Child Care approach & Processes
Health being an integral aspect of care of young children, MAYA's ECCE approach, seeks to address it through distinct community processes that ensure that the health and well-being of the child is looked at holistically; and rather as a public concern than in isolation of the centre alone or relegated to the individual responsibility of the family. Addressing health of the young child as a community agenda calls for complete involvement of the caregivers in the health related processes of the ECCE facility. Given the prevailing situation of the young child in the country (47% of children aged below three years are undernourished and 58% of children -in the 12-23 months age group-are not fully immunised) addressing issues of health by the State has become a critical concern, especially in terms of creating access to these facilities & organising both preventive & curative measures.
The approach entails addressing three different aspects of care, rooted in the context & experience of the community- the nutrition; preventive & curative care; and accessing health services. Beginning from prevalent practices already existing in the communities, the caregivers and the significant others in the communities are encouraged to build on health related understandings and experiences in promoting the young child's health. The various aspects are addressed in a manner enhancing community capacity- be it in the parent's committee taking responsibility towards providing supplementary nutrition to their children; or parent's negotiating with the local PHC to make possible regular visits of the ANM and doctors; or teachers and parents together organizing immunization camps. Underlying the health related tasks are processes facilitated by the group of ECCE facilitators and lead teachers, towards strengthening communities in organizing continual care for their children. Hence most activities do not seek only tokenistic participation of the parents acting as mere beneficiaries instead lay emphasis on enrolling parents beginning from identifying child care need; planning and organizing towards its fulfilment and its implementation.
Nutrition:
Nutrition being mainly the responsibility of the parents, the community owned preschool tries to inculcate the awareness of and the need for good nutrition especially for young children. This takes the form of dialoguing with the caregivers on aspects of nutritious food content. This input is often a part of community health meetings involving mother's as participants mapping what could be enhanced in a child's diet. The apathy towards child care so acute in urban low income areas characterized by atomized families and often strained employment conditions of parents, is often the cause of neglect of child's dietary needs. Although over the years with all community owned preschools we have been able to bring about a culture & habit of parents partaking in the child's development- all children coming to the centres are seen carrying their lunch boxes with a can of water.
Most centres in the rural and peri-urban areas closely linked to the local government schools have been able to extend their mid day meal schemes to reach out to even the younger children in their villages. In some spurred on by the interest of the local school master whereas in some it is through the volition of the local GP member. Having effectively run their own schools without any external support for the first three months and then generating resources from within to support their schools has only confirmed their belief in being able to organise early child care and education facilities by themselves only seeking external resources for further strengthening their facility. Most external support sought by the communities is then allocated for providing meals or towards enhancing the monthly honorarium requirement for the teachers.
Accessing health facilities:
Characteristic of the present system is the gap in information between the people- service target groups - and the various government departments. The health department in liasoning with the ICDS has a convergent policy which helps the government to finally reach out to children in adverse eco-socio circumstances. The existing service of the local Government hospitals extended to the Government Anganwadis include a monthly visit by the Auxiliary Nurse Midwife (ANM) to provide regular de-worming, vitamin and iron & folic tablets; and ensuring that appropriate vaccinations are given on time. This is supplemented by an examination of the children by a Government doctor once in three months.
The teachers of the centres with the support of the parents create and maintain individual Child Health Records that document the important points of medical history of the child including immunization. Apart from check ups during times of illness, most parents were not seen maintaining their child's immunization records and very rarely accessing the local general hospital for accessing vitamin supplements and de-worming dosages.
In providing the community with accurate information about the various services which can be accessed by them annual health processes are undertaken briefing them on the locally accessible service and the manner in which they could plan and effectively organise its access to all children in their areas. The cluster committees then plan for organizing health check ups with their local hospitals and prepare lists of number of children, addresses of various preschools to be appended with a formal application in extending the community health services.
Preventive & Curative care:
The aspect of organising preventive & curative care of children entails working with the caregivers in a consistent manner over a period of time building capacities to actualize many of the tasks. For instance, the teacher is specifically trained in maintaining & preparing child health records before a health check up by the local doctor. It involves the teachers to undertake a house to house survey of the children of the community owned preschools in recording their immunization details ( helping recall in case of missing cards) and organise the mothers to meet before the actual commencement of the health check up, emphasizing the significance of immunization and keeping a track of each child's health status. Following which each teacher is trained to also monitor growth of every child and share the information at mother's meeting, using that as factual data with which to begin discussions on provision of healthy nutritious food and development of the child. Training sessions of teachers on health; ongoing processes with the mothers; and follow up processes with both the above group of caregivers form the core of formulating processes & activities around preventive and curative health care.
Immunisation
Immunisation being the most important issue of preventive health care, which is primarily provided by the State health services for the low-income groups, the community owned preschool partner with the Health department at the local levels in ensuring the complete immunisation of all the children who attend the preschools. Almost every local general hospital is involved in ensuring complete immunization of all preschoolers in the community owned ECCE centres and in extending health check up and referral services to them as in the anganwadis. This has proved effective in garnering the support of the larger community and providing recognition for the many community owned structures that organise the centres.
Monitoring of growth
Given the age group of the children, the teachers of the community owned ECCE centres are trained to monitor the growth of the child through a quarterly checking of the child's height, weight and mid-arm circumference. This information is shared with the parents to ensure that they remain informed and aware of their child's growth while observing any signs of malnutrition which is rather common among young children in low-income groups. Besides this, the individual attention paid to each child would offer indications of changes in health which the teachers will be trained to observe through an awareness of health related issues that are generally common in children of this age. Specially-abled children requiring specific attention are also referred to appropriate sources of treatment and care. These processes of monitoring are adequately reinforced by the regular visits of the ANM and the Government doctors.
Health Check up
The community is supported to organise an annual health check up for all the children of the preschools through the local government hospitals. This health check is useful both for the children and their parents in identifying any medical problem of the child while also providing the community the opportunity and the learning of organizing & accessing facilities from the larger community for the well being of their children.