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Location

35 villages of 3 blocks of Kaushambi district, Uttar Pradesh
Thematic Focus: Health & Nutrition


Project Background

Doaba Vikas evam Utthan Samiti (DVEUS) has been implementing CRY project in 35 villages of 3 blocks viz. Manjhanpur, Saraswan and Kaushambi of Kaushambi district in Uttar Pradesh with the aim to uplift people living in Kaushambi district. Mr. Pervez Rizvi is the project holder. Since his college days, he had an active involvement in social activism. In 1989, he along with like-minded youths formed a group to work and understand the problems in the society. The project holder has a good understanding of local concerns on various issues related to social, educational, economic wellbeing of the people. It has a dedicated and committed team who put tremendous effort to drive focus on the issue of malnourishment in the district amongst the community, media and the administration. Through its various intervention strategies, the organization has initiated periodic growth monitoring that gives significant results in terms of positive grade movement of children on various nutrition parameters.

Problem Statement:


The status of children in the project district is abysmal, as has been reported in NFHS-4 data of the district. Almost 53% of children under the age of 5 years are underweight and 67% children in the 5-59 months age-group are found to be anemic. Only 30% children under age of 3 years were breastfed within the first hour of birth and only 35% children under age 6 months were exclusively breastfed. A total of 3,884 out of 4,832 children in the age-group of 0-5 years were covered under growth monitoring, among whom where 9% (345, 185 girls & 156 boys) were found to be severely acute malnourished (SAM), another 37% (1,171, 599 girls & 572 boys) were found to be under moderately acute malnourished (MAM). Though there are provisions to organize Sneha Shivir camps to identify and address the same, the same has not been organized by the government. There is a Nutritional Rehabilitation Center (NRC) in the district head quarter for care and treatment of severely acute malnourished children. Community finds it difficult to travel and stay for 14 days due to other family compulsions including care of other family members.

Child health status scenario in the areas is very alarming as neo-natal deaths are very high in intervention area due to lack of awareness and facilities for care and treatment. In the project areas 30 infant deaths (11 boys and 19 girls), 7 child deaths (1 boys and 6 girls), 15 stillbirth (11 boys and 4 girls), and 5 maternal deaths have been reported from in the year 2018 which broadly captures the gravity of the issue. Out 30 infant deaths, 18 were neo-natal death which occurred within 28 days of birth. Follow up plan is not prepared by the local health workers including proper identification of high risk pregnancy, delivery plan along with proper ANC (antenatal check-up) and PNC (postnatal check-up). Mother and child health cards are not properly filled which resulted to lack of proper tracking status of pregnant women. Apart from this, it was found that workload of ANM impacted ANC and immunization processes in the areas as they are covering more than prescribed number of villages. Though infrastructures in health care institutions are there, there are serious gaps in staffing including positions of pediatrician and gynecologist. The issue has been raised with govt. officials without any success. Absence of government health care services has been a boon for the untrained health practitioners/ quack to lure community to seek their health care services which has posed serious threats to maternal and child health.

The health and nutrition status has remained low, especially among marginal communities, as most of them are either landless or marginal farmers and they hardly have any secure livelihoods. Most people depend on daily wages, bidi rolling, working in brick kiln through seasonal migration. Implementation of employment guarantee scheme (MGNREGA) and state livelihood mission is very poor and not reaching the deserving households. Apart from income poverty, there is prevailing community level superstitions and sorcery which further aggravate the child health and nutrition status. Healthy child care practices are still absent including colostrum feeding and exclusive breastfeeding during the first six months of birth due to beliefs and superstitions. At the same time, government supported mechanisms are poorly functional as ICDS (Integrated Child Development Scheme) Anganwadi centers coverage is not adequate in the areas and as many as 16 new Anganwadi centers are required for the community as per population norm which is not yet to be fulfilled by the government. Non-implementation of hot-cooked food under ICDS in the district for over a year is a sheer child rights violation under Right to Food Act. Above all, recurring Anganwadi workers strike in the state has seriously impacted the functioning of the ICDS.

