Mid Day Meal Scheme: Understanding Critical Issues with Reference to Ahmedabad City

Problems of illiteracy, malnutrition, anaemia, vitamin-A and iodine deficiency are very common among children in India. In 2001 Supreme Court of India ruled that state governments must provide mid-day meal (MDM) to children of government assisted primary schools. The 2007-2008 budget of the central government has allocated about Rs. 73 billion for the MDM scheme. Therefore, it becomes imperative that a comprehensive evaluation of the programme be undertaken to judge its efficacy. We studied the implementation of the scheme, made field visits to schools to document food preparation and delivery, and collected meal samples to test them in laboratory for nutritional contents and food safety. Study seems to indicate that the implementation of the scheme may be wanting on the grounds of nutrition and food safety. For example, protein and iodine content is not sufficiently provided by the meals. Raw food samples contained uric acid levels higher than stipulated by food laws. Traces of aflatoxins were also found. Food safety may be improved by employing food safety systems such as HACCP, contracting out meal preparation and distribution to reputed private parties, and offering packaged foods which also provide variety. Offering nutrition bars and fruits such as banana not only will ensure delivery of hygienic food but it will enhance the nutrition delivery of the MDM scheme.

A Public Private Partnership Model for Managing Urban Health: A Study of Ahmedabad City

Urbanization is an important demographic shift worldwide. India’s urban population of 300 million represents 30 % of its total population; with the slum population in urban cities registering a 5 % growth in the last few years. Responding to the healthcare needs of urban poor is therefore very essential. Government of India focus has been mainly on rural health till the late 90s. Recognizing the urgency to manage urban health for the vulnerable sections of our population, the 9th and 10th Five Year Plans of the Government of India have laid special emphasis on developing a well structured network of urban primary care institutions. Ahmedabad city (also known as Ahmedabad Municipal Corporation, AMC) is the sixth largest city in India with a population of 3.5 million spread over 192 square kilometers, across 43 wards. AMC has nearly 2500 slums and chawls housing approximately 1.5 million people. Out of 43 wards in AMC, 9 wards which house more than 20 % of AMC population, have no government health facility at all. With more than 3500 private health facilities in AMC, it is therefore worthwhile to explore Public Private Participation (PPP) to improve the delivery of healthcare services. In this working paper, we outline our approach to developing a PPP model for a decentralized and integrated primary healthcare center for each ward of AMC. Our model is built on a clear understanding of the socio-economic profile, status of public health, and the healthcare seeking habits of Ahmedabad population. Our GIS (Geographic Information System) methodology guides the AMC authorities to identify good locations for urban health center (UHC) so as to ensure availability, affordability, accessibility, and equity to primary healthcare facilities to the slum populations. We illustrate our methodology for Vasna and Naroda wards in AMC.