Purnia, Bihar: When she grows up, 14-year-old Amita Kumari wants to become a police officer just like her mother. The class eight student of a government middle school in Kasba, a town in eastern Bihar’s Purnia district, knows that she needs to be “strong” in order to become a police officer. At 5 feet 3 inches, Amita, whose height is ideal for her age as per the World Health Organisation standards, is an exception in her class. A majority of her classmates are shorter than her. “I used to dislike vegetables earlier,” Amita said, “but now I eat a lot of them because I want to grow strong.”
Amita changed her diet after her school teacher started taking a class on the importance of dietary fruits and vegetables, and when she started helping to maintain a vegetable garden in the school backyard. “They taught us how to grow our own vegetables and why we should eat them everyday.”
The ‘they’ that Amita referred to was a team from the United Nations Children’s Fund (UNICEF) India who helped build the ‘nutrition garden’ in Amita’s school in 2016. The garden was part of a pilot project called Ankuran, started in 2016 to improve students’ diet diversity--a balanced diet that includes a combination of food groups such as cereals and millets, pulses, green leafy vegetables, fruits, fats, etc in the right proportion. The programme sought to engage students in organic cultivation of vegetables in the school backyards since vegetables and fruits provide essential protective substances such as vitamins, minerals and phytonutrients.
Ankuran is a Sanskrit word, which means to sprout. The Ankuran programme is a part of Bihar’s 2016 Swabhimaan programme, which aimed to improve the nutritional status of girls, pregnant women and mothers of children under two years. During the Ankuran pilot, UNICEF India gave 100 schools in Purnia district a one-time grant of Rs 10,000 each to set up nutrition gardens. UNICEF India also took care of training, monitoring and logistics to support the programme.
Amita Kumari, 14, (right) and Raksha Kumari, 14, study in class eight at the government middle school in Kasba, Bihar, November 21, 2019. Amita Kumari started eating more fruits and vegetables after her teacher told them about the importance of diet diversity.
Micronutrient deficiency in Bihar
Ankuran was scaled in 2017 to cover 20,000 schools across Bihar where micronutrient deficiency and malnutrition lead to a significant number of child mortalities. Bihar had the highest percentage of stunted (sub-optimal height-for-age) children among all the states, according to the October 2019 Comprehensive National Nutrition Survey (CNNS). Forty-two percent of children under the age of five in Bihar were stunted, a significantly higher proportion compared to the all-India average of 34.7%. The state also had a higher proportion of underweight children--38.7% compared to the national average of 33.4%.
The CNNS also found that a higher percentage of children in Bihar had vitamin A, vitamin D and zinc deficiencies than the national average. Iron, folate and vitamin B12 deficiencies were less common in the state compared to all-India levels. Close to a third of children between five and nine years and adolescents between the ages of 10 and 19 in Bihar were anaemic. Among smaller children, these rates were much higher, with 43.9% of one to four-year-olds being anaemic, against 40.6% nationwide.
Malnutrition was the predominant risk factor for death in children under five years of age in India in 2017, accounting for 68.2% of the total deaths in that age group, IndiaSpend reported on September 19, 2019.
Malnutrition also affected the country’s workforce, and in turn, the economy. Because of childhood stunting, 66% of the country’s workforce earned 13% lower remuneration, IndiaSpend reported last year. Vitamin and mineral deficiencies cost India over Rs 73,000 crore annually ($12 billion) in GDP, according to a 2014 World Bank report.
Radishes grow at a nutrition garden in a government school in Belouri in eastern Bihar’s Purnia district, November 20, 2019. The Bihar government, along with UNICEF, have undertaken a project to improve student’s diet diversity by setting up vegetable gardens in government schools.
The Ankuran programme, run by Bihar’s health, education and agriculture ministries, aims to nudge children to eat more nutritious food. It involves creating nutrition and hygiene awareness among students as well as setting up children-run nutrition gardens, or poshan vatikas, in schools.
For the pilot, the ideal size of the garden was determined to be 225 square feet. Schools were selected for these gardens based on the availability of land. The land was divided into multiple plots where a variety of vegetable seeds were planted and grown organically.
The district Krishi Vigyan Kendra (KVK) and panchayat-level agriculture coordinators helped schools identify crops that could be planted based on the soil condition and season, as well as in preparing the garden beds. Programme guidelines were distributed to all the 100 schools. The guide had illustrations about the correct way to water and manage specific crops. Teachers relied on textbooks that had stories and activities to engage students.
In addition, schools were provided guidelines for the nodal teacher, who had been trained to run the activities under the programme, guidelines for the poshan vatika worker or mid-day meal cook and a ‘food compendium’ that listed every food source available in the region and its nutritional quality.
Student bodies such as the bal sansad (children’s parliament, wherein selected students work as ministers) and meena manch (an all-girls’ group that talks about feminine hygiene and menstrual issues) played a vital role in the management of the nutrition gardens and in leading the activities.
Each plot at the nutrition garden was assigned to a group of 2-3 students. The ‘agriculture minister’ of the bal sansad ensured that all students took care of their respective plots. Student leaders discussed issues with groups and rallied other students to participate in the activities. Despite the program targeting students between the ages of eight and 14, most activities were conducted by students of classes 8 and 9 (13- and 14-year-olds).
Source: Ankuran Operational Guidelines
“Our aim was not only to provide information on nutrition to students but also to engage them and get them to be excited about nutrition,” Arunendu Jha, UNICEF India’s consultant for Ankuran in Purnia, told IndiaSpend.
