Nutrition Center Concept Note 2006

8/8/2019 Nutrition Center Concept Note 2006

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Nutrition Center

Introduction

The magnitude of malnutrition shows that:

About 47% of children under the age of three are underweight and

46% are stunted

74% of children between the ages of 6-35 months suffer from anemia

About 36% of women 15-49 years are undernourished

Prevalence of anemia among women is about 52%

Causes of Malnutrition


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Malnutrition began before mother become pregnant

Child growth failure

Low birth Early Low weight and

weight babies Pregnancy height in teens

Small adult women

The Maternal and Child Nutrition Link

AdolescenceNutrient stores built up in adolescence help the

nutrition of women during and between

pregnancies.

At birthBirth weight is closely associated with child survival and growth

,which influences nutrition in adolescence and determines how

well nourished mother is when she enters pregnancy

At 2 yearsPrevention of stunting in girl children during

the first 2 years can help to break the cycle of malnutritionPregnancyMothers nutrition before andduring pregnancy influences

growth and development of the

fetus and its birth weight,

it affects her chances of surviving

the delivery.

LactationAdequate nutrition for the

mother should be maintained

during breast feeding.

MotherMothers nutrition is important for practicing child-rearing,care and householdeconomic tasks,and for recovery for future pregnancies

Maternal under nutrition can lead to an undernourished baby

Most of the weight gain of the baby in the womb occurs in the last few

months of pregnancy

Poor diet and heavy physical work with inadequate rest

Mother is not well-nourished during pregnancy, she is unable to provide

sufficient nutrients for the body stores of the child


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Iron deficiency causes anemia and severe anemia can lead to maternal

and perinatal deaths

Folic acid deficiency in early pregnancy leads to birth defects (neural tube

defects)

Vitamin C deficiency leads to anemia

Dietary iodine deficiency during pregnancy hinders development of the

fetus

Way to address malnutrition: Life cycle pproach

Establishment of Nutrition Center where pregnant women, lactating

mothers and children up to two years of age are provided with nutritious diet

everyday. The center mainly aims for a holistic development of the women bycentrally focusing on improvement of health and nutritional status. The nutrition

center caters to the needs of the most vulnerable classes of the society i.e.

women and children especially from POP and poor families.

In the initial stages, the nutrition center is to cater the nutritional needs of

pregnant and lactating women and children up to two years. In the subsequent

stages its focus will be on extension of Nutrition cum Day care center. The

ultimate vision is to see the center as a forum for Nutrition and health care cumlearning center for women and children to address the issues of malnutrition in

the entire life cycle.

Vision: Center for social and behavior change

All pregnant women, from the day of enrollment of their pregnancy till

6months of lactation period and children between 6months to 2years of age

(i.e.,12 months for the mothers + 18 months for children) can get benefit from

the center by having a nutritious diet everyday. The center must ensure that themost vulnerable and disadvantaged get the maximum benefit out of it. By

becoming a member at the center, the status of malnutrition and deaths can be

averted especially among infants and pregnant women. The results would slowly

influence the intra household behaviors to provide special attention to women


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and children who are most vulnerable and on demand due to changes in the

physiology.

o Initially the nutrition center is expected to provide nutritious diet as well as

health education sessions for pregnant and lactating women. Health

education sessions will be imparted for pregnant and lactating women,

adolescent girls (would be mothers) and other women from the community.

It is aimed at preparing these women as change agents in the community for

advocacy of preventive and promotive health care measures.

o Enrolled members can get training in some vocational skills which involves

less physical stress and can start an income generating activity.

o The crche is open for children who do not have support to take care of them

at home when their parents go to filed. Preference shall be given to children

from POP/poor families.

o Finally, this center shall become a center for social change with the

counseling sessions conducted for husbands and mother-in-laws of the

members attending the center.

How to Operationalise?

1. Pre requisites to start a Nutrition center:a.VOs with strong Institution Building: regular SHG meetings, regular

internal lending and repayments, participation in social activities in the

community.

b.VOs with Food security in place.

c. VOs with regular savings for health and health risk fund in place.

2. Cost estimates to start a Nutrition Center

As per NFHS-2, the percentage of pregnant and lactating mothers in 1000population is 3.51. In a VO with 25 SHGs, approximately 1500 population will

be present. Of them approximately 50% of them will be from POP and Poor

families. So, each VO will have approximately 26 pregnant and lactating

mothers together. But it may vary from district to district.


