1) The project aimed to address maternal and child malnutrition in Palghar district, Maharashtra through social behavior change communication, community mobilization, and health education. 2) Interventions focused on nutrition-sensitive approaches at the village, household, and school levels and included community awareness sessions, nutrition gardens, and health literacy training. 3) Evaluations found the interventions improved health outcomes, with undernourished children gaining weight and height, and increased awareness of balanced diets, hygiene, and malnutrition among adolescents.

1. Social behaviour change
communication and community
mobilisation to address the issue of
maternal and child malnutrition in
Palghar district, Maharashtra
Focus: Health
ANKUR CHHABRA

2. Project Location – Jawhar
• Situated in the Sahayadri mountain range
• Oldest municipal councils in the state of Maharashtra
• Vibrant cultural heritage
• Tribal Communities – Varali, Konkana, Koli, among others
• Main Occupation - Agriculture

3. Project Background
• Malnutrition – primary cause of deaths among children aged 0-5 years
• A multi-dimensional and an inter-generational phenomenon
• Vicious cycle of malnutrition – health crisis and is no less than an epidemic
• An urgent and persistent requirement to address the critical health issue
of malnutrition plaguing the tribal population
• Project intervention strategies focussed on nutrition-sensitive
interventions rather than only nutrition-specific interventions

4. Project Focus Area
• To develop community-based malnutrition awareness interventions
• To provide health awareness to the tribal village residents via nutrition-
sensitive awareness, community mobilisation and food and nutritional
security
• To conduct awareness sessions and campaigns focussing on vulnerable
sections at the village and household level
• To provide health promotion and health literacy at the tribal school
targeting adolescent girls and boys

5. Target Group
• Pregnant and lactating women (PLW)
• Mothers
• Newborn and children (under the age of 5)*
• Adolescents**
*The target group at the village and household level were children with severe acute
malnutrition (SAM)
**Adolescent school children studying in standard 8th and 9th, at the school level

6. Project Objectives
3 key pillars –
• As the foundation of nutrition programme and primary healthcare of the country’s health
ecosystem, especially rural areas, the Anganwadi centres (AWCs) provided an effective mechanism
for improving health outcomes through community-based and participatory behaviour change
communication (BCC)
• Anganwadi workers (AWWs) and Accredited Social Health Activists (ASHAs) could effectively
mobilise members of the village community and interface with various actors and institutions to
activate the public health system and respond to the needs of the most vulnerable sections of the
society, that is, mothers, PLW and children under the age of 5
• Schools, specifically tribal residential schools (ashram shalas) could effectively form the base for
health information, education and communication and preventive and promotive healthcare
interventions targeting adolescent children

7. • The dual aims of my project were to: a) mitigate the extent and severity of
malnutrition among mothers, PLW and children under the age of 5 via
behaviour change communication and community mobilisation; and b) ensure
information and knowledge dissemination, improve health and hygiene literacy
and increase the awareness levels about malnutrition and malnutrition
prevention among adolescent children via interpersonal communication,
among others
• The motive of my project was to address the issue of malnutrition with the
following approaches viz. social behaviour change communication (BCC);
information, education and communication (IEC); interpersonal
communication (IPC); and community mobilisation (CM)
The project entailed both qualitative and quantitative analyses of the multiple
conventional and non-conventional factors that directly or indirectly result in
maternal, newborn and child malnutrition

8. Approach
1. Health Promotion and Health
Education
2. Behaviour Change Communication
3. Community Mobilisation
3. Nutrition-specific – food security via
‘perennial nutrition gardens’
4. Nutrition-sensitive – Balanced Diet,
WASH, Child Marriage, Girl Education,
among others
Adolescent
Girls & Boys
MNCH

9. Methodology
• Institutional and stakeholder mapping
• Community needs assessment
• Conducting baseline surveys (pre-intervention surveys at the village,
households and the school)
• Designing project structure at the school and village and household level
• Implementing project interventions based on the project structure
• Impact assessment of project interventions at the village, household and
school

10. Institutional Stakeholder Mapping and
Community Needs Assessment

12. Baseline Surveys - Village
Critical Findings –
• 10 children that were severe acute malnourished (SAM) and 2 children that were
moderate acute malnourished (MAM)
• Further, the data points studied to ascertain the extent of malnourishment was based
on weight, height, Body Mass Index (BMI) and mid-upper arm circumference (MUAC)
• As far as mothers were concerned, 3 mothers were underweight, 3 were overweight
and 6 had normal weight (per BMI definition prescribed by theWHO)
• Birth-spacing was found to be normal.That is, on average 2 years
• Out of the 12 households surveyed, 5 households were landless.The remaining
households had farming land anywhere between 1 – 2 acres in area
• Half of the village households did not have a toilet constructed at home

13. Baseline Surveys – School
Pre-intervention survey statistics:
Awareness Levels –
• Students having awareness about balanced diet (21%)
• Hygiene (personal, food and environment) stood at 47% students
• Waste management (50%)
• Child marriage (44%)
• Anaemia (15%)
• Importance of micronutrients,specificallyVitamin A (15%)

