With nearly a quarter of its children stunted (or being too short for their age), India has its work cut out to reduce the prevalence of malnutrition among its youngest citizens. The World Bank estimates that malnutrition costs India’s economy $12bn a year in lost productivity and higher healthcare spending. Beyond macroeconomic losses, malnutrition is very hard on the average family residing in a slum. It makes children more susceptible to diseases and affects cognitive growth. Malnourished children grow up to earn lesser wages, studies have shown. The worst effect of malnutrition is that a significant chunk of the population never fulfils its true potential as human beings and that it keeps families entrapped in abject poverty.
SNEHA, a Mumbai-based non-profit organization that has been implementing public health programs, in partnership with public systems since 2000, takes a holistic and systemic view of malnutrition. ‘We follow a two-pronged approach, we work closely with communities, to improve health seeking behaviour, feeding practices and knowledge of health systems and schemes, to seek relevant services, while working closely with the Integrated Child Development Services (ICDS) scheme, to improve the quality of its services and build capacity among its staff and field workers to match the needs and expectations of vulnerable populations,’ says Anagha Waingankar, Associate Programme Director, Child Health & Nutrition.
SNEHA’s flagship child malnutrition programme, Aahar, currently works with 150 anganwadis (childcare centres), across Wadala and Dharavi, to upskill and build greater capability among ICDS sevikas (Government employed community health workers) to improve coverage of nutrition services to pregnant women and children under the age of 3 years. In its previous phase, Aahar, worked focused on early screening and treatment of malnourished children, using UNICEF’s Community-based Management of Acute Malnutrition (CMAM) Approach. Covering 300 anganwadis across Dharavi, Aahar I successfully reduced acute malnutrition by 25% among 0-3 year olds. Aahar II, which has been implemented since 2016 is focusing on building capacity and supporting the ICDS to deliver better quality services across its core areas. While working on the supply side, Aahar II also works with communities to identify a cadre of volunteers to promote community ownership of child nutrition while becoming proactive users of public health services.
Reaching over a lakh and a half people through our work, we are privileged to witness incredible stories of transformation. We dug into our story bank to bring to you some of the best stories:
Mobina is a 29-year-old woman who stays with her husband and in-laws in a joint family at Naik Nagar, Dharavi. She is a homemaker, while her husband works as a helper in a local shop. The ICDS Sevika, SNEHA’s Community Organizer (CO) and a local Volunteer met Mobina and her husband on one of their community mobilization visits, and found Mobina to be in her seventh month of pregnancy. She seemed to be very frail and introverted and didn’t communicate much. After spending some time in their house, Mobina’s husband revealed to the Sevika and CO that Mobina was in her seventh month of pregnancy and was fearful about the future as she had undergone five miscarriages previously.
When the Sevika asked her husband about her quiet nature, he revealed that being into seventh month of pregnancy, a fear hovered around her since she had five miscarriages in the past. The husband also explained that Mobina had poor eating habits. The Sevika and CO took out nutrition flashcards and explained to Mobina’s husband various nutritional foods such as vegetables, meat, pulses and fruits, their nutritional values and health benefits, as well as when and in what quantities to be consumed. Mobina’s husband diligently followed Sevika’s instructions and started giving her nutritious food. He thanked the Sevika and CO for sharing such valuable knowledge about nutrition. By the time Mobina approached childbirth, her nutritional status had improved. However, in view of her past miscarriages and her current health status, her gynaecologist strongly suggested that Mobina undergo a C-section. The doctor told Mobina’s husband to arrange for O-ve blood group within 48 hours since it was not available with the hospital. Her husband enquired at various blood banks and started searching for donors with O –ve blood group, but panicked because he couldn’t find any donors. Out of despair, he approached an Aahar community volunteer and explained the urgency of the situation. The volunteer happened to know a donor with the said blood group and immediately requested the donor to rush to the hospital for help. The donor arrived at the hospital the very next morning. His blood group was confirmed and the blood was utilized during Mobina’s C-section. She gave birth to a healthy baby boy weighing 3.30 kgs. Her husband got very emotional and sincerely thanked the volunteer for his exceptional presence of mind and help just in time. Mobina’s husband got inspired to such an extent that now he has taken up active volunteerism with SNEHA and is helping his community with referrals to the ICDS, for child malnutrition and antenatal care.
