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Community Involvement In
Promoting Neonatal & Infant Nutrition In Tribal Vadodara
Deepak Foundation
Vadodara
INDIA
Project supported by World Bank under SAR DM initiative
June 12-13, 2012
Knowledge sharing forum, Kathmandu 1
Barriers in Improving Infant Survival and Nutrition in Tribal
Areas
High level of maternal anemia
Suboptimal infant and young child feeding and care practices
Poor hygiene and sanitation & unavailability of clean drinking water
Under reporting, poor identification and referral of low birth weight
Lack of convergence of health and nutrition services at village level
Lack of systems to promote community ownership
June 12-13, 2012 2 Knowledge sharing forum, Kathmandu
Source: Mid term analysis of large scale PPP intervention study (2005)
Objectives
Broad Objective:
Improve neonatal and infant nutrition practices through convergence of inter
departmental government services and community participation
Specific Objectives:
Promote parental and community involvement in documenting birth date,
time of initiation breast feeding and birth weight with the help of horoscope
Conduct monthly health and nutrition days and distribute complementary
food premix “balbhog” and micronutrient supplements to 6-24 months old
Promote convergence of services through various government departments
June 12-13, 2012 3 Knowledge sharing forum, Kathmandu
300 randomly selected villages
from 4 tribal blocks of Vadodara
District, Gujarat (India)
Project Site
June 12-13, 2012 4 Knowledge sharing forum, Kathmandu
Gujarat State
Vadodara District
June 12-13, 2012 Knowledge sharing forum, Kathmandu 5
Study Design
Target Group:
Children below two years of age, pregnant and nursing mothers, community
members
Study Design:
Pre and post intervention design
Project Period: 18 months (January 2010 – June 2011)
The Innovation
• Use of horoscope as a cultural tool for sensitizing and eliciting
community participation in recording vital statistics and improving
nutritional status of under two children in tribal areas.
Horoscope in lieu of recording vital
information on :
- Date of birth
- Time of birth
- Time of initiation of breast feeding
- Birth Weight within 24 hours
June 12-13, 2012 6 Knowledge sharing forum, Kathmandu
Improved vital registration
and IYCF practices
Provision of horoscope to parents for
recording key indicators
Birth celebration through
community participation
Integration of services and
Water Testing Monitoring distribution of supplements
Community sensitization through wall
paintings
Strategy for implementation
June 12-13, 2012 7 Knowledge sharing forum, Kathmandu
Leveraging on existing large scale PPP project
June 12-13, 2012 Knowledge sharing forum, Kathmandu 8
Project Monitoring and Evaluation M&E Framework
Program Monitoring Evaluation M&E
approach
Indicators
Data Sources
Input •% ASHAs trained
Process
•% birth celebrations conducted •% children receiving health and nutrition services
Output •% newborns given horoscope •% LBW identified
Impact % infants in
normal category of Nutritional
Status
Outcome •Indicators of IYCF practices • % Birth registered •% LBW referral
NFHS (2005-6), DLHS-III, Baseline and Endline surveys , project MIS formats maintained by ASHAs , SMCS MIS formats
Targets: Increase recording of Birth Weight from 53% to >80%, Increase timely identification and referral of low birth weight babies from <1% to> 40%, Improve early initiation of breastfeeding from 27% to 80%, Reduce proportion of underweight children (<24 months) from 47% to <30%
Cluster level (15-20 villages)
Data Collection and Flow – Nutrition Project
June 12-13, 2012 9
Implementation Team
Associate Project Coordinator
Trainers Block Coordinators
M & E Officers
Office Assistants
ORWs
Facilitators
ASHAs
M& E Assistants
D&R Assistants
Knowledge sharing forum, Kathmandu
Lab. Technicians
Village level (1000 population)
Block level (100-150 villages)
MIS Team Training and Monitoring Team
M&C tracking
Register (SMCS)
Data verification
Monitoring
Data
Entry
Project Manager
Campaigns data
– Form 1
Newborn
Information
Form-2
Data processing & consolidation
June 12-13, 2012 Knowledge sharing forum, Kathmandu 10
Data Processing