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Cost estimation shall be made keeping in view the recommended dietary

intake by pregnant and lactating women, the present cost of food items in

the market and cost of other activities involved such as fire wood and a

helper for cooking.

a. The diet prescribed for pregnant and lactating women

recommended by Indian Council for Medical Research (ICMR):

Pregnant Women Lactating mother

Food itemsQuantity per day(in grams)

Quantity per day(in grams)

Cereals 400 450Pulses 55 65Leafy 150 150

Vegetables 75 75Roots and tubers 75 75Fruits 30 30Milk 225 225Oil & fats 40 50Sugar/jaggry 30 50Meat, fish, egg 40 60

b. Cost estimates: ( where comprehensive Food security is in place)

Member contribution@Rs4 per day per member

S.No Particulars 10 members 20 members 30 members

1 Total cost per month 16*10*25= 4000 8000 12000

2 FSL component 8*10*25=2000 4000 6000

3

Effective cost per month

towards additional diet & 2000 4000 6000

4

Contribution from member

@Rs4/member/day 4*10*25=1000 2000 3000

5 Expected FSL net income 2000 4000 6000

6

50% of FSL net income as

contribution to Nutrition center 1000 2000 3000

9

Funds availabiltiy to meet the

effective cost=4+6 1000+1000=2000 2000+2000=4000 3000+3000=6000

Food provided for 25 days

Food cost per member per day is Rs 16/day

FSL cost is Rs 8/member/day 50%of FSL income Rs4/-member contribtuion

Ready reckner for cost estimates to run a Nutrition center by Village

organisation- Pregnant women_lactating women


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Member contribution@Rs4 per day per member

S.No Particulars 10 members 20 members 30 members

1 Total cost per month 16*10*25= 4000 8000 12000

2 FSL component 8*10*25=2000 4000 6000

3


towards additional diet &

overheads(Mother) 2000 4000 6000

4


towards additional diet &

overheads(6months-

24months) 3*4*25=300;

4*5*25=500 300+500=800 1600 2400

5


towards additional diet

+overheads(Mother+Child) 2000+800=2800 5600 8400

6Contribution from member@Rs4/member/day 4*10*25=1000 2000 3000

7 Expected FSL net income 2000 4000 6000

8

50% of FSL net income as

contribution to Nutrition center 1000 2000 3000

9 JSY 834 1668 2502

10 60%of Janani Suraksha Yojana 500 1000 1500

11

Expected funds from ICDS

@Rs2/child/day 2*7*25=350 2*14*25= 700 2*21*25=1050

12Funds availabiltiy to meet theeffective cost (6+8+9+10+11)

1000+1000+850=2850

2000+2000+1000+700=5700

3000+3000+1500+1050=8550

Food provided for 25 days

Food cost per member per day is Rs 16/day

FSL cost is Rs 8/member/day; 50%of FSL income ;Rs4/-member contribtuion; Rs2/-ICDS support

Ready reckner for cost estimates to run a Nutrition center by Village organisation -

Pregnant women_lactating mother_Children


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c. Sources of finance :

i. Social CIF: Release of HRF @ 100000 per VO with 25 SHGs.

ii. Beneficiary contribution:

o In the form of dry ration as a member share in the family taken

under FSL ( @Rs 8/day for 2 meals)

o Contribution as cash @Rs 2/ meal (Rs 4/day for 2 meals)

iii. Use 50% of the profits available with VO due to

implementation of comprehensive food security line.

iv. From the interest on corpus available at VO (or ) on HRF

amount/grant released

v. Source of funds to be tapped from line departments

a. From ICDS :

o @Rs 2.00 per beneficiary per day

b. From Janai suraksha Yojana (JSY)

o @Rs 1000 per pregnant women = 1000

3. Options for sustainability

i. Integrating with comprehensive food security line: obtain

contribution in the form of kind from their regular ration allocated as

a member of the family and a minimum beneficiary contribution per

meal to have foods during pregnancy/lactation. It covers 2/3rd of the

budget required and the rest 1/3rd can be tapped from line depts.

such as ICDS and health dept or can meet from the interest

accumulated /50% of the profit gained due to implementation of

comprehensive food security programme at VO. (Vizag model)

ii. Use ofinterest generated on the corpusavailable under HRF in a VO

and give it as loan to pregnant and lactating mothers

iii. Sanction ofsocial CIFSP @2.50lakhs to establish Nutrition centers

as per need based.


