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TABLE OF CONTENTS
S. No.ProjectsPage no.
BACKGROUND 4
1.PuShTI- Transparency, Quality, Efficiency & Accountability in THR
distribution in Gujarat
5
2.Improving nutritional quality through Food Fortification 8
3.Harnessing the potential of India’s medical colleges to improve
maternal nutrition services (Uttar Pradesh, Bihar & Jharkhand)
11
4.Promotion of Millets in Tribal areas- Odisha Millet Mission15
5.Dakshata- Developing an enabling environment for service providers
for improved maternal and new-born health in Rajasthan
18
6.Introduction of Double Fortified Salt through ICDS in Gujarat & PDS
in Madhya Pradesh
21
7.Developing Anganwadi Centres as Nutri-Education Centre in
Aspirational District- West Singhbhum, Jharkhand
25
8.“Mo Upakari Bagicha” (My beneficial garden) in Odisha 28
9.Human Milk Banking- Universalizing access to human milk for all
babies
31
10.Introduction of Millet based meals in Hot Cooked Meals- Pilot in
Vikarabad, Telangana
36
11.Strengthening the service delivery and institutional mechanism with
a focus on first 1000 days in Uttar Pradesh & Gujarat
39
12.Engaging religious leaders and faith communities to improve MCH
outcomes in Uttar Pradesh
42
13.State Management Centre to monitor Women and Child
Development schemes in Gujarat
44
14 . Born Healthy: Strengthening coverage & quality of antenatal care in
Rajasthan
46
COVID-19 SPECIFIC INITIATIVES/MEASURES
1.“Umbare Anganwadi” – Anganwadi at Doorsteps, ICDS Gujarat 49
2.Ensuring uninterrupted supply of IFA, Chhattisgarh 51
3.CO-BOT: The Technological solution to prevent COVID-19 spread;
Meals on Wheel & Essential service delivery in West Singhbhum
(ADT), Jharkhand
52
4.SHG members as Community Warriors54
5.POSHAN Van: Healhty Nation, Beautiful Children55 4
Background
With an objective to facilitate knowledge sharing and showcasing innovative approaches &
effective strategies which have led to a desirable change in the Health and Nutrition outcomes,
this compendium on Health and Nutrition Practice Insight Vol. II was developed. As this practice
insight was prepared while our nation was devising measures to tackle COVID-19, few initiatives
which have been undertaken by State Govt. and District Administration particularly to ensure
access to essential services to target population have also been captured.
The methodology involved defining the criteria for identifying the practices which included:
effectiveness, efficiency, relevance, sustainability and possibility of replication and involvement
of the community. This was followed by contacting States/ UT representatives and Development
partners working with the States to collect those practices conceived by them to achieve the
desired outcomes. The vetting of the practices received from development/technical partners
was done by reaching out to the concerned State Dept. and cross verifying the details of the
project. The practices which had produced the desirable behaviour change and contributed to
improving the health & nutritional status of the target population have been made a part of the
compendium. While, impact evaluation of most of these practices have been conducted but as
some of these practices are new, their evaluation is not yet conducted.
The broad thematic area of the practices includes maternal and child health outcomes, dietary
interventions like dietary diversification (including Nutri-cereals) & food fortification, program
strengthening (service delivery & institutional mechanism) and community mobilization (involving
religious leaders).
This Compendium is expected to benefit the decision makers and relevant stakeholders by
providing an opportunity for cross-learning through exchange of ideas and diverse experiences.
This document also provides guidance for improving the effectiveness of existing health and
nutrition programs by serving as a useful reference tool to reach out to the most marginalized
sections of the population. 5
Objective: To apply digital technology for transparent, timely and accurate supply chain management
of Take Home Ration with a bottom up approach. The project ensures just in time availability of the
supplementary nutrition for beneficiary eliminating the gap between actual requirement and supply.
Target group: ICDS beneficiaries- 6months to 6 years children, pregnant and lactating women and
adolescent girls
Implementing Government Department & partners: Women and Child Development Department
and Gujarat Co-operative Milk Marketing Federation and SUMUL, AMUL and BANAS Dairy Unions and
Gujarat Info Petro Limited (GIPL).
Duration of the project: The projected started in 2017 with 6 Blocks and gradually covered the entire
State by January 2020. The project continues to run today and in future.
About the Project: In the month of September 2017, Government of Gujarat has signed a tripartite
agreement with the Gujarat Cooperative Milk Marketing Federation (GCMMF) to procure energy dense
micronutrient fortified food –Take Home Ration (THR). The purpose of this agreement was to ensure
uninterrupted supply of THR through manufacturing at three leading District cooperative milk unions
as Banas, Amul and Sumul Dairy under GCMMF. Three different products namely Balshakti for children,
Matrushakti for pregnant and lactating women and Purnashakti for adolescent girls is designed
considering the requirement of the specific age groups.
To streamline the THR service delivery and real-time monitoring, a software has been developed by
the department. Monthly indenting, approval and delivery of THR packets till AWC level is monitored
through the dashboard.
Process flow for the demand generation and monitoring of THR
Project- PuShTI “Poshan umbrella for Supply chain through Tech
Innovation” (Ensuring Transparency, Quality, Efficiency &
Accountability in THR distribution in Gujarat) 6
It is a unique solution comprised of a Web based application for demand & supply cycle and an Android
based App for transportation solutions. This ensures smooth, transparent, speedy and error free supply
of THR at the Anganwadi centres.
Benefits of the project:
• Transparency (the entire process is
available at public domain and all the
stakeholders are equally responsible)
• Quality- It is ensured as THR is initially
tested at Amul lab and after passing of
decided parameters it is distributed at
AWCs. To cross check the quality, it is
again tested in Government of Gujarat
Food & Drug Laboratory and after passing
of the test, it is allowed to distribute to
beneficiaries for consumption.
• Safety (as the packaging of the product is
good and free from contamination)
• Standardization (same quality & quantity
of product at the entire state as per the
norms)
• Community involvement and Social Audit
(as the distribution of THR is also done
on monthly basis on 4th Tuesday in the
presence of local persons)
• The entire supply chain management follows the principle of demand driven supply as opposed
to the supply driven management.
• OTP based tracking of distribution of THR upto AWCs.
• Online certification of delivery is provided in the system in order to ensure timely and correct
payment to the supplier.
• Timely and regular supply (supply on monthly basis at the scheduled time)- Timely delivery
of THR ensures timely distribution of Ration to beneficiaries, which will directly support in
nutritional indicators.
Outcome & Impact: Directorate of Evaluation a unit under the Planning Department of Govt. Gujarat
has conducted third party survey and key finding tells that the acceptance of the THR has been
increased in the community and beneficiaries consumes it.
Reward & Recognition: Awarded with Order of Merit- Skoch Award and received appreciation from
Ministry of Women & Child Development Govt. of India.
Delivery of THR till AWC 7
Live tracking of Take Home Ration 8
Objective: To improve nutritional and learning outcomes by using fortified staples to prepare meals
served to children under MDM in selected schools of Karnataka, Andhra Pradesh, Telangana, Gujarat
and Uttar Pradesh
Target group: Children (6 to 14 years) receiving MDM
Government Department: Department of School Education, Government of Karnataka, Andhra
Pradesh, Telangana, Gujarat & Uttar Pradesh
Implementing Partner: The Akshaya Patra
Foundation
Duration of the project: This initiative
started in 2016 and is being continued
and expanded
About the Project: Under this project,
meals prepared with fortified rice,
wheat flour, oil and double fortified salt
are prepared and served to children
to improve their nutritional & learning
outcomes overall resulting in improved
attendance and retention in schools. The
rice is fortified with essential nutrients
including Iron, Folic acid, Vitamin B12,
Vitamin A, Vitamin B1, Niacin & Vitamin
B6 by a simple, cost-effective technology.
Till date, they have managed to reach 5,339 schools and 720,742 children through fortified rice meals
Impact Assessment:
• The Akshay Patra Foundation conducted the impact evaluation of fortified rice meal among
children in Karnataka and Gujarat:
• In Karnataka, a longitudinal cohort study was conducted across 6 Districts with 2 years of
intervention. Data was collected from 1,661 children (6-10years) across 50 schools.
• In Gujarat, a case control study was conducted for an intervention period of 8 months. A
total of 484 children from intervention group and 489 from control group were enrolled
and followed to measure the outcome of interest.
Outcome of the impact assessment conducted:
• 9% reduction in underweight, 4% reduction in stunting and 3% reduction in wasting
amongst students from baseline to end-line (Karnataka)
Project- Improving the nutritional quality of meals served
under MDM through Food Fortification 9
• Positive impact on morbidity profile- an overall decrease in incidence of fever (12% to
8.9%) and diarrhoea (4.3% to 0.83%) from baseline to end-line (Karnataka)
• Overall 43% students showed improvement in Mathematics and English scores from
baseline to end-line (Karnataka)
• A significant increase in average haemoglobin levels amongst children of intervention
group (Gujarat)
• Reduction in prevalence of moderate and mild anaemia among intervention
group (Gujarat)
• Positive impact on cognitive behaviour- 11 points increase in the intervention group as
compared to control (Gujarat)
• Majority of the teachers (89%) opined that students performance in school improved
after introducing fortified rice in MDM
Contributing Factors:
• Fortifying the staples part of regular diet and additionally using fortified oil and double fortified
salt to enhance the nutritional quality
• Ensuring sanitation and hygiene- Children have access to safe drinking water, hand washing
stations and effective deworming programs in place to reduce frequent illness and resulting
absenteeism
• Educating children and children on nutrition, health and WASH 10
Rice blenders at the Akshay Patra Kitchen 11
Objective: To strengthen the integration of MIYCN into the functioning of select Government medical
colleges and hospitals in Uttar Pradesh, Bihar and Jharkhand, including undergraduate curriculum,
service delivery, research and government program support (capacity building, quality assurance and
monitoring)
Target group: Undergraduate medical students of selected medical colleges
Implementing & Supporting Government Department:
• UP: Directorate General of Medical Education, State Health Mission, four Government medical
college and hospitals
• Bihar: Department of Health & Family Welfare, five Government Medical college and hospitals
and one private medical college
• Jharkhand: State Health Mission, one Government medical college, in partnership with WeCaN/
IPE Global
Technical Partner: Alive & Thrive, FHI Solutions (UP & Bihar); WeCaN/IPE Global (Jharkhand)
Duration of the project: January 2017 to ongoing
About the Project: The project was conducted in a participatory way to support effective delivery,
develop champions for the approach and maximize its potential scale up and sustainability. The
initiative is unique in maximising the expertise and experience of medical colleges by prioritising
undergraduate teaching and influencing the curriculum to have a better integration of maternal nutri-
tion, thus creating a well-trained future generation of medical practitioners for both the public and
private sectors with a basic grounding in MN. The project strengthened the integration of MIYCN in the
following areas:
• A strengthened MIYCN curriculum for integration in undergraduate medical training was
developed in alignment with the existing teaching competencies prescribed by the Medical
Council of India (MCI) as set in 2019.
• Updated MIYCN service delivery protocols were adapted for each service delivery contact points
across the ‘1,000 Days’ period, antenatal outpatient department (OPD), labor room, postnatal
ward, immunization and pediatric OPD.
• A quality improvement (QI) approach was introduced within medical colleges and affiliated
hospitals. It followed the “plan-do-study-act” (PDSA) cycle. QI teams were established to improve
MIYCN service delivery at various critical contact points with facilitation/mentoring from A&T QI
facilitators and National and State expert group members.
• A project to measure the quality of nutrition service delivery in the community and inform
Block, District (and State and National) Government programming was initiated with two of the
medical colleges in collaboration with the Indian Association of Preventive and Social Medicine
Project- Harnessing the potential of India’s medical colleges to bring
maternal nutrition services to scale 12
(IAPSM). Faculty participated in the development of the tools and processes for data collection,
conducted monthly field assessments, and participated in district review meetings to share their
findings and feedback on the approach for continuous improvement.
What worked:
• Commitment and ownership of the state government and the heads of medical colleges to lead
and sustain the initiative secured through Memorandums of Understanding (MoUs)
• A visioning exercise was conducted in medical colleges with the departments of Pediatrics,
Obstetrics & Gynecology (OBGY), and Community Medicine, to set the direction for the project
• A gap assessment of MIYCN knowledge, skills and practice, teaching-learning methods and
research priorities was conducted in the selected colleges to inform the development of a
strategic roadmap and implementation plan
• National and State expert group and interdepartmental committees consisting of senior
academicians, practitioners and researchers were formed to guide the initiative and provide
overall oversight to the implementation of mutually decided actions.
• Capacity building of faculty and hospital staff, including postgraduate residents and nursing staff
from the three departments, was conducted for adoption of the strengthened MIYCN curriculum,
service delivery protocols and QI approach.
Training of faculty doctors, SRs, JRs, interns and Staff nurses on MN service delivery protocols 13
Outcome & Impact:
• Integrated MIYCN curriculum and protocols have been endorsed by Department of Health &
Family Welfare, Government of Bihar and Directorate of Medical education, Government of Uttar
Pradesh and adopted by all nine government medical colleges in UP and Bihar and one private
medical college in Bihar and one college in Jharkhand
• Significant improvements in service delivery indicators across all nine colleges:
• All India Institute of Medical Science (AIIMS) Patna- early initiation of breastfeeding in
uncomplicated C-section deliveries increased from 0% to 89% during a four-month period
along with adoption of a policy of zero-separation of mother and newborn
• Improvement in patient flow and management led to nearly three-fourth of the patients
receiving complete ANC services during the defined period
• Weight, hemoglobin and blood pressure measurement was completed for 84% of the
antenatal mothers
• Maternal nutrition counselling delivered to 76% of the women. Exit interviews of the
antenatal mothers to assess retention of key messages on importance of IFA tablets 60% to
72% women; diet diversity 64% to 78%., among other
• At Government Medical College, counselling on exclusive breastfeeding in postnatal ward
increased from 13% to 94% in nine weeks, with above 90% retention in exit interviews
of key messages such as “no water,” “nothing apart from breastmilk” and “continued
breastfeeding during illness”
• Nearly 600 doctors, nurses and counselors in Bihar and 750 in UP were trained on the service
delivery protocols and QI approach.
Challenges faced: Prioritization of the project
by health authorities and medical college
staff, adoption of a project mode with clear
deadlines and metrics, and collaboration
across departments were critical challenges for
implementation of the project. However, the
participatory approach described above was
effective at achieving desired objectives.
Plan for scale-up:
• Scale up in UP and Bihar: The process to
scale up the strengthening of MIYCN into
the functioning of medical colleges to all
government medical colleges across the
state is ongoing in Bihar and UP. In Bihar,
a Government letter was issued by the
Principal Secretary Department of Health
mandating scale up of MIYCN strengthening
into the undergraduate curriculum and
service delivery protocols, along with
nomination of one medical college as nodal 14
institute for MIYCN and budget allocation is being discussed. In UP, as suggested by the Additional
Mission Director, a proposal outlining key activities, outcomes and a budget to seek government
funding to scale up activities across all the medical colleges in the state is under development.
• Scale up in other States: Advanced discussions were held on scale up across the state in
Jharkhand. Discussions on implementation in Rajasthan conducted with the State NHM,
Department of medical education and UNICEF early in the year suggest interest for scale up in the
State. 15
Objective: To revive Millets on farms and plates with simultaneous focus on Production, Processing,
Consumption, Marketing and Inclusion of Millets in Government schemes
Target group: Farmers of the selected Districts (14)
Implementing & Supporting Government Department: Department of Agriculture & Farmers
Empowerment, Govt. of Odisha
Technical Partner: WASSAN (Watershed Support Services and Activities Network)
Duration of the project: Implemented in September 2018 & to be continued till 2025
About the project: OMM was initiated in 2017 for promoting Millets (Ragi) as a staple crop of the
farming system. This project emerged from various consultations held between Government, Academia
and Civil Society to increase household consumption of Millets by reviving Millet production in
identified areas and improving their productivity by means of improved agronomic practices followed
by setting up decentralised processing units to reduce drudgery of processing of millets to add value
to them and make them market ready. For this, promotion of Farmer Producer Organization (FPOs) for
aggregation and better marketing is conceptualised and most importantly include millets in ICDS, MDM
and PDS.
Entire project is to be implemented by FPOs with support of local NGOs under guidance of line
Departments at District and Block level. The key steps for Millet procurement includes:
• Operationalize procurement of Ragi at Minimum Support Price (MSP) conforming to Fair Average
Quality (FAQ) norms
• Make subsidized Ragi available for inclusion in the PDS, ICDS and MDM schemes, closing the
production cycle and multiplying benefits of Ragi production for the region
• Explore markets for distribution of surplus Millets beyond the requirements of PDS, ICDS and
MDM schemes
The Mission was started with 30 Blocks (7 Districts) in 2017 but due to positive response and demand
from the farmers it was expanded to 55 Blocks (11 Districts) in 2018 to 72 Blocks (14 Districts) in 2019
by the Government of Odisha. Another 4 Blocks were added in the June 2020. . The program shall be
implemented in each selected Blocks for 5 years, and these Blocks are currently at varying stages of
implementation.
Various guidelines on Ragi procurement from local farmers at MSP, farmer registration, District wise
storage godowns, route Map from possible procurement locations to Storage godowns and Millet
Procurement Automation System were developed to streamline this initiative.
Project- Promotion of Millets in Tribal areas-
Odisha Millet Mission (OMM) 16
Outcome & Impact:
• Increase in number of Farmers growing Millets from 7,014 in 2016-17 to 8,596 in 2017-18
• Increase in area under Millets cultivation from 2949 hectares to 5182 hectares (almost double) &
increase in yield by 120% between 2016-17 to 2017-18
• 215% increase in gross value of produce per farmer household from Rs. 3957 to Rs. 12486
• 26495 Farmers registered, almost 95% of Ragi procured from farmers in 2019-20
• Procurement infrastructure set up in 14 Districts: this assured market supports bolsters Ragi
production programmes in the area.
• Procurement made subsidized Ragi available which led to inclusion on Ragi in ICDS, MDM and
PDS schemes, closing the production and economic cycle
Inclusion in PDS
In 14 Districts procuring Ragi, 1kg of rice has been substituted by Ragi owing to its higher nutritional
value. It was distributed at the rate of Rs. 1 per kg under PDS scheme in 6 Districts to 16,01,206 ration
card holders under NFSA.
