Importance of nutrition counseling and monitoring in addressing malnutrition issues in India
In India children have mid-day-meals in their schools and people receive monthly rations through an ever-improving Public Distribution System.
Ready-to-eat packets and hot meals are served to mothers and children at Anganwadi Centres (AWCs), under the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan.
Further, various add-ons such as egg, banana, protein powders, peanut chikki and jaggery are also being distributed under various special State-specific schemes,
an example being the Mukhyamantri Suposhan Yojana in Chhattisgarh.
But, nutrition security is still a distant dream.
People often lack knowledge of proper eating and feeding practices.
Myths around food and increased accessibility to highly processed food have compounded the problem.
Nutrition counselling can potentially be the answer to this problem.
Counselling people on eating and feeding practices along with monitoring their progress can prove to be a game-changer.
It is important to note that “Jan Andolan”, or social and behaviour change communication (SBCC), has been a facet of POSHAN Abhiyaan.
This includes bicycle rallies, plantation of Poshan Vatikas, celebration of Poshan Maah, Poshan Pakhwaras and Godh Bharaais.
Different States have held various awareness programmes under the SBCC.
However, the concept of nutrition counselling has yet to be properly institutionalised and implemented uniformly across States.
In fact, according to the POSHAN Abhiyaan Progress Report, 2018, “A focused and coherent SBCC Action Plan is essential to take the work of POSHAN Abhiyaan forward.”
Thus, there is a need for field staff to be properly trained in nutritional counselling and there is a need for it to be implemented, mandatorily and uniformly, by States.
Lessons from Bemetara
Bemetara in Chhattisgarh is a puzzling district in the context of its malnutrition status.
Situated in the fertile plains of Chhattisgarh, it is unaffected by Naxalite activities and is agriculturally rich.
Its inhabitants are also relatively rich.
However, the number of Severe Acute Malnutritioned (SAM) children there was as high as 3,299 in December 2022.
This figure bears a striking resemblance to the situation in tribal-dominated and Naxal-affected districts such as Bastar.
It points to the lack of proper knowledge about feeding practices.
The problem is not about access but improper knowledge around when, how and what to eat.
This is why nutrition counselling combined with robust monitoring was chosen as the modus operandi for this area.
Potth Laika Abhiyaan:
Potth Laika Abhiyaan — which means “Healthy Child Mission” (literal translation) in the Chhattisgarhi language.
It is a nutrition counselling programme that is being implemented in 72 of the most affected AWCs in the Bemetara sub-division of Bemetara district.
It has the technical support of UNICEF, Chhattisgarh.
Here, ground-level staff from the Health and Women and Child Development departments have been well trained on how to provide nutrition counselling in the region.
Every Friday, the parents of the targeted SAM and Medium Acute Malnutritioned (MAM) children are summoned and counselled.
They are taught in simple Chhattisgarhi language the importance and the constituents of “Tiranga Bhojan” (a balanced diet), the need to wash hands regularly and many other tips in order to lead a healthy lifestyle.
Many harmful dietary myths and superstitions are dispelled as well.
The progress of the targeted children is being monitored.
Local leaders such as sarpanchs, panchayat sachivs and religious heads have also participated in the counselling sessions.
Door-to-door visits to the houses of targeted children are also done to monitor their progress.
As a result of the nutrition counselling along with regular monitoring and evaluation, as many as 53.77% of targeted children were brought out of malnutrition by the Potth Laika Abhiyaan, in a span of nine months.
Further, 61.5% of MAM children and 14.67% of SAM children have been brought out of malnutrition.
These figures are both encouraging and statistically significant.
Further, while providing meals requires elaborate budgeting and the risk of leakages, this mission is a zero cost one, requiring no more than a few training sessions and regular monitoring.
Thus, it has shown itself to be cost effective as well.
From the experiences highlighted, this model needs to be replicated on a larger scale across districts and States.
Providing food needs to be supported with nutrition counselling and monitoring in order to truly accelerate the eradication of malnutrition.
It is only when this simple but impactful strategy of nutrition counselling is followed both in letter and spirit, that India can move closer towards achieving the ambitious yet noble dream of a “Kuposhan Mukt Bharat”.
Poshan Abhiyaan
Poshan Abhiyaan
Poshan Abhiyaan was launched on 8 March 2018 from Jhunjhunu, the district of Rajasthan.
Poshan Abhiyaan, or the National Nutrition Mission, is the Government of India’s flagship program to improve nutritional outcomes for children, pregnant women, lactating mothers, and children from 0 to 6 years of age.
The Poshan Abhiyaan scheme plays an important role in tackling malnutrition and providing cooked meals to children.