The engagement was manifest in schools. “Yellow, White and Green!” students at the government school in Belouri chanted alongwith their teacher, Nikita Kumari, as she conducted a routine nutrition session using the teaching guide provided by the education department. “Every meal needs to have food items of these three colours.” The morning assembly also incorporated key awareness activities. Students were encouraged to discuss issues about nutrition and hygiene in a 30-minute session.
Nikita Kumari, a teacher at the government school in Belouri, in eastern Bihar’s Purnia district, conducting a session on nutrition, November 20, 2019.
Integration with other schemes
The scheme was also integrated with other nutrition-based government programmes, including the mid-day meal scheme. Vegetables grown in the nutrition gardens were used to fortify the free mid-day meals that the schools provide. The yield from the gardens though was far from adequate for the mid-day meals.
“We require about 25 kg vegetables for each meal,” Sona Devi, head cook at the Jalalgarh government school, told IndiaSpend. “We get less than 2 kgs from the garden on a good harvest day.”
Students at the government middle school in Simal Gachhi in Bihar’s Purnia district eat the free mid-day meal that the school provides, November 20, 2019. Vegetables from the school garden are added to the mid-day meal but do not suffice.
Incorporating vegetables in the mid-day meal became problematic when the meal was outsourced in some schools in Purnia district. These schools started receiving the daily meals from an NGO kitchen in Purnia in October 2019.
Among such schools, a few came up with temporary solutions to the problem. For instance, in the Belouri school, the produce was to be distributed among the students, school teacher Prerna Kiran said. And in the school at Thadha, the principal had decided to cook the vegetables and add them to the outsourced meals for as long as the school had cooking gas supply, school principal Archana (who only uses her first name) told IndiaSpend.
“The focus of the programme is not to increase the nutrition level of the mid-day meals per se,” Rabi Parhi of UNICEF Bihar said. “The fortification is a by-product.”
The Ankuran programme is also integrated with the Weekly Iron Folic Acid Supplementation (WIFS) programme wherein iron folic acid tablets are distributed on a weekly basis. The rationale is that increased nutritional awareness would prompt students to take these tablets. Quarterly health check-ups are also conducted under the Rashtriya Bal Swasthya Karyakram (National Children’s Health Programme or RBSK).
Eight-year-old Alina demonstrated the correct way to wash hands at the morning assembly at the Simal Gachhi government school, November 20, 2019. The Ankuran programme is integrated with several government health and nutrition programmes.
Diet diversity among adolescent girls improved in the two years that the programme had been functional in Purnia district, according to the findings of a 2018 midline survey conducted by UNICEF India in 104 villages in Kasba and Jalalgarh blocks, covering 484 households. The improvement cannot be statistically linked to the Ankuran programme as the overarching Swabhimaan programme impacted the complete district and impacted all children, not just those in government schools with vegetable gardens.
Adolescent girls between the ages of 10 and 19 had started consuming more food groups between 2016 and 2018, according to the survey, which examined the impact of the larger Swabhimaan programme.
In the programme intervention area, the mean diet diversity score--number of food groups consumed 24 hours before the survey--increased from 3.9 in 2016 to 4.87 in 2018. The scores were computed on a 10-point scale based on 10 food groups as per the methodology by the 2016 Food and Agricultural Organisation.
Adolescent girls also consumed more dark green leafy vegetables and vitamin A-rich fruits and vegetables such as carrots, spinach and locally found leafy vegetables. For instance, 62.1% of girls ate foods high in vitamin A in 2018 compared to 36.3% of girls in 2016, according to the midline survey. In the group which was not directly impacted by the Ankuran intervention, the percentage of girls eating these fruits and vegetables increased from 50.3% in 2016 to 64.3% in 2018.
Changes in diet diversity cannot be seen immediately from the Ankuran interventions, UNICEF India consultant for Ankuran, Prakash Singh, told IndiaSpend. “It takes years of consistent effort and intervention to bring about change in students’ diets.” he said. “Students are now aware of the need to eat nutritional food. In time, they will start including more nutritious food in their diet.”
Staff, funding shortfall
Shortage of personnel and finances was limiting the execution of the Ankuran programme, as IndiaSpend found across schools in Purnia district. When the programme was piloted, each school had a caretaker because of UNICEF India funds. After the project was scaled to include 20,000 schools, the caretaker position was eliminated. This lead to poorly maintained nutrition gardens.
“There used to be a caretaker when the programme had started,” said Satyendra Kumar Suman, principal of the school at Simal Gachhi. “He used to take care of the garden. Now, the cooks have an added burden of looking after the plants.”
Other schools had not maintained the gardens due to the lack of funds. For instance, the unfenced garden at the government school in Belouri was destroyed, presumably by local pedestrians and stray animals during vacations in October. “When we requested funds to set up a fence, the principal said the school didn’t have any,” teacher Nikita Kumari said.
IndiaSpend contacted Vinod Kumar Singh, director of the mid-day meal scheme in Bihar, who is also in-charge of the Ankuran programme, to ask if schools receive separate funds to maintain the nutrition gardens. This report will be updated if and when we receive a response.
Despite the setbacks, the Ankuran programme had been instrumental in engaging and informing students about nutrition, Suman said. A pilot to introduce the programme to anganwadis across the state is in the pipeline, and will hopefully motivate others like Amita Kumari to eat more vegetables.
(Reporting for this story has been supported by ROSHNI-Centre of Women Collectives Led Social Action.)
(Shreya Raman is a data analyst with IndiaSpend.)
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