Inclusion in ICDS
Ragi laddoo mix, made from ragi procured from farmers under the mission, was piloted in the
Anganwadi menu in Keonjhar District on July 2nd, 2020, and the same has been requisitioned for
Sundergarh District. Keonjhar District is also set to pilot ragi biscuits in the MDM/ICDS utilizing 401.4
quintals of surplus ragi.
Farmers bringing their Ragi to Mandi for sale Farmers cleaning the light sand in Ragi through
winnowing at Mandi 17
A child with Ragi laddoo mix which
was distributed at the doorstep of the
beneficiaries due to COVID-19. Children
relished the taste of the laddoo mix
Challenges:
• The farmers faced registration issues on the Millet Procurement Automated System (M-PAS) due
to lack of familiarity with the process
• The long distances to limited mandi points in each block, di-incentivized farmers from
transporting their produce for procurement
• Limited decentralized infrastructure for procurement and processing persisted in some areas 18
Objective: To empower healthcare providers for improved maternal and new-born health care during
institutional deliveries
Target group: All the health care providers engaged in providing intrapartum and immediate
postpartum care in public health facilities in selected Districts of Rajasthan
Implementing Government Department: Maternal Health Division-NHM, Govt. of Rajasthan
Technical Partner: Jhpiego (Funding support from CIFF)
Duration of the project: August 2015 to August 2020
About the Project: Dakshata is a strategic initiative developed by the Govt. of India to address the
problem of adverse maternal and neonatal outcomes during and immediately after childbirth.
Rajasthan is one of the few states which adopted Dakshata from its core and were able to bring a
substantial positive reduction in Still Birth Rate (SBR) across the targeted facilities. The program was
implemented in a phased manner to cover 20 out of 34 Districts of Rajasthan with a target of covering
202 high delivery points across these 20 District. The profile of the 202 public health facilities involved
in the Dakshata program were District hospitals (9%), Sub-district hospitals (7%) or community health
centers (76%) and Primary Health Centre (8%). Dakshata strategy involves developing an enabling
Project- Dakshata: Developing an enabling environment for service
providers for improved maternal and new-born health 19
environment for service providers by ensuring critical supplies at the point of use and bringing changes
in the Labor rooms to make it more conducive. It also aims to make healthcare providers more
competent and confident by conducting targeted training and structured mentoring and support visits
so that providers adhere to WHO recommended evidence based practices. Considering the importance
of the availability of timely data collection and utilization, program developed MWMIS (Maternity Wing-
Management and Information system) and Dakshata Mentor app.
Outcome and Impact:
• Against the target of 202 high delivery points in 20 Districts, the program managed to cover 313
high delivery load points of all 34 districts.
• The intervention facilities catered to more than 70% of deliveries in public health facilities of
targeted districts.
• The program was successful in bringing about improvement at the level of resources and quality
of several services (An independent evalauation of the program by PHFI, still to be published)
• Substantial reduction in adverse neonatal outcomes. Stillbirth rate data from Pregnancy, Child
Tracking and Health Services Management System (PCTS)- part of HMIS in State of Rajasthan,
depicts reduction in Phase I facilities in comparison to the remaining facilities of the state (23.9%
vs 14.1%) as well as in Phase II facilities in comparison to the remaining facilities of the state
(12.3% vs 5.5%)
Challenges:
• Most of the Dakshata facilities are deficient in human resources as per norms outlined in
the Government of India’s Maternal and Newborn Health (MNH) toolkit.
• Another issue was the frequent rotation of trained human resources from labor rooms
to other wards of the facilities, which required extra efforts by mentors to train newly
transferred in staff on the clinical guidelines and processes in the labor room.
• The suboptimal entry of case sheets data into MWMIS (Management information system
to improve service delivery in labour rooms) by the data entry operators is another
bottleneck. Thus, the utilization of this data for decision-making was difficult.
• The implementation of Dakshata program requires ownership and accountability at all
levels of the health system. Despite of government initiative, lack of ownership in poor-
performing facilities has been an impediment in the initiation of corrective measures for
improvement.
Plan for scale-up or mainstream implementation: Dakshata Program is an initiative of the Government
of India. Considering the impact of program Government of Rajasthan has scaled up the program across
34 districts and hired 19 designated cadre name “Dakshata Mentor” in 19 districts that were designed
based on the successful implementation of the program by Jhpiego. It demonstrates a possible
approach for other states with high mortality. The learnings from this program can also be vital for
informing new programs for similar settings across the country.
As per a Guidance Note released by Maternal Health Division, MoHFW on Operationalization of
Dakshata, the States interested in implementation of Dakshata program can send an expression of
interest to GoI. To commence with, the States should implement the program in their High-Priority 20
Districts (HPD). with a plan for scale-up to other Districts. Priority should be given to facilities such that
maximum number of deliveries in the Districts are targeted.
RESPONSE DURING COVID-19
To help the community during this pandemic
crisis and to provide assistance to pregnant
women so that essential services can be delivered
to pregnant mothers, District authorities of
all 34 Districts of Rajasthan, in collaboration
with Dakshata team initiated the helpline/
teleconsultation for pregnant women. A team
was prepared and the District Administration
released an advertisement in the newspapers
to inform the general public of this team and
gave the mobile numbers of the panel members,
who could be called at any time for assistance
for pregnant women. Since then, the panel
is receiving many calls and being able to help
pregnant women and their families every day,
with most of the calls coming from remote or
complete lockdown areas. 21
Objective: To reduce the prevalence of anaemia amongst the ICDS beneficiaries through regular
consumption of DFS
Target group: Children (6 months to 6 years), adolescent girls, pregnant and lactating women registered
under ICDS
Implementing & Supporting Government Department: Department of Women and Child
Development, Gujarat State Civil Supplies Corporation Limited (GSCSC) and Food, Civil Supplies and
Consumer Affairs Department, Government of Gujarat
Technical Partner: Nutrition International (NI)
Duration of the project: Distribution of DFS started in August 2018 (ongoing project) across all 33
Districts of Gujarat
About the Project: In line with the goals and objectives of the
National Nutrition Mission (Poshan Abhiyaan), launched by Hon’ble
Prime Minister in March 2018, the DFS program was launched by
Hon’ble Chief Minister of the State Sh. Vijay Rupani in July 2018 at
Gandhinagar. As the regular consumption of this salt has shown to
reduce the prevalence of anemia.
1,2
under this initiative, DFS is being
used in preparation of hot cooked meal for children (3-6 years of
age) and 1 Kg of DFS named “SATVA” is provided to adolescent girl,
pregnant and lactating women registered under ICDS every month.
The aim is to reach 3.6 million registered beneficiaries with DFS.
What worked:
Effective collaboration between WCD dept. and Dept. of Food, Civil
Supplies and Consumer Protection- WCD department allocates budget (Govt. of Gujarat invested INR
23.53 crores for procurement) and request Department of Food, Civil Supplies and Consumer Protec-
tion to procure and distribute it through their Fair Price Shops (FPS) at the village level (distribution of
33,619MT of DFS through ICDS).
• Capacity building of relevant stakeholders at State, District and Block level including government
officials to plan implement and monitor the program by the technical partner.
• Enhancing the knowledge of front-line workers on the importance and benefits of consuming DFS
through SATCOM
• Executing an effective Behaviour Change Communication (BCC) campaign to improve the
acceptability of DFS amongst beneficiaries and position DFS as a value added product.
Project- Introduction of Double Fortified Salt
through ICDS in Gujarat
1
Jere D. Haas, Maike Rahn, Sudha Venkatramanan, Grace S. Marquis, Michael J. Wenger. Double-Fortified Salt is efficacious in improving indicators of iron
deficiency in female Indian tea pickers. JNutr.2014; doi: 10.3945/jn.113.183228.
2
Andersson M, Thankachan P, Muthayya S, et al. Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized
ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Am J Clin Nutr 2008; 88(5):1378-87 22
Outcome: Uninterrupted distribution of DFS in 33 districts since August 2018
Challenges: Lack of knowledge about anaemia and use of DFS - Initially, the beneficiaries did not have
much knowledge about anaemia and benefits of using DFS. This resulted in low uptake, although there
are communication interventions happening in the program, a large-scale communication campaign is
required to increase acceptance and offtake of this intervention
Quote from field: Kinjal Patel (38 years of age) is an anganwadi worker in Jhalod Block, Dahod District
says “I joined ICDS in 2015. As ICDS was then supplying iodized salt to its beneficiaries (pregnant and
lactating women) I learnt about the importance of iodine in the human body, and how to use and store
iodized salt. Later in 2018, when ICDS started providing Sattva-DFS, I had queries related to the black
particles present in it. The beneficiaries also had the same queries. Then, my supervisor explained to
me that these black particles are indication of presence of iron, added along with iodine, to the salt.
I also learnt about the benefits of DFS through the SATCOM training. I ensured its usage in the hot
cooked meals at the anganwadi center, and also started encouraging the beneficiaries (pregnant and
lactating women, and adolescents) to use DFS while cooking at home through counselling during THR
distribution. I could explain about it’s benefits to pregnant women and babies, lactating women and
adolescent girls, and also how to use and store it. I used to feel sad when initially the beneficiaries
refused to use DFS but now the beneficiaries have become more aware and they themselves come and
ask whether the Sattva-DFS supply has come. I feel very happy now” 23
Objective: To reduce the prevalence of anaemia amongst the PDS beneficiaries through regular
consumption of DFS
Target group: Registered beneficiaries under the National Food Security Act across 20 Districts (89 Tribal
Blocks) of Madhya Pradesh
Implementing & Supporting Government Department: Department of Food, Civil Supplies and
Consumer Protection, Madhya Pradesh State Civil Supplies Corporation (MPSCSC), Department of
Women and Child Development, Tribal Welfare Department, Department of Health and Family Welfare,
Govt. of Madhya Pradesh
Technical Partner: Nutrition International (NI)
Duration of the project: The project started in 2017 and distribution of DFS started in April 2018
(ongoing)
About the Project: Challenged with the prevalence of high level of anaemia, particularly among
children (68.9%), pregnant women (54.6 %) and women of 15 to 49 years if age (52.5%)
3
, Department of
Food, Civil Supplies and Consumer Protection, Government of Madhya Pradesh introduced DFS through
PDS in 2018 with an objective to reach 13.5 million individual beneficiaries. The DFS program and BCI
campaign was launched by Hon’ble Chief Minister of Madhya Pradesh, Sh. Shivraj Singh Chauhan on
June 3, 2018 in Mandla block. Through this program, every family registered under National Food
Security Act has access to 1 Kg of DFS every month at a subsidized cost of INR 1 in 89 Tribal Blocks
across 20 Districts of the State. So far, Government of Madhya Pradesh has invested INR 43.15 crores
(incremental cost of INR 11.54 crores from regular iodized salt) for procurement and distribution of
57,468 MT of DFS through PDS since April, 2018.
What worked:
• Executing an effective Behaviour Change
Communication (BCC) campaign with an adolescent
girl named “Lali” (translates as red color, denotes
rich iron in blood) as mascot, improved the
acceptability of DFS amongst beneficiaries as the
campaign positioned DFS as value added product.
• Periodic monitoring visits to warehouses and Fair
Price Shops (FPSs) and sharing the report with
Government officials to ensure smooth functioning
of the initiative.
• Capacity building and awareness generation of the
concerned personnel managing the FPSs who would further pass on the necessary messages to
beneficiaries and encourage them to consume DFS.
Double Fortified Salt in PDS
in Madhya Pradesh
3
Government of India, Ministry of Health and family Welfare, National Family Health Survey-4. 2 24
Outcome:
1. Uninterrupted distribution of DFS in 89 tribal blocks from past 24
months since April 2018
2. More than 85% of the registered beneficiaries are procuring and
consuming DFS on a regular basis
3. Capacity building conducted for 295 officials at State and 453 officials
at District level. Approximately 2317, fair price shop owners sensitized
about the importance and benefits of consuming DFS.
Plan for scale-up or mainstream implementation: The Government of Madhya Pradesh has decided
to scale up the program and has already issued orders for use of DFS in preparation of hot cooked
meal served through Integrated Child Development Services (ICDS), Mid-Day Meal (MDM), Nutrition
Rehabilitation Centres (NRCs), District Hospitals (DH) across the entire state on a daily basis, reaching
approximately 1.6 million beneficiaries.
PDS Beneficiary with DFS
Quote from field: Anita Katare, a Fair Price Shop owner from Kothisodpur village, Nalcha block, Dhar
district. Anita encourages every card holder of her fair price shop to regularly consume DFS and says
“Agar subzi ka rang thoda badle tou badlne dena, achi cheeze hain namak main isliye badlata hain or
khana banane ke baad hi namak dalna pahle nahi”. 25
Project- Developing model anganwadis as nutri-education centre
focusing on ECCE & holistic development of a child
Objective: To change the image of AWCs as places serving food to a centre providing integrated
nutrition, healthcare and education services
Key activities:
• Improve learning outcomes of children in Aanganwadi and make them school ready
• Capacity building of Anganwadi workers, Helpers and Lady supervisors
• Develop fine motor skills and gross motor skills of children
Target group: Frontline workers of ICDS program (Lady Supervisors, Anganwadi Workers, Helpers) are
trained to address children (3-6 years) of anganwadis
Implementing Government Department: District Social Welfare Department, West Singhbhum,
Jharkhand
Technical Partner: TITLI (Together In Transforming Learning in India)
Duration of the project: 3 years
Source of Fund: District Mineral Fund
Targeted no. of AWCs: 843 Anganwadi Centres
About the Project: The education that the teachers receive has a direct and indirect impact on the
way they deliver it to the children. In this regard, the program helps frontline workers of ICDS prog.
to acquire the knowledge and pedagogical skills necessary, to develop and implement child- centered
curriculum practices that intrinsically motivate and stimulate children’s desires to become
meaningfully engaged in
their own learning. Hence,
District Administration,
Chaibasa in collaboration
with Titli organisation trained
843 Anganwadi workers,
Anganwadi helpers and
Lady supervisors in ECCE.
Handholding support is
provided by Titli’s Ground
Supervision Team who visits
Anganwadis on regular basis,
observes the daily activities,
monitors and report in their
dashboard and suggest
improvements. 26
Some unique aspects covered in training include: developing
different Learning centres within the anganwadis;
preparation of teaching aids using naturally available
resources and waste materials; storytelling, etc.
From nutrition perspective, the District Administration has
begun distributing Poshak laddoos for the children aged 6m
to 6y in selected Anganwadi Centres of the District. The idea
behind the laddoo was to encourage children to come to the
AWCs which would thereby positively affect the attendance
and the educational level of the students.
Further, for Kitchen garden, they have roped in respective
BDOs , Mukhiya and savika and sahika to ensure that
selected AWCs must have kitchen gardens. The 14th finance
and untied fund is being utilized for the kitchen garden.
This is an initiative will be an effective step towards
addressing malnutrition.
Outcome and impact:
• Frontline workers are able to understand the importance of positive environment in the
anganwadi for children and focus on their needs
• Poshak laddoo resulted in a positive impact on health of children and also a reason behind
increment in enrollment rate
• Kitchen garden helps to provide fresh and healthy food to children and mother
Challenge: Handholding support is required frequently for the anganwadi workers 27
Mainstream implementation: It has been planned to train the Anganwadi workers, helpers and Lady
supervisors of all 2300 anganwadis of the District with a focus on:
• POSHAN Vatika- Nutri-basket at centers to collect vegetables/fruits to add nutritional value in all
2330 AWCs
• Learning outcome assessment- Make it more rigorous and scientific with iterative learning 28
Objective: Improving the dietary diversity score of women
and children by increasing their consumption of a greater
number of food groups and thus contributing to improved
nutritional status
Target group: Children below 5 years, pregnant women,
lactating mothers and adolescent girls
Implementing Government Department: Odisha Livelihood
Mission, Department of Panchayati Raj & Drinking Water,
Government of Odisha
Funding & Technical Partner: Azim Premji Philanthropic
Initiatives and Living Farms, PRADAN, Harsha Trust
Duration of the project: The project started in October, 2019 for a period of 3 years
Pilot phase of the project: During 2014-2016, Azim Premji Philanthropic Initiatives made a partnership
with Living Farms, a local NGO to mobilize community in Kalahandi and Rayagada districts of Odisha
for establishing individual nutrition garden at their backyard to grow and consume fruits, vegetables,
eggs and meat. The objective was to ensure dietary diversity through intake of vegetable and animal
protein to prevent malnutrition among children, adolescent girls, pregnant women and lactating
mothers. A post project evaluation by Valid International revealed a very positive result of this pilot
project on reducing malnutrition.
About the Project: Based on the experience of working with Living Farms, Azim Premji Philanthropic
Initiatives in partnership with Odisha Livelihoods Mission (under aegis of the of Panchayati Raj &
Drinking Water Department), scaled up and initiated a nutrition sensitive project “Mo Upakari Bagicha”.
There are three important components of this project viz. 14 modules of Participatory Learning
and Action- Linking Agriculture to Nutrition (PLA-LANN), Nutri garden promotion and livestock
management. APPI has also partnered with three Resource NGOs (PRADAN, Harsha Trust and Living
Farms) for prototype development, preparation of manuals and providing technical inputs for designing
PLA-LANN meetings at SHG level and promotion of Nutrition garden, Backyard Poultry and Goat Rearing
at household level.
The programme initially began with few selected Districts but later scaled up to cover all the District
of the State. It aspires to reach out to 75,000 SHGs covering 7, 50,000 households across 107 blocks of
28 districts in Odisha within a span of three years. It also accentuates on building the capacity of 9000
community cadres, who will carry forward the momentum created at community level and will stand
tall as torch bearers for fight against malnutrition in the state. An online MIS specific to Nutrition project
is planned to be built upon the existing MIS of OLM to capture the nutrition garden and livestock
activities as well as consumption by four targeted masses. A six- monthly concurrent evaluation, by a
third party (Oxford Policy Research) is being undertaken to measure the impact of project activities and
make necessary mid-course correction (if any).
Project- “Mo Upakari Bagicha” (My beneficial garden to
improve Dietary Diversity)
Women carrying fresh vegetable produce
from her garden 29
Key Interventions: The program focusses on involving women self-help groups to establish the nutri-
garden alongside training them for rearing poultry and goats. It aimed to transform agricultural
practices, improve access to public services and re-establish the use of forests as a source of food
through intensive community involvement. The key interventions include:
• Community engagements and regular
meetings
• Nutri-gardens and nutri- fields
• Mixed cropping
• Conservation and management of natural
resources
• “Learning by doing” for capacity
development initiatives resulted in
strengthening the knowledge base and
sharpening the skills of cadres
Outcome & Impact (as on 31st May 2020):
Nutrition gardens became the source of constant supply of nutritious and vitamin enriched vegetables
(planted during last harvesting season) for disadvantageous sections who were earlier deprived of this
opportunity and had restricted their consumption to largely cereals and pulses, to certain extent.
