committee thought it fit to suggest certain recommendations, as above, for the health care and other issues of adolescent girls, pregnant women and nursing mothers.

Chapter: I V

IdentiJcation, Medical Assessment & Treatment of ICDS and Non ICDS Chiklren

Identification, Medical Assessment & Treatment sf ICDS Children

Information furnished to the Committee by the Child Development, Government of Karnataka indica& 35,99,484 children enrolled as beneficiaries under the up. Similarly, 16,12,163 children not covered under I C medical check up. The chart detailed below indicate number of childzr check up.

m ah a
-.-1 ,--

..-

; & '

cal

Severe :13,081

6,80;605

It is clear from the above chart that 35, 99,484 children covered under ICDS were medically examined. Out of the above 23,96,752 are normal, 11,39,459 are moderately malnourished and 63,273are severely malnourished.

IDENTIFICATION. MEDICAL ASSESSMENT & TREATMEA T O F ICDS AND NON ICDS CHILDREN

Similarly 16,12,163 children not covered under ICDS were examined. Out of the above, 10,73,123 (rural 54262 1 + urban 530502) are normal, 2,17,889 (rural 124903 + urban 92986) are moderately malnourished and 2 1,15 1 (rural 1308 1 + urban 8070) are severely malnourished. The above chart further indicates that 63,273 children covered under ICDS are identified as severely malnourished. Out of them 3,757 children are in need of medical treatment. Similarly 2 1,151 children are identified as "severely malnourished", though they are not covered under ICDS. Out of them 3,390 children are in need of medical treatment. The study conducted by the Committee has revealed that the scheme adopted by the State Government, to identify, medically assess and treat the severely malnourished children who have been enrolled as beneficiaries under ICDS in the State, appears to be inadequate. In respect of children not covered under ICDS, it appears that the Government has not introduced any specific scheme to identify, medically assess and treat such severely malnourished children. It is the duty of Central and State Government to take care of children, irrespective of the fact whether the children are covered under ICDS or not. Therefore, the Committee suggests the following recommendations regarding identification, medical assessment and treatment of children covered under ICDS and Non-ICDS:
A.

Measures to identify medically assess and for treatment of children enrolled as beneficiaries under ICDS
1.

The Government shall take appropriate steps to getmedically examinedthe children in between the age group of 0-6 years enrolled in Anganwadi centres. Further, the Government shall ensure that in respect of severely malnourished children, medical examination be conducted with the assistance of paediatricianslexpert doctors. The above said exercise should be carried out jointly by the Department of Women and Child Development, Department of Health and Family Welfare, Department of Medical Education, Department of RDPR and Urban Development Department of Government of Karnataka.

11.

..

IDENTIFICA TION. MEDICAL ASSESSMENT & TREATMENT OF ICDS AND NON ICDS CHILDREN

The Government shall establish Nutritional Rehabilitation Centres in the premises of District Civil Hospitals and in the hospitals attached to Medical Colleges in the State.There shall be a separate ward of minimum of 20 beds earmarked to address to the problems of severely malnourished children as such children require immediate medical treatment and care. The Government shall ensure that after identification of severely malnourished children, Department of Health and Family Welfare, Government of Karnataka should take steps for health assessmentlcheck up of such children. Severely malnourished children who are in need of immediate medical treatment shall be admitted to the nearest Nutritional Rehabilitation Centre established by the Government of Karnataka in pursuance of recommendations made by the Committee in itsInterim Report dated 1 1th June, 2012 /Speciality Hospital at the option of the parentlguardian of such child. The Government shall ensure that Nutritional Rehabilitation Centres in the State shall be provided the requisite infrastructure and provision therein shall be made for stay of mother1 guardiadrelative of the child and food be provided to them during the period of treatment of the child. Severely malnourished children admitted to Nutritional Rehabilitation Centres1 Speciality Hospitals in the State shall be treated by the specialists, at the cost of the Government and they beprovided nutritious food, as per the directions of the Nutrition Expertslmedical officers etc., attached to the concerned Hospitals. The health profile of each severely malnourished child is required to be maintained with online monitoring facility until the said child comes out of the state of malnourishment.
ix.

The Government shall pay minimum wages,as fixed under the provisions of Minimum Wages Act I Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNAREGA)to such motherlguardianlrelative during the period of treatment of the child, as they would be losing their earnings during the said period of treatment of child. The Government shall ensure that every child enrolled in the Anganwadi Centres is subjected to medical check up by a medical officer, at least

IDENTIFICATION. MEDICAL ASSESSMENT & TREATMENT OF ICDS AND NOR' ICDS CHILDREN

once in 3 months and in respect of severely malnourished children, such medical check up be done at least once in a month, on regular basis. xi. The Government shall provide awell-equipped Mobile Medical Unit for each taluka in the State with required medical and nursing staff to attend to emergent medical treatment of adolescent girls, pregnant women, nursing mothers and children.

B. Measures to identify, medically assess and for treatment of children not enrolled as beneficiaries under ICDS
i.

The Government shall take appropriate steps to identify children in age group of 0-6years and not enrolled as beneficiaries under ICDS and shall take steps to medically examine such children. The Government shall organisemedical camps for examination of children in the age group of 0-6 years of migrant families of construction and building workers at the places where they temporarily reside as also the children in the above age group of the above said families at work siteslplaces in the State where building and other construction workers work in large number. The Government shall ensure that after the identification of severely malnourished children, the Department of Health and Family Welfare, Government of Karnataka should take steps for providing treatment for such children.

11.

..

111.

...

iv. Severely malnourished children who are in need of immediate medical treatment shall be admitted to the nearest Nutritional Rehabilitation Centre within their jurisdictionestablished by the Government of Karnataka in pursuance of recommendations made by the Committee in its Interim Report dated 1 lthJune, 2012 /Speciality Hospitals at the option of the parentlguardian of such child. v. The Government shall ensure that Nutritional Rehabilitation Centres shall be provided requisite infrastructure and provision be made for stay of children and it should be ensured that there is proper supply of food to the mother1 guardianlrelative of such children in the very same Centre during the period of treatment of the children.

vi. Severely malnourished children admitted to Nutritional Rehabilitation Centres1 Speciality Hospitals shall be treated by the specialists, at the cost of the

IDENTIFICATION, MEDICAL ASSESSMENT & TRE.4 ThlENT OF ICDS AND NONICDS CHILDREN

Government and all such children be provided nutritious food, as per the directions of the Nutritional Experts attached to the concerned Hospitals. vii. The profile of each severely malnourished child is required to be maintained with online monitoring facility until the said child comes out of the state of malnourishment. viii. The Government shall pay minimum wages, as fixed under the provisions of Minimumwages Act / Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNAREGA) to such mother/guardian/relatives, during the period of treatment of their child, as they would lose their earnings during the said period. ix. The Government shall take steps for issuance of "Child Health Card" to children of migrant families of building and construction workers who do not have a fixed place of abode and to provide treatment for the children in question in nutritional rehabilitation centre/speciality hospitals for providing health care of the said children till the said children attain the age of 6 years. The Government shall issue necessary directions to the departments of DWCD and Health and Family Welfare, Government of Karnataka to provide required help / assistance to the holder of child health card, whenever such child approaches the nearest AWC / PHC/ CHC/ THC / DHC / NRC for medical aid. The Government shall take steps for counselling the parents / guardian of such child, while the child is admitted in the NRC with regard to the child health care, nutrition and hygiene that they are required to be followed in future from the point view of the health of their child. The Government shall take appropriate steps to motivate the parents / guardian of the child medically examined but not enrolled as beneficiary under ICDS, to enrol the said child as beneficiary under ICDS so that services under ICDS would be available to such child.

x.

xi.

xii.

C. Identification, Medical Assessment And Treatment Of Adolescent Girls, Pregnant Women And Nursing Mothers
A large number of adolescent girls are out of school. They get married early. Poor nutrition, early childbearing and reproductive health complications augment the difficulties of adolescent girls. Anaemia is one of the primary contributors to maternal

IDENTIFICATION. MEDICAL ASSESSMENT & TREATMENT OF ICDS AND NON ICDS CHILDREN

mortality. Nutritional deprivation, excessive menstrual loss and early 1 frequent pregnancies aggravate anaemia and its effects. Thus, proper care and protection of adolescent girls is essential in preventing the problem of child malnutrition. Similarly, care and protection for pregnant and lactating mothers is also important. Otherwise, it may lead to maternal mortality or child malnutrition or infant mortality.

Photo of adolescent girls in front of the building of "Sneha clinic'" The study conducted by the Committee revealed that the schemes meant for adolescent girls, pregnant and lactating mothers are not effectively implemented by the Government. It is also brought to notice of the Committee during its visits to various AWCs in the State, especially, in tribal arek and Hyderabad-Karnataka region that adolescent girls, pregnant &d lactating mothers are deprived of timely medical check ups, nutritional food etc,.

k,:

Thus, the Committee suggests the following recommendations to medically assess and treatment of adolescent girls, pregnant and lactating mothers:

1. The Government shall ensure that adolescent girls are medically examined, regularly at "Sneha Clinic" which are established under NRHM,

2. The Government shall ensure that "Sneha Clinicn which are established under NRHM to address the health related problems of adolescent girls are ready to render friendly health s e ~ c e to s adolescent girls not only onevery Thursday in between 3pm to 5pm but also on any other two working days in a week, preferably on Monday and Saturday in between 2pm and 6pm.
3. The Government shall take steps to medically examine adolescent girls who attend6SnehaClinics and provide required medical aid / treatment to the needy

- 30 -

IDENTIFICATION, MEDICAL ASSESSMENT & TREATMENT OF ICDS AND NON ICDS CHILDREN

adolescent girls, either in the same Primary Health Centre or in any other Government Hospital, if necessity arises.
4. The Government shall ensure that there is regular supply and timely distribution of IFA tablets to the adolescent girls, pregnant and nursing mothers, in addition to providing proper counselling regarding health, hygiene and nutritional aspects.

