Nutrition in Banjar block, Nutrition in Banjar block, Himachal Pradesh – can we Himachal Pradesh – can we

strengthen the District Health strengthen the District Health system?system?

Over viewOver view

Situation summary – why nutrition Situation summary – why nutrition campaign?campaign?

Actions for interventionActions for intervention AchievementsAchievements Lessons for learningLessons for learning

Nutrition programmeNutrition programme

Nutrition in under 5’s – Tandi Nutrition in under 5’s – Tandi Panchayat, HP, INDIAPanchayat, HP, INDIA

ICDS programme – Integrated ICDS programme – Integrated Child Development SchemeChild Development Scheme

Largest programme in Largest programme in IndiaIndia

780 000 across India780 000 across India Anganwaddi – each with Anganwaddi – each with

‘madam’ and helper‘madam’ and helper Growth monitoringGrowth monitoring Pre-school 3-6y (3hrs)Pre-school 3-6y (3hrs) Rations for children and Rations for children and

mothersmothers Support to ANMs and Support to ANMs and

immunisation/ antenatal immunisation/ antenatal (primary sub-centre)(primary sub-centre)

Initial analysis – Banjar block Initial analysis – Banjar block ICDS programmeICDS programme

October – Dec 06 Survey October – Dec 06 Survey of 15 anganwaddisof 15 anganwaddis

90% centres staffed90% centres staffed

50% no utilisation of meds50% no utilisation of meds

100% have completed 100% have completed growth monitoringgrowth monitoring

60% under supplied rations60% under supplied rations

50% of mother’s don’t 50% of mother’s don’t attendattend

ICDS programme BanjarICDS programme Banjar

Programme not Programme not accessible to over 50% accessible to over 50% of population (more of population (more than 1 hour walk) than 1 hour walk)

Growth monitoring Growth monitoring limited (lack of scales limited (lack of scales and inaccurate)and inaccurate)

Lack of training to Lack of training to workersworkers

Financial disincentive if Financial disincentive if reporting malnutritonreporting malnutriton

Our strategy to support and Our strategy to support and work with ICDS programme work with ICDS programme

Banjar, HPBanjar, HP

StrategyStrategy

Build relationships with Government Project Build relationships with Government Project Officer and District officialsOfficer and District officials

Support anganwaddi with child health clinics Support anganwaddi with child health clinics for all malnourished children on 15for all malnourished children on 15thth dates dates

Training each month to ICDS staffTraining each month to ICDS staff Train Nutrition promoters based in Train Nutrition promoters based in

communities to work with anganwaddi workerscommunities to work with anganwaddi workers Outreach work – rations/ growth monitoring by NPs to Outreach work – rations/ growth monitoring by NPs to

more remote villagesmore remote villages Register 30 children eachRegister 30 children each Share all growth monitoring data with ICDSShare all growth monitoring data with ICDS Advocates with communities on nutrition/ ICDSAdvocates with communities on nutrition/ ICDS

How are we going so far?How are we going so far?

District health programmeDistrict health programme

District and block project officers very District and block project officers very supportive and gives us teaching of all supportive and gives us teaching of all of anganwaddiof anganwaddi

Uses our information to give feedback Uses our information to give feedback Keen to work together furtherKeen to work together further Anganwaddi staff very glad for support Anganwaddi staff very glad for support

– use our scales and data, refer – use our scales and data, refer childrenchildren

Medical doctor (PHC) disinterested Medical doctor (PHC) disinterested

Nutrition promotersNutrition promoters

Growing in Growing in confidence with confidence with communitiescommunities

Speaking at Gram Speaking at Gram panchayat and panchayat and women’s gatheringswomen’s gatherings

Working with familiesWorking with families Need to increase Need to increase

political actionpolitical action

What we are doing rightWhat we are doing right

Identifying need and priority of communityIdentifying need and priority of community Develop programme iterativelyDevelop programme iteratively Evidence basedEvidence based Take small stepsTake small steps Frequent meetings with Govt officersFrequent meetings with Govt officers Asking communities for participation and Asking communities for participation and

evaluation (Jibhi CHAI and Govt workers) evaluation (Jibhi CHAI and Govt workers) Working in partnership and not parallelWorking in partnership and not parallel

What we would change next What we would change next time…time…

1.1. Nutrition promoter selection- Difficulty Nutrition promoter selection- Difficulty mixing high and low caste/mixing high and low caste/

2.2. Some girls without leadership abilitySome girls without leadership ability3.3. TALK to others BEFORE STARTINGTALK to others BEFORE STARTING4.4. How to get Govt Doctors onside?How to get Govt Doctors onside?5.5. Take longer with everything - increase Take longer with everything - increase

community participation and make more community participation and make more a People’s programmea People’s programme

Thoughts?Thoughts?