|Year : 2019 | Volume
| Issue : 4 | Page : 210-215
Evaluation of infrastructure and financial resources in the Midday Meal Program: An in-depth study in upper primary schools of Kolkata
Aparajita Dasgupta1, Madhumita Dobe2, Jayeeta Burman1, Sembagamuthu Sembiah3
1 Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
2 Department of Health Promotion and Education, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
3 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
|Date of Submission||19-Jun-2019|
|Date of Decision||07-Jul-2019|
|Date of Acceptance||28-Aug-2019|
|Date of Web Publication||21-Nov-2019|
11B/5 Prabhuram Sarkar Lane, Kolkata - 700 015, West Bengal
Source of Support: None, Conflict of Interest: None
Introduction: The Midday Meal (MDM) Program in India is for primary and upper primary school students. To continue an effective program, infrastructure and financial resources should be both maintained and sustained.Objectives: The objectives of this study are to assess the adequacy of infrastructures and fund support available for the MDM Program of upper primary schools of Kolkata. Methodology: An institutional-based observational study with a cross-sectional design was conducted in government and government-aided schools of Kolkata over a period of 2 years from November 2016 to October 2018. A sample of 52 schools from a total of 515 schools was selected by simple random sampling. Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Sciences software version 16.0 (IBM, SPSS Inc., Chicago, USA). Descriptive statistics and inferential statistics were performed. Results: Infrastructure was satisfactory in 29 (55.8%) schools and unsatisfactory in 23 (44.2%) schools. There was a statistically significant difference of infrastructure between government schools and government-aided schools (P = 0.043). Financial resource was satisfactory in 88.9% of government schools and 85.7% of government-aided schools and this difference was not statistically significant. Conclusion: This evaluation study showed more than half and most of the schools were satisfactory in terms of infrastructure and financial status of the mid-day meal programme of Upper Primary Schools of Kolkata respectively, still intensified efforts like proper allocation of resources and supervision were needed to fulfill the lacunae.
Keywords: Financial resources, infrastructures, Midday Meal Program
|How to cite this article:|
Dasgupta A, Dobe M, Burman J, Sembiah S. Evaluation of infrastructure and financial resources in the Midday Meal Program: An in-depth study in upper primary schools of Kolkata. CHRISMED J Health Res 2019;6:210-5
|How to cite this URL:|
Dasgupta A, Dobe M, Burman J, Sembiah S. Evaluation of infrastructure and financial resources in the Midday Meal Program: An in-depth study in upper primary schools of Kolkata. CHRISMED J Health Res [serial online] 2019 [cited 2019 Dec 14];6:210-5. Available from: http://www.cjhr.org/text.asp?2019/6/4/210/271336
| Introduction|| |
Malnutrition has become an urgent global health issue. Good health, quality cognitive behavior depends on proper nutrition, which also affects the productive potential of a child. Hence, many initiatives have been taken to prevent malnutrition in children and adolescents. Initiation of early exclusive breast-feeding improves an infant's cognitive development. After the age of 6 months, appropriate, affordable, acceptable, and accessible complementary feeding is offered to the baby. Beyond this, supplementary feeding is done through the Integrated Child Development Services and later through Midday Meals (MDMs) at the school.
The MDM Program is the world's biggest supplementary school lunch program and is being implemented for all primary and upper primary school students of government and government-aided schools of India. In a resource-limited country like India, the implementation of MDM Program needs an explicit evaluation from time to time at all levels of its execution. For a healthy and successful program, its infrastructure and financial resources should be well maintained. No in-depth sincere efforts have been made till now to evaluate the status of infrastructure and financial resources of the MDM Program in this part of the country.
With this background, we did an in-depth assessment of adequacy of infrastructure and financial resources of the MDM Program of upper primary schools of Kolkata. We strongly felt that the idiosyncrasies, deficiencies, and the lacunae identified by the researchers will help the concerned authorities, health managers, and policy-makers to take fitting steps to make this program highly effective, completely flawless, and exceedingly successful.
| Methodology|| |
An institutional-based observational study with a cross-sectional design was conducted in upper primary schools (government and government-aided schools) in Kolkata over a period of 2 years from November 2016 to October 2018. Approval was obtained from the Ethics Committee of the Institute.