5. The Government shall ensure that pregnant women and nursing mothers, whether they are enrolled as beneficiaries under ICDS/ not shall be subjected to timely medical check up, regularly.

Photo of a child taking impure drinking water for drinking from the water pot in one of the Anganwadi centres in Benagluru City.

Chapter: V

Nature of Nutrition, Procurement and Distribution

Nature of Nutrition, Procureme~it and Distribution

It has emerged from the study conducted by the Committee that food habits of the people of Karnataka differ from District to District. Food the people from the region of Hyderabad-Karnataka area prefers is not the same as that of the people from the coastal region and other parts of the State. As the food habit of the people the State differs from region to region, supply of uniform type of SNP to all the beneficiaries under ICDS, throughout the State, will not serve the object. The Committee noticed that the food that needs to be given to the beneficiaries should not only be based on local 1 regional food culture, but the same should be seasonal also. Taking into consideration above aspects, the Committee suggests the following recommendations:

1. The Government shall take appropriate steps to provide seasonal, fresh and hot cooked nutritious food to the children attending Anganwadi centres, based on the local or regional food culture, as advised by the Nutrition Experts and Doctors. 2.
The Government shall take steps to provide seasonal fruits in addition to SNP to the children attending Anganwadi Centres.

3. T11e Government shall ensure that moderately malnourished children are provided the same quantity of nutritious food provided to SAM children to prevent MNC to fall in the category of SAM.
4.
The families of children suffering from malnutrition be issued Anthyodaya or BPL Cards subject to their economic and social background i.e., their entitlement to get such cards so that the family would be able to meet the nutrition requirement of the child suffering from malnutrition. The Government shall ensure that the names of children of the family are entered in the Ration Cards to be issued to the families, in future, by the Department of Food and Civil Supplies.

5.

6. The Government shall take appropriate steps to provide nutritious food to adolescent girls, pregnant women and nursing mothers, based on their local or regional food culture, as advised by the Nutrition Experts and Doctors.

h'ature o f Nutrition, Procurement and Distributiun

7. The Government shall ensure that requisite nutritious food supplied to adolescent girls, pregnant women, nursing mothers and children attending Anganwadi Centres should contain the following nutrients :- .
carbohydrates, 11. proteins, . .. 111. fats, iv. vitamins and v. minerals.
..

i.

8. The Government shall take steps for establishment of "Regional Nutrition Council" for the purpose of research and recommend the nature of nutritional needs to be supplied to the beneficiaries under ICDS, from time to time.
9. The Government shall take steps to revise unit cost of SNP, from time to time, taking into consideration the price index of the food articles selected for supply as SNP to the ICDS beneficiaries.

10. The Government shall take steps to create separate emergency fund to meet emergency medical treatment expenses and to provide nutrition to severely malnourished children so that the child identified as severely malnourished are not deprived of getting timely medical treatment and required nutrition, for want of funds.

1 I . The Government shall ensure that the ration required for distribution to the beneficiaries of the ICDS as THR is supplied, regularly and well in time to all Anganwadi Centres in the State.
12. The Government shall take appropriate steps to procure locally available food grains, fruits, etc., for supply by SNP to the children in the age group of 3-6 years enrolled as beneficiaries under ICDS, as they need to be served with hot cooked food, as per order of Hon7ble Supreme Court of India in Writ Petition (C) No 19612001 dated 22-04-2009 (Peoples7 Union for Civil Liberties v/s Union of India 8r others). 13. The Government, if deemed fit, may provide complete nutrition food to the beneficiaries in the age group of 3-6 years instead of SNP.

Chapter: VI

A warerr ess Through Information, Education and Cornrnunication (IEC)

Awareness through Information, Education and Communication (IEC)

The study conducted by the Committee and suggestions submitted to the Committee by individuals, NGOs, experts etc., has revealed that lack of basic knowledge/awareness regarding the causes and consequences of malnutrition is one of the main eventually contributing factors for malnutrition. Duty is cast upon the State Government to create awareness among adolescent girls, pregnant women and nursing mothers and the public at large regarding causes and consequences of malnutrition. Hence, the Con~n~ittee suggests that the State Government shall take following steps, forthwith:

i.

To set up teams of volunteers having good knowledge, regarding the causes and consequences of malnutrition, the said volunteers having presentation and communication skill to express in local language. These teams must be entrusted with the work of creating awareness anlong adolescent girls, pregnant women and nursing mothers with regard to the causes and consequences of malnutrition. In order to create awareness among girl students studying in 7th standard, adolescent girls attending Secondary schools and Pre-University Colleges regarding the effects of malnutrition, the Government shall identify and give training, at least, to one female teacher in each secondary school and PreUniversity College in the State, for the purpose of educating girl students of the secondary school and Pre-University College in question with regard to health, hygiene and benefits of consumption of nutritious food. The Government shall provide compulsory training to Anganwadi workers and Anganwadi helpers and also ASHA workers working under the Department of Health and Family Welfare Department, Government of Karnataka, so that

ii.

iii.

.4 U:4RENESS THROUGH INFORMA TlON, EDUCATIOAr AND COMI~IC'IVICA TION (IEC)

they are well equipped to create awareness among illiterate adolescent girls, pregnant women and nursing mothers with regard to the causes and consequences of malnutrition.
iv.

The Government shall direct the Department of Rural Development and Panchayath Raj to conduct Gram Sabhas for the purpose of empowering the concerned on the benefits of health care of children so that the children will not slip into the category of malnutrition. The Government shall take necessary steps to give wide publicity, through paper publication, display of sign boards, radio / FM broadcasting, television advertisement etc., indicating the benefits available under ICDS and NRHM which are meant for adolescent girls, pregnant and nursing mothers. The Government shall take necessary steps to give wide publicity, through paper publication, display of sign boards, radio / FM broadcasting, television advertisement etc., with regard to the right of the children to get enrolled as beneficiaries in Anganwadi centres and the services that they would get through AWCs if they are enrolled as beneficiaries. The Government shall take necessary steps to give wide publicity through paper publication, display of sign boards, radio / FM broadcasting, television advertisement etc., highlighting the advantages of institutional deliveries from the health point view of mother and child as also from the point view of preventing neonatal deaths. The Government shall take necessary steps to create awareness to the public regarding importance of breast feeding, personal hygiene, consumption of healthy food and on other aspects which are necessary to prevent child malnutrition:a ) Through mass programmes, holding Gram Sabhas, holding street plays, community video shows and video show through community cable TV. b) Specific agenda on the above issues be included for deliberation in the meeting of Stree Shakthi groups.

v.

vi.

vii.

viii.

A WARENESS THROUGH INFORMA TION, EDLiCA TlON A ND COMMUNICA TlON (IEC)

c) Special focus be made in GP and VHNSC meetings with regard to steps to be taken as follow up for identified severely malnourished children.
d) Posters be displayed on prominent outer wall of buildings of Anganwadi Centres, Gram Panchayats, PHCs, Taluk Offices, Taluk Panchayaths, Taluk Health Centres, District Health Centres, Zilla Panchayath offices at District levels and Deputy Commissioners in the State indicating the availability of Toll Free Help Line Number 1800-425-25250 for use in case of emergency and need.
is.

Hon'ble High Court may direct the Government to utilize the services of under graduate and post graduate students in social work and nursing courses for the purpose of creating awareness among adolescent girls, pregnant women and nursing mothers with regard to health, hygiene, nutritional aspects, causes and consequences of malnutrition etc., Hon'ble High Court may direct Karnataka State Legal Services Authority, Bangalore, to create awareness among adolescent girls, pregnant women and nursing mothers regarding health, hygiene, nutritional aspects, causes and consequences of malnutrition, etc., through its District Legal Services Authorities and Taluka Legal Services Committees in the State.

x.

Chapter: VII

Basic Infrastructures to Angan wadi Centres

Basic infrastructures to Anganwadi Centres

Integrated Child Development Scheme was launched for the Country on 2ndOctober, 1975, with the following objects:

1. To improve the nutritional and health status of children in the age-group 0-6 years;
2. To lay the foundation for proper psychological, physical and social development of the child; 3. To reduce the incidence of mortality, morbidity, malnutrition and school dropout; 4. To achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and

5. To enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education and to achieve the above objectives through the following services; i.
I I.

supplementary nutrition, immunization, health check-up, pre-school non-formal education and

..

...

iv. referral services,

v.

vi. nutrition & health education In the state of Karnataka, ICDS scheme was launched by establishing 100 Anganwadi centres at Tirumalakudu (T) Narasipura in Mysore District. As per the information furnished by DWCD, GOK, 63377 Anganwadi Centres are sanctioned by the Government of India for Karnataka State. Out of the above 57,344 (90%) Anganwadi Centres are located in rural areas, 3,510 (6%) in tribal area and 2,523 (4%) are in urban areas. Each of the 185 Blocks in the State has ICDS project of which 166 are in the rural areas and 9 in tribal areas. In addition, there are 10 projects in urban areas.

