New Delhi: The future of a country depends upon the health of its citizens but in a place like remote Nanduri village in the Melghat region of Amravati district of Maharashtra malnutrition is a huge challenge. Through the NDTV-Dettol Banega Swasth India campaign, an attempt is being made to move the conversation from Swachh to Swasth as both are closely interlinked and one cannot do without the other. Since one of the major challenges in tackling malnutrition is poor hygiene, Community Nutrition Workers (CNWs), a group of young women from the tribal communities of the region are attempting to bring about change on the ground.
Melghat, 125 kilometres away from the district headquarters of Amravati in Maharashtra is scenic with pristine views, lush forests and breathtakingly beautiful hills is alluring. But amidst this beauty lies an ugly truth that successive governments have made an effort to tackle. Malnutrition is prevalent here and two decades ago, the talukas of Chikhaldara and Dharni, of Melghat made headlines for all the wrong reasons. As 5000 children were reported as dead from malnutrition-related complications at that time, efforts have been made to ensure the babies born here have a fair shot at life with a healthy childhood. The situation has improved since then but six in every hundred children died within a year of birth in Melghat in 2018-2019 and the reason for this is malnutrition leading to susceptibility to infections and high mortality.
The local Taluka Health Officer in Dharni teshsil, Dr. Shashikant Pawar told NDTV,
The population here is mostly illiterate and unaware. The standard of living is poor and there is unemployment. As a result of this, a lot of people leave the village and go out for their livelihood. As a result of this, the proper care of children and their mothers does not happen. What is also happening here as a result of the backwardness is that there are early marriages. If they get married at an early age the women are not fully developed for motherhood. As a result the children that are born to them are born with a low weight.
Nabaneeta Rudra from Plan India, the NGO that is training these Community Nutrition Workers or CNWs told NDTV,
There are challenges here. The network is an issue here. We have designed a mobile-based intervention which is basically offline. When we are implementing our programme at the village level it is offline. When we go out of the village the device is connected and the data comes to our desktop. Then it becomes an online system which gives you real-time data. This helps us in our monitoring and how we need to fine-tune in our intervention.
Experts feel the change has to come from within and now their hopes are pinned on Community Nutrition Workers (CNW) to make that happen. These young women have been equipped with modern tablets to enter data and monitor day to day progress of each malnourished child. The CNWs are chosen from within the tribal communities that live in this area and they are being trained to educate the tribal population and change their perceptions towards health and hygiene.
Latabai Babanrao Olambe the Auxillary Nurse Midwife at Nanduri Village told NDTV,
From the time these Community Nutrition Workers have come into this field, in our zone, they have done very good work. When they go for counselling to each and every home and talk about breastfeeding, nutrition and personal hygiene it helps our area because people listen to them. Our work has become much easier.
Shelesh Naval, the District Collector told NDTV,
The malnutrition issue in Melghat, as well as the health challenges, has a very peculiar feature which not only includes a challenging terrain there but also the cultural issues of the area. In the past two decades or so a lot of interventions have been taken and success has been achieved in those areas. In the last five years or so a tremendous impetus has been given for improving the overall health scenario of the region. However, with technology-driven community-oriented intervention with the efforts of the partners like Plan India, it has achieved a quick gain in the last hundred days or so. Also because of the communication challenge in those areas these motivated community workers like the Community Nutrition Workers appointed by Plan India and other people, they bridge the communication gap that exists because of the poor mobile technology or the other infrastructure bottlenecks that exist.
In the battle to eradicate malnutrition in the state of Maharashtra, there have been success stories in this village as well. The timely intervention has ensured that the lives of the poorest, most vulnerable and malnourished children have been saved. The community nutrition workers in their pink outfits are a common sight in villages in Melghat district these days. Their presence is making a noticeable impact in villages where often severely malnourished children have been given medical attention due to the effort of the community nutrition worker.
Ravi Bhatnagar, Director – External Affairs, Reckitt Benckiser, who has been a driving force in training and preparing the Community Nutrition Workers says,
Community Nutrition Workers try to find out the households which are at risk. They support the district administration, the state administration. They help in referrals of malnourished kids to the Nutrition Rehabilitation Centre, they educate mothers on the role of nutrition. We have introduced certain game tools like the Poshan Thali. So these women who are the ground with us, they don’t just promote the nutrition part, they also work on the lactation part, which means that they promote breastfeeding on the ground.
Forty-one community nutrition workers are already on the ground in Melghat and in some villages they are simply identified by their outfit. Usually, they travel on an average of 15 kilometres a day and cover every village in the area reaching every home that has a child susceptible to malnutrition or an expecting mother.
