ICDS MISSION “SuPoSHaN” Community Based Intervention - Curative Strategy : Sneha Shivir (VHNCCS) - Preventive Strategy : 20 Counseling sessions, 25 IEC Sessions 6 VHNDs VIDEO CONFERENCE 31.01.14 CRITICAL INDICATORS PARTICULARS Prevalence of low birth weight Initiation of Breast feeding with in 1 hour Pre-lacteals given Exclusive Breastfeeding (0-5 months) Initiation of compl. feeding At 6 months % Full Immunization ( 12-24 months children) Coverage of 9-59 months children for Massive Dose Vitamin A Supplementation (%) Coverage of Pregnant women for IFA Tablet Distribution (%) Coverage of 12-59 months children for IFA Tablet/Liquid Distribution (%) INDIA NFHS - 3 (Rural 2005-06) 23.4 46.3 55.8 43.5 M.P. NFHS - 3 (Rural 2005-06) 23.4 13.3 58.7 21.6 31.5 - NIN (2010) 19.1 26.4 16.1 71.0 23.5 84.2 - 81.7 - - 78.0 - - 25.0 Nutrition status (Based on WHO Child Growth Standards - 2006) Underweight Stunting Wasting 45.9 38.4 19.1 60.0 50.0 35.0 51.9 48.9 2 25.8 Age Group wise Percentage of Underweight Children (0-5 years) M.P. v/s India (NFHS-III 2005-06) 20 64.9 61.2 61.8 • Undernutrition in the first 5 years (esp. first 2 years) of life60.7 47.6 needs special53 emphasis. 44.8 • Lifelong adverse impact on growth and development 45.6 44.9 43 • Higher risk35.7 of dying in infancy • 29.5 Consequences are severe & often irreversible 10 • 70 % of Children 60 50 40 30 0 Lifelong cognitive and physical deficits and chronic health problems <6 6-11 12-23 24-35 36-47 48-59 Age (months) India Madhya Pradesh Data Source: NFHS-3 (2005-06) VISION 2018 • iks"k.k lq/kkj ds çHkkoh gLr{ksi – dqiksf"kr cPpksa dh ns[kHkky ds fy;s xzke Lrj ij Ms ds;j lsaVj LFkkfir djus ds fy;s xzke vkjksX; dsUæksa ds ek/;e ls leqnk; dks lfEefyr djuk – ifjokj vk/kkfjr i)fr ls dqiks"k.k ds dkj.kksa dks nwj djus gsrq cgq&{ks=d dsUækfHkeq[k xfrfof/k;ksa dklapkyuA – fodsfUær ,oa çklafxd i)fr ls lkeqnkf;d xfrfof/k;ksa }kjk iks"k.k lEcU/kh ;kstukvksa dk dk;kZUo;uA – vkbZlhMh,l ds varxZr csgrj lsok,a miyC/k djkus ds fy;s vkaxuokM+h dk;ZdrkZ dks xzke lHkk LOkLF; xzke rnFkZ lfefr ds fodsUnzhd`r ek/;e ls lqfo/kkvksa esa c<+ksRrjhA – O;ogkj ifjorZu gsrq LoLFk f'k'kq izfr;ksfxrk] ekr`Ro ,oa f'k'kq lEesyu tSlh xfrfo/k;ksa dk vk;kstuA – iks"k.k xfrfof/k;ksa ds csgrj fØ;kUo;u ,oa dqiks"k.k esa deh ykus ds iz;klksa gsrq fo'ks"k fuxjkuh ra= dh LFkkiukA 5 OBJECTIVES “SuPoSHaN” Abhiyan fpagkfdr vfrde otu ds cPpksa dk leqnk; dh fuxjkuh esa Supportive iks"k.k izca/ku Programme on ekrk&firk dks LokLF; ,oa iks"k.k Lrj dks lq/kkjus gsrq Sustaining “SuPoSHaN” ijke'kZ nsdj muds O;ogkj esa ifjorZu ykuk Health and & leqnk; dks xzke esa vfrde otu ds cPpksa gsrq "SuPoSHaN" Nutrition dk;Z;kstuk cukus ,oa fdz;kUo;u gsrq l{ke cukuk & dqiks"k.k eqDr xzke ds fy;s leqnk; dks l{ke cukuk NUTRITIONAL STATUS OF CHILDREN (0-5 YEARS) 32.7 32.1 Only 15% needs facility care 27.3 26.7 26.3 22.4 19.8 22.2 23.7 17.5 12.6 8.3 Severe UW Moderate UW Underweight (Weight-for-Age) Severe Wasting Moderate Wasting Severe Stunting Wasting (Weight-for-Height) NFHS III (2005-06) Moderate Stunting Stunting (Height-for-Age) NIN Survey (2009-10) WHO Growth Standards (2006): MODERATE = Median <-2 SD to ≥ -3 SD & SEVERE = Median <-3 SD 8 “SuPoSHaN” ABHIYAN ‘Abhiyan' for reduction and prevention of undernutrition Conceptualized as a community based programme Targeted convergent approach Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM “Sneha Shivir” , Mangal Diwas, IEC, ABM Adapted from globally acknowledged Positive Deviance Approach d. ftyk dsUnzz SUW>=4 1 2 3 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 bankSj [kaMok [kjxkSu nsokkl uhep eanlkSj jryke 'kktkiqj vkxj xquk nfr;k f'koiqjh fHk.M eqjSuk ';ksiqj dVuh fNanokM+k tcyiqj fM.MkSjh jktx<+ jk;lsu fofn'kk lh/kh mefj;k 234 219 1151 430 265 369 915 329 195 277 102 628 53 236 161 471 100 144 44 400 92 57 208 205 izFke pj.k ds izLrkfor