Feature story

Mission nutrition

Mothers and children are the concern of a collaborative effort in malnutrition-stricken pockets of Andhra Pradesh

Eighteen-month-old Akash Reddy from Ganapavaram village in Andhra Pradesh’s NTR district was thin for his age and often listless. His mother, Rukhmini, found it difficult to get him to eat. What she did not know was that Akash’s weakness and fussiness were caused by severe acute malnutrition (SAM), a condition brought on by poor nutrition in early childhood.

Akash and the Reddys were lucky. The family received a visit from a poshan sakhi (nutrition friend) working with an exceptional programme that addresses one of the root causes of malnutrition in rural India: the lack of an adequate and diverse diet for women and children.

Launched in 2021 in 35 villages across NTR and Anakapalli districts, the three-year ‘Yes! To Poshan’ programme is being implemented by the Vijayavahini Charitable Foundation (VCF), an associate organisation of the Trusts, and it has reached more than 7,000 women and 3,000-plus children in underserved communities, among them Ms Reddy and her son.

Visiting the Reddys’ home for a routine monitoring, the sakhi found Akash to be severely underweight for his age. The child was referred to a nearby district hospital before being put on a feeding regimen. The sakhi taught Ms Reddy to prepare food that would help her son gain ‘healthy’ weight and the family received nutritional premixes and iron and folic acid tablets from the local anganwadi (childcare centre).

Schoolchildren at an essay-writing competition — which is part of the programme — in Khajipalem in Anakapalli district

Akash’s treatment plan included psychosocial sessions with the family to drive home the importance of good nutrition. The timely intervention resulted in Akash gaining 3kg in four months. The risk of malnutrition retreated, his energy levels improved and he became active and sociable. “I have understood the importance of focusing on my child’s nutrition for the first 1,000 days. I now know what to feed him,” says Ms Reddy.

The programme is part of the Tata Trusts’ efforts to tackle malnutrition in underdeveloped regions of 13 states. Yes! To Poshan, which unfolds exclusively in Andhra Pradesh and is executed in collaboration with Asian Paints and P&G Health, concentrates on community awareness about nutrition and bolsters this through capacity building for frontline workers at anganwadis (there are 53 of these centres in the initiative).

“Yes! To Poshan’s multipronged approach covers behaviour-change communication and participation by frontline workers, local communities, mothers’ groups, children and others,” says P Kasee Srinivas, a programme manager with the Trusts. 

Bleak picture

Malnutrition in women and children is an endemic health crisis in India, especially in the country’s rural reaches. The latest National Family Health Survey 5 revealed that among children aged up to 5 years, 35.5% were stunted, 19.3% were wasted and 3.12% were underweight. More than two-thirds of these children and about half of all women between the ages of 15 and 49 were anaemic.

Malnutrition may be largely invisible but its developmental, social and economic manifestations are clear and lasting. The Yes! To Poshan programme adopts a holistic approach to tackle this malaise by looking at factors beyond nutrition that can impact families and have inter-generational consequences. “Addressing the underlying cause is crucial to improving the quality of life of mothers and children at the household level,” says Mr Srinivas.

VCF’s project team has used a mix of methods to tackle the malnutrition issue. A big barrier here is ignorance about dietary nutrition and the public health resources available to communities. The team uses a participatory learning and action approach at the village level to build community awareness.

Home visits are done by poshan sakhis to monitor children and to talk to mothers, the most crucial individuals in the nutrition equation. Households are encouraged to use existing services in the anganwadi network, which distributes take-home rations for pregnant and lactating women and for babies.

The sakhis play a vital role in the project, gathering village-level information and enabling outreach in large numbers. They work closely with anganwadi workers and auxiliary nurse midwives, the key frontline health workers in rural India. Organising capacity-building sessions and holding community meetings to share recipes and conduct cooking demonstrations are some of the other activities of the sakhis.

A lot rides on the personal connect these sakhis bring to the programme. Says Ramya, a 25-year-old mother from Kothagudem in NTR district: “Vani D, the poshan sakhi in our village, counselled me on the precautions to take while feeding my child and about the importance of breast milk for my child’s overall health. And I learned about the vaccines my child needs over the next six months.”

A nutri-garden in Ganapavaram village in NTR district

Garden-variety kind of wellness

Rampant malnutrition is an age-old concern in India and its effects are widespread. Micronutrient deficiencies cause impaired physical and cognitive development in children that can go on to affect them in later years. To get families to eat right means ensuring they have access to the right food. In many rural areas, however, diets revolve around what’s available and affordable.

The Yes! To Poshan programme has found a solution in the form of nutri-gardens where communities can grow fruits and vegetables. The team provides seeds of leafy vegetables, bottle gourd, beans, etc and also provides technical support to help community members improve the harvest quality from the gardens.

The nutri-garden model is being implemented at three anganwadis (childcare centres). These gardens provide anganwadi beneficiaries with fresh vegetables, rich in nutrients and energy, on a daily basis. Each of these anganwadis can grow enough to cover the nutritional requirements of 30-40 people.

The Tata Trusts team has also started promoting homestead plantations, with about 200 households contributing to the development of vegetable gardens. Additionally, about 60 individual households have nutri-gardens on their plots.

The sakhis also advise the community about the importance of handwashing for sanitation, they monitor the growth in weight and height of infants and children, and distribute take-home rations. The sakhis include men at these events, given that they are typically the primary decision-makers in the household.

The community as a whole is made aware of the importance of diet in the first 1,000 days of a child’s life, the decisive period that decides good health. To engage the community, the team holds demonstrations of nutritious recipes that use local ingredients. An interesting concept is the idea of nutri-gardens at anganwadis and households.

The Yes! To Poshan team publishes recipe manuals using locally-sourced food resources. These resources are in the local Telugu language and carry pictorial messaging for easier dissemination. The idea is to promote local food products and the consumption of germinated cereal flour (sprouts), which are rich in the amylase enzyme and good for a child’s growth.

A community meeting in Ganapavaram village in Eluru district

“The programme plays a critical role in creating awareness about diet diversity and reducing malnutrition among children and pregnant and lactating women,” says Donthu Sreenivasulu, project coordinator with VCF.

The progress of the Yes! To Poshan programme in Andhra Pradesh over the last year has paved the way for the expansion of the Tata Trusts’ nutrition drive in other states. The Trusts are now exploring similar partnerships with state governments and like-minded partners to widen the programme’s impact.