marvi nutrition integrated model balakot, district mansehra
TRANSCRIPT
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MARVI Nutrition Integrated Model
Balakot, District Mansehra
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• Intervention initiated in three Union Councils of Tehsil Balakot in district Mansehra
• Pilot Phase = 6 months (April 15 – October 14, 2015)• Implementation phase = 18 months (October 15, 2015 – March 14, 2015)• 20 villages in pilot phase and 30 villages in implementation phase • Target Beneficiaries– Pregnant women = 1125 – Lactating women = 2250– Adolescent girls = 2250 – Children Under 5 year =4500
Introduction
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Intervention is focused on • Nutrition counseling for behavior change to improve the feeding
practices of women and Children • Prevention of iron deficiency anemia and other micro-nutrient
deficiencies
Main objectives:• Improved nutritional knowledge of the women in pregnancy,
lactation, adolescent girls and children feeding • Improved dietary practices for women and children • Improved nutritional status of women and children
Introduction
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• 35-40% population is not covered by the Lady Health worker program (LHW) in Pakistan (http://www.emro.who.int/pak/programmes/service-delivery-lady-health-workers.html)
• As HANDS has developed and tested a model of community based health worker called MARVI, for non-LHW areas for promotion and provision of reproductive health, nutrition and Family planning basic services
• The MARVI model is a solution to improve access for the rural remote uncovered and underprivileged communities. She remains accessible and source of information and guidance to the community on nutritional issues
• The MARVI workers work under the close supervision of qualified and trained Lady Health Visitors (LHV)
Innovation
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Approach
MARVI key to community intervention
Linkages and referral to
Public Health Facilities
Provision of Iron & Folic Acid Tablets
Screening and growth
monitoring women and
children
Group Counseling on nutrition and diet
Home visits for Individual counseling
Record keeping of all
enrolled women
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• MARVIs are selected through community dialogue• MARVIs are trained and skilled in behavior change communication• They form a bridge between community and government health
facilities through referral mechanism
Approach
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They use Information and education material for group and individual counseling to improve the dietary diversity and dietary intake
Approach
The MARVI health house is established to make a center/ hub of counseling and provision of iron-folate supplements, growth monitoring of women and children, and record keeping of all clients and activities
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Public Sector Involvement through lens
Consultation with Provincial Health Department
Monitoring by LHW Program
Review of IEC material DHO during MARVIs training
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Community Involvement through lens
Male community session Male community session
Women group meeting Counseling with female
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Expected Outcomes:• Short Term:• Number of women with appropriate weight gain during
pregnancy• Reduction in low birth weight • Improvement in ANC visits to the public sector health facilities• Number of women taken iron-folate supplements regularly during
pregnancy and lactation• Number of children on exclusive breast feeding for 6 months• Improved knowledge of women about nutrition and proper diet
for women and children bothLong Term:• Reduction in malnourished and under-weight children, women
and adolescent girls • Reduction in anemia among women and adolescent girls
Intended Outcomes
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Motivated MARVI worker can bring some change through consistent counseling• 28 years old • Educated up to grade 12• Trained under the project• Faced resistance while performing routine
activities • Kept herself motivated and continued
counseling local families to attend sessions
• Convinced families for measurement • Educated families on correct dietary
practices • Referred and accompany women to
nearby BHU for ANC
Experience from the Field Nadia Bibi – MARVI Worker
Village Katwi Char
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MARVIs through counseling sessions addressing the following myths for correction
• Women have many myths related to intake of certain foods (cold and hot foods)
• Women don’t disclose pregnancy till 5 months (Nazar)• They don’t feed colostrum ( perceived it as bad for newborn)• Perceive iron and folic acid tablets as Family Planning tablets • Introduce ghutti (Korichar patta - local leaves) to newborns (for
better digestion of the newborn)
Role of MARVIs addressing local misconceptions
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• Poor access due to mountainous terrain and poor infrastructure
• Frequent disruptions due to land slides during rainy season and
snowfall during winter
• No women medical officer available at nearby BHUs
• Female avoid to consult with male doctors
• Mobility of females is restricted without husband consent
• Prefer home deliveries due to lack of financial resources
Challenges
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• Continuous liaison and progress sharing with the Government
partners has build a trust and now they are more supportive
• Engagement and involvement of the local political, religious and
local administrative leadership help in getting buy-in of these
community leaders and their communities
• Community dialogues and subsequent large community meetings
with the male members help in creating conductive environment
Lesson Learned
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• The MARVIs may be sustained as a trained, skilled human
resource for providing basic Nutritional advices and services in
LHW uncovered areas.
• MARVIs may be selected by the health department and inducted
in LHW program as LHWs, after completion of the project.
• HANDS social marketing program will support these MARVI
workers through training and provision of other RH products.
• Social marketing program provide products on subsidized cost
• MARVI generate income by selling these products
Sustainability
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• Continuous linkages with the Government health department
• Evidence based advocacy
• Some livelihood schemes in future to improve the household
earning especially of the community women,
• Scale-up the pilot in other non-LHW areas in the same district and
other districts
Way Forward
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THANKS