Strengthening of Nutrition Infrastructure in Sabarkantha, Gujarat

Project Vruddhi- an initiative by Action Against Hunger, is committed to supporting the efforts of the Health and Women & Child Development Department (WCD) within the Government of Gujarat to support the accelerated realization of the goals outlined under Poshan Abhiyan. With a focus on enhancing health and nutrition service delivery systems, the project aims to lend technical assistance to the taskforce overseeing Maternal, Infant and Young Child Nutrition (MIYCN) under the Health and ICDS scheme.  Additionally, it strives to equip the district officials with leadership acumen and Supervisory cadre with supportive supervision skills, thereby fostering sustainable progress.

In alignment with this vision, a two-day training workshop was organized for Sabarkantha district officials across both the departments in collaboration with the Department of Health and ICDS – WCD, Zilla Panchayat, Sabarkantha between December and February 2024.

Dr. Raj Sutaria, CDHO Sabarkantha, Dr. S. H. Dedhrotiya, RCHO Sabarkantha, and Manisha Brahmbhatt, Program Officer, ICDS, were the key guests at these workshops.

 1.Leadership Excellence: Igniting Potential, Inspiring Action 

The Leadership Excellence workshop, organized in December 2023, aimed to equip participants such as Programme Officers and Taluka Health Officers with essential leadership skills, enhance their strategic thinking, and inspire them to lead with authenticity and impact. The workshop incorporated theoretical knowledge, interactive activities, and practical applications to provide participants with a comprehensive understanding of leadership essentials.

 2.Empowering Health and ICDS Supervisors: A Workshop on Leadership and Enhancing Supportive Supervision 

Empowering Health and ICDS Supervisors workshop, organized in February 2024, aimed to equip participants such as Female Health Workers (FHS), Multi-purpose Health Workers (MPHW) from the Health Department, and Lady Supervisors from the ICDS – WCD Department with knowledge, skills, and tools to become effective leaders and supportive supervisors within their organizations. This workshop served as a platform to share experiences and network.



From Despair to Hope: Kishan’s Journey in Gram Chaurakhadi, Madhya Pradesh

Gram Chaurakhadi is nestled along the banks of a river, near the border of Madhya Pradesh, and is surrounded by mountains on all sides. The village is predominantly inhabited by the Sahariya community. While the primary health center is located 15 kilometers away, the sub-health center is closer, situated 5 kilometers away in Bil Kheda Dang.

On June 14, 2019, during a screening session, Kishan was identified as severely malnourished, with a MUAC (Mid Upper Arm Circumference) of 94. His mother passed away when he was just 5 months old, and since then, he has been under the care of his grandmother, Dulari Bai Sahariya, and his grandfather, Mohanlal. When Kishan developed diarrhea and fever, his family sought help from practitioners of witchcraft, but his condition did not improve. As part of these rituals, a goat was sacrificed twice, costing them more than 10,000 rupees. Despite visiting a private doctor in Devri, Kishan’s health continued to deteriorate.

Following a screening conducted by our community mobilizer, it was evident that Kishan’s condition was critical. His grandparents and father were immediately informed about the Malnutrition Treatment Center (MTC), and Kishan was admitted on the same day.

After some initial improvement, Kishan’s grandmother brought him back to the village without consulting the doctor, staying at the MTC for only 5 days. Since Kishan was still unwell, he was sent to the Baran MTC for further treatment through the Anganwadi worker and our community mobilizer. After a noticeable improvement, Kishan’s grandmother brought him back home, following the doctor’s advice. Subsequently, our community mobilizer made regular follow-up visits to Kishan’s home, guiding his grandmother on preparing nutritious meals and providing nutritional support from the Anganwadi. The visits emphasized the importance of nutrition and a balanced diet. The Anganwadi worker was also instructed to visit Kishan’s home regularly.

Through persistent efforts, Kishan’s condition gradually improved. Today, seeing him smile and play, we are immensely gratified.