The results have already begun to show. Anita Jagdish Bhilawekar whose child has been severely malnourished is now recovering slowly and this has been possible due to the consistent efforts of the community nutrition workers. As the mother and child share a meal that is meant to cover their nutrition needs, this recovery is an example of how timely interventions can save lives. Anita Bhilawekar told NDTV,
She had a fever and a cough and cold. She used to cough a lot. Now it has reduced. We took her to the health centre after the Community Nutrition Worker asked us to.
Similarly, another beneficiary, Sukhmani Bhilawekar is happy that her son now has the energy to play as the initial few months after pregnancy was a huge challenge. The baby was born underweight and community nutrition workers say they would lose the child perhaps had it not been for the continued effort to push the mother and child towards healthcare centre.
My baby was just 1kg during the delivery. We had to go to Amravati and we stayed for one month there. Then we came back here and for three months he would keep crying. Now he is fine? He was admitted into the NRC and then slowly he started drinking milk. Rakhi Madam would visit us regularly, Sukhmani Bhilawekar told NDTV.
Sarita, one of the young Community Nutrition Workers, told NDTV,
We follow up with the families that do not send their kids to the NRC and we meet families whose kids have returned from the NRC for six months and educate them about the importance of hygiene. We teach them about all this through videos.
Vaishnavi Metkar, another young community nutrition worker says,
There is no auto available for the villages and even bikes don’t go as the road there is very bad. I have to travel on foot. I travel for two to three kilometres on foot and visit the anganwadi and then I ask them about Severe Acute Malnutrition, Moderate Acute Malnutrition kids. I visit their homes after that. Then I talk to them about cleanliness and we often notice the lack of hygiene in some of the homes.
Rakhi Maraskole engages with several villagers by showing them videos in familiar dialects. She says at first women are uncomfortable interacting with them but once she is able to strike a rapport with them they are more open to listening to her suggestions.
I carry my nutrition kit and when I conduct mothers meetings I play five games that are about nutrition. I make the mothers play the game and through the game, I share information with the mothers on how important nutrition is. There are five types of games and through these games, I teach them. After this, I visit the village and interact with the Severe Acute Malnutrition, Moderate Acute Malnutrition kids and pregnant and lactating women. I visit their homes, check on them physically and make updates on their health,’ she says.
The community nutrition workers are not only tackling the challenge of educating villagers about hygiene and healthy habits but also they are working with authorities to overcome the cultural challenges like dependence on traditional healers who are called humkas.
Govind Ringu Dhonde, a Humka at Chaurakund village for many years says whenever a child falls in or even a mother, villagers rush to him. Sometimes he treats three to four children a day and by his own admission some recover and some don’t recover. Dhonde is not averse to showing us his medicinal plants that are often roots that have been collected from the forest which he uses as medicine to treat young children.
We squeeze lemons and give it to them along with water. Malnourished children won’t get better. But if there are winds from elsewhere then he will recover. We give them three types of water. Lemon, salt and onion. If he is possessed by a ghost or evil spirits, then those spirits will leave after administering three types of water. I can’t treat malnutrition but if there is some very serious illness I refer them to the Public Health Centre. Everyone in the village knows I treat people so they come to me, he told NDTV.
Ravi Bhatnagar says,
The role of Reckitt Benckiser under the Dettol Banega Swasth India campaign is to see that we are complementing the efforts of the Government of Maharashtra. We are working with the district administration; we are giving them support in terms of the behaviour change communication material, in terms of infrastructure strengthening, in terms of having the breastfeeding pods and then working on the targeted communities where the problem lies in Melghat. So working on those areas, having the targeted intervention, bringing the women from those places for early referral and early care and strengthening the networks we have in place and we are continuously actually investing in that. The desired output is that by the end of three years we will have a reduction in stunting by around 40%.
Zilla Parishad CEO at Amravati, Manisha Khatri told NDTV,
The first thing that we looked at when we started this programme is that we wanted the CNWs to work in tandem with the existing resources that we had there and this includes both human resources and infrastructure resources that we have. The first thing that we wanted from them was correct data that they needed to collect and then we wanted to check our government data and see if it was adequate or not. The real-time data collection that has been done has been a huge success and we have been able to find the loopholes where we have been under-reporting. Earlier our anganwadi sevikas and the other lower-level staff, they did not have that much capability to effectively communicate to people the needs of health, sanitation and nutrition. With CNW’s who have been trained particularly on these subjects, these kinds of gaps we are being able to fill.
The training of the Community Nutrition Workers is regularly held in the district headquarters of Amravati. Their training includes familiarizing them with techniques of collecting data and helping them develop their skills in information education and communication activities.
The mandate of community nutrition workers is to complement and support the government’s interventions in the area. The interventions have been designed in close coordination with the governments’ huge effort to end malnutrition. and the role community nutrition workers is to ensure that the government’s committed resources are matched with the needs of the beneficiaries which is exactly what is happening as they become a frontline force in the battle against malnutrition in Maharashtra.