Nov 2015 – Mar 2018

Treating acutely malnourished children in Rajasthan (POSHAN)

India

Country

India – South Asia

To support the establishment of India’s first government-led programme for the treatment of acutely malnourished children. Also, to support the state government to scale-up and mainstream fortified edible oils and milk with vitamin A and D, and wheat flour with iron, folic acid and vitamin B12.

$3,300,000 Multi-Year Grant Value

Other funders

  • Government of Rajasthan -

  • UNICEF

This investment will support the first ever government-led community management of acute malnutrition programme delivered through the public health system in India. This follows a decision by the Government of Rajasthan to introduce community management of acute malnutrition programmes at scale in the state. 

The programme will result in:

  • In the first year: the introduction of community management of acute malnutrition into the health system in Rajasthan, with the successful treatment of 5,000 acutely malnourished children
  • In the second year: the expansion of service delivery to reach at least 100,000 acutely malnourished children across 13 districts

The programme will be implemented in phases. The government of Rajasthan’s chosen provider of technical assistance, GAIN, will support the programme during phase one and phase two, lasting for a total of two and half years. 

  • Phase one (lasting 6-8 months) will introduce community management of acute malnutrition into the government system in 41 blocks (sub-districts) 
  • Phase two (lasting 18- 22 months) will take the learnings from phase one to expand the programme to reach 100,000 children across 13 entire districts (this number may change based on the available caseload and prevalence)
  • In phase three (lasting 36 months) the Government will manage the programme without external support and has committed to scale the programme across the state (33 districts)

Impact

The investment was successfully launched on 22 December 2015 by the Honourable Health Minster of Rajasthan. 

As of January 2016, over 230,000 children across 13 districts had been screened. 9,529 of these children were identified with severe acute malnutrition and are now being treated using international protocols. 

Children identified through the programme will be fed Energy Dense Therapeutic Food under supervision of more 2,000 front line health workers over the following eight weeks across 550 centres and the progress of each child will be documented. 

Food fortification is now being mainstreamed into all public funded programmes and through open market channels in Rajasthan. The state government will fortify milk and edible oil with vitamin A and D across the state from April 2016. This will be done in partnership with the Rajasthan Cooperative Dairy Federation, and Oil manufacturers and re-packers respectively. 

GAIN - as a lead partner on fortification in the state and a key member to the task force set up by the Chief Minister of Rajasthan - is providing expert advice on how to fortify the staple foods (milk, wheat, rice, edible oils and salt) and working towards bringing food fortification legislation at the state level. 

At the national level, the government plans to fortify food products like wheat, rice, salt, and milk in the preparation of’ mid-day meals served in the schools and the supplementary nutrition provided under the Integrated Child Development Services programme. 

The Food Safety and Standards Authority of India has already granted the fortification of whole wheat flour and refined wheat flour, and is currently in the process of developing standards for the fortification of milk and edible oil with vitamin A and D.

The government plans to issue National Food Fortification Legislation this year. GAIN - along with the World Food Programme - are among the key technical partners working on this initiative.

Severe acute malnutrition (Mayank)

Meet Gouram

Gouram is four years old. He and his family live in Mundapura, Karauli, Rajasthan.

When he first arrived for treatment, he was severely malnourished. He was weak and unable to eat or drink.

Health workers provided counsel and support, including the use of ready-to-use therapeutic food.

With the support of these health workers, Gouram has returned to health, and is able to eat and drink normally. He wants to be a doctor when he grows up.

Photo credit: CIFF/Poulomi Basu (Gouram's name has been changed)