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Location

S 15 villages of Pohri block in Shivpuri district of Madhya Pradesh
Thematic Intervention: Health and Nutrition


Background

Vikas Samvad Samiti(VSS) is a resource organization that partnered with CRY since 2007. The project holder is Mr Sachin Jain, who established Vikas Samvad Samiti to give a new shape to media advocacy on CR issues. He has written over seven hundred articles and features on socio-economic and political issues affecting the marginal groups of society. As an active member of Right to Food Campaign, he has played a key role in bringing the ‘Right to Food Update’ to keep organizations, activists, district administration and government informed about the latest developments in the matter of food security. VSS started project implementation work in 10 villages of Pohari block of Shivpuri district in April 2017 considering the criticality of health and nutrition issues among children of Saharia tribal community.

Problem Statement:


Madhya Pradesh, a state in central India, is home to more than 50 tribes and the Sahariyas are one of them who are residing predominantly at Shivpuri. The health status of this tribe is extremely poor due to malnutrition, lack of proper hygiene and illiteracy. Lack of proper nutrition, especially protein-deficient diet in children, very often predisposes them to diseases like Marasmus and Kwashiorkor & TB. The sahariya is a primitive tribe, who traditionally live in the jungle and make handicrafts such as pottery, baskets etc. They do hunting, fishing and primitive cultivation.

The situation is even worse in the 10 intervention villages where the project has been operating since last one year. In these villages, VHNDs are not held at all and only after the projects intervention, ANMs started visiting these villages but only once in 3-4 months. Almost 60% of pregnant women have no MCH cards with them and the percentage of institutional delivery in the area is only 78%. High incidence of IMR and CMR is also a common feature in the area. There were 6 cases of child deaths and 1 case of maternal death during the year. There were 20 cases of miscarriages and 6 cases of stillbirths among Sahariyas during the year 2018. Lack of awareness among communities is a major factor contributing to these deaths apart from the poor services at health facilities. The problem is still very huge as only one doctor is posted at CHC, Pohri and this CHC on an average attends to 70-80 deliveries. The ICDS centres which play a crucial role in ensuring proper nutritional status of children is almost defunct. Out of 15 Anganwadis, only 8 are functioning as per norms. Only 2 out of 15 Anganwadi workers are from Sahariya community which again results in discrimination. There is also acute shortage of ICDS centres as 15 centres are catering to 1704 children which mean each centre is catering to more than 100 children.

Achievements & Impact


Key Result Area: Ensure quality health services available and service delivery institutions are accountable to the community.

Program Activities Planned Progress and Achievements

? Conduct rapid assessment in all 15 Villages covering 100% households. ? Facilitate community in preparation of Village Health Report Card. It will present status of services, causes behind problems, and services being provided within the community related to water, immunization, health and nutrition. The community will prepare report and share the gaps/ findings with service providers to address them. This will in both advocacy and monitoring. ? Conduct orientation sessions on prevention of seasonal diseases through home visits and community level meetings, to spread awareness on schemes available for malaria prevention and similarly other diseases, to reduce mortality and morbidity due to various seasonal diseases. ? Conduct interface meeting with department of Women & Child Development and Public Health & Family Welfare to strengthen welfare scheme implementation.

? Rapid Assessment was conducted at all 15 Villages to assess the socio economic conditions. 440 households were surveyed (20% of the total households) ? Growth monitoring was initiated for the first time by ICDS workers in all the 10 new villages with the support of partner team. ? Community mobilisers conducted home visits to all vulnerable families throughout the year and this has helped in increasing the percentage of ante and pre natal services. ? 59% of Sahariya women have started receiving Janani Suraksha Yojana (JSY) facilities. ? 234 families has been linked to the Public Distribution Services (PDS) while regular weight monitoring at ICDS centers has been done and Village Health and Nutrition Days (VHNDs) have been held in 8 new ICDS. ? 243 adolescent girls were counseled on menstrual hygiene and nutritional diet and anemia.


Key Result Areas: Prevent and protect children from falling into the Severely Acute Malnourished (SAM) category.

Program Activities Planned Progress and Achievements

? Conduct regular growth monitoring of children identified as malnourished. ? Conduct “First 1000 days” study of a child’s life in 4 villages to understand the nutritional consumption and children’s growth. ? Facilitate operating “Nutri Corner” at Anganwadi centers. These corners will contain food items such as gram, murmura (stuffed rice), jaggery and dry food items made by locally available food material. ? Conduct sensitization sessions with pregnant and lactating mothers, and mother-in-laws on IYCF (Infant Young Child Feeding Practices) practices through home visits and community meetings. ? Conduct training on sustainable and site-appropriate agriculture, to ensure availability of traditional seeds within the families and community and the farmers are capacitated to improve productivity with natural fertilizer and farming techniques. Seeds will be given to the cultivators to initiate the seed banks during the training.

? “First 1000 days” is a nutrition-centric study that has been conducted by the partner. The study has been completed ed in which 500 families have been surveyed from 5 villages and the analysis of data is in process. 20% adolescent girls, all pregnant and lactating mothers, 5% other women from the communities were selected for the survey. ? 2 Poshan Samvad (Nutrition Awareness) sessions were organized during the year wherein issues relating to children like immunization, improper growth tracking, lack of weighing machines etc were discussed. ? VHND (Village Health and Nutrition Day) was organized by all the ICDS workers in December’18. ? Food demo session was organized at all AWCs where women brought various food items, grains available in their homes. A total of 31 food demo sessions were organized. ? Nutri-corners have been started at Anganwadis of 5 Villages i.e. Nonheta Khurd, Jakhnod, Sonipura, Gwalipura and Machakhurd. ? Home visits to pregnant and lactating mothers were regularly being conducted by the project team and IYCF practices were discussed in detail during such visits. Partner had also developed a pamphlet on IYCF practices and distributed it in the communities. ? 10 cases of children with tuberculosis were identified during the year and the treatment has been started. Individual case histories have been prepared for each child and 6 are free from tuberculosis now. ? 23 severely underweight children were identified during the year from communities and all were referred to the Nutrition Rehabilitation Centers. 4 have come out of malnutrition and are normal while 4 have graduated to the moderate underweight category. The rest of the children have come out of the danger zone.

