Report Poshan Pakhwada, 2022

PPAOKSHHAWNADA 2022 Your NFP Name Role of PRI Leaders in Amplifying support for Nutrition in Bihar

Role of PRI Leaders in Amplifying support for Nutrition in Bihar

CTAOBNLTEENOTFS 01 Introduction 02 Bihar on Nutrition Index 03 About Centre 04 Mentoring PRI for Catalyzing as Nutrition Change Advocates 05 About Poshan 06 Poshan Pakhwada Pakhwada 2022 Participation 07 Major 08 Poshan Activities Pakhwada: Conducted Impact 09 Innovative 10 Testimonies Solutions 11 Media 12 Way Forward Coverage 13 Conclusion

INTRODUCTION POSHAN Over the last forty-Six years, India has experimented several nutrition focused large scale programs like Integrated Child Development Services and Mid Day Meal Scheme. However country is still home to the largest number of malnourished population of this world. Good Nutrition is critical to avert the irreversible cumulative growth and development deficits. It contributes towards improving maternal and child health, learning outcomes, adult productivity, and strengthening gender equality. As per the WHO, malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related no communicable diseases. To improve the nutritional status of children from 0-6 years, adolescents, pregnant and lactating mothers, Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan was launched in March 2018. The goal of POSHAN Abhiyaan is to make India malnutrition-free by 2022. The Abhiyaan aims to target the unique 1,000-day window of child-birth, antenatal care, and postnatal care to mothers to reduce malnutrition. The POSHAN Abhiyaan aims to provide a platform for convergence among the three pillars i.e. Behavioural change, infection management, and the intergenerational cycle of undernutrition. With the slogan ‘Jan Andolan (people’s movement)’, the Abhiyaan intends to make the fight against malnutrition a national goal for every citizen. The Ministry of Women and Child Welfare, the nodal ministry in charge of the Abhiyaan, celebrates ‘Poshan Maah’ in the month of September and ‘Poshan Pakhwada’ in March. POSHAN Abhiyaan emphasizes active engagement of PRIs in aggravating Jan Aandolan activities to combat the intergenerational cycle of malnutrition and improve nutritional outcomes for the mother and child. REPORT: POSHAN PAKHWADA 2022 01

INBNIUHDTAERXRITOIONN Malnutrition is an inter-generational concept i.e., children born of malnourished mothers are likely to suffer from malnutrition and become malnourished mothers in turn. The increased rate of malnutrition also has an impact on the low economic well-being and prosperity of any state. As per the latest NFHS-V (2019-2020) data released by the Ministry of Health and Family Welfare; Bihar has significantly improved on some of the child health and nutrition-related indicators compared to the NFHS – IV. For example, the incidence of stunted children has decreased from 48.3% to 42.9%. Likewise, the incidence of underweight children has decreased from 43.9% to 41%. NMR, IMR, and U5MR all have shown a decline from 36.7% to 34.5%, 48.1% to 46.8%, and 58.1% to 56.4% respectively. Infant and Young Child Feeding practices, the number of under 6-month children exclusively breastfed has increased from 53.4% in NFHS-IV to 58.9% in NFHS-V; the number of 6–8- month children receiving solid/semi-solid food along with breast milk has increased from 30.8% to 39% and the total number of children receiving adequate diet from 6-23 months has also increased from 7.5% to 10.9%. In terms of NFHS-V findings with regard to maternity care indicators indicate that the number of mothers who had an antenatal check-up in the first trimester has increased from 34.6% to 52.9%; mothers who had at least four ANC visits increased from 14.4% to 25.2%; mothers who consumed IFA for 180 days or more when they were pregnant has increased from 2.3% to 9.3%; mothers who received post-natal care from a doctor/LHV/ANM/midwife/other health personnel within two days of delivery increased from 42.3% to 57.3%. In terms of improvement in delivery care indicators in Bihar compared to the last NFHS round, the number of institutional births has increased from 63.8% to 76.2%, with births in public facilities having increased from 47.6% to 56.9%. The slight gains in these data suggest that a lot remains to be done in the state of Bihar before decent coverage and outcomes are achieved. There are a number of schemes directly/indirectly addressing the nutritional status of children (0-6 year's age), pregnant women and lactating mothers; however, these schemes need local support and coordination for implementation. REPORT: POSHAN PAKHWADA 2022 02

