Improving nutritional status of women and children
Nutrition is an important factor in maternal and child health, and water, sanitation and hygiene practices have a major bearing on nutritional status.
Despite the nutritional status of women and children in Nepal improving between 2001 and 2011, malnutrition rates, especially chronic undernutrition, remain some of the highest in the world. Among children under the age of five, 41% are stunted while 35% of all women, 48% of pregnant women and 39% of breastfeeding women are anaemic.
We have worked in India to support several state governments to improve the nutritional status of marginalised rural populations through community based health, nutrition and water, sanitation and hygiene (WASH) services. From this experience, lessons can be applied in Nepal where we continue to support efforts to improve the nutritional status of women and children.
The prevalence of undernutrition in children under five in India has declined significantly in the last 10-15 years, but in several states, including Odisha, it remains unacceptably high.
Better data on the use of service and health outcomes was needed to inform government departments of programme impact on the health and nutritional status of communities. Accordingly, we supported implementation of a Concurrent Monitoring (CCM) survey to provide independent feedback on the use of health, nutrition and WASH services. These surveys were the first in India to provide household and block-level data disaggregated by socio-demographic characteristics including caste and standard of living. Concurrent Monitoring was also used to assess progress and steer management decisions at state, district and blocks levels.
We also provided intensive support in 15 nutritionally vulnerable districts in Odisha in order to improve the availability and quality of WASH services. We worked with local communities to promote the use of these – and broader health and nutrition – services and helped communities engage with local government and service providers to ensure that services were responsive to needs, and that government would be held to account when services are sub-standard.
In Bihar, we implemented the Sector Wide Approach to Strengthening Health (SWASTH) programme, to improve the population’s health and nutritional status by increasing access to quality health, nutrition, and WASH services - particularly for underserved groups. We helped to improve planning, organisational strengthening, human resource management, decentralisation and programme ‘convergence’ among key departments. The programme also used community level processes to manage demand and monitor services.
Under SWASTH, we pioneered an initiative called Gram Varta (Village Dialogue) to mobilise women’s self-help groups and communities around health issues. Gram Varta used a participatory learning and action approach to educate women through meetings on health, nutrition, and WASH. This enabled women to identify and prioritise problems related to poor nutrition and health, find local solutions, promote behaviour change and adopt appropriate actions for themselves and their families. Part of this initiative focused on nutrition and health check-ups to identify malnourished children.
In 2009, we supported the Nutrition Assessment and Gap Analysis (NAGA) from which a five-year multisectoral plan for nutrition was prepared. This included evidence-based interventions for the health, agriculture, education, WASH and welfare sectors.
Our Nepal Health Sector Support Programme (NHSSP) highlighted to government that maternal and child nutrition was not improving sufficiently following which the Ministry of Health designated as a high-priority investment area.
We also supported the Integrated Maternal and Neonatal Micronutrient Programme (IMNMP) in 2003 which focused on intensive advocacy activities, including building awareness through public media, and the training of health workers and volunteers. Under this programme we worked in selected districts to identify strategies to improve micronutrient coverage and protocol compliance. Other targeted interventions included monthly take-home rations of fortified supplementary food, homestead food production, improving school environments and health and nutrition behaviours in public schools.
- In Nepal, we supported the national programme for high-dose vitamin A supplementation for post-partum women (200,000 international units within 45 days of delivery).
- In Bihar, Gram Varta reached out to nearly 800,000 women and their families through 78,300 self-help groups. Through this, severely malnourished children were referred to a Nutrition Rehabilitation Centre for intensive care.
- In Odisha, we established monitoring systems to track the health of vulnerable groups and determine those in need of financial support in order to access health services.
Integrated Maternal and Neonatal Micronutrient Programme implemented in 74 districts of Nepal
In Odisha, the number of people using sanitation services rose from 9 million in 2011 to 13.8 million in 2015
Gram Varta reached out to nearly 800,000 women and their families through 78,300 self-help groups leading to improved referrals for severely malnourished children