BASIC INFRASTRUCTURES TO ANGAMYADI CENTRES

Below mentioned graph clearly indicates the number of AWCs located in the State of Karnataka:

Source: Director, DWCD, GOK, dated 24-07-20 12

The concept of providing a package of services is based primarily on the consideration that the overall impact will be much larger if the different services develop in an integrated manner as the efficacy of a particular service depends upon the support it receives from related services. The below table indicates the services required to be rendered, the target group and the name of service provider:-

BASIC INFRASTRUCTURES TO ANCANWADI CENTRES

The basic information regarding ownership or bthenvise of Anganwadi Centre buildings in the State is presented in above the graph.
57% of Anganwadi Centre buildings are in buildings owned by Government. 16% of the Anganawadi Centres are in rented buildings. 27% of Anganwadi Centres are in other category buildings i.e., Anganwadis being run in temples, Yuvaka 1 Mahila mandals, school buildings, Samudaya Bhavan (Community Hall), godowns of Government etc.,

Photo of inside portion of Anganwadi Centre run in a water pump shed at Kowsarnagar, Chikaballapur

6 " -

BASIC INFR4STRUCTURES TO ANGANWADI CENTRES

Staff Pattern of ICDS Project in Anganwadi level Karnataka

60046

1 ,
I

56601

Sanctioned

r In Position
Vacancies

Anganwadi Supervisors

Anganwadi Workers

Anganwadi Helpers

Source: Director, DWCD, GOK, dated 24-7-2012

The above graph shows the details of staff pattren of ICDS project at Anganwadi level in Karnataka. Anganwadi Supervisors, Workers and Helpers are the frontline staff of ICDS Project. Success of any ICDS programmes primarily depends upon the interest and effeciency and sufficiency of the above said frontline staff. In Karnataka, 430 posts of supervisors, 1666 posts of AWWs and 3445 posts of AWHs are vacant, as per the information furnished by DWCD. The Committee is thus of the opinion that lack of adequate members of staff in many of the AWCs in the State has severely hampred the effective functioning of AWCs in the State to a great extent thereby pushing the ICDS children towards the area of malnuorishment.

During the course of visits of the Committee to various AWCs in the State, it is noticed that in many of the AWCs, no provision is made for separate kitchen, dining hall, store room, rest room and toilet. It is the experience of the Committee that in some of the AWCs, there is only one room meant for overall activities of the AWCs. In majority of buildings of AWCs, there is neither adequate and proper supply of

- 40 -

BASIC INFRASTRUCTURES TO ANGANWADI CENTRES

water nor electrical connection forcing the anganwadi children to study in an environment not conducive for their good study, stay and good enviroment. The following graphes clearly indicate the condition of AWCs in the State of Karnataka. (The graphes are prepared on the basis of information furnished by DWCD)

'

IYes

.No

BASIC INFRASTRUCTURES TO ANCANWADI CENTRES

Details of Benificiaries covered under ICDS programme

1

Survey

Enrolled in AWC

6m -3years 3y 6years

Pregnants

Nursing Mother

Adolescent Girls

Source: Director, DWCD,GOK. dated 24-7-2012

Availability of children weighing scales in Anganwadl Centres Karnataka

Yes

Source: Director, DWCD, GOK. dated 24-7-2012

BASIC INFRASTRUCTURES TO ANGANWADI CENTRES

Photo of an anganwadi worker weighing a child to know the health status of a chlld in one of the Anganwadi Centres in Bengaluru

Toilet facility in Anganwadi Centres - Kamataka

Source: Director, DWCD, GOK. dated 24-7-2012

BASIC INFRASTRUCTURES TO ANGANWADZ CENTRES

Playgroundfacility in Anganwadi Centres in Kamataka

Source: Director, DWCD, GOK. dated 24-7- 2012

Mode of cooking in Anmanwadi Centres

Otherthan
Gas

-4

*m

Source: Director, DWCD, GOK. dated 24-7- 2012

BASIC INFRASTRUCTURES TO ANCANWADI CENTRES

Availability of water 1

Anganwadi Centres

Yes

4 No

In between 24-4-2012 and 2.6.2012, Hon'ble Chairman of the Committee accompanied by members of the Committee, team of Officers of concerned Departments of Government of Karnataka visited 81 Anganawadi Centres in 14 Districts in the State. Added to the above, some of members of the Committee also visited some of the Anganawadi Centres in the State. They too have submitted reports to the Committee to the above effect. The Committee had sought information on xlarious aspects from the Department of Women and Child Development, Government of Karnataka more particularly with regard to infrastructure provided to the Anganawadi Centres. In a majority of the cases, children attending Anganawadi Centres are from the section of the society which is below the poverty line.

BASIC INFRASTRUCTURES TO ANGANWADI CENTRES

Photo of Anganwadi Centre located at EWS colony, Komangala, Bengaluru City but up with zinc sheets)

The study so far conducted by the Committee has revealed that the basic infrastructure provided to Anganawadi Centres in the State of Karnataka is inadequate. As the Anganawadi Centre is not only a Child Care Centre, baby-sitting centre but also a pre-school playing and learning centre to the children in between the age group of 3 to 6 years, children attending Anganawadi Centres should feel comfortable and safe.

Photo of Anganwadi Centre at Swarna Kuppam, K.G.F, Kolar District

BASIC INFRASTRLICTURE.5' TO ANGA,VWADI CENTRES

Therefore, the Committee suggests the following recommendations: i. The Government shall ensure that the ambience / elevation of the Anganawadi Centres should be elegant and attractive so as to inspire the parents and the community at large to enrol their children to the Centres in large numbers. The Government shall supply pure and warm drinking water to Anganawadi Centres in the State. The Government shall ensure that Anganawadi Centres are provided electrical connection and sufficient lights and requisite ceiling / pedestal fan. The Government shall provide child friendly toilet with separate provision for disabled children attending Anganawadi Centres in the State. The Government shall ensure that Anganawadi Centres be provided with weighing scale. The Government shall ensure that Anganwadi Centres be provided with the following weighing scales:

ii.

iii.

iv.

v.

vi.

a) Infant weighing scale b) Salter's weighing scale c) Adult weighing scale

vii. The Government shall ensure that calibrations of all such weighing scales are done, periodically, as per rules. As the children attending Anganawadi centre are required to be served with hot cooked food, the Government shall provide cooking gas stove with regular gas supply to all the Anganawadi Centres in the State. Wherever it is not possible to provide gas stove and gas connection immediately, the Government shall provide modern chimneys to such Anganawadi centres, with required quantity of fire wood.

viii.

BASIC INFRASTRUCTLTRES TO ANCANWADI CENTRES

is.

The Government shall ensure that Anganawadi Centres in the State are supplied with required utensils for preparation and serving food to the children attending Anganawadi centres. The Government shall supply required quantity of containers of good quality to the Anganawadi Centres for storing provisions, food grains, food articles etc., in hygienic condition. The Government shall supply required number of mats and small study tables to the children studying in Anganawadi Centres in the State. Where the Anganawadi Centres are run in buildings owned by Government, Corporation, Municipality, Zilla Panchayat, Taluk Panchayat, Gram Panchayat or any other local authorities, the said buildings having sufficient land adjoining the same , the Government shall take steps, forthwith, to put up compound wall for such Anganawadi Centres. The Government shall direct Department of Horticulture, Government of Karnataka to plant fruit bearing saplings i.e., guava, chikku (sapota), papaya, pomegranate and local seasonal fruit bearing saplings i.e., nerale (blackbeny) anjur (fig), sitaphal (custard apple) etc., in the backyard of the Anganawadi Centres. The Government shall ensure that 30% of open space in the buildings of Anganawadi Centres be reserved as playground for the children and required facilities to play -thegames be provided. The Government shall direct Departments of Forest and Horticulture, Government of Karnataka to plant required number of ornamental and fruit bearing saplings in the remaining 70% of vacant space of buildings in Anganawadi Centre in the State before the onset of monsoon. The Government shall take steps to shift Anganawadi Centres running in rented buildings or in any other type of buildings or under the shade of a tree etc., to the buildings of nearest Government Primary, Higher Primary

x.

xi.

xii.

siii.

xiv.

xv.

xvi.

BASIC INFRASTRUCTURES TO ANGANWADI CENTRES

school or PHC if accommodation to run Anganawadi centre is available in such buildings.

xvii.

The Government shall provide two pairs of uniforms, every year, to the children in between the age group of 3-6 years attending Anganawadi Centres as also to Anganawadi workers and Anganawadi helpers. The Government shall ensure that the services of one Anganawadi worker and two Anganawadi helpers be provided to Anganawadi Centres where the strength of the children attending Anganawadi Centre is more than 20. The Government shall ensure that the services of one Anganawadi worker and one Anganawadi helper be provided to Anganawadi Centres where the strength of the children attending Anganawadi Centre is less than 20. The Government shall ensure that the services of Anganawadi worker and Anganawadi helper should not be used for any purpose other than the one for which they are employed. The Government shall take steps to upgrade mini anganwadi centres in the State as regular Anganwadi Centres by providing requisite infrastructures to such centres. The Government shall earmark sufficient funds, every year, for the maintenance and repairs of buildings of Anganwadi Centres in the State. The Government shall take steps to create homely environment in Anganwadi Centres so that the beneficiaries attending Anganwadi centres should feel the centre as their own home. The Government shall take steps to provide coin booth telephone facility to all the Anganwadi centres in the State so that AWW / AWH / ANM / ASHA workers and others can make use of the phone facility, in case of emergency, for providing emergent health services to adolescent girls, pregnant women, nursing mothers and children.

xviii.

xix.

xx.

xxi.

xxii.

xxiii.

xxiv.