A list of upper primary schools of Kolkata was collected from the office of the Project Director, MDM office of West Bengal. The total number of upper primary schools present in Kolkata is 515. It was decided that 10% of total schools would be included in the study for feasibility and practical considerations of data collection. A sample of 52 schools was then selected by simple random sampling. Those schools that received supply of cooked MDM from the central kitchen were excluded. Data were collected by observation method with the help of a structured checklist and face-to-face interview of MDM in-charge of each school. Permission was obtained from the Director of MDM Program and Nodal Officer of Kolkata district and the various principals of the study schools. The purpose of the study was explained to the school MDM in-charge of each school, and written informed consent was obtained from them. Thus, data were collected using a predesigned, pretested, structured schedule and a checklist adapted from the Food Safety and MDM Guidelines.
Infrastructure was envisaged under the following topics which were assessed as follows from the checklist.
Water supply and water testing
It was assessed based on four criteria and scored from 0 to 4. A score of more than equal to (median) was considered satisfactory.
Condition of kitchen
It was assessed based on six criteria and scored from 0 to 9. A score of more than equal to 75th percentile of attained score was considered satisfactory.
Infrastructure assessment was based on ten criteria, and attainable score range was 0–13. A score of more than equal to attained median score was considered as satisfactory infrastructure.
Assessment was based on four criteria and attainable score range was 0–4. A score of more than equal to attained median score was considered as a satisfactory financial resource.
The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
| Results|| |
Background characteristics of schools
MDM is served in all upper primary schools from Class VI to Class VII. About 53.8% schools were government-aided schools and 46.2% were government schools. About 48.1% of schools were up to secondary level, and 50% schools were up to higher secondary level. The logo of MDM was painted on the entry gate in 69.2% of total study schools. About 75% of schools had menu board. Among 24 government schools, the total eligible students for MDM were 2767; among them, 78.93% attended the schools on the day of visit and MDM was consumed by 78.8% of the total students. Among 28 government-aided schools, the total eligible students were 5972; among them, 85.1% attended the schools on the day of visit, and MDM was availed by only 56.7% of the total students.
Water supply, testing of water, and cleanliness of water tank
Seventy-five percent of government schools and only 39.3% of government-aided schools had a continuous supply of potable water. All schools were using tap water for cooking and washing utensils except one government-aided school. They were using stored water for washing utensils. Almost all schools had adequate water for cooking and washing. All the schools which were included in the study neither they have cleaned the water storage tanks regularly nor they have tested water for chemical and microbiological contamination. Water supply was satisfactory in 95.8% of government schools and 75% of government-aided schools. Thus, satisfactory water supply was more in government schools than in government-aided schools and this difference was statistically significant [Table 1].
Status of kitchen hygiene
All the schools were provided with separate kitchens. There were no windows, doors, and other openings fitted with net or screen and not a single school had any display board mentioning do's and don'ts of quality cooking. Seventy-five percent of the schools were well ventilated with adequate light. Safety measures of fire were maintained in 95.8% of government schools and 75% of government-aided schools. Seventy-five percent of government school kitchens were pucca while the same was true for 53.6% of government-aided schools. Health checkup facility for cook-cum-helpers CCH was not available in any schools. Nearly 70.8% of government schools and 60.7% of government-aided schools were using covered bin for garbage disposal. Among them, 4.2% of government schools and 21.4% of government-aided schools were using plastic bags for garbage disposal. All the schools cleaned their waste bins daily. Kitchen condition was satisfactory in 83.3% of government schools, but it was satisfactory only in 32.1% of government-aided schools and this difference was statistically significant [Table 2].
