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Location

14 villages – 2595 households in Charkhari Block of Mahoba District, Uttar Pradesh
Thematic Intervention: Health and Nutrition


Project Context

Kriti Shodh Sansthan (KSS), Gahrauli was established in 2000 by a group of active and excited youths having its office at Parmanand Tiraha, district Mahoba. KSS was established with the mission to bring about all round development among children in the perennially drought affected Bundelkhand region of Uttar Pradesh state in India. Mr. Manoj Kumar is the Secretary of Kriti Shodh Sansthan (KSS). He has been associated with various forums and civil society networks in Bundelkhand region. KSS believes and practices participatory approaches in community engagement to address social, economic and political issues. KSS has been able to develop its own distinctive identity of working on child rights issues and currently operates in Charkhari block of Mahoba district with children of socially and economically marginalized communities.

Problem Statement:


Mahoba is one of the most drought prone districts of Bundelkhand region in Uttar Pradesh. Recurring drought in the district has led to a serious impact on food security and livelihood of people in the area, also leading to large scale distress migration. This has directly increased vulnerability of children especially their access to education, nutrition and a protective environment. In last year, out of 4334 children between 0-18 years, 1569 children (36%) have been directly impacted due to migration. The caste groups that have been impacted greatly are the scheduled castes comprising of the ahriwar and chamar castes as well as other communities are lodhi, yadav and general castes.

Problem Statement:


The status of child nutrition in the intervention area is very poor. During the month of August 2018, out of 623 children covered under growth monitoring, 65 children (28 boys and 37 girls) were severely acute malnourished and 206 children (90 boys and 116 girls) were medium acute malnourished. 967 children were not covered under growth monitoring due to migration issues. Though there is provision for referral of severe malnourished children (SAM) to the Nutritional Rehabilitation Centre (NRC), Mahoba, children are not able to access the facilities due to distance to the centre as well as other conditions like migration of family members. Follow - up visits have not been done for children who were discharged from the hospital. Sneha Shivirs (to be done by the ICDS) have not been organized at cluster level for treatment and counseling of malnourished children. Certain practices of the community have also contributed to the poor status of children. Exclusive breastfeeding of children for six months is not being done. Furthermore malnourished children (sukha rog) are taken to local quack/ojha who treat children by putting a hot iron rod point mark in the stomach of children. The ICDS centers do not function properly and there are issues in the access to supplementary food to irregular supply and the provision of Hot cooked food in ICDS centres is non-functional for over one year in the state. In last year, as a result of Supreme court judgement on drought relief to the families, the state government had distributed rations but lack of information on distribution and the distance to reach block headquarters meant that the impacted households did not access the relief support.

There are two Public Health Centres (PHCs) in the intervention area but due to the geographical positioning people prefer to approach Community Health Centre (CHC) which is situated in Charkhari. The CHC and district hospitals are ill-equipped with poor facilities, irregular doctors and lack of technical staff to operate the equipment in the neonatal Intensive Care Unit (ICU). The existing sub-centres of Sudamapuri, Kusharma, Chandauli and Bagron are also equally ill equipped. In the absence of adequate health care facilities there has been an increased influence of local quacks (locally known as panjjababa) for treatment of illness and different diseases.

Achievements & Impact


Key Result Areas: Improved community understanding on issues related to child health and nutrition, behavioral aspect of parenting practices which can enhance nutritional status among children in intervention areas.

Program Activities Planned Progress and Achievements

* Conduct awareness meeting of community in all intervention villages on child nutrition, issue related to early girls marriage, anemia among adolescents, low birth weight, nutritional deficiency among children, its impact on overall growth and development.
* Organize meeting with pregnant / lactating mothers on importance of colostrums feeding, exclusive breast-feeding and complementary feeding / infant & young child feeding practices.
* Facilitate process for participation of target group in Village Health and Nutrition Day organized in ICDS centre.

