Quarterly Progress Report for the Malnutrition Eradication Program, Madhya Pradesh, India


As the monsoon rolls into Southwestern MP, Real Medicine Foundation is reflecting on the progress to date in the first six months of our Malnutrition Eradication Program. This project seeks to empower communities through health literacy and connects rural communities with existing government health and nutrition services locally available, thus reducing the prevalence of malnutrition. We employ 55 tribal women as Community Nutrition Educators, covering 500 villages across 5 of the districts hardest hit by malnutrition in Madhya Pradesh.

This quarter, with the ambitious baseline stage of the program completed, the Community Nutrition Educators have been able to move into the intervention stage of the Childhood Malnutrition Eradication Program.  Our staff has been incredibly well received by the communities they are working in, even better than we expected. They are getting recognition from the local government and have a great rapport with our target populations. Already 1,271 village level nutrition training sessions have been conducted, with almost 15,000 local men and women in attendance. Our staff has individually counseled 10,680 families of malnourished children during one to one counseling sessions in their homes, and has seen 1,141 SAM and MAM kids improve because of their interventions (roughly 20%). Through our referrals to Nutrition Rehabilitation Centers, 123 children have been successfully treated to date, with another 30 children currently under NRC care.

Below is a summary of our accomplishments this quarter

• Compiled “rapid assessment” data from the 65,876 children we measured with MUAC tests to identify number of cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) captured
• Compiled family data on over 60,000 families to assess their socio-economic and health status
• Calculated total cases of SAM and MAM by village and district and total number in all five districts, identifying priority villages based on case load
• Established relationships between District Coordinators and their counterparts in the NRCs for better follow up, referral and general trouble-shooting of care for patients with SAM
• Successfully ensured the 14 day treatment of 123 of the most serious cases at local Nutrition Rehabilitation Centers (including 20 children referred to RMF’s new NRC)
• Saw an 8% improvement rate in SAM children counseled and a 17% rate in MAM children counseled, 1,141 children whose nutritional status improved directly from our intervention
• Conducted 1,271 village nutrition training sessions, with over 14,822 people in attendance
• Conducted 10,680 one on one counseling sessions in the month of June
• Continued to identify new children after the baseline and into the day to day intervention, finding 58 new children in June

Now that the baseline assessments have been completed, the CNEs were able to begin the actual intervention phase of the program. Each CNE has been assigned ten villages and, with the information captured by the assessments, knows which children are malnourished in these villages and where their families live.  With this information, the CNE can visit with the family twice a month to counsel them on nutritious food, proper preparation of food, hygiene, proper breastfeeding and the importance of supplemental feeding after 6 months, and what health services are available to them for treatment of malnutrition. In addition to the family counseling, the CNEs began their community meeting in each village to give the entire community, not just the families of malnourished children, lessons on the importance of good nutrition in children under five, awareness of malnutrition, and coordinate with the government village health worker, the Anganwadi, on referrals, feedings, and follow up with cases of MAM at their homes.  1,271 of these training sessions have been held so far, with almost 15,000 people attending the sessions.

In addition to the counseling aspect, the CNEs also referred cases of complicated SAM to NRCs for treatment. The referrals are usually done by the village Anganwadi worker, who receives compensation for every child admitted into the NRC, as a means of strengthening government structures and providing sustainability to the program. In Madhya Pradesh, SAM is treated on an in-patient basis at the NRC over fourteen days with each child receiving supervised, regular feedings of therapeutic food. In addition to the feedings, the mothers are also given education similar to what our CNEs provide. Over the course of the fourteen day treatment, RMF’s District Coordinators follow up with the families of our referrals and verify that they are still in treatment, that the child is recovering, and to follow up with any of the family’s needs.  So far 123 children have been successfully referred, treated, and received follow up visits from our staff.

During this time our CNEs have developed a relationship with the communities they work with.  This bond is the most important part of our program, as we want the communities to see our CNEs as part of the community rather than workers coming to visit. Most of the CNEs are locals and live close to the villages, so establishing that bond comes naturally to them, however, some communities are reluctant at first. Slowly, with each success story, our CNEs are becoming trusted members of the community. The communities have started come to the CNEs with nutrition questions, rather than our workers having to seek out SAM cases. Furthermore, as they get to know the communities better, each CNE can track the progress of individual children, and asses their health and family in a more familiar way.

Our dedicated staff is already receiving recognition for their hard work and excellent rapport with the communities in which they work. Representatives from the district and state government health and women and child departments have praised their work and have now expressed a desire to work more closely with RMF. NGOs such as DFID, Action Against Hunger, UNICEF and Clinton Foundation have come to SW MP to see our work in the field and learn from our approaches and have been continually impressed.

Challenges Faced

One of the largest challenges facing our CNEs, and the treatment of SAM in MP in general, is getting children requiring treatment to the NRC. Even after successful referrals, the rate of defaulters is very high as many of the women cannot stay with their children for the entire fourteen day course of the treatment.  Each child must have a caretaker stay with them for the entire course of treatment.  However, many of the women are not able to stay that long, or even go at all, because of family pressure, household responsibility such as cooking or agricultural work, or the presence of other small children in the household with no other caretaker.

The CNEs and coordinators try to solve this with a variety of techniques, including:

• Increased counseling in the field about the NRC treatment and why it is important
• Follow up with successful referrals by our coordinators
• Coordination with NRC workers by our coordinators to address problems specific to our referrals
• Follow up with defaulters in the field by our CNEs
• Suggestions for other caretakers, such as grandparents or siblings
• Increased communication about the need and specifics of treatment, such as why it takes fourteen days

Goals for next quarter

• All 50 CNEs regularly visiting their 10 villages at least twice a month and conducting group training sessions, one on one counseling sessions, job trainings for Anganwadis and referring serious cases to NRCs
• Provide specific counseling based on the needs of communities during the monsoons such as treatment of diarrhea, identification of malaria, avoidance of water
• Refer 1,000 SAM children to government centers for treatment with a 50% success rate
• 90% follow rate for all children discharged from NRCs
• Conduct 3,000 Community Nutrition Meetings (500x2x3 months)
• Hold at least 3,000 meetings with Anganwadi, giving them on the job support
• Conduct 9,000 individual Family counseling sessions
• Ensure timely and accurate reporting from all staff
• Send CNEs to NRCs to help counsel families present
• Continue to develop linkages with government health and nutrition services