BASIC INFRASTRUCTC'RES TO ANCANWADI CENTRES

xxv.

The Government shall ensure that all the villages in the State shall have road connectivity so that the public in general are not deprived of the facilities provided by the Government. The same would also benefit the beneficiaries under ICDS and other welfare schemes of the Government meant for adolescent girls, pregnant women, nursing mothers and children. The Government, from time to time, shall take steps to supply medical kits to Anganwadi Centres in the State so that AWW is able to provide required emergency medical services to Anganawadi children.

xxvi.

xxvii. The Government shall take steps to provide play tools for indoor and outdoor games, viz., equipments like slides, swings, push scooters, pedal cycles, tricycles, sand pit etc., to the Anganwadi Centres in the State. xxviii. The Government shall direct the Department of Women and Child Development to install "suggestion box" in the premises of Anganwadi Centres in the State to enable interested persons to offer suggestions for the effective running of Anganawadi Centres. xxix. The Government shall direct Child Development Project Officers to open the "suggestion box" and collect letters and take appropriate action. The State Government shall establish Anganwadi Centres in all urban slums, scheduled caste and scheduled tribe habitations, minority habitations and tribal areas in the State. The State Government shall take appropriate steps for universal coverage of Integrated Child Development Scheme.

xxx.

xxxi.

xxxii. The State Government shall take steps to earmark in future sitels for construction of Anganwadi Centres in the State, in Government approved residential layouts, i.e., layouts formed by BDA, BBMP, City Muncipal Corporations, Town Muncipal Councils, District / Taluka Development Authorities, Registered Housing Societies etc.,

B,4SIC INFR.4STRUCTURES TO ANGANWADI

C E -

xxxiii. The Government shall ensure that Balavikas Samiti and Village Health

Nutrition and Sanitation Committees be constituted in all the villages and same be strengthened by effectively monitoring its activities which in turn can effectively supervise the working of Angawadi Centres in the State.
xxxiv. The Government shall ensure that buildings of Anganawadi Centres to be

constructed in future, both in urban and rural areas, shall be as per the proposed plans (which are eight in number prepared by the Principal Chief Architect, Government of Karnataka, which are at page numbers 52 to 59 of this report) as indicated below:-

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YOW R ~ m* F YIIWM

n m

-*G

SCHEDULE O F OPENINGS

Kw&'
SO OW DV3 03 KKCHEN WROEN 15635XYK10 (51'-3319'-03

9 W X 2 5 W -P.V.C. -1050X2500 9 W X 2500 9 0 0 X 2100

SUDING WOR

(54-3319'-03

0U00000l700
(20'-oslla.-a?

w2

- 2000X1200

W (1'-6"XZ'-0") DESK - 450X300 (I'-~"XI'-O~)

v V1

- 3533x600
2000xm

- 15WX6W

AREA STATEMENT
GROUND FLOOR AREA 120.00 sq.rnls. (1292.00 sg.ft.)

WASH-

2500x2385 (8'-4"X8'-03 2500X2500 (8'-4"X8'-4') 5500X5000 (1s'-4.xia-am) 3530x3385 (1 1'-8711'-3") 1 NOS. W C 1100X1350 (3'-8"X4'-6") IN@. DISABLED TOILEl - 1800X1500 (6'-CmX5'-03

la-

oaar 5) TOLEI 4)

=ORE-

OWICE OP m PRINCIPAL C r n F ARCBITECI P.W.D.OPFICES.GOVT. O F KARNATAKA K.R.CIRCLE, BANGbLI)RE - 560001.

DEUT BT : DMWN Ei :

SENIOR

ASSISUIT

ARCHITECT

D E P ~ARCHITECT

G ~ E N- 15635x5800 (51'-3"X19'-03 7)PlAY AREA

10460X5800 (34'-3"X19'-0')

DEPUlY

ARCHKECT

DEPUTY CHIEF ARCHTECT.

PRINCIPL CHIEF ARCHTECT

PROJECT

NAME:

DESIGN FOR ANGANWADI RURAL CATEGORY -1

GROUND FLOOR PLAN(120.0 SQ.M)

W

(FOR 40 CHILDREN)

SHEET TITLE: GROUND FLOOR PLAN, ELEVATION k SECTION

PLAN
scm
1:M)

SCALE
ME

1:100

DRG NO : 13471/2/RC-I/SR

OF BLUE P R l W

GENERAL SPECIFICATIONS
I.~UHDATION : TO E ODYYLD
FOR OROVHO h

nm

m.

z.mm
R C t FUT Rm

iDUl W I f f i SmmURT

m
h l m SRTERS)

SlUUs.noomc

: 1 m m

m a h l?mm M U BR~K w u : ~mvr m n m nlrs. ( ~ n WE r m%

PWWP.woul
KirCHCh

m HIM

m " m 4
TH.

4,DADOOING

mn YO w ~ r m r l n m nus WLSH h TOKE - RLY~ au*m : YnxW sRun W H W M t R ? Wm C W l C nlrs

i Y n a * : IN

- M W W & FWlED WE/

Tam UPTO

20-

?HCl W M

U r n " M .

~.~*INTINC

: ~ m l w: srcm mm uux wuuorr wm mw WDn mm S W E m m C O I l

'

m l l l rnUrSlOH.

l ~ l ~ , ~ 1 l1 j 1 , ~' 1 ~ ~ ~ : ; ' Il " ,,'

8

XXWEA. CMU

: B R M nlm DUYEL PNHT : W U BUCK DWrU PNNl.

FRONT ELEVATION

8.DWRS k m o w s

:
:

J U W lOm (mRS & WlNrm5.

SECTION AA

7.ROOQlNC

R.C.C.

M T

RD)F llTH I . P C

T O

=QUIRE0

SLOPE

SCHEDULE OF OPENINGS
-

RQQa
SD

- 9 0 0 X 2 1 0 0 P . V . C . SLIDING DOOR
-1050X2100 900 X 2100

04 03
1500 HIGH COMPOUND WUL W2

1500x1050

KlTCH.CN GARDEN 15820x5930 (51'-1 l X l 9 ' - 6 7

1) SITE AFSA 2) TEACHING

- 25.00MX16.69M (82'-O"X55'-8")
20 PERSONS- 5000X4000 (1 6'-8"Xl3'-4")

W
v1

V2 V3

- 2315XM)O - 15Wx600
12WXM)O

- 20WXM)O

CUSS

EACH PERSON- SEATING-450x600

(1'-6"Xl'-Om)

AREA STATEMENT
c a o v ~ oF L ~ R m

3) KlTCHEN

102.00 sq.rnts.

(I 1 0 0 . w 9q.n.)

2885x4000 (9'-4"X13'-4') 2500x1885 (8'-4"X6'-3')

WASH-

STORE4) DRIMG
5)

2500X2000 (8'-4"X6'-8") 4200X4000 (14'-O"X13'-4") 2315X4000 (7'-E"X13'-4") 1NOS. W.C. - 1100X1350 (3'-8"X4'-6") 1NO DISABLED TOILE7

OFFICE OF THE PRINCIPAL CHIEF ARCHITECT P.l.D.OFFICES,COV. OF KARNATAW K.R.CIRCLE, BANGALORE 580001.
. DEALT 5 7 :

TOILET

DRAWN B I :

-----opening upto DIN1

1800X1500 (6'-O"X5'-On)

SENIOR ASSISTANT AQCHmCT

DEPUTY

ARCHITECT

6) KITCHEN

G f i_ AREA

(51'- 11 "X19'-6") ~ 15820x5930 ~ ~

90COX5930 (29'-6"Xlg'-6")

D E W

ARCHITECT

O E P W CHIEF ARCHITECT.

PRINCIPL CHIEF ARCHITECT

A

PROJECT

NAME:

DESIGN FOR ANGANWADI RURAL CATEGORY - 1

(FOR 20 CHILDREN) SHEET TITLE: GROUND FLOOR

GROUND FLOOR PLAN(AREA-102.00SQ.M)

PLAN
SCALE
<

PLAN, ELEVATION

& SECTION

SCALE

1 : 1 0 0 DRG NO : 13471/3/RC-I/FR

DATE OF BLUE PRINT-

1:60

GENERAL SPECIFICATIONS

a c c RAT RW
lmr I.P.C. 10
IIEWIrn

I.?OLIMIATION

: m E DN~YW

FOR

csouuc

&

n m nm.

SLD"E

2.SWW ilYl8LIRD4 ZTRUCrURL K r SlllUcnlRE : 1Ylrnm THKI d Il5mm THKI B a a 1 U . 3.PLWRlNC : Emm - r nm 1 w r lmr

I l W m TH. Bmnm H M

P~LYYERU~M - z ~ m m THKK wsnm c w m mnm - w s ~ m d u r n c w m l

Jmm SPICERSI

urn

PID

wmc

w ma
4.omoINc
-IS

TO^
IN

WED

w m

mRlnED

n m

: m x s m wwr wmplm wm

m m wm L Bacn 8~

C ~ W Kn m YMim

S . P ~ C:

m w

.
:

wrn WE orursru p u n . wrn $ W E m m m UYT

FRONT E M A T I O N SECTION AA
1500 HIGH
8.WORS & : m o m

J ~ W W : nffim
CRU

mm a

a m l a R WUrsTU.

