Department of Women & Child Development
Government of Odisha
29th May 2013
Working multisectorally to improve
maternal and child nutrition in India –
Odisha experience

Scheme of presentation
 Setting the context
 Strategies:
 System strengthening
 Multi sector collaborations- processes, mechanisms,
strategies
Line departments of govt
Civil Society
Rights based groups
NGOs, others
Communities , Self Help Groups
 Addressing the vulnerable

Setting the context

Odisha coverage of 10 proven interventions
(NFHS 3 -2005-06)
54.8
51
67.5
30
7
29.5
38.6 38
54.8
2.2
0
10
20
30
40
50
60
70
80
90
100
1
Initiation of BF <1 hr
Exclusive BF upto 6 mo
Introduction of CF at 6-9 mo
Three IYCF practices
Stools safely disposed
Vitamin A supplementation (0-35 mo)
Adolescent girls(15-19 yr) non-anemic
Household with iodized salt(>15ppm)
Diarrhea: Children fed>=usual
SAM: Children with access to care*
The Goal  100%
Source: NFHS-3 data (2005-06) Odisha; *NFHS III data for all India
BF: Breastfeeding; CF: Complementary foods; IYCF: Infant and Young Child Feeding; SAM: Severe Acute Malnutrition

Setting the context: Under-nutrition in
Children
(below 3 years of age)
50 49
30
40
44
24
0
10
20
30
40
50
60
Underweight Stunted Wasted
NFHS-2
NFHS-3
Source: NFHS-3, Odisha, 2005-6
Percent

0
10
20
30
40
50
60
70
80
90
Three ANC Institutional Delivery PNC within 2days of birth Full Immunisation
% Percentage utilisation of MCH services by Scheduled Tribe (ST) women
and all women in Odisha: 2005/6 and 2011
All - NFHS-3 (2005-06) All -CCM 2011
ST -NFHS-3 (2005-06) ST - CCM 2011
No. of Households sampled: 41,460
% of ST Household: 28.3%
Source: Concurrent Monitoring (CCM), ORG Centre for Social
Research, Nielsen Company , commissioned for GoO

Setting the context:
Odisha ranks 8th in the country on “Composite ICDS
Implementation Index” developed by Central Monitoring Unit of
NIPCCD based on the data collected through Supervision &
Monitoring of ICDS Scheme
Evaluation Report on ICDS by PEO, Planning Commission,
(March 2011)
Odisha is a High Performing state
Good Performer (> 80%) frequency of Delivery of SNP
Quick Evaluation Study of Major Developmental Programmes in
33 districts affected by LWE by PEO, Planning Commission
(2010-11)
High level of satisfaction among respondents for AWC services
in LWE districts of Odisha

Nutritional Status
Nutritional Status (Weight for Age) of children 0-59
months by Wealth Index
8.3
42.7
25.8
36.4
40.142.6
11.9
15.316.816.9
.0
10.0
20.0
30.0
40.0
50.0
Lowest Second Middle Fourth Highest
Percentage
Underweight
Severely Underweight
NOP Baseline survey Odisha , 2010-11

Prevalence of Anaemia
Prevalence of Anaemia (6-59 months children) by
Wealth Index
51.7
57.3
65.169.270.4
0
20
40
60
80
100
Lowest Second Middle Fourth Highest
Percentage
Anaemic

What should be the strategies?
 Address the socio economic gradient and underlying
causes of poor outcomes- specially the vulnerable groups.
 Move beyond schemes to more directly address the social
determinants. A key strategy has to be making
communities involved
 A comprehensive approach across sectoral boundaries
 Look at prevention being equally, if not more important
than cure
 Strengthen system capacity to deliver

Systems Strengthening

Strengthening delivery systems
 Supervision checklists
 CDPOs training in financial management
 Financial management guidelines issued
 Computer, training, broadband, operational manuals
 AWC construction – 18000 buildings -BALA
 Ongoing Capacity Building -- Video Conferencing up
to supervisors, CDPO conference, FAQs for AWWs
 Dashboard monitoring
 AWWs FAQs
 Collectors handbook

Strengthening delivery systems
 Mobile kunji
 Supervisors tours online entry software being
developed
 CPSMS for joint accounts and AWW/AWH
honorarium
 HRMS
 AWC as pre school
 District wise analysis and planning for convergence:

