Nutrition in Banjar block, Himachal Pradesh – can we strengthen the District Health system?

Over view Situation summary – why nutrition campaign? Situation summary – why nutrition campaign? Actions for intervention Actions for intervention Achievements Achievements Lessons for learning Lessons for learning

Nutrition programme

Nutrition in under 5’s – Tandi Panchayat, HP, INDIA

ICDS programme – Integrated Child Development Scheme Largest programme in India across India across India Anganwaddi – each with ‘madam’ and helper Anganwaddi – each with ‘madam’ and helper Growth monitoring Growth monitoring Pre-school 3-6y (3hrs) Pre-school 3-6y (3hrs) Rations for children and mothers Rations for children and mothers Support to ANMs and immunisation/ antenatal (primary sub-centre) Support to ANMs and immunisation/ antenatal (primary sub-centre)

Initial analysis – Banjar block ICDS programme October – Dec 06 Survey of 15 anganwaddis 90% centres staffed 50% no utilisation of meds 100% have completed growth monitoring 60% under supplied rations 50% of mother’s don’t attend

ICDS programme Banjar Programme not accessible to over 50% of population (more than 1 hour walk) Growth monitoring limited (lack of scales and inaccurate) Lack of training to workers Financial disincentive if reporting malnutriton

Our strategy to support and work with ICDS programme Banjar, HP

Strategy Build relationships with Government Project Officer and District officials Build relationships with Government Project Officer and District officials Support anganwaddi with child health clinics for all malnourished children on 15 th dates Support anganwaddi with child health clinics for all malnourished children on 15 th dates Training each month to ICDS staff Training each month to ICDS staff Train Nutrition promoters based in communities to work with anganwaddi workers Train Nutrition promoters based in communities to work with anganwaddi workers Outreach work – rations/ growth monitoring by NPs to more remote villages Outreach work – rations/ growth monitoring by NPs to more remote villages Register 30 children each Register 30 children each Share all growth monitoring data with ICDS Share all growth monitoring data with ICDS Advocates with communities on nutrition/ ICDS Advocates with communities on nutrition/ ICDS

How are we going so far?

District health programme District and block project officers very supportive and gives us teaching of all of anganwaddi District and block project officers very supportive and gives us teaching of all of anganwaddi Uses our information to give feedback Uses our information to give feedback Keen to work together further Keen to work together further Anganwaddi staff very glad for support – use our scales and data, refer children Anganwaddi staff very glad for support – use our scales and data, refer children Medical doctor (PHC) disinterested Medical doctor (PHC) disinterested

Nutrition promoters Growing in confidence with communities Growing in confidence with communities Speaking at Gram panchayat and women’s gatherings Speaking at Gram panchayat and women’s gatherings Working with families Working with families Need to increase political action Need to increase political action

What we are doing right Identifying need and priority of community Identifying need and priority of community Develop programme iteratively Develop programme iteratively Evidence based Evidence based Take small steps Take small steps Frequent meetings with Govt officers Frequent meetings with Govt officers Asking communities for participation and evaluation (Jibhi CHAI and Govt workers) Working in partnership and not parallel Asking communities for participation and evaluation (Jibhi CHAI and Govt workers) Working in partnership and not parallel

What we would change next time… 1. Nutrition promoter selection- Difficulty mixing high and low caste/ 2. Some girls without leadership ability 3. TALK to others BEFORE STARTING 4. How to get Govt Doctors onside? 5. Take longer with everything - increase community participation and make more a People’s programme

Thoughts?