Malnutrition is a major problem in India, with 47% of children under 3 years old being underweight. South Asia has the highest rates of malnourished children globally. While India has the largest nutrition program in the world, malnutrition rates remain high, showing a gap between resources and their implementation. The proposed Nourish to Flourish initiative would address malnutrition in India using a Positive Deviance model to identify and spread successful feeding, caring, and health practices in vulnerable communities.

1. Nourish to Flourish: An Initiative to
Reduce Malnutrition
TEAM DETAILS
El Fuego- Abhishek Sachan, Akshay Agarwal, Ashutosh Pandey,
Tapan Kumar, Sudhanshu Ranjan

2.  47 percent of India’s children below the age of three years are malnourished (underweight).3 The World Bank puts the
number – probably conservatively – at 60 million.4 This is out of a global estimated total of 146 million.
 47 percent of Indian children under five are categorized as moderately or severely malnourished.5
 South Asia has the highest rates – and by far the largest number – of malnourished children in the world.
 The UN ranks India in the bottom quartile of countries by under-1 infant mortality (the 53rd highest), and under-5
child mortality (78 deaths per 1000 live births).6 According to the 2008 CIA fact book, 32 babies out of every 1,000
born alive die before their first birthday.
 At least half of Indian infant deaths are related to malnutrition, often associated with infectious diseases.
 Malnutrition impedes motor, sensory, cognitive and social development 8, so malnourished
 children will be less likely to benefit from schooling, and will consequently have lower income as adults.
India has the largest nutrition programme in the world, yet India has the largest
nutrition programme in the world. Obviously, there is a great divide between the
resources available and those actually acquired, between existing laws and their
implementation, and between rights and the tangible services provided.
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3. Conceptual framework of the determinants of child
malnutrition
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4. Inter-generational Cycle of Malnutrition and Ill Health
Malnourished
Mother
Low Birth
Weight
Stunted Child
Malnourished
Girl
No Colostrum/ Exclusive Breastfeeding for 6 Months
Inadequate Food and Health Care
Delayed, Inadequate Complementary Food
after 6 Months
Frequent Infections and
Prolonged diarrhoea
Poverty
Lack of awareness
Infections
Inadequate Food and Health care
Low BMI
Poor Diet
Gender Discrimination
Early marriage
and pregnancy
Inadequate Foetal Nutrition
Low Weight Gain
during Pregnancy
Gender Discrimination
Multiple Pregnancies
Inadequate Catch Up
and Growth
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5. Snapshot of solution proposed
Instead of creating dependency ,the approach should be to provide skills so that communities become competent.
The mismatch between the intentions of the government programs,and its actual implementation should be overcome.
Public investment should be directed towards the most vulnerable population, lower casts and women.
The govt. should adopt a calorie based approach to fight malnutrition.
. Corruption should be checked and accountability should be fixed.
Government encouragement to small & marginal farmers to ensure local nutritional security.
Nutrimix, made of easily available, low- cost ingredients – wheat and pulses -- which can be made at home and is
by young. Consumed by young.
Include a separate national plan for nutrition in the National Economic and Social Development Plan.
ICDS and other such programs address some of the causes of malnutrition but not all of them. A separate national
plan will cover all the aspects of malnutrition.
Government encouragement to small farmers will boost their self sufficiency and lead to economic growth.
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6. Positive Deviance Model
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• The term “Positive Deviance” has been defined as “adaptive responses for satisfactory child growth under harsh
circumstances such as food scarcity, while negative deviance is described as the failure of children to grow
satisfactory even though good satisfactory even under good economic condition”.
• Based on positive deviance inquiry, villagers together with the program staff will identify the positive deviants
Families special and demonstrably successful current feeding ,caring and health-seeking practices which enable
them to “out perform "their neighbors whose children are malnourished but who share the same resource base.
• Based on the positive Deviance inquiry findings ,the villagers and the program staff plan a Hearth nutrition
Program featuring “Nutrition Education and Rehabilitation Sessions”(NERS)to address the problem of malnutrition
in their community today.
Goals
• To rehabilitate identified malnourished children in the community
• To enable their families to sustain the rehabilitation of the children at home of their own.
• To prevent malnutrition in future children born in the community.

