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Location

35 villages of 3 blocks of Kaushambi district, Uttar Pradesh
Thematic Intervention: Health and Nutrition


Project Context

DVEUS has been an implementing CRY project in 35 villages of 3 blocks viz. Manjhanpur, Saraswan and Kaushambi, of Kaushambi district in Uttar Pradesh with an aim of upliftment of people living in Kaushambi district. Mr. Pervez Rizvi is the project holder. Since his college days, he had an active involvement in social activism. In 1989, he along with like-minded youths formed a group to work and understand the problems in the society. The project holder has good understanding of local concerns on various issues related to social, educational, economical upliftment of the people. It has a dedicated and committed team who puts tremendous effort to drive focus on the issue of malnourishment at the district level amongst the community, media and the administration. Through its various intervention strategies, the organization has initiated periodic growth monitoring that gave significant results in terms of positive grade movement of children on various nutrition parameters.

Problem Statement:


The status of children in the project district is abysmal, as has been reported NFHS-4 data of the district. 53% children under 0-5 years are underweight and 67% children under 5-59 months are found to be anemic. Only 30% children under age of 3 years were breastfed within one hour of birth and only 35% children under age 6 months were exclusively breastfed. A total of 3,884 out of 4,832 children under 0-5 years were covered under growth monitoring, among whom where 9% (345; 185 Female & 156 Male) were found to be under severely acute malnourishment, another 37% (1,171; 599 female & and 572 male) were found to be under moderately acute malnourished. Though there are provisions to organize Sneha Shivir camps to identify and address the same, the same has not been organized by the government. There is a Nutritional Rehabilitation centre (NRC) in the district head quarter for care and treatment of severely acute malnourished children.

Child health status scenario in the areas is very alarming as neo-natal deaths are very high in intervention area due to lack of awareness and facilities for care and treatment. In the project areas 30 infant deaths (11 boys and 19 girls), 7 child deaths (1 boys and 06 girls), 15 stillbirths (11 boys and 4 girls), and 5 maternal deaths have been reported from in the project year which broadly captures the gravity of the issue. Out 30 infant deaths, 18 were neonatal death which occurred within 28 days of birth. Follow up plan is not prepar ed by the local health workers including proper identification of high risk pregnancy, delivery plan along with proper ANC and PNC. Mother and child health card not properly filled which resulted lack of proper tracking status of pregnant women.

The health and nutrition status has remained low, especially among marginal community, as most of them are either landless or marginal farmers and they hardly have any secure livelihoods. Most people depend on daily wages, bidi rolling, working in brick kiln through seasonal migration. Implementation of employment guarantee scheme (MGNREGA) and state livelihood mission is very poor and not reaching the deserving households. Apart from income poverty, there is prevailing community level superstitions and sorcery which further aggravate the child health and nutrition status. Healthy child care practices are still absent including colostrums feeding and exclusive breastfeeding due to beliefs and superstitions. At the same time, government supported mechanism is poorly functional as ICDS Anganwadi coverage is not adequate in the areas and as many as 16 new Anganwadi centers are required for the community a per population norm which is not yet fulfilled by the government. Non-implementation of hot-cooked food under ICDS in the district for over a year is sheer child rights violation under Right to Food Act. Above all, recurring Anganwadi workers strike in the state has seriously impacted the functioning of the ICDS.

Achievements & Impact


Key Result Area: Strengthen good parenting practices among community

Program Activities Planned Progress and Achievements

• Capacity Building of the mothers committee on the importance of locally available nutritional food, importance of colostrums feeding/ early initiation of breastfeeding and exclusive breast feeding and complementary feeding to the children.
• Sensitize male members in community on maternal and child health related issues including aspect of reproductive health, menstrual cycle, pregnancy related complication, newborn care and related issues, infant/child mortality as well as nutritional issues.

• Sensitization done for 206 adolescent girls. 37 High Risk mothers were provided with counselling and medical checkups. Medicines were provided to 785 community members.
• 6,600 households were contacted in the process of providing specific inputs/counselling to the members/parents on nurturing children, healthy breast feeding practices and infant young feeding practices.
• 53 male members who are about to experience first time fatherhood were sensitized in engagement on women reproductive health.


Key Result Area: Strengthen community birth management system and public service institutions in health & nutrition domain

Program Activities Planned Progress and Achievements

• Capacity building of ANM, ASHA & Anganwadi workers on home based new born care. Develop follow up plan at community level for proper home based care.
• Household tracking will be conducted for doing individual counselling for the rest and care of pregnant women, delivery plan, and specific plan for high risk pregnancy.
• Create awareness among community on maternal and child entitlements including Pradhan Mantri Matru Vandana Yojna (PMMVY) under NFSA and Jananai Suraksha Yojna (JSY).

• More than 500 community members were reached through focused group meetings on the issue of early marriage and birth spacing.
• Three child marriages were also stopped as a result of community meetings.
• 696 out of 724 pregnant mothers were registered at the ICDS centre and were provided with Mother and Child protection Card during the reporting period
• 152 out of 163 HRG (High Risk Group) mothers identified during the year have had safe delivery under projects supervision.


