(“One Full Meal” For Pregnant  and Lactating Women At The Anganwadi Centre)
An implementationofICDShas resultedin improvementof the nutritional status ofwomen and children in the state, the desired goalshavenotbeenachieved.Thepercentageoflow birthweightbabies, underweightchildren (<3 years)and pregnantwomen who are anaemic isstill high. Asaresult,reductionofInfantMortality Rate(IMR)andMaternalMortality Rate (MMR)continues tobeachallenge.
Scientific evidence shows that malnutritionstartsearly in lifeand its effects become irreversible after 2-3 years. Meetingthe nutritionalneedsof Pregnant & Lactating womenis thereforeoneofthecriticalwindowsofopportunity availabletoprevent malnutrition. Hence a needwas felt tomodifythenutritionprogrammeofICDSespecially 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 ArogyaLaxmi 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

After state bifurcation 2015 onwards it was scaled up in 149 ICDS (100 %). ICDS Projects. Projects covering 31,897 Main AWCs and 4,076 Mini Anganwadi Centers in Telangana State.  The one full meal consists of Rice, Dal with leafy Vegetables/sambar, vegetables for a minimum of 25 days, boiled Egg and 200ml. milk for 30 days in a month.  The one full meal will meet 40-45% of the daily calorie and 40-45% of protein and calcium requirement per day of the pregnant and lactating mothers. Along with the meal, Iron Folic Acid (IFA) tablet is to be administered. For children between 7 months to 3 years are providing 16 Eggs per month where as children from 3-6 years were providing 30 Eggs per month.

 Objectives of “Arogya Laxmi programme”
Enhance the quality and acceptability of supplementary nutrition by the Pregnant and Lactating women

Ensure food supplied is consumed by only the Pregnant and Lactating womenratherthanthe wholefamily

Ensurethat Pregnant and Lactating women consume 90+ IFAtablets.

Improve the enrollment of mothers at AnganwadiCenters (AWCs).

Eliminate or decrease number of Pregnant and Lactating women with anaemia/ who are undernourished.

Reduce the incidence of low birth babies and malnutrition among children.

Ensurethat Pregnant and Lactating women receive health check ups and immunization.

Reduce the incidenceof infant mortality andmaternal mortality.
Operational guidelines for Arogya Laxmiprogramme

Government after careful examination hereby issue “Operational Guidelines” for One Full Meal Programme for improving nutritional status among Pregnant and Lactating Women and to reduce low birth weight and mortality of infants and children under 6 years.

One Full Meal Committee
Eleven members Committee called the “Anganwadi Level Monitoring & Support Committee” (ALMSC) shall be constituted for each AWC. This Committee consists the following members

• Surpanch or Ward member preferably women  -                 Chairperson
• ASHA                                                                                                     - Member
• Mothers (2 members on rotation pregnant &7m to 3y)                - Members
• Community (Science Teacher/Retired Govt. officers/
• Parents of pre-school children-3)                                                            - Members
• Sakhi under SABLA programme/Adolescent girl - Member
• 2 Representatives from Village Organization                                      - Members
• Anganwadi Worker       

 

Responsibilities of Committee:

• The committee shall meet once in a month on the first Nutrition Health Day (i.e., the first of every month) and create awareness on One Full Meal Programme.
• Ensure correct demand and supply of food grains such as Rice, Dal, Oil, Eggs, Milk and Vegetables etc. to the AWCs.
• Identify Milk vendors or chilling centers where central procurement is not available.
• Mobilize all eligible beneficiaries to the AWC.
• Ensure no beneficiary carries the meal home or allows it to be consumed by any other family member.
• Fix the menu and timing of the spot feeding
• Ensure the attendance, quality, hygiene and other aspects of the programme
• Certify the attendance registers of Anganwadi Centers for accounts reconciliation.

