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SAFANSI

Engaging communities in the Golden 1,000 Days in Nepal

Kaori Oshima's picture
Field survey team in Nepal
A field survey team for the qualitative study holding a focus group discussion with women in one of the SHD project communities. Photo credit: World Bank

In Nepali, “Sunaula Hazar Din” means, “Golden 1000 Days” – which is a critical window of opportunity between conception and the age of two years that, with good health and nutrition, can mitigate the risks of malnutrition that hamper a child’s long-term physical and cognitive development.

Sunaula Hazar Din (SHD) is also the local nickname of the Government of Nepal’s recently completed “Community Action for Nutrition Project”, implemented by the Ministry of Federal Affairs and Local Development and  financially supported by the World Bank from 2012 to 2017. The project aimed to improve practices that contribute to reduced under-nutrition of women of reproductive age and children under the age of two and to provide emergency nutrition and sanitation response to vulnerable populations in earthquake affected areas.

The project used a “Rapid Results Approach (RRA)”, where target communities formed groups of nine members that would collectively select and work on an activity to address malnutrition for 100 days. RRA focused especially on the “1000 days” households– namely, households with children under 2 years and pregnant and/or lactating women and also had community -wide interventions targeted to address malnutrition.  

To better understand the local dynamics around the SHD design and activities, a qualitative study was conducted, with support from the South Asia Food and Nutrition Security Initiative (SAFANSI).

The study team gathered the voices of various stakeholders, including the community members, facilitators, and the village and district-level authorities. Listening to the voices of these stakeholders makes development practitioners and project teams recognize how participatory designs may work as expected – or not – in a specific context.

A path toward better health for India’s women

Parvati Singh's picture
 World Bank
In India, Members of a self-help group (SHG) like this one discuss women’s  health issues with female health workers. Credit: World Bank

A little over six years ago, Neelam Kushwaha’s first daughter was born weighing 900 gm at birth, severely underweight. Neelam went into labor while working at the local construction site in Jori village, Rewa, Madhya Pradesh, India. Many people work at such local construction sites in rural areas for daily wages ranging from INR 150-280 (about $2- 4$) per day. Her daughter Manvi, was preterm, and Neelam spent months recovering from child birth complications.

Three years later, when Neelam was pregnant with her younger daughter, Sakshi, she quit wage labor and sought employment at an incense manufacturing unit established by World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP) in 2011. At her new role, she earned more and did not engage in labor intensive work during the final months of her pregnancy. Sakshi was born a healthy 3 kilos.

In the course of my field work supported by South Asia Food and Nutrition Security Initiative (SAFANSI) in 2015, I came across several similar stories.

MPDPIP’s livelihood based approach offered several opportunities towards income supplementation for women self-help groups (SHGs) and rural households through agriculture, dairy/poultry farming and local enterprises, among others.

As evident by Neelam’s experience, MPDPIP’s benefits went beyond income and spilled over into health improvement as well.

I learnt that prior to MPDPIP, childbirth in hospitals was difficult due to prohibitively high costs of travel and hospital stay. Pre-existing government schemes such as the Janani Suraksha Yojana (JSY) offer about INR 1,400 ($20) to rural women who opt for hospital deliveries. However, this payment occurs post-partum, and pre-delivery costs have to be borne upfront by pregnant women.

Post MPDPIP, women were able to opt for hospital deliveries with greater ease due to access to credit from their SHGs. This is particularly relevant for Madhya Pradesh as it has consistently fared poorly with respect to institutional deliveries.

Happy New Year! In Sri Lanka, a time to celebrate many things – and to think

Idah Z. Pswarayi-Riddihough's picture
 Joe Qian / World Bank
A group of women in a Sri Lanka Estate. Credit: Joe Qian / World Bank

Happy New Year to all our Sri Lankan friends and colleagues celebrating the Sinhala and Tamil New Year this month; and Happy Easter to those celebrating it.

This is my first opportunity to celebrate these various holidays in my adopted country. I love the energy, the buzz of excitement everywhere and the decorations coming up in many of the commercial districts. I have been asking so many questions about the importance of the New Year holiday; and at the same time enjoying the preparations for the festivities, the anticipation of the big day as well as the serious messages.

I have learnt that the Sinhala and Tamil New Year, also known as 'Aluth Avurudda' (in Sinhala) and 'Puthandu' (in Tamil) is very important to all Sri Lankans and it celebrates the traditional Lunar New Year. It is celebrated by most Sri Lankans – a point of Unity and a Joyful occasion.

