Background

According to the National Family Health Survey 2005-06 , about thirty eight percent of
all Indian children are undernourished. Hunger and under nutrition ruin children’s
health, undermine their learning abilities and impair their lives in many other ways. In
world very few countries have such high levels of child under nutrition. Simeraly,
Education statistics are also alarming. At least 20 per cent of Indian children (in the 6-
14 age groups) are out of school. This too, impairs their future in many ways.

The well being of children is everyone’s responsibility – not just that of their parents.
Indeed, parents alone are not always able to protect their children’s interests, especially
when they are weighed down by poverty, illiteracy, poor health and social discrimination.
This is one reason why the protection of children’s rights depends crucially on social
arrangements, such as universal schooling, school based provision of health care and
nutrition etc. . These arrangements are typically initiated by the state, but their
effectiveness depends in many ways on the involvement of the public at large. For
instance, the success of a village school depends a great deal on what the teachers, the
parents, the Gram Panchayat and the village community actually do for it. Even the
physical presence of a school often requires organized demand from the village
community in the first place. The provision of cooked, nutritious midday meals in
primary schools is an example of social arrangement geared to the protection of
children’s rights. Their primary objective is to promote the right to food and the right to
education, but they can also serve many other useful purposes today, every child who
attends a government or government-assisted primary school is entitled to a nutritious
midday meal, as per recent Supreme Court orders. However, this entitlement is far from
being realised: the coverage of midday meals is close to universal, but their quality is
still very low in most states.

The idea behind implementation of the MDMP was to enroll more students with regular
attendance. It’s a fact that a hungry child is less likely to attend school regularly as
hunger drains him/her will & ability to learn. Chronic hunger can lead to malnutrition,
which will result a child not only more susceptible to diseases like measles, diarrhea,
respiratory infections etc. but also increases the severity of various diseases . And even
if a malnourished child does attend school, their ability to concentrate and participate
in the teaching/learning activities in the school remains poor. Hence malnutrition
hampers the overall growth & development of the child.
. MDMP is an also effective tool for reducing the gender gap as it considerably enhances
female school attendance. With a view to enhance enrollment, retention and attendance
and simultaneously improve nutritional levels among children, the National Programme
of Nutritional Support to Primary Education (NP-NSPE) was launched as a centrally
sponsored scheme on 15th August 1995, initially in 2408 blocks in the country to
children in Classes I-V of govt/govt aided, local body schools, etc. It consisted free
supply of food grains @ 100 gms/child/school/day and subsidy for transportation of food
grains up to a maximum of Rs. 50/quintal. In addition to food grains, MDM involved two
other major inputs, i.e. cost of cooking (cost of ingredients, fuel, wages/remuneration to
personnel or to an agency responsible for cooking) and provision of essential
infrastructure (kitchen-cum-store, adequate water supply for cooking/drinking, washing,
cooking devices, utensils etc).

In September 2004, the NP-NSPE was revised to provide cooked mid day meal with 300
calories and 8-12 grams of protein to all children studying in class I-V in government
and aided schools and EGS/AIE centers. The revised scheme provided central assistance
with improved costing guideline for cooking cost, transport subsidy, management/m &
e, provision of mid day meal during summer vacation in drought affected areas.

Today, the NP-NSPE is the world’s largest school feeding programme reaching out to
about 12 crore children in over 9.50 lakh schools/EGS centers across the country.
Several independent evaluation studies were conducted which testify to the increase in
enrollment, particularly of girls and to the narrowing of social distance. Following the
main difficulties like Rs 1/- towards cooking cost was found to be inadequate for meeting
the cost of nutritious meal, absence of kitchen sheds in schools leads to classrooms to
be used for storage and cooking purposes, and existing nutritional norm was felt to be
inadequate to meet the growing needs of young children, the NP-NSPE was revised
during June 2006.
Uttarakhand
The government of India launched a new ‘centrally-sponsored scheme’, the National
Programme of Nutritional Support to Primary Education. Under this programme, cooked
mid-day meals were to be introduced in all government and government-aided primary
schools within two years. In the intervening period, state governments were allowed to
distribute monthly grain rations (known as ‘dry rations’) to schoolchildren, instead of
cooked meals. Six years later, however, most state governments were yet to make the
transition from dry rations to cooked meals. The Supreme Court gave them a wake-up
call on November 28, 2001, in the form of an order directing all state governments to
introduce cooked mid-day meals in primary schools within six months. Once again, most
state governments missed the deadline, and even today, some states (notably Bihar,
Jharkhand and Uttar Pradesh) are yet to comply. Nevertheless, the coverage of mid-day
meal programmes has steadily expanded during the last two years, and cooked lunches
are rapidly becoming part of the daily school routine across the country.

