How a multi-dimensional approach is changing lives in rural Rajasthan

By Bharat Dogra 

Reducing malnutrition in areas of high vulnerability remains a significant challenge for health and nutrition in India. While the Indian government has succeeded in expanding nutrition programs across the country, budgetary and implementation problems persist. If community mobilization and participation can be increased and a multi-dimensional approach adopted, with greater resources and improved implementation, significantly better results can be achieved.

Such a multi-dimensional effort, implemented by the voluntary organization Basic Healthcare Services (BHS), has achieved encouraging results over about a decade in several clusters of remote villages in the Udaipur and Salumbar districts of South Rajasthan.  Earlier surveys had revealed high levels of malnutrition. When asked if they had consumed vegetables and pulses during the last 24 hours, about half the women replied that they had not. When asked about milk, only 5% replied that they had consumed milk in the last 24 hours.

BHS operates a health program in the region with clinics called AMRIT and community health workers based in nearby villages. Female health workers closely monitor the health of various households in their village, and those suffering from malnutrition are encouraged to go to the clinic. In addition to standard clinical treatment, certain categories of individuals with serious malnutrition also receive nutrition supplements, including malnourished children. TB patients also receive nutritious food for the duration of their treatment.

Child nutrition is strongly supported by setting up 17 phulwaris, or child nutrition and play centers. Small children attend for about seven hours and are served three meals of khichdi (a combination of cereal, pulses, and vegetables), sattu (based on gram flour), and eggs. They play and also acquire some learning skills and health information, in addition to adopting hygiene practices.

In addition, efforts are made to increase the sustained availability of healthy food by helping households to increase and improve livelihoods based on poultry and goats. Households are also encouraged to grow more kitchen gardens and are assisted by the provision of seeds. BHS has also secured the help and partnership of another voluntary organization, Gramshree, in these efforts. These initiatives are aimed mainly at increasing the availability of nutritious food in these households, particularly in the form of vegetables and eggs, while in some cases also helping them increase cash earnings, such as from the sale of goats.

Community health workers make constant efforts to disseminate essential nutrition messages on subjects like easily available and cheaper sources of good nutrition in local conditions. Several attractively produced picture books and leaflets on this subject have been published and are available with the community health workers.

All these initiatives taken together have resulted in a significant reduction in malnutrition, particularly in the villages covered by the phulwaris.

The current period is particularly important for stepping up nutrition programs in this region, as the kharif crops standing in the fields have been badly damaged. In such conditions, setting up food banks to provide pulses, millets, and cereals could be useful.

While the BHS nutrition program is already multi-dimensional, it can be conceptualized at a yet wider level to advance nutrition, food security/sovereignty, seed sovereignty, sustainable livelihoods, and self-reliance issues in a more holistic way. This can be done in ways that are also in tune with climate mitigation and adaptation, thereby meeting another pressing need of changing times.

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The writer is the Honorary Convener of the Campaign to Save Earth Now. His recent books include India’s Quest for Sustainable Farming and Healthy Food, Earth without Borders, Man over Machine, and A Day in 2071