Chhattisgarh Government scales up ICICI Foundation’s Nutrition Security Innovations Programme to 70 blocks across the state

The success of the Foundation’s Nutrition Security Innovations (NSI) programme in 23 blocks of Chhattisgarh has prompted the state to replicate specifics of the programme and other nutrition and communication strategies.

Nutritional status of women and children in Chhattisgarh are particularly poor, with 41 percent women and 48 percent children undernourished. Government services and programmes including the Integrated Child Development Services (ICDS), the Mid-Day Meals Scheme (MDMS) and the Public Distribution System (PDS) are all mandated to have universal coverage in Chhattisgarh. However, the state’s large vulnerable population and issues surrounding coverage and quality of services continue to plague the schemes. The schemes are also affected by factors related to urbanisation and lifestyle changes such as changes in diet and food habits among tribal groups, newer approaches to maternal and child care, and a decrease in the availability of food items high in micronutrients.
Additionally, many people are not aware of the various government welfare programmes and schemes. This does not just impact their ability to create effective demand, but also the government’s ability to assess the effectiveness of their programmes in the absence of any community monitoring and accountability.
With this in mind, the NSI programme was undertaken in 23 blocks across 11 districts of Chhattisgarh.

In March 2011the Nutrition Security Innovations (NSI) programme concluded in Chhattisgarh. The Government of Chhattisgarh has now taken forward the project in order to implement it across the state, creating vital links within its health delivery system.

The NSI programme was initiated by the foundation within the pre-existing Swasthya Mitanin Programme (community health worker programme) in 2006 in partnership with the State Health Resource Centre (SHRC), Chhattisgarh. The project was aimed at deepening the impact of community health workers (mitanins), and to bring about convergence between health interventions of the Mitanin Programme and the nutritional interventions of the Integrated Child Development Services (ICDS).

Introducing a new cadre

The first phase of the NSI programme rolled out with the introduction of a new cadre of community health workers called Poshan (nutrition) Fellows, whose role is to create awareness about nutrition within their communities. They help to train the mitanins and prashikshaks and provide them with continuous support. One Poshan Fellow is selected for every block, and two coordinators are selected at the regional level to guide and supervise the Poshan Fellows. State-level programme coordinators support the Poshan Fellows and regional coordinators through regular monthly meetings, updates, technical support and systematic problem solving — providing overall guidance to the programme.
SHRC programme staff trained the Poshan Fellows on matters of nutrition, dietary requirements, food security, and other issues relevant to their communities through various workshops. Supported by the Poshan Fellows, the prashikshaks and the mitanins undertook the following specific interventions within the programme:

Chhattisgarh Government scales up ICICI Foundation’s Nutrition Security Innovations Programme to 70 blocks across the state

The success of the Foundation’s Nutrition Security Innovations (NSI) programme in 23 blocks of Chhattisgarh has prompted the state to replicate specifics of the programme and other nutrition and communication strategies.

Nutritional status of women and children in Chhattisgarh are particularly poor, with 41 percent women and 48 percent children undernourished. Government services and programmes including the Integrated Child Development Services (ICDS), the Mid-Day Meals Scheme (MDMS) and the Public Distribution System (PDS) are all mandated to have universal coverage in Chhattisgarh. However, the state’s large vulnerable population and issues surrounding coverage and quality of services continue to plague the schemes. The schemes are also affected by factors related to urbanisation and lifestyle changes such as changes in diet and food habits among tribal groups, newer approaches to maternal and child care, and a decrease in the availability of food items high in micronutrients.
Additionally, many people are not aware of the various government welfare programmes and schemes. This does not just impact their ability to create effective demand, but also the government’s ability to assess the effectiveness of their programmes in the absence of any community monitoring and accountability.
With this in mind, the NSI programme was undertaken in 23 blocks across 11 districts of Chhattisgarh.

In March 2011the Nutrition Security Innovations (NSI) programme concluded in Chhattisgarh. The Government of Chhattisgarh has now taken forward the project in order to implement it across the state, creating vital links within its health delivery system.

The NSI programme was initiated by the foundation within the pre-existing Swasthya Mitanin Programme (community health worker programme) in 2006 in partnership with the State Health Resource Centre (SHRC), Chhattisgarh. The project was aimed at deepening the impact of community health workers (mitanins), and to bring about convergence between health interventions of the Mitanin Programme and the nutritional interventions of the Integrated Child Development Services (ICDS).