Achievements & Impact


Program Activities Planned Progress and Achievements

Key Result Area: Sensitization of the community on appropriate mother and child care practices and related health and nutrition seeking behavior.

* Ensure all the mothers are healthy and not anaemic or underweight and have completed full immunization.
* Ensuring ASHA (Accredited Social Health Activist) takes adequate steps to organize transport for taking the women to the pre-determined health institution for delivery.
* Immunization tracking and submission of identification and follow up, referral and quarterly reporting of Adverse Events Following Immunization (AEFI) to the district authorities in writing.

* 378 mother’s group meetings conducted in the reporting period to sensitize them regarding appropriate mother and child care practices. A total of 2,234 mothers attended sessions.
* 31 Villages are having access to safe drinking water. The organization has helped in installation of hand pumps and accessing pumped water.
* 17 Villages are having proper toilets in every house. 616 of them have been constructed through the project's advocacy efforts.
* 1,002 mothers attended VHND celebration wherein 931 mothers were linked with various schemes like JSY , PMVY and similar other schemes.
* 513 pregnant mothers registered themselves in their 1st trimester and 413 mothers received 100 IFA (Iron and Folic Acid) tablets in the 2nd and 3rd trimester.
* 91.84% women had institutional deliveries.


Program Activities Planned Progress and Achievements

Key Result Area: Ensure quality and professional health and nutrition services are available in the project area through continuum of care approach for the different life stages including adolescents.

* Advocacy for the up-gradation of 3 Health Sub-Center (Bakeliper, Ranipur, Pindra Sahbanpur) in the project area.
* Half yearly mapping of the new CHC (Karari) based on the IPHS norms, and report non-adherence.
* Facilitate community interface with the district administration and health departments and other stakeholders for proper functioning of CHC, including availability of required personnel, infrastructures and equipment as per norms.

* All the health institutions were mapped and advocacy papers prepared based on IPHS standards. The report was shared with all the key actors like SCPCR , Health Directorate, NCPCR , Media and all the relevant district authorities.
* One new health Sub-Center and 6 Health and Wellness Center were approved in the reporting year.
* 13 new ICDS Anganwadi Centers were approved at the start of the year as a result of sustained advocacy along with the project community.


Program Activities Planned Progress and Achievements

Key Result Area: Improve the food security and under-nutrition situation in the field area by improving the reach out of social welfare schemes and agriculture practices.

* Conduct AAA (ASHA, Anganwadi Worker & ANM) meetings regularly to ensure growth monitoring of children are done across Anganwadi in the project area, with data for SAM, MAM and Normal children, and customize interventions accordingly.
* Conduct balanced nutrition food demonstration, family Counselling, and dietary intervention in extremely vulnerable SAM cases to ensure children remain healthy.
* Conduct death audits and document nutritional deficiency related death cases, if any such cases are reported.

* 164 children were breastfed exclusively for 6-9 months by their mothers and 226 mothers of 9-12 months old children initiated complementary feeding in the seven month.
* Almost 60% of SAM children who were referred to NRC recovered after treatment.
* Food demo is conducted in 40 villages. In 24 of the villages the organization collaborated with the department and learned how to use Supplementary Nutrition Program (SNP) food packets as different dishes.
* 706 out of 812 children (86.94%) were immunized through VHNDs (Village Health and Nutrition Day celebrations) and awareness generation.


Program Activities Planned Progress and Achievements

Key Result Area: Reduce diarrheal diseases and acute respiratory infection episodes among young mothers, adolescent girls and infants and young children through WASH programming.

* Strengthen reporting and monitoring mechanism to detect any abnormal increase in cases of diarrhea/ dysentery, fever with rigors, fever with rash, fever with jaundice or fever with unconsciousness; and early reporting to concerned Primary Health Center (PHC) as per IDSP (Integrated Disease Surveillance Project) guidelines.
* Improve habits of hand washing practices in households, schools, ICDS centers & community spaces through talks, video shows & practice events.
* “Healthy House” campaign to be launched by the children's group in each of the project villages to improve cleanliness in households.