As a whole, infrastructure (water and kitchen) was satisfactory in 29 (55.8%) schools and unsatisfactory in 23 (44.2%) schools and this difference was statistically significant. Therefore, infrastructure was much better in government schools than that of the government-aided schools and this difference was statistically significant (P<0.05) [Table 3]. Among them 70.8% of Govt. schools and 40.9% of Govt. aided schools had satisfactory infrastructure [Figure 1].
|Figure 1: Comparison of satisfactory infrastructure between government schools and government-aided schools|
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One hundred percent of government schools and 92.3% of government-aided schools received cost for MDM regularly. Nearly 87.5% of government schools and 71.4% of government-aided schools received cost for kitchen devices regularly. Nearly 95.8% CCH from government schools received monthly remuneration regularly. However, only 50% of CCH from government-aided schools received remuneration regularly. Fifty-two (100%) schools were using gas as a fuel and supply of fuel was regular in all 52 schools. Twenty-five percent government schools received cost for kitchen sheds and 39.3% of government-aided schools received cost for kitchen sheds. Financial support was more satisfactory (88.9%) in government schools than that of the government-aided schools (85.7%), but this difference was not statistically significant [Table 4] (Financial support was more satisfactory (88.9%) in Govt. schools than the Govt. aided schools (85.7 %.) [Figure 2].
|Figure 2: Comparison of financial resources for Midday Meal (government schools and government-aided schools)|
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| Discussion|| |
This study was conducted to find out the deficiencies and lacunae in the infrastructure and financial status of MDM program which provides supplementary nutrition to 120 million children everyday across India. Very few similar studies on MDM have been conducted in India. In this study, infrastructure which was assessed in terms of the status of water supply and status of kitchen hygiene were satisfactory in 29 (55.8%) schools and unsatisfactory in 23 (44.2%) schools.
In the present study, 75% of government schools and only 39.3% of government-aided schools had a continuous supply of water. All schools were using tap water for cooking and washing utensils except one government-aided school. The latter used stored water for washing utensils. Almost all schools had adequate water for cooking and washing. Water storage tanks were not regularly cleaned in any of the schools, and none of them ever tested water for chemical and microbiological contamination. According to food safety guidelines, the continuous supply of potable water should be ensured in the premises. In case of intermittent water supply, there should be an adequate and proper water storage system. Water both for drinking and cooking must be potable in nature. Water storage tanks should be cleaned periodically, and records of the same should be maintained. To ensure continuous supply of safe consumable water, it needs to be tested for chemical as well as microbiological contamination. In Himachal Pradesh study by Ravi, it was found that 100% students were drinking potable drinking water. It meant that there was an arrangement of clean water in all the schools. This was similar to our study. However, the findings of other studies (mentioned herewith) were dissimilar. In a study in schools of rural Vadodara by Nambiar et al., it was observed that village tank water was available in 90% schools and well and / hand pump were used by remaining 10% schools for cooking and drinking purpose. In a study on MDM in Nalgonda district by Vippala, it was found that there was no safe drinking water facility in majority of the schools (66.8%), whereas only 33.2% of schools had safe drinking water facility. In Nizamabad study by Vijaya, it was found that among 36 sample schools visited by the monitoring team, 27 schools had borewells for providing water for cooking purpose, 9 schools had public taps, and 5 schools had other provisions.
