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Location

20 villages/habitations of Golamunda block of Kalahandi district of Odisha
Thematic Intervention: Health and Nutrition


Project Context

CHALE CHALO was formed in the year 2005 by a group of experienced and committed young social activists. The organization has consistently focused on working for the holistic rights of children from the most marginalized communities. The project holder, Mr. Ranjit Swain, who has been working on social issues since his school days, is a senior and respected person in the child rights sector.

The CRY supported project currently operates in 20 newly identified villages of Kalahandi district and will expand to 19 more villages in the same district during the course of 2018 -19. Kalahandi district of Odisha ranks high in terms of the criticality of Health and Nutrition indicators for children and thereby Chale Chalo is concentrating its work on improving the status of children in this district. The project focuses on the children of the SC and ST Communities (Kandh and Gond are the major tribes) for whom access to basic rights has always remained a huge challenge.

Problem Statement:


There is a high prevalence of anemia and malnutrition among the children of the operational area. Data shows that more than 35% children are anemic while 11% of children in the age group of 6 to 59 months are in the moderate and severe categories of the growth chart thus indicating relevant levels of malnourishment. Diarrhoea is a common occurrence amongst children and morbidity (incidence of illness), particularly seasonal ones, like malaria is high.
The reasons for the aforementioned status of children are several which will need to be addressed. Access to quality government health care is a major concern. As per the IPHS norms there is an insufficient number of primary health centres both in Kalahandi district and in the project area. In the PHCs that do exist, the absence of doctors, nurses, ANMs and paramedical personnel effectively means that the community cannot get any health care. The outreach services in the operational area like antenatal and prenatal care is not regular and only 45 % of the mothers avail the ANC check-ups while only 12 % of the mothers avail PNC checkups (as in the year 2016-17). The parents and community lack information on schemes like Mamata, Janani Suraksha Yojana and Janani Sishu Suraksha Karyakram and are completely dependent on the ASHA workers and ANMs who have not been fulfilling their duties effectively.

While the government health system needs to be strengthened, the functioning of the ICDS centres in the operational area also reveals significant gap areas. There is a deficiency in the number of ICDS centers and concentrated engagement with the district administration is needed to ensure the required number of centers for all children. Growth monitoring was being done in the centers only for the data submission to the district and therefore was not done with accuracy and neither was the follow up with each child ensured. The problem of lack of coordination at different levels and between the service providers and beneficiaries continued thus affecting the transaction of services. It has also been seen that colostrum feeding was at a low 30-40% thus indicating a need to change practices of the community.
All the above issues are being addressed by the partner team along with the community and significant improvements have been noted in the last couple of years.

Achievements & Impact


1Indian Public health Standards – developed by the Govt of India for primary health centres & sub-centres

Key Result Areas : Access to free, primary health care in the intervention area

Program Activities Planned Progress and Achievements

* Training to Panchayati Raj Institute (PRI) organizations on standard care norms of sub centres.
* Block level consultation with line dept on the issue of child malnourishment and adolescent anemia with the focus on strengthening the implementation of schemes and health mechanism in the villages.
* Facilitate mothers to complete the Post Natal Care(PNC) services through community mobilization.
* Update status of Village Health and Nutrition Day (VHND) in sector meeting
* Initiative taken by Gaon Kalyan Samiti (GKS) and Panchayati Raj Institute (PRI) for HB test of Adolescent girls.
* Interaction with health and ICDS workers motivate them to maintain the norms of Antenatal Care (ANC)/ Postnatal Care (PNC).
* Orientation to Gaon Kalyan Samiti Member on Government Health schemes, Yojana, plans to facilitate plan of action for all the GKS.
* Identify the out of school adolescent girls and link them with SAG scheme. Ensure health card of out of school adolescent girls.

* 162 children out of 173 were immunized as per norms during 2017-18
* Increase to 98.26% in access to Antenatal care and increase to 54% in PNC during 2017-18.
* 160 mothers out of 168 got the benefit of JSY scheme and 115 mothers got the benefit from the Mamata scheme during 2017-18
* 97% children were given colostrum feeding as per the record of the institutional deliveries (168 children out of 173 infants).
* 168 institutional deliveries have been ensured during the reporting period.
* A monthly monitoring system of mothers (with the help of ASHA workers) has helped identify 16 mothers with anemia and ensure timely intervention with dietary counseling and supplements.


Key Result Areas : Reduction of Child malnutrition in operational areas from 0 to 6 year

Program Activities Planned Progress and Achievements

* Create awareness among community on importance of breastfeeding through Breastfeeding week observation.
* Develop nutritional status among 3-6 children through government entitlement.
* Regular growth monitoring and referring to Nutrition Rehabilitation Center (NRC).
* Campaign by adolescent on Kitchen Garden promotion in the new villages as well.
* Create village level awareness and continue Moringa Movement among community on nutrition content of green vegetable.

