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Location

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


Project Background

Doaba Vikas Evam Utthan Samiti (DVEUS) has been implementing CRY project in 35 villages in 3 blocks (Manjhanpur, Saraswan and Kaushambi) in Kaushambi district in Uttar Pradesh with the aim to uplift people living there. 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 youth 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 and 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 among 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.

The status of children in the project district is abysmal, as has been reported by NFHS-4 data of the district. Almost 53% of children under the age of 5 are underweight and 67% of children in the 5-59 months age-group are found to be anemic. Only 30% of children under the age of 3 were breastfed within the first hour of birth and only 35% of 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 old were covered under growth monitoring, among them 9% were (345, 185 girls and 156 boys) were found to be Severely Acute Malnourished (SAM). Another 37% (1,171, 599 girls and 572 boys) were found to be 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 headquarters for care and treatment of severely acute malnourished children. The community finds it difficult to travel and stay for 14 days due to other family commitments 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 areas 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 boy and 6 girls), 15 stillbirths (11 boys and 4 girls), and 5 maternal deaths have been reported in 2018 which broadly captures the gravity of the issue. Out of 30 infant deaths, 18 were neo-natal deaths which occurred within 28 days of birth. Follow up plans are not prepared by the local health workers including proper identification of high risk pregnancy, delivery plans along with proper ANC (Antenatal Check-up) and PNC (Postnatal Check-up). Mother and child health cards are not properly filled which resulted in 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 the prescribed number of villages. Though infrastructures in health care institutions are there, there are serious gaps in staffing including pediatricians and gynecologists. The issue has been raised with government officials without any success. Absence of government health care services has been a boon for the untrained health practitioners/ quacks to lure the 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 the marginal community, 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 and working in brick kilns through seasonal migration. Implementation of employment guarantee programs (MGNREGA) and state livelihood mission is very poor and not reaching the deserving households. Apart from income poverty, there are prevailing community level superstitions and sorcery which further aggravate the child health and nutrition status. Healthy childcare 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, the government supported mechanism is poorly functional as the 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 norms which is yet to be fulfilled by the government. Non-implementation of hot-cooked food under the ICDS in the district for over a year is a sheer child rights violation under the 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

Result Area: 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 60 project villages.
• Promote colostrum feeding/ exclusive breast feeding/ complementary feeding in all the communities through timely Information, Education and Communication (IEC) material application.
• Ensure 100% of mothers of children aged 0-36 months old 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 Iron and Folic Acid tablets through community awareness meetings conducted on the usage of Iron and Folic Acid tablets.

• VHND meeting was organized in all the 60 villages during the period in which 2,738 mothers attended Village Health Nutrition’s Day celebration
• 714 birth plans for the pregnant and lactating mothers were prepared.
• 126 meetings happened with mothers in which 2,488 mothers attended the sessions.
• 92% of mothers were linked with JSY, PMVY, ANC, PNC and other government programs.
• 70% of mothers were registered in their first trimester.
• 63% of mothers received TT injections when they are in 2nd or 3rd trimester.
• 73% of mothers received 100 IFA- Iron and Folic Acid tablets.
• 92% of institutional deliveries happened during the period.
• 85% of children (0-1 year old) were completely immunized during the period.
• 71% of mothers conducted exclusive breast feeding to their babies for the first 6 months.


Program Activities Planned Progress and Achievements

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.

• 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, use of weighing machines and growth chart plotting etc.
• Ensure 90% of 49 AWCs are having drinking water availability within/ close to the premises.

• CMC training was held which addressed the importance of:
- Women making health decisions in partnership with the CMC counselor.
- Women’s wishes and choices being respected.
- CMC counselor helping to find solutions and generate alternatives to suit the women’s needs.
- CMC counselor respecting the women, ensuring confidentiality, and demonstrating a non-judgmental attitude.
• The sanitary hygiene behavioral change activities conducted in 30 villages. Free sanitary napkins were also distributed in coordination with RBSK team.
• A total of 2,100 free sanitary napkins were distributed during the period.
• 80% of villages have toilets, where every household is having toilets- 216 toilets constructed through partner engagement with stakeholders.
• Screening of the film took place in the 17 of the villages on various themes of gender rights, sanitary hygiene and life skill training.
• 1,309 children above 10 years old participated in 35 life skill training undertaken in project villages in which sessions on self-awareness, interpersonal communication, communication skills and sessions on health and hygiene were taken up during the orientation program.