Sambalpur :Factors affecting maternal health
– ultrasound and abortion
 Sambalpur ranks 4th in the state in the
number of pregnancies resulting in abortion
and 15th in number of women who went for
ultrasound before abortion.
 Abortion performed by skilled health
personnel is only 33.6%, whereas safe
delivery stands at 83.7%. The district stands
at the 1st position in unsafe abortion in the
state. Average month of pregnancy at the
time of pregnancy is 2.6 .
Sex selection abortion is rampant, which is
often done at unsafe hands leading to
further complications in future pregnancies,
and 36% population is from Urban areas.
 The Sex Ratio at Birth is 877 while for All
Ages is 975… which implies abject neglect
towards girl child in recent times

37.5
93.6
45.2
19.8
16.3
48.3
30.9
46.4
79.7
41.5
54.9
76.6
56.2
39
79.2
89.1
80.4
56.2
95.6
63
18.6
32.4
75.2
22.3
74.5
71.5
24.8
72.9
86.7
63.4
55
92.4
89.1
89.9
0 50 100
Family Planning (Any Method)
Received any Antenatal Check-up
Antenatal Check-up in First Trimester
Full Antenatal Check-up
Ultrasound
Safe Delivery
Low Birth weight baby
Check-up within 48 hrs.
Children breastfed within one hour of birth
Exclusively brwastfed for at least six months
Received 3 doses of DPT vaccine
Received Measles vaccine
Received atleast one vitamin-A dose
Fully Immunized
Care sought for ARI
Care sought for Diarrohea
Care sought for Fever
Odisha
Koraput
Pre Pregnancy
Pregnancy
Birth
Infancy
Childhood
CONTINUUM OF CARE- ODISHA vs. KORAPUT

Mayurbhanj: Infant Health Indicators, AHS & NOP Baseline
Sl
no
Indicator Mayurbhanj State Best district Worst district
1 Newborns who were checked
up with 24 hrs of birth
75.5% 74.9% Bargarh – 91% Nawrangpur – 38.6%
2 Received Colostrum within an
hour of birth
62.7% 71.5% Nuapada – 89.8% Balangir - 36%
3 Full immunization (12-23 m) 67.8% 55.0% Kendrapada- 82% Rayagada – 11.9%
4 Exclusive breastfeeding for 6
months
40.1% 24.8% Nuapada – 48.4% Balangir – 4.4%
5 Children with birthweight less
than 2.5 kg
25.4% 22.3% Balangir – 16% Malkangiri -39.6%
6 Under nutrition level for 0-59
months children (Weight for
age)
48.8% 42.3%
(NFHSIII)
Jagatsinghpur –
21.7%
Keonjhar – 55.1%
7 Stunting for 0-59 months
children (height for age)
50.7% 46.5%(NFHS
III)
Gajapati – 25.5% Nawrangpur – 62.1%
8 Wasting for 0-59 months
children (weight for height)
26.2% 20.5% (NFHS
III)
Bhadrak – 11.9% Sundargarh – 37.7%
9 Prevalence of Anemia among
0-59 months children
61.3% 66.6% (NFHS
III)
Nayagarh – 36.6% Nawarangpur – 81.1%

Working multi sectorally-
mechanisms and processes

Nutrition safety Programmes
Missions /Programs Focus Dept
Rastriya Krishi Vikas Yojana Availability Agriculture
National Food Security Mission Availability FS&CW
National Horticulture Mission Availability Agriculture
Mahatma Gandhi National Rural Employment
Guarantee Act
Accessibility PR
School Noon Meal Programme Accessibility DWCD
Annapoorna Accessibility FS&CW
Universal and Targeted Public Distribution Systems Accessibility FS&CW
ICDS Accessibility DWCD
Rajiv Gandhi Drinking Water Mission Absorption RD
Total Sanitation Programme Absorption RD
National Rural Health Mission Absorption Health

Convergence mechanisms- govt
 Nutrition council
 State and district level committees
 Village and GP level structures
 Initiatives outside the structural framework

Convergence: Health
 Mother & Child
Protection Card
 Adolescent Anemia
Control Programme
 Sabla
 Kishori Shakti Yojana
 Adolescent girls
training
 Mamata divas- VHND
 Hygiene kits

HYGIENE KIT
Promotion of good
Hygiene practices among
Pre-school children

Health
Major Heads Activity Implemen-
tation
Support
Mal-mal-
nutrition
•Screening of Pregnant Women for Malaria
•Prophylaxis Malaria dose for all women during
Pregnancy in Malaria endemic areas
•Malaria testing of children in endemic areas
Health
Deworming Prophylaxis deworming of all Pregnant women Health
Yashoda • Training of Yahodas on 1000 days approach,
specially EIBF
• Sharing of Yashoda's regular report on ensuring
EIBF by NRHM with WCD
Health

Health
 Infant and Young Child
feeding practices
 Pushtikar divas for SAM children
 Mamata scheme – conditional cash transfers- 8.64
women, 260 crores through e transfer into bank
account- with Health, Banks, local governance,
Information & Public Relations, Training Institutes

