Intersectoral Convergence for Improving Access to Nutrition and
Health Entitlements of Women and Children -CHETNA’s Experience
Ms Minaxi Shukla
Additional Director, CHETNA, Ahmedabad Founder Director, CHETNA and Director, CHETNA Outreach, Ahmedabad
Background Outcome during the intervention period
Nutrition and Health Status of children and women Pre-Intervention
Banaskantha district is one among the backward districts in
terms of its performance on health and nutrition indicators and Identified Grade 3 and 4 children
vital rates. Malnutrition level is high; about 70 percent of young
140
children below six years of age, particularly girls are
132 123
undernourished. The community health workers can’t reach the
120
100
community residing in the interior and on the farms is not
receiving the health facilities. Institutional deliveries are 46%. 80
The household survey (1998-99) shows poor awareness about 60
nutrition and health. They are also not aware of the health 40
facilities. CHETNA undertook an action-research project during 20 9
2009-10 to improve access to nutrition and health services
0
through community awareness and prevent malnutrition among Total Grade 3 Grade 4
pregnant women, nursing mothers and children (0-3 years)
through a partnership between Government, Non-Government Relevant FigurePost
(results table, organogram, etc.)
Intervention
Organisations, CAIRN India as a part of CSR and the
Community. CHETNA approached to provide technical support
Improved Nutritional status
in implementation of the pilot project to improve Maternal and
Child Health (MCH) in 42 Villages of Kankrej, Deodar and 60
57
Tharad blocks of District Banaskantha, Gujarat State, India. We 47
50
took support of government infrastructure to conduct various 38
40
capacity building activities for Aanganwaadi workers (AWs),
Accredited Social Health Activist (ASHAs) and Auxiliary Nurse
30
Midwife (ANMs) etc. Funding was supported by CAIRN India and 20
10
project is monitored and implemented by CHETNA. 10
0 Lessons Learned/ Conclusion
Linkages and Networking: Grade 2 Grade 3 Grade 4 Not
weighed
Forging linkages among ICDS and Health functionaries at Village,
block and district levels through facilitating joint review meetings,
planning of activities, strengthening Mamta Day celebration
(Window approach for dissemination of nutrition and health Intervention
services for Pregnant and Nursing mothers and children below 6
years) done.
District Block Village Community awareness: To strengthen the ICDS and
health service delivery, linkages were facilitated with
the Dairy Cooperatives in an effort to encourage to
District District CDPO AWW donate milk for children. Ambaji Temple authorities
Authority Collector contributed Sukhadi (nutritious receipie made of wheat
Supervisors Helper
DDO flour, ghee and jaggery) for pregnant and nursing
ICDS BHO ASHA mothers. Matru mandals (MM) (mothers’ group) and
DPO
MO Sarpanch Sakhi Mandals (SM) (women friends’ group) were
Health enabled to provide support in organising awareness
CDHO
FHW School
RCHO Teachers activities at the Anganwadi, during Mamta Divas
Community (Window approach for dissemination of nutrition and
Children
ACDHO health services for Pregnant and Nursing mothers and
Youth children below 6 years). Child Development Project
Officers (CDPO), Supervisors trained and mentored by
ACTIVITIES DURING THE PROJECT INTERVENTION CHETNA provided support in joint planning and
Pre-Intervention Post-Intervention
organising activities as well as monitoring.
For Linkages at the district, block and village level:
To forge linkages among ICDS and Health
Generating evidence for corrective measure:
Monitoring Information System; collecting
data/information of the progress, formats/charts were
developed jointly by ICDS, Health and CHETNA. A list
of undernourished children, non-enrolled
children/pregnant women at AWC’s, challenges and
observation of the area were shared with CDPOs,
Supervisors, BHO and MO functionaries, joint training,
planning and review of activities were facilitated.
April, 2009 November, 2009 Quarterly meetings and interaction with District
collector and District Development Officer were useful
in organising joint activities. The data and observations
on the status were regularly shared at the state level.
Monitoring and Evaluation:
Monitoring the activities, collecting the data and
information of the progress, formats/charts developed
jointly by ICDS and CHETNA. Formats were developed
to evaluate the performance of Anganwadi Worker
(AWWs) and for field workers.
Future Plan of action: Community awareness
regarding Schemes and services available related to
Nutrition and Health through IEC materials and
activities such as night meetings, Empowerment of
Community based organisations/groups ( VHSNC,
MM,SM) ;Linkages and Advocacy with district and
block level officials
Ms Indu Capoor
Findings
Enrolment of Children and pregnant women: Community health
workers reach out to those who are residing near the village. So the
community residing in the farms or in the interior areas does not
receive their nutrition and health entitlements. Through village visits,
CHETNA identified 85 children and nine pregnant women who
were not enrolled in any Anganwadi centre. With the team’s efforts,
Total now all 85 children are enrolled. It was also observed that all the
eligible children and pregnant and nursing women were deprived of
Grade 3
the ICDS services because there is not enough number of AWCs to
cater to the entire population.
Grade 4
•Undernourished children: The nutrition and health status of
women and children is extremely poor. Randomly children were
selected from AWC register as well as during home visits children
were weighed. During visits total 132 undernourished children of
Grade 3 and Grade 4 from 42 villages were identified and with the
efforts of CHETNA team and AWWs the current situation of these
132 children is improved. (Project one year main focus is on grade
3 and 4 children because of that team recorded and track under
nourished children)Graphically the change was presented below in
figure title
•Coordination meeting of ICDS and Health Department: ICDS
and Health coordination meeting are now regularly organised
Recommendations:
Community:
• Need to form linkages with community based
organizations-VHSNC, MM, SM for effective
monitoring of the Anganwadi services
• Need to focus on strengthening the role of ASHA
through capacity building
Block level:
• Need for convergence between ICDS and Health
Departments for effective coordination of activities
at village level
• Need to strengthen the monitoring mechanism of
Supervisors and Medical Officers towards village
level activities
District Level:
Case studies of undernourished children and good
practices, field visit reports, challenges and
learning’s during working and three month
analytical quarterly reports were prepared to
assess the progress based on the data and
experiences from the field. Reports were shared
with District, block officials and CAIRN India.
Report helped in making the necessary changes in
the strategies and activities for the better outcome
of the project.
Resources to Learn More
• Process documentation of the project
• Policy brief on the learnings of the project
CHETNA
Acknowledgements
Dist officials of Banaskantha dist.; Department of
Women and Child Development and Department of
Health and Family welfare, Govt. of Gujarat;CAIRN
India, Community members esp. women and
Children
Contact Information
Ms. Minaxi Shukla-Additional Director, CHETNA,
Centre for Health, Education, Training and Nutrition
Awareness
Supath-II, B-Block, 3rd Floor, Opp. Vadaj Bus
Terminus, Ashram Road, Vadaj,
Ahmedabad-380013.
Phone: 91-079- 27559976/77
Fax: 91-079-27559978
Email: chetna456@gmail.com
Website: www.chetnaindia.org