Barwani Pilot Program for Malnutrition Eradication Initiative
January 24, 2011
Introducing a new pilot initiative within RMF’s Eradicate Malnutrition Program: Strengthening Community Management of Childhood Malnutrition through community mobilization, and nutrition and health education of mothers and pregnant women in Barwani, Madhya Pradesh
Madhya Pradesh has the highest rate of childhood malnutrition in India, with upwards of 60% of all children under 5 years old underweight. In many tribal communities in the state, this rate may be even higher, with alarmingly high rates of severe and moderate acute malnutrition. These communities often have limited access to government resources meant to prevent and treat malnutrition and have low levels of awareness about proper young child care.
To respond to these alarming levels of malnutrition in Madhya Pradesh, the Real Medicine Foundation (RMF) launched a childhood malnutrition program across 5 of the worst hit districts in Southwest Madhya Pradesh – Jhabua, Alirajpur, Khandwa, Khargone, and Barwani – employing 55 local women to act as Community Nutrition Educators to help empower communities to combat malnutrition and to identify children with severe acute malnutrition. Given the success of these women in addressing malnutrition at the community level over the last year, RMF is teaming up with the Department of Women and Child Development and the Madhya Pradesh Technical Assistance Support Team MPTAST) to roll out a pilot program in Barwani district to address childhood malnutrition through community mobilization. This program is supported with financial help from DFID and from technical assistance from Action Against Hunger.
To build the capacity of anganwadi workers and supervisors to drive community mobilization and provide high quality health and nutrition education services in order to develop community capacity to recognize malnutrition, respond to malnutrition using local resources and make referrals when necessary, and to prevent malnutrition in the long-run.
This pilot program will provide full coverage to two blocks in Barwani District – Pati and Barwani blocks –with a total of 204 villages and 370 anganwadi centers. The target population will be children under 5 years old and pregnant and lactating mothers.
Barwani is a remote and rocky district at the southern most corner of Madhya Pradesh, boarding Maharashtra and Gujarat, with a population of 10,81,039 (2001 census). It is the second most tribal district in Madhya Pradesh, with 67% ST population. The size of each village varies from roughly 800 and 3000 people, with larger towns scattered throughout the blocks. Barwani is considered one of the most remote districts of India. Many of its villages are located in hilly regions, cut off from roads and access to markets.
Social Mobilization Approach
The project’s social mobilization approach is founded on strengthening the capacity of the government’s ICDS programme to mobilize communities for child nutrition by delivering quality nutrition and health education classes to mothers. This will lead to increased community understanding of child nutrition issues, more women and families adopting better nutrition practices, and increased demand for government services that people are entitled to.
The project will achieve this by capacitating Anganwadi Workers, Supervisors and CDPOs to hold regular monthly community sensitization meetings to generate interest in and sustain momentum for community action. The sensitization meetings will increase awareness of malnutrition, its signs and the care that malnourished children need. Tools are being developed to help raise awareness of the scale of malnutrition in the village, how it can be identified, the location of pockets of malnutrition in the village, and stimulate debate on what individual families and the community can do to address this problem.
Through awareness raising events, influential persons and opinion leaders will provide support to the sensitization program through the Village Health, Sanitation, and Nutrition Committee which will serve as the local nutrition monitoring group. These newly formed Village Health, Sanitation, and Nutrition Committees will monitor the regularity, reach and quality of services provided at the Anganwadi Centre. They will provide feedback and suggestions to key members of the local community and will report any gaps in services to the panchayats for community action. Community leaders and influential persons and the local monitoring group will meet regularly to share monitoring information, help resolve local problems and enable the smooth functioning of Anganwadi Centres. Additionally, by focusing on strengthening anganwadi supervisors’ capacity for supportive supervision, the project will not only institute a system of stronger monitoring and evaluation into the program, but will begin a process of on-going trainings.
As a result of the on-going capacity building and trainings, this project will capacitate Anganwadi Workers to hold regular, participatory and practical health and nutrition education sessions for the mothers of malnourished and underweight children. It will also strengthen their interpersonal communication skills which will benefit other elements of their duties.
Anganwadi Workers with support from Supervisors and CNEs will hold nutrition and health education classes twice a month. CNEs will also assist supervisors and anganwadi workers on active case finding in children from hamlets and areas within villages who are not currently accessing anganwadi resources and will help connect these families with the system. Referrals for complicated cases of SAM and MAM will be made to the Barwani NRC.
Progress thus far
RMF began the groundwork for this project in November 2010 and officially started working on the project at the project’s approval in December 2010. The first step was to introduce the program to local leadership, and then work to recruit new positions for the program, begin developing manuals and IEC/BCC tools, hold the training for new CNEsm and to make the plan for the project moving forwards.