Empowering Baran: Project Navodaya’s District Workshop in Rajasthan

Action Against Hunger (ACF) India organized a two-day workshop to share the learning and experiences of Project Navodaya, supported by the SBI Life Insurance, in Baran, Rajasthan, which is an aspirational district. As this was the exit year of the project, ACF also used the opportunity to hand-over the project to the district administration which was represented by the District Medical Health Officer, Dr. Sampath Raj Nagar.

Dr. Nagar appreciated the efforts of ACF in helping administration upgrade the skills of ASHA and Aanganwadi workers (AWWs) as well reaching out to beneficiaries with targeted interventions for pregnant and lactating mother, low-birth babies, and malnourished children under the age of 5. He also emphasized the contribution that ACF made in the most backward tribal areas of the district namely Kishanganj and Shahbad.

Dr. Nagar also highlighted that while earlier there were issues with the record keeping and proper documentation of ANC & PNC check-ups as well as screening data by ASHA and Aanganwadi workers, the same saw major improvements thanks to ACF field and technical staff who for almost around five years provided day to day support to ASHAs and AWWs, monitoring and supervision assistance to the administration, and timely reporting of crucial data to the top district officials.

While handing over the project to the Baran administration, ACF India’s Chief Operations Officer Dr. Ulhas Vasave hoped that ACF’s prioritization of maternal and child health in Baran as per 1000 days approach will remain relevant for the district administration to execute their programs and plans. He further said that the learning and experiences of ACF’s work in Baran will help the organization to further its agenda eradicating malnutrition from the areas where we work.

Project Navodaya, that was a five-year grant from the SBI Life Insurance, comes to an end in Baran and Dhar districts of Rajasthan and Madhya Pradesh where it targeted pregnant & lactating mothers and malnourished children. Project’s emphasis on system strengthening and behavioral change through community engagement saw some high impact outcomes. ACF team feels confident that the improvements that the project saw in these two districts are of sustainable nature as the focus of Project Navodaya was always on empowering frontline workers and communities rather than treating them just as some service recipients or beneficiaries.



Ankleshwar, Gujarat

Project Sampurna launched in Ankleshwar, Gujarat is supported by Glenmark Life Sciences and implemented by Action Against Hunger India. The project adopts a comprehensive life cycle approach, seamlessly integrating health and Integrated Child Development Services (ICDS) to provide holistic support to the community.

As part of the initiative, Project Sampurna will conduct a robust baseline assessment, anemia screening in adolescent girls and screening for malnutrition amongst children. Our commitment extends from the pre-conception stage in girls through adolescence, incorporating Social and Behavior Change Communication (SBCC) interventions aligned with a 1000-day approach.

This project is poised to make a significant impact on the health and well-being of mothers and children up to 5 years old. We ensure timely referrals for facility interventions when necessary, ensuring that every child receives the care they need for a healthy start in life.

Our goal is to sculpt a robust, anemia-free India with a focus on nurturing a healthier nation.



Project Shubharambh: Empowering Adolescent Girls Against Anaemia

India’s National Family and Health Survey – 5 (2019-21) highlights a concerning rise in the prevalence of anaemia among women of reproductive age, with an alarming 57%. This signifies a 7.3% increase from NFHS 4, indicating a pressing need for targeted interventions. In the adolescent demographic, the increase is even more pronounced at 9.2%, escalating from 54.1% to 59.1%.

In response to this health crisis, Action Against Hunger India has launched Project Shubharambh, a pilot initiative in Sanand, strategically aimed at mitigating the burden of anaemia among adolescent girls.