Data Entry in Softwares 1. SAFAL net (SMCS) 2. Horo Software (Horoscope data) 3. Excel Sheet (Campaigns Data – 200 villages)
Data Reaches Head Office at District through Electronic Mail
Data Extraction for Monthly tracking of indicators of all Projects including Monitoring findings
Data verification and compilation during cluster level meetings
Data presentation and Review 1.Project Director 2.Block level teams
Data Collection Village level (1000 population)
Cluster level (15-20 villages)
Block level (100-150 villages)
District level (1548 villages)
Independent
Monitoring by
Facilitators in
20%
villages/month
Results
June 12-13, 2012 11 Knowledge sharing forum, Kathmandu
June 12-13, 2012 Knowledge sharing forum, Kathmandu 12
Newborns given Horoscope
N=4339/7386 (58.7%)
Timely collection of vital information facilitated horoscope distribution…
June 12-13, 2012 Knowledge sharing forum, Kathmandu 13
Birth Weight recording Increased
N=6760/7386 (91.5%)
While many newborns were reportedly weighed, information was not made available for generating horoscope…
June 12-13, 2012 Knowledge sharing forum, Kathmandu 14
Coverage: Average number of beneficiaries attending campaigns
N=3023
Source : Nutrition Project form 1
The project assisted in improving service utilization…
per campaign
June 12-13, 2012 Knowledge sharing forum, Kathmandu 15
Convergence: Nutrition campaigns attended by AWW,ASHA and ANM together
N=1929/3023 (63.8%)
%
The project assisted in improving convergence to a certain level… Source : Nutrition Project form 1
June 12-13, 2012 Knowledge sharing forum, Kathmandu 16
VHSC involvement : Campaigns attended by VHSC members
N=1612/3023 (53.3%)
Source : Nutrition Project form 1
VHSC involvement was difficult to elicit without sustained inputs…
June 12-13, 2012 Knowledge sharing forum, Kathmandu 17
Service delivery: 6-23 month old receiving complementary food premix at AWCs
N=48832/61651(79.2%)
More children started receiving CF premix at centers…
Source : MPR Register
June 12-13, 2012 Knowledge sharing forum, Kathmandu 18
Birth Registration
N=6143/7386 (83.2%)
Birth registration improved, was related to institutional delivery…
Source : Safal data
June 12-13, 2012 Knowledge sharing forum, Kathmandu 19
Referral of Low Birth Weight babies
N=442/785 (56.3%)
Unavailability of newborn care services affected referral…
Source : Horoscope data
Indicators Target Baseline
Value (%)
Endline
Value (%)
% children put to the breast within one
hour of birth
80 68.8 67.5
% infants 0–5 months of age fed
exclusively with breast milk
80 42.7 68.8
% children (6-23m) consuming iron
fortified complementary food premix
(balbhog)
80 - 51.7
% infants (0-23m) in normal category of
Nutritional status
80
57.6
54.2
IYCF practices and Nutritional Status
June 12-13, 2012 20 Knowledge sharing forum, Kathmandu
Discussion
• A tangible product can anchor behavior change, convergence and community mobilization efforts
• Demand creation needs to have a supply back up including availability of skilled manpower
• Linkages to all public departments are vital for overall impact
• Demand for nutrition services picks up quickly, but behavior change lags behind
• Project period too short to show impact on nutritional status
June 12-13, 2012 Knowledge sharing forum, Kathmandu 21
Challenges and Actions
• Optimization through time planning, local decision making Manpower attrition
• Combined meetings, trainings, mutual coordination, data sharing
Interdepartmental convergence
• Awareness generated but services limited
Safe water and sanitation
• Advocacy, demand generation, Public Hearings Erratic Supplies
• Time bound problem redressal Technology glitches
June 12-13, 2012 Knowledge sharing forum, Kathmandu
22
Final Thoughts
• Sanitation and infection control measures should be integral to nutrition improvement programs
• Supplies of products which aid nutrition behaviors should be adequate to meet demand
• Capacity building and continued mentoring of frontline health and nutrition functionaries including ASHAs in nutrition and care of newborn
• Existing service delivery need to be realigned into community owned models addressing hunger and malnutrition especially in tribal areas
June 12-13, 2012
Knowledge sharing forum, Kathmandu 23
Thank You
June 12-13, 2012 Knowledge sharing forum, Kathmandu
24