12 OCTOBER 2022

India has faced a vicious cycle of poor nutrition for many decades. The challenges range from malnutrition to anaemia and iodine disorders. The National Family Health Survey (NFHS) 2019-21, the 5th in the series, indicates limited improvement in health and nutritional status of the population. Post COVID-19, India faces serious challenges to improve its nutrition profile as well as meet global nutrition targets. Celebrated every year during the month of September, POSHAN Maah helps to fill the nutrition gaps amongst all ages in a holistic manner, with the help of right communication interventions leading to social and behaviour change.



What is POSHAN Maah?

POSHAN Maah (lit. month of nutrition) is celebrated across India from September 1 to 30th every year, as a part of national POSHAN Abhiyaan, a Central government initiative that aims to strengthen the efforts to end hunger and malnutrition. Through the fifth National Poshan Maah, the Government of India plans to rope in the Panchayati Raj Institutions in the rural areas to carry out various activities focusing on the health of the women and the children. The aim is in line with United Nations Sustainable Development Goal number two - to ‘End hunger, achieve food security, improve nutrition, and promote sustainable agriculture by the year 2030.’

Understanding POSHAN Abhiyaan

POSHAN Abhiyaan (Prime Minister's Overarching Scheme for Holistic Nutrition campaign) is an umbrella scheme to improve the nutritional outcomes for children, pregnant women and lactating mothers. It holistically addresses the multiple determinants of malnutrition and attempts to prioritize the efforts of all stakeholders on a comprehensive package of intervention and services targeted on the first 1000 days of a child’s life. It seeks to do so through a systemic intervention that includes effective delivery through an appropriate governance structure mechanism. The scheme leverages and intensified the implementation of existing programmes across multiple Ministries while at the same time trying to rope in the expertise and energies of a whole range of other stakeholders – State Governments, Communities, Think tanks, Philanthropic Foundations and other Civil Society Actors. The campaign aims to reduce child stunting, underweight and low birth weight by 2 percentage points per annum and anaemia among children (and young females) by 3 percentage points per annum. POSHAN Abhiyaan is making its way towards the unreached through pathbreaking interventions like POSHAN Maah, POSHAN Pakhwada and POSHAN Ghar.


An Anganwadi worker educates various beneficiaries about nutrition, growth monitoring and early childhood care development during POSHAN Maah in Kanker, Chhattisgarh. ©UNICEF/India/AltafQadri

POSHAN Maah, how it works

Every September is marked as the ‘POSHAN Maah’ around India. During this time, we see several communications and sensitization efforts on maternal health, nutrition, eliminating severe acute malnutrition and much more. POSHAN Abhiyaan is primarily based on four pillars that are also followed by POSHAN Maah: ensuring access to quality services, ensuring convergence of multiple programmes and schemes with its sub components; leveraging technology to empower the frontline worker; and Jan Andolan (People’s movement) that induces large scale behaviour change. 

The Ministry of Women and Child Development has outlined several programmes for the celebration of Rashtriya Poshan Maah 2022. These events are organised at the grassroots level through Gram Panchayats (village councils). Poshan Panchayat Committees work with field-level workers (FLWs) – AWWs, ASHAs, and ANMs to enhance the service delivery of basic Integrated Child Development services through Anganwadi Centres (AWCs), Village Health and Nutrition Day (VHNDs). Awareness Centres organise awareness drives about good health practices along with the organisation of a Swasth Balak Spardha (healthy child competition). Health camps for anaemia check-ups will be set up at AWCs for adolescent girls. Further, Nutri-Gardens or Poshan Vatikas will also be created near Anganwadi Centres.

The state-level activities are centred around traditional foods and how they can be linked to improving nutrition. A drive called Amma ki Rasoi (mother’s kitchen) helps link traditional food items and dishes with POSHAN Maah celebrations. Also, a national-level Toy Creation Workshop will be organised to promote the use of indigenous and local toys for learning in the Anganwadi Centres.

