1. Fulwari Scheme Community Managed Health and Nutrition Centres for Under-3 year children and mothers Chhattisgarh
August 2015

2. Issues in health and nutrition
Inadequate access of families to food items esp. high quality or protective foods (e.g. protein from animal sources).
Lack of adequate time for child feeding and care
Recurrent infections
Inadequate reach of Health Workers to children under-3 years age
Gaps in feeding and care of pregnant and lactating women leading to poor maternal nutrition status and also low birth weight
Gaps in household level production of diverse foods
ICDS resources more focused on 3-6 year olds and no centre-based spot feeding or care for under-3 age children or pregnant/lactating women
Situation is worse in tribal areas

3. Interventions needed
Health
Feeding
Care

4. The Fulwari Intervention
Fulwari – A Community managed Health and Nutrition Centre
The key features of Fulwari Initiative are:
Focus on feeding and care of under-3 year children, pregnant and lactating women
Prevent infections in children, ensure early detection and cure
b) Organise daycare through habitation based collective of mothers
c) Promote household /community level production of diverse foods

5. Fulwari Design No paid worker for working in the Fulwari
2 Mothers volunteer each day to run the Fulwari and take care of children
Fulwari is managed and run by group of mothers
All decisions with respect to Fulwari taken by this group
Group also manages the funds made available to them through Panchayats for food and other items in Fulwari

6. Fulwari Design Fulwaris initiated at habitation level in tribal blocks
Habitations with higher levels of poverty prioritized in initial short listing of habitations
No population norm for selecting habitations, each Fulwari covers 5-20 children depending on habitation size
Demand based, a series of Community meetings done, Fulwari sanctioned based on Community Resolutions demanding Fulwari, which are ratified by Panchayat

7. Functioning of Fulwari
Fulwari centre opens for 6-7 hours, depending upon timings of mothers work.
Fulwari runs on all days including holidays.
Fulwari run from space voluntarily given by a community member
Each Fulwari given a grant of around Rs for utensils, bed nets, toys etc.
At least three hot cooked meals provided to children and two meals to pregnant women.
Eggs (atleast per child per week), Oil, vegetables emphasized in menu which gets finalized by the group of mothers.

8. Functioning of Fulwari
Women and Child development department runs Fulwari scheme through Zila Panchayats who in turn involve Gram Panchayats
Community Health Workers (Mitanins) and their support structure play the key role in Community mobilization, health linkage, problem solving and capacity building for Fulwaris.
Rs. 6 per child per day provided for food (by Gram Panchayat)
Rs. 15 per pregnant women per day provided to Fulwaris for food.
Mothers/women volunteering to work in Fulwari also get food for that day.
Ready to Eat powder available from Anganwadis also fed in Fulwari as one breakfast

9. Functioning of Fulwari
Zila Panchayat provides grant for the food component and basic set-up through Gram Panchayats. An average budget of Rs.50,000 per Fulwari allocated by State Government
Fund Flow: ZP to Gram Panchayat to Mothers’ group running Fulwari.
All expenditure done directly by Mothers’ group.
Most food items purchased locally
Fulwari thus used as a base for promoting kitchen gardens, poultry etc in the families

10. Functioning of Fulwari
Day care centres also function as demonstration for feeding and care related behaviors like – use of eggs, oil, vegetables in diet, frequent feeding, hand washing, handling of drinking water, use of bed-nets etc.
Mothers group meets twice a month and this meeting provides Mitanin an opportunity for giving them nutrition and health education.
Children monitored for pneumonia, diarrhea, fever (malaria) and any cases detected given the required advice/treatment/referral by Mitanin.
Weighing of children done each month and grade (weight for age) communicated to mothers along with required counseling by Mitanin.
Community based management of Severely malnourished children happens in Fulwari.
Input to Fulwaris on Child Development i.e. Psycho-social stimulation aspects in collaboration with UNICEF

11. Fulwari Volunteer Duty Charts

12. Hand Washing

14. Vegetable Nursery

15. Papaya Plantation

16. Coverage
Fulwari Initiative started as an innovation in Surguja district
Hon’ble CM announced Fulwari scheme for all tribal blocks on 26 January 2013
Successful roll-out of replication completed in in all 85 tribal blocks through Panchayats in
2850 Fulwaris set-up across 85 blocks in 19 districts – covering total of 36,000 children and 16,000 pregnant / lactating women
State Budget allocation in – Rs.30 Crore, number of Fulwaris to be expanded to 6,000 in tribal areas.