Objectives:

  • Proactive Anaemia Testing and enhancing the quality of T3 (Test, Talk, Treat camps)
    • Strengthening T3 (Test, Talk and treat) camps to facilitate early identification and testing of anemia amongst adolescent girls.
  • Alleviating Burden on Specific Adolescent Girls:
    • Targeting high-prevalence areas in Sanand to focus resources on those most in need.
  • Nutrition Health Education sessions: Organizing nutrition and health education sessions and guiding adolescent girls on the basics of anaemia, its prevention, and treatment.
  • Community Engagement and leveraging festivals
    • Integrating community engagement and awareness programs by leveraging festivities of the traditional dance, Garba organized during and after the festival of Navratri to raise awareness on anaemia at the school and community settings.

Capacity & Ecosystem Strengthening:

In parallel, Action Against Hunger India is committed to strengthening the healthcare ecosystem. The organization will provide:

  • Capacity-Strengthening Training:
    • Focused capacity building of frontline functionaries of health and ICDS department by strengthening the current practices of identification, prevention, and treatment of anaemia.
  • Sustainability Measures:
    • Promoting sustainable practices of consuming locally and traditionally available iron rich foods in anaemia management to ensure long-term impact.
    • Establishing partnerships with local authorities and stakeholders to integrate anaemia prevention into routine healthcare services.
    • Promoting awareness among family members and adolescent girls to recognize the initial visible signs of anemia, encouraging adolescent girls to undergo testing, and facilitating early identification, prevention and treatment. This initiative not only aims to sensitize the community but also strives to promote the utilization of government-provided programs and facilities under anemia control initiatives such as free distribution of IFA tablets at schools and community settings and ensuring its consumption

Project Shubharambh is a holistic initiative designed to combat the rising numbers of anaemia among adolescent girls in Sanand. By combining targeted interventions, community engagement, and capacity-building efforts, Action Against Hunger India aims to create a sustainable model that can be scaled up to address anaemia challenges nationwide. Together, we strive for a healthier and brighter future for the adolescent girls of Sanand.



An Action Taken For Nutrition: Read Mayawati’s resilient story towards a Healthier Tommorow.

In the remote village of Doondabar, Rajasthan lies a close-knit community of the Shahariya tribe, heavily reliant on the forest, agriculture, and daily labor for their sustenance. Amongst them, 10-month-old Mayawati’s (name changed) family struggled to make ends meet, with her parents working as daily wage laborers, earning a meager income of INR 25000/- per year.

During a routine screening, Mayawati was identified as severely acute malnourished (SAM), weighing only 5kg with a Z-Score of <-3SD. Our dedicated team, determined to help Mayawati, engaged in extensive counseling efforts to convince her mother to admit her to the nearest malnutrition treatment center. Although Mayawati’s mother agreed initially, the celebration of festivals led her parents to reconsider, and they brought Mayawati back home after two days of admission.

Undeterred by the setback, we enrolled Mayawati into the ‘Naya Savera Programme,’ a government initiative to combat malnutrition at the community level through energy-dense nutrition supplements. Despite facing challenges of inaccessibility due to heavy rainfall and adverse weather conditions, our team ensured that Mayawati received regular EDNS supplies through the Anganwadi Worker and ANM.

Monitoring her health and growth was not easy, but our team persevered. We provided the family with extensive orientation on health practices, nutrition, WASH practices, and even cooking demonstrations, ensuring they were equipped to care for Mayawati effectively.

Her health condition had left her unable to walk and visibly irritated, but with constant efforts and regular support, Mayawati began to show signs of recovery. A few moths later, her measurements were truly heartening, with her weight at 8.1kg, height at 74.5 cm, MUAC at 125 mm, and Z-Score at 1SD

Mayawati’s transformation was astounding. From a SAM child to a normal, happy, and active little one, she even began walking, much to the joy of her family and the entire community. This inspiring journey of recovery exemplifies the power of dedicated efforts, timely interventions, and community support in combating malnutrition, even in the most challenging environments. Mayawati’s story is a testament to the impact that proactive and caring organizations like ours can make in the lives of vulnerable children and their families.