Other Highlight Processes and Achievements – 2018.


The organization partnered with an organization named Gooj to identify infrastructural improvements that need to be undertaken in the villages. The activities done with the support of Goonj were quite helpful in ensuring water availability in the villages throughout the year for plantation activities. As part of ensuring nutritional security in the villages, core group members were trained on site on appropriate sustainable agriculture, traditional seeds and cropping techniques. During the year, 61 families with malnourished children in 2 villages have started practicing kitchen garden. This was quite successful in both the villages due to sensitization of community on its importance and availability of water sources. The community was also oriented on site appropriate agriculture. Seed Banks were started at 2 villages by core group members and seed banks will be introduced now in each village, so that, they will have availability of traditional seeds. Other livelihood options like breeding of Kadaknath chicken with the help of Animal Husbandry department were also explored.

Update on engagement with the government:


As part of the efforts to control the outbreak of vector borne and other summer season diseases, VSS along with Madhya Pradesh State Alliance (MPLSSM) had submitted separate memorandums (of each districts) to the National Commission for Protection of Child Rights(NCPCR), State Commissions for Protection of Child Rights(SCPCR), Directorate of health services, respective district malaria officers, Chief Medical Health Officer (CMHOs) and block medical officers stating the need for immediate interventions to control the vector borne diseases. As a result, representatives from respective health and district Malaria departments visited the project intervention areas and conducted home visits and given information on vector borne diseases, mitigation methodologies, and how to control breeding of mosquitoes. They also cleaned the drinking water sources with bleaching powder and other disease prone areas through fumigation. As a result, the percentage of vector borne disease has decreased to 55% this year.

Knowledge and Capacity Building workshops:


Training of ASHA, Anganwadi workers and Core group Leaders, Antenatal Care( ANC),Prenatal Care(PNC) mothers and youth groups on Safe Motherhood was conducted which ensure increased institutional delivery among the community. School Management Committee (SMC) members were made aware of their responsibilities and child related issues.

Plans


Key Result Areas Program Activities Planned

100% access to free, quality primary health care in 15 intervention areas as per latest government policy during the ongoing year 2019

? Conducting 12 monthly meetings by project staff with ASHAs on administering Arogya Kendras (health centres for high risk pregnant mothers).
? Constitution of Village Health, Sanitation and Nutrition committee (VHSNC) in all 10 new villages and orient them on their roles and responsibilities.
? Formation of 3 model VHSNCs and ensuring they are regularly monitoring Village Health and Nutrition Day (VHNDs), they are meeting regularly, proper village development plan is formed and untied fund is properly used.
? Preparation of 12 Village Report Cards on top is related to maternal health and 12 Village centric advocacy plans based on the gaps identified in Village Report Cards.



Key Result Areas Program Activities Planned

Reduction in maternal, infant and child deaths in our intervention areas by at least 10 % against last year, by the end of the ongoing year 2019

? Preparation of the 1000 days study report (conception to 2 years of age).
? Organising 2 Poshan Samvad sessions with frontline health workers (ASHA, AWW and ANM).
? Conducting regular home visits to identify pregnant, lactating women, adolescent girls and children in villages and high risk pregnancies and counsel them on various services available, care and proper diet, menstrual hygiene management, Antenatal and Prenatal Care practices etc.
? Activation of ambulance services in each villages.
? Bimonthly meeting on Menstrual Hygiene Management with adolescent girls and women and ensure that they are getting iron tablets through ICDS centers.



Key Result Areas Program Activities Planned

Reduction in number of Severely Acute Malnourished (SAM) children to zero in 15 operational areas during the ongoing year 2019.

? 15 Anganwadi Centres (AWC) to be made functional and nutritional diet to be ensured to all beneficiaries.
? To ensure regular weight monitoring in the centres.
? Referring Severely undernourished cases to Nutrition and Rehabilitation Centres (NRCs).Regular follow ups after discharge.
? Establishing 15 Nutri Corners at all 15 Anganwadis. I.e food items such as gram, muramura (stuffed rice), jaggery and dry food items to be stored in a container at Anganwadi
centers. ? Strengthening core groups to monitor the functioning of ICDS center.



Key Result Areas Program Activities Planned

500 children from operational area acquired life skills and exercise their agency towards the fulfilment of their rights during the ongoing year 2019.

? Creating large level of awareness through Nukkad Nataks (street plays)
? One campaign at block level to spread awareness among the mass and authorities on intensity of addiction cases in the villages and the need to take appropriate actions by the authority.
? To conduct quarterly meetings in each village on preventive methods and consequences of tuberculosis.
? Formation of 15 youth groups, 15 children groups, and 15 adolescent groups to ensure equal participation from both boys and girls (It would be a mix group).

Financial Summary: January to December 2018


Budget Breakup 2018

Health

9,933

32%

Nutrition

9,933

32%

Administration

11,434

36%

Total Grant Approved

31,300

100%