TAKING NUTRITION ACTION TO THE DISTRICT LEVEL: IDENTIFYING WORKABLE SOLUTIONS THROUGH CROSS-SECTORAL DIALOGUE IN UNNAO DISTRICT, UTTAR PRADESH

As noted in this blog post, POSHAN has been supporting civil society partners in convening nutrition-focused solution-oriented workshops at the district level. This is the first of what will be a set of reports on such workshops across Uttar Pradesh.  Please see our previous blogs on such workshops in Madhya Pradesh (click here).  We will be synthesizing and distilling lessons from these experiences in the coming months. Read on, and stay tuned!

In an effort to close gaps and meet challenges in nutrition at the district and block levels in the Unnao district of Uttar Pradesh (UP), an inter-sectoral convergence meeting with Integrated Child Development Services (ICDS) and the Health Department of UP, was organized by Vatsalya, a POSHAN partner, on May 24, 2014.

Dr. Neelam Singh, from Vatsalya, opened the meeting by sharing a documentary on child malnutrition. She said that the issue is a major concern for UP, with reduction rates at a poor 1% annually. She added that the line departments must work together in order to combat malnutrition. According to the National Family Health Survey (NFHS), 42% of children in UP in the age group of 0 to 5 years are underweight and 7% are severely malnourished.

For her part, Ms. Neha Sharma, Chief Development Officer of Unnao, encouraged ICDS to adopt a holistic vision and work to inculcate a stronger commitment among officials to overcome the problem of undernutrition in Unnao. She pinpointed the need for an “awareness generation,” particularly in areas where people are less educated, as well as effective counseling of mothers to ensure that malnourished children are admitted into government hospitals. She emphasized the need to understand the motive and responsibilities of ICDS and the Health Department to help overcome the “curse of malnutrition”. She urged department officials to provide briefings to Anganwadi workers (AWW) on the inter-generational consequences of undernutrition and support interpersonal communication between mothers and AWWs so they are able to create awareness and demand on the issue.

Further to this, Ms. Shree Masood, Unnao’s District Program Officer (DPO), stated that a campaign on weighing children to identify malnutrition was initiated by the District Magistrate and a list of the malnourished children by block was shared with the Health Department. She proposed a joint meeting of ICDS with the Health Department in each block every month to promote a multisectoral approach, with detailed sharing of data and problem-solving sessions to eradicate malnutrition from the district.

During the discussion, a major gap was identified namely, that Child Development Project Officers (CPDOs) and supervisors have yet to visit the Nutrition Rehabilitation Centre (NRC). Immediate action was taken by the DPO that a mandatory and regular visit by CDPOs to the NRC would be conducted in order to build their understanding of the services provided there to malnourished children.

Moving the discussion on NRC forward, Dr. A. K Chaturvedi, Chief Medical Superintendent of the Unnao District Joint Hospital, shared the criteria for children to be admitted at the NRC. He indicated that only three children were referred to the NRC in January 2014, compared to 14 children in November 2013.

Medical officers from two blocks highlighted a major lack of coordination between the Health and ICDS Departments which has led to a low identification, treatment and management of Severely Acute Malnourished (SAM) children in the district. An immediate decision was taken that the CDPO and the Medical Officer-in-Charge (MOIC) would collaborate to identify affected children in the districts and provide them with referral and treatment services. The vehicle engaged under Rashtriya Bal Swasthya Karyakram (RBSK) will be used to refer children to the NRC. This scheme screens children aged 0-19 for the four Ds: deficiency, disease, disability and developmental delays. The ICDS department was not aware of the RBSK program and micro planning services being implemented in the district, and it was agreed that regular information sharing must happen.

A monitoring checklist on the Aanganwadi Centre (AWC) was introduced during the meeting, which can be used to observe and analyze the gaps at the AWC level. The DPO instructed all CDPOs to use the checklist and compile a monthly report to analyze the gaps and take immediate action.

Action points that came out of the meeting included the following:

• District-level monthly convergence meetings to be held with the Chief Medical Officer, DPO, block MOICs and CDPOs
• ICDS to share lists of malnourished children block-wise with their respective medical superintendent/MOIC
• Referral of malnourished children to happen every Saturday
• Better referral and treatment of severely malnourished children at NRC by the CDPO and MOIC
• Block level coordination meetings to take place between ICDS and the Health Department
• Relocation of AWC in accordance with the sub–center, which will improve coordination between the supervisors, AWWs, Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs)
• Involvement of Panchayati Raj in nutrition-related activities through Village Health Nutrition and Sanitation Committees funds
• Regular visits to take place to NRCs by CDPO and supervisors
• RBSK to share micro plans with other departments
• Capacity building of AWW and ASHAs to form part of their monthly sector and community health center meetings
• Supervisors to provide support through visits to all AWCs once a month
• Completion of AWC observation checklist by all supervisors to be analyzed by CDPOs