The state of Uttaranchal was created by combining the northwestern hill area districts of
Uttar Pradesh. The state has 13 districts, 49 tehsils, 95 blocks and 16,414 villages. It
has a population of 8.5 million. Its Total area is 53,483 Square kilometers, which is 18th
in terms of area and its density of population is 159 per km .The state is 11th most
sparsely populated state in the country. The literacy rate age 7 and above is 84% for
males, 60% for females, and 72% for the total population. As per NFHS-3 survey, 78%
of the population of Uttarakhand lives in rural area and rest 22% lives in urban area. The
87% of households are Hindus, 7% households are Muslims, 5% households are Sikh,
and 1% belongs to other religions. One third of Uttarakhand household and population
are the highest wealth index and only 7% of household are in the lowest wealth index.
The Administrative and Demographical profile of Uttarakhand
Divisions :2
Districts : 13
Development blocks : 95
Gram panchayats : 7261
Villages : 16742
Uninhabited villages : 954
Population : 8.49 million
SC population : 17.9 % of the total
ST population : 3.0 % of the total
BPL population : 34.66%
Literacy rate : 72.28%
Male literacy : 84.00 %
Female literacy : 60.26%
Total population of children (6-11) : 11,89,062
Total Children enrolled : 11,85,372
According to NFHS 3
1. Status of anemia amongst children 6 to 35 months is:
State: 61.5%
Rural: 62.0%
Urban: 60.2%
2. Undernutrition
Stunting
Waisting
2. IMR: Urban – 17; Rural - 50
In Uttarakhand till may 2002 the Dry rations distribution pattern was adopted for MDM
scheme however, most state governments were yet to make the transition from dry
rations to cooked meals. The Supreme Court gave them a wake-up call on November 28,
2001, in the form of an order directing all state governments to introduce cooked mid-
day meals in primary schools following the order of the honorable Apex court the
Government of Uttarakhand started the MDMP in the Sahaspur block of Dehradun district
in May 2002 – November 2002 as first phase covering 107 schools 10494 student.
Based on first phase outcome and experiences the scheme was extended in November
2002 as Phase–II to cover 26 Blocks in 13 district (2 block each district) extending the
coverage to 3196 schools & 2, 37,248 student. after successful implementation of
phase-II in selected blocks, In Phase –III from July 2003 onwards the government of
Uttarakhand has started implementation of the MDMP scheme in all the blocks of all
thirteen district covering all Primary schools of states, in phase–IV EGS/AIE centers,
were also included in the scheme and now during 2007-08 11698 Primary school, 1442
EGS has been covered under Mid day meal scheme And from January 2008 onwards the
Mid day meal programmes was also launched in upper primary school of 21
educationally backward blocks in Uttarakhand and from April 2008 the scheme is also
being implemented in all upper primary schools of state.
S.N Category of schools No of Primary schools Enrollment
1 Govt. 12141 1124467
(local bodies/Govt. aided)
2 No. of EGS Center 1609 41431
3 No. of AIE Center 187 10062
Objective of the study
This study primarily will focus to understand the impact of fortification schemes on the
quality of education and health status of the children. Furthermore, it will provide
information regarding its impact on children enrollment, retention and their
performance. It will also focus on comparative analysis between midday meal and
fortification schemes in different geological settings. The study will also explore the
alternatives of fortification base on available resources in the state and their financial
viability. The main objectives of study as following;

1. To assess the effectiveness of the fortification to reduce micronutrient

deficiencies with special reference to iron, folic acid and vitamin A & incidence of
morbidity of diarrhea, pneumonia and fever episodes among the target children.

2. To determine the impact of midday meal in students enrollments,

retention, attendance, performance and quality of education.

3. To find the scope of practical & financial feasibility for up scaling the
fortification progrmme in other districts.

4. To find the scope of better alternative for fortification of MDM through local
foods, vegetable and fruits.

5. To assess the community perception about the implementation and effect

of MDM and fortified MDM.