? 99% of the deliveries were institutional compared to 76% from the last year.
* 58 High risk mothers were identified through the birth plan preparation. Out of the 58 mothers, about 29 mothers were referred to hospital for check-ups. They have been receiving proper support now.
* Posters, wall paintings, community dialogue, games and many other methods was used to raise awareness in the community and help them make healthy choices in terms of practices and use of the government health system.


Key Result Areas: Strengthening institutions related to health and nutrition cares such that children are able to access services under them.

Program Activities Planned Progress and Achievements

? Facilitate processes for community monitoring of Anganwadi centre through ensuring their attendance in meeting of AWC / participation in VHND
* Mapping of all Anganwadi centers (14) as per norm to assess status of infrastructures and services, children access to Anganwadi centers etc and advocacy with government department
* Follow up at Anganwadi centre level for regular growth monitoring of children and ensure registration of malnourished children in Anganwadi centre.
* Facilitate referral services through local Anganwadi centre to Nutritional Rehabilitation Centre (NRC) Mahoba in case of medical complication as identified by ANM / Anganwadi workers.

? 2 ICDS centre buildings were sanctioned, one in Majhol and One in Bamahaurikhurd.
* 5 boys and 7 girls ( 12 children) were referred to NRC for care and treatment
* A total of 16 children (9 girls and 7 boys) with medical complications are referred in hospital
* Profiling was completed for 37 children with severe malnutrition. This has helped an individual care plan to be prepared for each child.


Key Result Areas: Improve livelihoods and food security at family and community level to enhance nutritional intake of children and thereby reducing malnutrition among children.

Program Activities Planned Progress and Achievements

• Conduct meeting in the community and share the idea of Kitchen garden and motivate the community action to combat nutritional deficiencies among children.
• Liaison with district horticulture office with regards to facilities community benefit from of free seeds from office. Mobilize community to raise nursery and develop kitchen garden of locally suitable and nutritionally rich fruit trees and vegetables.
* Explore opportunities of dry-land farming and promote cultivation of food items based on feasibility and sustainability in discussion with horticulture department

? 309 households initiated kitchen garden with the support of adolescent girls groups.
* 141 households were linked with the food security scheme under National Food Security Act (NFSA).
* Online registration was facilitated for farmers for the District farm - based gardening scheme and also free seeds were distributed

Other Processes and Achievements – 2018:


1. Due to consistent community awareness, the Infant Young Child Feeding (IYCF) practices like early initiation of breastfeeding, colostrums intake and exclusive breastfeeding has seen major increase from the last year.
2. To break the intergenerational cycle of malnutrition the partner has adopted a life-cycle approach to child development, with greater attention given to the care, empowerment and protection of adolescents, girls in particular. This has resulted in the following outcomes in the reporting period:
* 67 Girls immunized for the first time
* 35 Adolescent girls learnt tailoring
* 61 girls in two phases completed life - skill training in project villages on health issues
* 48 Adolescent girls participated in art competitions
* Sanitary napkins were distributed to 45 girls
* Adolescent girls participated in food demos on locally enriched nutritious food items.

Engagement with government:


The partner has engaged regularly with the government for the resumption of hot cooked food and supplementary nutrition in the ICDS centers of the district. The issue was raised before the district administration as well as the National Commission for Protection of Child Rights (NCPCR) through state alliance support. As a result of this engagement, supplementary nutrition was started in district. Based on a special request by the partner organisation, hot cooked meal preparation has been started in select project villages by the district administration.

Knowledge and Capacity Building workshops:


The children groups were oriented through series of trainings conducted by CRY and the partner as per Child Centre module in the project villages. The purpose was to make children group active participants and leaders in their communities. 30 such capacity building programs were conducted throughout the year. The positive outcomes of the process were as follows:

* Adolescent girls were motivated to attend school and were even able to convince their parents to allow them to pursue education after 10th standard in 3 villages of the operational area.
* Children are more vocal and articulate while speaking, giving opinions and even talking about menstrual cycles with female workers/health workers. * Children influenced adults of 9 households against consumption of liquor and smoking.
* Adolescent girls initiated creative writing through a newsletter-“Bundeli Bachhho Ki Awaz”
* Involvement of adolescent girls improved in the collective meetings.