From Despair to Recovery: The Inspiring Journey of Prema – A Tale of Community Mobilization, Collaboration, and Triumph Over Malnutrition

The case story of Hiral (name changed) is a testament to the dedication and effectiveness of community mobilizers like Tejas Korada, and the collaborative efforts of Action Against Hunger India, ICDS, the health department of Jawhar P.S., and local NGOs.

In the Katkari hamlets of Nandgaon village, Tejas our community mobilizer was conducting routine screening activities when he came across Hiral (name changed) and her daughter Prema (name changed). Immediately recognizing the signs of malnutrition in the 22-month-old child, Tejas decided to screen her for further evaluation. The screening revealed that Prema’s weight-for-height Z score was -3SD, indicating severe acute malnutrition (SAM).

Tejas wasted no time and, together with an Aanganwadi worker, visited Prema’s household to inform her caregivers about the seriousness of malnutrition and the need for immediate treatment. The caregivers were counseled on various aspects of malnutrition and convinced to admit Prema to the Nutrition Rehabilitation Centre (NRC) at the sub-district hospital in Jawhar.

On the same evening, Prema was admitted to the NRC, where she stayed for 14 days undergoing treatment as per protocol. Tejas provided continuous follow-up during her stay, ensuring she received the care and attention she needed to recover. However, upon discharge, it was observed that Prema had only gained 0.2 Kg of weight during her time at the NRC, which was not sufficient for her full recovery.

Recognizing the need for further intervention, Action Against Hunger India, ICDS, the health department of Jawhar P.S., and a local NGO jointly organized a health check-up camp for SAM and MAM children who were not showing progress despite treatment. Prema was referred to this camp, and transport arrangements were made to ensure her attendance.

During the camp, Prema underwent a thorough examination, and her blood and sputum samples were sent for testing. The results revealed that her hemoglobin levels were dangerously low, necessitating a blood transfusion. Additionally, it was discovered that Prema had developed a pediatric tuberculosis infection, and she was immediately put on medications to begin her treatment.

Throughout this challenging period, Mr. Tejas Korada continued to provide unwavering support. He conducted home visits to ensure Prema was receiving proper medication as directed by the medical officer.

In November, as part of routine follow-up, Prema was screened again, and the results were heartening. Her weight had increased to 8.00 Kg, and her height remained at 71 cm. Her weight-for-height Z score was now at -1SD, indicating that she had successfully overcome malnutrition and was on the path to recovery.

The success of Prema’s treatment was not only due to the efforts of the healthcare professionals and the community mobilizer but also because of the accountability and dedication shown by Prema’s caregivers. The timely and effective referral to institutional services played a vital role in ensuring Prema received the necessary medical attention and recovered from malnutrition.

Empowering Change: Shaneen Sheikh’s Inspirational Journey in Maternal and Child Healthcare Advocacy

Shaneen Sheikh’s (name changed) journey in Nehru Nagar slum became an inspiring case study for the dedicated team working on maternal and child healthcare. At 27 years old, Shaneen lived a modest life with her husband and children in a rented house, with her husband being the sole breadwinner for the family. It was during her second pregnancy that she enrolled with us in our healthcare program aimed at supporting pregnant women and new mothers in the slum.

Throughout her pregnancy, the healthcare team diligently visited Shaneen’s house, providing her with essential prenatal care and educating her about the significance of exclusive breastfeeding for her newborn. Shaneen seemed committed and assured the team that she was following their instructions carefully.

In November, Shaneen gave birth to her baby, and the team continued their regular visits. However, during one visit in April, Shaneen informed the team that she had visited Cooper Hospital and obtained the necessary medicine for her baby’s condition. However, she also revealed that her family had started giving complementary feeding to the baby, contrary to their earlier advice on exclusive breastfeeding.

The team didn’t lose hope and persisted in educating Shaneen about the significance of exclusive breastfeeding until the baby reached six months of age. They explained the potential risks of introducing solid foods too early and the benefits of breast milk for the baby’s overall health and development. Shaneen, despite her family’s pressure, promised the team that she would not initiate any complementary feeding until her baby completed six months.

