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Location

28 villages of Golamunda block of Kalahandi district in Odisha.
Thematic Intervention: Health and Nutrition


Project Context

Chale Chalo was formed in the year 2005 by a group of experienced and committed young social activists. The organization has consistently focused on working for the holistic rights of children from the most marginalized communities. The project holder, Mr. Ranjit Swain, who has been working on social issues since his school days, is a senior and respected person in the child rights sector.

The project currently operates in 28 newly identified villages of Kalahandi district and will expand to 19 more villages in the same district during the course of 2018-19. Kalahandi district of Odisha ranks high in terms of the criticality of Health and Nutrition indicators for children and thereby Chale Chalo is concentrating its work on improving the status of children in this district. The project focuses on the children belonging to scheduled caste (SC) and scheduled (ST) Communities, Kandh and Gond tribes being the prominent ones for whom the access to basic services as a matter of rights has always remained a huge challenge.

Problem Statement:


There is a high prevalence of anemia and malnutrition among the children of the operational area. Data shows that more than 35% children are anemic, and 11% of children in the age group of 6 to 59 months are in the moderate and severe categories of the growth chart thus indicating relevant levels of malnourishment. Diarrhea is a common occurrence amongst children and morbidity (incidence of illness), particularly seasonal ones, like malaria is high.
The reasons for the aforementioned status of children are several which will need to be addressed. Access to quality government health care is a major concern. As per the IPHS (Indian Public Health Standard) norms the number of primary health centers, both in Kalahandi district and in the project area are insufficient. In the Primary Health Centers (PHCs) that do exist, the absence of doctors, nurses, ANMs (Auxiliary Nurse Mid-wives) and paramedical personnel effectively means that the community cannot get necessary & quality health care. The outreach services in the operational area like antenatal and prenatal care is not regular and only 45 % of the mothers avail the ANC (Ante-natal) checkups while only 12 % of the mothers avail PNC (Post-natal) checkups (as in the year 2016-17). The parents and community lack information on schemes like Mamta, Janani Suraksha Yojana and Janani Sishu Suraksha Karyakram and are completely dependent on the ASHA (Accredited Social Health Activist) workers and ANMs who have been unable to fulfill their duties effectively.

While the government health system needs to be strengthened, the functioning of the ICDS (Integrated Child Development Scheme) centers in the operational area also reveals significant gap areas. The number of ICDS centers is not sufficient considering the population and concerted engagement with the district administration is needed to ensure the required number of ICDS centers are established to secure quality nutritional services for all the needy children. Growth monitoring was being done in the centers only for the data submission to the district and therefore was not done with accuracy and neither was the follow up with each child ensured. The problem of lack of co-ordination at different levels and between the service providers and beneficiaries continued thus affecting the quality in transaction of services. It has also been observed that colostrum feeding among the project community was at a low 30-40% indicating needs of intense effort to change practices of the community.
All the above issues are being addressed by the partner team along with the community and significant improvements have been noted in the last couple of years.

Situation

Chale Chalo has been implementing in-depth programming on health and nutrition themes in the intervention villages. The project conducted activities with children, communities and stakeholders to streamline the processes on health and nutrition in the operational area. Community meetings held in all villages; with training of PRI members, they took initiative and a female staff appointed in the sub center; pregnant and lactating mothers were linked with schemes; institutional deliveries increased and all have practices exclusive breastfeeding; all the sub health centers have ANM[1]s ; kitchen garden played important role in shifting of SAM[2] children to yellow category ; attendance in the VHND[3] has been increased; all ICDS[4] centers plotting growth chart; infrastructure and services improved in Anganwadi Centers; hand washing practice and discussion of nutrition food was held among children groups, Anganwadi Centers and schools; Children collectives are functional in the project area; child Centre training was imparted with children groups; adolescent groups strengthened in all villages. Use of the Mobile Vaani Technology has helped in spreading awareness amongst the community about the various issues and the schemes hence awareness from the community regarding services have increased. Major works undertaken during the last year by the partner are as follows –

KRA - Access to free, primary health care in the intervention area:
• Meetings with the PRI[5] members and ICDS health department at block level held to discuss the issue of child malnourishment, Growth Monitoring Chart (GMC) and adolescent anemia with focus on strengthening implementation of schemes and health mechanisms in the villages.
• Gram Kalyan Samiti (village committee) meetings were held due to the build relationship with the community, members were orientated on the effective Implementation of VHND and prepared yearly budget plan as per the need of ICDS Centre and tools/materials for VNHD session.
• Regular follow up by the Janch Committee, Mata Committee and the Women self-help group leaders with the 17 ICDS centers to know accessibility of nutritious food as per new menu chart status of ICDS at Mahaling, Leter and Khaliapali and sinapali Gram Panchayat area.
• Meetings of pregnant and lactating mothers to discuss with them the benefit of full ANC[6]/PNC[7]services and other governments. services. The mothers' groups were energized through individual Mobile Vaani (community radio) meetings to attend the VNHD and immunization.
• Identification of out of school adolescent girls and linking them with the SAG scheme was done and where IFA[8] tablet consumptions were ensured.
• Ensure the IFA consumption by 799 adolescents at School and Hostels.

