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Photograph of Mother and Child
Title of Women Development, Child Welfare and Disabled Welfare Department
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1.Overview

While implementation of ICDS has resulted in improvement of the nutritional status of women and children in the state, the desired goals have not been achieved. The percentage of low birth weight babies, underweight children (< 3 years) and pregnant women who are anaemic is still high. As a result, reduction of Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) continues to be a challenge.

Scientific evidence shows that malnutrition starts early in life and its effects become irreversible after 2-3 years. Meeting the nutritional needs of Pregnant & Lactating women is therefore one of the critical windows of opportunity available to prevent malnutrition. Hence a need was felt to modify the nutrition programme of ICDS especially as the Take Home Ration (THR) provided to Pregnant and Lactating women under ICDS is not only too meagre but also gets shared by all members of the family.

In this regard, the State Government introduced “Anna Amrutha Hastham” (AAH) programme which involves spot feeding of “one full meal” for Pregnant and Lactating women at the Anganwadi centre along with administration of Iron & Folic Acid (IFA) tablet. The programme was started on 01.01.2013 in ICDS Projects with most adverse health and nutrition indicators. During 2013-14 it was extended to some other ICDS Projects and now covers about 40% of the ICDS Projects and 40% of the Pregnant and Lactating women in the State.

The meal under AAH includes one egg and 200 ml milk daily along with rice, dal and vegetables (with green leafy vegetables atleast thrice a week). The meal provides more than 40% of the day’s calorie/ protein/calcium requirement of the Pregnant and Lactating women. Procurement of certain food commodities such as eggs, milk, condiments and vegetables have been entrusted to the federations of SHGs at the village level known as the Village Organization (VO) and the required amount is transferred as an advance into their account.

For transparency and effective monitoring, the village level AAH committee consisting of President of VO as chairperson and one member of the VO/SHG who is actively involved for procurement, one representative each from Pregnant and Lactating women, one mother of 7 months to 3 years and one mother of 3 to 6 years as members and AWW as convener-member has been constituted to monitor attendance, quality of food, hygiene and to mobilize Pregnant and Lactating women to avail the benefits of the programme.

During 2013-14, AAH trainings were imparted at mandal level for the AAH Committee members, the AWWs and the Cluster Coordinators. Impact studies were carried out by UNICEF and concurrent evaluation was entrusted to Home Science College, Hyderabad. Preliminary studies and feedback has shown that the acceptance of AAH by the target group is overwhelming and that the impact on improving maternal nutrition and reducing low birth weight is very positive

2.Objectives
   i) Enhance the quality and acceptability of supplementary nutrition by the Pregnant and Lactating women
   ii) Ensure food supplied is consumed by only the Pregnant and Lactating women rather than the whole family
   iii) Ensure that Pregnant and Lactating women consume 100 IFA tablets
   iv) Improve the enrollment of mothers at Anganwadi Centers(AWCs)
   v) Eliminate or decrease number of Pregnant and Lactating women with anaemia/ who are undernourished
   vi) Reduce the incidence of low birth babies and malnutrition among children
   vii) Ensure that Pregnant and Lactating women receive health checkups and immunization
   viii) Reduce the incidence of infant mortality and maternal mortality
3.Operational Guidelines for implementation of "Anna Amrutha Hastham" programme
1. In the monthly meetings of Village Organisations (VOs), Mandal Mahila Samakhyas (MMS) and Zilla Mahila Samakhyas (ZMS), the Anganwadi Workers, Supervisors /CDPOs and the PDs respectively will be invited for discussion on the implementation of the "Anna Amrutha Hastham"(AAH)
2. AWW, ASHA, SHGs, VOs will identify the target group and ensure early registration of the Pregnant women and enrollment of Lactating women in the Anganwadi Centres (AWCs). In addition AWWs will make house to house visit to survey, identify and make a list of the target group. All Pregnant and Lactating women will be issued MCP Cards
3. VOs along with ICDS and health field functionaries will create the necessary awareness and will mobilize the Pregnant and Lactating women to receive the "One Full Meal" along with other health and nutrition services at AWCs
4. A seven member Committee called the "Anna Amrutha Hastham Committee" will be constituted for each AWC. This Committee will be chaired by the President of VO, and will have one representative of VO/SHGs, one pregnant women, one lactating women, one mother of 7 months to 3 years children, one mother of 3-6 years children and AWW as members. The representative of VO/SHGs will be the one responsible for procurement on behalf of the VO. The Pregnant and Lactating women and mothers will be identified by the VO and will be among those who are regularly attending the AWC for the AAH/ ICDS programme. The Committee meeting will be convened by the AWW. The Committee will
  • help to mobilize women,
  • monitor the implementation of the various aspects of the programme such as attendance, quality of food, hygiene etc.,
  • finalize the menu and
  • fix the timings of the meal.
The Committee will also certify the attendance of the women at the AWC. The Committee will meet at least once in a month
5. Anganwadi Helper or in absence of the Anganwadi Helper a person identified by the VOs will cook the “One Full Meal” and serve the food at the Anganwadi Centre
6. The quantity, cost and nutritive value of food items to be served as part of "One Full Meal" is at Table - I
7. The average unit cost of the “One Full Meal” is Rs.15/- per women per day. Savings on any one of the items can be utilized for purchase of any other item in the menu. In addition Rs.5/- per women per day is provided as flexible amount to be used as per requirement and local variation in prices and as per decision of Project Director (ICDS)
8. The model menu is at Table - II. However the "Anna Amrutha Hastham Committee" can decide the menu as per local conditions
9. IFA tablets will be provided by ANMs and will be administered along with the food by AWW
10. The growth monitoring of all pregnant and lactating women will be done every month and birth weight of the new born will be recorded in the MCP Cards
11. Rice will be procured through Civil Supplies Corporation, Dal & Oil will be procured as DPC route / A.P.Oil Federation. These will be procured and supplied to AWCs at least one month in advance by PDs/CDPOs
12. Milk, eggs, vegetables and condiments will be procured locally by the VOs. For this purpose, the Supervisors of ICDS will enter into a MOU with the VO concerned. However, wherever packaged milk is procured at district/project Level from Dairy Corporation/Other Diaries the VOs will procure only eggs, vegetables and condiments locally. The rates for local purchase and the packaged milk will be finalized by the existing DPC chaired by the Jt. Collector and Project Director (DRDA) will be inducted as one of the members in this Committee for fixing the rates. VOs will maintain separate records for the purchases
13. Project Directors/CDPOs will release budget to Civil Supplies Corporation/A.P.Oil Federation /DPC fixed agents for rice, oil and dal. Where milk is purchased at district/project level the PD/CDPO will release budgets to the supplier of milk. The CDPOs will release budget of two months advance to VOs bank accounts for supply of milk, eggs, vegetables and condiments. The advance will be settled before 10th of next month as per the attendance certified by the “Anna Amrutha Hastham" Committee. Details of procurement & budget releases are at Table - III
14. Monitoring and inspections shall be taken up by ICDS functionaries for the programme as detailed below
  • Child Development Project Officers/Supervisors shall inspect at least 20 AWCs under "Anna Amrutha Hastham" per month
  • Project Director shall inspect at least 10 AWCs and 5 villages under AAH per month
  • Regional Deputy Director shall inspect at least 10 AWCs and 5 villages under AAH per month
  • They shall monitor attendance, quality and quantity of the food, cleanliness in cooking and serving, weight gain of pregnant women, colostrum feeding, exclusive breast feeding and immunization etc
15. The convergence structure of the "Maarpu" programme at different levels from the village to State will monitor the quality and quantity of the meal and rates of commodities and implementation of the services under "Anna Amrutha Hastham" programme
16. Joint trainings and awareness campaigns will be conducted for field functionaries, SHG members, VOs and others by the department and SERP
17. Grievance redressal mechanism including calls through 104 and call center of Rural Development will be established by the department
18. The community, PRIs, Civil Society and NGOs will be involved in monitoring, training, capacity building, communication, community mobilization and service delivery of the programme. At least two NGOs will be involved in each District for this purpose
19. Baseline survey shall be conducted by involving the Medical Colleges/Local Universities/Colleges/NGOs etc. Further, concurrent evaluation of the programme shall be done
20. Core Committee will be constituted at State Level consisting of Officials, Academicians, NGOs & Nutrition experts to review the implementation of "Anna Amrutha Hastham" programme and suggest improvements, if any
4.Monitoring

