Data, gath­ered at low cost, help check mal­nu­tri­tion

How a low-cost ev­i­dence-based ex­per­i­ment in data gath­er­ing helped a Ma­ha­rash­tra district in tack­ling mal­nu­tri­tion

Governance Now - - FRONT PAGE - Gee­tan­jali Min­has

What gets mea­sured gets im­proved.” Th­ese words were said by the great man­age­ment guru Peter Drucker decades ago. But they are rel­e­vant even to­day. Data has emerged as the new oil in this era. From Face­book to google and ama­zon to Zo­mato, ev­ery sin­gle firm is cash­ing on this in­for­ma­tion.

Data col­lec­tion and its anal­y­sis have the power to change the face of the world. in­dia has vast amounts of data, but the coun­try lags be­hind in har­vest­ing its true po­ten­tial. in July 2017, union health sec­re­tary ck Mishra ac­knowl­edged se­ri­ous prob­lems with in­dia’s pub­lic health statis­tics. For­mer rbi governor D sub­barao too ad­mit­ted that mon­e­tary pol­icy de­ci­sions of­ten go astray be­cause of er­ro­neous data pro­vided by the gov­ern­ment. lack of cred­i­ble sur­veys and fig­ures hin­der in mea­sur­ing the mag­ni­tude of so­cio-eco­nomic prob­lems.

For ex­am­ple, many phil­an­thropic ef­forts have been stalled in the se­verely mal­nour­ished belt of Pal­ghar district in Ma­ha­rash­tra be­cause of lack of data. The district doesn’t have a con­sol­i­dated data on mal­nu­tri­tion or an in­ven­tory of var­i­ous or­gan­i­sa­tions work­ing in the field. This has posed chal­lenges to the stake­holder agen­cies work­ing in the area.

also, when a donor from san­gli district in Ma­ha­rash­tra wanted to dis­trib­ute 1.5 tonne of grain, the district

ad­min­is­tra­tion had no avail­able net­work to guide him. in another case, af­ter an or­gan­i­sa­tion dis­trib­uted spir­ulina-rich (a high source of pro­tein) lad­doos in an­gan­wadis, it came to know that the vil­lage did not have any mal­nour­ished chil­dren.

“This could have been avoided as the chil­dren were healthy and the in­ter­ven­tion could have been bet­ter di­rected. We have seen or­gan­i­sa­tions dis­tribut­ing lcd TVS to an­gan­wadis that do not have elec­tric­ity,” says Digvi­jay Ben­drikar shinde, unicef re­search fel­low and district co­or­di­na­tor, so­cial trans­for­ma­tion cell, zilla parishad of Pal­ghar.

He adds: “To guide, com­ple­ment and eq­ui­tably dis­trib­ute such ac­tiv­i­ties the ceo of Pal­ghar, Milind Borikar, wanted to cre­ate a frame­work us­ing data. The work on this frame­work started about nine months ago.”

real-time ev­i­dence-based data is needed for ngos like larsen and Toubro Pub­lic char­i­ta­ble Trust (LTPCT), work­ing in Talasari block of Pal­ghar, to have a deeper un­der­stand­ing of the chal­lenges around mal­nu­tri­tion and early child­hood ed­u­ca­tion.

Lack of data can re­sult in mis­di­rec­tion of ef­forts and re­sources. It came to light, for ex­am­ple, that ladoos high in pro­tein were dis­trib­uted in a district where there was no mal­nu­tri­tion.

An ini­tia­tive to em­u­late

in 2017, to ad­dress th­ese is­sues, a low­cost pi­lot project was con­ducted in col­lab­o­ra­tion with the cen­tre for Tech­nol­ogy al­ter­na­tives for ru­ral ar­eas (ctara) iit-b, the Talasiri unit of in­te­grated child De­vel­op­ment ser­vices (icds), the zilla parishad and other civil so­ci­ety in­sti­tu­tions.

The project was aimed at gath­er­ing real-time data of mal­nu­tri­tion and was in­sti­tuted us­ing the ch­hat­tis­garh model of ‘Va­jan Ty­ohar’. For the first time, nss stu­dents were in­volved in gath­er­ing data.

ctara works in ar­eas like child mal­nu­tri­tion, ru­ral de­vel­op­ment, tech­nol­ogy scale-up, use of map­ping tech­niques in so­cial sec­tor plan­ning and pub­lic pol­icy.

