Sarvodaya Ashram, in a significant partnership with CARE India, successfully implemented the Integrated Nutrition and Health Program (INHP) in the Sitapur district of Uttar Pradesh from 1998 to 2006. This collaborative endeavor was strategically designed to enhance nutrition and health outcomes, with a particular focus on the most vulnerable segments of the population: children under six years of age and pregnant/lactating mothers.
Program Framework and Objectives
CARE India’s INHP was a multi-stakeholder initiative, forged through a robust partnership involving CARE India itself, various departments of the Indian government (specifically the Ministry of Women and Child Development and the Ministry of Health and Family Welfare), and local non-governmental organizations, including Sarvodaya Ashram.
Integrated Approach: The program adopted a holistic and integrated service delivery model, primarily utilizing Anganwadi centers as the central hubs. This comprehensive package of services included:
- Supplementary Nutrition: Addressing immediate dietary needs.
- Immunization: Ensuring critical vaccination coverage.
- Health Check-ups: Regular monitoring of health status.
- Referral Services: Facilitating access to higher-level care when necessary.
- Health Education: Empowering communities with vital knowledge on health and hygiene.
Target Population: The INHP meticulously targeted children aged 0-6 years and expectant/nursing mothers, recognizing these groups as requiring focused attention due to their heightened vulnerability to nutritional deficiencies and health complications.
Key Objectives: The overarching objectives of the program were multifaceted:
- To improve the nutritional and health status of the target population.
- To promote optimal psychological, physical, and social development in children.
- To reduce rates of mortality and morbidity.
- To enhance mothers’ capacity and knowledge in caring for their children’s health and nutritional needs.
Evidence-based Approach: A distinctive feature of the INHP was its commitment to an evidence-based approach. The program established certain sites as “learning laboratories,” where practices were rigorously tested and refined. This demonstration and replication model allowed for the identification of effective interventions that could subsequently be scaled up and integrated into broader government systems, ensuring sustainability and wider impact.
Intervention Components of the Neonatal Care Package
A critical component of the INHP was its structured neonatal care package, which outlined specific strategies and promoted behaviors across key periods:
- Prenatal Period:
- Strategies: This phase involved home visitations by auxiliary nurse-midwives, Anganwadi workers, and designated change agents. Their role was to provide comprehensive counseling on preventive care, maternal nutrition, preparedness for childbirth, and appropriate utilization of healthcare services for potential complications. Additionally, food supplements were provided to economically disadvantaged families at Anganwadi centers.
- Behaviors Promoted to Mothers/Families:
- Early registration of pregnancy with the Anganwadi worker and auxiliary nurse-midwife.
- Completion of at least three antenatal check-ups.
- Receiving two doses of tetanus toxoid immunization per pregnancy.
- Daily consumption of iron-folic acid supplements for three months.
- Reduction of pregnant women’s workload, including at least two hours of rest per day.
- Consumption of an additional meal or snack daily, along with micronutrient-rich foods.
- Proactive birth preparedness, encompassing identification of a trained provider, selection of a clean delivery site, saving for emergencies, and arranging for transport if needed.
- Obtaining or preparing a disposable delivery kit.
- Ability to identify and promptly seek care for danger signs in both mothers and neonates.
- Delivery Period:
- Strategies: Families were actively encouraged to engage auxiliary nurse-midwives or trained traditional birth attendants to oversee deliveries.
- Behaviors Promoted to Mothers/Families:
- Adherence to the “five cleans” protocol: clean surface for delivery, clean hands, new blade, clean cord tie, and clean cloth to wrap the neonate.
- Initiation of breastfeeding within one hour of delivery.
- Implementation of thermal care, which included immediately drying and wrapping the neonate after birth and delaying the first bath for three days.
- Promptly seeking trained medical care in the event of danger signs for either the mother or the baby.
- 0–27 Days Postnatal Period:
- Strategies: Community-based workers conducted visits as soon as possible after birth to provide crucial counseling on breastfeeding, essential newborn care (thermal care, hygiene, and clean cord care), identification of maternal and newborn danger signs, and appropriate healthcare utilization. Follow-up visits were also conducted for sick, premature, or low-birth-weight neonates.
- Behaviors Promoted to Mothers/Families:
- Consistent practice of essential newborn care, including early and exclusive breastfeeding, proper cord care, and thermal regulation.
- Strict avoidance of applying any substances to the cord stump.
- Ability to detect danger signs and seek immediate care from trained health providers.
Program Impact
The INHP demonstrated significant positive impacts on several key health indicators. Notably, it led to substantial improvements in breastfeeding practices, including increased rates of initiation within one hour of birth, feeding of colostrum, and exclusive breastfeeding for the first six months. Furthermore, the program contributed to improved weight-for-age z-scores and a reduced prevalence of underweight among children in the target areas. However, it was observed that the impact on complementary feeding practices showed some variability across the program’s duration and regions.
Sarvodaya Ashram’s Pivotal Role
Sarvodaya Ashram’s collaboration with CARE India was fundamental to the successful implementation and achievement of the desired outcomes of the Integrated Nutrition and Health Program. As a local partner, Sarvodaya Ashram played a crucial role in community mobilization, direct service delivery through Anganwadi centers, and fostering trust within the communities. Their deep understanding of local dynamics and their dedicated efforts were instrumental in ensuring the program’s effective reach and the sustained adoption of improved health and nutrition practices among the vulnerable populations of Sitapur district. This partnership exemplifies how local engagement is vital for the success and sustainability of large-scale public health initiatives.