Working towards targets through SBC

POSHAN Abhiyaan has fixed goals to reduce low birth weight, stunting and undernutrition in children (up to six years of age) by 6% in three years, at the rate of 2% a year; and anaemia among children, adolescent girls and women (up to 49 years of age) by 9%, at the rate of 3% a year. However, to accelerate the mission, it was important to involve communities and turn the campaign into a mass movement with a social and behaviour change approach. UNICEF provides technical support to the government in order to promote breastfeeding, improve nutrition value of the diet consumed by communities and combat issues like anaemia and malnutrition amongst women and children. Communication tools and IEC material specially designed for the campaign have played a major role in delivering the required messages to the public. UNICEF and partners continue to create and disperse thought provoking, research based materials like hoardings, radio jingles, press advertisements and social media posts for release in the masses.

The power of effective communication

As an important tool of POSHAN Maah, community radio has proven to be one of the most effective mediums for social and behaviour change that provides critical information to rural, far-flung, hard-to-reach groups living in remote areas. UNICEF has a partnership with the Community Radio Association and Radio Mewat that support promotion of a range of nutrition messages. A special Nutrition Literacy programme has been initiated by UNICEF and partners to create awareness on maternal and child nutrition including Infant and Young Child Feeding (IYCF) practices in media dark areas. The community radio stations are participating in the World Breastfeeding Week awareness campaigns conducted in 26 states reaching 35,000 villages in 146 districts and impacting 45 lakh individuals. Activities such as street theatre, door to door campaigns, drawing competitions, songs, jingles, and poetry recitations have been organized to further reinforce engagement. These initiatives have also reported to effectively dispel myths and answer queries of women and their families on breastfeeding, garnering huge participation from the community.

Bringing change within people

With nationwide interventions like POSHAN Maah, India’s POSHAN Abhiyaan has been successful in generating people’s participation towards filling the nutritional gaps in the society. This has also been possible with the help of initiatives like Poshan Ki Potli (bag of nutrition), a unique card game that has helped rural women of Bihar to understand the dynamics of dietary changes and the effect of food quality on our daily life. The game is being shared and will be played in 10 districts in the states of Kerala, Uttar Pradesh, Odisha, Gujarat, Haryana, Rajasthan and Madhya Pradesh as part of the Poshan Ghar initiative supported by UNICEF.

Local and community radios have reported conducting talk-shows, phone-ins and other participatory programmes where information on exclusive breastfeeding and nutrition is shared by experts and counsellors.

Addressing core gaps

Every year POSHAN Maah has shown gradual signs of bringing positive change and awareness within communities through various interventions at multiple platforms. As per the insights from the National Family Health Survey-5, healthy food groups have started making place in the diets of people across all age groups in a slow and steady manner during  2019-21. While there has been significant improvement in the consumption of dairy, fruits, eggs, chicken and fish – leafy vegetables and pulses are work in progress.  

“We are trying to work together to ensure that these high nutrition interventions are reaching every mother, every child, every family. And how are we going to ensure that nutritional literacy is there in every family in India. That they are not just eating to get a full stomach, but they are going to eat because they know nutrition is important,” said Arjan de Wagt, Chief of Nutrition, UNICEF India.

All State Missions in India under the DAY-NRLM (Deendayal Antyodaya Yojana - National Rural Livelihoods Mission) have observed POSHAN Maah with full vigour under the guidance and support of the national Mission. Under Food, Nutrition, Health & WASH (FNHW) component of DAY-NRLM, FNHW Digital Toolkit was formally launched to provide standard and uniform messaging across materials on the identified FNHW topics and operational aspects. This comprises resource material such as flipbooks, facilitator guides, posters, counselling cards, Standard Operating Procedures, etc. The Toolkit has been developed with the support of technical agencies i.e Bill & Melinda Gates Foundation supported TA to NRLM (PCI) and inputs from UNICEF supported ROSHNI Centre.

