India

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.

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.

Project Objectives during this reporting period:

• Continue to identify new SAM and MAM cases, refer complicated cases to the NRC and provide home-based counseling for all malnourished children
• Review all program data and make necessary changes in program reporting system
• Conduct Management of Information (MIS) Systems training for all program staff
• Conclude Barwani Community Mobilization Pilot Program together with the Department of Women and Child Development and make plans for next phase of work with DWCD
• Propose RUTF Pilot to government of MP
• Launch of Dimagi/Microsoft Research India reporting technology pilot
• Begin mapping villages using Google Androids
• Seek permission from the Government of India for Community based Management of Acute Malnutrition (CMAM) pilot
• Partner with the Department of Women and Child Development, Madhya Pradesh and the Atal Bhal Mission to design, plan, and rollout new strategies for malnutrition awareness, prevention, and treatment.

During this period RMF’s Malnutrition Eradication Program continued stronger than ever. After a full review of learnings and data collection systems from 2011 and a management training of RMF Supervisors, RMF introduced new, more streamlined and intuitive reporting formats in order to ease reporting for staff and facilitate their counseling. This positioned the team to be ready to integrate more advanced reporting technology into the program. In order to ensure that the right technology is selected for RMF’s field level reporting, RMF designed a pilot program to test different reporting systems together with the teams from Dimagi, a mobile technology developer and Microsoft Research India.

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 final report 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). After this pilot finished at the end of May, these staff members were incorporated into the Merck supported Malnutrition Eradication Program, bringing this program staff up to 65 staff in 600 villages.

During this quarter the program:

• Identified 844 children suffering from SAM and gave counseling to the caregivers of each of these children;
• Saw an overall improvement in 867 children ever identified;
• Identified 2,054 children with MAM and provided one on one counseling to the caregivers of these 838 children
• Saw an improvement from MAM to normal in 1,501 children;
• 1,473 were referred to NRCs with 155 children attending and admitted;
• Conducted 2,118 village nutrition training sessions, with over 9,816 people in attendance;
• Conducted 7,880 family counseling sessions in the months of April, May, and June;
• Finalized flipbook;
• Conducted MIS training for all CNEs in batches of 20 staff members;
• Various team members met with officials from the Department of Health and the Department of Women and Child Development 35 times to get the approvals and develop the plans for the RUTF pilot; 
• Revised and streamlined MIS and reporting systems;
• Conducted an independent assessment of 800 Anganwadi Centres and Workers in preparation for the RUTF Pilot (report attached as Annex II);

So far this program has directly impacted:

• 161 children who have received life saving treatment
• 867 of these SAM children who have improved directly through our intervention this quarter
• Almost 25,962 individuals from rural villages who have received training on malnutrition awareness and prevention in their villages
• The families of the 65 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.