Closing the Chasm

Sometimes, solutions lie in the simplest of things. Malnutrition is one such area where the solution, though not easy, may be more simple than we previously thought. This is illustrated by the experience in District Rajnandgaon in bridging the malnutrition gap. Healthy Child Mission—‘Potth Laika Pehel” in local Chhattisgarhi language—is a nutrition counselling, behaviour change and monitoring mission which aims to bring targeted children and Anganwadi Centres (AWCs) out of malnutrition by providing lifelong nutrition skills to the community. It is a tripartite mission involving District Administration of Rajnandgaon, UNICEF as knowledge partner, and Abis Exports group as CSR partner. Under this, 241 most malnourished AWCs with the most number of SAM (Severely Acute Malnutrition) and MAM (Moderately Acute Malnutrition) children were targeted.

The Malnutrition Gap and the Dire Need for Nutrition Counselling

1. Higher incomes but no commensurate decline in malnutrition: This is a huge dichotomy in India. In Chhattisgarh, the last decade has seen per annum per capita income rise from Rs 78,001 in 2014-15 to as high as Rs 1,33,898 in 2022-23 (58 per cent), while malnutrition levels alarmingly remain nearly the same. A comparison of NFHS-4 and NFHS-5 would reveal almost the same values over the years. Similarly, literacy rates have soared to 78 per cent with no commensurate decline in malnutrition.

2. Need for knowledge on macro and micro-nutrients: Practice of over-eating carbohydrates and under-eating protein and micro-nutrients prevails due to lack of knowledge about which foods are rich in which nutrients.

3. Need to dispel many myths around nutrition: Many myths perpetuate malnutrition. For example, giving babies under 6 months honey or water, that children do not need to eat very often, etc.

4. There is a need to discourage unhealthy habits which cause malnutrition, such as feeding children black tea, sugary biscuits, junk food etc., and habits such as feeding children only once or twice a day, not sending them to Anganwadi, not revealing pregnancy till the third trimester, etc.

5. Percentage of underweight children in Chhattisgarh has declined very marginally, only 6 per cent (from 37 per cent in NFHS-04, to 31.3 per cent in NFHS-05). Rate of underweight and wasted children has also witnessed just marginal improvement. According to NITI Aayog's State Nutrition Profile, 2022, wasting in children remains almost the same (20 per cent in 2005-06 to 19 per cent in 2019-21); the trend of underweight children has improved but not significantly (47 per cent in 2005-06 to 31 per cent in 2019-21).

6. Anaemia has gotten worse in Chhattisgarh, amongst many other states, over the years.

All this points to a lack of knowledge around nutrition and immense need for nutrition counselling & behaviour change. Hence, the need of the hour was a Jan Andolan in Suposhan. Consequently, Potth Laika Pehel was launched.

Methodology

Block- and cluster-level nodal officers from the Departments of Health, Women & Child Development, and National Rural Livelihood Mission were trained as Master Trainers (MTs) by UNICEF. These MTs then trained Anganwadi workers, Mitanins (ASHAs), and SHG didis at the grassroots level to provide nutrition counselling to parents and the community, along with monitoring progress. This training was conducted by both the Nutrition Wing and the Behaviour Change Wing of UNICEF. Field workers were equipped with a Poshan Margdarshika—a lucid and simple guide prepared especially for the people of Chhattisgarh.

This training was subsequently disseminated to the community at large through Paalak Chaupals (held every Friday), SHG women’s meetings (called Bihan Chaupals), home visits, and health check-ups.

Paalak Chaupal: A Bridging Force

This chaupal (caretakers’ meeting) serves as a platform for nutrition counselling and monitoring at the AWC or village level. Held every Friday (VHSND), it is attended by all stakeholders—parents of targeted children, pregnant women, sarpanchs, panchayat sachivs, community elders, newly married couples, etc. It serves as a vessel for behaviour change communication, discussion, and monitoring. The entire community is engaged, and people learn what/why/when to eat and feed their children through lucid and digestible materials (Poshan Margdarshika). Concepts like Tiranga Bhojan (balanced diet) are also promoted.

Apart from Paalak Chaupals, similar meetings are conducted by SHG women at the village, panchayat, and cluster levels. Monitoring is carried out through home visits and regular health check-ups.

Impactful Outcomes

By March 2025, within the first eight months of operation, and through collective community effort, 2,246 out of 3,413 children (65.81 per cent) in 241 targeted AWCs were brought out of malnutrition. This includes 262 SAM children and 176 severely underweight children. By contrast, in a randomly selected control group of 16 AWCs where the programme was not implemented, a marginal increase in malnutrition was observed over six months. While this may be due to various factors, it is evident that consistent nutrition counselling and weekly monitoring can significantly improve the nutritional status of children. Given the programme’s success in the 241 most malnourished AWWs, the initiative has now been replicated across all AWWs in the district.

Sustainability and Replicability

Sustainability lies in effecting long-term change. A top-down approach of merely providing extra food or supplements was avoided, as it is often costly and unsustainable. Instead, the focus has been on training and capacity building for lasting behavioural change, using simple, localised counselling materials designed for Chhattisgarhi communities. This has been a zero-cost mission, utilising existing human and financial resources available in any Indian district.

The malnutrition gap, prevalent across many parts of India, can be effectively addressed through nutrition counselling and regular monitoring. This can ultimately help realise the vision of a Kuposhan Mukt Bharat.

What has been achieved in Rajnandgaon under the inspired leadership of young IAS officer Suruchi Singh, CEO, Zila Parishad, is commendable. The model she has implemented is both replicable and scalable through public-private partnerships, embodying the true spirit of the Nexus of Good.

The writer is an author and a former civil servant. Views expressed are personal