 

The spread of COVID-19 pandemic witnessed high incidence of cases and reports of deaths from prisons around the world. As prisoners lagged behind in terms of COVID Appropriate Behaviours (CAB) and vaccination, it was realised that vaccination in prison settings has been highly dependent on vaccine delivery and reach. The following story establishes how vaccinating all those who live or work in a prison can help reduce cases and deaths as an efficient step towards controlling the ill effects of a pandemic.



A mix of urban and rural areas, Lohardaga district is situated in the south western part of the Indian state of Jharkhand. Spread in an area of 1,502 square kilometers, Lohardaga is known for its rich mines and minerals. The world class produce of Bauxite has given it the name of Bauxite Town in the country. With a population of 512,587, the district records literacy rates of about 68 percent with a population growth of 26 percent. Limited health resources and being far flung from the main cities throws many challenges at the population residing in the interiors of Lohardaga.

Health challenges and the pandemic

Lohardaga district has one District hospital, four Community Health Centers (CHC), six Public Health Centers (PHC) and 75 Sub Health Centers (SHC). However, most villages in the district are hard to reach, especially the ones in two blocks of Peshrar and Kisko. These two blocks also have the most number of villages facing vaccine hesitancy and prevalence of myths and misconception related to COVID-19. Affected by Left Wing Extremism and conflict, these areas are far from normalcy, which also makes them hard to reach in terms of health facilities. The challenges increased with the spread of COVID-19 in between 2019-2021 as the health workers struggled to ensure that vaccination and CAB awareness reached these areas and the communities residing in them.

Pandemic control behind bars

The Mandal Karagar (district Jail) situated in the District Headquarters of Lohardaga has more than 350 prisoners who reside inside the Public Correction Facilities Centre. The Health Department realised that this facility was in serious need of CAB awareness as well as vaccination drives, as most prisoners were unaware of the grave impact of COVID-19 virus on the world. Hence, first an awareness campaign was conducted in the jail that facilitated the path for vaccine acceptance as well as following CAB. After which the vaccination drive was organised in four different stages in a span of three months. This resulted in 100% vaccination with 1st dose and around 20% population covered for 2nd dose of COVID-19 vaccine.

“We faced no resistance or hesitancy towards the vaccine from all the jail mates. The ones who were not sure checked with us about the information they wanted on the vaccine and easily agreed to get immunized after that,” said Subhash Kumar, Jail compounder, Mandal Karagar.


Case studies like Lohardaga Mandal Karagar vaccination establish that vaccinating all those who live or work in a prison can help reduce cases and deaths as an efficient step towards controlling the ill effects of a pandemic. ©UNICEF/2022

Transformation of a prison

Currently, there are a total of 385 prisoners listed at Mandal Karagar out of which 170 are fully vaccinated for COVID-19. The authorities are working on COVID awareness and registering names for vaccination regularly as the jail has constant additions as newcomers into the premises.

While the prisoners continue to live in vulnerable condition, the number of cases reported has gone down remarkably. The vaccination of both prisoners and staff has helped improve the health conditions and led to confidence amongst the prisoners as well as the staff at Mandal Karagar. Varun Kumar, the computer operator at the prison says, “All staff is vaccinated with both doses now and we are very comfortable. We also understand the importance of vaccination for all and the impact it has on our immune systems.”

The vaccination drive started in May 2021 and has led to positive impact on prisoners’ health and wellbeing. During the second wave of pandemic 90% people were infected, however no loss of life has been recorded.

As India accelerates its vaccination drive, Government of India has revealed that 165,108 prisoners across India have received their first dose of COVID vaccine and the second dose vaccination is under fast progress (as of 30th August 2021). As per government records, 4,78,600 prisoners are housed in various jails across India. Mandal Karagar vaccination drive was supported jointly by UNICEF and USAID.

