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Location

15 villages of Pohri block in Shivpuri district of Madhya Pradesh
Thematic Focus: Health and Nutrition


Background of the Project

Vikas Samvad Samiti (VSS) is a resource organization that has partnered with CRY since 2007. The project holder is Mr. Sachin Jain, established Vikas Samvad Samiti with an objective to give a new shape to media advocacy on CR issues. He has written over seven hundred articles and features on socio-economic and political issues affecting the marginal groups of society. As an active member of Right to Food Campaign, he has played a key role in bringing the ‘Right to Food Update’ to keep organizations, activists, district administration and government informed about the latest developments in the matter of food security. VSS started to implement this project in 10 villages of Pohari block of Shivpuri district in April 2017 considering the criticality of health and nutrition issues among children of Saharia tribal community here.

Problem Statement:


Madhya Pradesh, a state in central India, is home to more than 50 tribes of varying population size and the Sahariyas are one of them who are residing predominantly at Shivpuri. The health status of this tribe is extremely poor due to malnutrition, lack of proper hygiene and illiteracy. Lack of proper nutrition, especially protein-deficient diet taken by children, very often predisposes them to diseases like Marasmus and Kwashiorkor & TB. The Sahariya is a primitive tribe, who traditionally live in the jungle and make handicrafts such as pottery, baskets etc. They do hunting, fishing and primitive ways of farming.

The situation is even worse in the 10 intervention villages where the project has been operating for the last one year. In these villages, VHNDs (Village Health and Nutrition Days) are not observed at. However, ANMs started visiting these villages as a result of stakeholder’s pressure after this project has been initiated. But, such visits are done only once in 3-4 months which needs to improve drastically. Almost 60% of pregnant women have no MCH (Mother and Child Health) cards with them and the percentage of institutional delivery in the area is 78%. High incidence of infant and child mortality is also a common feature in the area. There were 6 cases of child deaths and 1 case of maternal death associated with pregnancy & child birth during the year. There were 20 cases of miscarriages and 6 cases of stillbirths among Sahariyas during the year 2018. Lack of awareness among communities is a major factor contributing to these deaths apart from the poor services at health facilities. The problem is still very huge as the only one doctor is posted at CHC (Community Health Center) in Pohri and this CHC, on an average, attends to 70-80 deliveries a month. The ICDS (Integrated Child Development Scheme) Anganwadi centers which play a crucial role in ensuring proper nutritional status of children is almost defunct. Only 8 out of 15 Anganwadis are functioning as per norms. Only 2 out of 15 Anganwadi workers are from Sahariya community which again results in discrimination and possible poor engagement between Anganwadi Worker and the target community. There is also an acute shortage of ICDS centers as 15 centers are catering to 1704 children which means each center is catering to more than 100 children.

Achievements & Impact


Program Activities Planned Progress and Achievements

Result Area: 100% access to free, quality primary health care in 15 intervention areas as per latest govt. policy during the on-going year 2019

* Conduct monthly meetings with ASHAs (Accredited Social Health Activists) on administering Arogya Kendras (health centers for high risk pregnant mothers).
* Constitute Village Health, Sanitation and Nutrition committee (VHSNC) in all 10 new villages and orient them on their roles and responsibilities.
* Develop 3 model VHSNCs and ensure they are regularly monitoring Village Health and Nutrition Day (VHNDs), they are meeting regularly, properly prepare village development plans, and the untied fund is properly utilized.
* Preparation of 12 Village Report Cards on topics related to maternal health and 12 village centric advocacy plans based on the gaps identified in Village Report Cards.

* Capacity building of ASHA Workers was done on topics related to medicine handling and basic tests like blood pressure / hemoglobin etc. Improvement has been observed in the knowledge and practices of ASHA workers especially with respect to medicine handling.
* VHSNCs were constituted in all newly selected 10 villages.
* 85% of children aged 9-12 months were immunized as a result of structured home visits, improved accessibility to healthcare services, closely monitoring of immunization and ANCs (ante-natal check ups) by the community, identification of high risk cases by the project.
* 53% mothers of children aged 6-9 months have exclusively breastfed their child for 6 complete months.


Program Activities Planned Progress and Achievements

Result Area: Reduction in maternal, infant and child deaths in our intervention areas by at least 10% against last year, by the end of the on-going year 2019.

* Preparation of the 1000 days study report (conception to 2 years of age).
* Organising 2 Poshan Samvad sessions with frontline health workers (ASHA, AWW-Anganwadi Workers, and ANM).
* Conducting regular home visits to identify pregnant women, lactating mothers, adolescent girls, children, and high risk pregnancies, to counsell them on various services available, care and proper diet, menstrual hygiene management, ante-natal and post-natal care practices.

* 100% children are providing cooked food in the ICDS Anganwadi centers.
* Regular home visits and VHND camps have enabled to reduce malnourishment in the area. Currently 32 children out of 867 have been identified as SAM and referred to NRC.
* 80% of pregnant women have delivered babies in health care institutions.


Program Activities Planned Progress and Achievements

Result Area: Reduction in number of Severely Acute Malnourished (SAM) children to zero in the project areas during the on-going year 2019.

* 15 Anganwadi Centers (AWC) to be made fully functional and nutritional diet to be ensured to all beneficiaries.
* Referring severely undernourished children to the Nutritional Rehabilitation Centers (NRCs) and conduct regular follow-ups after discharge.
* Ensure regular weight monitoring in the ICDS Anganwadi centers.
* Establishing 15 Nutri-Corners in all 15 Anganwadis. This will ensure a corner in the Anganwadi center always has food items such as gram, murmura (puffed rice), jiggery and dry food items.
* Strengthening core groups to monitor the functioning of ICDS center.