“icds data was avail­able, but there were is­sues of qual­ity, re­li­a­bil­ity, etc. The district-wise data by the na­tional Fam­ily Health sur­vey (nfhs-4) was avail­able for the un­di­vided Thane. in au­gust 2014, Pal­ghar district was carved out of Thane district. so the need of the hour was to look at Pal­ghar data alone. We did not have sep­a­rate data for Pal­ghar and Thane,” says satish B ag­ni­hotri, for­mer cab­i­net sec­re­tary and pro­fes­sor, ctara iit-b.

The big ques­tion that loomed was how to get re­li­able data for clus­ters af­fected with mal­nu­tri­tion in Pal­ghar. By iden­ti­fy­ing ar­eas with low mal­nu­tri­tion one could learn from them. For ex­am­ple, if there is a poor house­hold with a mal­nour­ished child then one can check if that house­hold has worked 100 days un­der the Ma­hatma gandhi na­tional ru­ral em­ploy­ment gu­ran­tee act (Mgnrega). “if the house­hold has worked un­der Mgnrega then it has money, which can be utilised to ad­dress mal­nu­tri­tion. one can also see if the fam­ily is get­ting their ra­tion on time. in such cases, one can do house­hold- or clus­ter-spe­cific in­ter­ven­tions. Keep­ing th­ese things in mind we de­cided to do a cross-check on the lines of Va­jan­ty­ohar model,” adds ag­ni­hotri.

a child’s an­thro­po­met­ric data pro­vides in­for­ma­tion on preva­lence and sever­ity of mal­nu­tri­tion. This in­cludes weight, height and mid­dle up­per arm cir­cum­fer­ence (Muac) of each child. Based on this, three bur­dens of un­der-nu­tri­tion – un­der­weight (weight for age), wast­ing (height for height) and stunt­ing (height for age) – are cal­cu­lated.

“The data can be vi­su­alised on a map to find hotspots of mal­nu­tri­tion. ad­di­tion­ally, this data can be over­lapped with the data from the gov­ern­ment and NGOS to find suit­able lo­cal in­ter­ven­tions for tack­ling un­der nu­tri­tion. The child-wise data col­lected will act like a map to show where the fo­cus is needed. com­bin­ing this data with other de­part­ments’ data can help in un­der­stand­ing how in­ter­ven­tions can be done,” ex­plains shinde, who also co­or­di­nated the project.

in De­cem­ber 2017, 55 stu­dents from the chan­drab­han sharma col­lege of sci­ence and com­merce, Powai, trained un­der unicef guide­lines, sur­veyed an­gan­wadis of Talasari block to col­lect

“The data can be vi­su­alised on a map to find hotspots of mal­nu­tri­tion. Ad­di­tion­ally, this data can be over­lapped with the data from the gov­ern­ment and NGOS to find suit­able lo­cal in­ter­ven­tions for tack­ling un­der-nu­tri­tion. The child-wise data col­lected will act like a map to show where the fo­cus is needed.” Digvi­jay Ben­drikar Shinde UNICEF re­search fel­low and district co­or­di­na­tor, so­cial trans­for­ma­tion cell, zilla parishad, Pal­ghar

child-wise (0-6 years) an­thro­po­met­ric data. us­ing Kobo Tool­box soft­ware, the sur­vey took stock of the ba­sic in­fra­struc­ture of an­gan­wadis and their ge­olo­ca­tions to an­a­lyse the sever­ity and preva­lence of un­der-nu­tri­tion. in this way spe­cific in­ter­ven­tions for the Talasari block were de­vised. This was also the first time that app-based data was col­lected.

The project cov­ered al­most half of Talasari, i.e., 124 an­gan­wadis hav­ing more than 4,500 chil­dren, in­clud­ing all front­line and su­per­vi­sory level health work­ers.

in­volv­ing col­lege stu­dents proved to be a ben­e­fi­cial step as they were more ed­u­cated than the front­line work­ers who col­lect and feed data into the sys­tem un­der the ex­ist­ing sys­tem.