17. Current Status of Fulwaris – July 2015Sl
District
Number of Fulwaris sanctioned
No. of Fulwaris functioning regularly
% of Functional Fulwaris 1
Bijapur
120 90
75% 2
Raigarh
150
131
87% 3
Jashpur
240
213
89% 4
Koria
111
74% 5
Gariaband 87
97% 6
Bastar
210
175
83% 7
Surajpur
180
156 8
Surguja
510
458
90% 9
Balrampur
122
68% 10
Dantewada
104

18. Current Status of Fulwari – July 2015Sl
District
Number of Fulwaris sanctioned
No. of Fulwaris functioning regularly
% of Functional Fulwaris 11
Sukma 90 58
64% 12
Kondagaon
150 95
63% 13
Narayanpur 60 43
72% 14
Korba
117
78% 15
Kanker
210
174
83% 16
Dhamtari 30 29
97% 17
Balod 18
Rajnandgaon 88
98% 19
Bilaspur
67%
Total
2850
2340
82%

19. Benefits
High Acceptability – Despite requiring voluntary effort from mothers – in 92% of the Fulwaris mothers continued to be willing to contribute their time, communities willing to give space
Practices related to hygiene and feeding improved
Mothers by participation in activities of Fulwari learnt more about preventing infections and child feeding
It made it easier for Mitanin, Anganwadi worker and ANM to reach young children and pregnant women. Linkage with health likely to reduce infections, improve access to treatment without delay, reduce mortality
It has helped in reducing the episodes of illnesses (diarrhea, malaria, ARI) and also seems to have reduced child deaths as sick children get identified faster.
Better weight gain by pregnant women and improvement in birth-weights

20. Benefits Growth monitoring improved
Mothers were able to be free from child care for 6 days a week as childcare was provided in Fulwari
Household level production of vegetables etc. increased
Panchayats started getting involved in Nutrition and Health
It strengthens social image of Panchayats
Fulwari brought the community together around the issue of improving child nutrition
Fulwari ‘s collective ownership by mothers and their control over funds minimised chances of pilferage

21. Documentation and Research
Detailed Baseline Survey through UNICEF support and by External agency for Surguja and then for Chhattisgarh
Rapid assessment of the Impact was done by the team of experts from Pt. J.N.M. Medical College, Raipur (C.G.) & Pt.Ravishankar Shukla University, Raipur (C.G.) – early August 2013
Surguja Interim Assessment Survey after one year of Baseline survey -through UNICEF support and by External agency February 2014
Chhattisgarh – Interim Assessment Survey 2015 by SHRC
External documentation done by CIPS Hyderabad
External evaluation study conducted by hiring Expert on orders of Panchayat department

22. Impact on Health and Nutrition
Baseline: Underweight 29%, Severe-underweight 16%
Second Round Survey: Underweight 24%, Severe-underweight 10%
24% reduction in overall under-weight rate
August 2013, Rapid Assessment By Ravishankar University and JN Medical College Raipur showed 600 gm additional mean weight gain for children in Fulwari compared to children without Fulwari over the period February to August 2013 (6 month)
Chhattisgarh Interim Assessment Cohort Study (by SHRC) shows that 64% of severely-underweight children enrolled in Fulwari, were able to come out of severe-underweight category
The Low Birth Weight incidence has come down from 26% to 14% for newborn born to pregnant women enrolled in Fulwari.

23. Recognition
Fulwari Initiative recently got Prime Minister Award for excellence in public administration
Ministry of Health and Family Welfare GoI selected Fulwari as a Best Practice in It was presented at Simla Summit on Best Practices.
GoI has invited Fulwari to be included in Global Call to Action Summit scheduled for August, New Delhi.
Institute of Tropical Medicine (Antwerp) has included ‘Impact of Fulwari on improving Birth weights’ in its forthcoming Colloquium 2015
Nutrition Coalition (New Delhi) invited Fulwari Initiative to be presented in the South Asia Conference on Policies and Practices to Improve Nutrition Security July 2014
Centre for Innovation in Public Systems (an autonomous body promoted by GoI) chose Fulwari Initiative to be presented as a leading innovation in country on their Foundation Day in Hyderabad on 14th May 2014

24. Recognition
International Food Policy Research Institute (IFPRI) has chosen Fulwari Initiative and Documented its implementation as a promising strategy for strengthening community action on Nutrition. Presented in International Conference 30th October 2014
A research article (Dasgupta et al) in Indian Pediatrics Journal has referred to Fulwari Initiative as a key hope for community management of malnutrition.
Fulwari Intiative was invited and presented at Swasth Swachh Bharat – at New Delhi – A national seminar on Convergence organised Centre for Policy Research on 15th January 2015
Fulwari Initiative has been selected by UNICEF as a leading innovation for tribal nutrition and was presented at the Conclave on Tribal Nutrition, Bhubaneswar on 16th January 2015
Fulwari included at Asian Congress of Nutrition, Yokohama, Japan May 2015
Administrative Training Institutes of Government of Orissa, Madhya Pradesh and Andhra Pradesh invited Fulwari Initiative to be presented. Officers of multiple states are visting Fulwari.

25. Challenges
Creating Departmental ownership: Which department should own a convergence based and community-led programme ?
Programme was originally with Panchayat department but handed over to WCD who were reluctant to take-up a volunteer based programme
Health department is most suited to run it as Community Health Workers (Mitanins) associated with it play the central role in mobilizing communities for organizing and maintaining a Fulwari. Health department has moved a proposal to lead the scheme