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Community Involvement In Promoting Neonatal & Infant Nutrition In Tribal Vadodara Deepak Foundation Vadodara INDIA Project supported by World Bank under SAR DM initiative June 12-13, 2012 Knowledge sharing forum, Kathmandu 1

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Page 1: Community Involvement In Promoting Neonatal & Infant ...siteresources.worldbank.org/SOUTHASIAEXT/Resources/223546... · Community Involvement In Promoting Neonatal & Infant ... nutritional

Community Involvement In

Promoting Neonatal & Infant Nutrition In Tribal Vadodara

Deepak Foundation

Vadodara

INDIA

Project supported by World Bank under SAR DM initiative

June 12-13, 2012

Knowledge sharing forum, Kathmandu 1

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Barriers in Improving Infant Survival and Nutrition in Tribal

Areas

High level of maternal anemia

Suboptimal infant and young child feeding and care practices

Poor hygiene and sanitation & unavailability of clean drinking water

Under reporting, poor identification and referral of low birth weight

Lack of convergence of health and nutrition services at village level

Lack of systems to promote community ownership

June 12-13, 2012 2 Knowledge sharing forum, Kathmandu

Source: Mid term analysis of large scale PPP intervention study (2005)

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Objectives

Broad Objective:

Improve neonatal and infant nutrition practices through convergence of inter

departmental government services and community participation

Specific Objectives:

Promote parental and community involvement in documenting birth date,

time of initiation breast feeding and birth weight with the help of horoscope

Conduct monthly health and nutrition days and distribute complementary

food premix “balbhog” and micronutrient supplements to 6-24 months old

Promote convergence of services through various government departments

June 12-13, 2012 3 Knowledge sharing forum, Kathmandu

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300 randomly selected villages

from 4 tribal blocks of Vadodara

District, Gujarat (India)

Project Site

June 12-13, 2012 4 Knowledge sharing forum, Kathmandu

Gujarat State

Vadodara District

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 5

Study Design

Target Group:

Children below two years of age, pregnant and nursing mothers, community

members

Study Design:

Pre and post intervention design

Project Period: 18 months (January 2010 – June 2011)

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The Innovation

• Use of horoscope as a cultural tool for sensitizing and eliciting

community participation in recording vital statistics and improving

nutritional status of under two children in tribal areas.

Horoscope in lieu of recording vital

information on :

- Date of birth

- Time of birth

- Time of initiation of breast feeding

- Birth Weight within 24 hours

June 12-13, 2012 6 Knowledge sharing forum, Kathmandu

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Improved vital registration

and IYCF practices

Provision of horoscope to parents for

recording key indicators

Birth celebration through

community participation

Integration of services and

Water Testing Monitoring distribution of supplements

Community sensitization through wall

paintings

Strategy for implementation

June 12-13, 2012 7 Knowledge sharing forum, Kathmandu

Leveraging on existing large scale PPP project

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 8

Project Monitoring and Evaluation M&E Framework

Program Monitoring Evaluation M&E

approach

Indicators

Data Sources

Input •% ASHAs trained

Process

•% birth celebrations conducted •% children receiving health and nutrition services

Output •% newborns given horoscope •% LBW identified

Impact % infants in

normal category of Nutritional

Status

Outcome •Indicators of IYCF practices • % Birth registered •% LBW referral

NFHS (2005-6), DLHS-III, Baseline and Endline surveys , project MIS formats maintained by ASHAs , SMCS MIS formats

Targets: Increase recording of Birth Weight from 53% to >80%, Increase timely identification and referral of low birth weight babies from <1% to> 40%, Improve early initiation of breastfeeding from 27% to 80%, Reduce proportion of underweight children (<24 months) from 47% to <30%

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Cluster level (15-20 villages)

Data Collection and Flow – Nutrition Project

June 12-13, 2012 9

Implementation Team

Associate Project Coordinator

Trainers Block Coordinators

M & E Officers

Office Assistants

ORWs

Facilitators

ASHAs

M& E Assistants

D&R Assistants

Knowledge sharing forum, Kathmandu

Lab. Technicians

Village level (1000 population)

Block level (100-150 villages)

