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GUJARAT STATE NUTRITION MISSION (GSNM). Departments of H&FW and WCD. Presentation to Hon’ble Chief Minister. Agenda of the Meeting. Overview of the nutrition status in Gujarat-High incidence of undernutrition in Gujarat Nodal Departments for Gujarat State Nutrition Mission- HFWD & DWCD. - PowerPoint PPT Presentation
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GUJARAT STATE NUTRITION MISSION
(GSNM)
Departments of H&FW and WCDDepartments of H&FW and WCD
Presentation to Hon’ble Chief Minister
Agenda of the Meeting 1. Overview of the nutrition status in Gujarat-High
incidence of undernutrition in Gujarat2. Nodal Departments for Gujarat State Nutrition
Mission- HFWD & DWCD.3. To decide the Roles, Responsibilities and Structure of
Nutrition Mission4. To evolve Concept and Approach to achieve the
objective :- 3 –Tier Approach.5. Human and Financial resources for the Mission6. Maharashtra & Other Models – successful case study.7. Any other agenda items from the Chair
Apr 21, 2023 2Health & FW
National Family Health Survey-3, 2005 – 06,Gujarat
INDIA
Gujarat
Nutrition Situation of various States of India
38
37
37.625
22.929.8
32.5
39.9
44.6
25.6
42.4
60
39.6
24.9
26.1
36.5
56.5
40.747.1
48.855.936.4
19.7
22.1
39.619.9
32.5
25.2
38.7
45 % Children (<5 Yrs) of Gujarat are underweight.
3
DLHS-2, 2002-04
• 45% U5 underweight• 50% Breastfed in 1st hr ***• 45% Exclusively breastfed **• 56% Initiate Complementary feeding - 6-9 months ***• 24% Get adequate Proteins & Calories*• 80% Anaemic (6-35 m)• 56% HHs use Iodized salt• 56% Vit A supplement**
NFHS 2005-2006* NNMB (ICMR)** DLHS – 2008***CES, Unicef - 2009 4
Nutrition Situation in Gujarat
Types of Malnutrition
• Underweight- A composite measure – Low Weight for Age
• Stunting- An indicator of past growth failure – Low Height for Age
• Wasting- Current or Acute malnutrition – Low Weight for Height
• Micronutrient deficiencies- Iron(Anaemia), Iodine (Hypothyroidism, Cretinism-Mental retardation), Vit-A (Night Blindness)
Weight for Age criteria Weight for Height criteria
Normal %[Green]
Severe Under Weight % (Red)
Moderate Under Weight % [Yellow]
Nutrition Status in Gujarat
Normal %
Moderate Acute
Malnutrition (MAM) %
Severe Acute Malnutrition
(SAM) %
44.6%
Underweight (%)
55.4%
28.3%
16.3% 5.8%
12.9%
55.4%
18.7%
Wasting (%)
Source:- NFHS- 3 (2005-06)
25.9%
SUW/ MUW
Weight for Age criteria Weight for Height criteria
Normal %[Green]
Severe Underweight %
(Red)
Moderate Under weight % [Yellow]
Nutrition Status (Hungama Report- 2011)
Normal %
Moderate Acute
Malnutrition (MAM) %
Severe Acute Malnutrition
(SAM) %
42.3%
Underweight (%)
57.7%
25.9%
16.4% 3.3%
8.1%
57.7%
11.4%
Wasting (%)
As per the data of 100 focus districts of six states Bihar, Jharkhand, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh
30.9%
SUW/ MUW
Distribution (%) of 1-3 yrs children according to daily intake of Food stuffs as percent RDISource:- NNMB Tribal Survey
Percent of RDI
(>=70%) Kerala TN KarnatakaAndhra Pradesh Maharashtra Gujarat MP Orissa
West Bengal
Cereals & Millets 36.1 52 48.9 65.5 59.5 81.5 60.7 76 69.6
Pulses & Legumes 5.7 18 9 32.4 47.9 42.5 20.1 19.2 3.7
GLV 4.3 6.3 6.4 3.4 2 2.5 12.9 43.7 33.5
OV 22.2 32 28.7 28 19.2 39.6 24.4 36.6 34.6
R &T 56.1 43 35.1 48.8 24.2 53.5 38.4 50.1 70.2
M & MP 1.3 1.5 2.1 2.4 2.5 1.5 0.2 0.3 1
Fats & Oil 0.4 0 0.5 3.1 2.7 0.7 0.5 0 1
Sugar & Jaggery 0.4 0.9 13.8 6.1 15.2 1.5 4.3 0.3 1
Key Points:- The daily intake of food stuff for children age group 1-3 is higher than the average in case of Cereals &Millets , Pulses & Legumes , Other Vegetables and Roots &Tubers but less in case of Fats &Oils , Milk & Milk Products, Green Leafy Vegetables and Sugar & Jaggery . When compared to other States like Andhra Pradesh, Maharashtra and Orissa..
