Under nutrition is perhaps the most widespread problem in rural Chhattisgarh, and one of the leading causes of morbidity and mortality among our patient population. The cycle of under nutrition often starts young, with consequences that can last generations. Early childhood malnutrition leads to poor physical and cognitive development, which can negatively affect one’s future earning potential and further perpetuate the cycle of poverty and malnutrition. Likewise, women who were undernourished as girls tend to give birth to under weight babies, thus continuing the vicious cycle of ill health in the next generation.
In order to address the problem of under nutrition in children, we have started a “Phulwari” programme, which aims to provide a crèche facility to all children 6 months to 3 years living in any of the 54 programme villages that JSS serves. The programme supplies supplementary nutritional food and conducts activities to boost cognitive development among the children. JSS currently operates 83 phulwari programmes, serving over 1000 children.
How a Crèche is Run
The crèches are run by women who have been selected by their local community, with one woman responsible for up to ten children. Some villages have more than one crèche, and some crèches have up to 30 children with three women running the crèche together. The crèche co-ordinators are given orientation training on the basics of health and hygiene in addition to how to run the crèche. They also attend monthly meetings, during which the functioning of the crèche is reviewed, supplies are replenished, and some health teaching is done.
Children are given one cooked meal and two snacks of a high protein-high energy mixture called “sattu” during the five to six hours that they are in the crèche. Twice a week, the children are also given eggs. The food is prepared by women’s groups in one cluster of villages and is purchased by JSS for distribution to the crèches. Crèches have also been provided with toys to stimulate learning. However, our early child education initiatives still need strengthening.
The hours of operation for a crèche depends on the needs of the community. During the summer, crèches may start as early as 4 am, as NREGA work begins early to avoid the midday heat. Women with very young children often return to the crèche twice a day to breastfeed their children.
The response to the crèches has been largely positive, as parents feel that it answers one of their main needs – that of child care – when they have to go out to work. With the implementation of the National Rural Employment Guarantee Act (NREGA), the demand for crèches has increased, as more parents are absent from their homes for most of the day. By providing a safe place for children, parents no longer have to taken their children with them to the fields, where they are subject to heat, sun, and dust and where food and water are in short supply. In addition, several children who had dropped out of school for sibling care have returned to school after the crèche facility has been made available in their village.