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iv. Providing IGAs to the member/husband and to collect user fee on

daily/weekly /monthly basis.

v. Purchase of land under land development component:This is for

development of Community gardens and use the profits for running

nutrition centers.( long term approach).

vi. Inviting donations for development Nutrition centers as centers for

social change in all the VOs as project has limitations to provide

immediately to all the VOs . This is to continue till all the VOs have

comprehensive food security is in place.

4. Extension of Nutrition cum Day care centers

d. Once the Nutrition centers are stabilized, it can be extended as day

care centers to keep the children till their mothers come back from the

field.

e. The services of aged women who receives pensions in the village and

have no family support may be kept as incharge by providing lunch at

the nutrition center or by giving payment (@200/month by VO as they

decide).

f. Play equipment can be provided for the children to develop their motor

and intellectual skills before they enter in the primary school.

g. Feasible option would be the convergence with dept of WD&CW to

extend the services of AWW who are trained in pre-school Education

for which the VO can give honorarium for the extended hours beyond

1.00pm at AWC.

So, the budget requirement for the pre-school activities may not be

required immediately as there is every possibility for the other depts to

come and converge with the VOs after demonstrating the models on

community managed Nutrition centers. Otherwise, the donations received

shall be utilized for development of day care centers.


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5. Monitoring and monthly MIS

a. Progress of the beneficiaries can be measured by using indicators like:

o Hemoglobin levels

o Birth weight of the child

o Health awareness levels

b. Baseline Data and monthly progress relating to these indicators can be

measured and analyze the progress of the beneficiaries.

c. Maintenance of separate accounts in case of donations received and send

a copy of both physical and financial progress of the center to the donor.

d. Encourage the children of donors in case of NRIs to come and spend time

during their vacation and evaluate the progress along with the

community.

6. Responsibilities of Health activist and Health sub communities for

smooth functioning of Nutrition centers

a. The roles to be performed by HA:

o Should identify the eligible beneficiaries (pregnant and lactating women

and children in the age group of 6months to 2 years belong to PoP and

Poor groups) in the village and bring them to the notice of Health Sub-

committee.

o Should conduct training programs on health and nutrition topics using

effective audio-visual means of communications.

o Should also monitor the progress of the beneficiaries and their children at

the center.

o Should conduct home visits and induce behavior change at household

levels, to promote health.

o Should organize counseling sessions to the husbands and mother-in-laws

of the members attending the center.

o Should maintain Daily attendance register, stock register, expenditure

register and ANC register.

o Should assist in preparation of weekly menu at the center.


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b. The responsibility of the Health Sub-committee members:

o Selection of a SHG member to cook food at Nutrition center with wage

compensation for the time dedicated.

o Maintenance of a separate bank account for the CIF amount deposited

on the names of one health subcommittee member and one VO OB

member.

o Monitoring of Daily attendance register, stock register, expenditure

register and ANC register.


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Sequence of activities to be accomplished to

establish Nutrition centers

1. Dialogue with VO to introduce the concept of Nutrition center and discuss

the options for sustainable models such as:

a. Vizag model ( 2 meals @ Rs 16/day): Integration with

comprehensive food security programme.

Integrating with comprehensive food security and additional cash

contribution @Rs 2 per meal ( Rs 8+ Rs4=Rs 12)

Interest accumulated on social health fund released and the VO will

also use profit from implementation of comprehensive food security for

any other expenditure considering it as a social cause.

Facilitating funds from ICDS (Rs 1.40/pregnant women/day)

Release of funds available under Janani suraskha yojana to VO and

use of 80% of funds towards diet (Rs 800/per women/year: @

Rs2.60/day ) (ICDS and JSY funds will fill the gap of Rs4/day)

b. Release of exclusive grant to VO for establishment of Nutrition

centers.

c. Release of more amount of Social health fund to VO where they

have regular health savings and interested to run nutrition

centers.

d. Sanction of IGAs for generating income to sustain its activities

beyond project period.

e. Inviting donations from NRIs

2. Develop operational plans for implementation of the scheme

3. Orientation to VO EC members, health sub committee members and Health

activist.

4. Identify the other related activities that can be implemented using the same

forum such as:

Nutrition and health education sessions by HA,AWW and ANM


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Skill building sessions to enable them to take up IGA activities that are

involved with less physical activity.

Extension center for child care

5. Training of personnel identified for cooking on hygienic preparation and

nutritious recipes.

6. Preparation of a menu using locally available food items.

7. Regular and transparency in the accounts to be maintained

8. Submission of monthly MIS by HA in consultation with Health sub committee

members on functioning of Nutrition center.

Nutrition Center Concept Note 2006

Documents

Transcript of Nutrition Center Concept Note 2006