* The organization worked on the WASH campaign in coordination with the government department. Water sources were cleaned. Hand washing activities were conducted.
* 11 health camps were organized in which 2,126 people were examined out of which 7 cases were referred. 29 SAM cases were cured through effective and timely organization of health camps.
* Child led “Healthy Home” survey was conducted. The children collective prepared questionnaires, the questions ranged from whether household members washed their hands with soap before a meal, how they stored their drinking water, did they have a dustbin at home, and whether the household had access to and used toilets. Community members explained the findings and areas/ ways of improvements were explained.

Highlight on community action and government interface:


* There were few poor families who didn’t have access to basic food ration support under the National Food Security Act. The project team conducted the verification of such families’ registration for food card authentication of families in the relevant website. The discrepancies in distribution brought to the notice of Gram Pradhan. The Chief Minister’s (CM) online monitoring portal was used in a few cases. As a result of this 84 left out families were linked with the right to food entitlements.
* The government had launched a new health service program called Health and Wellness Center to basically upgrade existing health centers not meeting the requirements in certain geographies. The project team prepared a comprehensive report on the existing health situation and the resultant health situation. The report was shared with the SCPCR, health department, NCPCR, health directorate, CMHO and the district administration. The project functionaries are having very good rapport with the district magistrate which was a contributory factor for the achievement. As a result a total of 6 Health Sub-Centers were approved as Health and Wellness Center for the partner project area.

Plans


Key Result Areas Program Activities Planned

Sensitization of the community on appropriate mother and child care practices and related health and nutrition seeking behavior.

* Ensure Village Health and Nutrition Day (VHND) celebration is conducted in all the 50 project villages.
* Promote colostrum’s feeding/ exclusive breastfeeding/ complementary feeding in all the communities through timely IEC material application.
* Ensure 100% of mothers of children aged 0-36 months attend at least one Village Health and Nutrition Day (VHND) every 3 months.
* Ensure access to entitlements by 100% pregnant and lactating mothers-Tracking of Janani Surakshya Yojna (JSY)/ Pradhan Mantri Matru Vandana Yojna (PMMVY) on a regular basis.
* Ensure 70% timely registration for ANC-1 through sensitization of male members and elderly and regular contact with newly married couples.
* Ensure 90% of women received 100 IFA tablets through community awareness meetings conducted on the usage of Iron and folic acid tablets.



Key Result Areas Program Activities Planned

Ensure quality and professional health and nutrition services are available in the project area through continuum of care approach for the different life stages including adolescents.

* Organize 2 rounds of training on 1,000 days of care through Counseling and Monitoring Center (CMC).
* Conduct free Sanitary napkin distribution during Rastriya Balika Swasthya Karyakram (RBSK) team visit to project villages.
* Ensure at least 60% of 17 AWCS are having functional toilets - ICDS workers capacity will be built on the issue of growth monitoring, usage of weighing machines, growth charts plotting etc.
* Ensure 90% of 49 AWCs are having drinking water availability within/ close to the premises.

Improve the food security and under-nutrition situation in the field area by improving the reach out of social welfare schemes and agriculture practices.

* Influencing preparation of district and block health plans for considering finding of last year.
* Undertake mapping of facilities for newborn care including New Born Care Units (NBSU) & Sick New Born Care Unit (SNCU) as per the norms. Prepare a status report on facility based newborn care and sharing with Chief Medical officer (CMO) and health departments to address the gaps.
* Ensure triple A (ASHA, AWW & ANM) coordination meetings are conducted in every quarter so that scheduled services are provided to the mothers of malnourished children (SAM & MAM).
* In case of death occurrence irrespective of follow up the death audit and verbal autopsy for every IMR/MMR/CMR will be conducted in the area.

Financial Summary: January to December 2020


Budget Breakup 2020

Health

20,878

41%

Nutrition

20,878

41%

Administration

8,841

18%

Total Grant Approved

50,597

100%