7. Conceptual framework for designing our program
Identification of local resource
• Village Health Committee
• Health volunteer
• Formal and non formal health resources
Situational analysis of malnutrition in children
• Baseline nutrition survey
• Focus group discussions
• Setting-up program goals
Positive deviance enquiry
• Identification of successful feeding
• Caring and health seeking practices

8. Design of a NERS based PDI findings
• NERS menu and messages
• Positive deviance food contribution
• NERS protocol
• Integration with other existing programs
Positive Deviance Components
• Counseling caretakers
• GMP program
• NERS (Phase 1 only)
• Vital Events Monitoring
• Community management of NERS

9. Designing A Hearth Nutrition Program With PDI
Nutrition Education and Rehabilitation Sessions
NERS Participants
Identifying NERS Centers with the Help of Volunteers
Setting a NERS Schedule
Deciding on the NERS Daily Sessions Schedule
Creating NERS Menus Incorporating the PD Foods
Developing NERS Education Components
Developing Strategies to Promote Behavior Change
Other Hearth Nutrition Program Components
Growth Monitoring and Promotion
Vital Events
Community Management
Monitoring and Evaluation
Deworming
Vitamin A Distribution
Maternal and Child Health
Funds provided to food security bill which cover 67% of population runs in thousand’s of crore. Funds from this scheme can be
provided to this scheme which targets the most vulnerable section of our population.

10. IMPACTS
• A strong endorsement, involvement and participation
by the district health office in the Hearth Program can
significantly enhance its overall impact and potential
for "scaling up.“
• If a Maternal and Child Health/MCH component is
implemented as part of the Hearth Program, the district
health services can play a vital role in training public
health providers, TBAs and private providers in clean
delivery and post partum care, recognition of obstetric
"danger signs," referral guidelines, sterilization of
instruments, and so on.
• The active participation of district health personnel
during the pilot phase of a Hearth Program can be
invaluable at a later stage when "scaling-up" to other
communities in the district is desired. In Vietnam, for
example, the district provided trainers for Health
Volunteers in new pro-gram villages during the Hearth
expansion period.
CHALLENGES
• There are, however, certain problems and potential
pitfalls related to the participation of district health
personnel. In reality, very few of the countries in which
the Hearth Program has been imple-mented have
district health personnel with either the skill, will or
experience to work at the commu-nity level. With the
exception in a few countries of mobile EPI teams,
district level health personnel rarely if ever visit the
village.
• Another issue to consider is the inordinate power
vested in "higher-ups" in many developing coun-tries.
District health personnel may often be extremely
intimidating to local villagers and leaders
• Hence, it is important to decide within your local
context at what point district health participation will
be most useful and to strike a balance between the
potential benefits and risks inherent in that
involvement.

11. APPENDIX
References
 Deolalikar, A. (2012, July 23). A national shame: Hunger and malnutrition in India. Ideas for India. Retrieved
from http://www.ideasforindia.in/article.aspx?article_id=8
 UNICEF. (n.d.). Nutrition. Retrieved from http://www.unicef.org/india/children_2356.htm
 Ministry of Statistics and Programme Implementation. (2012). Children in India 2012 –A Statistical
Appraisal. Retrieved from http://mospi.nic.in/mospi_new/upload/Children_in_India_2012.pdf
 Food and Agriculture Organization. (2012). Economic growth, hunger and malnutrition. Retrieved from
http://www.fao.org/docrep/016/i3027e/i3027e03.pdf
 The World Bank. (2013). Helping India Combat Persistently High Rates of Malnutrition. Retrieved from
http://www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-
malnutrition
 UNICEF. (n.d.). Under-nutrition - a challenge for India. Retrieved from
http://www.unicef.org/india/nutrition_1556.html
 The World Bank. (n.d.). Undernourished Children: A Call for Reform and Action. Retrieved from
http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~page
PK:146736~piPK:146830~theSitePK:223547,00.html
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