on the details of
30 villages under Shahabad block of Baran district in Rajasthan, India
Thematic Intervention: Health and Nutrition
Prayatn Sansthan was founded in 1992 with an objective of empowerment of communities to respond to changes and enable them to change their situation of inequality and injustice. However, over a period of time it has also developed expertise on child rights issues like declining sex ratio, child education, child marriage etc and at present, most of the interventions of Prayatn across the states of U.P., M.P., Rajasthan & Orissa have specific child rights focus as per child rights situational analysis of the intervention area. Prayatn is recognized as a leading organization in the state which is working on child rights issues and is equipped with the ability to work directly at grassroots with added competency of conducting research, networking with stakeholders and lobbying & advocacy with government.
The Project Holder is Mr. Malay Kumar, whose major area of expertise has been on child rights, specifically protection related issues; He has a wide experience on pre-conception and prenatal Diagnostic Techniques (PCPNDT) Act, trafficking issue, research etc.
Baran, the only district in Rajasthan which has majority of Saharia population (categorised as the only Particularly Vulnerable Tribal Group , earlier known as primitive tribal group) in the state has dismal human development indicators. The child health and nutrition scenario of the intervention areas is abysmally very poor. The issue of nutritional deficiency among Saharia children, infant and child mortality, low weight birth of children, high anaemia among adolescent girls speak volumes about the child survival in the areas. In absence of adequate cultivable land, availability of required pulses, green vegetables for consumption is low. Lack of livelihood resources and employment opportunities for the Saharia tribe further escalated the issue of hunger and malnutrition among community and children in the areas. Apart from the issue of livelihood and food security issues, community level prevailing belief system, social custom and tradition including consumption of alcohol, tobacco, Aghori system, child marriage, myths with regards to immunization and breast-feedings have serious impact on maternal and child health.
There is absence of required infrastructures and staffs as per norm under ICDS Mission and thus, coverage of children access to ICDS provision is low. There is only One Child Development Programme Officer (CDPO) in place in-charge of 3 development blocks. Though issue of child malnutrition is high, Sneha Shivir is not yet organised by the ICDS department. There have been irregularity in supply of Supplementary Nutrition Programme (SNP) and hot cooked food in intervention areas.
- To ensure community based systems and mechanisms for ensuring proper health care, nutrition and food security of Sahariya women and children are in place.
- To facilitate safe deliveries and ensure effective administration of ANC and PNC care programs in all the villages.
- The children in 0-5 years of age access the appropriate services entitled for them in health and nutrition.
- Effective functioning and quality services being provided by the government institutions related with health, nutrition and food security to the communities.
- Community awareness and action on other aspects related health of Samaria people like seasonal diseases, hygiene and availability of proper quality of drinking water ensured.
Achievements & Impact in the Review Period
The CRY supported intervention of Prayatn Sansthan focused on addressing food security and nutrition issues and on bringing about a positive change in the lives of Sahariya children. During the period, the program at Saharia dominated block Shahbad of Baran has shown some significant outcomes and impact. The organisation leadership has shown its commitment on the issue and guided the team to bring out malnourished children from the death trap. It catered to the urgent needs of 101 children through referral services of ICDS centers in the villages and more than 50 children were brought from malnourished status to normal category. During its rapport building activity, the team has also been able to develop trust among the Sahariya community with their daily needs like drinking water facility, payment of Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA), immunization of children, etc were ensured through efforts of the team. Moreover, the limited understanding of the team about the Saharia tribe, its culture, and occupation has also been overcome as the team’s engagement with the community grew significantly during the period.
Community level confidence has also grown, as the hesitant Saharia members are now able to visit block offices by themselves. Most importantly, good rapport with the youth and children of the Sahariya community also encourages the team to take up tougher issues in the coming years. Some significant socio-cultural changes have taken place like, girls are now allowed to take admission in residential schools and parents feel proud of their girl child’s education, which simply indicates the gradual change in attitude of the Saharia parents.
Major achievements in the year include:
- The Team interacts and the sensitisation process is done through individual contact, participation in Maternal Health and Nutrition Day (MCHN). The CNNA exercise has been conducted successfully though the report has not been shared with the team. It has been advised to share the report and thereby facilitate a discussion with the team on the findings.
- Twelve orientations have been done by the team wherein around 350 people participated.
- There were 67 institutional deliveries out of 69 during the period.
- The process of exclusive breastfeeding and the supplementary food after 6 months is being monitored closely.
- Around 29 SAM children have been benefitted to improve their fooding and health care facilities.
- The seed distribution has been done for the cultivation of kitchen garden in the last quarter. A total of 616 families cultivated the vegetables.
- Regular meetings and one to one interaction is done with the caste leaders. There are issues such as liquor consumption, child marriage, and education of children which are primarily targeted through such intervention. There were personal interactions established with around 60 community leaders.
- Street plays were organised for spreading awareness on various other associated issues also such as alcoholism, substance abuse etc
- Number of beds in Malnourishment Treatment Centers (MTC) has been increased from 12 to 20 by the government due to regular advocacy and follows up.