~um

D U B U C K UYYa P Y n .

J U W IOOD D X I R b W Y W .

7.ROOFlNC

R.C.C RAT Rm lmr l P . C . TO RZWIRm YOR.

WI

IYm

(10'-07

WI

SCHEDULE OF OPENINGS
MQgg. S O - 9 W X 2100--PV.C. D4 - 1050 X 2 1 W DJ - 9 W x 21W

SLIDING DOOR

KnCHEN GARDEN I833SXSBM (53'-7x9'-07

W2
TEACHING CLASS

(rv-ox!v-s,

TEACKING CUSS

40 PERSONS- 6000X5030 (20'-8"X16'-8") EACH PERSON- SEATING-450x600 (1 '-6"XZ'-On) DESK

E~JOX
V

- 20WX1050

Vt

2000X800 1500X600

450x30

AREA STATEMENT
GROUND FLOOR ME* 136 W ,q.mb. (1484.00 -.It.)

(1'-6"Xl'-0")

3) KITCHEN
VASE-

3300X5000 (1 1'-O"X16'-8') z5ooxz3a5 (~'-4"xa'-o') 2500X2500 (8'-4"X8'-4')

STORE4) DINNG

1:60

5) T O W

5500X5000 (18'-4"X16'-8') 3530x3385 (1 1'-B'X11'-3') lNOS W.C. - 1100X1350 (3'-8'~d'-6') 1 NO. DISABLED TOILET

OFFICE OF T E E PRINCIPAL CHIEF ARCHITECT P.W.D.OFFTCES.GOV. O P KARNATAKA K.R.CIRCU. BANGAUIRE - 5 6 0 0 0 1 .

DEbLT 8i : DPAWN 0Y :

1800X1500 (6'-O"X5'-0")
SENIOR

ASSISTN

ARCHITECT

DEPUTY AQCH~ECT

'

GARDEN
7 ) P U Y AREA

- 16335x5800 (53'-7"X19'-03 - 10460X8000 (34'-3"X19'-0")

DEPUTY ARCHKECT

OWUR CHIEF ARCHITECT.

PRINCIPAL CHIEF ARCHITECT

PROJECT

NAME:

DESIGN FOR ANGANWADI RURAL CATEGORY -1

GROUND li'LOOR PLAN(136.00 SQ.bf)

(FOR 40 CHILDREN)

SHEET TITLE: >ROUND FLOOR PLAN. ELEVATION & SECTION

PLAN
S W
1:60

SCALE

1:100
PRINT:

DRG NO : 13471/4/RC-I/FR

DATE OF BLUE

R C C SLDPQO R m f

GENERAL SPECIFICATIONS
1.POUNDATION :
Be WUL
2JOrnm TH.

TO aE OtSICNEO FOR W H O

nmR

2.SUPER STT(UmRE : S.PU)OfSNC :

UYO B-NC

-UCWeF
l lSmm

WTY

210mm W l C I d

ROOUS

THICK BRIC* ILLIS

(NOW S W S MTP Jmm S P r C E R S )

,.

-#"ED

7 7 -

ELEXATION

PWTUNDYI

20mm

mtce

POUSHED

cwm

SECTION AA
4.oMDoINC S.P*nmPTG

KITCHEN-POUSHFD d FUMED C W I T L / urn S X ~ Owmc mlnm IILLS

wsw : mxsaa
DWING ~ R H

TONLEE

WEO

CWE.

~ R ~ G H mm/ulun T mm CERWNC ~ L F S DI T O I UPTO ~ L I ~ L

wcm.

: ~K~PHLL :
U:
JOINERY

BRIOW WRIOI BRICW

wm

s ~ u u l s <PNNT a~ nlm E Y USWE L S ~ Y . W ~ W E Rc w

M

.
:

BRIGHT WHITE E W C L RUHT. DUU B M K E W L L P

CRlU

6.DOORS k m o w s 7.ROOPWG

: :

JUNCLE -0

D m R S & llN00115.

R C.C. SLOPED ROOF W m W W D R E nLES CUDOlNC

INDEX: KITCHEN GARDEN

SITE AREA
TE*CBINC CUSS

17.89MX27.66U EACH PERSON-

(58'-7~Y90'-'3") 6'-8') SEATING-450x600 (1'-6-X2'-0') OESK

QQ!2&
OV4 OV3 03

SCHEDULE O F O P E N I N G S

(23'-0-X39'-5')

2 0 PERSONS- 4 0 0 0 X 5 0 0 0 (1 3'-4'XI

1050 X 2500 900 X 2500 900 X 2 1 0 0

450x300 (1'-6-X1'-0-]

KITCHEN WASH-

3 3 0 0 X 4 0 0 0 (1 1'-O'X13'-4') 2 5 0 0 X 1 8 0 0 (8'-4.X6'-0)

W W1

1500X1500 1500X1350

JUNCLE WOOD OOORS, WINDOWS & VENTILATORS

STOREDINING T o m

250OX1850(8'-4-X6'-2) 5 0 0 0 X 5 0 0 0 ( 1 6'-8-XI 6'-8) 2NOS. W.C.

1NO

RV

1 3 5 0 X 1 0 2 0 (3'-57.3'-67

W'

2155x600 1SOOY600

OIWLEO TOILn

l8OOYl 500 (6'-O.X5'-0.)

WCRgN GARDBN

AREA STATEMENT
CROUNO FLOOR AREA 9 2 0 0 Pq.mts. (990.00
oqft )

PUY AREA

OFFICE OF THE PRINCIPAL CHlEF ARCHITECT P.W.D.OFFICES.GOVT. OF KARNATAKA K.R.CIRCLE, BANGALORE - 5 8 0 0 0 1 .

-

ORAWN BY : OEALT BY -

OEPUlY -

SENIOR ASSISTANT ARCHI-ECT

ARCHITECT

OEPUTY

WCHITECT

OEPUlY CHIEF ARCHITECT.

PRlNClPAL CHIEF ARCHITECT

PROJECT

NAME:

DESIGN FOR ANGANWADI

R O A D
(FOR
2 0

CHILDREN)

PLAN(20 PEOPLE)(AREA-02.0

SQ.M)

SHEET TITLE: GROUND FLOOR P U N , ELEVATION & SECTION A A SCALE

-

1:lOO
.

~ ~ ~ 7 ~ 1 ; R c - n

OATE OF BLUE PRINT

I
ELEVATION SECTION AA

GENERAL SPECIFICATIONS

1.FOUNDAnON : TO BE DFSICUED FOR GROUND m O O R 2.SUPER L U B W I N C SIRUCTURE *ITH STRUCTURE : l m m m rHZI a 1 1 5 WICK ~ ~ BRICK w 3 . n . 0 0 ~ 1 ~ ~:
ROOUS

wmlnm n-.

PI*L/MRU(OU( KITCHEN-POLISHm

urn

srlo Rumc lmRlFIED n i E s

(WRT S H ~ E w m 3mm SPCERS) 20mm W I C K POUSHED G R U i m dl W E D CRUIITE/ WED ORUIITE.

WASH

TolLrn

4.DADOOINC 5.PNNTING

:
:

300x600 WRIChl WHlE/UlLW WlTE CFrVYlC TlLES Dm001NC IN TOIL= UPTO U W L HElCHT.
I m w : EXTERW :

WRIGHT WHITE %WE EYULSlON PNKT WRlChl WHITE S W E W W E R CCAT EXTERIOR EYULZlOH wRlcm

JOINERT CRlLL

mm

EMUEL

PNNT.

DULL W W I E W E L PUKT

15600
(51

07

B.DOORS k m o w s 7.ROOPING

: :

JVNCLE WOOD OOORS dl I I N D 3 1 S .

RCC

SLOPED ROOF WITH Y A H U L O R E T I E S CLLDDlNl

P U Y AREA 7889315600

KITCHEN GARDEN 12000X15600 (39'-4"X51'-0)

INDEX: 1 ) SITE AREA - 19.89MX32.89M(65'-3"Xl08'-0")

2 ) TEACHING CLASS
4 0 PERSONS6 0 0 0 X 5 0 0 0 (20'-8"X16'-8") SEATING-450x600 (1 ' - 6 " X Z ' - 0 " ) DESK

SCHEDULE OF OPENINGS

EACH PERSON-

OV3 03 SO

900 X 2500 900 X 2100 900 X 2100

- 450x300

YULIILPYYS.
W W1
-

(1'-6"Xl'-0")

1500X1500 1500X1350

3) KITCHEN

3 3 0 0 x 5 0 0 0 (1 1'-O"X16'-8") 2 5 0 0 x 2 4 2 5 (8'-4"X7'-9") 2 5 0 0 x 2 4 2 5 (8'-4"X7'-9")

P V C SLIDING DOOR

JUNGLE WOO0 DOORS. WINDOWS & VENTILATORS

I I
I

WASHSTORE4 ) DINING
5 ) TOILET

5 0 0 0 X 6 0 0 0 (1 8'-4"X16'-8") 3 4 7 0 x 5 0 0 0 (1 1'-6"X16'-8") 2NOS.