S (name withheld to protect privacy) is a 37-year old woman working as an ICDS Sevika for the last 3 years. In Aahar’s early days of intervention, S came across as a very reluctant person and the Aahar staff found it difficult to approach her for joint weighing and other activities and events. She chose to remain aloof most of the times and rarely cooperated with the other works at the anganwadi. It took several months of working with S for SNEHA’s Community Organiser to work with her and bring about an immense change in both attitude and behaviour. The Community Organizer meticulously took up community mobilization, weighing, THR distribution, planning and organization of community events in sync with S. She motivated S at every step and appreciated her painstaking efforts during mother’s group meetings. Such kind gestures transformed S into an exceptionally attentive and cooperative Sevika. So much so that once she was down with high fever on the day when weighing activities were to be conducted at her anganwadi. On learning about her ill health, the Community Organizer and other ICDS workers began with weighing, but were suprised to see her arrive at the Anganwadi in spite of her high fever. She diligently started weighing children and looked after documentation work. Seeing that only a few children had been brought in for weighing activities, she even went and mobilized the families in the community and convinced them to come at the Anganwadi. S was able to achieve an incredible 100% in her weighing targets. S thanked the Community Organizer for her immense motivation and appreciation that helped bring a significant change in her.
Every vaccination is a victory
Rasheeda is a 30-year-old woman staying with her husband and four children in Naik Nagar, Sion. She is a housewife, while her husband works at a footwear manufacturing unit. Rasheeda’s mother lives nearby. On one of their home visit days, a Sevika and SNEHA Community Organizer came across Rasheeda and her family. The Sevika enquired about the four children and remarked that the third and fourth children were very close in age. First, Rasheeda lied to the Sevika saying that the fourth child wasn’t hers but her neighbour’s. After a while, Rasheeda confessed that the fourth child belonged to her and was born recently, and was unplanned. The Sevika asked Rasheeda if she took the baby for weighing at the anganwadi and if he was vaccinated. Rasheeda admitted that she had not taken the baby and that he was unvaccinated. The Sevika and Community Organizer took the opportunity to explain about the importance of vaccination and how it protected a child’s immune system against opportunistic infections. Meanwhile, Rasheeda’s mother arrived and reacted harshly after hearing that the Sevika and Community Organizer wished to see the child’s hospital birth documents. She got furious and asked the Sevika and Community Organizer to leave their home instantly. It was from neighbours the Sevika got to know that all four children were born at home and Rasheeda did not avail antenatal care at any public or private hospital. The Sevika and Community Organizer then took the help of the local Health Post’s Community Health Volunteer (CHV), requesting her to accompany them on their next visit to Rasheeda’s home and convince her about vaccinating the baby. The CHV agreed and accompanied the Sevika and Community Organizer. When they went to Rasheeda’s house, they noticed her mother’s presence. Once again, Rasheeda’s mother raised her voice asking the Sevika and Community Organizer to leave again. But when the CHV came forward and introduced herself as a representative of the Health Post, Rasheeda’s mother calmed down. Further, the CHV explained them the importance of vaccination in depth, asked Rasheeda to bring the child to the health post for registration and creation of his records, handed over the vaccination schedule and instructed Rasheeda and her mother to bring the child to the vaccination camp which was to happen the very next day in the community. Rasheeda and her mother diligently followed the CHV’s instructions and got the child vaccinated.
Rasheeda thanked the Sevika, Community Organizer and CHV for opening her and her mother’s eyes and for being concerned and considerate towards her child’s health and wellbeing.