One-month-old Pallavi, born in Sapane village of Wada, Maharashtra, had been ill with cough and fever for a few days. In addition, she was identified as a severely malnourished child. And yet, the parents were reluctant to take the child to hospital. Changing their mind took the combined efforts of the local AAA team – the anganwadi worker (AWW), accredited social health activist (ASHA) and auxiliary nurse midwife (ANM) – who refused to take ‘no’ for an answer and continued to counsel them. After an hour, the parents realised the gravity and agreed to take little Pallavi to the hospital. Her story shows the positive impact of strengthened community healthcare systems.
Mr Madhusudhan, Lead, Nutrition, Tata Trusts, shares, “The AAAs are the frontline healthcare workers in rural India, the people most familiar with the local communities. Their unity was an integral element of Project Spotlight Palghar, a Tata Trusts’ initiative in Maharashtra’s Palghar district that strengthens the Government of India’s Integrated Child Development Scheme (ICDS).”
Dr Smriti Sharma, Program Officer – MIYCN, Tata Trusts, who anchors the Project Spotlight, explains, “Under normal circumstances the frontline workers work in the same village and yet operate in silos. The Anganwadi Centre is the first stop for a mother’s needs during pregnancies and until the baby turns 6 years old. The ANM and ASHA workers monitor pregnant mothers and young children for their health needs. The anganwadi worker doles out supplementary nutrition for children and mothers, while tracking their growth and providing pre-school education.” Highlighting the uniqueness of the project, she adds, “However, under Project Spotlight, with an overarching goal to improve the coverage of the ICDS scheme, amongst other initiatives, we particularly focused on training AAAs to work jointly on serving the common client to tackle issues related to ‘health and family welfare’ and ‘women and child development’. A tribal belt, Palghar has high numbers of malnourished mothers and children and Project Spotlight was launched to counter this by strengthening the system.”
The AAAs underwent intensive training on guidelines and processes to synchronise their work, with a focus on extensive follow-ups and joint household visits. The training helped the AAA team identify Pallavi as Severely Acute Malnourished during a growth monitoring session in January 2020. She was the third child in the family and born premature with low birth weight. The AAA group categorised Pallavi’s case as high risk, and took up the effort to save her.
Post hospital care, the team continued to visit Pallavi’s house. With counselling, monitoring and the team’s support, Pallavi’s health and weight started improving, and she moved into the ‘normal weight’ category in a short span of 22 days. The frontline workers continued to diligently monitor Pallavi to ensure that she remained a normal-weight baby.
The team also counselled her mother, Yashoda, on effective breastfeeding practices. Anganwadi worker Pranali Kale showed her videos on good nutrition practices on the Common Application Software. CAS is a digital tool launched by the Government of India to enable frontline workers improve nutrition service delivery with better monitoring and interventions. Yashoda was alerted to watch out for early warning signs of malnutrition.
Yashoda is grateful to the continuous support received from the AAA team and says, “I wish such attention was paid when Pallavi’s elder siblings were growing up. I was reluctant to take medical guidance and looked for home remedies for my older kids. I thought Pallavi looked normal, just like my other kids. But it was only through the persistence of the anganwadi, ASHA and ANM didis [sisters] that I understood how severe the problem was.”
Dr Sharma shares, “Along with taking up cases like Pallavi’s, the AAA team also comes together to collaborate on key events – such as the monthly ‘village health sanitation and nutrition day’. Together the team members focus on antenatal health check-up and growth monitoring service delivery, and document their assessment of the nutrition status of women and children in the reviewing template provided by the Trusts and approved by the Department. The joint visits by the AAA group motivates communities and beneficiaries, who are now far more aware that health and nutrition are closely related.”