Distribution (%) of 4-6yrs children according to daily intake of Food stuffs as percent RDI Source:- NNMB Tribal Survey
Percent of RDI (>=70)
Kerala TN Karna AP Maha Gujarat MP Orissa WB
Cereals & Millets >=70
27.4 55.6 43.3 78.4 67.9 71.2 58 84.2 86.8
Pulses 27 42.3 14.3 45.7 68.6 62.4 37.5 28.8 9.3
GLV 6.5 7.3 3.8 6.1 4.2 3 13.3 47.1 38.8
OV 29.1 51.6 41 34.5 21.1 35.2 29 39.2 35.3
R &T 52.6 26.2 31 43 21.3 49.4 46.7 43.8 74.8
M & MP 1.7 0.8 0.5 1.8 0.4 2.1 0.2 0 1.6
Fats & Oil0 2 1 4.6 5.5 2.7 1 0.8 1.6
Sugar & Jaggery
0.4 0 8.1 6.1 16.5 0.3 0.4 0.3 0.8
Key Points:- The daily intake of food stuff for children age group 4-6 is higher than the average in case of C&M, P& L, OV and R&T but less in case of F &O, M & MP, GLV and S&J. when compared to other States like Andhra Pradesh, Maharashtra and Orissa.
Focus Areas •Keeping in view insignificant improvement in SAM and MAM category of children, 3- tier approach seems to be necessary and desirable.
• Focus needs to be on adolescents, pregnant and lactating mothers.
•Need to strengthen micronutrient supplementation program .
•Special focus on Infant Young Child Feeding Practices (Especially Initiation of Breastfeeding within one hour , Exclusive Breastfeeding up to 6 months & Initiation of Complementary Feeding after 6 month ).
•Effective communication strategies to improve dietary practices and Life style .
•Emphasize on deworming of children, adolescent girls and Pregnant Women to improve absorption of nutrients.
Acute Malnutrition - SAM/MAM
Children with Severe Acute Malnutrition (SAM) have nine times higher risk of death.
Severe Acute Malnutrition (SAM) if :
W/H-L < -3SD &/or MUAC** <11.5cm &/or Bilateral pitting oedema
Severe Acute Malnutrition (SAM) if :
W/H-L < -3SD &/or MUAC** <11.5cm &/or Bilateral pitting oedema
Moderate Acute Malnutrition (MAM) if : W/H-L between <-2
and -3 SD &/or MUAC between 11.5 to <12.5 cm
Moderate Acute Malnutrition (MAM) if : W/H-L between <-2
and -3 SD &/or MUAC between 11.5 to <12.5 cm
SOURCE:- WHO & IAP ProtocolsSOURCE:- WHO & IAP Protocols
**MUAC=Mid Upper Arm Circumference- an age independent screening tool
Underweight - SUW/MUW
Severe Under Weight (SUW) if :• Weight for Age < -3SD
Severe Under Weight (SUW) if :• Weight for Age < -3SD
Moderate Under Weight (MUW) if :• Weight for Age < -2SD to -3SD
Moderate Under Weight (MUW) if :• Weight for Age < -2SD to -3SD
SOURCE:- New WHO Growth StandardsSOURCE:- New WHO Growth Standards
Ongoing Nutrition Interventions of H&FWD to tackle Malnutrition
Apr 21, 2023 14Health & FW
Mamta Abhiyan- Health and Nutrition service delivery strategy i.e. Mamta Diwas
Micronutrient Supplementations – IFA supplements, Vitamin A supplements & Iodized salt
Conditional Cash Transfer Scheme- “Kasturba Poshan Sahay Yojana” implemented from 29-2-2012.
