Post on 25-Dec-2015
Community Based Intervention - Curative Strategy : Sneha Shivir (VHNCCS) - Preventive Strategy : 20 Counseling sessions, 25 IEC Sessions
6 VHNDs
“SuPoSHaN”
ICDS MISSION
VIDEO CONFERENCE 31.01.14
2
CRITICAL INDICATORS
PARTICULARSINDIA
NFHS - 3 (Rural 2005-06)
M.P.NFHS - 3
(Rural 2005-06)NIN (2010)
Prevalence of low birth weight 23.4 19.1Initiation of Breast feeding with in 1 hour 23.4 13.3 26.4Pre-lacteals given 58.7 16.1Exclusive Breastfeeding (0-5 months) 46.3 21.6 71.0Initiation of compl. feeding At 6 months 55.8 - 23.5% Full Immunization ( 12-24 months children)
43.5 31.5 84.2
Coverage of 9-59 months children for Massive Dose Vitamin A Supplementation (%)
- -81.7
Coverage of Pregnant women for IFA Tablet Distribution (%) - - 78.0
Coverage of 12-59 months children for IFA Tablet/Liquid Distribution (%) - - 25.0
Nutrition status (Based on WHO Child Growth Standards - 2006)
Underweight 45.9 60.0 51.9Stunting 38.4 50.0 48.9Wasting 19.1 35.0 25.8
Data Source: NFHS-3 (2005-06)
<6 6-11 12-23 24-35 36-47 48-590
10
20
30
40
50
60
70
29.535.7
43 44.9 45.644.8
47.6 53
61.8 61.2 64.9
60.7
India Madhya Pradesh
Age (months)
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Children (0-5 years)M.P. v/s India (NFHS-III 2005-06)
• Undernutrition in the first 5 years (esp. first 2 years) of life
needs special emphasis.
• Lifelong adverse impact on growth and development
• Higher risk of dying in infancy
• Consequences are severe & often irreversible
• Lifelong cognitive and physical deficits and chronic health
problems
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VISION 2018
OBJECTIVES“SuPoSHaN” Abhiyan
Supportive Programme on Sustaining Health and Nutrition
“SuPoSHaN”
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Underweight (Weight-for-Age)
Wasting (Weight-for-Height)
Stunting (Height-for-Age)
27.3
32.7
12.6
22.4
26.323.7
19.8
32.1
8.3
17.5
22.2
26.7
NFHS III (2005-06) NIN Survey (2009-10)
NUTRITIONAL STATUS OF CHILDREN (0-5 YEARS)
Only 15% needs facility care
‘Abhiyan' for reduction and prevention of undernutrition
Conceptualized as a community based programme
Targeted convergent approach
Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs
Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM
“Sneha Shivir” , Mangal Diwas, IEC, ABM
Adapted from globally acknowledged Positive Deviance
Approach
“SuPoSHaN” ABHIYAN
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‘Abhiyan' for reduction and prevention of undernutrition
Conceptualized as a community based programme
Targeted convergent approach
Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs
Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM
“Sneha Shivir” , Mangal Diwas, IEC, ABM
Adapted from globally acknowledged Positive Deviance
Approach
“SuPoSHaN” ABHIYAN
• Every community has certain individuals or groups whose
uncommon behaviors and strategies enable them to find
better solutions to problems than their peers, while having
access to the same resources and facing similar or worse
challenges.
• Based on problem-solving and community-driven approach
that enables the community to discover these successful
behaviors and strategies and develop a plan of action to
promote their adoption by all concerned.
What is Positive Deviance?
STRATEGIESParticipatory Micro
Planning at Village level
1. Community Mobilization
• Facilities improvement
• Weighing drive2. Village Mapping3. Screening of children
• Presence of health worker at 1st screening
• Provision of 1st round of medication during special VHNDs (17th – 24th)
4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team
STRATEGIESParticipatory Micro
Planning at Village level
1. Community Mobilization• Facilities
improvement• Weighing drive
2. Village Mapping3. Screening of children
• Presence of health worker at 1st screening
• Provision of 1st round of medication during special VHNDs (17th – 24th)
4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team
Curative
Entry point to the village for accelerated reduction in moderate and severe under nutrition in children
Steered by Supervisor and Poshan Sahyogini
• 1st & 30th day Doctor completes screening, tracks status
• 12 days camp for 10-15 children
• Supervisors and Poshan Sahyogini conduct the camp
– 3 Supervised feeding of children
– Focused counseling session of mothers with PD exemplars
– Demonstrating local nutritious recipes - Mothers Learn by
doing
– Day to day child profiling
• Poshan Mitra, ASHA, AWW follow up by 18 home visits
• Monthly follow up and weighing of children for 6 months
• If required re-organize camp
Curative StrategySneha Shivir + C-NRC
STRATEGIESParticipatory Micro
Planning at Village level
1. Community Mobilization
• Facilities improvement
• Weighing drive2. Village Mapping3. Screening of children
• Presence of health worker at 1st screening
• Provision of 1st round of medication during special VHNDs (17th – 24th)
4.Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team
Curative
Entry point to the village for accelerated reduction in moderate and severe under nutrition in children
Steered by Supervisor and Poshan Sahyogini
Preventive
Empowering community to catalyze behavior change for taking out the village from the undernutrition trap
Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team
• Life cycle approach for improving nutrition
– Continuum of care beginning with adolescent girls to first
1000 days and till 5 years of age
Preventive Strategy
• Pregnancy (9 months 30 x 9 = 270)
• Birth – 24 months ( 24 x30 = 720 days)
• Total = 1000 days
• To increase children’s chances of survival,
improve development and prevent stunting,
nutrition interventions need to be delivered
during the mother’s pregnancy and the first two
years of the child’s life.
