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Improving Child and Maternal Nutrition through Community Managed Nutrition …€¦ ·  ·...

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Improving Child and Maternal Nutrition through Community Managed Nutrition cum Daycare Centers Experience from Fulwari Initiative in India Samir Garg, State Health Resource Centre, Chhattisgarh WPHN 2016

Improving Child and Maternal Nutrition through Community Managed Nutrition cum Daycare


Experience from Fulwari Initiative in India

Samir Garg,State Health Resource Centre, Chhattisgarh

WPHN 2016

Existing Gaps in food & nutrition

• Inadequate access of families to food items esp. high quality or protective

foods (e.g. protein from animal sources)

• Lack of adequate time for child feeding and care and high work burden on


• Inadequate reach of Health Workers to children under-3 years age

• Gaps in feeding and care of pregnant and lactating women leading to poor

maternal nutrition status and also low birth weight

Interventions needed around

• Health

• Feeding

• Care

India has a universal program for under-6 children called ICDS but its resources are focused mainly on 3-6 year olds.

It does not provide centre-based spot feeding or care for under-3 age children or pregnant/lactating women

The Fulwari Intervention

Fulwari – A Community managed Nutrition cum Daycare Centre

Funded by the Government

The key features of Fulwari Initiative are:

a) Focus on care and feeding of under-3 year children, pregnant and

lactating women

b) Prevent infections in children, ensure early detection and cure

c) Organise daycare through habitation based collective of mothers

d) Promote household /community level production of diverse foods

Fulwari Design

• Fulwari is managed and run by group of mothers

• 2 Mothers volunteer each day to run the Fulwari and

take care of children

• Mothers group has autonomy to take decisions with

respect to Fulwari

• Group also manages the funds made available to them

through Panchayats (local elected body) for food and

other items in Fulwari

How is it different from ICDS (anganwadi)

• Focus on under-3s

• Combines frequent spot-feeding with quality for under-3 children and mothers

• Arranges daycare with elements of holistic early

childhood development

• Organises mutual support

for mothers

• Community control over



• Replicated across 19 districts of Chhattisgarh.

• The state government has made it a state scheme in 2013

• 2850 Fulwari centres are operational, across 85 tribal blocks of the state with enrollment of around 35000 children and 16000 pregnant/lactating women

• The state government has increased the allocation to INR 300 million to allow expansion into 6000 Fulwari centres

Initiating a Fulwari• Fulwaris initiated at habitation level in tribal blocks

• Habitations with higher levels of poverty prioritized in

initial short listing of habitations

• No population norm for selecting habitations, each Fulwari

covers 5-20 children depending on habitation size

• Demand based, a series of Community meetings done,

Fulwari sanctioned based on Community Resolutions

demanding Fulwari, which are ratified by Panchayat

Management of Fulwari• State Government sends funds through local elected bodies called


• Fulwari given an initial grant for utensils, bed nets, toys etc. Subsequent

funding for local purchase of food items

• Community Health Workers (Mitanins) and their support structure play the

key role in Community mobilization, health linkage, problem solving and

capacity building for Fulwaris

• Convergence with ICDS: Take Home Rations given by ICDS also pooled in

Fulwari to prepare breakfast

Functioning of Fulwari• Fulwari centre opens for 6-7 hours daily, depending upon timings of

mothers work.

• Fulwari runs on all days including holidays.

• Fulwari runs from space voluntarily given by a community member

• At least three hot cooked meals provided to children and two meals

to pregnant women.

• Eggs (atleast per child per week), Oil, vegetables emphasized in

menu which gets finalized by the group of mothers.

Fulwari Volunteer Duty Charts

Functioning of Fulwari

• Day care centres also function as demonstration for feeding and care

related behaviors

• Children monitored for illnesses and any cases detected given the required

advice/treatment/referral by Mitanin CHWs

• Weighing of children done each month and grade (weight for age)

communicated to mothers along with required counseling by Mitanin

• Input to Fulwaris on Child Development i.e. Psycho-social stimulation


Hand Washing

Promotion of household /community level production of

diverse foods

Collective Vegetable


Fruit Plantation


High Acceptability – Despite requiring voluntary effort from mothers – in 92% of the Fulwaris, mothers continued to be willing to contribute their time, communities willing to give space

It strengthens social image of Panchayats (elected local bodies) & their role in nutrition

Fulwari brought the community together around the issue of improving child nutrition

Fulwari ‘s collective ownership by mothers and their control over funds minimised chances of pilferage

Impact on Nutrition• Baseline: Underweight 29%, Severe-underweight 16%

• Round 3 cross-section Survey: Underweight 23%, Severe-underweight 7%

• 33% reduction in overall under-weight rate in 2 years.

• 56% reduction in severe under-weight rate

• Cohort Study shows that 64% of severely-underweight children in Fulwari were able to come out of severe-underweight category

• The Low Birth Weight incidence has come down from 25.5% to 13.9% for newborn born to pregnant women enrolled in Fulwari

• Full evaluation planned for 2017

Debate on volunteerism of mothers vsfulltime/paid worker

Advantages of mothers volunteering over fulltime worker• Families trust the mothers group enough to leave very young children in

their care. Difficult to visualize people trusting a government appointedworker in a scaled-up program

• Mothers group can have greater autonomy in running the centre• Mothers learn about desired practices when they are involved in

managing day to day• No fixed costs. Improves viability for small habitations to get covered.

AND Mothers welcome the ‘Fulwari’ as:• She gets free from childcare for 6 days a week for 6 hours a day• She gets meals in Fulwari on her weekly day of volunteering in Fulwari.

BUT Child care work remains unpaid for volunteer mothers

AND role of fathers in childcare remains insignificant

Other lessons

• It builds a mothers group that is able to act as a mechanism for mutual support for mothers

• Being voluntary, Fulwari has greater scope for community participation and control

• Sustaining voluntarism is feasible, 2500 plus Fulwaris in 19 districts running for more than 3 years now

• A different person taking care on different days of a week is not a problem as children soon become familiar with neighborhood mothers

• Compulsory 8 hour daily ‘daycare’ and its regimentation as an institution may not be necessary

• And Flexibility is better as daycare is available for children if and when they need it.

Key Challenges

• Sustaining involvement of government departments and designing their role in a program built on multi-sector convergence and community ownership

• Ensuring timely fund-flow from government in a decentralisedprogram


• State-funded Nutrition cum Daycare for under-3s in combination with maternal nutrition is needed for any population with widespread malnutrition and poverty.

• Allowing substantial autonomy to mothers’ groups in decision-making is essential.

• ‘Local’ production and procurement of foods helps.

• Such models need an active support structure like Mitanin CHW program to facilitate community based processes.

Thank you

[email protected]