When Hemant Deshmukh talks about health and nutrition, the community in Dang and Navsari, Gujarat, listens. This is not just because Deshmukh is educated, unlike many of them, but also because he happens to be a tribal like them. Being from the same community has helped Deshmukh build trust, make learning fun and debunk myths and misconceptions to improve the health and nutrition status of women, children and adolescents in both these predominantly tribal districts. Just how important reaching out to these communities has been can be gauged from the data of the latest National Family Health Survey 2019–2021 (NFHS-5).
According to NFHS-5, almost 77 per cent of adolescent girls in Dang and 72 per cent in Navsari are anaemic, and a significant percentage of tribal women are impacted by anaemia (72 per cent in Dang and about 60 per cent in Navsari). Further, anaemia prevalence among children under five is 82 per cent in Dang and 75.3 per cent in Navsari — both higher than the national average (67 per cent). It was these worrying statistics that prompted CHETNA, the Ahmedabad-based not-for-profit working on health and nutrition awareness, to focus its attention on these two districts. In March 2022, it began implementation of its three-year project in 16 villages in these two districts to improve nutritional status and access to healthcare services for women, children and adolescents. The first step of this project, called Arogya, was to ensure that the cultural and traditional sensitivities of the tribal community were respected. The decision to choose Deshmukh as the field coordinator proved to be a good one, as he not only belonged to the same tribal community but also spoke the local dialect and was well-versed in the local customs and beliefs. He was able to counsel pregnant women, adolescents and caregivers of children below five years in Dangi and Kunki, the local dialects, on diets, health issues and even menstruation. Deshmukh was helped by the innovative anaemia kit developed by CHETNA to raise awareness of nutritional anaemia. Largely illustrative, the kit has multiple communication tools, including technical information on anaemia, a set of three posters on key messages, a script for a role play and a guide for the field workers on how to use these tools.
Additionally, it comprises a handout of local folk songs modified to include anaemia messages, and a spinning disc game to make discussions on the causes and prevention of anaemia engaging. The kit also comprises a window chart. In this, the image of women who eat greens and full meals are shown as healthy; and to show how women who do not follow this healthy diet look, an image of a weak and tired woman is inserted atop it. Also handy was the kit explainer — to assuage fears of anaemic pregnant women that if they ate too much the baby would get suffocated in the womb; or if they ate brinjals, the baby would be dark-skinned; and that eating white-coloured food would cause difficulty during labour. Another effective strategy used was collaboration with the local frontline health workers like the ASHA, ANM and Anganwadi workers. By getting them on board, Deshmukh was able to ensure an increase in access to Government schemes related to maternal, child and adolescent health. Thanks to the novel multi-pronged strategies and the dedicated effort by Deshmukh, women are no longer consulting witch doctors — a practice popular before Arogya was initiated. Instead, they are visiting primary and community health centres close to their villages and are registering their pregnancies. Their families are maintaining a watch on their health and nutrition so that no woman is undernourished or anaemic when she delivers. Women are coming for ante and post-natal check-ups, getting their tetanus shots and having folic iron tablets.
Another visible change has come in the form of women making use of the nutrient — rich food packets distributed at the Anganwadi centre to pregnant women and lactating mothers. Before the Arogya project started, these packets were being fed to the cows at home so that they produced good milk. However, after demonstrations by Deshmukh and his team on how to cook these packets by adding locally available vegetables like jackfruit, dates and drumsticks, these are being consumed by the women. Undernourished infants are now also being fed four or five small meals a day to meet their nutritional requirements — underlining that change is possible with people-centred programmes.
(The author writes on development and gender. Views are personal)