I
(5'-O"X6'-0")

AREA STATEMENT
GROUND FLOOR AREA 1 3 6 . 0 0 sq.rnts. (1464.00 sq.ft.)

- 1 0 8 0 X 1 1 0 0 (3'-6"X3'-7") < N O . D I S A B L E D TOILET - 1 5 0 0 X 1 8 0 0

W.C.

6 ) KITCHEN GARDEN 7) PLAY A R U -

12000X15600 (39'4"X51'-0") 7 8 8 9 x 1 5 6 0 0 (25'- l O " X 5 1 ' - 0 " )

OF THE PRINCIPAL CHIEF ARCHITECT P.W.D.OFFICES,GOVT. OF KARNATAKA K.R.CIRCLE, BANGALORE - 5 6 0 0 0 1 .

I
ARCHITECT

SENIOR ASSISTANT ARCHITECT

OEPUM

OEPUTY

ARCHITECT

OEPUM CHIEF ARCHITECT

PRINCIPAL CHEF ARCHITECT

PROJECT

NAME:

DESIGN FOR ANGANWADI

RURAL CATEGORY-2 (FOR 4 0 CHILDREN)

J7

R
.

D
~

c L -1

PLAN(4O PEOPLE)(AREA- 136 SQ.M)

SHEET TITLE: GROUND FLOOR PLAN, ELEVATION & SECTION AA DRG NO : SCALE 1:100 13472/2/RC-I1

IDATE OF BLUE PRINT

OPED RCOF WmH ORE ~ L CWOING E

GENERAL SPECIFICATIONS
I.POUNDA11ON : TO BE DESIGNED F W GROUND W D F i r m FLOORS 2.SUPER L W W I N G STRUCTURE IRH m U m R E : 2Y)mm TH d l l l m m B R E K W U . s.moRmc : ROOMS - n r w n m n ~ (~V~JRI s SME IRH Jmm SPYERS)
P r n W

rncHa
I S H

P ~ U ~ H Ea D FWEO CRUIITE/ SKIO R u m c ~ E n T M L ~ - WED cwm

20mm THlCK

m m
Es O

urn

4.DADOOING S.P*INTMC

YnX6CU B R I C ~ M~/YILXY M E CEW~C O*Da)lNG IN T O l L m UPTO L l m L HEICm.

: D m R W : BRffiYT ME BRIGrn

n m
PUNl COAT

: IMERIW
JOIHER~ CRlU

S W S EUUMON
* M E *EITHER PUNT. PUNl

Mm

aTERlW EMUMON. B R I C ~ wHrn WEL

DULL BUCK

EULL

8.DOORS & m o w s 7.ROOPlNC

JUHCLL l O O D R.C.C. Y W E D

CWRS &

WlNmrj CLIDOIHC.

ROOF IRH W M I E TES

SCHEDULE OF OPENINGS
PQPBZ

SECTION AA

DV4 DVS 03 SD W W1 W2 V

1.05 090 090 0.90

X X X X

2.10 2.10 2.10 2.10

W C SLIDING W O R JUNGLE WOOD 000RS. WINDOWS & VENTILATORS.

2.10 X 1.35 1.50 X 1 . 3 5 1.50 X 1.05

- 1.20 X 0 6 0

INDEX: SITE AREA

AREA STATEMENT
9.00MX12.00M (30'-O"X40'-0") 20 PERSONS - 4.95X4.60
( 1 6'-3"Xl5'-0") SWING-0.45XO.60
GROUNO FLOOR ARE* FIRST FLOOR AREA TOTAL AREA 57.00 sq.mts. 57.00 sq.mts. 1 1 4 . 0 0 sq.ft. ( 6 0 0 . 0 sqtt.) (600.0 sq.ft.) ( 1 2 0 0 . 0 0 sqtt.)

TEACHING CUSS

EACH PERSON-

(1'-6"X2'-0") DESK - 0.45X0.30 (1'-6"xl'-0")

OFFICE OF THE PRINCIPAL CHIEF ARCHITECT P.W.D.OFFICES.GOW. OF KARNATAKA K.R.CIRCLE, BANGALORE - 5 8 0 0 0 1 .

DEALT By :

DRAWN BY :

VERANDAH - 7.60X2.10 (25'-O"X7'-0") KITCHEN 3.20X2.00 (10'-6"X6'-9") WASHI

1.68X2.00 (5'-6"X6'-9") 1.80X2.00 (6'-O"X6'-9") 1.80X2.00 (6'-O"X6'-9") 4.95X4.60 (16'-3"X15'-0") 1.70X2.00 (5'-8"X6'-90")

SENIOR

ASSISTANT

ARCHITECT DEPUTY

ARCHITECT

STORETOY STOREDINING TOILET

I !I

d'

>

/'/

'\

'=,
\

II

DEPUTY

ARCHITECT

OEPUM CHIEF ARCHITECT.

~'_--____--_____-----------------------'1

W.C. - 1.40X1.94 (4'-6"X3'-!

1 NO. DISABLED TOlLCT
-

1")

PRINCIPAL CHIEF ARCHITECT

1.68X2.00 (5'-6'X6'-9')

PROJECT

NAME:

FIRST FLOOR PLAN

D E S I G N FOR ANGANAWADI ( U R B A N AREA)

(FOR 2 0 CHILDREN)

GROUND FLOOR PLAN

SHEET TITLE: GROUND FLOOR PLAN. FIRST FLOOR PLAN, ELEVATION & SECTION DRG NO :13473/1/UC SCALE 1 : 1 0 0
DATE OF BLUE PRINT:

GENERAL SPECIFICATIONS
1.FOUNDATLON Z.SUPER STRUCTURE : 3.FLOORING :

: TO BE DESIGNED FOR GROUND

& FIRST FLOOR.

LOAD B M I N G STRUCTURE WITH 23Dmm THICK & 1 1 5 m m THICK BRICK WALLS ROOMS - VlTRlFlED TILES. (IVORY SHADE WlTH 3 m m SPACERS) PUL/VERINDM - 2 0 m m THICK POUSHEO GWNITE. KITCHEN

- POLISHED & FLAMED GRANITE/ lWTl SKID RUSTIC MTRlFlED TILES. WASH & TOILETS - FLAMED GRANITE.
300X60D BRIGHT WHITE/MIW WHlTE CEWMIC TILES Dm001NG IN TOILETS UPTO UNTEL HEIGHT INTERNAL EXTERNbl : JOlNERl GRlU
: :

4.DADOOING 5.PAINTING

: :

BRIGHT WHITE SHADE EMULSION PAINT. BRIGHT WHITE SHADE WEATHER COAT EXlERIOR EMULSlON. BRIGHT WHITE ENAMEL PAINT. DULL BLACK ENAUEL PAINT.
& WINDOWS.

6.DOO WR IN SD O & WS ?.ROOFING

: JUNGLE WOOD DOORS

: R.C.C. SLOPED ROOF WlTH MANCALORE TILES CLADDING

SCHEDULE OF OPENINGS
aQQBs;
DV4 DV3 D3 SD WINDOWS: W W1
-

ELEVATION SECTION AA

1.05 X 2.10 0 9 0 X 2 . 1 0 0.90X2.10 0 . 9 0 X 2.10 2.10 X 1.35 1.50 X 1 . 3 5

JUNGLE WOOD DOORS.

P.V.C.

SLIDING DOOR

W2 - 1.50 X 1 . 2 0 VENTll4TQB5; V - 0.90 X 0.60 V1

JUNGLE WOOD DOORS. WINDOWS & VENTILATORS.

- 1.20 X 0.60

AREA STATEMENT
9 W m m HIGH 115mm THICK BRCK WAU Wrm Y.S. GRILL OF 12mm SaUME RODS UPTO UNTEL HEIGHT GROUND FLOOR AREA 60.80 sq.mts. (654.20 (654.20 (1308.40 sq.ft.) sq.ft.) sq.ft.)

INDEX: SITE

FIRST FLOOR AREA TOTAL AREA

60.80 sq.mtl. 121.60 sq.ft.

AREA

9.00MX12.00M 4 0 PERSONSEACH PERSON-

(30'-O"X40'-0") 4.80X6.80 (15'-g"X22'-41/2") SEATING-0.45X0.60

TEACHING

OFFICE OF THE PRINCIPAL CHIEF ARCHITECT P.W.D.OFFICES.GOVT. OF KARNATAKA K.R.CIRCLE. BANGALORE 560001.

(1 '-6'X2'-03
(1 5'-9x22'-41/23 DESK

- 0.45X0.30
(1 '-6"Xl'-0")

I DEALT
SENIOR

BY :

DRAWN B Y :

KITCHEN

3 . 0 0 X 2 . 1 0 (10'-O"X7'-0") 2 1 0 X 1 . 7 0 7'-O"X5'-7") 2.1 o x 2 . 1 0 (7'-O"X7'-0") ASSISTANT ARCHITECT DEPUTY ARCYITECT

H A N D WASHSTOREDINING

TOILET

4.80X4.30 2.10X2.40 1 NOS. W.C. 1NO

(15'-g"X14'-1") (7'-0x8'-03

I +
DEPUTY ARCHITECT

- l l 8 X 1 . 3 5 (3'-9"X4'-6.)
-

DEPUTY C H I E F ARCHITECT.