KRA 2: Reduction of child malnutrition in operational areas from 0 to 6 years
• Celebrated breastfeeding week in all the 17 ICDS centers as part of creating awareness among the community on the importance of breastfeeding.
• Conducted 54 hand washing practice and ensured 941 children in all ICDS centers second round basic as there were 3 practices done in all the centers.
• Out of 17 ICDS centers 7 centers have kitchen gardens, the rest of the 10 centers are in the process of having the kitchen garden and will be done by next year.
• Growth monitoring of 958 children was done out of this 21 identified as SAM, 71 moderately undernourished and 866 in the normal category.
• Campaign by adolescent on Kitchen Garden promotion in the new villages done.29 adolescent girls groups who have continued the Moringa movement.

There was a need for the up-gradation of Health Centers for the better availability of services to the community in the villages of Mahalinga and Chakriya. The team had conducted village level meetings with the stakeholders including PRI members and the challenge of the Health Center was discussed with them. The PRI members then out of their own fund, received as State Finance Commission’s allocation, decided to approve the up-gradation of the centers and purchased all the equipment. While both the centers have been successfully upgraded with necessary infrastructure, many services need activation and personnel deployed. The team is organizing follow-up engagement with the line department to ensure the same.

Plans:


Below are the activities which are planned by Chale Chalo for the year ahead;
Health
● Identify all pregnant and lactating mothers; registration of women with Anganwadi centers; ensure 90% of women avail government scheme;
● Identify pregnant mothers’; complete registration of pregnancy with Anganwadi centers; Ensure registered pregnant women avail services in AWCs.
● To ensure 100% of mothers of 0-36 months children attending at least one Village Health and Nutrition Day (VHND). There will be identification of mothers of the children between the age of 0-36 months;
● Organize community meetings in at least all 28 villages and conduct 1 breastfeeding week celebration and 1 food demonstration event in all the villages.
● Organize sessions with mother’s groups based on addressing issues impacting food plate like discussion on importance of exclusive breastfeeding; correct menu for supplementary feeding etc
● Home visits to invite mothers to mother’s group meeting; Decide agenda for meeting by discussing with mothers during home visit; Communicate agenda for meeting with members of mother group to impact the attendance positively.
● Form adolescent groups; Conduct regular meeting every month for all 28 villages; discuss issues of anemia and how to address the issue; work toward increasing sensitivity towards child marriage in the community.
● Identify all adolescent girls in community and in school; Take sessions with adolescents about importance of IFA tablets and effects of Anaemia; Motivate adolescent girls to participate in VHND and consume IFA tablets provided to them.
● Training will be organized for grass root functionaries (ASHA, AWW or ANM) on health service delivery.
● All children in the age group of 0-1 year to be immunized completely

Nutrition:
● Conduct meetings to talk about the importance of exclusive breastfeeding for 6 months; home visits to all mothers and ensure that mothers practice exclusive breastfeeding for 6 months; 100% coverage of the mother for guiding them to take proper nutritious food while lactating and encourage the consumption of Kadali and Moringa.
● Identification of mothers who have children aged 7 months and above; Conducting session with mothers on supplementary feeding along with exclusive breastfeeding; Food chart demonstration given to the mothers on supplementary feeding.
● Ensure that all children from 0-5 years measured for Growth Monitoring Chart; Identify all children who are Severely Acute Malnourished (SAM); Identify all children in critical condition and are referred to Nutrition and Rehabilitation Centre (NRC).Follow up with referred children so that they attend NRC
● Conduct training in all 17 Anganwadi Centers with all the workers and helpers on how they can identify children with symptoms of malnutrition.
● Conduct a training session in all Anganwadi Centers on process to measure growth of the children; Ensure that all children are enrolled in AWCs and all the children’s growth is measured according to the growth chart.
● Identify all the AWC which does not have the supply of eggs from department;
● Provide counseling to parents on food plate and growing of Kitchen Garden;
● Ensure that 100 % of the existing Anganwadi Centers have the provision of Take Home Ration (THR).

Financial Summary: January to December 2021


Budget Breakup 2021

Protection

5,387

41%

Participation

5,387

41%

Administration

2,365

18%

Total Grant Approved

13,140

100%