CCACHAEBNTAOATNURLGTYEEZFIONRG C3 is a key changemaking organisation focused on improving the condition of girls and women in the country. C3 designs solutions & create ecosystems, where girls and women can demand and get their due entitlements. Centre for Catalyzing Change (C3) is a national-level development organization with a mission to enable women and girls to realize their opportunities and rights. C3 has been working to improve the lives of girls and women in the country through technical assistance, community-based nutrition, reproductive and child health programs, innovative youth programs, and women’s leadership programs. Over the years, C3 has delivered a tested model of promoting Women Panchayat leader’s participation in governance and to make systems more responsive to the needs of women and children, especially in the domains of Nutrition, Maternal Health and Family Planning. C3 works with Panchayat Leaders to hone their skills as articulate and forceful advocates who can draw added public attention to local priorities and solutions. Based on evidence generated through various programs and approaches, it is evident that PRI and specifically Gram Panchayats at the village level can play a major role in facilitating all stakeholders in achieving the objectives of Government supported schemes. REPORT: POSHAN PAKHWADA 2022 03

MPAARDSEIVNNLOTUEOCTARARDIITNETEIRGSOSN PRI based interventions are built on Chief Minister’s focus on promoting the agency of women leaders in Bihar Centre for Catalyzing Change’s (C3) PRI-based intervention has been designed to address this synergy and local support on the part of the EWRs. The intervention is currently operational in 449 Gram Panchayats of 32 blocks in the 10 districts of Patna, Sheikhpura, Samastipur, Aurangabad, East Champaran, Nalanda, Nawada, Rohtas, Madhubani, and Muzaffarpur. Total 2441 elected panchayat representatives are benefitting from this program. The overarching focus is to mentor Panchayat Representatives to play a strong role as Health, Nutrition, and Family Planning Champions in their panchayats, by placing their ward level needs before district and state- level officials and influencers to improve accountability and implementation. The intervention using the accountability framework, leveraged the potential of grassroots leaders from gram panchayats to identify gaps and advocate for improvements in H&N services before government officials, Members of Parliament, and Members of the Legislative Assembly. The key components of PRI-based intervention are capacity-building, mentoring, and participatory strategizing and action. PRI representatives were capacitated to monitor the quality of services at the Village Health Sanitation and Nutrition Day, Health Sub-Centre, Primary Health Centre, and District Hospital. Their increased interaction with front-line workers has resulted in visible improvements in maternal and reproductive health and nutrition-related service delivery, utilization of untied funds available at the local health facilities, and committees for purchase of essential equipment at health and AWC facilities. Various evaluations have suggested that the leadership potential of these women should be leveraged to ensure the improvement of various aspects of rural development including health, nutrition, and education services. REPORT: POSHAN PAKHWADA 2022 04

PP20AO2KS2HHAWNADA Poshan Pakhwada intends to achieve the holistic goals of Poshan Abhiyaan with swiftness in a harmonized manner. The POSHAN Abhiyaan is committed to achieve the second goal of the Sustainable Development Goal of eliminating all forms of malnutrition by 2030, including the internationally agreed 2025 target of stunting and wasting in children under 5 years. To give momentum to POSHAN Abhiyaan, the 'National Council on India's Nutrition Challenges' on 24th July 2018 decided to celebrate the month of September as Rashtriya Poshan Maah. POSHAN Pakhwada is held every year in the month of March for a fortnight since 2019. The Pakhwada is one of the key components to sensitize and engage communities, under POSHAN Abhiyaan along with Jan Andolan, behavior change communications, and advocacy. The 4th anniversary of Rashtriya Poshan Pakhwada was celebrated from 21st March - to 4th April 2022. Poshan Pakhwada 2022 was focused on two broader areas viz. height and weight measurement of ‘beneficiary children up to 6 years of age’ and activities concentrated around Gender-Sensitive Water Management, Anaemia, and Traditional food for healthy mother and child. One of the key activities of the Pakhwada this year, focused on Gender Awareness in Water Management aiming at promoting the role of women in water governance, conservation and management through active sensitization by Poshan Panchayats and Mother Groups. REPORT: POSHAN PAKHWADA 2022 05