Facility based management of malnutrition- (a) Child Development and Nutrition Centers (CDNC)
(No of Centers – 76 in 20 districts)- at CHCs and District Hospitals.(b) Nutrition Counseling and Rehabilitation Centers. ( No of Centers – 6 )- at Medical College Hospitals.c)Bal Gram Parivar Yojana (pilot), A community based
malnutrition management program in three villages – Positive Deviance model .
Ongoing Nutrition Interventions of DWCD to tackle Malnutrition
Apr 21, 2023 15Health & FW
Growth Monitoring Supplementary Nutrition Program in the AWC for 6 month to 6 yrs
old:a) Energy dense Bal Bhog (3.5kg)/ month to 6 month to 3 yrs
age.b) Hot cooked food to 3 yrs to 6 yrs.c) Energy dense Take Home Ration (THR) for severe
underweight children 6m-3y – Bal Bhog (5kg)/monthd) Energy dense Take Home Ration (THR) for severe
underweight children 3-6y – Bal Bhog (2kg)/month Fruits to children 3- 6 yrs, twice a week Doodh Sanjeevani Yojana 10 Blocks of 6 Tribal districts, to children 3-
6 years, twice a week. Mobile Anganwadi scheme for NREGA/Migrants population. Nutri-Candy with micronutrients (Iron, Folic acid, Vitamin A and
Vitamin C) for age group of 3 to 6 years Conditional Cash Transfer Scheme- “Indira Gandhi Matratva Sahay
Yojana (IGMSY) ” implemented in Bharuch and Patan.
Gujarat State Nutrition MissionConcept and Approach
Apr 21, 2023 16Health & FW
Gujarat State Nutrition Mission Structure
Autonomous and independent structure of the Mission• An independent structure with autonomy in decision
making and planning-in the form of Society /Trust ?• Three Tier Approach• Mission Director/Director General – a dedicated senior
official of the level of a Principal Secretary / Secretary & not on additional charge.
• Joint responsibility of HFWD & DWCD• Convergence with other line departments – Education,
Food & Civil Supplies, Water Supply, Panchayat and Rural Development, Urban Development etc.
Apr 21, 2023 .17Health & FW
Gujarat State Nutrition Mission Structure
The operational structure of the Mission should include A.State Level –12 persons - Mission Director/Director
General (IAS), Deputy Directors-3, Consultants and Project Officers -4, M&E Asst.-1, Data Entry Operators-2, Finance Asst.-1, Office Asst-1. Aim is to have specialists on board.
B. District Level- 3 persons – District Nutrition Officer, Dist. M&E Asst., Data entry operator, reporting to both CDHO and PO- ICDS to ensure convergence.
C. Taluka Level- 2 persons – Taluka Nutrition Assistant, Date Entry Operator reporting to Taluka Health Officer and designate Taluka CDPO .Apr 21, 2023 18Health & FW
Gujarat State Nutrition Mission Structure
D. Urban Level –(1) Corporation level- 3 persons – Corporation Nutrition
Officer, Corporation M&E Asst & Data entry operator, reporting to both MO- Urban Health and PO- Urban ICDS to ensure convergence.
(2) Zonal Level- 2 persons – Zonal Nutrition Assistant and Date Entry Operator reporting to Corporation Nutrition Officer.
Apr 21, 2023 19Health & FW
Apr 21, 2023 Health & FW 20
Gujarat State Nutrition Mission Organogram (State Level Team)
Mission Director/ Director General (IAS) (1)
Mission Director/ Director General (IAS) (1)
Deputy Dir (Nutrition)
(1)
Deputy Dir (Nutrition)
(1)
Deputy Dir (Health)(1)
Deputy Dir (Health)(1)
Deputy Dir (Mon)(1)
Deputy Dir (Mon)(1)
Consultants/POs (Community Nutrition, Monitoring, IEC and Capacity building) -4
Consultants/POs (Community Nutrition, Monitoring, IEC and Capacity building) -4
Monitoring and Evaluation Asst
(1)
Monitoring and Evaluation Asst
(1)
Data Entry Operators
(1)
Data Entry Operators
(1)
Finance Asst(1)
Finance Asst(1) Office Asst
(1)Office Asst
(1)
State Level(12 members) State Level
(12 members)
HFWDHFWD DWCDDWCD
Apr 21, 2023 Health & FW 21
Gujarat State Nutrition Mission Organogram (District & Taluka level Team)
District Nutrition Officer (1)
District Nutrition Officer (1)
District M& E Asst (1)
District M& E Asst (1)
Data Entry Operator (1)Data Entry
Operator (1)
Taluka Nutrition Assistant (1)
Taluka Nutrition Assistant (1)
Data Entry Operator (1)Data Entry
Operator (1)
Chief District Health Officer (Health)
Chief District Health Officer (Health)
District Program Officer (WCD)
District Program Officer (WCD)
District Level(3 members)
Taluka Level
(2 members)
DDODDO
Apr 21, 2023 Health & FW 22
Gujarat State Nutrition Mission Organogram (Urban)
Corporation Nutrition Officer (1)
Corporation Nutrition Officer (1)
Corporation M& E Asst (1)
Corporation M& E Asst (1)
Corporation Data Entry Operator
(1)
Corporation Data Entry Operator
(1)
Zonal Nutrition Assistant (1)
Zonal Nutrition Assistant (1)
Data Entry Operator (1)Data Entry
Operator (1)
Medical Officer (Urban Health)
Medical Officer (Urban Health)
Municipal Commissioner /DMC
Zonal level(2 members)
Corporation level (3 members)
CDPO
Focus of the Mission
• To strengthen growth monitoring and evaluation system and bringing in subject specialist.