* 91% children (867 out of 954) were covered under AWCs weight monitoring process.
* 27 severely underweight children were identified during the year and all were sent to NRCs. While 22 have graduated to the moderate underweight category, the rest has come out of the danger zone.
* Kitchen gardens were initiated in 429 families with the help of core groups and the Horticulture department) and poultry had been distributed to 589 families with the help of the Animal Husbandry Department. Animal Husbandry department had distributed 45 chicks of Kadak Nath breeds Sahariya families in Pohri block for free of cost.
* 45 tribal farmers from 15 villages participated in a training organized in Pohri Block. It was aimed to capacitate on season appropriate agricultural practices and thereby ensuring food availability in the villages across all seasons and to eventually ensure nutrition security in the villages in the long run. Efforts were placed to introduce crops like sawa,millet, kodo, khudki rice etc.


Program Activities Planned Progress and Achievements

Result Area: 500 children from operational area acquired life skills and exercise their agency towards the fulfilment of their rights during the on-going year 2019.

* Creating awareness among the community on child participation through Nukkad Nataks (street plays).
* Organize one campaign at block level to spread awareness among the mass and government officials on the intensity of addiction cases in the villages and the need to take appropriate actions by the authorities.
* Conduct quarterly meetings in each village on preventive methods and consequences of tuberculosis.

* The project organized 4 Poshan Samvad, a forum for dialogue, facilitating face-to-face discussions on nutrition and health from children’s perspective with service providers and frontline workers of ICDS along with communities. The ICDS supervisor, ANMs, ASHAs and AWWs in the area attended the program. As a result, service providers from the intervention areas are now giving more attention to children, and the weight monitoring process and immunization is also streamlined across all villages.
* 189 women participated in food demonstration sessions organized in 15 project villages.

Other Highlight Processes and Achievements – 2019


VSS core group led campaign on health, nutrition and addiction: Substance abuse is a significant problem in Pohri & Shivpuri, and is a matter of high concern. A large number of women and children are addicted to it and it has a direct impact on their overall health. Also, Shivpuri being one of the highest tuberculosis prevalent districts in the country, substance abuse was somehow hindering the recovery process in patients. During July, the project organized a month long sensitization campaign in the intervention villages on the consequences of substance use. Street plays were performed and meetings held on the consequences of substance as a part of the campaign. Also, through media and wall paintings, the intensity of the issue was shared to the larger audience. This campaign had helped in convincing the health department to initiate to develop an action plan to immediately address the issue. As per the request submitted by the project to establish a de-addiction center in Shivpuri, the health department has established a de-addiction center in Shivpuri district hospital in November, 2019.

Plans


Key Result Areas Program Activities Planned

Strengthen access to essential health and nutritional services and entitlements under various welfare schemes

* Conduct 2 training sessions for ASHA workers on handling medicine and basic tests like blood pressure / haemoglobin tests.
* Organise 12 monthly meetings with AWWs, ASHAs and ANMs on various topics related to continuum of care (MCH) such as adolescence, basic preparations before pregnancy, care during pregnancy & birth, postnatal care of mother and child, motherhood, infancy, childhood.
* Facilitate interface meetings among community, health officials, ANM, ASHA to ensure frontline service providers such as ANM & ASHAs are regularly visiting Arogya Kendras, constant registration of new pregnancies, regular monitoring of their health, timely immunizations, distribution of IFA tablets and maintaining nutrition corners in each of the 15 ICDS AWCs.
* Conduct 3 Refresher training of all 15 VHSNCs, and ensure the 3 model VHNSCs are regularly monitoring VHNDs, conducting meetings regularly, have properly developed village development plan, and fully utilizing untied funds.
* Linking 200 pregnant and lactating mothers with the existing govt. schemes like PMMVY.



Key Result Areas Program Activities Planned

Reduce malnutrition (SAM & MAM) among children, pregnant women, lactating mothers and adolescent girls in the project area

* Ensure 70% families are linked with the PDS scheme.
* Conduct growth monitoring in 15 ICDS Anganwadi centers regularly through ensuring 100% enrolment and maintaining growth charts.
* Conduct capacity building sessions with Anganwadi Workers, ASHA and Community Workers on malnutrition and mitigation strategies.
* Conduct nutritious food demonstration sessions in all 15 intervention villages of Shivpuri with the families having pregnant, lactating and malnourished children, and guide them on maintaining Kitchen Garden and poultry to address malnutrition at family level economically.



Key Result Areas Program Activities Planned

Improve community and stakeholder’s understanding and approach to child protection issues.

* Conduct 12 community level orientation meetings to sensitize community on ICPS and child protection related issues.
* Facilitate 60 interface meetings between community and stakeholders involving officials from ICDS, ICPS, WCD, Child line etc. to discuss child protection issues and to improve infrastructures and reporting mechanisms to secure child rights.
* Conduct one Kala Jatha (using Nukkad Natak, rallies, IECs materials etc.) to build awareness among general community on child labor, child sexual abuse (CSA), child marriage etc.
* Capacity School Management Committees (SMCs) to identify school dropouts/ never been to school from respective villages to ensure 300 re-admissions.



Key Result Areas Program Activities Planned

Strengthen agencies among children

* Transact CRY Child Center’s life skill modules among adolescent and youth group members to capacitate them so that they can exercise their agencies.
* Conduct workshops and promotional meetings to ensure at least 100 children from project families participate in local level sports events.
* Organize 2 rounds of sports competitions to promote sports among children from project communities & families.

Financial Summary: January to December 2020


Budget Breakup 2020

Health

12,008

28%

Nutrition

12,008

28%

Administration

18,593

44%

Total Grant Approved

42,609

100%