POPOAUKSTHRHEAWANACDHA: PRI Leaders are mobilizing, tracking, extending support, and enabling women and families to achieve Nutrition goals. PRI Leaders from 10 districts of Bihar with the mentoring support of the Centre for Catalyzing Change (C3) organized many community-based activities, facilitated the movement of Poshan Rath on the ground to realize and achieve the objectives of improving the nutritional status of children, adolescent girls, pregnant women and lactating mothers of Bihar during Rashtriya Poshan Pakhwada 2022. Overall 1649 Panchayat Leaders along with 1703 15,000 FLWs/Govt. Officials from 306-Gram Panchayats of 29 blocks of 9 districts of Bihar namely, Patna, 10,000 Sheikhpura, East Champaran, Nalanda, Nawada, Rohtas, Madhubani, Aurangabad, and 5,000 Muzaffarpur districts under various PRI based interventions organized 1779 community events 0 and recorded unprecedented participation of EastMCMuhzaaadfmhfpuarabrpaaunnri Patna 50,963 community members. AuranRgoahbtaads Nawada SheiNkalhapnurdaa 15,000 29,176 10,000 Women 5,000 0 East CMMhuazadafmhfpuarabrpaaunnri Patna AuranRgoahbtaads Nawada Nalanda Sheikhpura Overall participation of women is more than that of men but it is 43% 21,787 encouraging to record a significant number of male participation Men in Poshan Pakhwada activities. This will ensure collectivizing effort to improve the Poshan of family. 06 REPORT: POSHAN PAKHWADA 2022

ACMOCATNJIODVRUITCIETSED Poshan Pakhwada 2022 successfully engaged communities, service providers, parents, religious leaders, influential people and people from all walks of life to raise awareness and promote positive nutrition practices. Poshan Pakhwada 2022 witnessed joint efforts of PRI members, Sevika, Sahayika, ANMs, ASHAs, Teachers, Vikash Mitra, Tola Sevak to spread nutrition related messages to families. All of these stakeholders together laid emphasis on Poshan Vatika, Growth Monitoring, Celeberation of VHSND, God Bharai Diwas, Annaprashan Diwas, mainstreaming home visits, group and interpersonal counseling sessions on themes like breastfeeding, complementary feeding, maternal dietary diversity, management of anemia and personal hygiene and sanitation. To effectively communicate messages, they also approached unique methodologies like Poshan Selfie, Letter to Parents, Quiz Competition, Poshan Mehndi, demonstration of local food items, identification of local popular dishes and its nutrient value, engagement through nutrition games like ‘Snake & Ladder Game’, etc. Here are the snippets of the various activities held under Poshan Pakhwada 2022 across geographies of PRI based intervention of C3, details below : 01 Poshan Vatika 09 Poshan ki Pathshala 02 To encourage communities to switch to 10 To create awareness on eating locally grown 03 Poshan Vatika so that expecting mothers, food and maintaining a balanced diet, 04 11 nutrition session was conducted with 05 growing girls, and children could have 12 Mothers group, Adolescent Group, Youth 06 maximum nutrients. 13 group, school children. 07 14 08 Painting Competition 15 Home Visits to promote Breastfeeding To encourage children, adolescents to draw pictures to highlight the importance of To push forward the messages for starting nutrition and hygiene in our daily lives. breastfeeding within one hour of delivery, gradually introducing complementary foods Rally/Prabhat Pheri once the six months exclusive breastfeeding period is completed. To inform communities about ensuring right nutrition for children, pregnant women and God Bharai Celebration lactating mothers. To raise awareness of pregnant women and Growth Monitoring her husband about various healthy safe motherhood practices during maternal and To identify SAM/MAM children who needs child care services. special care and referral support. Handwashing Techniques by Paustik Thali Competition of To encourage a healthy lifestyle To spread the message of eating right and demonstrating proper techniques healthy living through the demonstration of handwashing to communities, locally prepared healthy dishes. Poshan Wala Tyohar Rangoli Competition To use popular festival for nudging To educate the communities about the community on benefits of colourful diet, importance of color in our food, good breastfeeding, 100 days care, maternal nutrition and balance diet. nutrition and others to tackle malnutrition and promote positive nutrition practices Counselling Sessions Poshan Pratigyan To provide healthy tips to adolescent girls on anaemia, menstrual health, diet diversity and To encourage families to sign across the balanced diet. pledge along with FLWs for practicing nutrition-related care and hygiene practices. Poshan Panchayat Candle March/Burning To discuss around availability, accessibility, Effigies and reach of nutrition-related services, major issues related to malnutrition, developing To abolish malnutrition, anaemia & other priorities & action plans for improving the nutrition-related burden and pave the way to status of nutrition etc create a healthy and nourished panchayats REPORT: POSHAN PAKHWADA 2022 07