• Ensuring growth monitoring and promotion by improving– Survey efficiency– Weighing efficiency– Plotting of weights on growth charts, and– Identification of undernourished children and detection of
growth faltering and stagnation and focusing on the most vulnerable- SAM, MAM, SUW and MUW
• Improving Infant and Young Child Feeding (IYCF) practices to reduce malnutrition.
• Mass awareness (IEC) on nutrition related issues including IYCF and healthy food habits through a community based approach.
Apr 21, 2023 Health & FW 23
Malnutrition Screening Tools & Equipments
Apr 21, 2023 Health & FW 24
Digital Weighing Scale : Cost Rs 4000/- Spring Scale Rs 800 - 1500/-Digital Weighing Scale : Cost Rs 4000/- Spring Scale Rs 800 - 1500/-
Weight for HeightSAM if W/H <-3SD
MAM if W/H <-2SD to -3SD
Weight for HeightSAM if W/H <-3SD
MAM if W/H <-2SD to -3SD
Indigenous Board:- Rs 1000/-Indigenous Board:- Rs 1000/-
Malnutrition Screening Tools & Equipments
Apr 21, 2023 Health & FW 25
Mid Upper Arm Circumference (MUAC)
SAM if MUAC <11.5cmMAM if MUAC 11.5 to 12.5 cm
Mid Upper Arm Circumference (MUAC)
SAM if MUAC <11.5cmMAM if MUAC 11.5 to 12.5 cm
MUAC Tape - Low Cost Tool (Rs 3/-)MUAC Tape - Low Cost Tool (Rs 3/-)
Plan of the MissionManagement of SAM and MAM Children (WASTED) through 3 - tier approach1. To adopt and follow SAM and MAM Identification Criteria as per WHO Standards.
2. To establish demand based facilities at all levels•Village - Village Child Nutrition Centres (VCNCs) at AWCs. Duration of Program will be for 30 days. Cost approx Rs 40/child/day•PHC/CHC/SDH - Child Malnutrition Treatment Centres (CMTCs). Duration of Program will be for 21 days. Costs approx Rs 200/ child/ day (current CDNCs will function as CMTCs)•District Hospital/Medical College - Nutrition Rehabilitation Centers (NRCs). Duration of Program will be for 25 days. Costs approx Rs 250/ child/ day.
PApr 21, 2023202 26Health & FW
Hierarchy of 3- tier approach
Children admitted with defined SAM criteria with severe
Medical Complications/
Oedema
Children admitted with defined SAM criteria with severe
Medical Complications/
Oedema
Children admitted with defined SAM
criteria with Medical Complications
Children admitted with defined SAM
criteria with Medical Complications
Children admitted with defined SAM &
MAM criteria without Medical
Complications
Children admitted with defined SAM &
MAM criteria without Medical
Complications
Roles of HFWD and DWCD in the 3-Tier Approach
Village Child Nutrition Centre (VCNC)
• Target Group:- Both SAM and MAM children• At Village level, at Anganwadi Centers managed by
AWW, AWH & ASHA.• Incentive to AWW, AWH & ASHA.• Nutritional Supplements as per standard protocols• Stay will be for 30 days• Daily visit by an ANM• An expenditure of Rs 40/- per child/day: Rs 20 for Diet
(Dynamic as per region) , Rs 10/- for Medicines and Rs.10/- for Incentives.