Even more importantly the holiday coincides with the New Year celebrations of many traditional calendars of South and South East Asia – a regional point of unity! Above all, this is also known as the month of prosperity.

So what does the holiday mean to you as a Sri Lankan, or maybe you are someone like me who may not be Sri Lankan but loves the country and its people?    

At the World Bank Group, promoting shared prosperity and increasing the incomes of the poorest 40 percent of people in every country we work in is part of our mission. The first goal is to end extreme poverty or reduce the share of the global population that lives in extreme poverty to 3 percent by 2030.

How protein deficiencies impact the health of communities in India

Parvati Singh's picture
Soybean farmers discuss best practices that can leverage improvement of food and nutrition security in Madhya Pradesh.

The state of Madhya Pradesh in India is largely vegetarian with limited consumption of eggs and meat. 

While these dietary preferences are commonplace in other Indian states, Madhya Pradesh is facing a protein deficiency epidemic which threatens the long term health of its population.

How did it get there?

In 2015 I spent five weeks in rural and tribal areas of Madhya Pradesh evaluating the World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP II), with the support of the South Asia Food and Nutrition Security Initiative (SAFANSI)

Across the 8 districts I visited, families shared how they had improved their agricultural productivity, started backyard kitchen gardening, and supplemented their income through dairy and poultry farming, collective procurement and small scale enterprises.

As I examined local village level health records, Anganwadi Center (AWC) registers, Auxiliary Nurse and Midwife (ANM) registers and Primary Health Center (PHC) documents, I noticed a reduction in severe malnutrition and severe anemia among pregnant women and under 5-year-old children.

However, this decrease did not extend to moderate or mild malnutrition and anemia.

In Bangladesh, changing behaviors for better health

Rokeya Ahmed's picture
A toilet in Chunarughat, Hobigonj reduces fecal contamination for this family (World Bank/M. Monir)
A toilet in Chunarughat in the Habiganj district in Bangladesh has helped reduce fecal contamination for Amena Begum and her family. Credit: World Bank/M. Monir

Amena Begum resides in a village in the Habiganj district in Bangladesh and is a mother to three young children.  Last year Amena spent US$100 to construct a toilet to ensure her three children were hygienically protected from feces.
 
Even though her family members have adapted to using the toilet, exposure to fecal contamination can occur anywhere.  For example, while playing outside, a child may accidentally ingest soil with animal feces, or the child could be exposed when he or she eats food off of dishes washed with pond water.  
 
It is also not uncommon for families without toilets to throw feces into a nearby bush, which remains exposed in their living area. These actions can lead to the contraction of hazardous, lethal diseases and create a traumatizing effect on the lives of many children, not to mention the unfavorable impact on the environment.
 
A new study on early childhood diarrhea in rural Bangladesh found that despite high on-site latrine access, frequent fecal contamination was present along all environmental pathways investigated. Human fecal markers on children’s hands and in soil, and rotavirus in stored water, soil and on hands had been detected. Animal (particularly ruminant) fecal markers were highly prevalent in water, soil and on hands.

Enabling children to grow: Tackling the multiple determinants of nutrition

Ashi Kathuria's picture

During a recent visit to Barsam village in the Saharsa district of Bihar, I talked with members of a women’s self-help group - one of over 480,000 such groups formed under Jeevika, a rural livelihoods program supported by the World Bank in Bihar.

SHG women sitting in a circle

Among the group was nineteen year old Shobha. Like millions of girls across the country, Shobha had never been to school. She was married at fifteen, and now has a ten-month old daughter. Shobha sat among us, cradling little Anjali on her lap.

I was happy to hear that, when she was pregnant, Shobha enrolled herself at the local Aanganwadi center which offered nutrition and health services for both mother and child under a public program. At the center, Shobha learnt how to care for Anjali. As a result, the child was exclusively breastfed for six months and received all the necessary immunizations. Now the little girl is being correctly fed a diverse diet of vegetables, pulses, cereals and animal milk, while continuing to be breastfed.

But my happiness was only momentary. As we talked, it emerged that Anjali was only being given a spoonful or two at most of these foods. While the amounts were far from adequate, Shobha thought they were enough for a child of Anjali’s age. And, all the other women agreed.