Empowering Families and Communities: RMF v.s. Malnutrition, India

India is the epicenter for malnutrition worldwide, effecting 60 million children or 46% of children under five years old in the country.

Malnutrition isn’t just a problem of families not getting enough food to eat, but is defined by the inadequate intake of essential nutrients.  Children in India are malnourished because their bodies do not have the building blocks necessary to function on a cellular level.  Unable to produce cells at a normal rate, the immune system fails causing common or chronic diseases to become deadly.

Across India malnutrition is so prevalent that it in some ways it has become hidden in plain sight.  When the children look the same, and have looked the same for generations, it is hard to recognize the problem.

Years of drought and failed crops have left families consistently struggling to get by. Farmers in remote rural areas are feeling the worst of the effects, but with world food prices steadily rising without daily salaries following suit.

Malnutrition is one of the most serious and large scale health problems facing the Indian state today.   Malnutrition is constitutes 22% of the country’s disease burden because it severely weakens a child’s immune system, raising their mortality rates from common diseases such as pneumonia, malaria, and diarrhea. Children with severe acute malnutrition have extremely high mortality rates – between 20-30%  – a rate of death approximately 20 times higher than well-nourished children.

The millions of children who do survive childhood will be forever affected by malnutrition: children who have been malnourished in the first 5 years of life will have limited mental and physical growth capacity as compared to a well-nourished child. There is evidence that a malnourished child will someday have children with low birth weights, perpetuating the cycle of malnutrition

Need for malnutrition intervention in India’s largest tribal state, Madhya Pradesh:

The areas worst hit by malnutrition in India also coincide with the “adivasis” or indigenous populations in India living in the area of what known as the “Tribal Belt.”  This includes the states of Orissa, Chhattisgarh, and Madhya Pradesh (MP) where 75% of all of India’s tribal population resides.  Madhya Pradesh has the largest tribal population of any state, with 46 scheduled tribes and 3 tribes that are classified as “special primitive tribes.”  The tribal communities in MP are the most rural and marginalized communities in the country, having almost zero access to any health services and also the worst development indicators in the country.

Tribal children and their families require urgent prevention and treatment interventions catered to their community and their needs in order to break the cycle of poverty, disease, and death.

There is a safety net in place: Nutrition Rehabilitation Centers (NRC) throughout the state.  But with 160 NRCs in place and roughly 2500 beds, there is no way they can help the 1.3 million children with Severe Acute Malnutrition (SAM).

On the village level there are also angawadi community centers that serve village health needs providing nutrition and general health support services to children under 6, pregnant and lactating mothers, and adolescent girls.  These outpost centers are meant to stand as support systems, medically, emotionally, and psychologically, for those on the front line: local families.

Our approach in India is to reinforce existing systems, connecting the dots between government services offered, locally available solutions to malnutrition, and rural communities.   By focusing our attention on supporting anganwadi centers and other local groups, we can alleviate the strain on existing NRCs.   By training families and communities to recognize and treat malnutrition at home, we can reach more children in less time and have a real effect.

The Real Medicine Plan: RMF Approach to Malnutrition

RMF is tackling malnutrition at the community level, combining short-term emergency identification and treatment activities with long-term and sustainable community education and capacity building activities to prevent malnutrition, engaging each community on a micro level and tailoring programs to fit their needs and customs.  

•    Identify:  RMF creates the awareness and demand for malnutrition treatment and need for prevention services by using Measurement of Upper Arm Circumference (MUAC) to identify and screen for malnutrition.  MUAC is the easy-to-use WHO recommend method for screening malnutrition cases at the field level.  We give trainings in this method and distribute MUAC bands to local NGOs, self-help groups, and village leaders in order to increase malnutrition identification in rural communities

•    Treat:  We focus on detecting malnutrition early in the community, strengthening referrals to government NRCs and public health centers (PHC), and strengthening follow-ups for discharged patients on the community level.  We are setting the groundwork for introducing a full community-based therapeutic care model once appropriate products are available so that SAM patients can be treated as outpatients.  Local nutritional supplements will be used for MAM.  In parallel, RMF is also working towards a locally acceptable Ready to Use Therapeutic Food (RUTF)

•    Prevent:  RMF educates mothers, teachers, SHGs, and community leaders on various aspects of malnutrition prevention.   By strengthening anganwadi workers, anganwadi helpers, ASHA workers, and midwifes and involving the entire community we promote high health literacy surrounding nutrition in each village.

RMF activities include:

•    On the ground training for anganwadis and anganwadi helpers on malnutrition identification, treatment and prevention

•    Strengthen referrals from the communities to the Nutrition Rehabilitation Centers for complicated cases of SAM.

•    Increased AWC, NRC, PDS and block supervision with random spot checks to ensure that teams on the ground have what they need and are working well.

•    Make AWC’s child friendly so children will want to spend more time there: colorful paint, toys, books

•    Empower and support self help groups for pregnant, new, and nursing mothers

•    Nightly class sessions for rural villages discussing: proper child and infant feeding practices, locally available nutrition, sanitation/hygiene, breastfeeding initiation, disease management, supplementary feeding

•    Support the production of locally made supplements for moderate malnutrition on the village level

•    Create long-term community-based therapeutic care programs to continue on throughout the year so that information, treatment and care are more accessible to children residing in interior villages.

•    Stringent monitoring and evaluation of our programs so that our successes and challenges can be shared with government and NGO partners

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