Q1/2011: Malnutrition Eradication Program Update

May 10, 2011

Caitlin McQuilling

Project Goal

To reduce the prevalence of underweight children under 5 years old and to reduce child mortality from malnutrition by strengthening communities and village level government facilities’ capacity to identify, treat, and prevent malnutrition. This project aims to prove that a holistic, decentralized, community-based approach to malnutrition eradication will have better health outcomes, be more inclusive for children under 5 and will be more cost-effective in the long-run than centralized approaches, especially for rural, marginalized tribal communities.

Photo: RMF Staff conducting spot checks in the field

This project will empower communities through health literacy and connect rural communities with the government health and nutrition services available.

In Year Two, RMF will not just act as a catalyst mobilizing communities to the resources available, but will also work on a more intimate level with government health and nutrition workers and Village Health and Sanitation Committees to help build their capacity towards social mobilization, referrals, and provision of effective nutrition counseling. Throughout the year RMF will gradually transfer the responsibilities of our CNEs to government supervisors and anganwadi workers, helping integrate RMF’s work into the government framework to ensure long-term sustainability.

Progress this reporting period

During this reporting period RMF focused on tightening up the program fundamentals in preparation for the launch of a high profile government pilot for RUTF and integrating technology into our reporting through and Microsoft Research India. While the CNEs spent their time in the field, RMF focused on building the capacity of managers, refining the training and field manuals, and streamlining monitoring and evaluation of program data. The CNEs in Barwani district worked directly with anganwadi supervisors and anganwadi workers in a pilot to integrate RMF’s work together with the Department of Women and Child Development (DWCD). The reports which RMF has sent to the government on the progress of this pilot program are attached as ANNEX I. The extra work in this program, including the salaries of 10 new CNEs and a program manager was provided by a supplemental grant from the Department of Foreign International Development (DFID) through their technical support team the Madhya Pradesh Technical Assistance Support Team (MPTAST).

Photo: RMF Staff refresher training in Barwani

• Identified 355 children suffering from SAM and gave counseling to the caregivers of each of these 355 children
• Saw an improvement from SAM to MAM in 843 children
• Identified 838 children with MAM and provided one on one counseling to the caregivers of these 838 children
• Saw an improvement from MAM to normal in 2414 children
• Successfully ensured the 14 day treatment of 161 of the most serious cases at local Nutrition Rehabilitation Centers
• Conducted 2227 village nutrition training sessions, with over 17587 people in attendance
• Conducted 12422 family counseling sessions in the month of June
• Consolidated best practices from 2010, review lessons learned, and assess gaps in order to strengthen the program
• Conducted management training for DCs and a serious of social mobilization trainings of trainers for RMF CNEs and anganwadi workers in Barwani district
• Translated and refined field training manual
• Developed flipbook
• Reviewed all program data, checking not only consolidated reports, but going back to the CNE’s daily diaries and MUAC registers to verify that all the data is accurate and reporting consistent. Based on feedback from the team during this process RMF refined the reporting formats to streamline the system
• Met with officials from the Department of Health and the Department of Women and Child Development to get the approvals and develop the plans for the RUTF pilot. Submitted formal proposal to DWCD for the pilot.
• Presented program to Krishna Tirath, the Union Minister for the Department of Women and Child Development
• Barwani WCD Pilot: please see attached reports to WCD

So far this program has directly impacted:

• 161 children who have received life saving treatment
• 3257 of these children who have improved directly through our intervention this quarter
• Almost 30,000 individuals from rural villages who have received training on malnutrition awareness and prevention in their villages
• The families of the 55 women RMF employs as part of this initiative, many of whom are from the intervention villages themselves and use their salary from RMF to support their children’s education and to improving the lives of their families

Challenges faced during this reporting period:

One of the main objectives for this quarter was an increased focus on integrating the RMF program into the government’s Integrated Child Development Scheme (ICDS) on a pilot basis. RMF signed an agreement with the DWCD to build the capacity of the government’s anganwadi workers on a pilot basis in Barwani District before scaling up the integration into all RMF districts. Throughout the last year of the program RMF has enjoyed a good working relationship with anganwadi workers and supervisors, but on an unofficial basis. This reporting period was the first time that RMF has been interacting with, training and capacity building anganwadi workers on an official basis and with that came new challenges. Diving deeper into the functioning of anganwadi centers and the training of anganwadi workers, RMF also noticed new problems with anganwadi centers which proved to be a challenge to the program.

Photo: RMF staff in the field for spot checking villages

Some of the challenges noted throughout this period are:
• The AWCs have become food distribution centers and little else in many of villages. Families come to collect packets and then leave the AWC. The supervisors said the system worked better before when they cooked for the mothers and with the mothers
• Many of the village community kitchens have been given to individuals and SHGs with political contacts – if the supervisors or villages complain about them not working they’ll receive political pressure and intimidation
• The Community Kitchens are overburdened and cannot provide high quality food for all the beneficiaries
o For example, in one cluster of villages there are 8 schools and 3 anganwadi centers totally about 800 children who come for midday meals. How can one SHG have the capacity to make 800 rotis?
• There have been a multitude of WCD circulars and government orders to anganwadi workers. They are confused as to what they’re supposed to be doing
• The Atal Baal Mission has called for a more efforts to wipe out malnutrition, but the Collector asked how this can be possible to implement when 6 out of the 8 blocks in Barwani have no CDPO posted, including Pati. The Collector has been asking WCD to appoint people for these positions for months.
• Grading system v. new WHO growth standards – it emerged during the supervisors training that either out of habit or lack of training many of the supervisors and anganwadi workers still refer to malnutrition by the old grading system (I – IV) instead of the new growth standards. Dr. Athar reviewed the new definitions and WHO growth charts and explained that we now use standard deviations and not grades, but this may take more training
• Supervisors were also unclear on immunization schedules, so a revision of immunization training is also necessary – RMF’s manual just provided a basic overview and the schedule but does not go into depth on the different immunizations and vaccinations

Plans for the next reporting period:
• Conduct mapping of all RMF Villages in Barwani and Jhabua districts using Google Android Phones and Open Data Kit
• Refer 1000 SAM children to government centers for treatment with a 50% success rate
• Conduct 2500 Community Nutrition Meetings
• Hold at least 2500 meetings with anganwadi, giving them on the job support
• Conduct 9000 individual Family counseling sessions
• Ensure timely and accurate reporting from all staff – rolling out new, more streamlined reporting formats based on feedback from last 1 year
• Send CNEs to NRCs to help counsel families present
• Continue to develop linkages with government health and nutrition services
• Launch of pilot with the Department of Women and Child Development on Community Based Treatment of Severe Acute Malnutrition

Country Page: India Initiative Page: Childhood Malnutrition Eradication Program