Authors: Holly Carter, Investments Analyst, The Power of Nutrition; Anne Walsh, Senior Nutrition Specialist, The Power of Nutrition; Rajalakshmi Nair, Nutrition Specialist, UNICEF India; Dr. Aparna Deshpande, Nutrition Officer, UNICEF India

How frontline workers in Nandurbar, Maharashtra have adapted vital nutrition screenings in response to COVID-19 and other adversities.

COVID-19 saw health systems across the world respond rapidly with virus containment and prevention measures while needing to manage the spread of the virus. However, as the months pressed on, it became clear that systems did not only have to react to the pandemic, but they also had to reshape routine services to prevent dramatic declines in uptake. Across Africa and Asia, The Power of Nutrition’s programmes introduced prompt and innovative adaptations to protect maternal and infant health and nutrition.

One example is from our Maharashtra programme delivered in partnership between Unicef, the Government of Maharashtra and the Government of India in Nandurbar. Despite the multiple challenges posed by COVID-19 on top of shifting weather patterns, health workers in the region continued to deliver routine health and nutrition interventions and activities. Sharing the story of these workers celebrates those who make the improvements we strive for possible and highlights their dedication in the face of adversity.

Nandurbar: A story of commitment

Inhabitants of Nandurbar, a hilly and predominantly tribal district in Maharashtra, faced multiple challenges related to health and nutrition well before COVID-19. Seasonal changes see families migrate to adjacent states and districts for employment, and this movement and upheaval – worsened by rampant monsoon seasons –, poses a challenge for parents and children to maintain good health and nutrition. This ongoing state of flux has led to high rates of malnutrition, anaemia and stunting in the district, which can have lifelong detrimental effects.

Door-to-door screening of infants and mothers has been conducted since 2014 to help detect cases of malnourishment and refer them to treatment. The Department of Health and Integrated Child Development Services (ICDS) deploy numerous teams to make sure all households are covered. Yet with 2020 seeing the majority of frontline workers engaged in COVID-related work (such as surveys, containment, and treatment) it appeared impossible to continue these regular programmes, despite their importance.

Whilst the odds were stacked against health workers, the decision was made that all efforts should be deployed to continue vital screening of children and pregnant women. A huge effort was undertaken between May and July pulling together various Anganwadi (local health centre) workers, local NGO personnel, medical officers and ICDS supervisors. Implementing this was not only difficult because of reduced personnel numbers but because of COVID-19 restrictions preventing standard procedures. Teams used technology driven solutions, engaging platforms like Zoom, WhatsApp, and video calls to plan and conduct meetings, and extra measures were taken to prevent the spread of infection, including use of masks, hand sanitisers and gloves.

Having extensively planned and adapted the modality of home visits, workers faced further challenges of poor road connectivity, intermittent electricity and mobile networks, lack of infrastructure, widely dispersed houses, summer heat and hilly terrains. Despite this, a small number of teams walked for miles in hot weather to conduct door-to-door screenings.

In total, 149,797 children were screened, enabling the detection of 18,644 cases of moderate malnutrition, and 3,710 of severe malnutrition. Of the 6,560 pregnant women screened, 371 were found to be at high risk and were given appropriate support, follow-up visits or referred to hospital.

Partnering for impact

Each case represents a life potentially changed. This story touches upon just one of the priority districts that over five years the programme will cover where, thanks to extensive State and Government commitments, treatment will reach an additional 271,000 children with severe acute malnutrition and frontline health workers for over 2 million children will receive critical healthcare training. Whilst COVID-19 has undoubtedly introduced obstacles to this goal, the dedication of frontline workers underlines that it can still be reached.

In a country of over 1.3 billion, it is inevitable that not every child will be reached with critical interventions and, despite myriad Government initiatives and investments, 38% of children under-five suffer from stunting (NFHS-4, 2016). Programmes like this are vital to addressing gaps where support is most likely to make the greatest contribution and help strengthen existing government structures.

Pooling funding from the Government of Maharashtra, Unicef and our platform, this is a powerful example of The Power of Nutrition’s convening power in action – where more partners has meant more collaboration and effective programming, at a time when this is needed most.

Special thanks to Dr. Sunil Lokhande, Medical Officer RBSK Taloda, Nandurbar; Dr. Jyoti Potare, State Consultant for Nutrition & Documentation, Maharashtra; and Mr. Nitin Vasaikar, Nutrition Consultant, Nandurbar for their contribution to this piece.