MIS Team Training and Monitoring Team

M&C tracking

Register (SMCS)

Data verification

Monitoring

Data

Entry

Project Manager

Campaigns data

– Form 1

Newborn

Information

Form-2

Data processing & consolidation

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 10

Data Processing

Data Entry in Softwares 1. SAFAL net (SMCS) 2. Horo Software (Horoscope data) 3. Excel Sheet (Campaigns Data – 200 villages)

Data Reaches Head Office at District through Electronic Mail

Data Extraction for Monthly tracking of indicators of all Projects including Monitoring findings

Data verification and compilation during cluster level meetings

Data presentation and Review 1.Project Director 2.Block level teams

Data Collection Village level (1000 population)

Cluster level (15-20 villages)

Block level (100-150 villages)

District level (1548 villages)

Independent

Monitoring by

Facilitators in

20%

villages/month

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Results

June 12-13, 2012 11 Knowledge sharing forum, Kathmandu

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 12

Newborns given Horoscope

N=4339/7386 (58.7%)

Timely collection of vital information facilitated horoscope distribution…

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 13

Birth Weight recording Increased

N=6760/7386 (91.5%)

While many newborns were reportedly weighed, information was not made available for generating horoscope…

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 14

Coverage: Average number of beneficiaries attending campaigns

N=3023

Source : Nutrition Project form 1

The project assisted in improving service utilization…

per campaign

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 15

Convergence: Nutrition campaigns attended by AWW,ASHA and ANM together

N=1929/3023 (63.8%)

%

The project assisted in improving convergence to a certain level… Source : Nutrition Project form 1

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 16

VHSC involvement : Campaigns attended by VHSC members

N=1612/3023 (53.3%)

Source : Nutrition Project form 1

VHSC involvement was difficult to elicit without sustained inputs…

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 17

Service delivery: 6-23 month old receiving complementary food premix at AWCs

N=48832/61651(79.2%)

More children started receiving CF premix at centers…

Source : MPR Register

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 18

Birth Registration

N=6143/7386 (83.2%)

Birth registration improved, was related to institutional delivery…

Source : Safal data

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June 12-13, 2012 Knowledge sharing forum, Kathmandu 19

Referral of Low Birth Weight babies

N=442/785 (56.3%)

Unavailability of newborn care services affected referral…

Source : Horoscope data

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Indicators Target Baseline

Value (%)

Endline

Value (%)

% children put to the breast within one

hour of birth

80 68.8 67.5

% infants 0–5 months of age fed

exclusively with breast milk

80 42.7 68.8

% children (6-23m) consuming iron

fortified complementary food premix

(balbhog)

80 - 51.7

% infants (0-23m) in normal category of

Nutritional status

80

57.6

54.2

IYCF practices and Nutritional Status

June 12-13, 2012 20 Knowledge sharing forum, Kathmandu

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Discussion

• A tangible product can anchor behavior change, convergence and community mobilization efforts

• Demand creation needs to have a supply back up including availability of skilled manpower

• Linkages to all public departments are vital for overall impact

• Demand for nutrition services picks up quickly, but behavior change lags behind

• Project period too short to show impact on nutritional status

June 12-13, 2012 Knowledge sharing forum, Kathmandu 21

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Challenges and Actions

• Optimization through time planning, local decision making Manpower attrition

• Combined meetings, trainings, mutual coordination, data sharing

Interdepartmental convergence

• Awareness generated but services limited

Safe water and sanitation

• Advocacy, demand generation, Public Hearings Erratic Supplies

• Time bound problem redressal Technology glitches

June 12-13, 2012 Knowledge sharing forum, Kathmandu

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Final Thoughts

• Sanitation and infection control measures should be integral to nutrition improvement programs

• Supplies of products which aid nutrition behaviors should be adequate to meet demand

• Capacity building and continued mentoring of frontline health and nutrition functionaries including ASHAs in nutrition and care of newborn

• Existing service delivery need to be realigned into community owned models addressing hunger and malnutrition especially in tribal areas

June 12-13, 2012

Knowledge sharing forum, Kathmandu 23

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Thank You

June 12-13, 2012 Knowledge sharing forum, Kathmandu

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