• 45,985 and 28,360 Nutrition Gardens were established in Rabi season and summer season
respectively
• 15,290 Pregnant Women, 24,022 Lactating Mothers, 46,967 Adolescent Girls & 36,681 Children
covered till date
Women working to create their own Nutri-garden
Vegetables starting to grow in Rectangular model Demonstration on circular model preparation 30
Minimum Dietary Diversity for Women (MDD-W) Survey
This was conducted by a team of researchers from Resource NGOs in Feb 2020. MDD-W is an
indicator of whether or not women of reproductive stage (15-49 years of age) have consumed
at least five out of ten defined food groups on the previous day or night, an important
dimension of diet quality
50 sample households were taken each from 45 project operational blocks across 13 Districts,
covering 2250 sample households. A simple one-page structured questionnaire was used by
each surveyor for 24-hours dietary data recall from the respondents.
To reduce bias of food intake, data was not collected on festival day or houses having marriage
or other functions. Data collection was done from only those households, who had raised
nutri-gardens (rectangular, circular or gunny bag models) for the first time in Rabi season (Oct
2019-Feb 2020)
Major findings: A positive correlation between promoting nutrition gardens and improving
dietary diversity (MDD score) among women was found:
• 37 blocks have reported positive changes,
• 36 Blocks reported 72-100% coverage of nutrition gardens in sample households during
Rabi 2019
Way Forward: Odisha State Cabinet has taken the decision to promote 5 lakhs nutrition gardens
across 30 districts of Odisha. Government of Odisha has made budgetary allocation of 500 crores for
promotion of nutrition gardens in convergence with MNREGS so that assets can be created, income
enhanced along with increasing the access of rural households to nutritious and vitamin enriched diet.
Gunny bag farming for limited area/land Rearing goat to make animal protein part of diet 31
Objective: To universalize access to human milk by setting up Comprehensive Lactation Management
Centres (CLMC) to support mothers to breastfeed and express milk, encourage Kangaroo Mother Care
(KMC) and collect, store, process and feed Donor Human Milk to babies in need
Target group: Newborn babies especially preterm and low birth weight (LBW) babies
Implementing Government Department: Ministry of Health and Family Welfare, Govt. of India,
Department of Health and Family Welfare, Govt. of Rajasthan
Technical Partner: PATH
Duration of the project: The project started in 2018 and is currently ongoing
About the Project: CLMCs are centres that protect, promote and support breastfeeding, assist in milk
expression for sick newborns (Neonatal intensive care unit), encourage kangaroo mother care and
provide safe donor human milk to sick and vulnerable newborns, those without access to mother’s
own milk. The model prioritizes breastfeeding and puts human milk banks as ancillary support to
breastfeeding and kangaroo mother care. It is based on the Mother Baby Friendly Initiative (MBFI+)
Model and forms the basis of the guidelines released by Ministry of Health and Family Welfare-
“National Guidelines for Lactation Management in Public Health Facilities.”
Project- Integrated Human Milk Banking /Comprehensive
Lactation Management Centres - Universalizing access to
human milk for all babies
It builds on India’s three-tier public health system by establishing CLMCs, Lactation Management
Units (LMUs), and Lactation Support Units (LSUs) at the tertiary, secondary, and primary levels of
care, respectively 32
What Worked:
• Strengthening facility-based lactation systems by building capacities of health workers, creating
a cadre of trainers, institutionalizing tools and processes and engaging multiple stakeholders and
key opinion leaders
• Supporting individual health facilities to leverage funds allocated in National Guidelines to set up
lactation centres
• Impact level indicators for CLMC and LMUs to ensure monitoring and supportive supervision by
State or facility leaders basis the data shared on a quarterly basis
Outcome/Impact:
• India now has on date 83 functional CLMCs increased from 14 functional CLMCs back in 2014.
• In the last 2 years, 54214 mother - baby dyads and 108428 influencers (father, grandmothers
and close relatives) have been reached, through the program. 75% babies-initiated breastfeeding
within an hour, 70% mothers expressed milk for their babies in neonatal intensive care units
(NICU) and 67 % NICU babies received exclusive human milk diet (MOM (mother’s own milk, EBM
(expressed human milk, DHM). 13002 mothers donated 2204.59 litres of milk and 3147 neonates
received donor milk. SNEHI helped sensitize 903 government officials from the national and state
health departments. Nearly 4960 health care providers and stakeholders were sensitized through
training, mentoring and conferences.
• Tools such as the CLMC evaluation toolkit, CLMC training toolkit and Hazard Analysis Critical
Control Point toolkit has been institutionalized as part of the government system.
• States such as Rajasthan has shown exemplary achievement by establishing 18 CLMCs and
is working on further scaling them up to cover the entire state. Rajasthan CLMC-Best model
presented at Good & Replicable Practices & Innovations in Public Health Care System.
• Some other noteworthy initiatives have been the use of the “green corridor” (organ donation
van) in Rajasthan to transfer milk to needy babies, establishment of a mobile van equipped with
a breast pump and a refrigerator for collecting donor milk from mothers in the community in the
state of Maharashtra. 33
Challenges:
• CLMC being a newer concept for many healthcare professionals, takes time for them to
understand, accept and implement it.
• There is poor understanding of processes to apply and secure government funds for
establishment of Human Milk Bank among hospital functionaries
• Despite efforts, mothers and families have low awareness on importance of breastfeeding and
advantages of donation and donor human milk
Lessons learnt:
• The overall value of human milk as a key component of essential newborn care must be shared by
health care workers and management in order for a CLMC/HMB to be effective
• Institutionalizing the National Guidelines on CLMCs requires strong commitment,
ownership and support from a range of stakeholders including policy makers, local authorities
and hospital leadership
• Strengthening systems rather than one off interactions with a few hospital staff will go a long way
in quality controlled and robust scale up of CLMCs
• Availability of strong basic newborn care services in facilities helps to integrate the HMB model
in facilities
Evaluation of the integrated MBFI+/CLMC intervention
• Conducted at a tertiary care facility in Mumbai with an established human milk bank
from July 2017 to September 2018
• The study followed a point of care quality improvement approach and included term
mother and infants as well as sick neonates and their mothers in NICU as participants
• The results demonstrated:
An increase in early initiation of breastfeeding rates among babies delivered
virginally, which rose from 9 percent at baseline to 90 percent post intervention.
Among C-section delivered babies improved from 0.35 percent to 74 percent after
intervention.
Exclusive breastfeeding rates among healthy new-borns climbed to 54% from 39% at
baseline.
A forty-one percent increase in rates of KMC was recorded. 69 percent NICU mothers
34 35
Medical Staff pooling DHM for
pasteurization. Standard processes
are being followed at all level
in CLMC 36
Objective: To revive consumption of Millets and enhance the nutritional content of the Hot Cooked
Meals served to children under ICDS thus contributing to reduction in stunting, wasting, anaemia
and underweight
Target group: Children (3-6 years), their mothers and community members
Implementing Government Department: District Administration, Vikarabad, Telangana
Technical Partner: WASSAN (Watershed Support Services and Activities Network)
About the Project: Telangana has a dryland area and Millets were traditionally grown and consumed.
However, over the years both production & consumption of Millets has declined. Considering the
nutritional and environmental benefits of Millets and with an objective to bring it back into the farms
and plates, District Collector of Vikarabad decided to engage mothers and children on the need to
increase millet consumption through ICDS, as generational change must begin early with children.
Finalisation of Millets based recipes through food festivals: A series of 3 Millet food festivals were
organized to finalize the menu and build consensus around their inclusion in ICDS. Further, through the
online NIN platform “count what you eat”, energy and nutritive values of the recipe were calculated to
meet the standards. These festivals were also used as a medium to spread awareness about benefits of
Millets and encourage communities to make them a part of their diet. At these festivals, Children and
mothers were served dishes cooked with millets and the feedback was collected from members of the
community, mothers, people representatives, anganwadi workers, helpers and kids:
• An overwhelming positive response was
received from all stakeholders
• It was broadly agreed that Millets are
highly nutritious and should be served at
anganwadi meals for kids at least every
alternate day of the week
• Foxtail millet kichidi & Jowar upma prepared
with vegetables were finalized based on the
feedback received
• It was decided to impart training
to Anganwadi workers and helpers
on preparing these dishes. The AW
functionaries were also willing to put extra
effort for cooking millet dishes
• Resolutions were given by the mother’s
committees to promote inclusion of millets at
the AWCs
Project- Introduction of Nutritious Millets into Anganwadi
Centres Vikarabad District, Telangana
Food Festival 37
Pilot Introduction of Millets in AWCs: After the finalisation of the menus, it was proposed that a
pilot would be tried for 3 months and based on the experience, necessary changes will be made to
the program and implement it for further. Pilot program was taken up in 45 Anganwadi Centers in 3
Mandals of the District with about 1000 children. It was decided to serve Millet based meals for 4 times
a week.
Children consuming Millet Khichdi at AWC
Cost Estimation: As rice is available for ICDS at a subsidized price, Millets are not covered under subsidy
and hence millet meals have higher cost per meal. The cost of normal rice based meal per child is
Rs.6.13, the korra (foxtail millet) and Jowar Upma costs at Rs. 8.32 and Rs.10.39 respectively; with equal
standard of energy and proteins but with enhanced micro nutrients and fiber. If subsidy is extended,
then millets based menus might be cheaper or on par with rice.
Source of Fund: The Pilot of 3 months covering 45 AWCs and 1000 children incurred a cost of 1.73
Lakhs as additional expenditure. This additional expenditure was met from the flexible fund given to the
collector by the State Government.
Operational Processes Adopted in ICDS Pilot:
A. Procurement of Millet grains: The grains were procured
from Farmers Cooperatives at a price fixed by a
committee lead by DM, Civil Supplies by referring to the
market price. Farmers’ cooperative also quoted the price
to supply millets which was found to be lesser
than others.
B. Quality Standard & Assessment: Civil Supplies
Department ensured that the grains procured meet the
standard specifications and they would also visit the
stock points, processing units to assess the quality and
submit report.
C. Processing of the Millet: This was also done by
farmers’ cooperative. Cooperative has credit from
FWWB and NABFINS, with this they met their working
capital requirements.
Processing & Procurement 38
D. Payments: Once stock reaches the Mandal-Level Stock (MLS) points, Civil Supplies Dept.
makes payment as per the purchase order to farmers’ cooperatives. AWWs lift Millets
from MLS points.
Recognition: The then Secretary of Dept. of Women and Child Development, Govt. of Telangana,
appreciated the initiative and suggested that this initiative should be scaled up to entire State
Challenges/Policy Constraints:
• The mainstreaming of Millets is constrained by lack of a level playing field between millets &
paddy rice/wheat
• Mismatch between market price and MSP of Millets. There is no regular state procurement of
Millets; the processes are not well established
• Setting up a local procurement system and finding additional budget outside the regular ICDS
programs becomes necessary to expand even successful millets inclusion programs.
• No established procurement mechanism for Millets by corporations like rice & wheat 39
Objective: To strengthen delivery of improved maternal and newborn care and infant and young child
health and nutrition services and practices through a continuum of care at both facility and community
levels in selected Districts of Uttar Pradesh (18) and Gujarat (10)
Target group: Pregnant and lactating women, their newborns and growing infant and young children
(0-23 months of age)
Implementing & Supporting Government Department: Department of Health and Family Welfare and
Department of Women and Child Development, Govt. of Uttar Pradesh and Govt. of Gujarat.
Technical Partner: Nutrition International (NI)
Duration of the project: 5 years (2016-2020. Demo Phase: 2016-2018 (5 District); Scale Up Phase: 2018-
2020 (28 Districts)
About the Project: This project was initiated in 5 demonstration Districts and scaled up to 28 Districts
with a clear focus on maintaining continuum of care through the first 1000 days, by improving the
quality and uptake of maternal and newborn, child health and nutrition (MNCHN) services both in
facility and community settings from 2016-2020 . The program strategy comprised of key components
including Planning & budgeting; Intra-departmental coordination; Procurement & supply chain;
Behaviour chain intervention; Capacity building; Monitoring, reporting & review and
Gender mainstreaming.
They interventions included strengthening the labour rooms in the health facilities; establish or
strengthen Newborn care and KMC Corners. To help achieve this, NI team members advocated District
Government officials to pool resources from their approved PIP’s to procure required equipments.
Simultaneous efforts were also put in place to ensure continuous supply of essential consumables and
materials for provision of newborn care in the facilities.
What Worked:
• Regular assessments of delivery points, hand-holding and mentoring of service providers to
strengthen delivery points during supportive supervisory visits conducted each month
• Biannual KAP surveys of the service providers (Staff Nurse, ANM, ASHAs, AWWs)
• Capacity building of the service providers with a focus on identifying and follow-up of high risk
pregnancies, low birth weight babies and SAM children to strengthen and improve quality of
care provided
• House-to-house monitoring every quarter (in each block) of caregivers of children 0-23 months,
to understand service coverage, awareness levels
• Mentor FLWs to improve documentation, reporting and counselling during VHSND
Project- Strengthening the service delivery and institutional
mechanism with a focus on first 1000 days 40
Maternal Health New-born health Infant and Young Child Nutrition
Early ANC registration improved
from 46% to 59% in UP and 65%
to 72% in Gujarat
Improvement in early/timely
initiation of breastfeeding was
seen in UP from 48% to 53%
Improvement in exclusive
breastfeeding was observed in
UP from 56% to 61%. In Gujarat it
dropped from 72% to 68%
4 ANC services by skilled health
provider improved from 13% to
42% in UP and 26% to 69% in
Gujarat
Kangaroo Mother Care (KMC)
in low birth weight infants
improved from 14% to 43% UP
and 5% to 25% in Gujarat
Improvement in continued
breastfeeding- Continued
breastfeeding at 1 year of child
has been above 70% and at 2
years it is above 60% in both
the States
Receipt of at least 100 IFA
tablets improved from 24% to
42% in Gujarat and marginally
in UP
Mothers of children 6-23 months
received counselling on IYCN
improved from 13% to 88% in UP
and 4% to 46% in Gujarat
Consumption of at least 100 IFA
tablets improved from 8% to
11% in UP and 19% to 51% in
Gujarat
Improvement in minimum
acceptable diet improved from
5.3% to 13% in UP and 5.8% to
11% in Gujarat
Father giving KMC in Hospital Chandauli, UP Strengthened Labour room at DCH Chakiya,
Chandauli.
• Web based monitoring which allowed real time capture of program coverage data generated
reports which were later shared with Government officials in both the States. This also helped in
strengthening review mechanism and further planning.
Outcome: Data of baseline evaluation, end line evaluation carried out in demonstration Districts in
2016 and 2018 and; Nutrition Intervention Monitoring Survey carried out in scale up Districts in 2019
have been referred to show improvement presented below: 41
Challenges faced: Availability of trained HR at the facilities, especially in 24*7 facilities and NBSUs
continued to be a challenge. Another challenge has been in terms of translating knowledge to practise,
both amongst caregivers and service providers. A simple example, as can be seen from the survey that
though counselling of mothers on IYCN has improved, exclusive breastfeeding and minimum acceptable
diet could be further improved.
Plan for scale up or mainstreaming implementation: NI plans to continue its project in UP and Gujarat
around essential newborn care in 16 Districts and operational research on infant and young child
nutrition in 4 Districts from 2020 to 2025.
Quote from field: ‘Up to the age of 6 months, I will only provide my breast milk to Prapti. After 6
months, I will introduce other liquid, semi solid and solid foods but will continue to breastfeed my child’ -
A first time mother and home maker from Gayaj village in Vadodara district (2019).
A mother administering KMC to a preterm child of birth
weight 1380 grams born on April 18, 2019
After 3.5 months the child’s weight increased to
2.8kgs
Positive effect of KMC and counselling mother on weight of a
low birth weight infant 42
Objective: To spread awareness on key component of maternal and child health like immunization,
ANC, PNC, etc. through religious and faith leaders among community members in Aspirational Districts
of UP
Target group: Population residing in five Aspirational Districts of Uttar Pradesh (Bahraich, Balrampur,
Chitrakoot, Shravasti and Sonbhadra) of Uttar Pradesh
Implementing Government Department & partner: District Administration of respective Districts and
Piramal Foundation
Duration of the project: Started in March 2019 and is presently ongoing
About the Project: With an understanding about the trust and respect shown in religious and
community leaders by the community members and the positive influence they might have on
individuals behaviour, Piramal Foundation collaborated with these community influencers to spread
awareness on key component of maternal and child health like immunization, ANC, PNC, hygiene and
sanitation etc. In the interventions first component, 28 religious leaders were sensitised and trained in
key messages at state level where in representation of every above-mentioned district was ensured.
Post state level training every district went ahead to select influential religious leaders from each block.
A total of 164 leaders were oriented at district level in Uttar Pradesh. Each leader pledged to spread
awareness among their fellow community members and support their messages with references from
their religious books.
Some Unique highlights from the District:
Bahraich- Mohammad Khalid Quasmi (Jamitul Ulama e hind Bahraich, Nayib) is a religious leader
who has provided his support towards mobilization of community and breaking various myths and
misconceptions in the community regarding immunization and early registration of pregnancy.
He regularly meets the community and initiates discussion on importance of early initiation of
breastfeeding and exclusive breastfeeding up to 6 months. In recent days he is very active in sensitizing
community on COVID-19 crisis. His focus is on sensitising community on good sanitation practices such
as regular washing of hands with soap. He is also appealing if anyone has a history of foreign travel,
they should take extra care and in case anyone has symptoms like fever, cough & cold, they should visit
the hospital at the earliest.
Project- Engaging religious leaders and faith communities to
improve maternal and child health outcomes 43
Balrampur- Religious leader named Mohammad Ali in Rehra Bajar is running his Madarsa in Kharika
Masoompur Village. He regularly disseminates the information regarding maternal and child health in
the community. Furthermore, in collaboration with Piramal Foundation and RBSK team, Mohammad
Ali organized a health checkup camp in the premises of his madarsa. Around 387 girls were checked
for anemia. This health camp was helpful in identifying 215 anemic adolescent girls were found anemic
which were all counselled by RBSK team. Additionally, the health checkup resulted in the following:
• Eyes checkup were done and reading glasses were distributed to 53 girls
• Sanitary Pad Distribution was done by RBSK team
• Distribution of Adolescent IFA tablets were done by RBSK team
• Counselling on personal hygiene and adapting of Good life style was conducted in the camp
Plan for Scale-up: Next step is to identify religious leader at block & village level and orient them to
disseminate positive behaviour messages among their community.