Introducing a new cadre

The first phase of the NSI programme rolled out with the introduction of a new cadre of community health workers called Poshan (nutrition) Fellows, whose role is to create awareness about nutrition within their communities. They help to train the mitanins and prashikshaks and provide them with continuous support. One Poshan Fellow is selected for every block, and two coordinators are selected at the regional level to guide and supervise the Poshan Fellows. State-level programme coordinators support the Poshan Fellows and regional coordinators through regular monthly meetings, updates, technical support and systematic problem solving — providing overall guidance to the programme.
SHRC programme staff trained the Poshan Fellows on matters of nutrition, dietary requirements, food security, and other issues relevant to their communities through various workshops. Supported by the Poshan Fellows, the prashikshaks and the mitanins undertook the following specific interventions within the programme:

Awareness building and behaviour change communication

The most significant role of the mitanin is using behaviour change communication to increase awareness among families on dietary practices and nutritional goals.

  • While the Mitanin Programme had previously focused on promoting exclusive breastfeeding practices, which contributed significantly to the improvement in child health in the state, this project focuses on other aspects of children’s health, such as appropriate complementary feeding practices and the identification of undernourished children through regular growth monitoring by anganwadi workers.

In an effort to improve maternal health, the Mitanin Programme now focuses on the importance of adequate nutrition for pregnant women and attempts to boost intake of nutritious foods during pregnancy and after delivery.

  • To involve the community in improving their own nutrition, the Mitanin Programme raises awareness about locally-available nutrition-rich foods, encourages families to develop kitchen gardens, and helps remove superstitions surrounding dietary practices.
  • Interventions in community monitoring and action – Themitanins, supported by the prashikshaks and the Poshan Fellows, encourage the community to take collective action and monitor the various government-run food schemes. This community mobilisation was facilitated at the hamlet, village and cluster levels.

Locally relevant training modules

One of the innovations of the NSI project was the creation of picture-based training modules that can easily be used by the mitanins for nutrition counselling and mobilisation.

The three modules – Nutrition and Social Security, Child Caring and Feeding Practices, and The Nutrition Book – educate within the context of local cultural practices and are in the Chhattisgarhi language, using local terms for food items. The Nutrition Book identified and presented 173 locally-available foods in Chhattisgarh and listed their nutritional values in terms of vitamins and micronutrients. In addition to detailing the nutritious forest fruits, roots, and leaves that are unique to the state, the book also gives recipes to prepare these foods in order to retain their maximum nutritional value.

Building Public Health Capacity

To develop institutional and individual public health capacity, ICICI Foundation supported the setting up of the Public Health Resource Society (PHRS). PHRS works to empower practitioners at the district and sub-district levels and to build resource groups and active practitioner networks for knowledge and experience sharing, interactive activities, projects and mutual support.

Building institutional and individual capacity in public health at the district and sub-district level is essential for sustainable and continuous improvements in health services and programmes. Trained, motivated, empowered and networked health personnel are required to carry out effective district health planning and other district-level programmes of the National Rural Health Mission.

In 2008-2009, ICICI Foundation supported the setting up of the Public Health Resource Society (PHRS). PHRS functions through network offices known as Public Health Resource Network (PHRN) in the state of Bihar, which has some of the poorest health indicators. This initiative aims to address the critical and growing need to build public health capacity amongst the health functionaries working with the state as well as members of civil society groups. Through a range of training and capacity building initiatives, PHRS seeks to enhance and consolidate resource capacity in these states and to facilitate state and civil society partnership for strengthening the public health system.

PHRS offers the following programmes through its state network offices:

  • The Distance Learning Programme on Public Health is conducted over an 18-month period, and relies on self-study modules, interactive workshops and mentored field activity. The certificate of level of achievement is provided by PHRN at the end of the course. Indira Gandhi National Open University (IGNOU) has adopted the course structure and modules and offers it as a Post Graduate Diploma Programme in District Health Management.
  • The Fast Track Capacity Building Programme is designed to improve skills and capacity at the district level in order to facilitate quality district health plans based on situational analyses. The programme began in 2008 and includes three rounds of a six-day long training workshop and operates in Bihar. The programme is a collaborative initiative among state governments, PHRS and the National Health Systems Resource Centre (NHSRC).
  • The Community Health Fellowship is a two-year full-time programme focused on creating motivated community health professionals with the technical competencies to work with communities, civil society and the government to further the ideals of ‘Health for All’. The fellows are placed in districts and linked to both District Health Societies and local civil society groups in Bihar. The project’s partners are PHRN, SEARCH in Gadchiroli and NHSRC.