A very positive finding in this study was the presence of separate kitchen away from the classrooms in all the study schools. However, there were no windows, door, and other openings fitted with net or screen and no display board mentioning do's and don'ts for the CCH put up inside at a prominent place in the premise in the local language. Seventy-five percent of government schools and government-aided schools were well ventilated and well lighted. Safety measures for fire were maintained in 95.8% of government schools and 75% of government-aided schools. Kitchens were pucca only in 53.6% of government-aided schools and 75% of government schools. Only 70.8% of government schools and 60.7% of government-aided schools were using covered bin for garbage disposal. Among them, 4.2% of government schools and 21.4% of government-aided schools were using plastic bags instead of regular covered dustbins for garbage disposal. All the schools which used dustbins cleaned their bin daily. Garbage disposal was better in government schools than in government-aided schools. In a study which was conducted by Nutrition Foundation of India in Delhi by Sharma et al., it was observed that the cooking area was partially covered and had natural light/ventilation. According to Food Safety Guidelines, the kitchen-cum-store should be clean, adequately lighted, and ventilated and should have sufficient free space for movement. Proper waste disposal must be there. The dustbin should have a lid and should be always covered. Raised platform for cooking should be there with a proper arrangement for drainage. Windows, doors, and other openings should be fitted with net or screen, as appropriate to make the premise insect-free. A display board mentioning do's and don'ts for the CCHs regarding food safety and food hygiene should be put up at a prominent place in the premises, and it should be in the local language for everyone to understand. In a study in Meerut by Agarwal et al., it was found that a separate room for the kitchen has been allotted in each school, but the food is prepared in that kitchen in only 16 (41%) schools. Other schools prepared food in the open. Ventilation and lighting of the kitchen in 82% of the schools were poor, and in 18%, the floor was not cemented. The waste was collected in covered areas in most schools 52 (66%), whereas in the rest 27 (34%) schools, it was collected in open dustbins. In Nizamabad study by Vijaya, it was observed that in 6 (60.0%) upper primary schools, pucca kitchen-cum-shed was constructed and in use, and in 1 (10.0%) upper primary schools, it was constructed but not in use. In study in Lucknow, it was found that the kitchens were available in 93.10% primary schools and 62.5% upper primary schools, while the rest of the schools did not have any room allotted for cooking.
In the present study, 100% of government schools and 92.3% of government aided schools received cost for MDMP regularly. Nearly 87.5% of government schools and 71.4% of government-aided schools received cost for kitchen devices. About 95.8% CCH from government schools received monthly remuneration regularly. However, only 50% of CCH from government-aided schools received remuneration regularly. The workers were also disheartened because they missed there remuneration for at least 2 months a year when the schools remained closed for vacation. Fifty-two (100%) schools were using gas as fuel and supply of fuel and fuel cost was regular in all 52 schools. Twenty-five percent of government schools and 39.3% of government-aided schools received cost for kitchen sheds. On the whole, financial support was satisfactory in 88.9% of government schools and 85.7% of government-aided schools. In a study in Birbhum district by Molla and Sheikh, it was found that the amount of money given by the government for fuel was not sufficient for fuel. This scarcity in the amount of money for fuel could be adjusted in a rural area, but this scarcity could not be adjusted in an urban area because the cost of fuel was cheaper (wood, cow dung) in a rural area than in urban area. In Himachal Pradesh by Ravi study, it was clear that not even a single cook was satisfied with the salary being provided to them under the MDM scheme. According to MDM norm, ₹. 5000/- per school has been provided by the Government of India for procurement of kitchen devices. Fund of the same amount is allotted for replacement of such devices to the schools after every 5 years. In Nizamabad study by Vijaya, it was noticed by the monitoring institute that ₹. 1000/- was being paid as an honorarium for CCHs in the 10 (50.8%) sample schools and the payment was regular. Regarding cooking cost, it was observed that 34.6% of primary schools and 20.0% of upper primary schools were receiving cooking cost regularly in advance.
The present study was a cross-sectional study; hence, findings of a single observation were collected, recorded, and analyzed, and associations worked on could not be considered as causal associations. There might be bias due to inaccurate self-reported and recall-based responses.
| Conclusion and Recommendation|| |
Good-quality infrastructure and adequate, timely finances which lead to uninterrupted MDM program should be sustained. Training program must be arranged for MDM in-charge. Some teachers and parents may be roped into contribute to the planning, implementation, and maintenance of high-quality MDM Program in all these schools. Time-to-time evaluation of this program may be performed, feedback report may be transferred to appropriate authorities, and any lacunae identified may be dealt with as early as possible through advocacy meetings with the Director of MDM and other stakeholders.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]