Methodology

This study will conduct in 56 primary and 24 upper primary schools in Tehri and Nanital
districts, Uttarakhand. The blocks were pre decided based on altitude (Upper and lower
Himalaya) and the number of school and percentage of student already mentioned in
TOR. However, the school with in the block will decide according to distance from the
blockhead office and walking distance from the roadside. In this study, more than 50%
school will selected from remotest part of the block. This study also conceders 50-50%
of boys and girls and adequate presentation of schedule caste and tribe and backward
students. The major objectives of the study
 Name of the Primary Upper primary Number of
Block
District school school student

Tehri Devprayag 14 6 40% of children

Bhilangana 14 6 40% of children

Nanital Ramnagar 14 6 40% of children

Okhalakanda 14 6 40% of children

Study design

The study will conduct in the two blocks of districts Tehri (Bhilangna and Devprayag)
which would be controlled district where fortification of MDM is in practice and Nanital
(Ramnagar and Okhalanda). The major objective of study is to assess the effect of a
Premix, fortified with iron, Vitamin A, hemoglobin, Iodine on Health indicators and
quality of education (attendance, enrollment, retention etc.). The will use three
sections, the first section will include health and education status, second one includes
lab investigation and third section will investigate financial and physical feasibility of local
alternative for fortification. (needs to be reworded)

Information dissemination and legal consent

The first step of study will disseminate adequate and appropriate information to all
concern authorities such as health and education department at state, district and block
level, school staffs and Gram Pardhans. The study will involve block level education
officer in the school selection process. The study will also ensure the community’s legal
consent from the principal of the school and Gram Pardhan.

Sample size

The sample size will depend on the total number of students in the selected 56 primary
and 24 upper primary schools. According the TOR, if the total number of students will be
less than 50, than all of them will become the study subject however, if the total
number of student will be more 50, than 40% of the total students will be taken as
study subjects (but not less than 50). In case of lab investigation, the study will select
randomly 300 students but not less 75 from each block. At block level, study will
investigate 22 students in upper primary school and 53 students in primary school. At
school level Stratified random sampling of the students will be done to select the sample
population considering the gender and caste (schedule caste, schedule tribe, backward)
and general.)

Process of sample selection

Process of sample selection will be as per following steps:

1. Selection of school will be on the basis of distance from the blockhead

office and distance from roadside

2. The study will select at least 50 student from each school and if the
number of students is more than 50, study will select 40% of students but it will
ensure that number should not be less than 50.

3. Sample size of students for investigation has been decided based on

prevalence rate of anemia, iodine deficiency, vitamin B12 and folic acid and
vitamin A deficiencies. however, the student will be randomly selected for the
investigations in the school. All the investigations proposed in the study will be
carried out in the each of the selected student for the study.(300 students)
Quantitative data collection
The quantitative data collection tool will have information on household characteristics,
Biodemographic characteristics, school attendance, retention and performance. The
quantitative data tool will also collect the information about subject wise marks and
anthropometric indicators such as height, weight and circumference of upper arm. Tool
will also capture the sign and symptoms of the vitamin and mineral deficiency and
history of diarrhoea, pneumonia and fever etc. Furthermore, it will provide evidence
based data collection on pathological test.

Data processing & Analysis Of quantitative findings

The following steps will require to be taken for analysis of data:
1. Verification of questionnaire
2. Identification number
3. Development of variables SPSS for Window, version 16
4. Computer data entry - SPSS for Window, version 16
5. Data Verification and rectification
5. Tabulation plan
6. Frequencies and cross table analysis
7. Development frequency base and correlation graph,
Test of significance will be applied to measure the significance of the difference
between fortified and non-fortified food.
8. Report writing
Qualitative data collection

The qualitative data collections will focus on in depth interviews with teachers- 5 (3
primary and 2 upper primary schools) ABSA -1 and, BEO -1 from each block and WFP
programme officer at district level. The qualitative finding and observations will also be
collected from community meeting at block level, which will ensure the representation
of all the sections of society.

Data processing & Analysis Of qualitative findings

The following steps will require to be taken for analysis of data:
1. Translation
2. Free listing
3. Domain Identification
4. Coding
5. Computer data entry
6. Quantitative marking in Percentage
7. Qualifiers: The following qualifiers will use for semi-quantitative expressions
and observations.
Population of Respondents Qualifier Used Adjectives Used
<10 % < 1+ Very few
10 - 24 % 1+ Some
25 - 49 % 2+ approximately half
50 - 74 % 3+ Majority / Over half
75 - 89 % 4+ Most
≥ 90 % 5+ Almost all.
8. Report writing
Pathological investigation
Development of study instrument
The study has many objectives hence the study instrument will be developed separately
for each objective. Finally, the investigation tool will come in the form of a section wise
questionnaire with proper indication for investigators to understand where they have to
use or not.

1. To assess the effectiveness of the fortification to reduce micronutrient

deficiencies with special reference to iron, folic acid and vitamin A &
incidence of morbidity of diarrhea, pneumonia and fever episodes among
the target children.

