Process Documentation of Initiatives/Innovations under ABM

Initiative by DWCDWith technical

support from MPTAST

Background

Atal Bal Arogya Evam Poshan Mission

Atal Bal Mission was established to strengthen and fill the gaps in the existing Integrated Child Development Scheme (ICDS).

The objective of this mission is to work in an integrated and coordinated manner to bring an improvement in the nutrition and health status of children in Madhya Pradesh State thus addressing the problem of child malnutrition in the state.

The districts had immense scope in utilizing the funds to implement need based activities, take initiatives and apply innovative approaches to address malnutrition.

District Action Plan

Initial Review

• Review meeting held from 17th – 26th September 2012

• Based on the presentations made by the District officials, thematic areas were identified for documentation and eighteen districts were identified for process documentation.

• Third / additional meal to beneficiaries (pregnant women/lactating women/malnourished children) under ABM

• Web-based tracking / monitoring

• Strengthening nutrition counseling modalities / community participation

• Periodic tests for assessment of AWWs skills/knowledge followed by need-based capacity building.

• Other specific theme/s

Thematic areas

Process Documentation

1. Identify and document the initiatives/innovations that can be scaled up across the state of Madhya Pradesh.

2. To assess the impact / change after implementing the initiative/innovation in the selected district/s.

3. Inclusion of successful initiative/innovation into the districts’ Annual plan (2013-2014) for implementation and scale-up across the state.

Objective

Methodology

1. Finalization of list of Initiatives/Innovations and districts

2. Field-Assessments by a combined team of officials from DWCD, DoH&FW and MPTAST

3. Compilation and Screening

4. Inclusion in upcoming Annual Planning (2013-2014)

5. Implementation and Scale-up

Template for field-assessments

Defining the Initiative/Innovation

• Name of the Initiative/Innovation• Goal/Aim• Objective• Target Population/Group • Extent of Intervention (no. of village/AWC/sector/cluster etc.)• Areas of Intervention (specify the names)• Duration (start and end date) of Intervention• What was the need for this initiative/innovation beyond ICDS SNP

program already being provided at AWCs?• Describe the intervention

Describing the various components / elements of Initiative/Innovation

• Components of initiatives being provided Ex. Tiffin meal, pockets etc. • Constituents of food being provided

Ingredients Quantity of Ration per bens • Rationale behind using these ingredients• Anybody from the state directorate visited to see this intervention• Basis of the selection of ingredients (RDA/technical advice/local

conditions/implemented in other areas)• Are the ingredients locally available?• Seasonal variations in the availability of any of the ingredients• Is there a rotational menu? Frequency of rotation of menu.• Procurement procedure and quality assurance

Template for field-assessments

• Storage facility Place of storage Prevention of dust/rodents/moisture infiltration Pilferation issues

• Distribution modalities Quantity per beneficiary Transportation and quality assurance Prevention of dust/rodents/moisture infiltration Place of distribution Frequency of distribution Containers for distribution Pilferation issues

Template for field-assessments

• Consumption by the beneficiary (monitoring mechanism)• Preparation (Cooked)• Is hygiene ensured (Based on the field visit and observation)

Availability of water (running or stored) Washing of ingredients and washing area Cooking area Cooking process Storage Others (Utensils, hands etc.)

• Staff involved in this activity (Regular or additional staff)• Community involvement in this initiative

Describe various stages of community involvement

Template for field-assessments

Monitoring and Financial aspects of implementation of the Initiative/Innovation• Monitoring mechanism and formats used?• Impact of this intervention

In the words of DPO, AWW, Community etc. What are their indicators for the impact

Any pre post assessment done to measure the impact (what is the change - mention numerator and denominator)

Data from the MIS available for analysis Records available of the DPO for assessment No. of beneficiaries till date

• Monthly and annual expenditure on this activity?• No. of beneficiaries per month and year based on the above mentioned cost. • Cost per beneficiary• Did any of the beneficiaries drop out of the program?