Outcome and Impact: Following the orientation at the district level, these religious leaders have started
orienting community on various issues related to immunization, Maternal& child health, sanitation etc.
Till now approximately 9500 community members have been directly oriented by these faith leaders.
Community is listening to these leader as they have deep faith in them.
District Number of
religious leaders
Trained
Total
meetings
conducted
Issues discussed in the
public gathering
Community
members
impacted
Shravasti 25162 Immunization, Early breast
feeding, Institutional
delivery, Covid-19, VHSND
Mobilization, Information
regarding VHSND services.
1600
Bahraich 3056560
Sonbhadra 321183000
Chitrakoot33401150
Balrampur 441293187
Total 164 5059497 44
Objective: To strengthen the communication system of WCD at each level & improve the monitoring
of programs by setting up a feedback mechanism for field functionaries and beneficiaries about ICDS
service delivery and subsequently take corrective measure at each level.
Target group: ICDS beneficiaries and functionaries
Implementing Government Department: State Management Center has been established at the Office
of the Commissioner of Women & Child Development
Duration of the project: Started in 2019 for a year, it shall be extended after the annual review of
its achievements.
About the Project: With an overall objective of qualitative
improvement in the entire gamut of services being provided by
ICDS, State Management Centers (SMCs) were inaugurated by
Hon. Chief Minister Shri Vijay Rupani at Commissioner’s Office,
Gandhinagar on 7th October 2019. These SMCs function like a
call centre with a staff strength of 16 desk operators, one Project
Manager and One Quality Manager. This team is led by two Team
Leaders and a nodal officer has been appointed to work as Single
Person of Contact (SPOC) for smooth implementation of SMC.
Functioning of SMC- Each Desk Operator has been allotted two
Districts to administer a questionnaire designed specifically for
each of the schemes being monitored through SMC. The operators
talk to field functionaries (Anganwadi workers, Lady Supervisors,
CDPOs, POs and Women and Child Development Officers) as well
as beneficiaries. They point out the priority areas and share the
areas where the field functionaries might be lagging so that they
can improve. Likewise, the beneficiary feedback is shared on a
regular basis with the various branch heads of the Office, so that they can take measures to remove the
bottlenecks, simplify and streamline the delivery. On an average one desk operator makes 60 calls daily
and monthly average has been around 19000 calls.
As all the Anganwadi workers (AWWs) and Lady Supervisors in the State have received smartphones
and training for ICDS-CAS under the ambit of POSHAN Abhiyaan and are using Smartphone for service
delivery, an online questionnaire has also been prepared on which the responses of the functionaries/
beneficiaries is being captured and progress monitored through the Dashboard.
Activities which have been enlisted for regular monitoring through SMC using ICDS CAS dashboard
includes: Daily attendance of AWC opening; Growth monitoring of children; Home visit by Anganwadi
worker and Supervisors; Delivery of Take-Home Ration (THR) and; Monitoring and follow up calls to
Program officers and CDPOs. Dissemination of key messages to district and project officials as
per requirement
Project- Establishment of State Management Centre to
monitor Women and Child Development schemes 45
Recognition: The practice was endorsed by Secretary, Ministry of Women & Child Development in the
meeting of 5th Meeting of the National Council on India’s Nutrition Challenges under POSHAN Abhiyaan
Plan for scale up: The scope of SMC shall be increased in a phased manner and more WCD schemes like
Pradhan Mantri Matrutava Vandana Yojana, Doodh Sanjivani, among others shall be brought into its
ambit for regular monitoring and analysis.
Response during COVID-19: This setup has served as a powerful tool for communication during the
COVID-19 crisis. More than 13000 calls have been made in April 2020 during lockdown period to
Aanganwadi Workers for THR follow-up, distribution, safety during home visits, support to beneficiaries
in difficult situation and counselling. 10 different types of SMSs were sent from the system to all
frontline workers (55000 persons including AWWs & Supervisors) during COVID-19.
Apart from ICDS CAS dashboard indicators, SMC team is also following up on Community Based Events
(CBEs), beneficiaries feedback on the quality of THR and participants feedback on various trainings
provided & knowledge assessment
Source of fund/Funding support: The expenses for this project were incurred from the Flexi Fund of
POSHAN Abhiyaan approved by Ministry of Women & Child Development, Govt. of India.
Outcome & Impact: With the setting up of SMC, communication with the field staff has improved
manifold. Moreover, noticeable improvement in several key indicators are evident:
Fig in %
Source: ICDS CAS Nov 19 & Jan 20 46
Objective: To demonstrate a successful model of evidence-based antenatal care with special focus on
maternal infections and targeted iron and calcium supplementation leading to reduction in low birth
weight and adverse perinatal outcomes
Target group: Pregnant women and new-born babies in selected Districts of Rajasthan
Implementing Government Department: Maternal Health Department- NHM, Government
of Rajasthan
Technical Partner: Jhpiego
Duration of the project: August 2017 to December 2021
About the project: The project is being implemented in four Districts of Rajasthan (Bundi, Dholpur,
Karauli, Udaipur) in 125 intervention facilities (4 District Hospitals, 3 Subdistrict Hospitals, 26
Community Health Centres, 37 Primary Health Centres and 55 Subcentres). It aims to demonstrate a
successful model of evidence-based ANC with special focus on maternal infections through introduction
of point of care testing and targeted iron and calcium supplementation along with contextualization of
innovative service delivery mechanisms such as group antenatal care, with the intended outcome of
reduction in low birth weight.
The program intends to do this through capacity building of service providers, translating the skills to
practice through onsite mentoring visits, ensuring the availability of essential resources at the point of
care, streamlining the data recording and reporting systems, and periodically auditing the intervention
facilities to assess the providers’ adherence to evidence-based practices.
Jhpiego’s Born Healthy team is providing technical support to strengthening the ANC module of the
Government of Rajasthan’s upcoming digital platform called Nirogi Rajasthan. As the data uploaded
on this digital platform will directly sync to PCTS (the government’s health management information
system), this could help ensure proper recording and reporting of ANC data and eliminate data loss
during transmission, and thus result in optimal ANC data quality.
Outcome and Impact:
• Increase in detection of high risk pregnancies- It more than doubled in intervention Districts
contrast to 30% increase in other Districts due to to a considerable improvement in the capacities
of ANMs. Close to 99% of all posted ANMs in the intervention Districts have been trained.
• Improvement in the coverage of 4 ANC visits (2% to 71%) and in ANC registrations within the first
trimester (63% to 76%) has also been observed in the past three years (2016-17 to 2019-20) at
intervention facilities.
• A considerable improvement in the logistics at the targeted ANC sites- the availability of
multireagent urine dipsticks for identification of asymptomatic bacteriuria- Urinary Tract
Infection causing bacteria (improved from 0% to 97%. IFA and calcium tablets are available at all
intervention facilities.
Project- Born Healthy: Strengthening coverage and
quality of antenatal care 47
• For the first time, HIV and Syphilis testing using point of care diagnostics has been initiated at
outreach level at the 55 Born Healthy intervention subcentres.
• Availability and adequacy of essential resources improved due to continuous monitoring by
program team and improved indenting by store incharges and health workers
Challenges: Maternal infection data was not being captured in State reporting systems. Consequent
to the advocacy by Jhpiego, State has introduced fields for capturing maternal infections including
asymptomatic bacteriuria, Tuberculosis, Malaria and Hepatitis B in the newer RCH register.
Recognition: Born Healthy program was showcased as an innovation to strengthen the coverage and
quality of antenatal care at the WHO SEARO TAG meeting on 25th November 2019 by Government
of India
Plan for scale-up or mainstream implementation:
• Govt. of Rajasthan adopted the Born Healthy ANC training package “Vatsalya” and sanctioned
budget for conducting State level Training of Trainers and District level training batches for the
Born Healthy training package for ANMs and MOs across the state in the financial year 2019-20
• Learnings from Born Healthy program implementation are being incorporated in national
ANC guidelines
Frontline Health Workers in Action 48
Continued efforts during COVID-19: Use of digital platform and social media during pandemic for
knowledge update of health workers; facilitating distant training of health care providers on facility
readiness in the context of COVID 19; staying in touch with frontline health workers to keep continuity
of these workers’ contacts with pregnant women through home visits, especially for the supply of
IFA and providing essential health messages; technical support to district authorities by program staff
to combat COVID-19 in selected districts (Bundi & Udaipur) of Rajasthan and to develop COVID 19
dedicated IEC materials on health messages for pregnant and breastfeeding mothers; facility providers
for reorganizing care for antenatal care for pregnant, women during labor, and postpartum women at
the facility based on latest national and international guidelines. 49
Apart from ensuring doorstep distribution of supplementary nutrition during COVID-19, this initiative of
WCD Dept. Gujarat focused on:
• Engaging the parents of the beneficiaries to guide them in undertaking creative learning activities
for their children while at home
• Providing a forum to unleash the hidden talents/potential of children, adolescent girls, mothers
and AWWs/AWHs
For engaging parents, the Department adopted a three-pronged strategy – OMG (Providing
Opportunity, Material and Guidance):
• Provide “Opportunity”: for parents and children to work together. Online competition “Maro
Samay, Maru Sarjan” (My time, My Creation) was launched to engage children in creative pursuits
and showcase their talent while Staying Safe at Home.
• Provide Material: AWWs distributed the theme based, age specific activity books and drawing
books for 3- 6 years’ children at their home. The idea was to facilitate home based learning.
Activity books & drawing books were distributed to about 16 lakhs 3 -6 years’ Anganwadi children
• Provide Guidance: Utilizing the SATCOM facility of BISAG, the department started telecasting
live interactive sessions for parents and AWWs/AWHs entitled ‘Umbare Anganwadi’. Beginning
from 8th April 2020, these sessions were organized every alternate day and can be viewed on
Vande Gujarat channel 1, JIO TV as well as on the Department’s YouTube channel. The sessions
emphasized the importance of parental involvement in the holistic development of their children
and demonstrated how creative activities for the kids can be organized with the things available
at home.
Social media was extensively used to propagate all the activities under the umbrella of
‘Umbare Anganwadi’
Way Forward:
• Institutionalise the use of the online/mass media platforms for strengthening ICDS interventions
post lockdown through better planning and enhanced quality.
• Plan online training for Anganwadi workers & parents on ECCE, focusing on parenting
• Development of more Web based material on preschool education for both workers and parents.
“Umbare Anganwadi” – Anganwadi at Doorsteps
Maintaining Nutrition & Learning continuum at Home
COVID-19 Specific initiatives 50 51
To ensure the availability and continuity of Anemia Mukt Bharat (AMB) scheme services targeted at
adolescents, pregnant and lactating women during lockdown period due to COVID-19, a tele-call check
list was developed for officials at District, Block and Cluster levels as well as for Front Line Workers and
beneficiaries. This tele check list collected information on distribution and coverages of IFA supplements
in the field as well as on Inter Department Coordination across different levels.
National Health mission, Dept. of Education and Dept. of Women and Child, Govt. of Chhattisgarh along
with Nutrition International implemented this initiative.
This initiative started in the month of April, 2020 to ensure uninterrupted supply of IFA to registered
beneficiaries when the State Govt. of Chhattisgarh issued guidelines to distribute IFA supplements
through an alternate platform like door to door visits. The Tele check list based assessment provided an
opportunity to coordinate with all concerned departments and address the bottlenecks. For instance,
as the school were shut during lockdown, the IFA blue tablets which is distributed at school weekly,
were struck in school’s storage. To address this the Block Medical Officers communicated their Block
Education Officers to release WIFS tablets to local health functionaries, so that IFA blue tablets could be
distributed during lockdown.
ANM distributing IFA to adolescents
in Batauli, Surguja
RHO distributing IFA to pregnant woman in
Malkharoda, Janjgirchampa
Ensuring uninterrupted supply of IFA to
prevent anemia
COVID-19 Specific initiatives 52
To protect the frontline warriors from acquiring infection while taking care of COVID-19 positive cases
and to minimize the interaction between them, CO-BOT has been designed and deployed in healthcare
facilities to deliver medicine, food and water to patients, thus reducing the need of health workers and
ancillary staff to attend to COVID-19 patients in person in West Singhbhum District, Jharkhand.
The Deputy Development Commissioner (DDC) of the District, an engineering graduate, guided the
developed of this CO-BOT. This CO-BOT is remote controlled and the main features include:
• The Co-Bot has been developed at a cost of ₹25000 per Bot while its carrying capacity is 45 kgs.
• The machine has a range of 200-ft, thus can serve to the largest possible wards.
• It is fitted with 2 way speaker and mic system (Doctor can talk to patient and vice versa).
• Ultrasonic obstacle warning system
• A waterproof device, so it can be sanitized and washed completely.
• I P enabled camera to give live video feed that can be seen from anywhere in the world.
The CO-BOT which can move freely and operate remotely
fitted with Wi-Fi camera with a micro- phone for two-way
communication- doctors can pass on necessary instructions
to patients without coming close to them. The cameras can
also keep vigil on the interaction between patients in the
isolation wards.
Presently its being used in two COVID Care facility of the
District including District hospital and has the potential of
being designed, customized and deployed in any COVID care
facility across the country.
CO-BOT: The Technological solution to prevent
COVID-19 spread
COVID-19 Specific initiatives
CO-BOT Serving in Isolation Ward of Sadar
Hospital 53
Meals on Wheels
To provide food to underprivileged, poor, elderly and daily-wage earners who have been struck the
hardest due to the lockdown, ‘Meals on Wheels’ (MoWs) have been specially devised. This initiative
ensures food provision to stranded migrant laborers who are neither able to move back to their homes
nor have sufficient means to cook.
• A total of 9 MOWs are running across the District serving approximately 7000 people on a daily
basis with hot cooked meals every day.
The District administration has planned for further expansion. This successful practice is being
implemented at zero cost to the District Administration who have created grain banks across the District
as well as invited donations. The amount received as donation is used to pay rent, fuel and manpower
and the grains received are sufficient enough to prepare the meals. These vehicles are also being
utilized to disseminate essential messages regarding COVID-19 among masses and distribute masks.
Feeding the needy Social distancing by using old
rubber tyre to maintain 1m gap
Grain donation point
Essential Services Delivery Cell
In the absence of big players like Big Bazar, Zomato or Swiggy, etc. to home
deliver the essentials during complete and partial lockdown, the District
administration established a essential service delivery cell. For this a general
call for self-motivated, young volunteers was made to serve the purpose who
were oriented, trained and as well as acquainted with prepared FAQs as the
first step. Identifying the shops to provide the essential items followed this.
The contact no. of shops was shared with each volunteer. E-rickshaw was
choosen to deliver the goods whose drivers were paid on a daily wage basis
thus supporting their livelihood in these economically tough times. A control
room was set up in the Collectorate where the coordinators would receive
calls from people all over the subdivision. They would then assign a volunteer
of their team to fulfill the requirement. But this was not easy as the residents
were apprehensive about the home delivery process as well as scared about
being overcharged. However, when they were ensured that they would only be
charged for printed MRP and not even a single penny will be charged for delivery, the order started to
flood. This was further expanded to include fruits and vegetables. This helped in ensuring that people
stay indoors as well as receive delivery of essential goods at their doorstep. 54
Support in providing protecting commodities: Due to their rich experience and training in stitching,
Women SHG members produced more than 17.70 crore face masks as a collective effort of more
2.87lakh women SHGs (June 2020). Additionally, they also stitched Protective gears (4.47 lakh) and
produced sanitizers and hand wash.
SHG members as Business Correspondent Agents: BC Sakhi (Business Correspondents/BC Points) have
played an important role in connecting with the rural population and delivered door step financial
services, across the nation during the times of COVID-19. DAY-NRLM with support of all banks ensured
to transfer all three installments of Rs.500.00 to all women Pradhan Mantri Jan Dhan Yojana (PMJDY)
accounts. With nationwide lockdown and restriction in movement, these BC Sakhis brought bank
services close to women beneficiaries in times of utmost need of financial resources. Since 25th March
2020, around 6457 BC Sakhis’ from 14 States have done 67.56 lakh transaction for PMGKY and other
DBT disbursement of Rs.1407.35 Crore till 3rd July, 2020. Cumulatively, over 9000 SHG members have
been deployed as BC Sakhi across the country.
Farm livelihood-ensuring supply of essential food commodities: In Jharkhand, Odisha, Madhya
Pradesh, Bihar, Telangana and Assam, SHG members engaged in farm production. The Producer Groups
and Farm Producer Organizations (FPOs) procured fresh fruits and vegetables from SHG members and
made it available to customers in times of interrupted supply during complete lockdown. Jharkhand
have developed application based software to connect the producer with the market.
Community kitchens: These were initiated in some of the States. The SHG members took utmost care
in maintaining food safety & hygiene while preparing serving good quality food. As on 19th June 2020,
6491 community kitchens have served 4.63 crore persons across 3 States.
SHG members as Community Warriors during
COVID-19 Lockdown
COVID-19 Specific initiatives 55
With an objective to prevent undernourished children to further slip in a state of malnourishment thus
resulting in adverse risk to their life, District Administration Chatra, Jharkhand, launched the Mobile
POSHAN Van on 20th May 2020 for a period of one year by utilizing District Mineral Funds. This van is
conceptualized to organize two or more POSHAN Shivir (camps) in a day with a cyclic repetition in 15
days, to deliver stated nutrition service.
