Community Managed Nutrition cum Day Care Centers in rural Andhra Pradesh, India Bringing Health to the Community! Society for Elimination of Rural Poverty, Indira Kranthi Patham Project Andhra Pradesh – India Lakshmi Durga Chava, State Project Manager, Health & Nutrition Unit, SERP, Hyderabad. Email ID: email@example.com and visit us at http://www.rd.ap.gov.in/ Introduction: How is NDCC established? Monitoring & Evaluation Indira Kranthi Patham (IKP) is the largest Villages for Health & Nutrition interventions through CRP strategy are -- HN interventions have an inbuilt monthly surveillance community-based rural poverty reduction identified based on strong Institution Building, Health Savings and Food system, Management Information System (MIS), project in Southeast Asia, involving 9,646,000 Security schemes. that collects information on input, output and outcome self-help group (SHG) women throughout Step 1: Team of five External CRPs come to stay in the village chosen for indicators at the Village Organization (VO) level the state of Andhra Pradesh, India. SHG implementation of HN interventions and one among them is exclusively -- Bookkeepers and Health Sub-Committee are trained at federated at village as Village Organizations responsible for the establishment of NDCC. the village level for data collection (VO),Mandal as Mandal Mahila Samakhya Step 2: CRPs conduct survey, establish dialogue between the community -- Information was collected from a sample of 200 NDCC covering 14 districts. (MMS) and district as Zilla Samakhya (ZS). regarding health and nutrition conditions of women & children. -- Impact Assessment study in progress. Step 3:Individual counseling sessions with the beneficiaries; husbands, P IKP targets multi-dimensional causes of mothers and mothers-in-laws and VO members. o Poverty through programs in Microfinance, Hierarchy of MIS Data Collection Education, Gender, Land Purchase and 1 State Office Step 4: Preparation of Micro Credit plans (MCPs) including the details on l (State Project Sustainable Agriculture, Insurance and Monitoring duration proposed to take diet at the center, and the amount for monthly i Unit) Village Organization Mandal level District level State level Marketing among others. installments for each of the beneficiary enrolled. level c Step 5: Release of one time grant of Rs 3.00 lakhs to the VO as revolving fund y IKP is under the direction of the Society for Elimination of Rural Poverty (SERP), a to each NDCC and Rs.50,000 towards capacity building of CRPs. Health Nutrition State Project Health Activist Community District Coordinator unique organization that draws from both governmental and private sector Step 6: Regular follow up for 6 months by the internal CRPs in the village and Coordinator Management Unit personnel and resources to fill gaps in government development programs. M the field staff of the Mandal & Zilla Samakhyas. a Health and Nutrition interventions (HN) is one of the components taken up by IKP Step 7: Daily health education sessions for the mothers when they come for k and is implemented in 63 pilot Mandals across all of 22 districts in AP. The HN lunch at the center by the Health activist/ASHA using the flip books and e package of interventions targets health and nutritional status at each phase of the exclusive films developed. Collect Data Consolidate Review MIS Data Analysis r life cycle approach. Step 8: Complete ANC and PNC at the fixed Nutrition and Health Days (NHDs) via Base MIS forms forms & Reports Registers s organized at the centers. Step 9: Trainings for bookkeepers, Health Activists, Health Sub-Committees Step 10: Periodic Social Auditing for transparency of accounts and community stewardship. Maternal & Child Health Outcomes: Enrollment (% of total eligible) Pregnant women 43.8% (2111/4825) Lactating women 41.1% (1977/4810) Children 6.7% (1892/28318) Maternal Health & Service Coverage Deliveries N 1098 Antenatal Care % of women who delivered (N)* 97.4% (1041) Weight Gain during Pregnancy % (N) >10kg 43.3% (475) 7-10kg 51.2% (562) Health Activist holding a health <7kg 3.8% (42) education session about safe delivery, Place of Delivery % (N) Institution 88.5% (972) neonatal and infant care practices. Home with trained attendant 9.2% (101) Community Resource Persons Strategy: Home without trained attendant 2.2% (24) Type of Delivery % (N) Normal 86.2% (946) Community Resource Persons (CRPs) are the best practitioners identified from Beneficiaries with their children Cesarean 10.5% (115) SHGs in rural villages. They are trained in all aspects of IKP Health and Nutrition Complicated 2.2% (24) interventions with five specific themed areas: 1.Health Agenda, 2.Health Savings- Postnatal Care % (N)* 99.0% (1058) Health Risk Fund-Health Insurance, 3.Trainings, 4.NDCC, and 5.Water & Maternal Deaths N 0 Sanitation-Fixed NH days-weaning food (via convergence). These women, who Nutrition cum Day Health Activist weighing the pregnant beneficiary Neonatal Care & Outcomes serve as Behavior Change Role Models, are sent to different villages in teams of Care Center Neonatal birth weight % (N )** >3kg 56.2% (514) 2.5-3kg 42.2% (388) five for two weeks at a time to motivate the community to take up the Health and <2.5kg 1.4% (13) Nutrition activities. Neonatal/Infant deaths N 2 • Team of 5 external CRP Conduct survey & community meeting. Neonatal care practices % (N)*** Colostrum feeding 98.9% (723) • Introduce the concept of HN interventions to SHG members No pre-lacteal fluids 96.7% (707) Phase 1 -15 Immediate wrapping 98.5% (720) • Motivate the community members to take