Template for field-assessments

Before summing up the detailed and collated information; value-add on by the field assessment team/evaluators based on the objectives of the assessment• Observations• Comments/Suggestions• Do you consider it as an innovation or initiative • Is it fit to be scaled up across the state• Do you think the intervention is in line with the set objectives if

so, how and why. If not, why not.• It there a possibility that this initiative will also lead to

achievement of other outcomes besides those that were envisaged. If so how and why.

• Any other questions which have not been addressed above.• Conclusions.

Template for field-assessments

Feedback by the community and summarizing the interactions with them• Please interact with at least three beneficiaries.• What is the profile of the beneficiaries?Age group Literacy status Assumed Socio economic status • Do the beneficiaries have an overview of the objectives of

initiative/innovation?• Are they accessing the services of the initiative/innovation

regularly, if not why?• Do they think the initiative/innovation has benefited them?• Describe how it has benefited them?• Any general comments about the initiative/innovation?

Template for field-assessments

List of Innovations

S.No Component District Innovation

1. MIS Betul

Web Based Monitoring / Atal Betul mix

2. Counselling Vidisha Baal Chaupal Karyakram

Neemuch Ujjawala Abhiyan(Nutrition / Health)

Dewas Elderly women (badi maa) for counselling to the families of undernourished

Barwani Breast feeding counselors appointed by Health under ABM

Dindori Project Protsahan

3. Training Mandsaur Dakshata Parikshan

List of InnovationsS.No Component District Innovation

4. Nutrition

Shajapur Pocket stitched in dressesSatna Nutri-corner

Khandwa Akshay patra yojnaDhar Vatsalya Kendra

Jhabua Aanchal KendraIndore Booster Meal

Gwalior Dugdh SanjivaniDatia One additional meal to pregnant

women

Guna Tiffin System5. Health Dindori Mor Dubaliya

Chhindwara

Identification & Management of Anemia in P/L women and MCTS Tracking(Nutrition & MIS)

Hoshangabad Project Samarpan / Vatsalya software

Team

S.No. Cluster of districts

Innovation / Initiative Component Documentation Team

Visiting Officials (DWCD)

1

HoshangabadVatsalya Software

MIS, Nutrition

and Health

Sreenivasan Kallam, Richa Som and Dr.

Archana Mishra

Mr. Mahendra Dwivedi-Deputy Director (MIS) + Team

Project Samarpan

BetulWeb-based MonitoringAtal-Bal Mix

Chhindwara

MCTS TrackingDay-Care CentreIdentification & Management of Anemia in P/L women

Team

S.No. Cluster of districts

Innovation / Initiative

Component Documentation Team

Visiting Officials (DWCD)

2

VidishaBal Chaupal Karyakram

Nutrition and Health

Naresh Ramnani and Pooja Madan

Kohli

Mr. Akshay Srivastava - Joint Director (ICDS) Satna Nutricorner

DindoriProject Protsahan

Mor Dubaliya

3

Neemuch Ujjwala Abhiyan

Capacity Building, Nutrition

and Health

Risha Kushwaha and Kavita Chauhan

Mr. Vishal Meda – Asst. Director (ABM) Mandsaur

Dakshata Parikshan

ShajapurPocket stitched in children’s dresses

TeamS.No. Cluster of districts Innovation /

InitiativeComponent Documentation

TeamVisiting Officials (DWCD)

4

Gwalior Dugdha Sanjivani

NutritionRajesh

Shrivastav and Deepika

Mr. Govind Raghuvanshi – Asst. Director

Guna Tiffin System

DatiaAdditional Meal to Pregnant Women

5Dewas

Badi-maa to families of under-nourished Counseling

and Nutrition

Pragnya Das and Hamza

Mr. Sanjay Sisodia – Deputy Director (ABM)Indore Booster Meal

Dhar Vatsalya Kendra

6Barwani

Breast-feeding counselors appointed by Health dept. under ABM

Counseling and

Nutrition

Dr. Ajay Khare, Ajay Reddy/Dr.