Young Buddho lives with her parents, Ginni and Santosh and her grandmother, Kashi in Shahbad Tehsil of Baran district in Rajasthan, India. When Prayatn foundation came to know of Buddho’s family, she was severely malnourished with the family barely able to make ends meet. Her father was working as a bonded laborer and her mother was unable to work since she was pregnant. The diet of salt, chilli powder and millet bread that they fed Buddho had caused her to become underweight with severe dysentery which further deteriorated her condition. The family could not afford to get private medical treatment for her. The team counselled the family and taught them how they could take better care of Buddho. They noticed that Buddha remained unclean and her body was prone to itching. She was provided with Oral Rehydration Salts to help her regain strength and local medicines were suggested for the body itch. It was revealed that Buddho had fallen into the habit of eating mud, a free but dangerous option to satisfy her hunger. Her parents were advised to closely monitor her eating habits. The close monitoring and medicines paid off, and in two days the team observed that her itching had subsided. But a few days later, when the team visited again, they saw that Buddho’s health was not improving. When they learnt that the family could not afford the nutritious food and milk that they were advised to provide for the baby they took the responsibility upon themselves. As part of the consecutive follow up visits, Buddho was administered with de-worming medicine and food packets were made available to her from the Anganwadi.
Simple and affordable food recipes were shared with her mother so that the children could eat simple, healthy and nutritious food. With time Buddho’s weight continued to increase considerably. Even when her parents had to migrate to other villages for work, they followed up with the team and it was seen to that Buddho received food packets regularly including administrations of Calcium medicine. Now, Buddho has crossed the levels of malnutrition and is at a healthy 13.6 kgs.
The Prayatn Sanstha has been working for the Sahariyas in the Baran district on health and nutrition with the support of CRY from past five years. The sahariya tribes are the primitive tribes and the initial entry is a difficult task. Prayatn has done the initial base work with the community and has established good rapport, credibility and presence in the field in the intervention areas. The plans are as follows:
Focus 1: Community based systems and mechanisms for ensuring proper health care, nutrition and food security of Sahariya women and children are in place
- To undertake the orientation and sensitisation of the community through community meetings, small group meetings, adolescent girls groups, the groups of husbands, mother in laws on varied issues (such as fooding habits of pregnant women, importance of rest and care ,health and hygiene practices, their immunisation, safe delivery, importance of breastfeeding within one hour of delivery, exclusive breastfeeding, supplementary nutrition after six months, interval between births and other related issues)
- Specific focus on changing the habits of gutkha (substance chewing) amongst children and alcohol consumption amongst adults. To also specifically map the expenditure pattern after leaving gutkha.
- Community Meeting with adolescent youth on appropriate age of Marriage & related responsiveness, health and hygiene.
Focus 2: To facilitate safe deliveries and ensure effective administration of ANC and PNC care programs in all the villages.
- Ensuring regular tracking of Pregnant women (PW) and registration in ICDS centre. To also give specific focus on migratory/floating population.
- Ensuring that Mother and Child health card (MCH) is given to all the Pregnant Women. To ensure that the remaining 39 women receive the MCH card which was not received by them so far.
- Household tracking will be conducted for doing individual counselling for the rest and care of pregnant women.
- Sensitisation on importance of immunization of pregnant women. Immunization, check-up and IFA distribution to the pregnant women.
- Sensitisation on the importance of safe delivery. Discussion on the details of the available health institutions in vicinity. Sensitisation and enhanced awareness of the benefits of colostrums feeding.
- To ensure postnatal care and regular tracking of nursing mothers for importance of breastfeeding within one hour and breast feeding practices.
- Linkage to ICDS all lactating mothers (LM) will be linked to ICDS centres. Sensitisation on judicial use of the nutrition received.
Focus 3: The children in 0-5 years of age access the appropriate services entitled for them in health and nutrition.
- Child wise tracking to be continued on a regular basis.
- Undertake analysis of the data of the malnourished children on the basis of age, gender etc. Also, the seasonality and the underlying causes to be analysed.
- Linkage to ICDS To ensure enrolment of children up to the 6 month to 6 years in Anganwadi centers and children getting supplementary food.
- Regular community meetings and counselling of parents, child protection committee members, youth cadre on the issues of health and hygiene, safe drinking water, nutritious locally available food intake etc especially for the malnourished children.
- To understand the health seeking behaviour of sahariyas and the related economics on health and the indebtedness.
- To continue birth registration of all the children born and immunisation.
Focus 4: Effective functioning and quality services being provided by the government institutions related with health, nutrition and food security to the communities.
- Interface with government officials and PRI members at block level to share findings of the Assessments of different institutions.
- Orientation of members of Anganwadi level Management and Support Committee at Anganwadi level.
- To take stock of the Mothers Committees and regular meetings with Mothers Committees and their activation process.VHND to be mapped.
Focus 5: Community awareness and action on other aspects related health of Sahariya people like seasonal diseases, hygiene and availability of proper quality of drinking water ensured.
- To gather understanding on the prevalence and nature of seasonal diseases in the intervention area.
- Analysing the implementation gaps in the vertical programmes such as Malaria Eradication, Diarrhoea, Pneumonia and Cholera prevention etc.
- Sensitisation for community based management of preventable disease. There should be discussion about diarrhoea and the possible home based remedies
- To map the water resources in the area and the specific practices of Sahariyas with respect to water usage. To sensitise the communities and start the process of revival of traditional water bodies.
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