Banda district, of the easternmost in Bundelkhand region of Uttar Pradesh, is proving an inspiration with its community-led model of tackling malnourishment among children. Out of 173,000 children who participated in ‘bal poshan satr’ (BPS) drive, so far 11,985 children in the red (severely malnourished) and yellow (at risk of malnutrition) category have benefited under the ‘Banda Suposhan Karyakram’.
The government runs the Banda Suposhan Karyakram to help children improve their overall health and nutrition status, including gain weight, in a three-step scheme. The first stage involves a seven-day food drive at the anganwadi centre (AWC) to enhance awareness about improved food eating practices. The second stage focuses on counseling mothers about nutrition and its health benefits, not only for family members but also herself. The third aspect focuses on ensuring that children with medical complications get treatment by referring them to the community health centres (CHC) for treatment. These steps have helped improve the health conditions of people in eight blocks in Banda, particularly the growth of small children.
Banda is the first district in UP to adopt the community-based Management of Acute Malnutrition (CMAM) approach that enables community volunteers to identify and initiate treatment for young children with acute malnutrition before they become seriously ill. The whole programme, being undertaken across the whole state, is a major challenge considering that in Uttar Pradesh, India’s most populous state, according to NFHS 4, only 5% of children aged between six and 23 months in rural UP receive an adequate diet. As many as 18% of children under the age of five are emaciated or severely underweight, while 41% are underweight.
Even amongst adults, lack of adequate nutrition is apparent: 28.1% of women and 29.1% of men have body mass indices (BMIs) below normal. In response to this growing burden of malnutrition, the UP-State Nutrition Mission (SNM) was launched in 2014 to strengthen coordination and synergies between departments to address malnutrition.
The launch of POSHAN Abhiyaan in 2018 by Prime Minister Narendra Modi has helped to redouble the pace of fight against malnutrition in the state. While hospital-based care for SAM (severe acute malnutrition) is important, several global experts have emphasised the importance of a community-based response to children with non-complicated SAM, which constitutes almost 90% of SAM cases.
Under the community-based ‘Banda Model’ or Banda Suposhan Karyakram, some of the crucial strategies involve:
-Establishing a care platform at community level through capacity building of health functionaries on screening and identification of acute malnutrition cases.
-Delivering health and nutrition education and organisation of 12 days’ nutrition sessions called ‘bal poshan satr (BPS)’ at anganwadi centres.
-Strengthening health facilities for delivering initial medical management of SAM and timely referral of complicated SAM to nutrition rehabilitation centres (NRC).
To ensure proper implementation, BPS sessions were conducted at anganwadi centres where mothers of severely and moderately acute malnourished and severely underweight children were demonstrated appropriate feeding and care practices. Alongside, they were encouraged to participate in the preparation of nutritious recipes based on take-home ration (panjiri) for their children to help them replicate the same at home.
These sessions provide community workers an excellent opportunity to initiate behaviour change communication for sensitive nutrition interventions, like the importance of breastfeeding and timely introduction of complementary feeding, dietary diversity, meal frequency, hand washing, disposal of faecal matter, immunisation, etc. using positive examples from within the community.
Our journey for tackling malnutrition has just commenced, we have a long way to go. The results have been possible due to support from all departments. The government’s intent about improving national nutritional status of women, children of 0-6 years of age, lactating mothers, adolescent girls is reflected in a 25% increase in the budget outlay from Rs 29,165 crore in 2019-20 to Rs 35,600 crore in 2020-21 for nutrition-related programmes.
The government seriousness is also reflected in plans for setting up a taskforce for recommending the age of girl entering motherhood, effectively linking it with the ‘Beti Bachao , Beti Padhao’ campaign and women’s safety issues. The expansion in the role of SHGs (self-help groups) in seed storage, sorting, grading and farm-gate processing at the village level to ensure local consumption of food will help in reduction farm produce handling costs and thus improving farmer’s income.
The government has hit the right notes in addressing malnutrition issues. It should help the state to achieve that target of reducing severe acute malnutrition, moderate acute malnutrition, stunting, severe underweight and anaemia, thereby improving India’s chances of meeting the SDG 2030 global vision.
(The author is District Magistrate, Banda, Uttar Pradesh)