Aboli Gore

Mr. Sanjay Sisodia – Deputy Director (ABM)

Jhabua Aanchal Kendra

ReflectionsFrom

Field-Assessments

Third/Additional Meal to Pregnant Women, Lactating Mothers and Malnourished Children

Booster Meal

• Eight children (SUW) identified for booster meal

• 120 gms / child provided in the evening slot of 5-7 PM by AWW and AWH.

• Weight monitoring every week and recorded.

Corn-soya-wheat (salty)Corn-soya-wheat (sweet)Groundnut-soya-wheat

Indore

Complete meal to Pregnant women

• Providing one complete meal to Pregnant women from 2nd trimester till delivery of the child.

• Meal prepared by SHG based on day-to-day meal chart.Datia

Day Care Center

• 13574 SUW children identified and made to stay at AWC from 9 AM to 4 PM.

• The meals included:Morning snackHot cooked mealRajgir ladoo- third mealTHR- fourth mealAtal bal ladoo- fifth mealOctober 2011- 13574March 2012- 6259November 2012- 2907

Chhindwara

NutriCorner

• Transparent box containing food ingredients based on weekly menu is kept in an identified corner in the AWC.

Satna

Stitched Pockets

• Children have the habit of eating packet snacks available locally.

• Pocket stitched in two dresses of identified SUW children and filled with roasted gram/groundnut and jaggery for three days. For 6 months to 3 yrs children powdered form in polythene packs provided to their mothers.

Shajapur

Tiffin System • Food was given to SUW

children through tiffin. Managed through the SHGs. Timing: 3-4 PM

• Atal Bal Mitr- link between AWW and households.

Meetha daliaNamkin dalia khichdiChawal kheer9419 SUW children number has reduced to 4274 in November 2012

Guna

Adoption of underweight children

Ratlam

• Community leaders like MLA, ward member, businessmen etc played a pivotal role in adopting the SUW/MUW children of the AWCs of their areas.

• Sattu, Aid (multivitamin and half a spoon of coconut oil mixed in food) provided

Periodic tests for assessment of AWWs skills/knowledge followed by need-based capacity building.

Dakshata Parikshan

Mandsaur• A test was conducted to

assess the skills of the AWWs.

• Based on results, AWWs who secured grade C&D were given training to refresh their knowledge.

Shajapur• An examination was first

conducted for 1256 AWWs of the district.

• Second examination for AWWs including mini-AWCs was conducted (follow-up of) after imparting training. Year gap.

Blood transfusion to P/L mothers

• Pregnant and lactating mothers who were anemic were referred to the district hospital for blood transfusion.

• Main objective was to address LBW children and anemia in women

• 14 bedded ward exclusively dedicated for anemic P&L mothers set up.

Chhindwara

Ujjwala Abhiyaan

• Increase awareness among adolescent girls who are either school-going or are drop-outs on proper nutrition, hygiene, reducing anemia and increasing age of marriage.

Neemuch

Samarpan • Also called as “early intervention clinic”.

• Is an initiative for early identification, screening, treatment and rehabilitation of children with developmental delay or physical disability.

• Convergence of WCD, NRHM and DDRC

• IPGMER developed questionnaire for screening.

Hoshangabad

Breastfeeding Counselor

• Facility based counseling to the mother for colostrum feeding.

• Addresses issues of newborn care practices, kangaroo care and institutional deliveries.

Barwani Job chart of breast feeding counsellors

ANC counselling at the time of admission

PNC counselling

Breast feeding counsellor must be present at the

time of labour

Educate mother about the advantages of Kangaroo

care and ensure the thermal care

Counselling on attachment between mother and

new-born baby

Ensure early and exclusive breast feeding practices

Ensure colostrum feeding

Mor Dubaliya

Dindori

•

731 pregnant mothers have been felicitated with the kit that comprises relevant information and materials related to pregnancy care.

Vatsalya Software

• Software was developed with financial support from Red Cross Society.

• Completely online. Has lots of data.

• Has won e-global awardHoshangabad

Counseling

Bal Sanskar- Vidisha

• Inviting parents to AWC quarterly and educating the parents on growth and development of child

Vidisha

THANK YOU