vkaxuokM+h dsUnz d. 64 59 75 65 38 64 66 31 20 45 32 76 84 82 37 61 108 89 64 87 55 77 72 26 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 ftyk dsUnzz SUW>=4 Vhdex<+ neksg iUuk gks'kaxkckn vyhjktiqj /kkj cqjgkuiqj v'kksduxj Xokfy;j ujflagiqj ckyk?kkV eaMyk flouh Hkksiky lhgksj jhok lruk flaxjkSyh vuwiiqj 'kgMksy Nrjiqj lkxj cSrwy gjnk 150 101 115 77 441 1425 399 136 143 46 67 54 75 202 89 195 424 285 77 133 342 290 34 36 izFke pj.k ds izLrkfor vkaxuokM+h dsUnz 57 58 44 62 46 141 30 31 48 41 97 72 72 65 44 111 112 54 41 50 76 88 89 24 “SuPoSHaN” ABHIYAN ‘Abhiyan' for reduction and prevention of undernutrition Conceptualized as a community based programme Targeted convergent approach Targeted to 14698 (70% undernutrition) AWCs - 4 or more SUWs Rastriya Bal Swasthya Kariyakram (RBSK) and C-NRC of NRHM “Sneha Shivir” , Mangal Diwas, IEC, ABM Adapted from globally acknowledged Positive Deviance Approach What is Positive Deviance? • Every community has certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges. • Based on problem-solving and community-driven approach that enables the community to discover these successful behaviors and strategies and develop a plan of action to promote their adoption by all concerned. STRATEGIES Participatory Micro Planning at Village level 1. Community Mobilization • Facilities improvement • Weighing drive 2. Village Mapping 3. Screening of children • Presence of health worker at 1st screening • Provision of 1st round of medication during special VHNDs (17th – 24th) 4. Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team STRATEGIES Participatory Micro Planning at Village level 1. Community Mobilization • Facilities improvement • Weighing drive 2. Village Mapping 3. Screening of children • Presence of health worker at 1st screening • Provision of 1st round of medication during special VHNDs (17th – 24th) 4. Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team Curative Entry point to the village for accelerated reduction in moderate and severe under nutrition in children Steered by Supervisor and Poshan Sahyogini Curative Strategy Sneha Shivir + C-NRC • 1st & 30th day Doctor completes screening, tracks status • 12 days camp for 10-15 children • Supervisors and Poshan Sahyogini conduct the camp – 3 Supervised feeding of children – Focused counseling session of mothers with PD exemplars – Demonstrating local nutritious recipes - Mothers Learn by doing – Day to day child profiling • Poshan Mitra, ASHA, AWW follow up by 18 home visits • Monthly follow up and weighing of children for 6 months • If required re-organize camp STRATEGIES Participatory Micro Planning at Village level 1. Community Mobilization • Facilities improvement • Weighing drive 2. Village Mapping 3. Screening of children • Presence of health worker at 1st screening • Provision of 1st round of medication during special VHNDs (17th – 24th) 4. Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team Curative Entry point to the village for accelerated reduction in moderate and severe under nutrition in children Steered by Supervisor and Poshan Sahyogini Preventive Empowering community to catalyze behavior change for taking out the village from the undernutrition trap Steered by AWW, Gram Swasthya Samiti and Poshan Mitra Team Preventive Strategy • Life cycle approach for improving nutrition – Continuum of care beginning with adolescent girls to first 1000 days and till 5 years of age FIRST 1000 DAYS • Pregnancy (9 months 30 x 9 = 270) • Birth – 24 months ( 24 x30 = 720 days) • Total = 1000 days • To increase children’s chances of survival, improve development and interventions need prevent to be stunting, delivered nutrition during the mother’s pregnancy and the first two years of the child’s life. Preventive Strategy • Life cycle approach for improving nutrition – Continuum of care beginning