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Fighting under-nutrition being a prerequisite to build human capital

Education of women, improving the basic access to health services, quality of care for the child and pregnant mother and good hygiene practices have been the pillars on which Gujarat has tackled the silent epidemic of under-nutrition.

With fighting under-nutrition being a prerequisite to build human capital, Gujarat has led from the front with proper planning and effective implementation of initiatives & schemes. The ability to take people centric decisions based on ground reality has prompted Gujarat to roll out initiatives which are aimed at community empowerment as well. Decisive steps taken by the State government to tackle under nutrition in children below 5 years have contributed in creating a Progressive Gujarat on all fronts.

Emphasis to provide children with supplementary nutrition, immunization, periodical health check-ups and referral services have proved a handful in reducing under-nutrition in children below 5 years. Resilient political will, proactive governance and participative growth have shown that Gujarat is focused on acting on the problem rather than ignoring the same.

So where does this vicious cycle of Malnutrition start? It starts with an underweight expectant mother, who is often burdened with pregnancy in her teens, inadequate spacing between successive children, excessive work and lack of appropriate nutrition and health care. The cycle continues with a low birth weight baby exposed to poor health, hygiene and nutrition practices who further develops into an underweight and stunted child. Thereafter, the new cycle of early marriage and pregnancy condemns yet another generation to this vicious cycle of malnutrition.

Gujarat’s determination to identify the root of the epidemic and to exhaustively work to weed it out has set the tone in fighting under-nutrition. The catalysts to fight the epidemic have been the Anganwadis (Kindergarten). The holistic approach of the government to empower the Anganwadis and its workers on necessary information, services and skill building in tackling under-nutrition has reaped much needed rewards in seeing the discernible change in the state today. Gujarat is home to 52137 Anganwadi centers covering 62.60 lakh beneficiaries to all the schemes doled out by the State government which are operational in 336 blocks. Out of the 336 blocks, 80 blocks are in tribal areas and 23 blocks in urban slum areas. Anganwadis have also played a pivotal role in nutrition and health education for mothers and children below 6 years.

57% of the population in Gujarat live in the villages, combatting the epidemic in villages has been the core area of focus for the State government. Through the Village Health sanitation and Nutrition Committee, the imperative has been to enhance community participation. In choosing women to play a significant role in this, Sakhi Mandals (self-help groups) and Matru Mandal (Mother support groups) were formed. Through this the State government was instrumental in giving women an opportunity for income generation and enhancing their social status by involving them in community care programs. Through Sakhi mandals, children in the age group of 3-6 years at Anganwadi centers are being provided hot cooked food like masala fada, sheera, sukhadi, gadya pudla etc, twice a week at Rs. 3 per beneficiary rate on no profit basis. In addition, a scheme for providing Sukhdi as Take Home Ration (THR) through 49,992 AWCs twice a week to 1,17,359 adolescent girls, pregnant women and lactating mothers is also operational.

With an objective to inform, disseminate, sensitize and motivate the communities to utilize services like the ICDS, the Gram Sabhas (social audit forums), are organised by the Gram Panchayats twice a year. The ICDS in Gujarat is now revamping its strategy to provide the much needed focus on 10 most critical and essential interventions as suggestions as suggested by the Lancet, 2009 proven to reduce under-nutrition.

Persistent efforts of the State government to raise the scale of skill development has prompted the Anganwadi centers to hold regular recipe shows/rasoi shows for the communities which showcase preparation of various nutritious recipes using the resources available locally.

In a country which wants to reap its demographic dividend, the health of the under-six population is a huge concern. Malnutrition in infancy affects both the physical development and mental growth of a child. Thus, having understood that significant role that nutrition and mental stimulation received in the first three years of a child in his/her performance in school, Gujarat has paid specific attention to the under-six population. The Nutrition program has steered all the initiatives in tackling the epidemic for children below 6 years by ensuring periodic rise in supplementary nutrition given to them. Earlier, children under 6 years were given 300 calories and 8-10 grams of protein under the per child expenditure not exceeding Rs.2, the state government in 2009 revised these norms to 500 calories and 12-15 grams protein at the per child expenditure of Rs. 6 ( 2013-14). Children who are severely underweight below 6 years who were earlier given 600 calories and 16-20 grams of protein at the per child expenditure of Rs. 2.70, which was revised to 800 calories with 20-25 grams of proteins at the child expenditure of Rs.9(2013-14).

Pregnant and lactating mothers has now been revised to serve 600 calories and 18-20 grams of protein at the cost of Rs. 7 per pregnant and lactating mother (2013 – 14).

On understanding the criticality and the importance of the providing better to nutrition to girls, Gujarat began to give Sheera, Sukhadi, Upma and Ready to cook premix packets under SABLA since 2010 at Rs. 7 per beneficiary.

In compliance with the Revised Feeding Norms (2009) by GoI, Gujarat initiated provision of ‘Ready to Cook’ Energy dense Micronutrient Fortified Blended Supplementary Food as Take Home Rations (THR). Bal Bhog for young children (6 m – 3 years) and Sheera, Upma and Sukhadi for adolescent girls, pregnant mothers were also provided. Pregnant mothers in Gujarat are now being educated on proper diet during pregnancy during Mamta Diwas [Village Health Nutrition Day]. Special schemes such as Kishori Shakti Yojana, SABLA, Mamta Taruni have also been launched to ensure education and nourishment of young adolescent girls. Under these schemes, the girls are given packets of premixes. The premixes are easy to make and act as supplements to the regular diet making up for the nutritional needs of the beneficiaries. In addition, adolescent girls, pregnant women and lactating mothers are also given iron folic tablets, calcium tablets and iodized salt at the Anganwadi centres.

Under the Mission Balam Sukham of the Gujarat State Nutrition Mission (GSNM), Bal Shaktim Kendra is located at Anganwadis as a first level care centre for children without medical complications. This was introduced in the period January to March 2013; in total 2067 VCNCs were functional wherein 930 eligible children completed the 30 day camp. The strategy of Mission Balam Sukham will focus on both preventive and curative aspects, keeping in view the various stages of desirable interventions namely Adolescence, 9 months of pregnancy to first two years of life (critical 1000 days i.e. (-) minus 9 months to 2 years of age and for children up to 6 years of age. For the management of severely acute Malnourished Children, 26 Bal Sanjeevani Kendras [Nutrition Rehabilitation Centers] have also been set up. E-Mamta Mother and Child Tracking System have been developed for tracking every child.

Mobile Anganwadi Vans are on the move in all the districts to address the nourishment needs of the people living in remote areas. Annaprashann Divas, which is celebrated on every fourth friday of every month, emphasizes the importance of initiation of Complementary Feeding (CF) at 7 months and to strengthen infant and young children feeding practices (IYCF) and Mamta Diwas, which is celebrated on a selected wednesday of the month, on this day services of ICDS i.e. vaccination, weighing, counseling and distribution of THR to all beneficiaries are provided.

In essence after making rapid economic development for the past 10 years Gujarat has paid careful attention to social indices which guarantees human development. Proactive governance has helped the state stich the gap of Economic Development with Human Development ensuring holistic growth of demographic segments of Gujarat.

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