Program Activities Planned Progress and Achievements

Result Area: Improve the food security and under-nutrition situation in the field area by improving the outreach of social welfare programs and agriculture practices.

• Influence preparation of district and block health plans while considering findings of last year.
• Undertake mapping of facilities for newborn care including NewBorn Care Units (NBSU) and Sick NewBorn Care Units (SNCU) as per the norms. Prepare status reports on facility based newborn care and sharing with Chief Medical Officer (CMO) and health departments to address the gaps.
• Ensure triple A (ASHA, AWW and ANM) coordination meetings are conducted in every quarter so that scheduled services are provided to the mothers of malnourished children (SAM and MAM).

• 97 low birth weight babies were found and are receiving continued care in the villages.
• 96 home deliveries were tracked during the period. After identification, DVEUS staff closely worked with the mothers and ensured exclusive breastfeeding for the child on one hand and on the other hand working to ensure diversified nutritional intake during pregnancy. Pregnant women were also convinced and motivated to initiate colostrum feeding and exclusive breastfeeding during the home visit.
• One training was organized with the ASHA, ANM and Anganwadi workers at the block level with the government for do’s and don’ts during Covid in which 153 first line duty bearers participated.

Covid Response by DVEUS:


1,240 households were provided Covid relief materials by the DVEUS team as an emergency relief response. The entire task was done in joint coordination with the district authorities, planned and executed under the guidance of district administration. The Panchayat members and Community Based Organizations (CBO) were also involved in the distribution of packaged materials. The entire relief material was audited by the government department. During the distribution, the norm for social distancing was maintained. DVEUS executed the Covid relief by:
• Ensuring that essential services for women and children are safely made accessible during and after the lockdown period
• Supporting the provision of continued access to essential health and nutrition services for women, children and vulnerable communities, including referrals in high risk cases.
• Supporting communities to access alternate livelihood mediums like MNREGA (Mahatma Gandhi National Rural Employment Guarantee Act)
• COVID risk communication and community engagement
• DVEUS alerted the district authorities on the prevailing hunger situation because of COVID

Engagement with children through Story Telling and Life-Skill sessions:


DVEUS in the Kaushambi district, Uttar Pradesh has been conducting sessions on life skills for adolescent girls and children using audiovisual techniques or Flip Charts. In keeping with all safety and distancing protocols, these sessions are intended to help them adopt healthy eating practices, making them aware of their rights, gender norms and sensitizing them about menstrual health and hygiene practices.


Work on Maternal and Child Health:


DVEUS work during the lockdown period was to address the issue of the existing hunger situation and to attend to ante-natal care and post-natal care in the target villages. The influx of migrant workers from different parts of the country has however increased the quantum of the work. The pressure on the healthcare system due to the pandemic and lack of clear guidelines has caused severe disruptions in access to maternal healthcare and antenatal services. The critical procedures affected include routine check-ups, scans, institutional deliveries, and follow-ups. The DVEUS team, during the COVID period, worked with health functionaries, opinion leaders and communities to understand and address the challenges and in the process empower the mother to confidently take health based decisions for herself and her child. During the lockdown period, the team focused on essential immunization like BCG (Bacilli Chalmette-Guerin) and OPV (Oral Polio Vaccine). In the recovery period complete immunization has been restored of every child in the project area through behavioral counseling and by maintaining safe distancing.

THR- Take Home Rations/ Nutritional Counseling /Public Distribution System /MNREGA[1]:


DVEUS during the lockdown and post lockdown period has focused extensively on the promotion of kitchen gardens/ zero disruption in the supply of protein rich THR (Take home rations) and continued counseling of mothers in line with government approved IEC- Information/education/communication materials like – MAA (Mother’s Absolute Affection) module of health ministry. The DVEUS team helped them by linking with social protection programs for the families who have lost their sources of income due to COVID
• 191 families were linked under PDS (Public distribution system)
• 1,300 households were promoted with kitchen gardens
• 6,300 individuals were linked in MNREGA (Mahatma Gandhi National Rural Employment Guarantee Act
• 100% (1,100 Pregnant and Lactating Mothers) were benefited with take home rations





Plans


Outcome Program Activities Planned

RMNCAH+N (Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition) services access and availability continued and continues in the project area

• Training Frontline Workers (ASHA, AWW, ANM etc.) on Covid related prevention and treatment measures to help families with young children and pregnant and lactating mothers
• Educating children and their parents and families about Covid and its risks and prevention measures.
• Ensuring proper handling of suspected cases (protocols, training, mentoring, monitoring, referral) from community to facilities

• Adapt all activities related to maternal care at community and facility level, to preserve at the least minimum service delivery (ANC[2]; PNC[3]; newborn care) based on principles of respectful maternal care.
• Utilize the immunization platform to preserve at the least minimum immunization services via adaptation of delivery strategies and to include COVID related support.