part in HN activities days Delayed bathing 75.5% (552) Exclusive breastfeeding 99.0% (724) • Next month, the same five member team returns to the village to gauge the quality and coverage of HN interventions. * Out of 1069 deliveries with complete data • Support the community to manage the interventions independently. **Out of 915 neonates with complete data Phase 2 – 15 • Establish systems to sustain the activities. ***Out of 731 neonates with complete data Monthly growth monitoring days • Hand over the responsibility of implementation and monitoring to newly identified internal for children under five at CRPs from the village. Fixed NH days ANM worker giving TT vaccine to pregnant woman at Fixed NH days. Weight Gain During Pregnancy Infant Birth Weight •After 2 months, same team of five external CRPs come to the village to the evaluate the progress of HN interventions. 100 <90 days 100 <90 days 90 90-120 days 90 90-120 days •In between phases 1, 2 & 3, the newly identified internal CRPs supervise HN activities to 80 120-150 days 80 120-150 days Phase 3 – 3 make sure they are prompt and effectively operated. Community Kitchen Garden 70 70 150-180 days days •After six months of experience in their own village, Internal CRPs are selected to train as 150-180 days Percent Percent 60 60 External CRPs as the HN Program is scaled-up. 3rd trimester 3rd trimester 50 50 40 40 “I wish such Centers would be available to every woman. I would be happy to 30 30 16 State CRPs/ 20Team 664 External CRPs- Internal CRPs in over 300 have such Center in my mother-in-law’s village” 20 20 Guide – Serve as serves as a trainers VOs- serve as resource - Chennu Himabindu, Salem Palem, Krishna. 10 10 troubleshooting who are sent to persons in their own 0 0 “The nutritious food I get at the Center like, green leafy vegetables, and a villages to establish HN community & make sure 10-12 kg 7-10 kg <7 kg >3 kg 2.5-3 kg <2.5 kg experts in strengthen & deepening of the NDCC interventions the activities are sustained. variety of other vegetables, fruits, milk and lentils has enabled me to put on Correlation between weight gained during pregnancy (Left) or infant birth weight (right) and number of days woman was enrolled in the Nutrition Center. Presented as percentage of weight. Earlier I weighed 47 kilos. Now I weigh 50 Kilos. I get advice and **When they are not involved in training, the State CRPs and Team Guides serve as resource persons for their own villages** women who gained the indicated amount of weight out of all women enrolled for each information at the Center. I’m very happy now” category of time. -Bhupathi Nagavalli, Koduru. Nutrition & Day Care Center (NDCC): Aim: To improve perinatal and neonatal outcomes in rural Andhra Pradesh Cost Estimate of a NDCC: Scale-Up Plans: Features: -- Physical center i.e., building with kitchen, dining and a garden for Start-up Recommendations SERP Targets Activities & Status Component Details •2007-08 Goals achieved. growing leafy vegetables Cost 1. Investment in Social 2007: 500 CRPs -- Two meals in a day prepared and served to pregnant, lactating women Capital: Continuous 2008: 1500 CRPs •Funding released from and children < 5 years. Microfinance Loans for the From 2009 Health Department under Seed capital to the capacity building of -- Each meal includes rice, dhal, 2 types of vegetable curry, green leafy vegetables, beneficiaries. Rs.200,000 onwards 2000 NRHM & APHSRP for scale Village Organization CRPs, Health Activist up of capacity building. egg, yogurt, fruit, and a cup of milk. additional CRPs will and Health Sub- be developed and -- Serves as a health education center where the Health Activist holds daily sessions on a number of maternal and child health topics. Committees. trained every year . -- Cost of meals: Capacity Building of Monthly State trainings & Rs. 50,000 * Rs 25 per day for TWO MEALS for pregnant and lactating CRPs review. women * Rs 10 per day for TWO MEALS for Children <5 years 2. Government 2007: 200 NDCC •2007-08 Goals achieved Cook, room rent, kitchen -- Pregnant and lactating mothers pay Rs 18 per day for two meals the Initial Operating 2008: 1000 NDCC •Funding released from utensils, community Commitment: balance of Rs 7 is subsidized by the Community-Based Organization. Expenses kitchen garden, weaning 2009: 2500 NDCC Health Department under Rs. 50,000 Convergence & NRHM & APHSRP for scale and also dovetailing the funds from line departments of the Government of food, toy & play 2010: 5000 NDCC coordination of up of NDCC Andhra Pradesh. equipments. By 2013: coverage various public health of entire AP state •Institutionalization of -- The beneficiary’s contribution is financed via a microfinance services and Fixed NH days. loan which is repaid over 24–36 programs: ICDS, months depending on income Poorest of the Poor Health Department, Support exclusively for POP of the beneficiary. Fund to Village with longer grace period to Rs.50,000 NRHM. -- So far, 400 NDCCs have been Organization repay the installments. established in 20 Districts of AP. Impact assessment •Publishing periodic 3. Impact Assessment progress reports about study underway and will be the HN interventions for published in April policy implications & TOTAL Rs.350,000 2009 replication purposes. Acknowledgments: Funding for Health and Nutrition interventions under IKP is provided by National Rural Health Mission, Government of India, Andhra Pradesh Health Sector Reform Program, Department of Rural Water Supply, Department for International Development & World Bank.
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