Five registers are given to AWWs for recording the details of AAH program implementation. These five registers are as follows:

  • AAH Committee meeting register
  • VO food material supply, utilization and expenditure details register
  • Pregnant and Lactating women attendance register
  • AAH monthly report register
  • Pregnant and Lactating women register

Information is provided by Anganwadi worker to CDPO in monthly reporting format given in the AAH Register-4. Based on the reports given by Anganwadi workers, CDPO prepares MPR-4 and submits it online before 5th of every month. The report consists of coverage of pregnant and lactating mothers, number of days food material not-available due to any disruption, weight gain among pregnant women, number of children more than 2.5 kgs weight at birth, maternal and infant deaths details and VO account reconciliation and advance release details

Assessment and evaluation studies have been entrusted to UNICEF and Home Science College, Hyderabad. NIN, Hyderabad is also entrusted with the study of impact of AAH which is to be carried out periodically every 3 years

5.References
G.O.Ms.No.33 - Dated:01-12-2012
Nutrition programme under the ICDS – Introducing "One Full Meal" under "Anna Amrutha Hastham" programme for Pregnant and Lactating women in 102 ICDS Projects - To improve health and nutrition status of women and children in the State – Orders - Issued
Govt Memo No.3462/ICDS-A1/2012 - Dated:20-12-2012
Nutrition Programme under the ICDS – Introducing "One Full Meal" under "Anna Amrutha Hastham" programme for Pregnant and Lactating women in 102 ICDS Projects to improve health and nutrition status of women and children in the State – Issue of Guidelines
G.O.Ms.No.29 - Dated:05-11-2013
Nutrition Programme under the ICDS - "One Full Meal" for Pregnant & Lactating women under "Anna Amrutha Hastham" programme – Extending the programme to another 63 ICDS Projects under 2nd phase of expansion during the year 2013 -2014 – Orders - Issued
G.O.Ms.No.31 - Dated:20-12-2013
“One Full Meal” under “Anna Amrutha Hastham” programme for Pregnant and Lactating women in the bifurcated ICDS Projects - Continuation - Orders - Issued
G.O.Rt.No.187 - Dated:17-05-2014
Implementation of Anna Amrutha Hastham (AAH) programme for Pregnant & Lactating women - Enhancement of flexible amount from Rs.2.00 to Rs.5.00 per woman per day – Permission to PD (DW&CDA) to utilize the flexible amount – Orders – Issued
G.O.Ms.No.21 - Dated:22-05-2014
Implementation of Anna Amrutha Hastham (AAH) to mitigate fluoride problem in Nalgonda District - Implementation of AAH progarmme in another 3 ICDS projects i.e., Nalgonda (R), Ramannapet & Bhongir of Nalgonda District and to sanction AAH programme to Ghanapavaram ICDS Project in lieu of Nallajerla ICDS Project – Orders - Ratification - Issued