Afsana, a mother of four, is a housewife in an impoverished household in Mandrayal village in the Karauli district of Rajasthan in India. Her husband works as a driver and is often away. When her second child was 10 months old, Afsana gave birth to twin boys. The family celebrated along with the whole village and named the babies Shahil, which means guide, and Sameer, meaning loyal companion. However, the celebrations were short-lived because the children became severely malnourished.
Taking care of all four young children was difficult for Afsana. Three of her children were less than a year old and needed milk and food that the family could not afford. Shahil and Sameer started losing weight and, despite help from Afsana’s aunt, the children did not improve and became severely malnourished.
Fortunately Karauli was one of the 13 districts in the Indian state of Rajasthan screened by health professionals for malnutrition as part of community-based nutrition program by GAIN, the Government of Rajasthan’s National Health Mission, UNICEF and Action Against Hunger (ACF).
Shahil and Sameer were two of more than 9,000 children successfully treated for severe malnutrition. In nine months, 234,000 children from 1,574 villages in 13 districts were screened by health professionals and 9,640 children were diagnosed with severe acute malnutrition. The children were then treated with an energy dense nutrition supplement (EDNS), locally known as Poshan Amrit for eight to 10 weeks, resulting in 95% of them recovering fully.
The Management of Acute Malnutrition (CMAM) project, funded by the Bestseller Foundation and Children’s Investment Fund Foundation (CIFF) is the single largest community-based intervention implemented by a state government in India. More than 2,500 government frontline workers and community volunteers were involved in the intervention.
“At the completion of phase 1 of the project in June 2016, more than 95% of the 9,640 children enrolled for this treatment have recovered and have been discharged. These 9,128 children have been treated successfully and are now on road to good health,” says Tarun Vij, GAIN’s Country Director in India. Shahil and Sameer’s conditions improved and they were discharged from the clinic after eight weeks.
“There have been less than 0.3% deaths and around 2.5% children could not recover, which is below the global acceptable limits for similar programs. The results also show that 12% more girls were enrolled for treatment than boys, which is generally the opposite within public health services, indicating that a community-based approach can successfully improve the health and wellbeing of young girls who may have otherwise been excluded from this treatment.”
The project, referred to locally as the Poshan (Nutrition) project, celebrated its last weekly Poshan Day on 5 June where elected members of local self-governments (sarpanches) were invited to local medical centres to give lunch boxes to the children to mark their journey to health. Poshan days were organized every Sunday to measure and report vital parameters in malnutrition screening such as the middle and upper arm circumference, height and weight of the enrolled children.
Based on the success of this first phase, the Government of Rajasthan is allocating budget to scale up the intervention to more districts with the aim to reach 25,000 children. In March, the Chief Minister of Rajasthan announced that the Finance Department of the Government of Rajasthan has committed Rs.1,716,000,000 ($265million USD) towards the National Health Mission (NHM).