India

Valid’s work in India has included

• Setting up and implementing a ground-breaking CMAM pilot program in Kandhamal District with the Government of Odisha between 2013 and 2015.
• An extension of the programme in Odisha in 2015 to include all 14 blocks in the neighbouring district, Bolangir.
• Continuing work in two districts of Odisha with plans to expand into a third in 2016.
• Screening of over 158,336 children across 1703 Anganwadi Centres in Bihar State
• In Uttar Pradesh, currently exploring the possibilities for initiating a CMAM programme with Tata Trust and the Government.

From 2013-2015 Valid International, with funding from DFID India, supported the Odisha Department of Women and Child Development (DWCD) and Department of Health and Family Welfare (HFW) in Kandhamal District to design, set up and implement a CMAM pilot programme. The programme allowed the Government to treat SAM effectively in the community at scale and with high coverage for the first time, and is widely seen as a major breakthrough. The pilot showed that CMAM can be implemented through the existing Integrated Child Development Services scheme (ICDS) using the community based Anganwadi Centre (AWC) as the point of treatment. Over 2000 Anganwadi workers (AWWs) have been trained to conduct routine mass screening, identification, enrolment, and referral of SAM children across the 2101 AWCs in Kandhamal.

The pilot compared the effectiveness of three different approaches to CMAM: 1) Hot cooked meals (HCM), 2) Modified take home ration (MTHR), and 2) Energy Dense Nutrient Rich Food (EDNRF). The rate of recovery, weight gain and the rate of MUAC gain were significantly better in the EDNRF arm when compared to the other two arms. EDNRF also proved to be more cost effective when all factors including recovery rate and transport are taken into consideration. Mortality rates were low in all three arms. The coverage of SAM cases was high, in excess of 90%. The pilot indicated that CMAM can be implemented at scale through the existing infrastructure, however recovery rates even in the EDNRF arm were lower than international, highlighting the need for substantial inputs into community sensitisation, mobilisation and empowerment to improve compliance and adherence to treatment protocols.

There has also been a decrease in the number of MAM cases throughout the programme. The prevalence of SAM and MAM cases was 0.38% and 5.4% at the start of the project in November 2014 (across approx. 72,000 children screened). However that has decreased more than 60 % and in March 2016 the prevalence was 0.04% and 1.75%. In November 2014, 3938 MAM children were identified in mass screening, and in March 2016 this figure was 1264. The visible changes in the SAM children receiving treatment helped the community to see the CMAM model positively, and this contributed to more families of children with acute malnutrition participating in screening, treatment, and follow up. As a result, AWWs have more time to provide counselling on proper care and feeding practices to families with MAM children, which may go some way to explaining the observed decrease in MAM cases.

In April 2015, the programme was extended to include all 14 blocks in the neighbouring district, Bolangir. Valid, the Government of Odisha, and DFID India held a workshop in January 2016 to disseminate key findings to stakeholders and share lessons learned as a platform for moving CMAM forward in Odisha and other states. As a result of the programme’s success and the well-received lessons learned workshop, work has continued in two districts of Odisha and is planned to roll out in a third this year.

Work has also started in Bihar state with the Government of Bihar where, to date, over 158,336 children have been screened across 1703 AWCs, and in Uttar Pradesh working with the Government and Tata Trust to explore the possibilities for initiating a CMAM programme.<