Shaneen’s determination to prioritize her baby’s health and follow the team’s guidance even amidst familial pressures impressed the healthcare workers. Her willingness to embrace change and learn about better healthcare practices made her a role model for other mothers in the community.

The success story of Shaneen Sheikh and her baby became an example of how education, persistence, and genuine care can make a significant difference in the lives of vulnerable families. The healthcare program in Nehru Nagar slum continued its mission, inspired by Shaneen’s journey, to improve maternal and child healthcare outcomes in the community.

Unveiling Project Sampurna: Sculpting a Healthier Tomorrow in Ankleshwar, Gujarat!

The launch of Project Sampurna in Ankleshwar, Gujarat, supported by Glenmark Life Sciences and implemented by Action Against Hunger India, marks a pivotal moment in our collective journey. The project adopts a comprehensive life cycle approach, seamlessly integrating health and Integrated Child Development Services (ICDS) to provide holistic support to the community.

As part of the initiative, Project Sampurna will conduct a robust baseline assessment, anemia screening in adolescent girls and screening for malnutrition amongst children. Our commitment extends from the pre-conception stage in girls through adolescence, incorporating Social and Behavior Change Communication (SBCC) interventions aligned with a 1000-day approach.

This project is poised to make a significant impact on the health and well-being of mothers and children up to 5 years old. We ensure timely referrals for facility interventions when necessary, ensuring that every child receives the care they need for a healthy start in life.

Our shared goal is to sculpt a robust, anemia-free India by addressing health challenges at their roots. The project is a testament to the transformative power of unity, illustrating how collaboration can pave the way for a healthier and brighter future for all.

This initiative is not just about addressing immediate health concerns but is a long-term commitment to fostering a community that thrives. Join us in this journey as we work together to create a meaningful and lasting impact on the lives of the mothers and children we aim to serve. Together, we can build a healthier, brighter tomorrow.

 



Unquenchable Thirst: The Endless Water Crisis in Rural India by Dr Roshni Vakilna

Picture Courtesy: The Gray Matter

As we mark World Food Day under the compelling theme, “WATER IS LIFE, WATER IS FOOD. LEAVE NO ONE BEHIND,” it’s imperative that we reflect on the profound role that water plays in shaping our lives, economies, and ecosystems.


Dr. Roshni Vakilna
serves as the Technical Lead for Project Vruddhi at Action Against Hunger in Gandhinagar, Gujarat. Her dedication and expertise are driving innovative solutions to combat hunger and create a brighter, more sustainable future for communities in need. Dr. Vakilna, a brilliant mind is a passionate advocate for positive change.

Water is the lifeblood of our planet, an indispensable element that not only sustains us but also underpins the very foundation of our global food systems. As we mark World Food Day under the compelling theme, “WATER IS LIFE, WATER IS FOOD. LEAVE NO ONE BEHIND”, we must reflect on the profound role that water plays in shaping our lives, economies, and ecosystems.

With over 50% of our bodies composed of it and 71% of the Earth’s surface covered by it, water’s significance is undeniable. However, the troubling reality is that while only 2.5% of water is fresh and suitable for essential purposes like drinking and agriculture, we are facing an unprecedented challenge. Rapid population growth, urbanization, economic development, and the relentless impacts of climate change are straining our precious water resources, pushing them to the brink.

As fresh water becomes scarcer, it’s often the world’s most vulnerable communities, including smallholder farmers, Indigenous Peoples, migrants, and refugees, who bear the brunt of this crisis, sparking competition and conflicts over access to this life-sustaining source. In this pressing context, it is our collective responsibility to safeguard this invaluable resource and ensure that no one is left behind in our pursuit of a sustainable and equitable future.