DISABLED TOILET

2.10X1.35 (7'-O"X4'-67 PRINCIPAL C H I E F ARCHITECT

T O Y STORE-

1 . 5 0 X 2 . 1 0 (5-O"X7'-0")

PROJECT

NAME:

C
I

ROAD FIRST FLOOR PLAN GROUND FLOOR PLAN

DESIGN FOR ANGANAWADI (URBAN AREA)

(FOR 40 CHILDREN)

SHEET TITLE: GROUND FLOOR PLAN, FIRST FLOOR PLAN. ELEVATION & SECTION SCALE 1:100 DRG NO : 1 3 4 7 3 / 2 / U C

Chapter: VIII

Qualifications/ Eligibility, Duties & Responsibilities of Angan wadi Workers, Angan wadi Helpers, Auxiliary Nurse Midwives and ASHA Workers

Qualitications/ Eligibility, Duties & Responsibilities of Anganwadi Workers, Anganwadi Helpers, Auxiliary Nurse Midwives and ASHA Workers
The Anganwadi Workers, Helpers, ANM and ASHA workers are the front line workers in the community. The said front line workers have to play important role in the steps to curb malnutrition of children. As the front line workers are required to provide necessary information, proper guidance, counseling and to extend timely help regarding health, hygiene, balanced diet to the adolescent girls, pregnant women and nursing mothers, they should be well equipped with necessary information and knowledge besides having rich experience in their field. The Anganwadi Workers and Helpers are community based front line honorary workers under the ICDS Scheme. The scheme envisages the Anganwadi workers 1 Anganwadi helpers as 'honorary workers' from the local community who come forward to render their services, on part-time basis, in the area of child care and development. As per the guidelines of the scheme, AWW and AWHs should be from the women folk of local village and acceptable in the local community. ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. She would be a promoter of good health practices. She will also provide a minimum package of curative care, as appropriate and feasible for that level and make timely referrals. The study conducted by the Committee has revealed that the said front line workers are not discharging their duties and responsibilities as they are expected to. It is further noticed by the Committee during its visits to some of the Anganwadi Centres in the State that the front line staff have failed to discharge their responsibilities, effectively, either on account of lack of knowledge, lack of experience, lack of proper training besides being careless. Thus, it is necessary to create awareness to the front line workers with regard to their duties and responsibilities on regular basis.

()1!~1I,IFI(~:l TIO.YT, ELlClBILITY, DL'TIES & RESPONSIBILITIES OF .Al;XILIAKY ,YI/'RSE AIIDWIVEJ' A.YD 4SHA WORKERS

The suggestions submitted to the Coinmittee by various NGOs, individuals, experts etc., indicate that the Government is not following the prescribed guidelines in selection of Anganwadi Workers and Helpers. At some places, Anganwadi workers so appointed are not the residents of place of location of Anganwadi Centres in question. This results in the Anganwadi workers not being in time for opening the AWC. It is also brought to the notice of the Committee that AWWs, AWH, ANMs and ASHA workers are not rendering services properly. It is also brought to the notice of the Committee that the frontline workers are to be trained to improve their efficiency. It is noticed by the Committee that they lack in basic knowledge on health, hygiene and nutrition aspects and some of the frontline workers contribute to some extent to the problem of malnutrition. It is also noticed by the Committee that failure on the part of Government in filling the vacant posts of AWWs, AWHs and ANMs also contributed to a great extent to problem of malnutrition of Anganwadi children.

Thus, the Committee suggests the following recommendations:

I.
The Government shall entrust the responsibility of filling the vacant posts of AWW and AWH in the district to the Deputy Commissioners of the concerned Districts by following roaster system. The Government shall take steps to fill the vacant posts of AWWs, AWHs, Supervisors, CDPOs and ACDPOs, as expeditiously as possible, so that 110 Anganwadi Centre in the State is crippled from functioning properly for want of staff.

11.

111. The Government shall take steps to fill vacant posts of ANMs in the Department of Health and Family Welfare, as expeditiously as possible, so that no beneficiaries under ICDS 1 non-ICDS are deprived of getting required health care services at the right time. 1V. The Government shall take appropriate steps to introduce at least one year certificate course in nutrition, health, hygiene and child care for members of staff of AWCs in the State. V. The Government shall prescribe minimum qualification for appointment for the post of AWW which shall be a pass in loth standard examination with one year certificate course in nutrition, health, hygiene and child care from recognized institution from Government. The Government shall prescribe minimum qualification for appoiritment to the post of AWH which shall be a pass in 7'" standard examination.

VI.

QL'.4LIHCATlO~VS. ELIGIBILITY, DUTIES & RESPO,&SIBILITIES O F . 4 Ir,YlLI.4RF .VI1RSEMlDN'II 'ES .4,VD .4SlI. 1 II'ORXERS

VII. The Government shall further ensure that the AWWs presently working in the State shall undergo one year certificate course in nutrition, health, hygiene and child care, within the next three years.
The Government shall take steps to train parallel / alternative AWWs / AWHs who can be deployed whenever member of staff of AWC proceed on long Ieave, either maternity, medical

IX.

The Government shall ensure that the services of one Anganwadi worker and two Anganwadi helpers be providcd to the Anganwadi Centres where the strength of the children attending Anganwadi Centre is more than 20. The Government shall ensure that the services of one Anganwadi worker and one Anganwadi helper is provided to the Anganwadi Centres whcrc thc strength of the children attending Anganwadi centre is less than 20.

XI.

The Government shall take steps to impart effective and regular training (job course and refresher course) to AWWs, AWHs and ASHA workers.

XIT. The Government shall ensure that AWWs. AWHs and ASHA workers working in the State undergo training in Infant Young Child Feeding (IYCF) practices.

XIIl. The Government shall take steps to subject AWWs, AWHs and ASHA workers working in the State to undergo medical check up, at least once in three months. XIV. The Government shall ensure that thc services of Anganwadi workers and Anganwadi helpers are not availed for any purpose other than the one for which they are employed.

xv.

The Government shall pay honorarium to Anganwadi workers and Anganwadi helpers on the first of every month for services rendered by them in the preceding month since it was brought to the notice of the Committee that there is delay in making the requisite paymcnt of honorarium.

XVI. The Government shall fix the following responsibilities to AWWs:

To elicit community support and participation in n~nning the programme. To weigh each child, every month, record the weight graphically on the growth card, use referral card for referring cases of mothers/children to the sub-centresl PHC etc., and maintain child cards for children below the age of 6 years and produce the same before visiting medical and para medical personnel. To conduct, once in a year, survey of all the families, especially, of mothers and children at the respective area of work.

OUALIFICA TI0,VS. ELIGIBILITY. DC:TIES & RESPOIVSIBILITIES OF AUXILIARY NliRSE MID WII'ES AND ASHA WORKERS

To organize non formal pre-school activities in the Anganwadi Centres for children in the age group 3-6 years and to train them in making indigenous of toys and play equipments. To organize supplementary nutrition feeding for children (0-6 years) and expectant and nursing mothers by planning the menu based on locally available food and local recipes. To provide health and nutrition education and counselling on breastfeedingl infant & young feeding practices to mothers. Anganwadi workers, being close to the local community can motivate married women to adopt family planninglbirth control measures. Anganwadi workers shall share the information relating to birth that takes place during the month with Secretary of PanchayatIGram Sabha SewaWANMl Officer notified as RegistrarISub-Registrar of Births & Deaths in her village. To make home visits for educating parents and enable mothers to chalk out plan for effective role in the growth and development of child with special emphasis on new born children.
a

To maintain files and records, as prescribed. To assist the staff of PHC in the implementation of health component of the programme viz., immunisation, health check-up, ante natal and post natal check up etc., To assist ANM in the administration of IFA and vitamin 'A' by keeping stock of the two medicines in the Centre. To share information collected under ICDS with the ANM. However, ANM shall not solely rely upon the information obtained from the Anganwadi worker. To bring to the notice of the Supervisor1 CDPO any development in the village requiring their attention and intervention, particularly, in regard to coordinating with different departments. To build liason with other institutions1Mahila Mandals and involve female school teachers and girls of the primarylmiddle schools in the villages in the functioning of Anganwadi Centre. To guide Accredited Social Health Activists (ASHA) engaged under National Rural Health Mission in the delivery of health care services and maintenance of records under the ICDS.

VtiALIFIC,-ITIO&S, ELIGIBILITY, Dl;TIttS & RESP0,VSIBILITIES OF.-lL;YILIARY NZ'RSE rMIDWII'ES 4 4 ' 0 .,ISHA NORfiERS

To assist in implementation of Kishori Shakti Yojana (KSY) and motivate and educate the adolescent girls, their parents and community in general by organizing social awareness programmes1 campaigns etc., Anganwadi workers should also assist in implementation of Nutrition Programme for Adolescent Girls (NPAG), as per the guidelines of the Scheme and maintain such record, as prescribed, under NPAG. Anganwadi worker should function as depot holder for RCH kitlcontraceptives and disposable delivery kits. However, actual distribution of delivery kits or administration of drugs, other than OTC (Over The Counter) drugs be carried out by the ANM or ASHA, as decided by the Ministry of Health & Family Welfare, Government of India. To identify disability among the children during her home visits and refer the case immediately to the nearest PHC or District Disability Rehabilitation Centre. To support in organizing Pulse Polio Immunization (PPI) drives. To inform the ANM in case of emergency cases like diahorrea, cholera etc., The AWW shall compulsorily attend the meetings of VHNSC (Village Health Nutrition and Sanitation Committee) and shall assist the Committee to chalk out plan of action to tackle Village Health Nutrition and Sanitation problems. XVll. The Government shall take steps to fix the following responsibilities for

AWHs:
a. To cook and serve food to children and marchers.
b. To clean the Anganwadi premises, daily, and fetch water for the Centre.
c. To take care of Anganwadi children.

d. To bring Anganwadi children from their homes to Anganwadi Centre.