PPIMAOPKSAHHCAWTNADA: Poshan Pakhwada, 2022 received massive responses from the participants across geographies of PRI based intervention of C3, which is also evident from 09 SAM/MAM children referred to NRC/PHC for further consideration, growth monitoring of 827 children, 29 families started Poshan Vatika, Paushtik Laddoo was distributed among 710 children, 53 pregnant women, adolescent girls, and children received IFA tablet/syrup, Deworming tablets to 946 children, distribution of ORS packets to 376 families etc. 10 Districts 306 Panchayats No. of communities supported in Support in Institutional Delivery 17Antenatal and Post Natal Care 02 No. of communities provided No. of communities provided 53IFA Tablet/Syrup 946Deworming Tablet No. of communities provided No. of communities provided 67Vitamin A Syrup 376ORS Packet No. of communities provided No. of communities supported in 710Paushtik Ladoo 827Growth Monitoring No. of communities supported in No. of malnourished children sent to 29establishing Kitchen Garden 24Nutritional Rehabilitation Centre No. of communities provided No. of families supported in 02Zinc Syrup 494immunization REPORT: POSHAN PAKHWADA 2022 08

SINONLOUVTIAOTNIVSE Heading POSHAN Rath on the roads and trails of villages for norm change on positive nutrition practices has been the most important aspect of this Poshan Pakhwada 2022. Designed by C3, Poshan Rath is an auto- rickshaw/E-rickshaw designed to erase wrong perceptions and practices related to Nutrition in local communities and build awareness about the benefits and the process of right Nutrition. The colouful Auto-rickshaws/E-Rickshaws have graced the lanes and trails of panchayats spreading awareness about Right Nutrition during Poshan Pakhwada, 2022. Centre for Catalyzing Change along with Integrated Child Development Services, came together for the movement of POSHAN Rath to promote right nutrition during Poshan Pakhwada 2022. C3 team with inputs from ICDS Secretariat, Govt. of Bihar finalized the nutrition related messaging based on the Poshan Pakhwada theme for decorating of Poshan Rath. POSHAN Rath was a perfect mode of transport which had crossed narrow roads for reaching to large number of community people with the positive messages of nutrition. The final design of Poshan Rath had messages related with importance of IFA supplementation of pregnant women, balance diet, growth monitoring of children, slogan of Poshan Abhiyaan etc. and huge header about Poshan Pakhwada 2022 at top of the rickshaw. It had a Poshan Rath…Sahi Poshan, Desh Roshan header on the centre of vehicle, and made it very special for village roads of ten districts of Bihar. Many PRI members utilized the movement of Poshan Rath for organizing community meetings, demonstrating good practices and disseminating messages related to benefits of colorful diet, breastfeeding, 1000 days care, maternal nutrition & others to tackle malnutrition and promote positive nutrition practices within their respective constituencies. Most of them have pre informed their community members about the route chart of Poshan Rath for ensuring their participation. REPORT: POSHAN PAKHWADA 2022 09

TESTIMONIES \"I am 25 years old and pregnant for three months. I did not take IFA and Calcium tablets during my first pregnancy. After knowing this, Somanti Devi who is the ward member of our ward invited me to a program during the Poshan Pakhwada 2022. In that program, a Poshan Rath was called to give information related to nutrition, in which many posters, banners were displayed and melodious nutrition songs were also playing. I understood the importance of IFA, Calcium tablets, balanced diet and proper care during pregnancy after attending that program. Somanti Devi also accompained me to Arogya Diwas for ANC check ups, counselling by ANM didi and also provided me sufficient quantities of IFA and Calcium tablets\". - Sundari Kumari, Deeha Panchayat, Ariyari block, Sheikhpura district, Bihar \" 10 \"During the Poshan Pakhwada, I had ensured the movement of Poshan Rath in my Veerpur Panchayat. Many people gathered there listened and read the message being given through Poshan Rath. During this program I met a couple (Ramashankar Kumar and Alka Kumari). Alka Kumari had a seven-month-old baby in her lap but she had not yet started giving complementary food to her child. Even after listening to the messages being given during the program, Alka Kumari was still wondering how her little one would be able to digest the food. I explained the family that breastfeeding alone is no longer enough for optimal growth and development of the child older than six months. Hence, it is necessary to start complementary feeding along with breast milk. If you do not feed the complementary foods, the child may become weak! He may lose weight and gradually may become a victim of malnutrition! This was understood by both of them and they take a pledge to provide complementary foods along with breast milk to child from very next day\". - Rekha Kumari, Ward No.11, Veerpur Panchayat, Kanti block, Muzaffarpur district, Bihar REPORT: POSHAN PAKHWADA 2022