with adolescent girls to first 1000 days and till 5 years of age • Strengthen and streamline delivery of ICDS – Universal survey and enrolment of beneficiaries at AWC – Vajan Mela every every month 1st to 4th – Screening of children by health care providers and referrals – Swachhata Abhiyan every month 5th to 7th – Targeted activities Monday to Friday Targeted activities Monday to Saturday Days Targeted Activities Monday Regular dialogue with community - Special VHNDs + Poshan Meetings with gram swasthya samitis and poshan mitra Tuesdays Lakshit Mangal Diwas campaign Wednesday Intensive home visits targeted to Pregnant women Thursdays Intensive home visits targeted to lactating mothers of children 0 to 6 months Fridays Advocacy and dialogue with community for behavioral change - 25 IECs Saturday Intensive home visits targeted to lactating mothers of children 6 months to 2 years - 20 themes along with sanitation Support - "SuPoSHaN“ Abhiyan Village level • • • • Sector Level AWW • Supervisor AWH • ANM ASHA • NGO Gram Sabha nominated by Swasth Gram District Tadarth Samiti officials • Poshan Mitra Team • PRI Block Level • • • • BMO CEO JP Project Officer Mobile health team District Level • • • • • • • • • CEO ZP EE PHE CMHO DD Agri/Horti Food Officer DPO AWTC DTO (Health) Home science faculty OUTCOME Sr. no. Out come indicators Target 1 Weight gain of children after 12 days 75% children will show minimum 200 gm weight gain 2 Weight gain of children after 30 days 75% children will show minimum 400 gm weight gain 3 Weight gain of children after 2 months Growth curve children will trajectory 4 Weight gain of children after 3 months 50% children will show positive change in nutritional status 5 Nutritional status of children after 6 months 80% children will show positive change in nutritional status of on 75% of positive 22 Phase Out Strategy • Success in a village will be assessed – by complete elimination of SUW – decrease in MUW • Exit strategy after 1 year of implementation of Sneha Shivir in any village – Weighing all eligible children (0-5 yrs) – Third party would conduct the “audit” – If no cases of severe under nutrition and borderline moderate cases for a period of one year it may be decided to phase out Sneha Shivir – Remaining MUW children would be rigorously monitored and care givers counselled on best practices at regular health education sessions and during home visits IMPERATIVES • Active involvement of Health, Panchayats, PHE, Agriculture, Food • Community participation through poshan mitra team, gram sabha swasth gram tadarth samiti • Sensitive Poshan Sahyogini • Quality training • Good Micro-planning and implementation • Intensive monitoring • Adequate and timely resources TIME LINES • March - 3035 camps in 1st phase in 2 cycles – Cycle 1 : March 1 to March 12 – Cycle 2 : March 24 to April 4 • January and February – Selection of villages, Poshan Sahyogini and Poshan Mitra – Trainings at all level – Microplanning – Preliminary screening of children and medication • April - Preparation for 2500 camps in May (1-12th) • May - Phase 2 camps and Preparation for 2500 camps in June (1-12th) Expectations From Collectors • Build and mobilize for enabling environment and community participation • Strengthening convergence with – – – – – Health for screening and monitoring Panchayat for infrastructure, facilities and participation - employment PHED for Safe drinking water and sanitation campaign MDM for improved Hot supplementary nutrition given at AWC Agriculture for minikits / Food for PDS • Monitor ICDS to ensure : – Universal survey, identification and weighing – Quality of training and inputs of Abhiyan – Delivery of services including THR • Provide administrative, technical and financial sanctions for the optimum usage of resources
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