VIDEO CONFERENCE 31.01.14

PARTICULARS
INDIA
NFHS - 3
(Rural 2005-06)
Prevalence of low birth weight
Initiation of Breast feeding with in 1 hour
Pre-lacteals given
Exclusive Breastfeeding (0-5 months)
Initiation of compl. feeding At 6 months
% Full Immunization ( 12-24 months children)
Coverage of 9-59 months children for
Massive Dose Vitamin A Supplementation
(%)
Coverage of Pregnant women for IFA Tablet
Distribution (%)
Coverage of 12-59 months children for IFA
Tablet/Liquid Distribution (%)
23.4
46.3
55.8
43.5
-
-
-
Nutrition status (Based on WHO Child Growth Standards - 2006)
Underweight
Stunting
Wasting
45.9
38.4
19.1
M.P.
NFHS - 3
(Rural 2005-06)
23.4
13.3
58.7
21.6
-
31.5
-
-
-
60.0
50.0
35.0
NIN (2010)
19.1
26.4
16.1
71.0
23.5
84.2
81.7
78.0
25.0
51.9
48.9
2
25.8

Age Group wise Percentage of Underweight
Children (0-5 years)
M.P. v/s India (NFHS-III 2005-06)
70
60
50
40
30
20
10
0
61,8 61,2
64,9
•
Undernutrition in the first 5 years (esp. first 2 years) of life 60,7
47,6 53
44,8
• Lifelong adverse impact on growth and development
43
44,9 45,6
•
35,7
• 29,5
• Lifelong cognitive and physical deficits and chronic health problems
<6 6-11 12-23 24-35 36-47 48-59
Age (months)
India Madhya Pradesh
Data Source: NFHS-3 (2005-06)

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5
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"SuPoSHaN"
& leqnk; dks xzke esa vfrde otu ds cPpksa gsrq
& dqiks"k.k eqDr xzke ds fy;s leqnk; dks l{ke cukuk

27,3
19,8
Only 15% needs facility care
32,7
32,1
22,4
17,5
26,3
22,2
12,6
8,3
23,7
26,7
Severe UW Moderate UW
Underweight
(Weight-for-Age)
Severe Wasting Moderate
Wasting
Wasting
(Weight-for-Height)
Severe Stunting Moderate
Stunting
Stunting
(Height-for-Age)
NFHS III (2005-06) NIN Survey (2009-10)
WHO Growth Standards (2006): MODERATE = Median <-2 SD to ≥ -3 SD &
SEVERE = Median <-3 SD
8

 ‘Abhiyan' for reduction and prevention of undernutrition
 Conceptualized as a community based programme
 Targeted convergent approach
 Targeted to
14698
(70% undernutrition) AWCs - 4 or more SUWs
 Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM
 “Sneha Shivir” , Mangal Diwas, IEC, ABM

Adapted from globally acknowledged Positive Deviance
Approach

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SUW>=4
234
219
1151
430
277
102
628
53
236
161
471
265
369
915
329
195
100
144
44
400
92
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64
59
75
65
82
37
61
108
45
32
76
84
38
64
66
31
20
89
64
87
55
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29
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48 Nrjiqj
49 lkxj dqy vkaxuokM+h dsUnzz
SUW>=4
150
101
115
285
77
133
342
290
77
46
67
54
75
202
89
195
441
1425
399
136
143
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57
58
44
62
41
97
72
72
65
44
111
46
141
30
31
48
112
54
41
50
76
88

 ‘Abhiyan' for reduction and prevention of undernutrition
 Conceptualized as a community based programme
 Targeted convergent approach
 Targeted to
14698
(70% undernutrition) AWCs - 4 or more SUWs
 Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM
 “Sneha Shivir” , Mangal Diwas, IEC, ABM

Adapted from globally acknowledged Positive Deviance
Approach

• Every community has certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges.
• Based on problem-solving and community-driven approach that enables the community to discover these successful behaviors and strategies and develop a plan of action to promote their adoption by all concerned.

Participatory Micro
Planning at Village level
1. Community
Mobilization
• Facilities improvement
• Weighing drive
2. Village Mapping
3. Screening of children
• Presence of health worker at 1 st screening
• Provision of 1 st round of medication during special VHNDs (17 th
– 24 th )
4. Steered by AWW,
Gram Swasthya Samiti and Poshan Mitra Team

Participatory Micro
Planning at Village level
Curative
1. Community Mobilization
• Facilities improvement
• Weighing drive
2. Village Mapping
3. Screening of children
• Presence of health worker at 1 st screening
• Provision of 1 st round of medication during special VHNDs (17 th
– 24 th )
4. Steered by AWW,
Gram Swasthya Samiti and Poshan Mitra Team
Entry point to the village for accelerated reduction in moderate and severe under nutrition in children
Steered by Supervisor and Poshan Sahyogini