Fighting rumours and superstition to combat COVID-19 vaccine hesitancy in Jharkhand villages

Lack of awareness has been a major hindrance to COVID-19 vaccination in several rural parts of India. Factors like fears of change, superstition and myths have stopped people from openly understanding and accepting the idea of immunization in many conservative communities around the country. The following two stories witness how UNICEF with support of USAID worked with two such vulnerable communities in Jharkhand villages to eradicate vaccine hesitancy and leading to social and behaviour change.

Known for its ancient connect with the Hindu mythology, Gumla is one of the 24 districts in the Indian state of Jharkhand. The district has been an age-old meeting centre for people following an old barter system in the region where they exchange goods and livestock during fairs and gatherings. The name itself is derived from the word Go-mela literally meaning ‘cow festival’. Due to geographical challenges, the local communities have to face many hurdles in order to avail the government facilities available in terms of health and medicine. The district has a total population of 972,228, more than 70 percent of which is constituted of Scheduled Tribes (STs). Spread in an area of 5337 square kilometres, Gumla has a tropical climate with 944 inhabited villages and constant struggle for electricity and clean drinking water.

The power of native language

90 percent of the Kodi village in Dumri Block of Gumla district has a tribal population who earn a living from agricultural labour jobs in the area. With low literacy rates, the village follows many superstitions, which are a hindrance to growth and awareness especially in difficult times like the COVID-19 pandemic. Thus, when the frontline workers supported by UNICEF reached the village, it was realised that only 48 percent of the population had been vaccinated with the first dose of COVID-19 vaccine. The rest did not agree to get vaccinated. The challenge was to eliminate superstition and myths from the minds of community members and convince them for vaccination. The project coordinator along with various frontline workers organised a meeting with the villagers and a local person was assigned the task of communicating the required messages in the local tribal language. Based on UNICEF’s flip book, all doubts were cleared one by one and the villagers seemed convinced to accept the concept of immunization. Within a few days, a vaccination camp was organised in the village campus where 72 persons were vaccinated. 

At the start of the intervention in Kodi village in December 2021, the health workers had a target of vaccinating 534 people in the area. Currently, 514 persons have received the first dose of COVID-19 vaccination while 504 are vaccinated with both doses. 66 persons have also received their booster dose of COVID-19 vaccine.


A street play organised in Barwe Nagar village of Jharkhand led to 100% of the villagers getting both doses COVID-19 vaccine. ©UNICEF/India/Archives/SyedAltafAhmad

Theatre leads to change of heart

Village Barwe Nagar in Gumla has a total population of 2272, out of which 70 percent are Muslims while 30 percent belong to other communities. During the COVID-19 vaccination drive, the biggest challenge faced by frontline workers was the myths associated with the vaccine. Majority of the people believed that the vaccine leads to death, infertility and genetic disorders. Despite regular home to home visits by the ANM (Auxiliary Nursing Midwife) workers, people refused to come out for vaccination.

UNICEF discussed the matter with the local authorities and decided to organise a Nukkad Naatak (street play) to try delivering the message in a different form and tone to the villagers. Promotional announcements were made around the village for this in advance and influencers like the village head were also invited to watch the performance. Hundreds of people, including women and children gathered to watch the play after which there was a round of discussion for all. This helped people openly ask questions related to the vaccine which were answered by the frontline workers and supported by influencers. A few locals immediately opted for vaccination while others agreed gradually.

Tur Mohammed, Block Co-ordinator of UNICEF’s local NGO partner Lohardaga Gram Swarajya Sanhthan played an instrumental role in mobilizing the village communities. “I went from house to house with the health workers and spoke to everybody about the benefits of the vaccine. I told them that I was from their community too and all my family members and I have taken both doses of the vaccine. Gradually everybody understood that they need to keep the rumours and myths aside and focus on their health,” he said.

100 percent of the villagers in Barwe Nagar have received both doses of COVID-19 vaccine. People in both Kodi and Barwe Nagar villages are aware of the vaccine benefits as well as COVID Appropriate Behaviours.