Enabling increased use and sharing of primary health services by building frontline health workers' capacity and ensuring continuity of critical maternal and child health services through VHND and ICDS services

• Support dissemination of State Guidance on VHNDs in the context of COVID to prevent transmission during delivery.
• Growth Monitoring and screening of Severely Acute Malnourished (SAM) cases by adopting more rapid less intrusive measures like observation based methods etc.
• Appropriate COVID prevention guidance for NRCs to be rolled out in Varanasi as in the government website and this to be tracked by the team.



Outcome Program Activities Planned

Ensuring good WASH[4] and waste management practices that serve as barriers to human-to-human transmission of the COVID-19 virus in homes, communities, health care facilities, schools, and other public spaces.

Covid Response Key Plan (WASH)
• Social distancing – avoid promoting activities that require person to person interactions (e.g. face to face training; mass hand washing stations).
• Hand Hygiene - Hand washing with soap and water frequently / sanitizing with 70% alcohol based hand-sanitizer.
• Maintaining overall cleanliness (no spitting in open spaces, correct disposal of waste). • Safe storage and handling of drinking water.


From this year forward, DVEUS will expand its intervention in the slum area of Prayag (Allahabad) city along with the previous operational area of Kaushambi district in Uttar Pradesh. The Key Responsibility Areas (KRA) for this new intervention are as follows:


KRA1: Educationally empowering children through Children Activity Center (CAC), who are dropped out, or are never been or, are in need of academic support by providing age appropriate competencies via digital literacy, sports in education, life skills and remedial education. The key focus will be on adolescents.
KRA2: Empowerment of communities in slums on quality education issues to improve demands.
KRA3: Ensuring enrollment, retention, attendance and quality of education improved in the slums of Allahabad district for the age group of 3-18 year old children (Target: Enrollment by 100 %, Retention by 80% , Attendance by 90% and improvement in quality mapped through learning outcomes)
KRA4: Networking with the education duty bearers at multiple levels for the improvement in infrastructure, human resource, mid-day-meal and quality education.

Plans


Following are the highlights of plans based upon the above KRAs:

Outcome Program Activities Planned

Children’s access to meaningful education was introduced through the onset of CAC.
Children attained age and subject specific competencies in a child friendly environment

• Tracking and child profiling of 6-14 and 14-18 year old children who are out of school or are in need of academic support.
• Implementing series of life skill sessions and sports in education as a part of regular curriculum in the CACs.
• Making the children tech savvy by digitally empowering them.
• Conducting periodic assessment for children and mainstreaming at least 5% of dropout children in formal schools.

Community got empowered on existing educational provisions and started making collective demands with the relevant authorities.

• Conduct orientation on ECCE[5]/RMSA[6] and RTE[7] amendments for the project staff, Community Based Organizers (CBOs)/School Management Committees (SMC) and parents.
• Ensuring 100% enrollment in elementary schools and 80% enrollment in secondary level across all the age groups.

Educationally Vulnerable communities identified in project slums and specific plans are in place to mitigate the situation.

• Empowering the School Management Committee (SMC) members on a regular basis and using them as a medium to bring in the desired change in the functioning of the schools.
• Focusing on girls’ education in slums which contribute to 50% of the total girl child drop out.
• Ensuring meetings with the migrant families and persuading them to enroll their children into schools by figuring out a feasible solution.

Quality intervention made in the project slums across the age group of 3-18 years old with sustainable outcomes realized

• Conduct a detailed mapping of the non RTE indicators like drinking water availability, teacher attendance etc. and sharing it with the concerned authorities.
• Ensure transition mapping is in place and thus provide children migration from pre-schooling to primary and primary to elementary and elementary to secondary education.
• Providing academic support to students in need of after school help to improve the learning outcomes.
• Highlight gaps in the RTE norms with the relevant authorities by correspondence and meetings.



Total amount disbursed in 2020 - 50,374


Financial Summary: January to December 2021


Budget Breakup 2021

Health

25,024

41%

Nutrition

3,514

6%

Education

18,298

30%

Participation

3,757

6%

Admin

9,997

17%

Total Grant Approved

60,590

100%