* 949 children in the age group of 6 months to 59 months are being monitored closely through the growth chart in the ICDS centers. 11 ICDS center and 05 Mini ICDS are doing growth monitoring proactively.
* 19 identified SAM children have received double ration. 6 Severely Acute Malnourished (SAM) children have been referred to Nutrition Rehabilitation Centers (NRC), where they have completed treatment and have shown growth movement.
* 488 kitchen gardens were promoted in the project area thus improving nutrition intake amongst pregnant women, lactating mothers and adolescents girls * Awareness on the importance of hand-washing was done across all schools and icds centers in the operational area. A total of 79 sessions were facilitated and 1975 Children participated in the sessions.


Key Result Areas : Children’s collectives align with the principles of engagement with children

Program Activities Planned Progress and Achievements

* 25 children club members to be strengthened with enhancing participation on health nutrition activities like hand washing, sanitation and cleanliness drive.
* 20 adolescent girls groups’ members will orient on child cell module & health hygiene.
* Orientation to adolescent girls groups on child cell module and health & hygiene.

* 21 adolescent girls’ collective meetings were organized for a total of 167 children from 7 villages. The focus of the sessions was on hygienic practices during menstruation/handwashing and awareness on the detrimental effects of child marriage.
* 7 adolescent girls groups have been formed in Kalipur, Kastura, Badjor, Kuliapada, Betrajpali, Jayantapur and Tentulipada. It is a very positive sign that in the reporting period no child marriage has been reported from these villages.
* 7 Child Center Module trainings was held for 7 children groups in schools. 126 children were orientated on Life Skills Education while 7 teachers also actively participated in the Training.

CCapacity Building by the CRY team:


In the reporting year, the following were the capacity building initiatives undertaken by the CRY team to enable a more robust program at the partner level:
* Close hand-holding and support was provided to streamline the MIS/MEAL data collection and management. This has involved a series of meetings and discussions with the partner, as a result of which the collection of data and porting was completed as per timelines.
* The Mobile Vaani Community Awareness Initiative was launched in Chale Chalo in 2018. It was felt that the partner could take on Information Communication Technology (ICT) for wider and more effective reach of the program in the operational area. Thereby, the CRY team enabled linkages between the partner and Mobile Vaani for digital integration. An orientation program was organised in March ‘2018 on the strategy and importance of digital integration for better outcomes. Thereafter, two staff members of Chale Chalo have been further trained and the Interactive Voice Response navigation application was set up thus currently reaching 314 families.

Update on engagement with the government to strengthen services for children:


Several processes have been undertaken to enhance the delivery of services on the ground for children in the operational area. A sensitization program on health and malnutrition was held at the block level by the partner organization which saw active participation by the CDPO, supervisors and anganwadi workers along with most of the block and district officials. This helped to build the issues regarding functioning and role of the systems to the fore and discuss positive methods of addressing them. There has been consistent engagement through the year with the district administration to seek sanction for a new Primary Health Center (PHC), for services within the existing centers and for 5 new ICDS centers required in the area. The local Member of Legislative Assembly (MLA)’s support was also enlisted to influence the district offices to increase the pace of action in addressing the issues.

Plans


Key Result Areas Program Activities Planned

Health: Access to free, primary health care in the intervention areas

* Training to Panchayati Raj Institute (PRI) organizations on standard care norms of sub centres.
* Block level consultation with line dept on the issue of child malnourishment and adolescent anemia with the focus on strengthening the implementation of schemes and health mechanism in the villages.
* Facilitate mothers to complete the Post Natal Care(PNC) services through community mobilization.
* Update status of Village Health and Nutrition Day (VHND) in sector meeting
* Initiative taken by Gaon Kalyan Samiti (GKS) and Panchayati Raj Institute(PRI) for HB test of Adolescent girls.
* Interaction with health and ICDS workers motivate them to maintain the norms of Antenatal Care(ANC)/ Postnatal Care(PNC).
* Orientation to Gaon Kalyan Samiti Member on Government Health schemes, Yojana, plans to facilitate plan of action for all the GKS.
* Identify the out of school adolescent girls and link them with SAG scheme. Ensure health card of out of school adolescent girls.
* HB and BMI test of adolescent girls and track the progress on quarterly basis.



Key Result Areas Program Activities Planned

Malnourishment: Reduction of child malnutrition in operational areas from 0 to 6 years.

* Create awareness among community on importance of breastfeeding through Breastfeeding week observation.
* Develop nutritional status among 3-6 children through government entitlement.
* Regular growth monitoring and referring to Nutrition Rehabilitation Center (NRC).
* Campaign by adolescent on Kitchen Garden promotion in the new villages as well.
* Create village level awareness and continue Moringa Movement among community on nutrition content of green vegetable.

Ensure alignment & implementation across 25 numbers of our children’s collectives and 25 adolescents based on the principles of engagement

* * 25 children club members to be strengthened with enhancing participation on health nutrition activities like hand washing, sanitation and cleanliness drive. * 20 adolescent girls groups’ members will orient on child cell module & health hygiene.
* Orientation to adolescent girls groups on child cell module and health & hygiene.

Financial Summary: January to December 2019


Budget Breakup 2019

Health

2,088

12%

Nutrition

8,358

49%

Participation

3,191

19%

Administration

3,553

20%

Total Grant Approved

17,190

100%