Community Based Intervention - Curative Strategy : Sneha Shivir (VHNCCS) - Preventive Strategy : 20 Counseling sessions, 25 IEC Sessions

6 VHNDs

“SuPoSHaN”

ICDS MISSION

VIDEO CONFERENCE 31.01.14

2

CRITICAL INDICATORS

PARTICULARSINDIA

NFHS - 3 (Rural 2005-06)

M.P.NFHS - 3

(Rural 2005-06)NIN (2010)

Prevalence of low birth weight 23.4 19.1Initiation of Breast feeding with in 1 hour 23.4 13.3 26.4Pre-lacteals given 58.7 16.1Exclusive Breastfeeding (0-5 months) 46.3 21.6 71.0Initiation of compl. feeding At 6 months 55.8 - 23.5% Full Immunization ( 12-24 months children)

43.5 31.5 84.2

Coverage of 9-59 months children for Massive Dose Vitamin A Supplementation (%)

- -81.7

Coverage of Pregnant women for IFA Tablet Distribution (%) - - 78.0

Coverage of 12-59 months children for IFA Tablet/Liquid Distribution (%) - - 25.0

Nutrition status (Based on WHO Child Growth Standards - 2006)

Underweight 45.9 60.0 51.9Stunting 38.4 50.0 48.9Wasting 19.1 35.0 25.8

Data Source: NFHS-3 (2005-06)

<6 6-11 12-23 24-35 36-47 48-590

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43 44.9 45.644.8

47.6 53

61.8 61.2 64.9

60.7

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Children (0-5 years)M.P. v/s India (NFHS-III 2005-06)

• Undernutrition in the first 5 years (esp. first 2 years) of life

needs special emphasis.

• Lifelong adverse impact on growth and development

• Higher risk of dying in infancy

• Consequences are severe & often irreversible

• Lifelong cognitive and physical deficits and chronic health

problems

5

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VISION 2018

OBJECTIVES“SuPoSHaN” Abhiyan

Supportive Programme on Sustaining Health and Nutrition

“SuPoSHaN”

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Underweight (Weight-for-Age)

Wasting (Weight-for-Height)

Stunting (Height-for-Age)

27.3

32.7

12.6

22.4

26.323.7

19.8

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8.3

17.5

22.2

26.7

NFHS III (2005-06) NIN Survey (2009-10)

NUTRITIONAL STATUS OF CHILDREN (0-5 YEARS)

Only 15% needs facility care

‘Abhiyan' for reduction and prevention of undernutrition

Conceptualized as a community based programme

Targeted convergent approach

Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs

Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM

“Sneha Shivir” , Mangal Diwas, IEC, ABM

Adapted from globally acknowledged Positive Deviance

Approach

“SuPoSHaN” ABHIYAN

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‘Abhiyan' for reduction and prevention of undernutrition

Conceptualized as a community based programme

Targeted convergent approach

Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs

Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM

“Sneha Shivir” , Mangal Diwas, IEC, ABM

Adapted from globally acknowledged Positive Deviance

Approach

“SuPoSHaN” ABHIYAN

• Every community has certain individuals or groups whose

uncommon behaviors and strategies enable them to find

better solutions to problems than their peers, while having

access to the same resources and facing similar or worse

challenges.

• Based on problem-solving and community-driven approach

that enables the community to discover these successful

behaviors and strategies and develop a plan of action to

promote their adoption by all concerned.

What is Positive Deviance?

STRATEGIESParticipatory Micro

Planning at Village level

1. Community Mobilization

• Facilities improvement

• Weighing drive2. Village Mapping3. Screening of children

• Presence of health worker at 1st screening

• Provision of 1st round of medication during special VHNDs (17th – 24th)

4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team

STRATEGIESParticipatory Micro

Planning at Village level

1. Community Mobilization• Facilities

improvement• Weighing drive

2. Village Mapping3. Screening of children

• Presence of health worker at 1st screening

• Provision of 1st round of medication during special VHNDs (17th – 24th)

4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team

Curative

Entry point to the village for accelerated reduction in moderate and severe under nutrition in children

Steered by Supervisor and Poshan Sahyogini

• 1st & 30th day Doctor completes screening, tracks status

• 12 days camp for 10-15 children

• Supervisors and Poshan Sahyogini conduct the camp

– 3 Supervised feeding of children

– Focused counseling session of mothers with PD exemplars

– Demonstrating local nutritious recipes - Mothers Learn by

doing

– Day to day child profiling

• Poshan Mitra, ASHA, AWW follow up by 18 home visits

• Monthly follow up and weighing of children for 6 months

• If required re-organize camp

Curative StrategySneha Shivir + C-NRC

STRATEGIESParticipatory Micro

Planning at Village level

1. Community Mobilization

• Facilities improvement

• Weighing drive2. Village Mapping3. Screening of children

• Presence of health worker at 1st screening

• Provision of 1st round of medication during special VHNDs (17th – 24th)