• 1 st & 30 th day Doctor completes screening, tracks status
• 12 days camp for 10-15 children
•
Supervisors and Poshan Sahyogini conduct the camp
– 3 Supervised feeding of children
– Focused counseling session of mothers with PD exemplars
– Demonstrating local nutritious recipes - Mothers Learn by doing
– Day to day child profiling
• Poshan Mitra, ASHA, AWW follow up by 18 home visits
• Monthly follow up and weighing of children for 6 months
• If required re-organize camp

Participatory Micro
Planning at Village level
1. Community
Mobilization
• Facilities improvement
• Weighing drive
2. Village Mapping
3. Screening of children
• Presence of health worker at 1 st screening
• Provision of 1 st round of medication during special VHNDs (17 th
– 24 th )
4. Steered by AWW,
Gram Swasthya Samiti and Poshan Mitra Team
Curative Preventive
Entry point to the village for accelerated reduction in moderate and severe under nutrition in children
Empowering community to catalyze behavior change for taking out the village from the undernutrition trap
Steered by Supervisor and Poshan Sahyogini
Steered by AWW, Gram
Swasthya Samiti and
Poshan Mitra Team

• Life cycle approach for improving nutrition
– Continuum of care beginning with adolescent girls to first
1000 days and till 5 years of age

• Pregnancy (9 months 30 x 9 = 270)
• Birth – 24 months ( 24 x30 = 720 days)
• Total = 1000 days
• To increase children’s chances of survival, improve development and prevent stunting, nutrition interventions need to be delivered during the mother’s pregnancy and the first two years of the child’s life.

• Life cycle approach for improving nutrition
– Continuum of care beginning with adolescent girls to first
1000 days and till 5 years of age
• Strengthen and streamline delivery of ICDS
– Universal survey and enrolment of beneficiaries at AWC
– Vajan Mela every every month 1 st to 4 th
– Screening of children by health care providers and referrals
– Swachhata Abhiyan every month 5 th to 7 th
– Targeted activities Monday to Friday

Targeted activities Monday to Saturday
Days
Monday
Targeted Activities
Regular dialogue with community - Special VHNDs + Poshan
Meetings with gram swasthya samitis and poshan mitra
Tuesdays
Lakshit Mangal Diwas - 20 themes along with sanitation campaign
Wednesday Intensive home visits targeted to Pregnant women
Thursdays
Intensive home visits targeted to lactating mothers of children 0 to 6 months
Fridays
Saturday
Advocacy and dialogue with community for behavioral change - 25 IECs
Intensive home visits targeted to lactating mothers of children 6 months to 2 years

Village level
• AWW
• AWH
• ASHA
• Gram Sabha
Swasth Gram
Tadarth Samiti
• Poshan Mitra
Team
• PRI
Sector Level
• Supervisor
• ANM
• NGO nominated by
District officials
Block Level
• BMO
• CEO JP
• Project Officer
• Mobile health team
District Level
• CEO ZP
• EE PHE
• CMHO
• DD Agri/Horti
• Food Officer
• DPO
• AWTC
• DTO (Health)
• Home science faculty

Sr. no.
1
2
Out come indicators
Weight gain of children after 12 days
Weight gain of children after 30 days
3
4
Weight gain of children after 2 months
Weight gain of children after 3 months
5
Nutritional status of children after 6 months
Target
75% children will show minimum 200 gm weight gain
75% children will show minimum 400 gm weight gain
Growth curve of 75% of children will on positive trajectory
50% children will show positive change in nutritional status
80% children will show positive change in nutritional status
22

• Success in a village will be assessed
– by complete elimination of SUW
– decrease in MUW
• Exit strategy after 1 year of implementation of Sneha Shivir in any village
– Weighing all eligible children (0-5 yrs)
– Third party would conduct the “audit”
– If no cases of severe under nutrition and borderline moderate cases for a period of one year it may be decided to phase out
Sneha Shivir
– Remaining MUW children would be rigorously monitored and care givers counselled on best practices at regular health education sessions and during home visits

• Active involvement of Health, Panchayats, PHE,
Agriculture, Food
• Community participation through poshan mitra team, gram sabha swasth gram tadarth samiti
• Sensitive Poshan Sahyogini
•
Quality training
• Good Micro-planning and implementation
• Intensive monitoring
•
Adequate and timely resources

• March - 3035 camps in 1st phase in 2 cycles
– Cycle 1 : March 1 to March 12
– Cycle 2 : March 24 to April 4
• January and February
– Selection of villages, Poshan Sahyogini and Poshan Mitra
– Trainings at all level
– Microplanning
– Preliminary screening of children and medication
• April - Preparation for 2500 camps in May (1-12th)
•
May - Phase 2 camps and Preparation for 2500 camps in
June (1-12th)

•
Build and mobilize for enabling environment and community participation
• Strengthening convergence with
– Health for screening and monitoring
– Panchayat for infrastructure, facilities and participation - employment
– PHED for Safe drinking water and sanitation campaign
– MDM for improved Hot supplementary nutrition given at AWC
– Agriculture for minikits / Food for PDS
• Monitor ICDS to ensure :
– Universal survey, identification and weighing
– Quality of training and inputs of Abhiyan
– Delivery of services including THR
• Provide administrative, technical and financial sanctions for the optimum usage of resources