How Chhattisgarh’s phulwaris are helping toddlers beat malnutrition | India News – Times of India

Eight children sit on colourful plastic woven mats getting a quick mustard oil body massage in the afternoon. Then, their hair is oiled and combed neatly by two women who run the creche. This is where parents, mostly mothers, of 14 children drop off their kids before heading out for work in Karhi Kachhar village in Chhattisgarh‘s Bilaspur district.
There are 83 such creches or phulwaris run by Jan Swasthya Sahyog (JSS), a non-profit running a low-cost, effective program to provide preventive and curative health services in Bilaspur’s tribal and rural areas. Unlike anganwadis, which only take in children from three years of age, these phulwaris are for children from six months to three years.
“After the mustard oil massage, they will be fed their third meal of the day, a khichdi,” says Shivkumari, one of the phulwari workers who donated the land for the creche to be constructed. Interestingly, the idea for phulwaris came from a village health worker who asked what families were expected to do with toddlers when the parents went to work, as anganwadis would not take in children below three years.
There were several incidents of unsupervised children getting hurt or deaths from drowning in water bodies that dot the landscape. Older kids were often forced to abandon schooling to look after younger siblings. The Unicef report on Chhattisgarh identified acute malnutrition among children as a major problem mainly due to unavailability of food, long working hours of mothers and inadequate knowledge of the nutritional needs of children after six months of age. It was found that children of working parents in the six months to three years age group were more malnourished as there was usually no one to feed them regularly.
Thus, in 2011, JSS decided to start phulwaris, basically daycare centres where children could also be fed regular, nutritious meals. Today, it has 83 phulwaris across 48 villages, which look after 827 children. Phulwaris are run by women from the same village, usually selected by the mothers. “Though the phulwari is supposed to open by 8am, sometimes during the harvesting season, the parents head for the fields by 4am and so we start very early. The mothers bring the food to be given to them before the first meal in the phulwari, which is at 10am,” says Shivkumari.
Being from the same village, the workers are more willing to be flexible with their working hours. Between 9am and 5pm, children are fed three meals – sattu at 10am, khichdi at 12pm and again at 2.30pm. They are given three eggs a week which boosts attendance.
“The children learn important healthy habits such as washing their hands before every meal, always using a mosquito net to sleep or using a chatai (a mat) to sit on the floor and wearing an apron before being fed so that their clothes do not get dirty. The parents tell us that they insist on these things even when they go back home,” says Dr Sheetal Gawali, the programme supervisor.
Parents are encouraged to collect the Take Home Ration (THR) provided in anganwadis for children aged six months to three years. “In 15 days, they get two packets of THR. We ask them to give one packet to the phulwaris, and ask the workers to feed the children the THR every alternate day for their 10am meal. That way, we can ensure that the child for whom the THR is intended gets at least half of it,” says Dr Gawali, adding that there was not enough monitoring of anganwadis to ensure that all intended beneficiaries got the THR. Along with regular meals, the children are also provided pre-school learning material, including toys for age-appropriate learning through songs and games. Phulwari workers also maintain a poshanbadi or kitchen garden in which they grow methi, palak, dhania and some vegetables, which are added to the children’s diet.
These have encouraged other women in the village to grow their own kitchen gardens. “The job of phulwari workers is much tougher than that of anganwadi workers because it is a full-time job of eight hours a day and it is much harder to manage 10 toddlers than it is to look after older children. They are paid about Rs 5,700 per month, which is lower than the minimum wage.
But actual wages here are very low and women are paid anything from Rs 70-100 per day for working in the field, and they don’t even get work on all days. The work they do in their own house and fields is unpaid. Moreover, unlike in the government system of anganwadis, where payments can get delayed, here they get paid regularly,” says Dr Gawali. Monitory is key.
A group of phulwaris has two supervisors, who deliver food supplies and cross-check attendance of children with the registers maintained. There are program coordinators who oversee functioning and inspect cleanliness of the premises and the children, and quality of food prepared. Village health workers of JSS also visit phulwaris periodically to measure the children’s weight and weight. An independent study conducted in 2019 on the impact of children attending phulwaris found that it helped reduce wasting and underweight by almost a third, though it did not find an impact on stunting. Dr Gawali explains how phulwaris prevent children from reaching the stage of severe acute malnutrition (SAM).
“We closely monitor their growth, and if in three months, a child’s weight has not increased by 300 gm, we call it growth faltering, and immediately act to prevent them from reaching the stage of SAM. We might have to counsel the parents, give them more nutritious food and find out if there is any health reason for not putting on weight,” she adds. It costs JSS roughly Rs 1.3 lakh per year to run a phulwari of 10 children. That works out to barely Rs 1,100 per child per month or Rs 36 per day.
“If government is serious about addressing malnutrition in children, they have to look at the six months to three-year age group. It is a crucial growth period. Just allocation of funds for creches will not be enough. Effective monitoring coupled with timely release of funds and committed workers are what makes a programme work,” says Dr Vasundhara Rangaswamy, who has been fundraising for the phulwari programme of JSS.

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