'NUTRITION RIGHTS COALITION' Maharashtra Poor acceptability, inadequate nutrition intake raise questions on the effectiveness of the ‘Take Home Ration’ scheme; reveals Report

'NUTRITION RIGHTS COALITION' Maharashtra

Poor acceptability, inadequate nutrition intake raise questions on the effectiveness of the ‘Take Home Ration’ scheme; reveals Report

A study conducted by the Nutrition Rights Coalition to assess the ‘Take Home Ration’ scheme in comparison with the provision of cooked meals, in four districts of Maharashtra

Mumbai, 13^th  January 2014 : A detailed study conducted by the Nutrition Rights Coalition, Maharashtra and supported by the Narotam Sekhsaria Foundation was revealed at a recently held press conference. The study brought to light that the government’s ‘Take Home Ration’ (THR) scheme for children below three years of age is not appropriate due to very poor acceptability and low nutrition intake related to this commercially produced packaged food supplement.

The study assessed the quality of supplementary nutrition provided to children below the age of three, comparing the effectiveness of THR packets vs. cooked food in terms of distribution, usage, nutritional value and nutritional status of the children. This study was conducted in four districts of Maharashtra i.e. Pune, Nandurbar, Gadchiroli (the districts where THR is distributed) and Amravati (the district where cooked food is distributed) covering a total of 15 villages and 211 children.

Dr. Vandana Prasad who presided the event as the chief guest quoted “The government and its departments are investing in numerous schemes and programs for social development. We appreciate the efforts of the Nutrition Rights Coalition in bringing to notice the discrepancies in the THR scheme. Modifications should be made to ensure that supplementary nutrition for under-3 children is appropriate and effective”.

In terms of the regularity of the supply, cooked meals far outweigh THR packets as the overall availability of THR packets was only 53 percent of the total requirement. Out of the required supply of three packets per month, 60 percent mothers reported that they received on an average only two packets of THR per month, and 40 percent mothers received only one packet per month during the last three months. On the other hand, all the respondents from Amravati reported that they received hot cooked meals i.e. khichdi and matki usal from the Anganwadis regularly.

Also, the poor quality of THR packets contrasts with better usage and consumption of cooked meals. During the span of a week, it was found that only 11 percent children in the THR districts were frequent users of the packaged food, while88 percent of children from Amravati frequently consumed the hot meals made available by the government. THR upma is often found to be bitter in taste (69.4 percent) and very salty (22.4 percent). Most of the respondents recommended that except for shira, the supply of all other THR packets should be discontinued. Among the families that reported that their children were not consuming THR, 79 percent stated that they use the THR packets instead of feed for their domestic animals.

The effective nutritive value of THR in terms of the actual consumption by children was found to be much lower than the nutritive value of cooked food consumed. The average protein intake due to THR was found to be about one-third of that due to cooked meals, and the average calorie intake due to THR was less than half of that due to cooked meals.

The nutritional status of children in THR areas was found to be poorer compared to the nutrition of children in areas where cooked food is served. The prevalence of Severe Acute Malnutrition (SAM) in villages where THR is being supplied was 5.7 percent, which is twice as high as severe acute malnutrition in areas where cooked food is being supplied (2.8 percent).

In the overall analysis, the findings suggest that for children below three years of age, cooked food is a much better form of supplementary nutrition rather than THR packets in terms of acceptability, consumption, effective calorie and protein content, and reduction of severe malnutrition.

Dr. Arun Gadre, Member, Nutrition Rights Coalition, Maharashtra, said, “Our study has clearly shown that acceptability and nutritive intake of THR packets is much lower than hot cooked food. Therefore we recommend stopping of commercial THR packets and providing daily hot cooked meals or locally produced dry, nutritious food instead."

Despite the positive impression of cooked meals, it was noticed that there is scope for improvement even in cooked meals. Khichdi is generally prepared without adding oil and with very little dal, hence it is not tasty and the children eat lesser quantities of it. In the absence of oil, there is almost no fat content and therefore it may not fulfill the required calorific requirement. Also, khichdi and usal are not very appropriate for children below nine months of age.

The research report has given some recommendations to improve the efficacy of this scheme. The government should replace THR packets with provision of cooked food including adequate dal, oil and vegetables. The menu should have more variety to ensure better acceptability among children, and special meals should be arranged for kids under one year of age. In situations where dry packaged food is required, instead of commercial private companies providing THR, this responsibility should be given to local groups and their quality may be monitored by communities. The report has also suggested that regular feedback should be taken from the mothers’ groups, Village Health Nutrition Sanitation Committee members and civil society organizations about the quality and acceptability of supplementary foods and modifications should be made accordingly.