Other deptts, community - Pre
school
 Uniforms
 Workbook
 New guidebooks
 Compilation of local songs
 School leaving certificates
and ceremony
 Parents meets
 Grandparents day
 Local occupations

Other deptts
 Monitoring by ULBs, ITDAs
 Celebration of weeks through kala jathas and IEC
materials
 RD for tubewells, toilets
 Panchayati Raj- construction of AWCs
 PRIs- joint accounts, monitoring
 Employment mission- Sabla vocational training
 Some examples of the nuts and bolts :

For SAM children
Major Heads Activity Implemen-
tation
Support
Supply
strengthening
Sale of pulses, double fortified salt and soap
through PDS
Food
Supplies &
Consumer
Welfare
Pustikar Diwas • Cost of medicine & pathological test
• Coverage of URBAN areas under PD
Health

Improved nutrition & care for
women and adolescent girls
Major
Heads
Activity Implemen-
tation
Support
Women and
AGs
Vocational training of 16-18 years Out of
School Adolescent Girls (AGs) at SABLA and
Other dists
Labour
• Life Skill Training on reproductive & sexual
health
• Improved allocation for Health checkup for
AGs
Health
Mainstreaming Out of School AGs School &
Mass
Education

Organizational Linkages
Major
Heads
Activity Implemen-
tation Support
Quality
control
Setting up of more Quality Testing Labs for
THR/Chhatua testing
Health, Food
Supplies &
Consumer
Welfare,
Agriculture
SHG
Empower-
ment
Providing support to SHGs that have got
stabilized in Chhatua production in
machinery procurement and others through
NRLM/ORMAS
Panchayati Raj
Office
infrastruc-
ture
• Supervisor Office Space at Rajiv Gandhi
Seva Kendra
• One dedicated computer terminal at Block
office for CDPOs in V-SAT areas (no BB)
Panchayati Raj

Organisational Linkages
Major Heads Activity Implemen-
tation
Support
Mamata
Diwas
• Intensive focus for coverage of hamlets in V3 &
V4 areas
• Coverage of URBAN/NAC areas under VHND
Health
MCP Card MCP Card and its training for
• Urban areas
• Industrial hospitals with Govt vaccine supply
Health

IEC/BCC
Major
Heads
Activity Implemen-
tation
Support
Swastha
Kantha
Messages on Nutrition based on 1000 days
approach should feature every month
Health
PRI
monitoring
• Inclusion of nutrition agenda in Gram
Sabha
• Monthly review of critical health & nutrition
indicators at the GP level
Panchayati
Raj

Other partners
 Activists and movements
 Dissemination
 Visits
 NGOs – social audit
 PHFI
 Supervisors online training
 Case studies
 Parents modules online
 A Randomised Controlled Trial in 3 districts covering 2.28 lakh people,
Published in The lancet –2010 : 45% reduction in NMR, 54% reduction in early
NMR, 57% reduction in moderate postnatal depression
 PLA in 3 distts with SHGs, Mothers Committees, to be scaled up to 15 distts with
Ekjut

Community: Decentralization of
SNP
 Joint accounts of AWWs and
ward members
 SHGs for THR
 Publication of Entitlement charts
 Photographs of Jaanch
Committee members and Mothers
Committee members at AWC
 E- transfers into joint account
 Encouraged local egg and veg
production

Community
 Decentralization model praised by
Commissioners to Supreme Court. Report filed
in SC citing Odisha and Kerala as best
practices.
 Social audit by NGO group in 7 districts-
reported success of decentralization.
 THR protocol developed and SHGs trained
 Jaanch committee and mothers committee
trained
 Annaprasanna- complementary feeding
 Messages for families

Community
 Messages for parents
 Involving communities in the 1000 days campaign
SHG, GKS, JC, MC
 Community growth charts
 Training SHGs in aneamia, nutrition, IYCF
 Identification of vulnerable families
 Recognizing best practices- positive deviance
 Award for best indicators

Targeting the vulnerable

Addressing the socio-economic
gradient
 Nutrition operation plan in 15 high burden districts
 All tribal districts covered
 District specific planning
 District level PMU
 Scheme for PVTGs
 Tracking individual children
 Other deptts and agencies involved
 Project mode

Addressing the socio-economic
gradient
 Community Management of Acute Malnutrition
 Hot cooked meal
 THR through SHGs fortified
 Milk based product through SHGs
 Provision for differently-abled children
 AWC design
 Preschool
 Jaanch committee
 Early detection
 NREGS crèches
 Migrant children, jails

Thank you
A serious student from Narayanpatna, Koraput