CMOEVDEIARAGE Media has a massive role to play in raising awareness & communicating messages around good nutrition and healthy diets to masses, but also in conducting advocacy efforts to ensure nutrition remains high on states agenda. PRI members have demonstrated the ability to influence various media houses to highlight the nutrition related issues affecting the lives of women and children. Due to their continuous effort, Total of 37 media pieces were published in prominent dailies covered the issues extensively and highlighted the efforts of women panchayat leaders in promoting positive nutrition related behaviours & practices within their communities. REPORT: POSHAN PAKHWADA 2022 11

WAY FORWARD Rashtriya Poshan Pakhwada 2022 have demonstrated the potential of PRI leaders as an advocate promoting awareness and uptake of Nutrition related services within communities. Some of the suggested way forward are: 12 FORMAL INTEGRATION INTENSE INVOLVEMENT Although Panchayat Representatives have diligently Capacity building of PRIs on Nutrition before Poshan spread the messages of Poshan Abhiyaan for four years Maah & Pakhwada. under C3 intervention areas, there still needs to be Promoting Malnutrition Free Panchayats campaign on recognition of PRI work on Poshan. the lines of ODF by Govt. A formal integration between PRI, ICDS, and the Health Provision of reward to panchayats declared as department with C3 would further pave the way for Malnutrition free. effective on-ground implementation, and scalability of Activating VHSNC for preparing of annual panchayat these efforts to other geographies. nutrition road map. 3 4 ENSURING MICRO CONVERGENCE PANCHAYAT NUTRITION MISSION Addressing malnutrition requires micro convergence Making PRI responsible for malnutrition and related among departments/agencies providing health, burden of their community education, sanitation, poverty alleviation-related services Ensuring engagement of PRI members in Poshan PRI function can be used to establish coordination among Tracking of SAM/MAM children these departments. Making PRI accountable towards Poshan Maah & Gram Panchayats can take lead in developing Ward Pakhwada Specific Poshan Vatika in barren Govt. land. This will Creating champion families who follow positive nutrition- benefit landless and deprived families. related practices REPORT: POSHAN PAKHWADA 2022 12

CONCLUSION Malnourishment can cause an irreversible negative impact on a child's physical and mental growth and requires utmost attention at policy to practice level. Active engagement of PRI leaders through their community-level influence have created an additional and effective channel for dissemination of any kind of positive messaging on nutrition as well as accelerated the campaign to eradicate malnutrition. Multi-prolonged approach to address Malnutrition Indicators like institutional delivery, optimal infant and young child feeding practices, access to safe drinking water, sanitation, immunization, early childhood development, food fortification, deworming, dietary diversification required significant attention for addressing malnutrition. Funds should be made available under Gram Panchayat Development Plan to rehabilitate malnourished children. Engaging Men in Nutrition is a great enabler for Poshan Abhiyaan Male supportive involvement in maternal health and nutrition is a vital element in endorsing family health, nutrition, and the overall well-being of society. Male involvement can be seen as encouraging men for more involvement and support to the women's needs, choices related to maternal health & nutrition. Increased male participation could break the gender-related barriers, make them supportive husbands, yield health & nutrition benefits for women and children by ensuring healthy practices during pregnancy, institutional delivery, and childcare. Incorporate the agenda of nutrition in Panchayat Level Meetings Inclusion of 'nutrition' in the agenda of all layers of panchayat level meetings would sensitize the community towards healthy nutritional practices and make panchayat accountable for nutrition-related issues of their communities. This would also create a feedback mechanism to help Govt. Line Departments to receive information as well as take necessary steps on various nutrition-related issues. These platforms would also promote reflections about malnourished women & children and collectively identifies ways to support them. REPORT: POSHAN PAKHWADA 2022 13

Contact Centre for Catalyzing Change 165/B, Shanti Sadan, Patliputra Colony, Patna – 800013, Phone : +91-612-2260534 www.c3india.org contact@c3india.org @c3_india