• Follow a camp approach.Apr 21, 2023 29Health & FW
Child Malnutrition Treatment Centre (CMTC)
• Target Group:- SAM Children with medical complication• At PHC / CHC / SDH level• Treatment as per standard protocols• Daily visit by a Trained Doctor.• Follow a camp approach for 21 days • Expenditure of Rs. 200 per child per day• Mother/guardian accompany and stay with the child
throughout and compensated Rs 100 per day for wage loss.
• Rs. 100 is expended on diet and medicines per day/ child (Diet- Rs 60 and medicines Rs 40 per child/ day).
Apr 21, 2023 30Health & FW
Nutritional Rehabilitation Center (NRC)
• Target Group:- SAM Children with severe medical complication
• At District Hospital and Medical Colleges level• Treatment as per WHO standard protocols• Daily visit by a Trained Doctor.• Expenditure of Rs. 250 per child per day• Mother/guardian accompany and stay with the child
throughout and compensated Rs 100 per day for wage loss.
• Rs. 150 is for diet and medicines per day/ child (Diet- Rs 60 and medicines Rs 90 per child/day).
Apr 21, 2023 31Health & FW
Financial Resources available for Mission Objectives
• State Budget 12-13:- Rs.60 Crores for Nutrition Mission which includes –
a) Mission Structure.b) Conditional Cash Transfer – Kasturba Poshan Sahay
Yojana (GR already issued on 29-02-2012).c) Anemia Management Package.d) Innovative interventions.• Gujarat Integrated Nutrition Project – Out of 60 crores
allocated as one time Central Assistance from GOI- Rs. 54 Crores is available ( Received in March 2010).
• NRHM- Rs. 40.09 Crores proposed for 2012-13.
04/21/23 Health & FW 32
Roles and Responsibilities of GSNM
• To set-up the structure of the VCNC,CMTC,NRC through HFWD and DWCD
• Organize trainings/orientation workshops for the staff
• Review through meetings and workshops• Strengthen MIS, Data collation , analysis and regular
feedback• Set-Up committees at State, District and Taluka level
for effective monitoring and implementation of the Mission objectives.
Apr 21, 2023 33Health & FW
1. State Level Gujarat State Nutrition Mission will have:a) Steering Committee under Hon’ble Chief Ministerb) Monitoring Committee to be Chaired & Co-chaired by
Hon’ble Ministers – HFWD and DWCD as per seniorityc) Governing Body, under Chief Secretaryd) Executive Committee- Chaired and Co-chaired by PS
(PH&FW)/ PS DWCD as per seniority.
2. District level Committee under Dist. Collector and DDO as Chairman & Co-chairman respectively.
3. Taluka Level Nutrition Committee -Prant Officer (ATVT)Apr 21, 2023 34Health & FW
Committees At Various Levels
Leveraging Partnerships (Jan-Bhagidari)
• Implement Positive Deviance approach by involving parents to share positive infant and young child feeding practices for making malnutrition-free village.
• Build strong Jan-Bhagidari through Village Health, Sanitation and Nutrition Committees (VHSNC) and Pani Samities.
• VHSNC/ RKS (Rogi Kalyan Samities) to be permitted to accept assistance by cheque/kind from public for this cause.
• Social Audit and Monitoring through Samities.• Malnutrition-free village campaigns through Samities• Partnership with Home Science Institutions for advocacy,
capacity building, monitoring and evaluation.
