Details for Reform Option "Integration of mother and child health services at village level"
Over 70% of children in India are born without malnutrition but by about 12 to 18 months of age about 60% or more are malnourished. Even in homes with sufficient food, young children become malnourished. The vast majority of these children can be maintained in the ‘normal’ grade through improved feeding practices, micronutrient supplements and better care and feeding during and just after illnesses.
The Integrated Nutrition and Health Project targeted children under 6, pregnant women and women with children under two.
The following programmes were implemented under the project -
(i) targeted supplementary feeding for children aged 6 – 24 months and pregnant and lactating women
(ii) iron and folic acid supplements for pregnant women
(iii) complete immunisation of children under one year and pregnant women
(iv) promotion of improved infant feeding (early breastfeeding, exclusive breast feeding, complementary feeding)
These programmes were implemented in the following ways:
(i) Advisory groups were formed at the block level consisting of Child Development Project Officer (CDPO), Block Medical Officer (BMO), Block Development Officer (BDO), Non-Government Organisations (NGOs) etc. for co-ordination.
(ii) Volunteers from the community, known as ‘change agents’, were trained to monitor and promote positive nutrition and health behaviour among 15–20 families.
(iii) In intervention sites, Anganwadi Workers (AWW) and Auxiliary Nurse Midwives (ANMs) made contact with families with pregnant women or children under one year of age. They checked about exclusive breast feeding, nutritional behaviour of mothers and children and focussed on weight gain. They emphasised feeding as part of treatment for Acute Respiratory Enfections (ARI), diarrhoea and fever. ANMs and AWWs reviewed the status % of ‘normal’ grade children.
(iv) Community-Based Monitoring Systems (CBMS) were designed to help empower communities to manage the health and nutrition status of women and children through village-level social maps depicting key indicators and family-based self-monitoring tools. The social maps helped define catchment areas with target populations.
(v) Nutrition and Health Days (NHD) were made fixed days, occurring at least once a month, when take-home rations were distributed and immunisation and/or antenatal care services were offered.
(vi) Key messages were also spread through street theatre, songs, wall writing, healthy baby competitions, and radio programs.
* The percentage of women receiving three or more antenatal check-ups during their pregnancy increased in 5 of the 7 project states (AP, Bihar, MP, Orissa and Rajasthan).
•There was an increase in the indicator “pregnant women receiving two or more doses of Tetanus Toxoid” in all states. Only 4 out of 7 states achieved the iron and folic acid targets, apparently partly because of supply problems.
•There was in all states except West Bengal, a general increase in the % of pregnant and lactating women receiving food from AWCs. All states except Uttar Pradesh showed an increase in the % of children fully vaccinated.
•There was a general increase in the % of children receiving breast milk in the first 8 hours of life. Five states (Bihar, MP, Orissa, UP and WB) showed an increase in the number of infants under 4 months who were exclusively breastfed.
Five states (AP, Bihar, Raj, UP and WB) showed a decline in the percentage of malnourished children.
Broad approach: This project has a broad approach to the health/nutritional problems of mothers and infants rather than merely targeting specific aspects of health care.
Inclusive: It also ensured a coordination between ANM, AWW and the community.
Supply dependent: It is dependent on efficient drug, vaccine supply from Government for the components of Iron and Folic Acid (IFA) supply and immunisation.
Unreliable: The results were in some places discouraging in proportion to the efforts invested.
Information not available.
Who needs to be consulted
State Government (specifically the Department of Family Welfare DFW); ANMs: Anganwadi Centre; local community.
•The programme depends upon the convergence of staff of the DFW, the ANM and the AWW and community ownership.
•It is debatable whether such a programme would continue to exist after withdrawal without further financial support.
Chances of Replication
It has already been replicated in 7 states.
The take-up of IFA tablets was severely limited by supply problems in several states.
Clare Kitchen, Research Consultant, ECTA, New Delhi. June 2005.