4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team

Curative

Entry point to the village for accelerated reduction in moderate and severe under nutrition in children

Steered by Supervisor and Poshan Sahyogini

Preventive

Empowering community to catalyze behavior change for taking out the village from the undernutrition trap

Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team

• Life cycle approach for improving nutrition

– Continuum of care beginning with adolescent girls to first

1000 days and till 5 years of age

Preventive Strategy

• Pregnancy (9 months 30 x 9 = 270)

• Birth – 24 months ( 24 x30 = 720 days)

• Total = 1000 days

• To increase children’s chances of survival,

improve development and prevent stunting,

nutrition interventions need to be delivered

during the mother’s pregnancy and the first two

years of the child’s life.

FIRST 1000 DAYS

• Life cycle approach for improving nutrition

– Continuum of care beginning with adolescent girls to first

1000 days and till 5 years of age

• Strengthen and streamline delivery of ICDS

– Universal survey and enrolment of beneficiaries at AWC

– Vajan Mela every every month 1st to 4th

– Screening of children by health care providers and referrals

– Swachhata Abhiyan every month 5th to 7th

– Targeted activities Monday to Friday

Preventive Strategy

Targeted activities Monday to Saturday

Days Targeted Activities

MondayRegular dialogue with community - Special VHNDs + Poshan Meetings with gram swasthya samitis and poshan mitra

TuesdaysLakshit Mangal Diwas - 20 themes along with sanitation campaign

Wednesday Intensive home visits targeted to Pregnant women

Thursdays Intensive home visits targeted to lactating mothers of children 0 to 6 months

FridaysAdvocacy and dialogue with community for behavioral change - 25 IECs

SaturdayIntensive home visits targeted to lactating mothers of children 6 months to 2 years

Village level Sector Level Block Level District Level

• AWW• AWH• ASHA• Gram Sabha

Swasth Gram Tadarth Samiti

• Poshan Mitra Team

• PRI

• Supervisor• ANM• NGO

nominated by District officials

• BMO• CEO JP• Project Officer• Mobile health

team

• CEO ZP• EE PHE• CMHO• DD Agri/Horti• Food Officer• DPO• AWTC• DTO (Health)• Home science

faculty

Support - "SuPoSHaN“ Abhiyan

Sr. no. Out come indicators Target

1Weight gain of children after 12 days

75% children will show minimum 200 gm weight gain

2Weight gain of children after 30 days

75% children will show minimum 400 gm weight gain

3Weight gain of children after 2 months

Growth curve of 75% of children will on positive trajectory

4Weight gain of children after 3 months

50% children will show positive change in nutritional status

5Nutritional status of children after 6 months

80% children will show positive change in nutritional status 22

OUTCOME

• Success in a village will be assessed– by complete elimination of SUW

– decrease in MUW

• Exit strategy after 1 year of implementation of Sneha Shivir in

any village– Weighing all eligible children (0-5 yrs)

– Third party would conduct the “audit”

– If no cases of severe under nutrition and borderline moderate

cases for a period of one year it may be decided to phase out

Sneha Shivir

– Remaining MUW children would be rigorously monitored and

care givers counselled on best practices at regular health

education sessions and during home visits

Phase Out Strategy

• Active involvement of Health, Panchayats, PHE,

Agriculture, Food

• Community participation through poshan mitra team,

gram sabha swasth gram tadarth samiti

• Sensitive Poshan Sahyogini

• Quality training

• Good Micro-planning and implementation

• Intensive monitoring

• Adequate and timely resources

IMPERATIVES

• March - 3035 camps in 1st phase in 2 cycles

– Cycle 1 : March 1 to March 12

– Cycle 2 : March 24 to April 4

• January and February

– Selection of villages, Poshan Sahyogini and Poshan Mitra

– Trainings at all level

– Microplanning

– Preliminary screening of children and medication

• April - Preparation for 2500 camps in May (1-12th)

• May - Phase 2 camps and Preparation for 2500 camps in

June (1-12th)

TIME LINES

• Build and mobilize for enabling environment and community participation

• Strengthening convergence with – Health for screening and monitoring– Panchayat for infrastructure, facilities and participation - employment– PHED for Safe drinking water and sanitation campaign– MDM for improved Hot supplementary nutrition given at AWC – Agriculture for minikits / Food for PDS

• Monitor ICDS to ensure :– Universal survey, identification and weighing

– Quality of training and inputs of Abhiyan

– Delivery of services including THR

• Provide administrative, technical and financial sanctions for the optimum usage of resources

Expectations From Collectors

THANK YOU