Leni Chaudhuri, Programme Head, Narotam Sekhsaria Foundation said, “There is an urgent need to augment the food basket delivered through the ICDS program. While the take home ration is an option forremote and inaccessible areas, the food has to be culturally appropriate. The THR is also not adapted according to the requirements of children under three years of age who cannot come to the Anganwadi Centers. Hope this study will provide greater insights into the problem.”

About the Nutrition Rights Coalition

The 'Nutrition Rights Coalition' is a coalition of civil society organizations working on Nutrition Rights in Maharashtra in the rural areas of Nandurbar, Pune, Gadchiroli and Amravati districts and the urban areas of Nagpur and Mumbai.


Is 'Take Home Ration' really
improving the nutrition of children?
A study of Supplementary Nutrition for under 3 children
in four districts of Maharashtra
Under the ICDS scheme to improve nutrition and health of pre-school children, the Anganwadi centre provides
hot cooked meals to children in the age group 3-6 years, while supplementary nutrition in the form of 'Take home
ration' (THR) packets are provided to children aged less than 3 years. Every year Maharashtra government is
spending around Rs. 300 crores on THR, yet there have been several complaints about these packets. On the other
hand, in Dharani and Chikhaldara blocks of Amaravati, nowinstead of THR packets, cooked food is being distributed
to all children in the under-3 age group, and after this change the experience of supplementary food was reported
to have improved.
Keeping this background in mind, the Nutrition Rights Coalition has undertaken a study to assess both types of
supplementary nutrition for under-3 children, comparing the effectiveness of THR packets vs. cooked food in terms
of distribution, usage, nutritional value and nutritional status of the children. This study was conducted in four
districts of Maharashtra i.e. Pune, Nandurbar, Gadchiroli and Amaravati during June 2013 to August 2013. Data
collectionwas carried out in total 15 villages fromfour districts, covering 211 children.
Studymethodology
In three districts where THR is being given (Pune, Nandurbar, Gadchiroli), one block each was taken for the study based on
presence of civil society organisation involved in the Nutrition Rights Coalition. The comparison district was Amaravati,
where two blocks (Dharni and Chikhaldara) were taken for the study, since here daily cooked food is being provided
instead of THR. In each block, three villages were selected randomly out of a larger sample of villages that had been
covered by an earlier situational analysis. Hence total of 15 villages were covered: 9 villages in THR districts and 6 villages
in the cooked food district.
In each study village, half of the children under 3 years of age in each village were randomly selected from the Anganwadi
register, and interviews of mothers / caretakers of these children were conducted. In the THR districts, 105 children got
included in the study sample, while in the cooked food district, 106 children were included, making a total of 211 children
covered by the study.
This study was conducted during June 2013 to August 2013.
1. Observation of actual preparation of food using THR mix in households, and noting downits recipe withamounts of
ingredient added. Usually three types of THR packets are distributed. So attempt was made to observe 3 to 4
recipes per village.
2. Interviewof caretakers of under-3 children to understanda.
Actual usage ofTHR
b. Food frequency recall for understanding THR consumption and overall dietary intake by the child. (weekly
consumption data)
Data collection involved four main aspects-
3. Anthropometric measurements of all studied children
4. Records fromAnganwadi - Height andweight, nutritional status of the child, details aboutTHRdistribution
Major Findings
Inadequate and irregular supply ofTHRpackets
Only11%children are consumingTHRpackaged food frequently
60 percent mothers reported that
they received on average only two packets per month,
and 40 percent mothers received only one packet per
month of THR, during the last threemonths.
Hence, frequent usage of cooked food is eight
times higher than frequent usage of THR.
Every child should get three packets of THR everymonth,
however in reality,
On the other hand, all the respondents from
Amaravati reported that they are receiving and taking
a hot cooked meal i.e. khichadi and matki usal from
theAnganwadi regularly.
On asking about consumption of supplementary food in the last one week, it was found that only 11 percent
children in THR districtswere frequent users of THR, while 88 percent of children fromAmravati, where cooked
food is being given,were frequent users of cooked food (Table 1).
On exploring what do people do with the unused packets,
some interesting responses came up. Out of nonusers of packets,
and remaining
mentioned that they mix it with other flour.
Upma
Upma 79 percent respondents said they give
it to animals or use it for fishing, followed by 11 percent respondents who throw it away
Poor quality ofTHRpackaged food
There is scope to improve quality of cooked food aswell…
Upma
Sattu Upma shira,
is often bitter in taste (69.4 percent) and very salty (22.4 percent). 58 percent respondents reported that
and smells bad. Most of the respondents recommended that except for supply of all other
THRpackets should be stopped.
One of the main reasons behind non-usage of THR is its poor quality, reported by majority of the respondents.
In Amaravati where cooked food is given, itwas reported that, the same food items i.e. Khichadi andMatki Usal
is distributed every day, which becomes monotonous for children. Khichadi is generally prepared without
adding oil and with very little dal, hence it is not tasty and children eat lesser quantities. In absence of oil, there
is almost no fat content and hence itmay not fulfill the required calorific requirement. Also Khichadi and Usal is
not so appropriate for children below9months of age.

