Celebrating well-being and convergence in tribal Nashik

Nashik: We reached Nanashi village in Nashik district’s largely tribal Dindori block at forenoon. When we asked around for the venue of the Poshan Pakhwada event, we were directed to a pandal awash in bright yellow and red, its canopy decorated with colourful ribbons. At first glance, it looked like a wedding pavilion but inside there was a different kind of celebration going on. As we walked towards the enclosure accompanied by Ankita Rathod, who was our guide for the day, a slogan blared from the loudspeaker: Ajaranna door thevuya, hirvya bhajya khauya (Let’s keep away diseases by having green vegetables). The ever dependable women in white, pink and blue saris, the auxiliary nurse midwife (ANM), anganwadi workers (AWW) and the accredited social health activist (ASHA) workers respectively were busy getting the day’s activities going.

Poshan Pakhwada is the fortnightly awareness and outreach campaign launched countrywide to mark the first anniversary of POSHAN Abhiyaan, a flagship government programme to boost nutrition among children and women. Taking the government’s nutrition mission forward, anganwadi workers from across India joined in the nationwide celebration to fight malnutrition, ensure holistic development and adequate nutrition for pregnant women, mothers and children. Counselling on nutrition, hygiene, exclusive breastfeeding, immunisation, regular weight checks, anaemia screening for pregnant women and linking with various government schemes were among the many activities planned from March 8-22, 2019.

“The nutrition programme has to be celebrated like a festival. Our poshan events must be as colourful and joyous as a wedding”, remarked Pradeep Pawar, state coordinator, Rajmata Jijau Poshan Mission (RJPM). The mission aims to reduce child malnutrition in Maharashtra by focusing on the first 1,000 days from conception, that is, nine months of pregnancy to 24 months. An autonomous technical and advisory body fully funded by Unicef, it works towards improving convergence and coordination between the public health department, the state government and the ICDS commissionerate.

Our guide Ms Rathod nodded in agreement. A Swastha Bharat Prerak (SBP) from Nashik, she is part of the SBP programme, a joint initiative of the ministry of women and child development (MoWCD) and Tata Trusts, which brings together the highest level of bureaucracy and the brightest young managers from premier management, engineering and social sciences institutions to drive and monitor the effective implementation of the POSHAN Abhiyaan.

Posters on health, food and the nutritional needs of pregnant women were displayed prominently inside the pandal. On our right, young girls dressed in nine-yard saris and boys in traditional kurta-dhoti were selling vegetables — methi (fenugreek), cabbage, tomatoes, a variety of forest greens and hadga-heti flowers (sesbania grandiflora) neatly piled in baskets.

On the other side, the local primary health centre (PHC) staff had set up a haemoglobin testing station where blood samples of school girls were being drawn and tested. “The HB count of most girls is normal. But there are a few whose count is below 10”, shared Nirmala Fuge, an ANM, who was in-charge. After the test, the students were led to the nutrition stall where Ms Fuge spoke to them about good eating habits and informed them about the nutritional values of green vegetables, sprouts, millets, jaggery, groundnuts and eggs. This group of girls was fit and in fact two of them were even part of the district’s kabaddi team.

At the recipe demonstration being held in the school hall, nachani bhakri (roti made from ragi millet), pickled jackfruit, hadga bhajia (fritters), ragi dhokla (steamed cake made from ragi flour) and other delicious fare was laid out, duly marked with their respective botanical names and nutritional values. Also on display were the fortified mixed grain atta (flour) and highly popular mixed millet noodles developed by the WCD ministry and distributed in the community as take home ration (THR) by the AWW.

Primarily a tribal block, Dindori is home to the Kokna and the Mahadev Koli tribes, the original inhabitants of the region. Every year after the monsoon, most families migrate for work either to brick kilns or to harvest grapes. When the families migrate, it’s usually the health of the women and children that takes a beating owing to poor living conditions and the lack of access to healthcare. “That’s why we need to work meticulously all through the year. We need sustained community engagement to ensure that the nutritional requirements of women and children are understood and met. We hold monthly meetings in the village and pregnant women are registered in their first trimester so that their progress can be monitored”, explained Savita Gawli, anganwadi supervisor — Beat 2, Nanashi. Additionally, under the government’s Amrut Ahaar Yojana, the AWW provide expectant adivasi women with one meal everyday from the third month of pregnancy. “It’s wholesome fare — sabzi-chapati, dal-rice and an egg — and she has to eat it in the presence of the AWW. It’s a part of the government’s first 1,000 days approach to combating malnutrition and ensuring a child gains optimum health, growth, and neurodevelopment”, informed Rakesh Kokne, ICDS child development project officer.

The village child development centre (VCDC) at Nanashi is also very active. The centre provides support for home-based management of children affected by severe acute malnutrition (SAM) by making available nutritious and energy dense foods, as defined by the World Health Organisation, Unicef India and the World Food Programme. Around '2,150 per child was spent for the treatment of malnourished children and the expense was borne by Nanashi panchyat. M.P. Gavit, the gram sevak (panchayat revenue officer) facilitated the fund disbursement in 2016.

Apart from dealing with the challenge of migration, health workers here are often up against age-old community practices as well. Ms Fuge narrated how her watchfulness saved a mother and her newborn. “The woman and her family refused any medical intervention but I kept an eye on how she was getting on with the help of the AWW. She delivered at home but the baby and she were critical. I went to her house and urged the family to reconsider their decision. I told them that without medical help the child would die”, she said. The young woman was too weak to protest and looking at the infant’s condition, the family also relented. After a month’s treatment at the civil hospital, the baby gained weight and bounced back to health. Today, the young adivasi woman helps the ANM, motivating other women to seek treatment.

The Poshan Pakhwada brought some great news for the teenage girls of Nanashi as well. Unveiled at the pandal was a brand new sanitary pad vending machine. A long-standing request, it was M.P. Gavit who took the lead to make it happen. To be installed in the anganwadi, the machine will finally give girls access to modestly priced sanitary pads — one napkin for '2.

“Holding the Poshan Pakhwada is a great way to celebrate health and spread the word on nutrition. However, we need sustained work to bring in the desired results in the long term. When families return to the village after their stint outside, we have to restart work on building their heath. Children are usually sick and the women emaciated. To break out of this cycle, the ICDS and public health department have drafted a plan to make the services available through anganwadis located near their place of work”, shared Kokane.

Indeed, it was heartening to see the commitment, convergence and synergy demonstrated by the various government departments and agencies along with the personnel on the ground as they went about delivering on the promise of good health to the community.

— Charkha Features