Study instrument
a) Quantitative tools- questionnaire (…………..household characteristics,
incidence of diseases, and anthropometric measurement)
b) Qualitative - Checklist for interview and FGD (teachers, parents and
Immediate health providers)
c) Pathological investigation - For the assessment of effect of fortification
food, study will assess the level of HB%, Vitamin A, Iodine and vitamin
B12 and Folic acid
1. Hemoglobin - HB%
2. Vitamin A - Retinol
3. Iodine - T3, T4 and TSH
4. Vitamin B12 - Vitamin B12 and Folic
2. To determine the impact of midday meal on student’s enrollments,
retention, attendance, performance and quality of education.

Study instrument
a) Quantitative questionnaire - based on school records from 2005 to 2008
marks obtained by students in Hindi and Math subjects at primary level and
Hindi, math and science subjects at upper primary levels will be recorded for
assessing the performance. Besides that enrollments, retention and percentage of
dropout students will be assessed based on the school records.
b) Qualitative – In- depth interviews with students and teachers will be
conducted to assess………… . Selected Psychometric test according to the
student’s age will be performed to assess their writing, reading, calculation abilities ,
Tests will also explore status of physical fatigue and short term memory of the
students.

3. To find the scope of practical & financial feasibility for up scaling the
fortification progrmme in other districts.

Study instrument
a) Analyze and Assess the existing fortification programme in the state as well
as other part of the state.
b) Use “Wings Methods” for analyzing the practical problems such as accessibility,
availability, transportation, distribution and preservation.
c) The study will incorporate cost benefit analysis to understand the financial feasibility
for up scaling the fortification program in other districts.
d) Findings from health status, education and lab investigation will be analyzed in the
context of socio-economic and geographical point of views.
4. To find the scope of better alternative for fortification of MDM through
local foods, vegetable and fruits.

Study instrument
a) Desk review of the literature will be conducted by Nutritionist, Agricultural
expert and Ayurvedic practitioners.
b) Probable options will be Analyzed for their food value by using food scale
method ,a booklet on most suitable food items will be developed (I understand this is
the requirement as per TOR)
c) The cost effective analysis will be done to understand the practical problems
such as accessibility, availability, processing, preservation transportation and
distribution

5. To assess the community perception about the implementation and

effect of MDM and fortified MDM.

Study instrument
a) Qualitative - community meeting checklist

Pre- testing of the research instrument

After the development of the questionnaire by the expert pool (Public health
professionals, educationists, nutritionists social scientists, psychologists, and
statistician,) Pre – testing will be conducted under the close observation of senior
consultant out side the study working area. The pre testing will conduct in one primary
and one upper primary schools and the total umber of students will not less than 50. The
all members of core team, consultant and investigators will have to participate in pre
testing process. The questionnaire /schedule will be finalized in consultation with expert
panel members based on the feed back of the pre – testing. The final of questionnaire
will send to government of Uttarakhand for their approval.

Recruitment and training

The recruitments of professionals, staffs and technician will be based on their
qualification and pervious experiences in research management, data collections and
analysis and report writing. The investigators will have good communication skills,
familiar with local language and dialect.

A 4 days orientation programme will be organized for the investigators to orient them
about he study and the various schedules tests etc. to be carried out under the study
Out of 4 days one day will be kept for the practices of field work.

Fieldwork and monitoring system

The entire fieldwork will be completed in two phases. The investigators will visit each
select school twice. The first visit will be an announced visit, investigators will collect
primary information through the questionnaire and also collect the blood sample for
pathological investigation and second visit will an unannounced with a gap of more than
a month to assess the child attendance, quality of education and patterns of midday
meal. The study coordinator, associated researchers and the senior members from the
state will plan minimum three visits for each block to ensure the quality data collection
and ensure 20 % spot checks for quality assurance of the fieldwork. The technical group
will have to reviewed the 20% of forms for the maintaining the quality of standard.
Data processing
The questionnaires will be submitted by the investigators to the head office after the
verification from the field monitoring team. The head office will give an Identification
number to each form and data will directly enter in statistical packages SPSS for
Window, version 16. The missing values will allow for the analysis and frequencies will
calculate from the univariate analysis. Bivariate analysis will use to describe the
relationship between different variables of interest and the dependent variables.