In rural India, the struggle for access to clean and sufficient water is an ongoing crisis that refuses to relent. Recent data underscores the severity of the issue, with nearly one-fifth of rural habitations falling short of the minimum entitled water quantity of 40 liters per capita per day, equivalent to just two buckets a day. This water scarcity intensifies during the dry season, ushering in a period of dire need. With the onset of summer, media reports flood in from various corners of the country, highlighting the escalating drinking water crisis. For weeks, if not months, a significant portion of India’s population—especially those in rural areas—grapples with the harsh reality of water scarcity. During this time, millions of rural residents, along with their livestock, embark on a relentless battle for survival. It’s a recurring nightmare, exacerbated by insufficient rainfall and drought-like conditions in various parts of the nation. Reports indicate plummeting groundwater levels, dwindling lakes, drying wells, reservoirs, and rapidly vanishing dams.

As the mercury soars and heatwaves become increasingly severe, several regions in Gujarat face an alarming water crisis, particularly affecting Saurashtra, Kutch, North Gujarat, and parts of tribal areas in central and South Gujarat. Over 20 districts suffer from severe water scarcity, with towns and villages receiving water only twice a week. In more than 500 villages across 14 districts, drinking water is delivered via tankers, a number expected to rise.

The crisis manifests differently in rural and urban contexts, influenced by various factors such as water supply systems, institutional accountability, socio-economic conditions, and reliance on different water sources.

Historically, rural areas have leaned on community-managed water sources, like wells and ponds, accessible to specific communities. Public or common property sources, including lakes and rivers, were also used for drinking. A minority of affluent households had exclusive water sources. This reliance on community water sources introduced its own set of challenges, including laborious water collection processes, poor water quality, seasonal shortages, and a lack of maintenance. Additionally, certain social groups were excluded from specific water sources. In response to these challenges, individual and household-level piped water supply systems were introduced to complement community sources. Access to piped water at the household level came to be seen as an indicator of an improved standard of living, particularly in urban areas. This concept gradually extended to rural India in the era of local governance. Since Independence, numerous programs have aimed to provide rural households with individual water connections, a goal that remains central to all drinking water schemes today. However, despite decades of effort, progress in this area remains limited and unsatisfactory. Recent statistics reveal that only 18% of rural households have piped water supplied to their dwellings. Over half of rural households still rely on public or common water sources. The Comptroller and Auditor General (CAG) noted that despite an expenditure of Rs 81,168 crores, the coverage of rural habitations only increased by 8% at 40 liters per capita per day during 2012-17. More than half of rural households (51%) rely on sources like tubewells, handpumps, or borewells for their water needs, sources that often run dry during the summer as groundwater levels decline.

The decline in community and common property water resources, along with neglect and privatization by dominant rural sections, has led to their progressive disappearance from the rural landscape. Government water supply programs have fallen short in establishing sustainable water supply mechanisms. These programs often prioritize achieving numerical targets rather than ensuring the sustained availability of water. Consequently, there are few efforts to introduce techniques that can preserve local sources, preventing scarcity and fluctuations in drinking water availability. It’s crucial to preserve, conserve, and revive traditional and common water sources with public and state intervention as part of water supply programs. Simultaneously, access to common resources should not replace the provision of household-level piped water connections. These approaches must complement each other, adapting to local needs and conditions. Such efforts are especially critical in drought-prone regions to ensure access to clean, reliable water throughout the year.

It’s the moment to embark on a journey of prudent water management! What steps should YOU take?

    1. Rethink Our Relationship with Water: It’s crucial for all of us to recognize the value of water and cease taking it for granted.
    2. Mindful Food Choices: Our food choices have a significant impact on water resources. Opt for locally sourced, seasonal, and fresh foods to reduce water consumption in food production.
    3. Minimize Food Waste: Cutting down on food wastage is another way to conserve water. Be mindful of how much food you buy and consume and find creative ways to use leftovers.
    4. Safe Reuse Practices: Embrace safe methods of reusing water while being vigilant about preventing water pollution.
    5. Collaborative Action: Together, as a collective, we can take meaningful steps towards securing a sustainable water future for food, people, and our planet.

“Originally written and edited for The Gray Matter