By- Preeti Pande
Senior Dietician, Apollomedics
Super Speciality Hospital, Lucknow
Uttar Pradesh (UP) has accomplishments to claim, successes to celebrate and hopes to look up to as it rolls out Mission Poshan 2.0 in its efforts to improve the nutritional status of women and children.
The launch of PoshanAbhiyaanin 2018, Central government’s flagship programme aimed to improve the nutritional status of children, adolescent girls, pregnant women and lactating mothers, in a time bound manner,drew the focus on fight against undernutrition among the most vulnerable groups.
The programme was based on four strategic pillars-use of technology for real time monitoring, community mobilization and behavior change, convergence of multiple departments of the state,and the focus on interventions during the critical first 1000 days of a newborn baby. The strategies were to translate into implementable activities,primarily through the Integrated Child Development Scheme (ICDS) mechanism.
This involved detailed planning and timely execution of training the Anganwadi Workers (AWWs) who are the backbone of the ICDS programme. The training was based on the incremental learning approach. UP was one of the first states to have completed the roll-out of all incremental learning modules for the AWWs. Anecdotal evidence from the field suggested an improvement in capacities of the AWWs and it was expected to subsequently lead to a positive shift in the community knowledge and behaviors, on maternal, infant, and young child nutrition.
Anganwadi Centres in UP were equipped with approximately 1.57 lakh growth monitoring devices to strengthen the monitoring of nutritional status of children and pregnant women, which is one of the key services of ICDS. An almost similar number of AWWs were provided with smart phones to be able to operate the mobile-based application for real-time monitoring of their field activities and build their knowledge base by accessing the e learning modules.The initiatives have gathered momentum in UP slowly but steadily. Some of these efforts, though got negatively impacted during the pandemic.
However, the findings of the National Family Health Survey (NFHS-5) for nutrition status in the state have been encouraging. There was an improvement in select nutrition indicators between NFHS-4 (2015-16) and NFHS-5 (2019-21).
Progress was evident in some of the indicators related to maternal, infant and young child nutrition (MIYCN) that can be attributed to the achievement of the objectives of PoshanAbhiyaan. Exclusive breastfeeding rate showed a marked improvement (at 59.7 percent in NFHS-5 vis-à-vis NFHS-4 when it stood at 45.6 percent). The percentage of underweight children showed a drop from 39.5 percent to 32.1 percent. There was an encouraging decrease in the percentage of stunted children from 46.3 percent to 39.7 percent. A drop in the prevalence of stunting reflects action at multiple levels across multiple sectors. Consumption of iron and folic acid tablets improved marginally and anemia prevalence in pregnant women also showed a decline.
Anganwadi Centresplayed a critical role as part of the Jan Andolan activities under PoshanAbhiyaan. Besides some centrally supported events, state-specific community-based events were also organized from time to time. These events provided an opportunity for knowledge sharing by the AWWs on issues relevant to maternal and child nutrition and peer learning for pregnant women and lactating mothers in an environment of celebration.
To involve the community in this endeavor, the government adopted traditional events such as ‘godbharai’ and ‘anna prashan’ as platforms to promote optimal nutrition and health behaviors in the community. These events provided an opportunity to reiterate and highlight the core and critical elements of good, wholesome nutrition, diet diversity, and balanced diets. These were institutionalized as Community Based Events (CBEs).
Similarly, the PoshanPakhwada and PoshanMaah were celebrated in the state with as much zest and fervor as across the country. There were efforts to establish a statewide review mechanism with monthly meetings organized at the block and district levels under the chairpersonship of senior officers in the district. Convergence of stakeholder departments was initiated for synergistic action on malnutrition and undernutrition. Innovations were encouraged for facilitating the uptake of services, enhancing community knowledge and behaviors on maternal, infant and young child nutrition. And all these efforts did yield positive results.
With the launch of Mission Poshan 2.0, UP will continue to work towards infant and young child nutrition and will also focus on maternal nutrition to complete the spectrum of MIYCN and contribute to further improvement in the nutritional status of women and children. Children with severe and moderate acute malnutrition will receive due attention and the probability of averting morbidity and mortality in these children will be much higher.
Steadily and surely, the state is making progress on the indicators of nutrition that are the fundamental markers of long-term good health.