The key features of this initiative includes:
• Provision of highly nutritious hot cooked food to the identified malnourished children. The food
would be cooked under the supervision of medical personnel in the kitchen built inside the van
• Facility for storing raw grains and other material used in preparation of food within the van itself
along with provision of water dispenser to make potable water available for drinking
• Centralized monitoring and supervision- Through camera fitted inside the van
• Taking health functionaries near the beneficiaries with a special focus on severely malnourished
children
• Displaying key POSHAN messages on the LED screen fitted in the van and help create a Jan
Andolan around POSHAN Abhiyaan
• Provision of nutrition counselling and growth monitoring once a month by ICDS functionaries
• The identified malnourished children would be followed up for a period of 3 months to ensure
sustained recovery
POSHAN Van:
Healthy Children, Beautiful Nation
COVID-19 Specific initiatives 56
TABLE OF CONTENTS
S. No.ProjectsPage no.
BACKGROUND 4
1.PuShTI- Transparency, Quality, Efficiency & Accountability in THR
distribution in Gujarat
5
2.Improving nutritional quality through Food Fortification 8
3.Harnessing the potential of India’s medical colleges to improve
maternal nutrition services (Uttar Pradesh, Bihar & Jharkhand)
11
4.Promotion of Millets in Tribal areas- Odisha Millet Mission15
5.Dakshata- Developing an enabling environment for service providers
for improved maternal and new-born health in Rajasthan
18
6.Introduction of Double Fortified Salt through ICDS in Gujarat & PDS
in Madhya Pradesh
21
7.Developing Anganwadi Centres as Nutri-Education Centre in
Aspirational District- West Singhbhum, Jharkhand
25
8.“Mo Upakari Bagicha” (My beneficial garden) in Odisha 28
9.Human Milk Banking- Universalizing access to human milk for all
babies
31
10.Introduction of Millet based meals in Hot Cooked Meals- Pilot in
Vikarabad, Telangana
36
11.Strengthening the service delivery and institutional mechanism with
a focus on first 1000 days in Uttar Pradesh & Gujarat
39
12.Engaging religious leaders and faith communities to improve MCH
outcomes in Uttar Pradesh
42
13.State Management Centre to monitor Women and Child
Development schemes in Gujarat
44
14 . Born Healthy: Strengthening coverage & quality of antenatal care in
Rajasthan
46
COVID-19 SPECIFIC INITIATIVES/MEASURES
1.“Umbare Anganwadi” – Anganwadi at Doorsteps, ICDS Gujarat 49
2.Ensuring uninterrupted supply of IFA, Chhattisgarh 51
3.CO-BOT: The Technological solution to prevent COVID-19 spread;
Meals on Wheel & Essential service delivery in West Singhbhum
(ADT), Jharkhand
52
4.SHG members as Community Warriors54
5.POSHAN Van: Healhty Nation, Beautiful Children55 4
Background
With an objective to facilitate knowledge sharing and showcasing innovative approaches &
effective strategies which have led to a desirable change in the Health and Nutrition outcomes,
this compendium on Health and Nutrition Practice Insight Vol. II was developed. As this practice
insight was prepared while our nation was devising measures to tackle COVID-19, few initiatives
which have been undertaken by State Govt. and District Administration particularly to ensure
access to essential services to target population have also been captured.
The methodology involved defining the criteria for identifying the practices which included:
effectiveness, efficiency, relevance, sustainability and possibility of replication and involvement
of the community. This was followed by contacting States/ UT representatives and Development
partners working with the States to collect those practices conceived by them to achieve the
desired outcomes. The vetting of the practices received from development/technical partners
was done by reaching out to the concerned State Dept. and cross verifying the details of the
project. The practices which had produced the desirable behaviour change and contributed to
improving the health & nutritional status of the target population have been made a part of the
compendium. While, impact evaluation of most of these practices have been conducted but as
some of these practices are new, their evaluation is not yet conducted.
The broad thematic area of the practices includes maternal and child health outcomes, dietary
interventions like dietary diversification (including Nutri-cereals) & food fortification, program
strengthening (service delivery & institutional mechanism) and community mobilization (involving
religious leaders).
This Compendium is expected to benefit the decision makers and relevant stakeholders by
providing an opportunity for cross-learning through exchange of ideas and diverse experiences.
This document also provides guidance for improving the effectiveness of existing health and
nutrition programs by serving as a useful reference tool to reach out to the most marginalized
sections of the population. 5
Objective: To apply digital technology for transparent, timely and accurate supply chain management
of Take Home Ration with a bottom up approach. The project ensures just in time availability of the
supplementary nutrition for beneficiary eliminating the gap between actual requirement and supply.
Target group: ICDS beneficiaries- 6months to 6 years children, pregnant and lactating women and
adolescent girls
Implementing Government Department & partners: Women and Child Development Department
and Gujarat Co-operative Milk Marketing Federation and SUMUL, AMUL and BANAS Dairy Unions and
Gujarat Info Petro Limited (GIPL).
Duration of the project: The projected started in 2017 with 6 Blocks and gradually covered the entire
State by January 2020. The project continues to run today and in future.
About the Project: In the month of September 2017, Government of Gujarat has signed a tripartite
agreement with the Gujarat Cooperative Milk Marketing Federation (GCMMF) to procure energy dense
micronutrient fortified food –Take Home Ration (THR). The purpose of this agreement was to ensure
uninterrupted supply of THR through manufacturing at three leading District cooperative milk unions
as Banas, Amul and Sumul Dairy under GCMMF. Three different products namely Balshakti for children,
Matrushakti for pregnant and lactating women and Purnashakti for adolescent girls is designed
considering the requirement of the specific age groups.
To streamline the THR service delivery and real-time monitoring, a software has been developed by
the department. Monthly indenting, approval and delivery of THR packets till AWC level is monitored
through the dashboard.
Process flow for the demand generation and monitoring of THR
Project- PuShTI “Poshan umbrella for Supply chain through Tech
Innovation” (Ensuring Transparency, Quality, Efficiency &
Accountability in THR distribution in Gujarat) 6
It is a unique solution comprised of a Web based application for demand & supply cycle and an Android
based App for transportation solutions. This ensures smooth, transparent, speedy and error free supply
of THR at the Anganwadi centres.
Benefits of the project:
• Transparency (the entire process is
available at public domain and all the
stakeholders are equally responsible)
• Quality- It is ensured as THR is initially
tested at Amul lab and after passing of
decided parameters it is distributed at
AWCs. To cross check the quality, it is
again tested in Government of Gujarat
Food & Drug Laboratory and after passing
of the test, it is allowed to distribute to
beneficiaries for consumption.
• Safety (as the packaging of the product is
good and free from contamination)
• Standardization (same quality & quantity
of product at the entire state as per the
norms)
• Community involvement and Social Audit
(as the distribution of THR is also done
on monthly basis on 4th Tuesday in the
presence of local persons)
• The entire supply chain management follows the principle of demand driven supply as opposed
to the supply driven management.
• OTP based tracking of distribution of THR upto AWCs.
• Online certification of delivery is provided in the system in order to ensure timely and correct
payment to the supplier.
• Timely and regular supply (supply on monthly basis at the scheduled time)- Timely delivery
of THR ensures timely distribution of Ration to beneficiaries, which will directly support in
nutritional indicators.
Outcome & Impact: Directorate of Evaluation a unit under the Planning Department of Govt. Gujarat
has conducted third party survey and key finding tells that the acceptance of the THR has been
increased in the community and beneficiaries consumes it.
Reward & Recognition: Awarded with Order of Merit- Skoch Award and received appreciation from
Ministry of Women & Child Development Govt. of India.
Delivery of THR till AWC 7
Live tracking of Take Home Ration 8
Objective: To improve nutritional and learning outcomes by using fortified staples to prepare meals
served to children under MDM in selected schools of Karnataka, Andhra Pradesh, Telangana, Gujarat
and Uttar Pradesh
Target group: Children (6 to 14 years) receiving MDM
Government Department: Department of School Education, Government of Karnataka, Andhra
Pradesh, Telangana, Gujarat & Uttar Pradesh
Implementing Partner: The Akshaya Patra
Foundation
Duration of the project: This initiative
started in 2016 and is being continued
and expanded
About the Project: Under this project,
meals prepared with fortified rice,
wheat flour, oil and double fortified salt
are prepared and served to children
to improve their nutritional & learning
outcomes overall resulting in improved
attendance and retention in schools. The
rice is fortified with essential nutrients
including Iron, Folic acid, Vitamin B12,
Vitamin A, Vitamin B1, Niacin & Vitamin
B6 by a simple, cost-effective technology.
Till date, they have managed to reach 5,339 schools and 720,742 children through fortified rice meals
Impact Assessment:
• The Akshay Patra Foundation conducted the impact evaluation of fortified rice meal among
children in Karnataka and Gujarat:
• In Karnataka, a longitudinal cohort study was conducted across 6 Districts with 2 years of
intervention. Data was collected from 1,661 children (6-10years) across 50 schools.
• In Gujarat, a case control study was conducted for an intervention period of 8 months. A
total of 484 children from intervention group and 489 from control group were enrolled
and followed to measure the outcome of interest.
Outcome of the impact assessment conducted:
• 9% reduction in underweight, 4% reduction in stunting and 3% reduction in wasting
amongst students from baseline to end-line (Karnataka)
Project- Improving the nutritional quality of meals served
under MDM through Food Fortification 9
• Positive impact on morbidity profile- an overall decrease in incidence of fever (12% to
8.9%) and diarrhoea (4.3% to 0.83%) from baseline to end-line (Karnataka)
• Overall 43% students showed improvement in Mathematics and English scores from
baseline to end-line (Karnataka)
• A significant increase in average haemoglobin levels amongst children of intervention
group (Gujarat)
• Reduction in prevalence of moderate and mild anaemia among intervention
group (Gujarat)
• Positive impact on cognitive behaviour- 11 points increase in the intervention group as
compared to control (Gujarat)
• Majority of the teachers (89%) opined that students performance in school improved
after introducing fortified rice in MDM
Contributing Factors:
• Fortifying the staples part of regular diet and additionally using fortified oil and double fortified
salt to enhance the nutritional quality
• Ensuring sanitation and hygiene- Children have access to safe drinking water, hand washing
stations and effective deworming programs in place to reduce frequent illness and resulting
absenteeism
• Educating children and children on nutrition, health and WASH 10
Rice blenders at the Akshay Patra Kitchen 11
Objective: To strengthen the integration of MIYCN into the functioning of select Government medical
colleges and hospitals in Uttar Pradesh, Bihar and Jharkhand, including undergraduate curriculum,
service delivery, research and government program support (capacity building, quality assurance and
monitoring)
Target group: Undergraduate medical students of selected medical colleges
Implementing & Supporting Government Department:
• UP: Directorate General of Medical Education, State Health Mission, four Government medical
college and hospitals
• Bihar: Department of Health & Family Welfare, five Government Medical college and hospitals
and one private medical college
• Jharkhand: State Health Mission, one Government medical college, in partnership with WeCaN/
IPE Global
Technical Partner: Alive & Thrive, FHI Solutions (UP & Bihar); WeCaN/IPE Global (Jharkhand)
Duration of the project: January 2017 to ongoing
About the Project: The project was conducted in a participatory way to support effective delivery,
develop champions for the approach and maximize its potential scale up and sustainability. The
initiative is unique in maximising the expertise and experience of medical colleges by prioritising
undergraduate teaching and influencing the curriculum to have a better integration of maternal nutri-
tion, thus creating a well-trained future generation of medical practitioners for both the public and
private sectors with a basic grounding in MN. The project strengthened the integration of MIYCN in the
following areas:
• A strengthened MIYCN curriculum for integration in undergraduate medical training was
developed in alignment with the existing teaching competencies prescribed by the Medical
Council of India (MCI) as set in 2019.
• Updated MIYCN service delivery protocols were adapted for each service delivery contact points
across the ‘1,000 Days’ period, antenatal outpatient department (OPD), labor room, postnatal
ward, immunization and pediatric OPD.
• A quality improvement (QI) approach was introduced within medical colleges and affiliated
hospitals. It followed the “plan-do-study-act” (PDSA) cycle. QI teams were established to improve
MIYCN service delivery at various critical contact points with facilitation/mentoring from A&T QI
facilitators and National and State expert group members.
• A project to measure the quality of nutrition service delivery in the community and inform
Block, District (and State and National) Government programming was initiated with two of the
medical colleges in collaboration with the Indian Association of Preventive and Social Medicine
Project- Harnessing the potential of India’s medical colleges to bring
maternal nutrition services to scale 12
(IAPSM). Faculty participated in the development of the tools and processes for data collection,
conducted monthly field assessments, and participated in district review meetings to share their
findings and feedback on the approach for continuous improvement.
What worked:
• Commitment and ownership of the state government and the heads of medical colleges to lead
and sustain the initiative secured through Memorandums of Understanding (MoUs)
• A visioning exercise was conducted in medical colleges with the departments of Pediatrics,
Obstetrics & Gynecology (OBGY), and Community Medicine, to set the direction for the project
• A gap assessment of MIYCN knowledge, skills and practice, teaching-learning methods and
research priorities was conducted in the selected colleges to inform the development of a
strategic roadmap and implementation plan
• National and State expert group and interdepartmental committees consisting of senior
academicians, practitioners and researchers were formed to guide the initiative and provide
overall oversight to the implementation of mutually decided actions.
• Capacity building of faculty and hospital staff, including postgraduate residents and nursing staff
from the three departments, was conducted for adoption of the strengthened MIYCN curriculum,
service delivery protocols and QI approach.
Training of faculty doctors, SRs, JRs, interns and Staff nurses on MN service delivery protocols 13
Outcome & Impact:
• Integrated MIYCN curriculum and protocols have been endorsed by Department of Health &
Family Welfare, Government of Bihar and Directorate of Medical education, Government of Uttar
Pradesh and adopted by all nine government medical colleges in UP and Bihar and one private
medical college in Bihar and one college in Jharkhand
• Significant improvements in service delivery indicators across all nine colleges:
• All India Institute of Medical Science (AIIMS) Patna- early initiation of breastfeeding in
uncomplicated C-section deliveries increased from 0% to 89% during a four-month period
along with adoption of a policy of zero-separation of mother and newborn
• Improvement in patient flow and management led to nearly three-fourth of the patients
receiving complete ANC services during the defined period
• Weight, hemoglobin and blood pressure measurement was completed for 84% of the
antenatal mothers
• Maternal nutrition counselling delivered to 76% of the women. Exit interviews of the
antenatal mothers to assess retention of key messages on importance of IFA tablets 60% to
72% women; diet diversity 64% to 78%., among other
• At Government Medical College, counselling on exclusive breastfeeding in postnatal ward
increased from 13% to 94% in nine weeks, with above 90% retention in exit interviews
of key messages such as “no water,” “nothing apart from breastmilk” and “continued
breastfeeding during illness”
• Nearly 600 doctors, nurses and counselors in Bihar and 750 in UP were trained on the service
delivery protocols and QI approach.
Challenges faced: Prioritization of the project
by health authorities and medical college
staff, adoption of a project mode with clear
deadlines and metrics, and collaboration
across departments were critical challenges for
implementation of the project. However, the
participatory approach described above was
effective at achieving desired objectives.
Plan for scale-up:
• Scale up in UP and Bihar: The process to
scale up the strengthening of MIYCN into
the functioning of medical colleges to all
government medical colleges across the
state is ongoing in Bihar and UP. In Bihar,
a Government letter was issued by the
Principal Secretary Department of Health
mandating scale up of MIYCN strengthening
into the undergraduate curriculum and
service delivery protocols, along with
nomination of one medical college as nodal 14
institute for MIYCN and budget allocation is being discussed. In UP, as suggested by the Additional
Mission Director, a proposal outlining key activities, outcomes and a budget to seek government
funding to scale up activities across all the medical colleges in the state is under development.
• Scale up in other States: Advanced discussions were held on scale up across the state in
Jharkhand. Discussions on implementation in Rajasthan conducted with the State NHM,
Department of medical education and UNICEF early in the year suggest interest for scale up in the
State. 15
Objective: To revive Millets on farms and plates with simultaneous focus on Production, Processing,
Consumption, Marketing and Inclusion of Millets in Government schemes
Target group: Farmers of the selected Districts (14)
Implementing & Supporting Government Department: Department of Agriculture & Farmers
Empowerment, Govt. of Odisha
Technical Partner: WASSAN (Watershed Support Services and Activities Network)
Duration of the project: Implemented in September 2018 & to be continued till 2025
About the project: OMM was initiated in 2017 for promoting Millets (Ragi) as a staple crop of the
farming system. This project emerged from various consultations held between Government, Academia
and Civil Society to increase household consumption of Millets by reviving Millet production in
identified areas and improving their productivity by means of improved agronomic practices followed
by setting up decentralised processing units to reduce drudgery of processing of millets to add value
to them and make them market ready. For this, promotion of Farmer Producer Organization (FPOs) for
aggregation and better marketing is conceptualised and most importantly include millets in ICDS, MDM
and PDS.
Entire project is to be implemented by FPOs with support of local NGOs under guidance of line
Departments at District and Block level. The key steps for Millet procurement includes:
• Operationalize procurement of Ragi at Minimum Support Price (MSP) conforming to Fair Average
Quality (FAQ) norms
• Make subsidized Ragi available for inclusion in the PDS, ICDS and MDM schemes, closing the
production cycle and multiplying benefits of Ragi production for the region
• Explore markets for distribution of surplus Millets beyond the requirements of PDS, ICDS and
MDM schemes
The Mission was started with 30 Blocks (7 Districts) in 2017 but due to positive response and demand
from the farmers it was expanded to 55 Blocks (11 Districts) in 2018 to 72 Blocks (14 Districts) in 2019
by the Government of Odisha. Another 4 Blocks were added in the June 2020. . The program shall be
implemented in each selected Blocks for 5 years, and these Blocks are currently at varying stages of
implementation.
Various guidelines on Ragi procurement from local farmers at MSP, farmer registration, District wise
storage godowns, route Map from possible procurement locations to Storage godowns and Millet
Procurement Automation System were developed to streamline this initiative.
Project- Promotion of Millets in Tribal areas-
Odisha Millet Mission (OMM) 16
Outcome & Impact:
• Increase in number of Farmers growing Millets from 7,014 in 2016-17 to 8,596 in 2017-18
• Increase in area under Millets cultivation from 2949 hectares to 5182 hectares (almost double) &
increase in yield by 120% between 2016-17 to 2017-18
• 215% increase in gross value of produce per farmer household from Rs. 3957 to Rs. 12486
• 26495 Farmers registered, almost 95% of Ragi procured from farmers in 2019-20
• Procurement infrastructure set up in 14 Districts: this assured market supports bolsters Ragi
production programmes in the area.
• Procurement made subsidized Ragi available which led to inclusion on Ragi in ICDS, MDM and
PDS schemes, closing the production and economic cycle
Inclusion in PDS
In 14 Districts procuring Ragi, 1kg of rice has been substituted by Ragi owing to its higher nutritional
value. It was distributed at the rate of Rs. 1 per kg under PDS scheme in 6 Districts to 16,01,206 ration
card holders under NFSA.
