Supporting the State of Gujarat alongside partners to improve women and children’s health and nutrition

Gujarat, despite being the most urbanised state in India, has exceptionally high rates of malnutrition, with 38% of children under five years old estimated to be stunted (where a child is too short for their height) and 21% wasted (where a child weighs too little for their height). Anaemia is a significant public health challenge with over half of women (55%) and more than two thirds (almost 70%) of adolescent girls suffering – neither of these stats have decreased in the last 10 years.

This partnership started in two districts where nutrition indicators are performing more poorly than in other parts of India: stunting prevalence among children under five is 51% in Bhavnagar and 48% in Sabarkantha. Since July 2023, the programme has narrowed its implementation geography to one state, Sabarkantha, where Action Against Hunger is working.

Historically, India has allocated extensive funding to government schemes, such as the Integrated Child Development Scheme, which provides nutritional support to more than 82 million children. Yet, despite the huge investment, high levels of malnutrition remain. Significantly better outcomes are possible but are dependent on increasing capacity and efficiency within existing programmes, as well as boosting demand itself from communities the programmes are designed to support. 

Our programme

To address these issues, The Power of Nutrition partnered with CARE International and Action Against Hunger with funding from UBS Optimus Foundation to support the Government of the State of Gujarat as it implements the Indian Government’s National Nutrition Mission. The National Nutrition Mission was launched in 2018 and aims to improve the nutritional status of children, adolescents, pregnant women and breastfeeding mothers throughout the country, thereby reducing stunting and wasting.

The programme works with the Government of India and the Government of the State of Gujarat over a five-year period to develop and strengthen its nutrition systems and services, sustaining improvements in nutrition by increasing capacity and building knowledge, skills and motivation of health workers in the State.

The way that this is done is two-fold:

• First, the programme aims to increase the capacity of health systems. This includes strengthening coordination and planning for nutrition among departments in Gujarat, training health workers to improve delivery of services, improving supervision skills and otherwise strengthening existing schemes, platforms and events and promoting core components of the national scheme.
• Secondly, the programme aims to improve essential health and nutrition practices by building knowledge, skills and motivation of people in the state. This is done by developing a Gujarat-specific strategy to increase knowledge and awareness of the benefits of nutrition and optimal nutrition practices.

Afsana's story

Afsana Aarifbhai Sharmari, a dedicated Anganwadi Worker from Bhavnagar, has experienced significant growth in her technical knowledge, confidence, and counselling skills over the past three years, thanks to the support and training provided by Project Vruddhi's field team. Despite having limited formal education, Afsana embraced the opportunity to make a positive impact on the lives of children and joined as an Anganwadi Worker whilst pregnant with her first child.

Project Vruddhi's intervention in Afsana's center began in 2020, focusing on systems strengthening. Afsana's commitment to making a difference and her eagerness to learn impressed the team. Through repeated training, support, and regular meetings with the field team, Afsana has enhanced her understanding of crucial topics like breastfeeding initiation, positioning, latching, and growth monitoring.

With her newfound knowledge, Afsana now sensitises mothers on the importance of positioning and latching starting from the third trimester, ensuring that each child is breastfed within an hour of birth. She no longer feels awkward touching a mother's breasts to demonstrate proper positioning. Additionally, she pays attention to accurate weight monitoring and conducts comparative weight analysis during community-based events to stimulate discussions among pregnant and lactating women.

Afsana also realised the significance of age-appropriate counselling and the need to reinforce messages with warmth and empathy. Instead of rushing through visits, she now takes the time to greet each woman, build trust-based relationships, and deliver impactful technical messages using the counselling cards developed by Project Vruddhi. Through continuous capacity building, Afsana has gained the confidence to speak to larger groups and facilitate meetings effectively. She has also taken the initiative to create a kitchen garden at the Anganwadi centre (a rural childcare centre), filled with medicinal plants and fruit-bearing trees, to benefit the children in her care.

Afsana's purposeful work and commitment have earned her the trust and appreciation of the community. She was recognised with the prestigious Mata Yashoda award from the Women and Child Development Department for her commendable efforts. Afsana, a devoted wife and mother, tirelessly nurtures her own family while positively impacting the foundation years of community children and pregnant and breastfeeding mothers as an Anganwadi Worker.

Since the start of the programme, interventions have been implemented in 3,515 Anganwadi centres across two districts. A social and behaviour change communication strategy to improve demand has also been finalised, incorporating interventions that had demonstrated positive impact during the pilot phase. Two social and behaviour change communication tools were developed and scaled up, and 8,000 copies of the counselling card booklet were distributed. Whilst the programme was severely affected by the Covid-19 pandemic, work was done to adapt and support the state’s response.

Next steps

In recent months, the structure of the programme in Gujarat has changed. The programme now focuses on the partnership with Action Against Hunger who is continuing to implement activities in Sabarkantha.

We also have programmes in Gujarat and Utter Pradesh which you can read about here, as well as a programme in Maharashtra which you can read about here.