14. Project Structure
Project Structure –Village
• Nutrition-sensitive awareness
• Social behaviour change communication
• Community mobilisation
• Health awareness sessions via Anganwadi centres and village health sub-
centre
• Knowledge sharing on nutritious recipes with the village Anganwadi
workers
• Health and hygiene awareness campaigns (with a focus on environmental
health, immunisation,etc.) via posters, banners and other health promotion
material

15. Project Structure – Household
• Targeted health awareness and promotional activities
• Health promotion via Anganwadi centres and health sub-centre
• Health and hygiene awareness campaigns via posters, banners, among
others
• Kitchen Garden initiative – ‘perennial nutrition garden’ via growing
perennial food crops
• Knowledge dissemination on nutritious recipes and traditional healing
practices with the households

16. Project Structure – School
• Nutrition-sensitive awareness
• Health information,education and communication
• Health literacy and malnutrition awareness training sessions covering
topics such as Food & Nutrition, Water, Sanitation and Hygiene, Child marriage,
Immunisation, Drinking water, Girl education, among others
• Creative learning techniques (essay writing, drawing competition,board
game, health education cards, comics, animations and illustrative health
education material, etc.)

17. Project Interventions – Village and
Households (SAM)
• Health promotion and education
• Comprehensive BCC approach –
Dissemination of vital knowledge
• Utilising all communication
channels such as posters, banners,
hand bills and leaflets, pamphlets,
among others
‘Swasthya Samwad’

18. Nutrition Garden Initiative – ‘Perennial
Nutrition Garden’
Nutrition Garden in
Households
Distribution of seed
packets
Demonstrations provided by
the CRP and the AWW

19. Health Awareness Campaigns
General health check-up camp Immunisation camp conducted at the village
health sub-centre

20. Project Interventions –Tribal School
Food, Nutrition and Balanced Diet Education via AV aids

21. Child Marriage - Class discussions and essay
writing
Issue based film on child marriage

22. Sanitation awareness drive engaging school
students
Use of posters for WASH awareness

23. Use of posters for Anaemia awareness
among adolescent girls
Animation film on malnutrition awareness

24. Malnutrition Awareness – Board
Game
School children playing the ‘Malnutrition
Board Game’
Self designed ‘Malnutrition Board Game’

25. Health Promotion Events
‘Swachh Gaon Abhiyan’
Various village and school sanitation events were conducted regularly to instil the importance of critical facets of environmental
health viz. hygiene, cleanliness, waste management, among others
‘Malnutrition Free India’
‘Malnutrition Free India’ event was conducted in August 2017 during India’s 71st Independence Day. The village community,
including school children were mobilised to get their health check-up done. The event was conducted in collaboration with the
Savali CharitableTrust and village health sub-centre in Walwanda village
‘Train theTrainer’
After the health interventions to provide malnutrition awareness, the selected teachers were given the training on healthy
practices and malnutrition.This was done to ensure continuity and sustainability of the project post completion of the fellowship
‘Student Health Ambassador’
Two student health ambassadors from standard 8th of the Tribal High School were selected (based on student elections) to
conduct training sessions for the next incoming batch of students. Further, the ‘Health Ambassador’ would conduct health
promotion activities with the incoming batch of students, mobilise his/her village community and also take responsibility and
ownership of managing and maintaining the resources (such as the training modules, health education material, malnutrition board
game, etc.), under the supervision of school teachers and the Principal

26. Outcomes – SAM Households
• Weight – Average weight gained – 0.6 kg
• Height – Average height gained – 5 cm
• MUAC – Average MUAC gained – 0.6 cm

27. Outcomes – School
Highest outcome – Awareness on ‘Balanced Diet’ and ‘Malnutrition’

28. Monitoring & Evaluation
Village/Household Level – Impact Highlights
• 7 out 12 SAM children were categorized as ‘Normal’ (as per height)
• 1 child transitioned from ‘MAM’ category to ‘Normal’ category
• Weight - apart from 3 children, every child gained weight on an average of
0.6 kg
• Height – apart from 2 children, every child gained height on an average of
5cm
• MUAC – An average of 0.4 cm increase in MUAC for half of the children
under observation

29. School Level – Impact Highlights
Average awareness levels –
• Importance of Balanced Diet – 100% of the class
• Hygiene (personal, food and environment) – 98% of the class
• Waste management (94%), child marriage (74%), Anaemia (75%) and
importance of micronutrients, specifically Iodine (96%) and Vitamin A
(74%) in the diet
• General awareness levels about malnutrition shot up to 89% (post-
intervention) from 48% (pre-intervention)

30. Impact Assessment
Positive impact on health literacy levels among adolescent school children, especially
girls

31. Conclusion
• A combination of nutrition-specific and nutrition-sensitive strategies is an effective
approach to prevent undernutrition.
• Post-evaluation of the project interventions concluded that nutrition-sensitive
programmes can help scale up nutrition-specific interventions and create a
stimulating environment in which young children can grow and develop to their full
potential
• The project was successful in both mitigating the extent and severity of
malnutrition among mothers, pregnant and lactating women and children under the
age of 5 via behaviour change communication and community mobilisation
• The project ensured formal health information and knowledge dissemination and
improved health and hygiene literacy
• The interventions increased the awareness levels for malnutrition and malnutrition
prevention among adolescent children via interpersonal communication, among
others

32. ThankYou!