Procurement of Food Commodities

Implementation and Monitoring

• AWW, ASHA shall identify the target group and ensure early registration of the Pregnant women and enrolment of Pregnant and 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 during Village Health and Nutrition Day.
• Panchayat / ALMSC 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.
• One Full Meal shall be served 25 days as spot feeding at AWC.
• 30 Eggs shall be served per month where 25 days during spot feeding at AWC and Eggs will be given as per the model menu to the beneficiary.
• Milk shall be served 25 days and another 5 days of milk will be served as curd along with rice and dal during spot feeding.
• Anganwadi Helper or in absence of the Anganwadi Helper a person identified by the ALMSC shall cook the “One Full Meal” and serve the food at the Anganwadi Centre.
• A permanent advance of Rs.1500/- shall be released to all AWWs at the beginning of the Programme and shall be maintained regularly by releases by the 5th of every month.
• The “Anganwadi Level Monitoring & Support Committee” (ALMSC) can decide the menu as per local conditions.
• IFA tablets shall be provided by ANM and will be administered along with the food by AWW.
• The growth monitoring of all pregnant and lactating women shall be done every month and birth weight of the new born will be recorded in the MCP Cards and registers.
• In the monthly meetings of Anganwadi Level Monitoring & Support Committee (ALMSC), Project Level Monitoring Committee (PLMC) and District Level Monitoring and Review Committee, the Anganwadi Workers, Supervisors / CDPOs and the PDs respectively will be invited for discussion on the implementation of the “One Full Meal” programme.
• Joint trainings and awareness campaigns shall be conducted for field functionaries, ALMSC members, others by the department.
• The community, PRIs, Civil Society, UNICEF, NIN and NGOs shall 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.
• 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 “One Full Meal” per month.
• Project Director shall inspect 10 villages from at least 5 projects per month.
• Regional Deputy Director shall inspect 10 villages from at least 5 projects 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.
• State level Monitoring Officer from HOD shall inspect at least 5 Projects and 15 AWCs in a month of their allotted Districts.
• In case of any food gaps, poor quality of food items, the CDPO and Supervisor of that particular project shall be held responsible and action shall be initiated accordingly.
• District Level Monitoring & Review Committee of ICDS shall be review the One Full Meal program at least once in a quarter by the District Collector chairmanship.
• One full meal program shall be an agenda in the GramaSabhas, General Body meetings of Mandal Parishad and ZillaParishad.

 

Food Model for spot feeding of Pregnant & Lactating Women in One Full Meal Programme ICDS Projects (per beneficiary)

Sl. No.	Item	Quantity per day	Tentative Cost per day (Rs.)	Nutritive Value
				Energy (kcal)	Protein (g)	Calcium (mg)
1	Rice	150 g	0.60	517.56	10.20	15.00
2	Dal (Red Gram)	30g	2.55	104.40	7.25	22.50
3	Oil	16g	1.10	144.00	0.00	0.00
4	Transport		0.10	0.00	0.00	0.00
5	Cooking		0.30	0.00	0.00	0.00
6	Milk (30 Days) (@ Rs.5.6 per day)	200 ml	9.85	273.00	10.03	490.00
7	Egg (30 Eggs) (@ Rs.3.5 per day)	1 No. (50 g)	4.20	100.92	7.76	35,00
8	Vegetables (Leafy Vegetables, Potato, Onion, Beans etc.,)	50 g	1.50	52.50	1.80	16.06
9	Condiments		0.60	0.00	0.00	0.00
TOTAL			21.00	1192.38	37.04	578.56

• Eggs to be given Monday to Saturday (remaining 5 will be added in model menu)
• Milk to be given Monday to Saturday (200ml milk will be served as curd in any two days).

 Menu of One Full Meal

Day	Item 1	Item 2	Item 3	Item 4	Item 5
Day1	Rice	Sambar with vegetables	-	Egg Curry	Milk (200ml)
Day 2	Rice	Dal	Green Leafy Vegetable Curry	Egg	Milk (200ml)
Day 3	Rice	Dal with Leafy vegetables	Egg Curry	Egg	Milk (200ml)
Day 4	Rice	Sambar with vegetables	100 Ml Curd	Egg Curry	Milk (200ml)
Day 5	Rice	Dal	Green Leafy Vegetable Curry	Egg	Milk (200ml)
Day 6	Rice	Dal with Leafy vegetables	100 Ml Curd	Egg	Milk (200ml)