Project Sampoorna’s success in reducing child malnutrition is a model that can be easily implemented anywhere
‘Let food be your medicine and medicine be your food’. This statement is often attributed to Hippocrates, the father of medicine, and actually summarizes Project Sampoorna which was conceptualized and successfully implemented in the Bongaigaon district of Assam.
an interlink
The project has resulted in reduction of malnutrition among children using almost zero economic investment. The overall UN Sustainable Development Goals and Food Systems Summit (September 2021) set out by UN Secretary-General Antonio Guterres include the need for food systems and social security that support resilience and food security. Prime Minister Narendra Modi had also identified health and nutrition as priority areas and launched the Prime Minister’s comprehensive plan for Samagra Poshan (Poshan Abhiyan) (National Nutrition Mission) in 2017 as ‘Kuposhan Mukt Bharat’ (malnutrition). The need for a free India was reiterated. -18.
During Poshan Maah (Poshan Month) in September 2020, 2,416 children were identified to be malnourished in the lush green Brahmaputra Valley district of Bongaigaon. The National Family Health Survey (NHFS)-5 has documented that the number of children under five years of age in the district who are underweight, frail, underweight and anemic women and children is higher than the national average. Anemia is a major determinant. With regard to maternal and child health.
These were confirmed by Project Saubhagya which was designed to reduce maternal mortality rate and infant mortality rate of the district. Once a high risk pregnancy is identified, a real time data sheet is updated by field level doctors, which is then followed till a safe delivery. The project has yielded encouraging results; Maternal deaths for six months (April 1, 2020 to September 30, 2020 compared to April 1, 2021 to September 30, 2021) fell from 16 to three and infant deaths to 130 to 63.
addressing child nutrition
The highest risk factor for a high-risk pregnancy is anemia which is usually nutritional. The vicious cycle of a malnourished child developing into an unhealthy adolescent, and then giving birth to a suffocating low birth weight child in an anemic pregnant young woman; This child then faces potential developmental delays, only to grow into a malnourished child; And this child who struggles further for nurturing and proper care, while the world around him barely makes a living, sucks up all the possibilities of a healthy society.
It portends a worst-case scenario, but the truth is actually stranger than fiction. To break out of this vicious circle, the fruit hanging down had to be targeted – the nutrition of children.
malnutrition, patriarchy
There are 1,116 anganwadis in Bongaigaon, with a total of 63,041 children below the age of five. The large-scale practice of plotting their weights and heights on the World Health Organization’s growth charts resulted in a total of 2,416 malnourished children; 246 cases of severe acute malnutrition (SAM) and 2,170 cases of moderate acute malnutrition (MAM).
District Nutrition Rehabilitation Centers or NRCs usually have up to 20 beds; And a monthly intake of 200 sam children is not practical. Also, the parents of the admitted children give up their daily wages (which is compensated to a certain extent by the government) and leave their farm for 10 days. Back home, Sam’s baby siblings are not looked after and may become malnourished. A SAM condition can slip back into place even after a treated child is discharged and if not cared for.
Now we needed to do something new. Building on the success of the community-based COVID-19 management model (Project Miley Julie), we launched Project Sampoorna, targeting mothers of SAM/MAM children, with the tagline ‘Empowered Mothers, Healthy Children’. Further, we identified the mother of a healthy child from the same Anganwadi Center (AWC) and linked her with the target mother; They would be ‘buddy mothers’ (2,416 pairs). They were generally neighbors and shared similar socio-economic backgrounds. Couples were given diet charts to indicate their children’s daily food intake; They will discuss about this at the Anganwadi center on all Tuesdays. Local practices related to nutrition will also be discussed.
The biggest obstacle in this project was patriarchy. Mothers had to be financially empowered for sustained results. Hence, they were enrolled in Self Help Groups (SHGs) under the National Rural Livelihoods Mission (NRLM). By the end of three months, 74.3% of mothers were enrolled in SHGs; By the end of six months, enrollment had grown to 75.6% and by the end of one year, it was 90%. Meanwhile, we arranged 100 ml of milk and one egg on alternate days for all 2,416 babies for the first three months, giving their mothers time to stabilize themselves in newly found jobs. Big hearted people of Bongaigaon adopted Anganwadis and filled their small stomachs with much-needed protein and their hearts with love.
a sea change
After three months of project completion, 27 (11%) of 246 SAM children remained SAM, 28 (11.4%) improved and 189 (76.8%) children returned to normal. Of the 2,170 MAM children, 12 (0.6%) deteriorated from SAM, 132 (6.08%) remained MAM and an incredible 2,015 (92.8%) returned to normal. The best was yet to come. Milk and eggs were discontinued after three months but we continued to see how our Big Mothers model and women’s empowerment model were working. Mothers have done what the organizations could not do for years. As of March 2021, 84.96% of SAM children and 97.3% of MAM children were normal; And as of September 2021, 92.3% of SAM and 98.9% of MAM children were normal. The entire project had withstood the test of time. The children who did not improve were examined and treated by doctors under the National Child Health Program (RBSK). UNICEF, IIT Guwahati, Tezpur University and the Department of Social Welfare extended their support to the curriculum reforms from time to time.
The entire project last year prevented at least 1,200 children from becoming malnourished. Our project has been recognized in the ‘Innovation Category’ by the National Nutrition Mission and the State Government. Assam Chief Minister Himanta Biswa Sharma has written an encouraging message for the project report which will be released soon. The model can be easily implemented anywhere in the world. We believe that children everywhere have a right to be healthy, and we hope to break this vicious cycle as soon as possible.
Dr. MS Lakshmi Priya, District Collector, Bongaigaon District, Assam, is a medical doctor turned IAS officer (2014 batch) from Kerala. Views expressed are personal. E-mail: drlakshmipriya1@gmail.com
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