Institution-based Care

Balwadis and Anganwadis

Seva Mandir’s Balwadis and the government-run Anganwadis which it is helping to strengthen are vital in addressing malnutrition in children and promoting a healthy and nutritious diet. Balwadis cater to children from one to five years, when they are most vulnerable to malnutrition. The Sanchalikas who run our Balwadis are trained by Seva Mandir to recognise the signs of malnutrition and to follow the prescribed procedures if it is identified. The children are provided with three meals (one hot cooked meal and two ready-to-eat meals) a day, along with micronutrients, thus meeting one third of their calorie and half of protein requirements. The children are also given deworming medicine at the Balwadis.

Seva Mandir is working with the government to help strengthen its preschool centres, or Anganwadis. The Anganwadis provide centre-based services (nutrition, health and preschool education) to children aged three to six, and they provide nutrition in the form of Take-Home Rations (THR) to children under three, pregnant women and lactating mothers. At the centre, children of three to six years get one hot cooked meal and one ready-to-eat meal a day.

Our team shows mothers how to use the THR, as well as other easily available ingredients, to produce healthy meals.

The immunisation camps organised at Anganwadis on Maternal and Child Health Nutrition Day (MCHN) deliver immunisation services for children and pregnant women.

(See also Early Childcare and Development for more information about Balwadis and Anganwadis.)


Malnutrition treatment

In the case of children with severe acute malnourishment (SAM), early identification and treatment is critical. The current model of treatment involves referral of these children, particularly those with complications, to government-run Malnutrition Treatment Centres (MTCs).

Malnutrition Treatment Centres are a government initiative to tackle malnutrition among children under five. They function according to the guidelines for Nutrition Rehabilitation Centres (NRCs) provided by the National Rural Health Mission. Malnourished children are given nutritious food in the form of therapeutic diets, and are treated for any additional illnesses. Families are given advice to enable them to provide adequate and nutritious food to the child at home. Children are kept at the MTC for on average ten days, until they attain their target weight. They are weighed daily and records kept to gauge improvement. In the case of emergencies or severe illness, children are referred to hospital.

But MTCs are simply inaccessible to many poor tribal families, both geographically (because, being located at district headquarters, they are far from most families’ homes) and economically. Many parents find it impossible to give up work so that a child can be treated at the centre for ten days. Balsakhis try to persuade families to take children in need of treatment to the MTCs, and often accompany them, but, in many cases, families simply find it impossible to use the centres.

Since 2016, Seva Mandir has been supporting an MTC which is at the government Community Health Centre at Rishabdev, in a rural area with high levels of malnutrition. We also run our own referral health centre (the Seva Mandir–AMRIT Clinic) at Kojawara, with technical support from Basic Healthcare Services (BHS), a non-profit organisation based in Udaipur. Children with severe malnutrition (with complications) are referred to these centres by Balsakhis, Balwadi Sanchalikas, as well as government Auxiliary Nurse Midwives and Accredited Social Health Activists.


Community-based management of Severe Acute Malnutrition (CMAM)

A large number of children with SAM, but without complications, can be treated at the community level without being admitted to a health facility or a therapeutic feeding centre. This is particularly helpful given the difficulties that poor families in our area experience in accessing MTCs.

The community-based approach involves timely detection of children with SAM in the community and treatment of children without medical complications by means of ready-to-use therapeutic foods (RUTF) or other nutrient-rich foods at home. Seva Mandir is using this approach to ensure appropriate identification and treatment of SAM children through trained nurses with the support of community members.

Seva Mandir began organising and managing fortnightly CMAM camps run by nurses in 2018. Balsakhis, Balwadi Sanchalikas and Anganwadi workers ensure that the moderately and severely malnourished children in their care attend. Between CMAM camps, the Balsakhis make regular visits to each child and ensure that he/she is taking the proper dose of medicine and RUTF.

As well as treating malnourished children, the CMAM camps treat children suffering from common ailments such as fevers, colds, coughs, diarrhoea and skin infections, thus ensuring that children and women don’t forgo healthcare because of an inability to access services due to geographic and/or financial constraints.


Impact 

Balwadis have provided healthcare to 30,000 children and given nutritional advice to their mothers. Over 160 Balwadis are catering to more than 4,000 children.

1,345 Anganwadis are providing better nutrition and healthcare services to 30,000 children. We have seen improved access to treatment for children with SAM: 212 children treated at Rishabdev MTC in 3 years.

Since Seva Mandir’s CMAM camps began in 2018, we have reached more than 600 children, treating them for malnutrition.

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