MARVI Nutrition Integrated Model

Balakot, District Mansehra

• Intervention initiated in three Union Councils of Tehsil Balakot in district Mansehra

• Pilot Phase = 6 months (April 15 – October 14, 2015)• Implementation phase = 18 months (October 15, 2015 – March 14, 2015)• 20 villages in pilot phase and 30 villages in implementation phase • Target Beneficiaries– Pregnant women = 1125 – Lactating women = 2250– Adolescent girls = 2250 – Children Under 5 year =4500

Introduction

Intervention is focused on • Nutrition counseling for behavior change to improve the feeding

practices of women and Children • Prevention of iron deficiency anemia and other micro-nutrient

deficiencies

Main objectives:• Improved nutritional knowledge of the women in pregnancy,

lactation, adolescent girls and children feeding • Improved dietary practices for women and children • Improved nutritional status of women and children

Introduction

• 35-40% population is not covered by the Lady Health worker program (LHW) in Pakistan (http://www.emro.who.int/pak/programmes/service-delivery-lady-health-workers.html)

• As HANDS has developed and tested a model of community based health worker called MARVI, for non-LHW areas for promotion and provision of reproductive health, nutrition and Family planning basic services

• The MARVI model is a solution to improve access for the rural remote uncovered and underprivileged communities. She remains accessible and source of information and guidance to the community on nutritional issues

• The MARVI workers work under the close supervision of qualified and trained Lady Health Visitors (LHV)

Innovation

Approach

MARVI key to community intervention

Linkages and referral to

Public Health Facilities

Provision of Iron & Folic Acid Tablets

Screening and growth

monitoring women and

children

Group Counseling on nutrition and diet

Home visits for Individual counseling

Record keeping of all

enrolled women

• MARVIs are selected through community dialogue• MARVIs are trained and skilled in behavior change communication• They form a bridge between community and government health

facilities through referral mechanism

Approach

They use Information and education material for group and individual counseling to improve the dietary diversity and dietary intake

Approach

The MARVI health house is established to make a center/ hub of counseling and provision of iron-folate supplements, growth monitoring of women and children, and record keeping of all clients and activities

Public Sector Involvement through lens

Consultation with Provincial Health Department

Monitoring by LHW Program

Review of IEC material DHO during MARVIs training

Community Involvement through lens

Male community session Male community session

Women group meeting Counseling with female

Expected Outcomes:• Short Term:• Number of women with appropriate weight gain during

pregnancy• Reduction in low birth weight • Improvement in ANC visits to the public sector health facilities• Number of women taken iron-folate supplements regularly during

pregnancy and lactation• Number of children on exclusive breast feeding for 6 months• Improved knowledge of women about nutrition and proper diet

for women and children bothLong Term:• Reduction in malnourished and under-weight children, women

and adolescent girls • Reduction in anemia among women and adolescent girls

Intended Outcomes

Motivated MARVI worker can bring some change through consistent counseling• 28 years old • Educated up to grade 12• Trained under the project• Faced resistance while performing routine

activities • Kept herself motivated and continued

counseling local families to attend sessions

• Convinced families for measurement • Educated families on correct dietary

practices • Referred and accompany women to

nearby BHU for ANC

Experience from the Field Nadia Bibi – MARVI Worker

Village Katwi Char

MARVIs through counseling sessions addressing the following myths for correction

• Women have many myths related to intake of certain foods (cold and hot foods)

• Women don’t disclose pregnancy till 5 months (Nazar)• They don’t feed colostrum ( perceived it as bad for newborn)• Perceive iron and folic acid tablets as Family Planning tablets • Introduce ghutti (Korichar patta - local leaves) to newborns (for

better digestion of the newborn)

Role of MARVIs addressing local misconceptions

• Poor access due to mountainous terrain and poor infrastructure

• Frequent disruptions due to land slides during rainy season and

snowfall during winter

• No women medical officer available at nearby BHUs

• Female avoid to consult with male doctors

• Mobility of females is restricted without husband consent

• Prefer home deliveries due to lack of financial resources

Challenges

• Continuous liaison and progress sharing with the Government

partners has build a trust and now they are more supportive

• Engagement and involvement of the local political, religious and

local administrative leadership help in getting buy-in of these

community leaders and their communities

• Community dialogues and subsequent large community meetings

with the male members help in creating conductive environment

Lesson Learned

• The MARVIs may be sustained as a trained, skilled human

resource for providing basic Nutritional advices and services in

LHW uncovered areas.

• MARVIs may be selected by the health department and inducted

in LHW program as LHWs, after completion of the project.

• HANDS social marketing program will support these MARVI

workers through training and provision of other RH products.

• Social marketing program provide products on subsidized cost

• MARVI generate income by selling these products

Sustainability

• Continuous linkages with the Government health department

• Evidence based advocacy

• Some livelihood schemes in future to improve the household

earning especially of the community women,

• Scale-up the pilot in other non-LHW areas in the same district and

other districts

Way Forward

THANKS