Apr 21, 2023 35Health & FW
Assumptions/ Basis for estimates- - Target Group:- 0 to 6 yrs
- SAM Children:- 5%- MAM Children:- 10%- Total (SAM and MAM) Children:- 15%-VCNC workload: (80% of SAM + 100% of MAM)-Expenditure per child at VCNC= Rs 40/day x 30= Rs 1200-CMTC workload: (15% of SAM with Medical Complications)-Expenditure per child in CMTC = Rs 200/day x21 day= Rs 4200-NRC workload (5% of SAM with Medical Complications) Expenditure per child in NRC= Rs 250/ day x 25 days= Rs 6250
Apr 21, 2023 36Health & FW
MAM(10%)
SAM(5%)
NOR-MAL(65%)
15%
SUW/MUW(20%)
Apr 21, 2023 Health & FW 37
Budget Estimates for different coverage scenarios
(a) Scenario 1All 41 backward talukas + 1 taluka each from remaining 10 districts = 51 talukas Anticipated Children:- 165431; Budget Required:- Rs 23.7 Crores
(b) Scenario 2All 43 Vanbandhu talukas + 1 taluka each from remaining 14 districts = 57 talukasAnticipated Children:- 202417; Budget Required:- Rs 29.0 Crores
(c ) Scenario 3Entire StateAnticipated Children:- 1086905; Budget Required:- Rs 155.8 Crores
Apr 21, 2023 Health & FW 38
•Population covered under one AWC = 1000•Population of (0-6) years Children @ 12% of total pop=120•SAM+MAM@15%= 18 children•SAM @ 5 % = 6 children•MAM @ 10%=12 children•Estimated Children /VCNC /(AWC)= SAM +MAM=6+12=18• Initially cover all targeted children of age group 6 months- 6 years with gradual reduction leading to closure of VCNC (Camp Approach)•Also target entire population for nutrition awareness so that parents start correct feeding on their own so as to prevent onset of malnutrition.
Estimated Workload SAM/MAM per Anganwadi Center(AWC)
Role of ASHA
1) To create awareness about nutrition in the community.2) To counsel on Infant and Young Child Feeding (IYCF)
practices. 3) To mobilize the community to access health and nutrition
services.4) To escort mothers with their SAM/ MAM children for
treatment to nearest VCNC / CMTC / NRC & to motivate mothers to stay for desired duration at CMTC/ NRCs.
5) To ensure that children are followed up at AWC /VCNC CMTC/ NRCs
Incentives to be paid under NRHM.
Apr 21, 2023 Health & FW 39
Apr 21, 2023 Health & FW 40
Malnutrition Management Programs of other states
State Programs for Under
Weight Children Programs for SAM/ MAM
ChildrenRemark
Maharashtra ICDS at AWC
(a) Total VCDC conducted ( At Village level):- 18454 (b) Total CTC completed ( At Block level):- 301 (c ) NRC :- ( At Medical College/ Super speciality)
3- tier approach for management of SAM/ MAM
Madhya Pradesh ICDS at AWC
NRC- 263 at District & Blocks for Management of SAM children
Community Based Mngt Program on SAM/ MAM in process for 2 districts
Management of SAM at District & Block level Health facilities
Jharkhand
ICDS at AWC
+
Dular Strategy implemented in 24 districts
(At Village level)
NRC at DH/Sub DH/CHC/PHC- (81)
Community based management program ( CBMP) at Village/ AWC/ Community level to strengthen ICDS system
Malnutrition Management Programs of other states
Apr 21, 2023 Health & FW 41
State Programs for Under Weight Children
Programs for SAM/ MAM Children
Remark
UP
ICDS at AWC +
IYCF Counseling through Mother Support Groups in
one district
NRC at DH/Sub DH/CHC/PHC- (19)
West Bengal
ICDS at AWC +
Positive Deviance (PD) approach (9 districts )
Positive Deviance (PD) approach (9 districts ) NRC at PHC/ CHC/ SDH/DH-
(11)
People recognize and practice positive early childhood care in feeding, home health seeking, hygiene and psychosocial care .
Bihar
ICDS at AWC +
Dular Strategy implemented in 24
districts (At Village level)
NRC at DH/CHC- (34)
Community based management program ( CBMP) at Village/ AWC/ Community level to strengthen ICDS system
Andhra Pradesh ICDS at AWC NRC - 2 Karnataka ICDS at AWC NRC - 2
Chhattisgarh ICDS at AWC NRC - 25
Rajmata Jijau Mother –Child Health and Nutrition (RJMCHN) Mission,
Maharashtra-Case Study
Apr 21, 2023 Health & FW 42
Operational Facets (Maharashtra)
• Independent and autonomous Mission Structure. • Neither Society nor Trust, steering by CM• Headed by a very senior IAS Officer of PS/Secretary level on
full time basis as Director-General of the Mission• Committed Officers (3 to 4) identified and posted in the
Mission to assist the Director -General. • Champions (people willing to contribute) identified in all
Depts.• Nodal Department is DWCD.• Funding from multiple sources like DWCD, NRHM, TSP, SCSP,
District Planning Boards, etc.
