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Early lessons from Swabhimaan, a multi-sector integrated health and nutrition programme for women and girls in India

This is a summary of a Field Exchange field article that was included in issue 65. The original article was authored by Monica Shrivastav, Abhishek Saraswat, Neha Abraham, R.S. Reshmi, Sarita Anand,  Apolenarius Purty, Rika Shalima Xaxa, Jagjit Minj, Babita Mohapatra and Vani Sethi.

Monica Shrivastav is a consultant with the UNICEF supported ROSHNI-Centre of Women Collectives led Social Action, Lady Irwin College, New Delhi, India.

Dr. Abhishek Saraswat is a demographer currently affiliated with the International Institute for Population Sciences, Mumbai, India.

Neha Abraham is a Knowledge Management Consultant at ROSHNI-Centre of Women Collectives led Social Action.

Dr. R.S. Reshmi is an Assistant Professor in the Department of Migration and Urban Studies at the International Institute for Population Sciences, Mumbai.

Dr. Sarita Anand is an Associate Professor at the Department of Development Communication and Extension, Lady Irwin College.

Apolenarius Purty is State Programme Manager, Health and Nutrition, Bihar Rural Livelihoods Promotion Society (JEEViKA), Government of Bihar, Patna, India.

Rika Shalima Xaxa is State Programme Manager of the Social Inclusion and Social Development at Chhattisgarh State Rural Livelihoods Mission’ BIHAN’, under the Department of Panchayat and Rural Development, Raipur, Chhattisgarh, India

Jagjit Minj is Programme Executive of the Social Inclusion and Social Development at Chhattisgarh State Rural Livelihoods Mission’ BIHAN’, under the Department of Panchayat and Rural Development, Raipur, Chhattisgarh, India.

Dr. Babita Mahapatra is the Additional Chief Executive Officer in the Odisha Livelihoods Mission (OLM), Government of Odisha.

Dr. Vani Sethi is a Nutrition Specialist at the Nutrition Division of UNICEF India.

In India, the Swabhimaan programme provides evidence that integrating nutrition interventions into large-scale poverty alleviation programmes via women’s collectives has the potential to improve nutritional outcomes for women and girls.

  • The integration of system strengthening activities into Swabhimaan is essential to improve access to timely maternal nutrition and health services.
  • Women’s collectives can successfully develop integrated nutrition microplans, manage grants and mobilise communities with the aim of improving nutritional outcomes for women and girls.
  • Challenges exist including resistance to programme activities due to gender and societal norms, delays in the flow of funds for government schemes on which the delivery of maternal nutrition services hinge, delays in the procurement and/or distribution of supplies, health worker strikes and variability in the stability of women’s collectives.

 

Background

A woman’s poor nutritional status before and during pregnancy is a major cause of foetal stunting and low birth weight. In 2016, Deendayal Antyodaya Yojana-National Rural Livelihoods Mission (DAY-NRLM), the Indian Government’s flagship poverty alleviation programme, launched Swabhimaan in partnership with UNICEF India across three states, Bihar, Chhattisgarh and Odisha. Swabhimaan is a five-year initiative that aims to improve the nutrition outcomes of women and adolescent girls.

Intervention

Swabhimaan provides a comprehensive package of 18 nutrition-specific and nutrition-sensitive interventions spanning the health, nutrition, agriculture and livelihoods sectors. These interventions are delivered through a combination of community-led and systems strengthening actions and focus on four primary target groups: adolescent girls, newly-wed women, pregnant women and mothers of children under two years of age.

For community-led actions, DAY-NRLM women’s collectives, made up of female representatives from self-help groups (SHGs) and their federations (Village Organizations (VOs) and Cluster Level Federations (CLFs) are used as the primary mode of delivery. Each federation develops an integrated nutrition microplan that identifies and prioritises nutrition and related problems among target groups, an annual plan of activities and a budget. The development of nutrition microplans is facilitated by a social action committee (SAC) for each VO. Each SAC nominates an active SHG member to be the Community Resource Person (CRP).

Following a three-day training, CRPs facilitate the development of nutrition microplans, facilitate monthly meetings for women and adolescent girls, provide home-based counselling for target groups, food demonstrations and support for the development of household nutrition gardens. The CRPs receive INR 450 (USD7) to develop an integrated nutrition microplan and a similar monthly incentive to facilitate planned activities. Community-led interventions are monitored through monthly reports submitted by CPRs.

The system strengthening interventions include:

 

Evaluation methodology

The baseline survey was conducted between October 2016 and January 2017 and included 6,352 adolescent girls, 2,573 pregnant women and 8,755 mothers of children under two years of age. The midline survey was conducted between September 2018 and June 2019 with 3,171 adolescent girls, 1,856 pregnant women and 3,277 mothers of children under two years of age. A midline process evaluation was also undertaken using a mixed-method approach comprising a cross-sectional survey and qualitative data collection. The endline survey will be conducted in 2021.

Results

Outputs

All 336 VOs across the three states developed integrated nutrition microplans. By the end of 2019 across the intervention areas:

In addition, the Swabhimaan programme facilitated the revision of VHSND guidelines and integrated maternal calcium supplementation, deworming and the screening of women at nutritional risk using maternal MUAC into the guidelines. The target base was also expanded to newly-weds and adolescent girls.

Outcomes

The comparison of baseline to midline survey data revealed:

Limitations and challenges

CPRs reported challenges in mobilising the target groups regularly for meetings and observed gender-related issues as barriers to improving nutrition.

As in most programmes that operate in real settings, systemic challenges exist. These are related to delays in the flow of funds for government schemes on which the delivery of maternal nutrition services hinge, delays in the procurement and/or distribution of supplies and health worker strikes. Secondly, the SHG-VO-CLF platform has varying maturity and stability across and within states, with some groups well established while some are fairly new. Consequently, the pace of implementation is non-uniform. To reduce this bias, Swabhimaan has retained the originally identified collectives in the research.

Lessons learned for scale up

The lessons learned from programme implementation to date include:

Conclusion

Over the three years of the implementation of the Swabhimaan programme, the findings suggest that both the community-led and systems strengthening components of the programme have significant impact on increasing coverage of essential nutrition-specific and nutrition-sensitive interventions for women and girls. Swabhimaan will continue to scale up activities within the three intervention states and focus on addressing gender norms and social issues during the next phase of the programme. Results of the endline and impact evaluations are forthcoming and will provide further evidence to inform maternal and preconception nutrition policy at national and state level in support of the integration of nutrition interventions into large-scale poverty alleviation programmes delivered via women’s collectives.

For more information, please contact Dr. Vani Sethi at vsethi@unicef.org

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Monica Shrivastav, Abhishek Saraswat, Neha Abraham, R.S. Reshmi, Sarita Anand, Apolenarius Purty, Rika Shalima Xaxa, Jagjit Minj, Babita Mohapatra and Vani Sethi. (). Early lessons from Swabhimaan, a multi-sector integrated health and nutrition programme for women and girls in India. FEX 65 digest , November 2021. www.ennonline.net/fexdigest/65/healthnutritionprogrammewomenindia

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