Analysis and report writing

The quantitative analysis of report will do by the help of SPSS window, version 16
according to tabulation plan and base on objectives of the study. The report will submit
in a standard research format. The draft report will sent to technical group and
Government of Uttarakhand for their suggestions and recommendations.
HIHT will submit following reports at the completion of the study
1. Health and education status of school going children in fortified and non
fortified districts
2. A report on Financial feasibility for replication of fortification program in the
other part of state
3.Alternative models for fortification of MDM through local foods, vegetable and
fruits( Including recipe booklet).
Time Frame

Phase -I

Phase -II

Phase -III

Phase -IV

Phase -V
S.N. Phase 1
1 1.5 Month (6 Week) W1 W2 W3 W4 W5 W6
1.1 Study office setup

1.2 Hiring of staff

Development of Research tools

1.3
Planning meeting with Study field staff

1.4 Pre testing of & modification of questionnaire

1.5 Pre testing of & modification of questionnaire

1.6 Orientation & Training of investigators & field staff.

1.7 Selection of schools.

Finalization of School wise sample size based on school

1.8
records. (B::G ratio / cast proportion)

1.9 Blood Sampling of student on randomly selected basis

Desk Research / review for Localization fortification of mid

1.10
day meal.

1.11 Planning meeting for IInd phase

Phase 2
2
1.5 Month (6 Week) W1 W2 W3 W4 W5 W6

2.1 First announced visit to school

2.2 Consent taking from Gram Pradhan

2.3 Field Monitoring

2.4 Questionnaire survey

2.5 Health data collection

2.6 Education Data collection (School records)

2.7 Anthropometric data collection

2.8 Parents interview

2.9 Blood Sampling of student on randomly selected basis

 Data collection for local food, vegetables, fruits, cultivation
2.10 status, availability in number of months in a year, nearest
source,
2.11 Planning meeting for III rd phase
Phase 3
3
1.5 Month (6 Week) W1 W2 W3 W4 W5 W6
Questionnaire verification Development of variables &
3.1
coding
Development of variables & coding
3.2

3.3 Data entry

Data validation
3.4
/ correction
Tabulation plan
3.5

3.6 Data analysis

3.7 Draft tabulation

3.8 Gap analysis

3.9 Collecting the results of Blood sampling test

Micro nutrient availability analysis in available local food,

3.10 vegetables, fruits.
Cost analysis, and financial viability

3.11 Planning meeting for IVth phase

Phase 4
4
1.5 Month (6 Week) W1 W2 W3 W4 W5 W6

4.1 Second unannounced visit to school

Random checking school attendance and performance of

4.2
Education

4.3. Random visit before mid day meal

4.4 Focus group discussion with Community

4.5 Focus Group discussion with teacher

4.6 Education Data collection (School records)

4.7 Interview BEO/ABSA/ Principal

 4.8 Interview with Bhojan Mata

4.9 Analysis of pathological results

Preparation of Recipe book for

4.10
Alternate

4.11 Planning meeting for phase 5

S.N. Phase 5
2 Month (8 Week) W1 W2 W3 W4 W5 W6 W7 W8
Final verification of questionnaire
5.1

Addition of new variables

5.2

Final Data entry

5.3

Data validation/ verification

5.4

Data analysis
5.5

Finalization of tabulation Plan

5.6

Report writing
5.7

Draft report submission

5.8

Feedback / comment
5.9
Final report submission
1. Quantitative report,
5.10 2. Recipe Book,
3. Financial and practical feasibility report for
Scaling up

S.N. Designation Post
1 Study Coordinator
2 Research Associate
3 Data entry operator
Executive assistant/
4 1
Accountant
5 Field investigator 16
6 Lab technician
7 Public health
8 Nutritionist
9 Educationist
Qualification and
Major task
experience
Post graduate in Social
science research and Overall coordination and Liaisoning and project management.
1 Program management with Guidance, Research design, development of research tools,
Experience in Social Indicators, data analysis, Report writing
research
P.G. in Social science, &
Coordination & supervision in the field, data analysis, report
1 experience in Social
writing.
research
Graduate & experience in
8 Computer and data entry / Data entry & tabulation.
data processing
Graduate and experience in Records management.
Office Management Support to field staff, logistics & accounts.
Post graduate in social
Conduct field survey, data collection (Interviews, FGDs, Filling
sciences and experience in
questionnaire/Schedule at the field level.)
research.
BMLT/DMLT and experience
Plan & coordinate all logistics support to Collect blood samples at
2 in blood Sample collection
field level, & ensure the quality control of the samples collected.
and testing
Consultant
Post graduate in public
1 Technical support to the project
health and experience in
community Health research
Consultant
1 Post graduate in Nutrition Technical support on nutrition issues to the project
and Experience in nutrition
Consultant
Post graduate in Education
1 and Experience in Assist in designing educational tools and pedagogical inputs.
educational research
pedagogy
22
 Organization

Technical Consultant
Study Coordinator Public health
Nutritionist
Educationist

Research Associate

Executive Assistant/ Accountant Field investigator 16 Lab technician 2

Data Entry operator 8

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