XVIII.The Government shall take steps to fix the following responsibilities for ASHA workers:
a.

ASHA shall take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation, hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilization of health & family welfare services.

QL ALII.IC.4 TIORS. ELIGIBILITY, DUTILS & RESPO V S I B I L l T I t S O F AL.YlLIAR1 NC'RSE M I D WIVES A.VD ASH.4 WORKERS

b. She shall counsel women on birth preparedness, importance of safe delivery,

breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infections/Sexually Transmitted Infections (RTIsISTIs) and care of the young child.
c.

ASHA shall mobilize the community and facilitate them in accessing health and health related services available at the village/sub-centerlprimary health centers, viz., as immunization, Ante Natal Check-up (ANC), Post Natal Check-up (PNC), ICDS, sanitation and other services being provided by the Government . She shall work with the Village Health & Sanitation Committee of the Cram Panchayat to develop a comprehensive village health plan. She shall arrange for escort/accompany pregnant women & children requiring treatment/ admission to the nearest pre- identified health facility i.e. Primary Health Centre/ Community Health Centre/ First Referral Unit (PHCJCHC IFRU). ASHA shall provide primary medical care for minor ailments such as diarrhoea, fever, and first aid for minor injuries. She will be a provider of Directly Observed Treatment Short-Course (DOTS) under Revised National Tuberculosis Control Programme.

d.

e.

f.

g. She shall also act as a depot holder for essential provisions being made available

to every habitation like Oral Rehydration Therapy (ORS), Iron Folic Acid (IFA) tablet, chloroquine, Disposable Delivery Kits (DDK), oral pills, condoms, etc., A drug kit shall be provided to each ASF-IA. Contents of the kit will be based on the recommendations of the expert/technical advisory group set up by Government of India.
h. Her role as a provider can be enhanced subsequently. States can explore the

possibility of graded training to her for providing newborn care and management of a range of common ailments, particularly, childhood illnesses.
i.

She shall inform regarding births and deaths in her village and any unusual health problenddisease outbreaking in the community to the Sub-centres / Primary Wealth Centre.

QC:4LIFIC:4Tl0,V$ ELIGIBILITY. DC'TIES & RESP0,VSIBILITIE.Y OF.4l:YILI,4RY .5'1'RSE.WII)II I &ES 4:VD .-ISH.4 I j OKKERS

j.

She shall promote construction of household toilets under Total Sanitation Campaign. Fulfillment of the different roles, as above, by Asha be envisaged through continuous training and upgradation of her skills, spread over a period of two years or more. The ASHA shall compulsorily attend meetings of VHNSC (Village Health Nutrition and Sanitation Committee) and shall assist the Committee to chalk out plan of action to tackle Village Health Nutrition and Sanitation problems.

k.

1.

XIX. The Government shall take steps to fix the following duties for ANMs:
a) The ANMs shall hold weekly / fortnightly meeting with ASHA workers and they shall guide ASHA workers in case they encounter any problem in the course of discharge of their duties.
b) The ANMs shall participate and guide in organising health days at Anganwadi centres.

c) She shall guide ASHA in motivating the pregnant women to come to sub centre for initial check-ups. d) She shall guide ASHA in motivating pregnant women for taking full course of IFA tablets and TT injections. e) She shall educate ASHA on danger signs of pregnancy and labour so that she can identify in time and help the beneficiary in getting further treatment.
f) She shall orient ASHA on the dose schedule and side effects of oral pills.

g) She shall inform ASHA the date, time and place for initial and periodic training schedule.
h ) She shall conduct medical check up of adolescent, pregnant, nursing mothers and children, from time to time, and shall report the same to her higher ups.

OC'.4LIFICATlORX ELIGIBILITY. DUTIES & RESPONSIBILITIES OFAUXILIARY NURSE MIDWIVES AND ASHA WORKERS

i) She shall take all possible steps to organise immunisation programmes at the village level and see that no child in the village is left out from taking immunisation at the appropriate age.

j) She shall compulsorily participate in Grama Sabhas and collect information regarding health, hygiene and nutrition aspects in the village and shall pass on the same to her higher ups.
k) The AlVM shall compulsorily attend meetings of VHNSC (Village Health Nutrition and Sanitation Committee) and assist the Committee to chalk out plan of action to tackle Village Health Nutrition and Sanitation problems.

Chapter: Z X

Co-ordination In Between Different Departments of Government of Karnataka and Effective Monitoring of Working of Angan wadi Centres

Chapter: IX
-

Co-ordination in between different Departments of Government of Karnataka and effective Monitoring of working of Anganwadi Centres
The primary responsibility to implement the programmes connected with the welfare of wonlen and child is with the Depart~nent of Women and Child Development. In fact, the Department alone can't achieve the above objects. Many a times, the parent department has to scck co-operation from the connected departments. If there is no co-ordination in between thc departments, then the parent department can't achieve the goal. Under such circumstanccs, the sufferers would be the innocent, ignorant, poor sections of the society. During the study, it has come to the knowledge of the Committee that co-operation and co-ordination in between the parent depart~nent and the other connected departments in i~nplctncnting the welfare programmes of Department of Women and Child Developnlent is lacking. Lack of inter-departmental co-ordination has also contributed, to some extent, to the problem of child malnutrition in the State. Effective monitoring is the key behind the success of any project. Unless there is proper supervision, monitoring and follow-up action, we can't get the expected . results. The study conducted by the Committee has revealed that lack of vigilance and co-ordination in between the different Departments of Government of Karnataka has resulted rather in not bringing success for the programmes launched for the welfare of women and child in the State of Karnataka. Thus, the Committee suggests the following recommendations for interdepartmental coordination and monitoring:
i.

Thc Government shall ensure that there is proper and timely co-ordination and co-operation in between the Departments of Revenue, Women and Child Development, Health and Family Welfare, Medical Education, Primary and Secondary Education, Food and Civil Supplies, RDPR and Urban Developmcnt Government of Karnataka, in the effective implementation of the programmes connected with adolescent girls, pregnant women, nursing mothers, children suffering from malnourishment and all other children who are enrolled as beneficiaries in Anganwadi Centres and also

I.VTER DEP,4RTMENTAL COORDINATION A h D hfONITORING

children not covered under ICDS i.e., children from the families of migrant workers, children belonging to the families of building and other construction workers etc.,
ii.

The Government shall make responsible the Principal Secrctaries of the Departments of Revenue, Women and Child Development, Health and Family Welfare, Medical Education, Primary and Secondary Education, Food and Civil Supplies, RDPR and Urban Development Department of Government of Karnataka, if there is any lapse in the effective implementation of programmes/schemes connected with Anganwadi Centres. The Deputy Commissioners, Chief Executive Officcrs of Zilla Panchayat, District Health Officers, District Surgeons, Director of the Medical Colleges and Deputy Director of Department of Women and Child Development of the Districts shall be held jointly responsible for any lapse in the implementation of programmes/schemes connected with Anganwadi Ccntres in the State.

iii.

i . The Government shall ensure that regular inter-departmel~talmeetings in each

District are convened under the chairmanship of the Deputy Commissioners of the respective Districts to address the issues pertaining to effective implementation of the programmes connected with adolescent girls, pregnant women, nursing mother, children suffering from malnutrition and the children attending Anganwadi centres.
v.

The Government shall identify at least one Anganwadi Centre from backward taluka of each district as Pilot Project Centre and shall implement the recommendations referred to in the report through the said Anganwadi Centre, forthwith, the said Pilot Project Centre to be treated as a "Model Centre" for implementation of recommendations of the Committee by the remaining Anganwadi Centres in thc State.

i . The Principal Secretary, Director, Deputy Directors of the Department of Woinen & Child Development should give surprise visits to Anganwadi

Centres in the State, at least once in a fortnight and take remedial action for the effective running of Anganwadi Centres in the State.
\.ii. The Government shall establish Vigilance Cells at Regional levels consisting of Regional Commissioner and Inspector General of Police of the concerned Region, empowering such Vigilance Cell to investigate complaints relating to the functioning of Anganwadi Centres and implementation of schemes

INTER DEPARTMENTAL COORDIN-1TION AND MONITORING

pertaining to adolescent girls, pregnant women, nursing mother, children suffering from malnutrition and the children attending Anganwadi Centres.
viii. The Government shall ensure that such Vigilance Cell is empowered to submit recommendations to the Government to take appropriate action including departmental enquirylpenal action against the erring officers and officials, in case the Vigilance Cell notices serious lapses in regard to the functioning of Anganwadi Centres and implementation of schemes pertaining to adolescent girls, pregnant women, nursing mother, children suffering from malnutrition and the children attending Anganwadi centres. is. The Central Government and State Government shall earmark separate funds in the budget for the effective implementation of the programmes/schemes pertaining to adolescent girls, pregnant women, nursing mother, children suffering from malnutrition and the children attending Anganwadi centres.
u.

The Government shall constitute "Independent Special Task Force" for the implementation of the recomn~endationsmade by the Committee, in a phased manner, and to file compliance report to the High Court of Karnataka, once in every three months, till the recommendations made by the Committee are implemented by the State Government.