- Stories from the Field
by Maheshweta Pradhan
Bastar, Chhattisgarh
It was a warm afternoon in the village of Satosha, a small settlement nestled in Bakawand Block of Bastar district, Chhattisgarh. The air was thick with anticipation as the Community Level Facilitators – Human Resources (CLF-HRs) and Mitanins (ASHA workers) gathered to discuss a pressing issue—malnutrition. For months, they had been working tirelessly under the guidance of Transform Rural India (TRI) a development design company, focusing on building awareness around health and nutrition.
TRI has been relentlessly working for health in Bastar, which involves training and capacity building of the CLF-HRs around this theme, taking “sankalp” for Healthy Panchayats in 45 out of 93 Panchayats, and facilitating first-hand information from the doctor of the Primary Health Centre (PHC) by inviting him to the training sessions. Their understanding was built around a holistic approach to nutrition and health to ensure efficient and effective information dissemination through Community Based Organizations (CBOs) such as Village Organizations (VOs), Self-Help Groups (SHGs), and other cadres.
The journey had not been easy. In March, they identified nine underweight children, their frail bodies a stark reminder of the silent crisis unfolding in the community. They knew the solution—these children needed immediate care at the Nutrition Rehabilitation Centre (NRC). But getting their families to agree was another battle. Here, it wasn’t just the mothers who needed convincing—the male family members also resisted, influenced by deep-seated patriarchal norms that dictated women’s roles within the household.
Approaching the mothers, the CLF-HRs explained the importance of the first five years of life, crucial for brain development and overall well-being. However, the resistance was strong. The mothers hesitated—fifteen days at the NRC meant being away from home, leaving their families without a caregiver. “Who will cook for the family?” they asked. It was a dilemma deeply rooted in gender roles and household responsibilities.
But the CLF-HRs were determined. Through multiple visits, they patiently explained the long-term impact of malnutrition, emphasizing the need for shared household duties. Slowly, the message began to resonate. The community started understanding the importance of prioritizing their children’s health over temporary inconveniences.
Another challenge was the villagers’ discomfort using the toilets and their experience of being taunted by the cleaning staff for hygiene.
Equipped with knowledge from their training, the CLF-HRs persistently visited the families three to four times before finally convincing them. The nine children, four girls and five boys aged between nine months and four years, were taken to the NRC, where they were kept under observation for fifteen days. However, the availability of NRCs remains a major challenge, with only one center in the entire block, operating with just 15 beds. Expanding both the number of NRCs and increasing bed capacity is critical for addressing malnutrition effectively. The government covered travel expenses, and the mothers who accompanied their children were provided a wage compensation of Rs. 150 per day, amounting to Rs. 2250 at the end of their stay.
The CLF-HRs were educated about the importance of weighing the child every six months to grade them and identify severely malnourished children. The parents of these children usually worked in the fields or traveled to neighboring townships early in the morning and returned late in the evening, leaving the eldest child to care for younger siblings. This, in turn, contributed to malnutrition due to poorly cooked food and inadequate feeding habits.
The results spoke for themselves. Each child gained weight—ranging from 100g to 700g—marking a step towards recovery. But the work didn’t stop there. During post-follow-ups, parents were educated about a ‘multicolored food platter,’ an evolution of the earlier ‘Tiranga Bhojan’ concept, emphasizing a broader variety of nutrients essential for a child’s growth. a diverse diet comprising rice, dal, vegetables, and protein sources like eggs and meat. They were encouraged to feed their children 5-6 times a day and incorporate iron-rich foods.
The CLF-HRs stressed the importance of weighing children every six months to track malnutrition and advocated for improved food habits. The traditional diet of just boiled saag and rice twice a day needed to be supplemented with a more balanced intake. Nutri-gardens were promoted, ensuring families had access to fresh, nutritious food.
Alongside community awareness, government health departments played a crucial role. Training sessions covered schemes, health systems, and the importance of Mother and Child Protection (MCP) cards. Initiatives like “Parivaar Bhraman” helped bridge the distance between homes and NRCs, while “Wajan Karo” reinforced the importance of periodic weight checks for children aged 0-5 years.
Many other initiatives were introduced, such as “Parivaar Bhraman,” which emphasized the need for convincing families about the importance of NRC visits, especially given that the centers were about 30 km away. Additionally, the “Wajan Karo” initiative highlighted the necessity of weighing children between 3-6 months to identify early signs of malnutrition.
Yet, some challenges remained. Delays in wage compensation discouraged participation, and frequent home visits were time-consuming. A more structured approach—ensuring timely disbursement of funds and leveraging trusted community figures—was necessary to sustain engagement.
The need to work on timely wage compensation disbursement was highlighted, as the amount often arrived late. Additionally, involving trusted community members with strong negotiation skills could help reduce the frequency of home visits required for convincing families.
This journey was more than just about tackling malnutrition—it was a testament to the power of collaborative efforts. The CLF-HRs, ANMs, Mitanins, and the community came together, proving that with persistent efforts, change was possible. The trust they built paved the way for improved healthcare access, breaking past hesitations and setting a foundation for a healthier future.
As the sun set over Satosha, the village had taken a small yet significant step towards progress. The sight of healthier children and informed parents was a reminder that when communities are empowered, true transformation begins.
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