“The cur­rent ed­u­ca­tion sys­tem is not mak­ing stu­dents aware of the so­cioe­co­nomic and de­vel­op­men­tal chal­lenges faced by al­most 80 per­cent of our pop­u­la­tion. By in­volv­ing a univer­sity a com­mit­ment was brought into the in­ter­ven­tions. stu­dents can be trained to col­lect sim­i­lar type of largescale, ev­i­dence-based data as part of their col­lege pro­jects. such ex­er­cises cre­ate aware­ness among stu­dents about so­cial prob­lems,” says shinde.

now, there is no man­date to col­lect child-wise an­thro­po­met­ric data at taluka or district level. only data re­gard­ing the num­ber of mal­nour­ished chil­dren is con­sol­i­dated. in some cases, even if child an­thro­po­met­ric data is col­lected, it does not go be­yond an­gan­wadis.

“an an­gan­wadi se­vika, who is al­ready over­bur­dened with work, finds it dif­fi­cult to gather all chil­dren and weigh them. as a re­sult, in the ab­sence of ac­cu­rate data the real face of mal­nu­tri­tion re­mains hid­den and the pro­por­tion of un­der­nour­ished chil­dren to that of nor­mal chil­dren in an an­gan­wadi is never re­ally looked into,” says shinde.

Agrees an of­fi­cial as­so­ci­ated with the project: “We fail in real-time re­port­ing of last-mile in­fra­struc­ture upgra­da­tion as data re­quired for it is not col­lected. gaps in data col­lec­tion of­ten re­sults in fudg­ing of the out­come. More­over, im­proper fil­ter­ing of data does not al­low a tar­geted ap­proach to ad­dress a par­tic­u­lar prob­lem. in cases where the owner of data is also the pol­i­cy­maker, the data mostly gets fudged.

“in tack­ling mal­nu­tri­tion, no­body was ad­dress­ing where the shoe pinches,” adds the of­fi­cial.

“our ex­pe­ri­ence in Talasari was very good. Within no time we could as­sist 124 an­gan­wadis and reach out to more than 4,500 chil­dren. This ex­er­cise has opened our eyes and the gov­ern­ment too is happy. Data col­lec­tion, man­age­ment, anal­y­sis and us­ing data for ev­i­dence-based pro­gram­ming are big is­sues to­day. The gov­ern­ment can use such in­no­va­tive pro­jects for wa­ter, health and so­cial sec­tors where third par­ties can col­lect data for them and train new tal­ent. When pol­i­cy­mak­ers and stu­dents work as part­ners, us­ing ground re­sources for data gath­er­ing, anal­y­sis and ev­i­dence­based plan­ning, it will cre­ate an el­e­ment of fear among those who fudge data,” says shinde.

a pro­fes­sional sur­vey would cost a cou­ple of lakhs, whereas the pi­lot project was done at a nom­i­nal cost and its re­sults were quite ac­cu­rate. “it should be done this way and scaled up fur­ther,” says ag­ni­hotri.

The data col­lected by the pi­lot project has been shared with the district ad­min­is­tra­tion, which will fur­ther take a call to carry out this ex­er­cise in the en­tire district.

arun Jad­hav, child de­vel­op­ment project of­fi­cer (CDPO), Talasari, says, “apart from giv­ing knowl­edge on so­cial is­sues such ex­er­cises also gen­er­ate aware­ness on var­i­ous gov­ern­ment schemes. Be­sides our on­go­ing work in an­gan­wadis this has in­creased our con­scious­ness on re­quire­ments of an­gan­wadis and we are now think­ing of ex­pand­ing this ex­er­cise to the en­tire Pal­ghar [district].”

In­volv­ing col­lege stu­dents in data col­lec­tion process proved to be a ben­e­fi­cial step as th­ese stu­dents were more ed­u­cated than front­line work­ers who col­lect and feed data into the sys­tem un­der the ex­ist­ing scheme of things.

Pho­tos: Digvi­jay B shinde

A ‘Va­jan Ty­ohar’ work­shop be­ing held for Talasari block

Col­lege stu­dents col­lect­ing data on mal­nu­tri­tion

Col­lege stu­dents with chil­dren from Talasari block

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