The Urban Nutrition Initiative- Simple Interventions Bringing Sustainable Change
The Urban Nutrition Initiative- Simple Interventions Bringing Sustainable Change

By auther pic. Gaver Chatterjee

April 17, 2019

The Urban Nutrition Initiative- Simple Interventions Bringing Sustainable Change

Training of ICDS Staff

When Committed Communities Development Trust (CCDT) launched its Urban Nutrition Initiative (UNI) in Maharashtra in March 2015, it was based on in-depth research. With a clearly defined goal of reducing malnutrition amongst children under two years of age, by reducing the percentage of Severely Acute Malnourished (SAM) by 2% and Moderately Acute Malnourished (MAM) by 4%, the initiative aimed to work with children aged 0-2 years, pregnant women and lactating mothers within selected high-burden urban Integrated Child Development Scheme (ICDS) projects over a three-year span. The programme continued till May 2018. Executed in the districts of Nagpur A, Nagpur B, Nashik, Malegaon, Mumbai (Khar & Santacruz (East)) and Bhiwandi-Nizampur, the total budget for this Tata Trusts supported initiative was 4.3 crores.


The organization partnered with the government of Maharashtra (Rajmata Jijau Mother and Child Health and Nutrition Mission (RJMCHNM)) and Tata Trust, while also tying up with four implementing NGOs—Amhi Amchya Arogyasathi, ISSUE, VACHAN and FMCH. UNICEF and RJMCHNM provided technical support and training for the project.


Says Chhaya Rade, COO of CCDT; “Nearly every third child in India is undernourished (NFHS 4). Unfortunately, the age group of 0- 2 years, and the period of pregnancy, are highly neglected. However, to address malnutrition the 1000-days, post-conception period are critical. Accordingly, CCDT designed the UNI model that focused on this period. The model works to strengthen ICDS functionaries (by training anganwadi workers) and ensuring that the scheme reaches those most vulnerable to malnutrition as well as their caregivers.”



ICDS services of Anthropometric Measurements


Carefully strategized, after multiple sessions with all stake holders and community members, the initiative successfully adopted six steps to curb malnutrition. The first was to strengthen the ICDS schemes. To do this, UNI worked towards building the capacity of anganwadi workers to deliver better services through training programs. It assisted them in conducting nutrition demonstrations, home visits and anthropometric measurements. Says Rade; “This training has gone a long way in strengthening the anganwadi workers. They are today an indispensable resource for home-based nutrition counselling and practical support to mothers on breastfeeding and complementary feeding.”


To tackle the second rung, enhancing demand generation for ICDS services, UNI first roped in the active participation of the beneficiaries themselves forming and training 490 mothers’ groups across the anganwadi centers. Members were made responsible for supervising the distribution of take-home-ration and monitoring the quality of meals, ensuring that anthropometric measurements were taken on a monthly basis and that referrals were made for immunization.



Making ICDS services  accessible of Take of Ration


Home visits and counselling for child rearing and feeding, focused on preventing malnutrition through constant vigilance and identification of at-risk pregnant women, lactating mothers, malnourished children and children who showed growth faltering. Focused interventions were imparted which included home-based counselling of mothers and other caregivers on healthy dietary practices during pregnancy and lactation, exclusive breastfeeding, nutrition during illness and immunization and other optimal infant and young child feeding practices.


Growth promotion and monitoring, the fourth intervention had the program staff identify and track all children aged 0-2 years and monitor their growth as well as facilitate line listing of those with faltering growth patterns. Explains Rade; “Through the program, anganwadi workers were trained to take and diligently record accurate anthropometric measurements, and share them with family members who are often not aware that their infant is slipping into malnutrition.”


The fifth step consisted of making timely and appropriate referrals for critical cases of high-risk pregnant women and SAM children. “This has been crucial to averting life-threatening situations and preventing maternal and child mortality,” says Rade. “A total of 1718 SAM children were identified and referred to Nutrition Rehabilitation Centers for Medical Nutrition Therapy.”


Finally, enhancing maternal health and nutrition included regular assessment of nutrition status, counselling on diet and care, promoting early registration, antenatal care and postnatal check-ups, IFA and calcium consumption as well as referral for supplementary feeding in case of under-nutrition. 


So, what have been the outcomes of UNI and has any qualitative change been recorded? Says Rade; “Over three years UNI reached 846 anganwadi centers and built the capacity of 1145 anganwadi workers. Over 32,258 children, 12,383 pregnant women and 12,338 lactating mothers were reached. Reduction in malnutrition rates has been significant; the percentage of SAM children reduced by 3.36% and that of MAM children by 7.3%.”


Significantly, what can truly drive long-term change is the empowerment of 1145 anganwadi workers to effectively implement ICDS services by building their capacity through training programs and assisting them in conducting nutrition demonstrations, home visits and anthropometric measurements.


Says Rade; “Anganwadi workers had been trained to effectively administer ICDS services. Each project has a dedicated mothers’ group to vigilantly supervise the delivery of these services and ensure accountability. Thus, the program interventions will continue to be implemented by community members and frontline workers, rendering the program sustainable in the long run.”


CCDT is now looking at launching a second phase of UNI in Maharashtra and also considering taking it to other states. Says Rade; “Although declines in India’s child under-nutrition rates have accelerated since 2006, these faster developments are still well below the rates of progress needed to achieve the global nutrition targets.” UNI therefore has its work clearly cut out for it and its focus firmly placed on the first 1000-day period.


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Gaver Chatterjee is a freelance journalist who has worked with many publications in the past including Education World, Hindustan Times, PowerLine and many others.


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