Inclusion in ICDS
Ragi laddoo mix, made from ragi procured from farmers under the mission, was piloted in the
Anganwadi menu in Keonjhar District on July 2nd, 2020, and the same has been requisitioned for
Sundergarh District. Keonjhar District is also set to pilot ragi biscuits in the MDM/ICDS utilizing 401.4
quintals of surplus ragi.
Farmers bringing their Ragi to Mandi for sale Farmers cleaning the light sand in Ragi through
winnowing at Mandi 17
A child with Ragi laddoo mix which
was distributed at the doorstep of the
beneficiaries due to COVID-19. Children
relished the taste of the laddoo mix
Challenges:
• The farmers faced registration issues on the Millet Procurement Automated System (M-PAS) due
to lack of familiarity with the process
• The long distances to limited mandi points in each block, di-incentivized farmers from
transporting their produce for procurement
• Limited decentralized infrastructure for procurement and processing persisted in some areas 18
Objective: To empower healthcare providers for improved maternal and new-born health care during
institutional deliveries
Target group: All the health care providers engaged in providing intrapartum and immediate
postpartum care in public health facilities in selected Districts of Rajasthan
Implementing Government Department: Maternal Health Division-NHM, Govt. of Rajasthan
Technical Partner: Jhpiego (Funding support from CIFF)
Duration of the project: August 2015 to August 2020
About the Project: Dakshata is a strategic initiative developed by the Govt. of India to address the
problem of adverse maternal and neonatal outcomes during and immediately after childbirth.
Rajasthan is one of the few states which adopted Dakshata from its core and were able to bring a
substantial positive reduction in Still Birth Rate (SBR) across the targeted facilities. The program was
implemented in a phased manner to cover 20 out of 34 Districts of Rajasthan with a target of covering
202 high delivery points across these 20 District. The profile of the 202 public health facilities involved
in the Dakshata program were District hospitals (9%), Sub-district hospitals (7%) or community health
centers (76%) and Primary Health Centre (8%). Dakshata strategy involves developing an enabling
Project- Dakshata: Developing an enabling environment for service
providers for improved maternal and new-born health 19
environment for service providers by ensuring critical supplies at the point of use and bringing changes
in the Labor rooms to make it more conducive. It also aims to make healthcare providers more
competent and confident by conducting targeted training and structured mentoring and support visits
so that providers adhere to WHO recommended evidence based practices. Considering the importance
of the availability of timely data collection and utilization, program developed MWMIS (Maternity Wing-
Management and Information system) and Dakshata Mentor app.
Outcome and Impact:
• Against the target of 202 high delivery points in 20 Districts, the program managed to cover 313
high delivery load points of all 34 districts.
• The intervention facilities catered to more than 70% of deliveries in public health facilities of
targeted districts.
• The program was successful in bringing about improvement at the level of resources and quality
of several services (An independent evalauation of the program by PHFI, still to be published)
• Substantial reduction in adverse neonatal outcomes. Stillbirth rate data from Pregnancy, Child
Tracking and Health Services Management System (PCTS)- part of HMIS in State of Rajasthan,
depicts reduction in Phase I facilities in comparison to the remaining facilities of the state (23.9%
vs 14.1%) as well as in Phase II facilities in comparison to the remaining facilities of the state
(12.3% vs 5.5%)
Challenges:
• Most of the Dakshata facilities are deficient in human resources as per norms outlined in
the Government of India’s Maternal and Newborn Health (MNH) toolkit.
• Another issue was the frequent rotation of trained human resources from labor rooms
to other wards of the facilities, which required extra efforts by mentors to train newly
transferred in staff on the clinical guidelines and processes in the labor room.
• The suboptimal entry of case sheets data into MWMIS (Management information system
to improve service delivery in labour rooms) by the data entry operators is another
bottleneck. Thus, the utilization of this data for decision-making was difficult.
• The implementation of Dakshata program requires ownership and accountability at all
levels of the health system. Despite of government initiative, lack of ownership in poor-
performing facilities has been an impediment in the initiation of corrective measures for
improvement.
Plan for scale-up or mainstream implementation: Dakshata Program is an initiative of the Government
of India. Considering the impact of program Government of Rajasthan has scaled up the program across
34 districts and hired 19 designated cadre name “Dakshata Mentor” in 19 districts that were designed
based on the successful implementation of the program by Jhpiego. It demonstrates a possible
approach for other states with high mortality. The learnings from this program can also be vital for
informing new programs for similar settings across the country.
As per a Guidance Note released by Maternal Health Division, MoHFW on Operationalization of
Dakshata, the States interested in implementation of Dakshata program can send an expression of
interest to GoI. To commence with, the States should implement the program in their High-Priority 20
Districts (HPD). with a plan for scale-up to other Districts. Priority should be given to facilities such that
maximum number of deliveries in the Districts are targeted.
RESPONSE DURING COVID-19
To help the community during this pandemic
crisis and to provide assistance to pregnant
women so that essential services can be delivered
to pregnant mothers, District authorities of
all 34 Districts of Rajasthan, in collaboration
with Dakshata team initiated the helpline/
teleconsultation for pregnant women. A team
was prepared and the District Administration
released an advertisement in the newspapers
to inform the general public of this team and
gave the mobile numbers of the panel members,
who could be called at any time for assistance
for pregnant women. Since then, the panel
is receiving many calls and being able to help
pregnant women and their families every day,
with most of the calls coming from remote or
complete lockdown areas. 21
Objective: To reduce the prevalence of anaemia amongst the ICDS beneficiaries through regular
consumption of DFS
Target group: Children (6 months to 6 years), adolescent girls, pregnant and lactating women registered
under ICDS
Implementing & Supporting Government Department: Department of Women and Child
Development, Gujarat State Civil Supplies Corporation Limited (GSCSC) and Food, Civil Supplies and
Consumer Affairs Department, Government of Gujarat
Technical Partner: Nutrition International (NI)
Duration of the project: Distribution of DFS started in August 2018 (ongoing project) across all 33
Districts of Gujarat
About the Project: In line with the goals and objectives of the
National Nutrition Mission (Poshan Abhiyaan), launched by Hon’ble
Prime Minister in March 2018, the DFS program was launched by
Hon’ble Chief Minister of the State Sh. Vijay Rupani in July 2018 at
Gandhinagar. As the regular consumption of this salt has shown to
reduce the prevalence of anemia.
1,2
under this initiative, DFS is being
used in preparation of hot cooked meal for children (3-6 years of
age) and 1 Kg of DFS named “SATVA” is provided to adolescent girl,
pregnant and lactating women registered under ICDS every month.
The aim is to reach 3.6 million registered beneficiaries with DFS.
What worked:
Effective collaboration between WCD dept. and Dept. of Food, Civil
Supplies and Consumer Protection- WCD department allocates budget (Govt. of Gujarat invested INR
23.53 crores for procurement) and request Department of Food, Civil Supplies and Consumer Protec-
tion to procure and distribute it through their Fair Price Shops (FPS) at the village level (distribution of
33,619MT of DFS through ICDS).
• Capacity building of relevant stakeholders at State, District and Block level including government
officials to plan implement and monitor the program by the technical partner.
• Enhancing the knowledge of front-line workers on the importance and benefits of consuming DFS
through SATCOM
• Executing an effective Behaviour Change Communication (BCC) campaign to improve the
acceptability of DFS amongst beneficiaries and position DFS as a value added product.
Project- Introduction of Double Fortified Salt
through ICDS in Gujarat
1
Jere D. Haas, Maike Rahn, Sudha Venkatramanan, Grace S. Marquis, Michael J. Wenger. Double-Fortified Salt is efficacious in improving indicators of iron
deficiency in female Indian tea pickers. JNutr.2014; doi: 10.3945/jn.113.183228.
2
Andersson M, Thankachan P, Muthayya S, et al. Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized
ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Am J Clin Nutr 2008; 88(5):1378-87 22
Outcome: Uninterrupted distribution of DFS in 33 districts since August 2018
Challenges: Lack of knowledge about anaemia and use of DFS - Initially, the beneficiaries did not have
much knowledge about anaemia and benefits of using DFS. This resulted in low uptake, although there
are communication interventions happening in the program, a large-scale communication campaign is
required to increase acceptance and offtake of this intervention
Quote from field: Kinjal Patel (38 years of age) is an anganwadi worker in Jhalod Block, Dahod District
says “I joined ICDS in 2015. As ICDS was then supplying iodized salt to its beneficiaries (pregnant and
lactating women) I learnt about the importance of iodine in the human body, and how to use and store
iodized salt. Later in 2018, when ICDS started providing Sattva-DFS, I had queries related to the black
particles present in it. The beneficiaries also had the same queries. Then, my supervisor explained to
me that these black particles are indication of presence of iron, added along with iodine, to the salt.
I also learnt about the benefits of DFS through the SATCOM training. I ensured its usage in the hot
cooked meals at the anganwadi center, and also started encouraging the beneficiaries (pregnant and
lactating women, and adolescents) to use DFS while cooking at home through counselling during THR
distribution. I could explain about it’s benefits to pregnant women and babies, lactating women and
adolescent girls, and also how to use and store it. I used to feel sad when initially the beneficiaries
refused to use DFS but now the beneficiaries have become more aware and they themselves come and
ask whether the Sattva-DFS supply has come. I feel very happy now” 23
Objective: To reduce the prevalence of anaemia amongst the PDS beneficiaries through regular
consumption of DFS
Target group: Registered beneficiaries under the National Food Security Act across 20 Districts (89 Tribal
Blocks) of Madhya Pradesh
Implementing & Supporting Government Department: Department of Food, Civil Supplies and
Consumer Protection, Madhya Pradesh State Civil Supplies Corporation (MPSCSC), Department of
Women and Child Development, Tribal Welfare Department, Department of Health and Family Welfare,
Govt. of Madhya Pradesh
Technical Partner: Nutrition International (NI)
Duration of the project: The project started in 2017 and distribution of DFS started in April 2018
(ongoing)
About the Project: Challenged with the prevalence of high level of anaemia, particularly among
children (68.9%), pregnant women (54.6 %) and women of 15 to 49 years if age (52.5%)
3
, Department of
Food, Civil Supplies and Consumer Protection, Government of Madhya Pradesh introduced DFS through
PDS in 2018 with an objective to reach 13.5 million individual beneficiaries. The DFS program and BCI
campaign was launched by Hon’ble Chief Minister of Madhya Pradesh, Sh. Shivraj Singh Chauhan on
June 3, 2018 in Mandla block. Through this program, every family registered under National Food
Security Act has access to 1 Kg of DFS every month at a subsidized cost of INR 1 in 89 Tribal Blocks
across 20 Districts of the State. So far, Government of Madhya Pradesh has invested INR 43.15 crores
(incremental cost of INR 11.54 crores from regular iodized salt) for procurement and distribution of
57,468 MT of DFS through PDS since April, 2018.
What worked:
• Executing an effective Behaviour Change
Communication (BCC) campaign with an adolescent
girl named “Lali” (translates as red color, denotes
rich iron in blood) as mascot, improved the
acceptability of DFS amongst beneficiaries as the
campaign positioned DFS as value added product.
• Periodic monitoring visits to warehouses and Fair
Price Shops (FPSs) and sharing the report with
Government officials to ensure smooth functioning
of the initiative.
• Capacity building and awareness generation of the
concerned personnel managing the FPSs who would further pass on the necessary messages to
beneficiaries and encourage them to consume DFS.
Double Fortified Salt in PDS
in Madhya Pradesh
3
Government of India, Ministry of Health and family Welfare, National Family Health Survey-4. 2 24
Outcome:
1. Uninterrupted distribution of DFS in 89 tribal blocks from past 24
months since April 2018
2. More than 85% of the registered beneficiaries are procuring and
consuming DFS on a regular basis
3. Capacity building conducted for 295 officials at State and 453 officials
at District level. Approximately 2317, fair price shop owners sensitized
about the importance and benefits of consuming DFS.
Plan for scale-up or mainstream implementation: The Government of Madhya Pradesh has decided
to scale up the program and has already issued orders for use of DFS in preparation of hot cooked
meal served through Integrated Child Development Services (ICDS), Mid-Day Meal (MDM), Nutrition
Rehabilitation Centres (NRCs), District Hospitals (DH) across the entire state on a daily basis, reaching
approximately 1.6 million beneficiaries.
PDS Beneficiary with DFS
Quote from field: Anita Katare, a Fair Price Shop owner from Kothisodpur village, Nalcha block, Dhar
district. Anita encourages every card holder of her fair price shop to regularly consume DFS and says
“Agar subzi ka rang thoda badle tou badlne dena, achi cheeze hain namak main isliye badlata hain or
khana banane ke baad hi namak dalna pahle nahi”. 25
Project- Developing model anganwadis as nutri-education centre
focusing on ECCE & holistic development of a child
Objective: To change the image of AWCs as places serving food to a centre providing integrated
nutrition, healthcare and education services
Key activities:
• Improve learning outcomes of children in Aanganwadi and make them school ready
• Capacity building of Anganwadi workers, Helpers and Lady supervisors
• Develop fine motor skills and gross motor skills of children
Target group: Frontline workers of ICDS program (Lady Supervisors, Anganwadi Workers, Helpers) are
trained to address children (3-6 years) of anganwadis
Implementing Government Department: District Social Welfare Department, West Singhbhum,
Jharkhand
Technical Partner: TITLI (Together In Transforming Learning in India)
Duration of the project: 3 years
Source of Fund: District Mineral Fund
Targeted no. of AWCs: 843 Anganwadi Centres
About the Project: The education that the teachers receive has a direct and indirect impact on the
way they deliver it to the children. In this regard, the program helps frontline workers of ICDS prog.
to acquire the knowledge and pedagogical skills necessary, to develop and implement child- centered
curriculum practices that intrinsically motivate and stimulate children’s desires to become
meaningfully engaged in
their own learning. Hence,
District Administration,
Chaibasa in collaboration
with Titli organisation trained
843 Anganwadi workers,
Anganwadi helpers and
Lady supervisors in ECCE.
Handholding support is
provided by Titli’s Ground
Supervision Team who visits
Anganwadis on regular basis,
observes the daily activities,
monitors and report in their
dashboard and suggest
improvements. 26
Some unique aspects covered in training include: developing
different Learning centres within the anganwadis;
preparation of teaching aids using naturally available
resources and waste materials; storytelling, etc.
From nutrition perspective, the District Administration has
begun distributing Poshak laddoos for the children aged 6m
to 6y in selected Anganwadi Centres of the District. The idea
behind the laddoo was to encourage children to come to the
AWCs which would thereby positively affect the attendance
and the educational level of the students.
Further, for Kitchen garden, they have roped in respective
BDOs , Mukhiya and savika and sahika to ensure that
selected AWCs must have kitchen gardens. The 14th finance
and untied fund is being utilized for the kitchen garden.
This is an initiative will be an effective step towards
addressing malnutrition.
Outcome and impact:
• Frontline workers are able to understand the importance of positive environment in the
anganwadi for children and focus on their needs
• Poshak laddoo resulted in a positive impact on health of children and also a reason behind
increment in enrollment rate
• Kitchen garden helps to provide fresh and healthy food to children and mother
Challenge: Handholding support is required frequently for the anganwadi workers 27
Mainstream implementation: It has been planned to train the Anganwadi workers, helpers and Lady
supervisors of all 2300 anganwadis of the District with a focus on:
• POSHAN Vatika- Nutri-basket at centers to collect vegetables/fruits to add nutritional value in all
2330 AWCs
• Learning outcome assessment- Make it more rigorous and scientific with iterative learning 28
Objective: Improving the dietary diversity score of women
and children by increasing their consumption of a greater
number of food groups and thus contributing to improved
nutritional status
Target group: Children below 5 years, pregnant women,
lactating mothers and adolescent girls
Implementing Government Department: Odisha Livelihood
Mission, Department of Panchayati Raj & Drinking Water,
Government of Odisha
Funding & Technical Partner: Azim Premji Philanthropic
Initiatives and Living Farms, PRADAN, Harsha Trust
Duration of the project: The project started in October, 2019 for a period of 3 years
Pilot phase of the project: During 2014-2016, Azim Premji Philanthropic Initiatives made a partnership
with Living Farms, a local NGO to mobilize community in Kalahandi and Rayagada districts of Odisha
for establishing individual nutrition garden at their backyard to grow and consume fruits, vegetables,
eggs and meat. The objective was to ensure dietary diversity through intake of vegetable and animal
protein to prevent malnutrition among children, adolescent girls, pregnant women and lactating
mothers. A post project evaluation by Valid International revealed a very positive result of this pilot
project on reducing malnutrition.
About the Project: Based on the experience of working with Living Farms, Azim Premji Philanthropic
Initiatives in partnership with Odisha Livelihoods Mission (under aegis of the of Panchayati Raj &
Drinking Water Department), scaled up and initiated a nutrition sensitive project “Mo Upakari Bagicha”.
There are three important components of this project viz. 14 modules of Participatory Learning
and Action- Linking Agriculture to Nutrition (PLA-LANN), Nutri garden promotion and livestock
management. APPI has also partnered with three Resource NGOs (PRADAN, Harsha Trust and Living
Farms) for prototype development, preparation of manuals and providing technical inputs for designing
PLA-LANN meetings at SHG level and promotion of Nutrition garden, Backyard Poultry and Goat Rearing
at household level.
The programme initially began with few selected Districts but later scaled up to cover all the District
of the State. It aspires to reach out to 75,000 SHGs covering 7, 50,000 households across 107 blocks of
28 districts in Odisha within a span of three years. It also accentuates on building the capacity of 9000
community cadres, who will carry forward the momentum created at community level and will stand
tall as torch bearers for fight against malnutrition in the state. An online MIS specific to Nutrition project
is planned to be built upon the existing MIS of OLM to capture the nutrition garden and livestock
activities as well as consumption by four targeted masses. A six- monthly concurrent evaluation, by a
third party (Oxford Policy Research) is being undertaken to measure the impact of project activities and
make necessary mid-course correction (if any).
Project- “Mo Upakari Bagicha” (My beneficial garden to
improve Dietary Diversity)
Women carrying fresh vegetable produce
from her garden 29
Key Interventions: The program focusses on involving women self-help groups to establish the nutri-
garden alongside training them for rearing poultry and goats. It aimed to transform agricultural
practices, improve access to public services and re-establish the use of forests as a source of food
through intensive community involvement. The key interventions include:
• Community engagements and regular
meetings
• Nutri-gardens and nutri- fields
• Mixed cropping
• Conservation and management of natural
resources
• “Learning by doing” for capacity
development initiatives resulted in
strengthening the knowledge base and
sharpening the skills of cadres
Outcome & Impact (as on 31st May 2020):
Nutrition gardens became the source of constant supply of nutritious and vitamin enriched vegetables
(planted during last harvesting season) for disadvantageous sections who were earlier deprived of this
opportunity and had restricted their consumption to largely cereals and pulses, to certain extent.
