The emergence of National Nutrition Mission (NNM) and its commitment to reduce the level of stunting, under-nutrition, anemia and low birth weight babies is a long awaited milestone towards a transformed nutrition landscape in India.
Improving nutrition in Indiawill require a multi-sectoral approach involving a wide spectrum of ministries and organizations addressing various aspects of malnutrition. The NNM has committed to undertake mapping ofvarious existing Government schemesdirectly and indirectly addressing malnutrition. Moreover, considering the diversity in the countryamong various states, even with existing national schemes, it is imperative to adapt differential strategies customized for various states and regions.
In Bihar every second child is stunted and every fifth child is wasted. The state leads the stunting level in India and requires a much more specific, integrated and intensive approach for the long run in the race against malnutrition. Among the potential stakeholders in the state,JEEViKA(the Bihar State Rural Livelihoods Mission, SRLM) stands out due to its formidable reach among the most vulnerable rural population, credibility among women in the population and its mandate related to poverty alleviation and vulnerability reduction through better nutrition and health in the family. JEEViKAis currently working with 714,000 women’s self-help groups in 534 blocks of all 38 districts of Bihar reaching nearly 8.5 million women and coveringaround 43million population which is 40.2% of entire population of Bihar. Integrating nutrition specific and sensitive interventions, through a social behavior change approach,into the JEEViKA self-help group and other community platformsis by far the most promising shotat improvingkey nutrition outcomes such asmaternal and child dietary diversity.
Project Concern International (PCI) India with financial support from Bill and Melinda Gates Foundation (BMGF), is collaborating with JEEViKA to provide Technical Assistance (TA) to create a Health, Nutrition and Sanitation(HNS) integrationmodel into the JEEViKA systems and community platforms. The major focus of this integration is on improving nutrition outcomes related to women and children in the first 1000 days period across 101 blocks of Bihar. The key outcome indicators around nutrition are 1) improving maternal dietary diversity 2) timely initiation of breast feeding 3) exclusive breast feeding and 4) complementary feeding with a special focus on dietary diversity.
Interestingly, the JEEViKA HNS integration model in Bihar, corresponds to the framework of the Jan-Andolan Initiative proposed in the National Nutrition Mission. The JEEViKA HNS model hinges around five population levers each building up towards creating a momentum towards mass awareness, action and change. The key levers being explored by JEEViKA HNS framework are: 1) BCC sessions in SHG meetings to increase awareness and collective action, 2) Reinforcement of messages through home visits to targeted beneficiaries by Health Sub Committee members 3) Generating community awareness, through community-level campaigns using line-listing of target beneficiaries, home visit to those beneficiaries, rally, video shows and recipe demonstrations 4) Navratnatool,an outcomebased peer review mechanism to track household and community level changes 5) Convergence with department of Health and Social Welfare for improving access and utilization of servicesat VHSND and Annaprassana Divas. Through these it is imperative that it aims at involving masses for their participation on nutrition through various activities which is similar to Jan Andoloan which has been envisaged in NNM as a key intervention.
Within two years of commencement of the program it was expanded by JEEViKA to 349 blocks of 32 districts from initial 101 blocks of 11 districts depicting ownership and interest of the state Government and huge acceptance of the program in the community. There are many promising early results and some of themare a) two-fold difference in dietary diversity (21% to 50%) outcome was found between the intervention and control arm after the intervention on session roll out along with collective cooking and feeding demonstration b) Knowledge of complementary feeding practices (dietary diversity) was significantly higher (28%-73%) in intervention areas and also among exposed C) Exclusive Breast feeding practice (24 hours recall) increased by >10 percentage point at population level (50% to 61%) after the intensive campaign on EBF.
The major learnings so far can be characterized as
- Integration of nutrition interventions in a wide reachingcommunity platform enabling rapid and sustainable changes at scale
- Communities’ involvement in their own change through community leaders, community cadre supported by an able steering of a well-organized and committed state livelihoods mission architecture
- Customized nutrition centric interventions with technical robustness,community friendly approach, adequate rigor, and, ensuring multiple exposure and dosage.
- Continuous program qualityassessment and monitoringusing Concurrent Measurement and Learning (CML) framework;rapid andeffective adaptation of learnings in program strategy and design.
With these confident steps and strides of the JEEViKA HNS experience in Bihar, it is time to take this Jan Andolan further.
Biraj Laxmi Sarangi
Technical Specialist- Nutrition
Project Concern International