Key Result Area: Securing access to health and nutritional entitlements for 0-6 years children

Program Activities Planned Progress and Achievements

• Periodic Growth monitoring of all 4,194 children under 0-5 years in the intervention villages as per WHO norms. Ensure monthly follow up and growth monitoring of severely acute malnourished children.
• Capacitate members of mothers committee (Matri Samiti) on their role and responsibilities to make Anganwadi Centers functional.

• 71 Families of severely acute malnourished were linked with provisions from national food security scheme.
• 700 out of 724 identified mothers received essential ration supplies under Supplementary Nutrition Program.
• 3,884 out of 4,832 (80%) children in 0-5 years age group were covered under growth monitoring where 345 were found to be under severely acute malnourished (9%) , and 1,171 were found to be under MAM (37%) .


Key Result Area: Enhance livelihood opportunities to improve nutritional status among children

Program Activities Planned Progress and Achievements

• Mobilize community to seek employment under MGNREGA and demand wages on time. Facilitate community demand for timely payment of wages for work under MGNREGA.
• Identify deserving households who have been excluded from NFSA and facilitate process to link those households under the program.

Government interface efforts at various levels of administration have resulted to :
• 67 Beneficiaries were linked with Pradhan Mantri Matru Vandana Yojna (PMMVY)
• 545 out of 728 targeted mothers to be were linked in Janani Suraksha Yojna (JSY).
• 224 Families received jobs under National Rural Employment Guarantee Act (NREGA)

i) Highlight on community action and government interface:


• Setting up of Learning Corners in ICDS centers: The learning corner has built the community understanding on health and nutrition. The ICDS centre integrated with Information Education and Communication (IEC) material was widely recognized and taken up by the district Women and Child Development (WCD) department for model building.
• Prenatal care through birth plan preparation: DVUS staff has prepared birth plan for pregnant women which included checking weight gain in pregnancy, anaemia, and blood pressure; providing micronutrient supplementation through advocacy and kitchen garden intervention; counselling on diet, workload reduction, colostrums and breastfeeding through meetings; and arranging for delivery in government hospitals.
• Preparation of SAM care plan and emergency response: Individual care plan is in place for 156 out of 356 children with special needs. 13 children including 9 females were provided with emergency response in governmental set-up. (Children with special health care needs (SAM) are defined as those who have or are at increased risk for a chronic physical, developmental standard based on growth monitoring or health indicators).
• District Level interface meeting involving “AAA” (ASHA, Anganwadi Worker, & ANM): The organization has structured district level interface meeting with involvement of ASHA (Accredited Social Health Activist), Anganwadi workers and ANM (Auxiliary Nurse & Mid-Wife) along with District Magistrate, Chief Medical Officer, District Probation officer and other district level officials. This interface resulted in discussion among key officials/staffs regarding operational issues and challenges and refined further road map to address the same.
• Opening of CHC (Community Health Centre): One of the key achievements in the current year is opening of a CHC in Karari block. This achievement was because a result of the regular follow-ups and making government departments accountable through data backed advocacy efforts.

Plans


Key Result Areas Program Activities Planned

Sensitization of the community on appropriate mother and child care practices and related health and nutrition seeking behavior.

• Ensure all the mothers are healthy and not anaemic or underweight and have completed full immunization.
• Ensuring ASHA takes adequate steps to organize transport for taking the women to the predetermined health institution for delivery.
• Immunization tracking and submission of identification and follow up, referral and quarterly reporting of Adverse Events Following Immunization (AEFI) to the district authorities in writing.

Ensure quality and professional health and nutrition services are available in the project area through continuum of care approach for the different life stages including adolescents.

• Advocacy for the up-gradation of 3 Health Sub-centre (Bakeli Per, Ranipur, Pindra Sahbanpur) in project area.
• Half yearly mapping of the new CHC (Karari) based on the IPHS norms, and non adherence issues to be reported.
• Facilitate community interface with the district administration and health departments and other stakeholders for proper functioning of CHC, including availability of required personnel, infrastructures and equipments as per norms.



Key Result Areas Program Activities Planned

Improve the food security and under-nutrition situation in the field area by improving the reach out of social welfare schemes and agriculture practices.

• Conduct AAA (ASHA, Anganwadi Worker & ANM) meetings regularly to ensure growth monitoring of children are done across Anganwadis in the project area, disaggregated for SAM, MAM and Normal children, and customize interventions accordingly.
• Conduct balanced nutrition food demonstration, family counseling, and dietary intervention in extremely vulnerable SAM cases to ensure children remain healthy.
• Conduct death audits and document nutritional deficiency related death cases, if any such cases is required.

Reduce diarrheal diseases and acute respiratory infection episodes among young mothers, adolescent girls and infants and young children through WASH programming

• Strengthen reporting and monitoring mechanism to detect any abnormal increase in cases of diarrhoea/ dysentery, fever with rigors, fever with rash, fever with jaundice or fever with unconsciousness; and early reporting to concerned Primary Health Center (PHC) as per IDSP (Integrated Disease Surveillance Project) guidelines.
• Improve habits of hand washing practices in households, schools, ICDS centers & community spaces through talks, video shows & practice events.
• “Healthy House” campaign to be launched by children group in each of the project villages to improve cleanliness in households.

Financial Summary: January to December 2018


Budget Breakup 2018

Health

17,848

38%

Nutrition

17,848

38%

Administration

11,390

24%

Total Grant Approved

47,086

100%