• 45,985 and 28,360 Nutrition Gardens were established in Rabi season and summer season
respectively
• 15,290 Pregnant Women, 24,022 Lactating Mothers, 46,967 Adolescent Girls & 36,681 Children
covered till date
Women working to create their own Nutri-garden
Vegetables starting to grow in Rectangular model Demonstration on circular model preparation 30
Minimum Dietary Diversity for Women (MDD-W) Survey
This was conducted by a team of researchers from Resource NGOs in Feb 2020. MDD-W is an
indicator of whether or not women of reproductive stage (15-49 years of age) have consumed
at least five out of ten defined food groups on the previous day or night, an important
dimension of diet quality
50 sample households were taken each from 45 project operational blocks across 13 Districts,
covering 2250 sample households. A simple one-page structured questionnaire was used by
each surveyor for 24-hours dietary data recall from the respondents.
To reduce bias of food intake, data was not collected on festival day or houses having marriage
or other functions. Data collection was done from only those households, who had raised
nutri-gardens (rectangular, circular or gunny bag models) for the first time in Rabi season (Oct
2019-Feb 2020)
Major findings: A positive correlation between promoting nutrition gardens and improving
dietary diversity (MDD score) among women was found:
• 37 blocks have reported positive changes,
• 36 Blocks reported 72-100% coverage of nutrition gardens in sample households during
Rabi 2019
Way Forward: Odisha State Cabinet has taken the decision to promote 5 lakhs nutrition gardens
across 30 districts of Odisha. Government of Odisha has made budgetary allocation of 500 crores for
promotion of nutrition gardens in convergence with MNREGS so that assets can be created, income
enhanced along with increasing the access of rural households to nutritious and vitamin enriched diet.
Gunny bag farming for limited area/land Rearing goat to make animal protein part of diet 31
Objective: To universalize access to human milk by setting up Comprehensive Lactation Management
Centres (CLMC) to support mothers to breastfeed and express milk, encourage Kangaroo Mother Care
(KMC) and collect, store, process and feed Donor Human Milk to babies in need
Target group: Newborn babies especially preterm and low birth weight (LBW) babies
Implementing Government Department: Ministry of Health and Family Welfare, Govt. of India,
Department of Health and Family Welfare, Govt. of Rajasthan
Technical Partner: PATH
Duration of the project: The project started in 2018 and is currently ongoing
About the Project: CLMCs are centres that protect, promote and support breastfeeding, assist in milk
expression for sick newborns (Neonatal intensive care unit), encourage kangaroo mother care and
provide safe donor human milk to sick and vulnerable newborns, those without access to mother’s
own milk. The model prioritizes breastfeeding and puts human milk banks as ancillary support to
breastfeeding and kangaroo mother care. It is based on the Mother Baby Friendly Initiative (MBFI+)
Model and forms the basis of the guidelines released by Ministry of Health and Family Welfare-
“National Guidelines for Lactation Management in Public Health Facilities.”
Project- Integrated Human Milk Banking /Comprehensive
Lactation Management Centres - Universalizing access to
human milk for all babies
It builds on India’s three-tier public health system by establishing CLMCs, Lactation Management
Units (LMUs), and Lactation Support Units (LSUs) at the tertiary, secondary, and primary levels of
care, respectively 32
What Worked:
• Strengthening facility-based lactation systems by building capacities of health workers, creating
a cadre of trainers, institutionalizing tools and processes and engaging multiple stakeholders and
key opinion leaders
• Supporting individual health facilities to leverage funds allocated in National Guidelines to set up
lactation centres
• Impact level indicators for CLMC and LMUs to ensure monitoring and supportive supervision by
State or facility leaders basis the data shared on a quarterly basis
Outcome/Impact:
• India now has on date 83 functional CLMCs increased from 14 functional CLMCs back in 2014.
• In the last 2 years, 54214 mother - baby dyads and 108428 influencers (father, grandmothers
and close relatives) have been reached, through the program. 75% babies-initiated breastfeeding
within an hour, 70% mothers expressed milk for their babies in neonatal intensive care units
(NICU) and 67 % NICU babies received exclusive human milk diet (MOM (mother’s own milk, EBM
(expressed human milk, DHM). 13002 mothers donated 2204.59 litres of milk and 3147 neonates
received donor milk. SNEHI helped sensitize 903 government officials from the national and state
health departments. Nearly 4960 health care providers and stakeholders were sensitized through
training, mentoring and conferences.
• Tools such as the CLMC evaluation toolkit, CLMC training toolkit and Hazard Analysis Critical
Control Point toolkit has been institutionalized as part of the government system.
• States such as Rajasthan has shown exemplary achievement by establishing 18 CLMCs and
is working on further scaling them up to cover the entire state. Rajasthan CLMC-Best model
presented at Good & Replicable Practices & Innovations in Public Health Care System.
• Some other noteworthy initiatives have been the use of the “green corridor” (organ donation
van) in Rajasthan to transfer milk to needy babies, establishment of a mobile van equipped with
a breast pump and a refrigerator for collecting donor milk from mothers in the community in the
state of Maharashtra. 33
Challenges:
• CLMC being a newer concept for many healthcare professionals, takes time for them to
understand, accept and implement it.
• There is poor understanding of processes to apply and secure government funds for
establishment of Human Milk Bank among hospital functionaries
• Despite efforts, mothers and families have low awareness on importance of breastfeeding and
advantages of donation and donor human milk
Lessons learnt:
• The overall value of human milk as a key component of essential newborn care must be shared by
health care workers and management in order for a CLMC/HMB to be effective
• Institutionalizing the National Guidelines on CLMCs requires strong commitment,
ownership and support from a range of stakeholders including policy makers, local authorities
and hospital leadership
• Strengthening systems rather than one off interactions with a few hospital staff will go a long way
in quality controlled and robust scale up of CLMCs
• Availability of strong basic newborn care services in facilities helps to integrate the HMB model
in facilities
Evaluation of the integrated MBFI+/CLMC intervention
• Conducted at a tertiary care facility in Mumbai with an established human milk bank
from July 2017 to September 2018
• The study followed a point of care quality improvement approach and included term
mother and infants as well as sick neonates and their mothers in NICU as participants
• The results demonstrated:
An increase in early initiation of breastfeeding rates among babies delivered
virginally, which rose from 9 percent at baseline to 90 percent post intervention.
Among C-section delivered babies improved from 0.35 percent to 74 percent after
intervention.
Exclusive breastfeeding rates among healthy new-borns climbed to 54% from 39% at
baseline.
A forty-one percent increase in rates of KMC was recorded. 69 percent NICU mothers
34 35
Medical Staff pooling DHM for
pasteurization. Standard processes
are being followed at all level
in CLMC 36
Objective: To revive consumption of Millets and enhance the nutritional content of the Hot Cooked
Meals served to children under ICDS thus contributing to reduction in stunting, wasting, anaemia
and underweight
Target group: Children (3-6 years), their mothers and community members
Implementing Government Department: District Administration, Vikarabad, Telangana
Technical Partner: WASSAN (Watershed Support Services and Activities Network)
About the Project: Telangana has a dryland area and Millets were traditionally grown and consumed.
However, over the years both production & consumption of Millets has declined. Considering the
nutritional and environmental benefits of Millets and with an objective to bring it back into the farms
and plates, District Collector of Vikarabad decided to engage mothers and children on the need to
increase millet consumption through ICDS, as generational change must begin early with children.
Finalisation of Millets based recipes through food festivals: A series of 3 Millet food festivals were
organized to finalize the menu and build consensus around their inclusion in ICDS. Further, through the
online NIN platform “count what you eat”, energy and nutritive values of the recipe were calculated to
meet the standards. These festivals were also used as a medium to spread awareness about benefits of
Millets and encourage communities to make them a part of their diet. At these festivals, Children and
mothers were served dishes cooked with millets and the feedback was collected from members of the
community, mothers, people representatives, anganwadi workers, helpers and kids:
• An overwhelming positive response was
received from all stakeholders
• It was broadly agreed that Millets are
highly nutritious and should be served at
anganwadi meals for kids at least every
alternate day of the week
• Foxtail millet kichidi & Jowar upma prepared
with vegetables were finalized based on the
feedback received
• It was decided to impart training
to Anganwadi workers and helpers
on preparing these dishes. The AW
functionaries were also willing to put extra
effort for cooking millet dishes
• Resolutions were given by the mother’s
committees to promote inclusion of millets at
the AWCs
Project- Introduction of Nutritious Millets into Anganwadi
Centres Vikarabad District, Telangana
Food Festival 37
Pilot Introduction of Millets in AWCs: After the finalisation of the menus, it was proposed that a
pilot would be tried for 3 months and based on the experience, necessary changes will be made to
the program and implement it for further. Pilot program was taken up in 45 Anganwadi Centers in 3
Mandals of the District with about 1000 children. It was decided to serve Millet based meals for 4 times
a week.
Children consuming Millet Khichdi at AWC
Cost Estimation: As rice is available for ICDS at a subsidized price, Millets are not covered under subsidy
and hence millet meals have higher cost per meal. The cost of normal rice based meal per child is
Rs.6.13, the korra (foxtail millet) and Jowar Upma costs at Rs. 8.32 and Rs.10.39 respectively; with equal
standard of energy and proteins but with enhanced micro nutrients and fiber. If subsidy is extended,
then millets based menus might be cheaper or on par with rice.
Source of Fund: The Pilot of 3 months covering 45 AWCs and 1000 children incurred a cost of 1.73
Lakhs as additional expenditure. This additional expenditure was met from the flexible fund given to the
collector by the State Government.
Operational Processes Adopted in ICDS Pilot:
A. Procurement of Millet grains: The grains were procured
from Farmers Cooperatives at a price fixed by a
committee lead by DM, Civil Supplies by referring to the
market price. Farmers’ cooperative also quoted the price
to supply millets which was found to be lesser
than others.
B. Quality Standard & Assessment: Civil Supplies
Department ensured that the grains procured meet the
standard specifications and they would also visit the
stock points, processing units to assess the quality and
submit report.
C. Processing of the Millet: This was also done by
farmers’ cooperative. Cooperative has credit from
FWWB and NABFINS, with this they met their working
capital requirements.
Processing & Procurement 38
D. Payments: Once stock reaches the Mandal-Level Stock (MLS) points, Civil Supplies Dept.
makes payment as per the purchase order to farmers’ cooperatives. AWWs lift Millets
from MLS points.
Recognition: The then Secretary of Dept. of Women and Child Development, Govt. of Telangana,
appreciated the initiative and suggested that this initiative should be scaled up to entire State
Challenges/Policy Constraints:
• The mainstreaming of Millets is constrained by lack of a level playing field between millets &
paddy rice/wheat
• Mismatch between market price and MSP of Millets. There is no regular state procurement of
Millets; the processes are not well established
• Setting up a local procurement system and finding additional budget outside the regular ICDS
programs becomes necessary to expand even successful millets inclusion programs.
• No established procurement mechanism for Millets by corporations like rice & wheat 39
Objective: To strengthen delivery of improved maternal and newborn care and infant and young child
health and nutrition services and practices through a continuum of care at both facility and community
levels in selected Districts of Uttar Pradesh (18) and Gujarat (10)
Target group: Pregnant and lactating women, their newborns and growing infant and young children
(0-23 months of age)
Implementing & Supporting Government Department: Department of Health and Family Welfare and
Department of Women and Child Development, Govt. of Uttar Pradesh and Govt. of Gujarat.
Technical Partner: Nutrition International (NI)
Duration of the project: 5 years (2016-2020. Demo Phase: 2016-2018 (5 District); Scale Up Phase: 2018-
2020 (28 Districts)
About the Project: This project was initiated in 5 demonstration Districts and scaled up to 28 Districts
with a clear focus on maintaining continuum of care through the first 1000 days, by improving the
quality and uptake of maternal and newborn, child health and nutrition (MNCHN) services both in
facility and community settings from 2016-2020 . The program strategy comprised of key components
including Planning & budgeting; Intra-departmental coordination; Procurement & supply chain;
Behaviour chain intervention; Capacity building; Monitoring, reporting & review and
Gender mainstreaming.
They interventions included strengthening the labour rooms in the health facilities; establish or
strengthen Newborn care and KMC Corners. To help achieve this, NI team members advocated District
Government officials to pool resources from their approved PIP’s to procure required equipments.
Simultaneous efforts were also put in place to ensure continuous supply of essential consumables and
materials for provision of newborn care in the facilities.
What Worked:
• Regular assessments of delivery points, hand-holding and mentoring of service providers to
strengthen delivery points during supportive supervisory visits conducted each month
• Biannual KAP surveys of the service providers (Staff Nurse, ANM, ASHAs, AWWs)
• Capacity building of the service providers with a focus on identifying and follow-up of high risk
pregnancies, low birth weight babies and SAM children to strengthen and improve quality of
care provided
• House-to-house monitoring every quarter (in each block) of caregivers of children 0-23 months,
to understand service coverage, awareness levels
• Mentor FLWs to improve documentation, reporting and counselling during VHSND
Project- Strengthening the service delivery and institutional
mechanism with a focus on first 1000 days 40
Maternal Health New-born health Infant and Young Child Nutrition
Early ANC registration improved
from 46% to 59% in UP and 65%
to 72% in Gujarat
Improvement in early/timely
initiation of breastfeeding was
seen in UP from 48% to 53%
Improvement in exclusive
breastfeeding was observed in
UP from 56% to 61%. In Gujarat it
dropped from 72% to 68%
4 ANC services by skilled health
provider improved from 13% to
42% in UP and 26% to 69% in
Gujarat
Kangaroo Mother Care (KMC)
in low birth weight infants
improved from 14% to 43% UP
and 5% to 25% in Gujarat
Improvement in continued
breastfeeding- Continued
breastfeeding at 1 year of child
has been above 70% and at 2
years it is above 60% in both
the States
Receipt of at least 100 IFA
tablets improved from 24% to
42% in Gujarat and marginally
in UP
Mothers of children 6-23 months
received counselling on IYCN
improved from 13% to 88% in UP
and 4% to 46% in Gujarat
Consumption of at least 100 IFA
tablets improved from 8% to
11% in UP and 19% to 51% in
Gujarat
Improvement in minimum
acceptable diet improved from
5.3% to 13% in UP and 5.8% to
11% in Gujarat
Father giving KMC in Hospital Chandauli, UP Strengthened Labour room at DCH Chakiya,
Chandauli.
• Web based monitoring which allowed real time capture of program coverage data generated
reports which were later shared with Government officials in both the States. This also helped in
strengthening review mechanism and further planning.
Outcome: Data of baseline evaluation, end line evaluation carried out in demonstration Districts in
2016 and 2018 and; Nutrition Intervention Monitoring Survey carried out in scale up Districts in 2019
have been referred to show improvement presented below: 41
Challenges faced: Availability of trained HR at the facilities, especially in 24*7 facilities and NBSUs
continued to be a challenge. Another challenge has been in terms of translating knowledge to practise,
both amongst caregivers and service providers. A simple example, as can be seen from the survey that
though counselling of mothers on IYCN has improved, exclusive breastfeeding and minimum acceptable
diet could be further improved.
Plan for scale up or mainstreaming implementation: NI plans to continue its project in UP and Gujarat
around essential newborn care in 16 Districts and operational research on infant and young child
nutrition in 4 Districts from 2020 to 2025.
Quote from field: ‘Up to the age of 6 months, I will only provide my breast milk to Prapti. After 6
months, I will introduce other liquid, semi solid and solid foods but will continue to breastfeed my child’ -
A first time mother and home maker from Gayaj village in Vadodara district (2019).
A mother administering KMC to a preterm child of birth
weight 1380 grams born on April 18, 2019
After 3.5 months the child’s weight increased to
2.8kgs
Positive effect of KMC and counselling mother on weight of a
low birth weight infant 42
Objective: To spread awareness on key component of maternal and child health like immunization,
ANC, PNC, etc. through religious and faith leaders among community members in Aspirational Districts
of UP
Target group: Population residing in five Aspirational Districts of Uttar Pradesh (Bahraich, Balrampur,
Chitrakoot, Shravasti and Sonbhadra) of Uttar Pradesh
Implementing Government Department & partner: District Administration of respective Districts and
Piramal Foundation
Duration of the project: Started in March 2019 and is presently ongoing
About the Project: With an understanding about the trust and respect shown in religious and
community leaders by the community members and the positive influence they might have on
individuals behaviour, Piramal Foundation collaborated with these community influencers to spread
awareness on key component of maternal and child health like immunization, ANC, PNC, hygiene and
sanitation etc. In the interventions first component, 28 religious leaders were sensitised and trained in
key messages at state level where in representation of every above-mentioned district was ensured.
Post state level training every district went ahead to select influential religious leaders from each block.
A total of 164 leaders were oriented at district level in Uttar Pradesh. Each leader pledged to spread
awareness among their fellow community members and support their messages with references from
their religious books.
Some Unique highlights from the District:
Bahraich- Mohammad Khalid Quasmi (Jamitul Ulama e hind Bahraich, Nayib) is a religious leader
who has provided his support towards mobilization of community and breaking various myths and
misconceptions in the community regarding immunization and early registration of pregnancy.
He regularly meets the community and initiates discussion on importance of early initiation of
breastfeeding and exclusive breastfeeding up to 6 months. In recent days he is very active in sensitizing
community on COVID-19 crisis. His focus is on sensitising community on good sanitation practices such
as regular washing of hands with soap. He is also appealing if anyone has a history of foreign travel,
they should take extra care and in case anyone has symptoms like fever, cough & cold, they should visit
the hospital at the earliest.
Project- Engaging religious leaders and faith communities to
improve maternal and child health outcomes 43
Balrampur- Religious leader named Mohammad Ali in Rehra Bajar is running his Madarsa in Kharika
Masoompur Village. He regularly disseminates the information regarding maternal and child health in
the community. Furthermore, in collaboration with Piramal Foundation and RBSK team, Mohammad
Ali organized a health checkup camp in the premises of his madarsa. Around 387 girls were checked
for anemia. This health camp was helpful in identifying 215 anemic adolescent girls were found anemic
which were all counselled by RBSK team. Additionally, the health checkup resulted in the following:
• Eyes checkup were done and reading glasses were distributed to 53 girls
• Sanitary Pad Distribution was done by RBSK team
• Distribution of Adolescent IFA tablets were done by RBSK team
• Counselling on personal hygiene and adapting of Good life style was conducted in the camp
Plan for Scale-up: Next step is to identify religious leader at block & village level and orient them to
disseminate positive behaviour messages among their community.