FIRST 1000 DAYS
• Life cycle approach for improving nutrition
– Continuum of care beginning with adolescent girls to first
1000 days and till 5 years of age
• Strengthen and streamline delivery of ICDS
– Universal survey and enrolment of beneficiaries at AWC
– Vajan Mela every every month 1st to 4th
– Screening of children by health care providers and referrals
– Swachhata Abhiyan every month 5th to 7th
– Targeted activities Monday to Friday
Preventive Strategy
Targeted activities Monday to Saturday
Days Targeted Activities
MondayRegular dialogue with community - Special VHNDs + Poshan Meetings with gram swasthya samitis and poshan mitra
TuesdaysLakshit Mangal Diwas - 20 themes along with sanitation campaign
Wednesday Intensive home visits targeted to Pregnant women
Thursdays Intensive home visits targeted to lactating mothers of children 0 to 6 months
FridaysAdvocacy and dialogue with community for behavioral change - 25 IECs
SaturdayIntensive home visits targeted to lactating mothers of children 6 months to 2 years
Village level Sector Level Block Level District Level
• AWW• AWH• ASHA• Gram Sabha
Swasth Gram Tadarth Samiti
• Poshan Mitra Team
• PRI
• Supervisor• ANM• NGO
nominated by District officials
• BMO• CEO JP• Project Officer• Mobile health
team
• CEO ZP• EE PHE• CMHO• DD Agri/Horti• Food Officer• DPO• AWTC• DTO (Health)• Home science
faculty
Support - "SuPoSHaN“ Abhiyan
Sr. no. Out come indicators Target
1Weight gain of children after 12 days
75% children will show minimum 200 gm weight gain
2Weight gain of children after 30 days
75% children will show minimum 400 gm weight gain
3Weight gain of children after 2 months
Growth curve of 75% of children will on positive trajectory
4Weight gain of children after 3 months
50% children will show positive change in nutritional status
5Nutritional status of children after 6 months
80% children will show positive change in nutritional status 22
OUTCOME
• Success in a village will be assessed– by complete elimination of SUW
– decrease in MUW
• Exit strategy after 1 year of implementation of Sneha Shivir in
any village– Weighing all eligible children (0-5 yrs)
– Third party would conduct the “audit”
– If no cases of severe under nutrition and borderline moderate
cases for a period of one year it may be decided to phase out
Sneha Shivir
– Remaining MUW children would be rigorously monitored and
care givers counselled on best practices at regular health
education sessions and during home visits
Phase Out Strategy
• Active involvement of Health, Panchayats, PHE,
Agriculture, Food
• Community participation through poshan mitra team,
gram sabha swasth gram tadarth samiti
• Sensitive Poshan Sahyogini
• Quality training
• Good Micro-planning and implementation
• Intensive monitoring
• Adequate and timely resources
IMPERATIVES
• March - 3035 camps in 1st phase in 2 cycles
– Cycle 1 : March 1 to March 12
– Cycle 2 : March 24 to April 4
• January and February
– Selection of villages, Poshan Sahyogini and Poshan Mitra
– Trainings at all level
– Microplanning
– Preliminary screening of children and medication
• April - Preparation for 2500 camps in May (1-12th)
• May - Phase 2 camps and Preparation for 2500 camps in
June (1-12th)
TIME LINES
• Build and mobilize for enabling environment and community participation
• Strengthening convergence with – Health for screening and monitoring– Panchayat for infrastructure, facilities and participation - employment– PHED for Safe drinking water and sanitation campaign– MDM for improved Hot supplementary nutrition given at AWC – Agriculture for minikits / Food for PDS
• Monitor ICDS to ensure :– Universal survey, identification and weighing
– Quality of training and inputs of Abhiyan
– Delivery of services including THR
• Provide administrative, technical and financial sanctions for the optimum usage of resources
Expectations From Collectors
THANK YOU