This scheme replaced the national program for mid-day meals in schools or mid-day meal schemes.
The Government of India's National Nutrition Mission, known as Poshan Abhiyaan, was introduced with the goal of solving the widespread problem of malnutrition in the nation.
Its primary goal is to improve children's nutritional status and decrease undernutrition.
The Abhiyaan targets to reduce stunting, undernutrition, anemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
Poshan Abhiyaan, makes use of technology and departmental and module convergence.
"Poshan," the program's name, is an acronym for "Prime Minister's Overarching Scheme for Holistic Nutrition."
The goal of the mission is to map diverse malnutrition-related initiatives and promote synergy using an ICT-based real-time monitoring system.
It places an emphasis on strong scheme convergence and provides incentives for states and Union Territories.
Under the Abhiyaan, Swasth Bharat Preraks will be deployed one in each district for coordinating with district officials and enabling fast and efficient execution of the Abhiyaan across the country.
Swasth Bharat Preraks would function as catalyst for fast tracking the implementation of the Abhiyaan.
5 Pillars of Poshan Abhiyan
Poshan Abayan ICDS-Common Application Software (CAS):
To assist field staff in providing services and overseeing programs at Anganwadis, the mission uses a mobile app called ICDS-CAS.
Through a dedicated call center, this technology-driven strategy increases efficiency and facilitates citizen involvement.
Convergence Action Planning:
At the state, district, and block levels, this pillar focuses on creating and enacting a Convergence Nutrition Action Plan.
To address nutrition issues holistically, it promotes coordination and collaboration amongst several ministries, including water and sanitation, rural development, health and family welfare, and education.
Poshan Abhiyaan ICDS officials' and employees' capacity building through the incremental learning approach (ILA):
Through the current supervisor's meetings, the mission prioritizes capacity- building programs for Anganwadi employees and officials.
Their ability to provide quality services is improved by this strategy.
Jan Andolan (Behaviour Change Communication and Community Mobilisation):
It is emphasized how crucial behavior change communication and community mobilization are.
It entails public relations efforts and neighborhood-based programs to increase awareness of important nutritional topics like prenatal care, breastfeeding, complementary feeding, immunization, hygiene practices, and more.
Several parties are actively involved in these activities, including government agencies, Panchayati Raj organizations, and self-help organizations.
Performance Incentives:
To promote and recognize successful nutrition intervention delivery, performance incentives have been created.
Features
Poshan Abhiyaan is a centrally sponsored scheme that has been launched for a period of five years, from 2021-22 to 2025-26, with a budget of Rs 1.31 trillion.
The centre bears the entire cost of the food grains, their transportation, and management under the PM Poshan scheme, but the components such as cooking costs and payment to cooks and workers are split in a 60:40 ratio with the state.
The Poshan Abhiyaan 2.0 aims to benefit about 11.80 crores and the children studying in 11.20 lakh schools in the country.
Under this scheme, mid-day meals have been extended to the children of Balvatika in addition to the children studying in classes 1 to 8 in government and government-aided schools in the country.
The extension of mid-day meals to pre-primary students was a key recommendation of the National Education Policy 2020.
Poshan Abhiyaan will involve the Farmer Producer Organisation (FPO), and Women Self Help Groups in the implementation of the scheme to support vocal for local and to fulfil the objectives of the Atmanirbhar Bharat initiative.
To check the implementation of the national nutrition mission, social audits will be made mandatory for each school in every district. It would engage University and college students to monitor the implementation of the Poshan Abhiyaan scheme through the field visit.
It will promote the development of nutrition gardens in the school, which will be used to provide additional micronutrients to the students.
The school will also be encouraged to organize cooking competitions and design the menu on the basis of the vegetables available in local markets.
The Poshan Abhiyaan scheme has the provision for the state or district having a high prevalence of anaemia to include any supplementary item.
If the state wants to include local vegetables or any other nutritional food, such as milk or fruit, they can include them with the centre’s approval.
The national nutrition mission has also included the concept of Tithi Bhojan, in which the students from private schools will be encouraged to voluntarily share their meals with the children from the marginalized section at least once a month.
Tithi bhojan is a community participation program in which people provide special food to the children on special occasions or festivals.
A nutrition expert is to be appointed in each school whose responsibility is to regularly conduct check-ups such as – Body Mass Index (BMI), weight, haemoglobin levels, etc.
Poshan Tracker App was launched to strengthen and bring transparency to nutrition delivery services. It enables real-time monitoring and tracking of all Anganwadi centres (AWC), Anganwadi workers (AWW), and beneficiaries.
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