Outcome and Impact: Following the orientation at the district level, these religious leaders have started
orienting community on various issues related to immunization, Maternal& child health, sanitation etc.
Till now approximately 9500 community members have been directly oriented by these faith leaders.
Community is listening to these leader as they have deep faith in them.
District Number of
religious leaders
Trained
Total
meetings
conducted
Issues discussed in the
public gathering
Community
members
impacted
Shravasti 25162 Immunization, Early breast
feeding, Institutional
delivery, Covid-19, VHSND
Mobilization, Information
regarding VHSND services.
1600
Bahraich 3056560
Sonbhadra 321183000
Chitrakoot33401150
Balrampur 441293187
Total 164 5059497 44
Objective: To strengthen the communication system of WCD at each level & improve the monitoring
of programs by setting up a feedback mechanism for field functionaries and beneficiaries about ICDS
service delivery and subsequently take corrective measure at each level.
Target group: ICDS beneficiaries and functionaries
Implementing Government Department: State Management Center has been established at the Office
of the Commissioner of Women & Child Development
Duration of the project: Started in 2019 for a year, it shall be extended after the annual review of
its achievements.
About the Project: With an overall objective of qualitative
improvement in the entire gamut of services being provided by
ICDS, State Management Centers (SMCs) were inaugurated by
Hon. Chief Minister Shri Vijay Rupani at Commissioner’s Office,
Gandhinagar on 7th October 2019. These SMCs function like a
call centre with a staff strength of 16 desk operators, one Project
Manager and One Quality Manager. This team is led by two Team
Leaders and a nodal officer has been appointed to work as Single
Person of Contact (SPOC) for smooth implementation of SMC.
Functioning of SMC- Each Desk Operator has been allotted two
Districts to administer a questionnaire designed specifically for
each of the schemes being monitored through SMC. The operators
talk to field functionaries (Anganwadi workers, Lady Supervisors,
CDPOs, POs and Women and Child Development Officers) as well
as beneficiaries. They point out the priority areas and share the
areas where the field functionaries might be lagging so that they
can improve. Likewise, the beneficiary feedback is shared on a
regular basis with the various branch heads of the Office, so that they can take measures to remove the
bottlenecks, simplify and streamline the delivery. On an average one desk operator makes 60 calls daily
and monthly average has been around 19000 calls.
As all the Anganwadi workers (AWWs) and Lady Supervisors in the State have received smartphones
and training for ICDS-CAS under the ambit of POSHAN Abhiyaan and are using Smartphone for service
delivery, an online questionnaire has also been prepared on which the responses of the functionaries/
beneficiaries is being captured and progress monitored through the Dashboard.
Activities which have been enlisted for regular monitoring through SMC using ICDS CAS dashboard
includes: Daily attendance of AWC opening; Growth monitoring of children; Home visit by Anganwadi
worker and Supervisors; Delivery of Take-Home Ration (THR) and; Monitoring and follow up calls to
Program officers and CDPOs. Dissemination of key messages to district and project officials as
per requirement
Project- Establishment of State Management Centre to
monitor Women and Child Development schemes 45
Recognition: The practice was endorsed by Secretary, Ministry of Women & Child Development in the
meeting of 5th Meeting of the National Council on India’s Nutrition Challenges under POSHAN Abhiyaan
Plan for scale up: The scope of SMC shall be increased in a phased manner and more WCD schemes like
Pradhan Mantri Matrutava Vandana Yojana, Doodh Sanjivani, among others shall be brought into its
ambit for regular monitoring and analysis.
Response during COVID-19: This setup has served as a powerful tool for communication during the
COVID-19 crisis. More than 13000 calls have been made in April 2020 during lockdown period to
Aanganwadi Workers for THR follow-up, distribution, safety during home visits, support to beneficiaries
in difficult situation and counselling. 10 different types of SMSs were sent from the system to all
frontline workers (55000 persons including AWWs & Supervisors) during COVID-19.
Apart from ICDS CAS dashboard indicators, SMC team is also following up on Community Based Events
(CBEs), beneficiaries feedback on the quality of THR and participants feedback on various trainings
provided & knowledge assessment
Source of fund/Funding support: The expenses for this project were incurred from the Flexi Fund of
POSHAN Abhiyaan approved by Ministry of Women & Child Development, Govt. of India.
Outcome & Impact: With the setting up of SMC, communication with the field staff has improved
manifold. Moreover, noticeable improvement in several key indicators are evident:
Fig in %
Source: ICDS CAS Nov 19 & Jan 20 46
Objective: To demonstrate a successful model of evidence-based antenatal care with special focus on
maternal infections and targeted iron and calcium supplementation leading to reduction in low birth
weight and adverse perinatal outcomes
Target group: Pregnant women and new-born babies in selected Districts of Rajasthan
Implementing Government Department: Maternal Health Department- NHM, Government
of Rajasthan
Technical Partner: Jhpiego
Duration of the project: August 2017 to December 2021
About the project: The project is being implemented in four Districts of Rajasthan (Bundi, Dholpur,
Karauli, Udaipur) in 125 intervention facilities (4 District Hospitals, 3 Subdistrict Hospitals, 26
Community Health Centres, 37 Primary Health Centres and 55 Subcentres). It aims to demonstrate a
successful model of evidence-based ANC with special focus on maternal infections through introduction
of point of care testing and targeted iron and calcium supplementation along with contextualization of
innovative service delivery mechanisms such as group antenatal care, with the intended outcome of
reduction in low birth weight.
The program intends to do this through capacity building of service providers, translating the skills to
practice through onsite mentoring visits, ensuring the availability of essential resources at the point of
care, streamlining the data recording and reporting systems, and periodically auditing the intervention
facilities to assess the providers’ adherence to evidence-based practices.
Jhpiego’s Born Healthy team is providing technical support to strengthening the ANC module of the
Government of Rajasthan’s upcoming digital platform called Nirogi Rajasthan. As the data uploaded
on this digital platform will directly sync to PCTS (the government’s health management information
system), this could help ensure proper recording and reporting of ANC data and eliminate data loss
during transmission, and thus result in optimal ANC data quality.
Outcome and Impact:
• Increase in detection of high risk pregnancies- It more than doubled in intervention Districts
contrast to 30% increase in other Districts due to to a considerable improvement in the capacities
of ANMs. Close to 99% of all posted ANMs in the intervention Districts have been trained.
• Improvement in the coverage of 4 ANC visits (2% to 71%) and in ANC registrations within the first
trimester (63% to 76%) has also been observed in the past three years (2016-17 to 2019-20) at
intervention facilities.
• A considerable improvement in the logistics at the targeted ANC sites- the availability of
multireagent urine dipsticks for identification of asymptomatic bacteriuria- Urinary Tract
Infection causing bacteria (improved from 0% to 97%. IFA and calcium tablets are available at all
intervention facilities.
Project- Born Healthy: Strengthening coverage and
quality of antenatal care 47
• For the first time, HIV and Syphilis testing using point of care diagnostics has been initiated at
outreach level at the 55 Born Healthy intervention subcentres.
• Availability and adequacy of essential resources improved due to continuous monitoring by
program team and improved indenting by store incharges and health workers
Challenges: Maternal infection data was not being captured in State reporting systems. Consequent
to the advocacy by Jhpiego, State has introduced fields for capturing maternal infections including
asymptomatic bacteriuria, Tuberculosis, Malaria and Hepatitis B in the newer RCH register.
Recognition: Born Healthy program was showcased as an innovation to strengthen the coverage and
quality of antenatal care at the WHO SEARO TAG meeting on 25th November 2019 by Government
of India
Plan for scale-up or mainstream implementation:
• Govt. of Rajasthan adopted the Born Healthy ANC training package “Vatsalya” and sanctioned
budget for conducting State level Training of Trainers and District level training batches for the
Born Healthy training package for ANMs and MOs across the state in the financial year 2019-20
• Learnings from Born Healthy program implementation are being incorporated in national
ANC guidelines
Frontline Health Workers in Action 48
Continued efforts during COVID-19: Use of digital platform and social media during pandemic for
knowledge update of health workers; facilitating distant training of health care providers on facility
readiness in the context of COVID 19; staying in touch with frontline health workers to keep continuity
of these workers’ contacts with pregnant women through home visits, especially for the supply of
IFA and providing essential health messages; technical support to district authorities by program staff
to combat COVID-19 in selected districts (Bundi & Udaipur) of Rajasthan and to develop COVID 19
dedicated IEC materials on health messages for pregnant and breastfeeding mothers; facility providers
for reorganizing care for antenatal care for pregnant, women during labor, and postpartum women at
the facility based on latest national and international guidelines. 49
Apart from ensuring doorstep distribution of supplementary nutrition during COVID-19, this initiative of
WCD Dept. Gujarat focused on:
• Engaging the parents of the beneficiaries to guide them in undertaking creative learning activities
for their children while at home
• Providing a forum to unleash the hidden talents/potential of children, adolescent girls, mothers
and AWWs/AWHs
For engaging parents, the Department adopted a three-pronged strategy – OMG (Providing
Opportunity, Material and Guidance):
• Provide “Opportunity”: for parents and children to work together. Online competition “Maro
Samay, Maru Sarjan” (My time, My Creation) was launched to engage children in creative pursuits
and showcase their talent while Staying Safe at Home.
• Provide Material: AWWs distributed the theme based, age specific activity books and drawing
books for 3- 6 years’ children at their home. The idea was to facilitate home based learning.
Activity books & drawing books were distributed to about 16 lakhs 3 -6 years’ Anganwadi children
• Provide Guidance: Utilizing the SATCOM facility of BISAG, the department started telecasting
live interactive sessions for parents and AWWs/AWHs entitled ‘Umbare Anganwadi’. Beginning
from 8th April 2020, these sessions were organized every alternate day and can be viewed on
Vande Gujarat channel 1, JIO TV as well as on the Department’s YouTube channel. The sessions
emphasized the importance of parental involvement in the holistic development of their children
and demonstrated how creative activities for the kids can be organized with the things available
at home.
Social media was extensively used to propagate all the activities under the umbrella of
‘Umbare Anganwadi’
Way Forward:
• Institutionalise the use of the online/mass media platforms for strengthening ICDS interventions
post lockdown through better planning and enhanced quality.
• Plan online training for Anganwadi workers & parents on ECCE, focusing on parenting
• Development of more Web based material on preschool education for both workers and parents.
“Umbare Anganwadi” – Anganwadi at Doorsteps
Maintaining Nutrition & Learning continuum at Home
COVID-19 Specific initiatives 50 51
To ensure the availability and continuity of Anemia Mukt Bharat (AMB) scheme services targeted at
adolescents, pregnant and lactating women during lockdown period due to COVID-19, a tele-call check
list was developed for officials at District, Block and Cluster levels as well as for Front Line Workers and
beneficiaries. This tele check list collected information on distribution and coverages of IFA supplements
in the field as well as on Inter Department Coordination across different levels.
National Health mission, Dept. of Education and Dept. of Women and Child, Govt. of Chhattisgarh along
with Nutrition International implemented this initiative.
This initiative started in the month of April, 2020 to ensure uninterrupted supply of IFA to registered
beneficiaries when the State Govt. of Chhattisgarh issued guidelines to distribute IFA supplements
through an alternate platform like door to door visits. The Tele check list based assessment provided an
opportunity to coordinate with all concerned departments and address the bottlenecks. For instance,
as the school were shut during lockdown, the IFA blue tablets which is distributed at school weekly,
were struck in school’s storage. To address this the Block Medical Officers communicated their Block
Education Officers to release WIFS tablets to local health functionaries, so that IFA blue tablets could be
distributed during lockdown.
ANM distributing IFA to adolescents
in Batauli, Surguja
RHO distributing IFA to pregnant woman in
Malkharoda, Janjgirchampa
Ensuring uninterrupted supply of IFA to
prevent anemia
COVID-19 Specific initiatives 52
To protect the frontline warriors from acquiring infection while taking care of COVID-19 positive cases
and to minimize the interaction between them, CO-BOT has been designed and deployed in healthcare
facilities to deliver medicine, food and water to patients, thus reducing the need of health workers and
ancillary staff to attend to COVID-19 patients in person in West Singhbhum District, Jharkhand.
The Deputy Development Commissioner (DDC) of the District, an engineering graduate, guided the
developed of this CO-BOT. This CO-BOT is remote controlled and the main features include:
• The Co-Bot has been developed at a cost of ₹25000 per Bot while its carrying capacity is 45 kgs.
• The machine has a range of 200-ft, thus can serve to the largest possible wards.
• It is fitted with 2 way speaker and mic system (Doctor can talk to patient and vice versa).
• Ultrasonic obstacle warning system
• A waterproof device, so it can be sanitized and washed completely.
• I P enabled camera to give live video feed that can be seen from anywhere in the world.
The CO-BOT which can move freely and operate remotely
fitted with Wi-Fi camera with a micro- phone for two-way
communication- doctors can pass on necessary instructions
to patients without coming close to them. The cameras can
also keep vigil on the interaction between patients in the
isolation wards.
Presently its being used in two COVID Care facility of the
District including District hospital and has the potential of
being designed, customized and deployed in any COVID care
facility across the country.
CO-BOT: The Technological solution to prevent
COVID-19 spread
COVID-19 Specific initiatives
CO-BOT Serving in Isolation Ward of Sadar
Hospital 53
Meals on Wheels
To provide food to underprivileged, poor, elderly and daily-wage earners who have been struck the
hardest due to the lockdown, ‘Meals on Wheels’ (MoWs) have been specially devised. This initiative
ensures food provision to stranded migrant laborers who are neither able to move back to their homes
nor have sufficient means to cook.
• A total of 9 MOWs are running across the District serving approximately 7000 people on a daily
basis with hot cooked meals every day.
The District administration has planned for further expansion. This successful practice is being
implemented at zero cost to the District Administration who have created grain banks across the District
as well as invited donations. The amount received as donation is used to pay rent, fuel and manpower
and the grains received are sufficient enough to prepare the meals. These vehicles are also being
utilized to disseminate essential messages regarding COVID-19 among masses and distribute masks.
Feeding the needy Social distancing by using old
rubber tyre to maintain 1m gap
Grain donation point
Essential Services Delivery Cell
In the absence of big players like Big Bazar, Zomato or Swiggy, etc. to home
deliver the essentials during complete and partial lockdown, the District
administration established a essential service delivery cell. For this a general
call for self-motivated, young volunteers was made to serve the purpose who
were oriented, trained and as well as acquainted with prepared FAQs as the
first step. Identifying the shops to provide the essential items followed this.
The contact no. of shops was shared with each volunteer. E-rickshaw was
choosen to deliver the goods whose drivers were paid on a daily wage basis
thus supporting their livelihood in these economically tough times. A control
room was set up in the Collectorate where the coordinators would receive
calls from people all over the subdivision. They would then assign a volunteer
of their team to fulfill the requirement. But this was not easy as the residents
were apprehensive about the home delivery process as well as scared about
being overcharged. However, when they were ensured that they would only be
charged for printed MRP and not even a single penny will be charged for delivery, the order started to
flood. This was further expanded to include fruits and vegetables. This helped in ensuring that people
stay indoors as well as receive delivery of essential goods at their doorstep. 54
Support in providing protecting commodities: Due to their rich experience and training in stitching,
Women SHG members produced more than 17.70 crore face masks as a collective effort of more
2.87lakh women SHGs (June 2020). Additionally, they also stitched Protective gears (4.47 lakh) and
produced sanitizers and hand wash.
SHG members as Business Correspondent Agents: BC Sakhi (Business Correspondents/BC Points) have
played an important role in connecting with the rural population and delivered door step financial
services, across the nation during the times of COVID-19. DAY-NRLM with support of all banks ensured
to transfer all three installments of Rs.500.00 to all women Pradhan Mantri Jan Dhan Yojana (PMJDY)
accounts. With nationwide lockdown and restriction in movement, these BC Sakhis brought bank
services close to women beneficiaries in times of utmost need of financial resources. Since 25th March
2020, around 6457 BC Sakhis’ from 14 States have done 67.56 lakh transaction for PMGKY and other
DBT disbursement of Rs.1407.35 Crore till 3rd July, 2020. Cumulatively, over 9000 SHG members have
been deployed as BC Sakhi across the country.
Farm livelihood-ensuring supply of essential food commodities: In Jharkhand, Odisha, Madhya
Pradesh, Bihar, Telangana and Assam, SHG members engaged in farm production. The Producer Groups
and Farm Producer Organizations (FPOs) procured fresh fruits and vegetables from SHG members and
made it available to customers in times of interrupted supply during complete lockdown. Jharkhand
have developed application based software to connect the producer with the market.
Community kitchens: These were initiated in some of the States. The SHG members took utmost care
in maintaining food safety & hygiene while preparing serving good quality food. As on 19th June 2020,
6491 community kitchens have served 4.63 crore persons across 3 States.
SHG members as Community Warriors during
COVID-19 Lockdown
COVID-19 Specific initiatives 55
With an objective to prevent undernourished children to further slip in a state of malnourishment thus
resulting in adverse risk to their life, District Administration Chatra, Jharkhand, launched the Mobile
POSHAN Van on 20th May 2020 for a period of one year by utilizing District Mineral Funds. This van is
conceptualized to organize two or more POSHAN Shivir (camps) in a day with a cyclic repetition in 15
days, to deliver stated nutrition service.
The key features of this initiative includes:
• Provision of highly nutritious hot cooked food to the identified malnourished children. The food
would be cooked under the supervision of medical personnel in the kitchen built inside the van
• Facility for storing raw grains and other material used in preparation of food within the van itself
along with provision of water dispenser to make potable water available for drinking
• Centralized monitoring and supervision- Through camera fitted inside the van
• Taking health functionaries near the beneficiaries with a special focus on severely malnourished
children
• Displaying key POSHAN messages on the LED screen fitted in the van and help create a Jan
Andolan around POSHAN Abhiyaan
• Provision of nutrition counselling and growth monitoring once a month by ICDS functionaries
• The identified malnourished children would be followed up for a period of 3 months to ensure
sustained recovery
POSHAN Van:
Healthy Children, Beautiful Nation
COVID-19 Specific initiatives 56