Apr 21, 2023 Health & FW 43
Organogram (Maharashtra)
Apr 21, 2023 Health & FW 44
Director General (IAS,Senior) (1)Director General (IAS,Senior) (1)
Deputy Director (Diet)
(1)
Deputy Director (Diet)
(1)
Deputy Director
(Health) (1)
Deputy Director
(Health) (1)
Deputy Director
(Monitoring) (1)
Deputy Director
(Monitoring) (1)
Director (MVS Cadre) (1)
Director (MVS Cadre) (1)
Coordinator (Training) (1) Coordinator
(Training) (1) Manager (MIS)
(1) Manager (MIS)
(1) Supplementary
Staff (2)Supplementary
Staff (2)Accounts
Manager (2)Accounts
Manager (2)
State Level(11 members) State Level
(11 members)
Levels of Intervention (Maharashtra)
Three tier approach adopted in Maharashtra:1. Village Child Development Centres / Camps (VCDC) at
AWCs- 30 days camp2. Child Treatment Centres / Camps (CTC) – at PHC/ Sub-
district/ district hospitals- 21 days camp on residential basis
3. Nutrition Rehabilitation Centres (NRC)- Medical College / super specialty hospitals- as per need.
Apr 21, 2023 Health & FW 45
Committee Structure (Maharashtra)
There are three committees :-
1. Mission Steering Committee : Headed by Hon. Chief Minister of Maharashtra
2. Mission Monitoring Committee : Headed by Hon. Minister, DWCD
3. Mission Advisory Committee : Headed by Hon. ACS (Health)
Apr 21, 2023 Health & FW 46
Village Child Development Camps /Centre (Maharashtra)
• Both SAM and MAM children• At Village level, at Anganwadi Centres managed by
AWW and Helper• Nutritional Supplements as per protocols• Incentive to AWW and AWH• Stay is for full 30 days• Daily visit by a Dr and an ANM• An expenditure of Rs 32/- per child/day: Rs 16 for diet
(Dynamic as per region) , Rs 8/- for Medicines and Rs.8/- for Incentives.
• Done in a camp approach.Apr 21, 2023 47Health & FW
Child Treatment Centre (Maharashtra) Child Treatment Camps CTC• At PHC / CHC / SDH level• Treatment as per protocols• Mother/guardian accompany and stay with the child
throughout and compensated Rs 60 per day for wage loss.
• Follow a camp approach for 21 days • Expenditure of Rs. 160 per child per day• Rs. 100 is expended per day on the diet and
medicines of the child and mother/ guardian
Apr 21, 2023 48Health & FW
Efforts done on IEC/ BCC (Maharashtra)
• IEC Action Plan of Rs. 6.23 crores covering activities from state to village level for campaign.• Rajmata Jijau Malnutrition- Free Village Campaign Each village attaining malnutrition free status are selected for Malnutrition- Free village award scheme which comprises of award Rs.1000/- and Rs 100/child as award for bringing each child in normal category .•Rajmata Jijau Excellence award for first 3 Malnutrition Free Villages in each district i.e.
(a) -1st Prize- Rs 1,00,000 and Certificate. (b) - 2nd Prize- Rs 50,000 and Certificate.
(c ) – 3rd Prize- Rs 50,000 and Certificate. A budget of Rs 10 crores /annum has been provided for this initiative
Apr 21, 2023 Health & FW 49
Year Phase No of Children admitted at VCTC
Children admitted in CTC
Severe Malnutrition Status
2002 Malnutrition Removal Campaign in Aurangabad
7.2%
2005 Maharashtra Nutrition Mission
Mr V. RamaniDirector General
2006-10 Expansion 97813 18115 1.9 %
2011 2nd Phase 132283 12245 Mr Nand KishoreDirector General
Achievements of Rajmata Jijau Mother- Child Nutrition Mission
Way Forward…..• Nodal Departments of Gujarat State Nutrition Mission- HFWD &
WCD• A separate Nutrition Mission structure • Society Structure as suggested • A Full time Mission Director/Director General for Gujarat State
Nutrition Mission• Screening criteria for SAM/MAM Children as per WHO Standard
to be accepted in addition to SUW/MUW• 3-Tier approach of Maharashtra namely VCNC, CMTC and NRC
merits consideration.• Malnutrition- Free Village Campaign.• Strategy need to be separately workout by WCD and Health on
Adolescent and Maternal Nutrition.Apr 21, 2023 51Health & FW
Thanks
Apr 21, 2023 52Health & FW
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