The complex issue of Malnutrition – where does one even begin to tackle it? Sponsor meals? Adopt villages? Talk to women about nutrition? Work with the ICDS ( Integrated Child Development Programme)? All of the above?
We were faced with a similar dilemma when we first ventured into Mokhada in 2006. The issue was all encompassing. The urgency to act upon it was more than ever before. But we needed to take one step at a time and understand what we were up against. As we peeled each layer of the problem, we got closer and closer to understanding what it was all about. And no, the solution was not as simple as sponsoring a mid day meal.
Malnutrition in Mokhada was the deadly outcome of the combination of low agricultural productivity, early marriages, large scale deforestation, water scarcity, poor access to basic health care as well as access to nutritious food. In order to address this problem holistically we needed to work on all these factors.
Our primary focus of work in 2006 was on the Health Programme. We worked in collaboration with the ICDS department and used their existing machinery to gain maximum outreach in Mokhada. We were always careful not to create any parallel systems to existing government programmes. With this in mind and ‘sustainability’ as the foundation to our philosophy we started the mammoth task of working on the issue of Malnutrition in Mokhada.
The micro planning programme had already given us a head-start in terms of identifying field staff, volunteers as well as partners at the village level. With this team in place and the ICDS staff as our primary support we began talking with people about their health – a completely alien concept so far. We learnt about traditional practices and we introduced new concepts – concepts that were greeted with hostility initially. But as time passed and people were able to see results – we were trusted more. .. but just a little… we still had a long way to go. We were looked upon with suspicion when we walked into villages with our malnutrition growth charts, diagrams of the reproductive system and fancy ideas of nutrition. We touched upon tabooed topics like menstrual hygiene, lactation, reproductive health and early marriage – it was only through sustained efforts that we were able to gradually convince people to alter age old practices and embrace new ones instead.
‘Access’ was another issue that was identified. Access to health services, access to the PDS ( Public Distribution System) and other basic services. It was a dilemma for us – we would encourage women to go for regular health checkups during pregnancy – but where could they go? Some women had to trek two hours just to reach the nearest Primary Health Centre. This was when we realized that we needed to build the capacities of people at the village level itself while simultaneously work on accessibility. The training mainly focused on talking to women and adolescent girls about appropriate nutrition, health practices as well as creating a support system at the village level itself. Field staff would monitor the regular weighing of children, recording of data collected, as well as build capacities of the Anganwadi staff to ensure the sustainability of the programme. Strengthening existing systems and working with the ICDS department at this stage was one of the major factors that helped us not only understand malnutrition in Mokhada, but also affect change and monitor it too.
Today, our health programme has grown by leaps and bounds, with external support as well as local trust we have been able to nudge if not push the monster of malnutrition out of Mokhada and Jawhar. Click here to read more about our current programme.
Photograph of growth chart: Google