Consumed Supplementary Nutrition 3 times or more in last week
Consumed Supplementary Nutrition less than 3 times in last week
Table 1 - Frequency of consumption of supplementary Nutrition
Frequency of consumption THR Distribution districts Cooked Food Distribution district
Total respondents (N) 105 106
0%
Non Users 61% 12%
Infrequent Users** 28%
Frequent users* 11% 88%
Calories and proteins being received by children from cooked food were found to be two to three times higher
than that received fromTHRpackets (Table no.2).
Itwas found that Calories and protein content in THR prepared by mothers is significantly lower than what is
mentioned in GR. For example - As per GR,
567Kcal and 16.3g recipes prepared by mothers
130 Kcal and 7.5g
Proportion of severely malnourished (SAM) children in THR distribution districts is double compared to
severe malnutrition in cooked food distribution area.
calorie and protein content in per serving of should be
respectively. However, if we see actual , calorie and protein
content in per serving of was respectively.
Likewise, the status of nutrition of under-3 children
was found to be substantially better in cooked food distribution district (Amaravati) compared to the THR
distribution districts (Pune, Nandurbar, Gadchiroli).
Shira
Shira
Table 2 - Comparison of Calories and proteins from cooked food and THR packets.
Type of food
113 3.7
253 9.2
Average calories / protein consumed by child per serving
Cooked food
THR
Kcal Protein (g)
14.2%
5.7% 2.8%
19%
75.2% 83%
Table 3
Comparison of nutritional status of children receiving THR packets and cooked food
Nutritional status THR distribution districts Cooked food distribution district
Normal
Severe acute malnutrition
(SAM)
Moderate acute malnutrition
(MAM)
Recommendations-
Government should immediately stop massive wastage due to
centrally purchased THR being provided by private companies,
and replace it with one of the following options-
Daily hot cooked food can be provided to under-3 children.
Considering people's experience regarding the present cooked
food, its quality should be improved by adding adequate dal, oil
and vegetables; there is also need to increase diversity of meals
to ensure better intake by children. Special foods would be
required for children under one year.
A second option could be local preparation of appropriate and acceptable dry supplementary
foods by local groups, to be provided regularly.
Based on the principle of communitybased monitoring, in order to ensure proper implementation of the
scheme, ICDS should regularly take feedback from mother's groups, Village health Nutrition Sanitation
Committee members and civil society organisations about the quality and acceptability of
supplementary foods being provided to children. Based on such feedback, modifications should be
madein the forms of supplementary food.

Dr. Arun Gadre (9822246327, sathicehat@gmail.com
Bandu Sane (9890359154, khojmelghat@gmail.com)
December,2013
In the ultimate analysis, data suggests that cooked food for children below 3 years is a much better form of
supplementary nutrition thanTHRpackets in terms of -
Acce
n of malnutrition
§ ptability
Consumption
Effective calorie and protein content (actual consumption)
Reductio

A Report by
Nutrition Right Coalition, Maharashtra
Financial & Technical assistance
Narotam Sekhsaria Foundation
Contact
Rachana (Pune), Khoj (Amaravati), Amhi Amchya Aarogyasathi (Nagpur, Gadchiroli),
Janarath (Nandurbar), Lokseva Sangam (Mumbai) & SATHI (Pune)
Comment on recentGovt. order recommendinglocally produced THR-
In February 2013, a new order has been issued, which states that THR should be now supplied from local level
(for example by Self-help groups, women groups etc.). However, as reported by civil society organisations
working on nutrition issues, the neworder has not yet been implemented in any area of Maharashtra. The order
of supply of THR from local level is positive in the sense that this may reduce delay in distribution, and could
potentially lead to provision of more locally appropriate foods. However, if the same technical criteria applied
for factory-made THR are made mandatory for these local groups, most groups may not be in a position to fulfil
it. In such scenario, contractors are likely to take over the contracts of THR. Thus, the government needs to
consider these points and this ordermay need to be modified accordingly.