Plans


Key Result Areas Program Activities Planned

100% access to free, quality primary health care in 14 project villages as per latest government policy during the ongoing year 2018-19

* Regular use of appropriate messaging to be developed for use at community level to make people aware on child health and nutrition.
* Orientation of Matri Samiti (Mothers Committee) members on their role and responsibilities and capacitate them towards monitoring and effective implementation of child health and nutrition program in respective villages.
* Awareness meeting of community in all intervention villages on child nutrition, issue related to nutritional deficiency among children, its impact on overall growth and development.
* Meetings to be organized with pregnant/lactating mothers on importance of colostrums feeding, exclusive breastfeeding and complementary feeding/ infant young child feeding practices.



Key Result Areas Program Activities Planned

In 10 villages (out of 14 in total operational areas), ICDS, ICPS, PDS, NRCs, MTCs are fully functional by the end of the year.

* Tracking of all children under 0-6 years in intervention areas and facilitate processes at community level for registration of all children in ICDS to access the services.
* Ensure participation on Village Health and Nutrition Day (VHND) of pregnant women/lactating women and adolescent girls in VHND meetings through active involvement of existing mothers committee.
* Facilitate processes for community monitoring of ICDS centre by ensuring their attendance in meeting of ICDS center/ participation in VHND.
* Organize capacity building sessions of children groups/ 07 adolescent groups on importance of services under ICDS including pre-schooling, supplementary nutrition program and take home ration.
* Facilitate interface of ICDS workers, ANM/ASHA with children collectives/ adolescent girls groups for awareness building on health and nutrition.
* Mapping of existing Nutritional Rehabilitation Centre(NRC) in the area to assess its functioning and follow up of children discharged after care and treatment (based on NRC operational guideline of government).
* Track and follow up at family level by targeting pregnant and lactating women for 4 Antenatal Care (ANC)and 4 Prenatal Care(PNC) as per norm.
* Identification of high risk pregnancy and develop referral plan for specializing institutional care. Pregnant women to be linked with maternity benefit schemes.
* Child to child tracking of children under 0-1 years for immunization. Analysis on status of immunization, timely immunization and sharing of issues with health workers.
* Awareness on issues of anemia among adolescent girls, pregnant women, issue related to high risk pregnancy case, referral services etc.
* Mapping of health care institutions (sub centers, Community Health Centers) as per IPHS norms.
* Workload analysis of all ANM(Auxiliiary Nurse Midwife) in the working areas, and find the gaps for sharing with health department .



Key Result Areas Program Activities Planned

Strengthen food security and livelihood option at family and community level led to enhanced nutritional intake of children and thereby reducing malnutrition among Children

* Meeting with District Development Office (DDO) and District Livelihood Mission for discussion on issue related to child malnutrition, distress migration and its impact.
Undertake advocacy with the departments for implementation of Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) with focus on water harvesting activities, plantation, land development programs and programs under livelihood.
* Understand different government schemes and program under convergence approach and facilitate processes for linking of households under Uttar Pradesh Rural Livelihood Mission (UPRLM).
* Update status at community level regarding coverage under National Food Security Act (NFSA), access to ration and also identify families not yet covered under the schemes.
* Discussion on importance of kitchen garden, how to improve nutritional intake to combat nutritional deficiencies among children.
* Tracking children of all migrant households in all intervention villages. Undertake assessment on impact of migration on child health and nutrition in all intervention villages and sharing the assessment report with district administration, District Development Office and National/State Commission for Protection of Child Rights N/SCPCR for advocacy to address the identified gaps.

Financial Summary: January to December 2018


Budget Breakup 2018

Health

5,528

32%

Nutrition

5,528

32%

Administration

6,017

36%

Total Grant Approved

17,073

100%