‘Let food be thy medicine and medicine be thy food’. This statement is often attributed to Hippocrates, the Father of Medicine, and quite literally sums up Project Sampoorna which was conceptualised and successfully implemented in Bongaigaon district of Assam.
The project has resulted in the reduction of malnutrition in children using near zero economic investment. Sampoorna is in tandem with the United Nations’ Sustainable Development Goals and those set by the UN Secretary General António Guterres in the Food Systems Summit (September 2021) including the need to have food systems and social protection that support resilience and food security. Prime Minister Narendra Modi also had identified health and nutrition as priority areas and reiterated the need for a ‘Kuposhan mukt Bharat’ (Malnutrition Free India) while launching the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN Abhiyaan) (National Nutrition Mission) in 2017-18.
It was during Poshan Maah (Nutrition Month) in September 2020 that 2,416 children were identified to be malnourished in the lush green Brahmaputra valley district of Bongaigaon. The National Family Health Survey (NHFS)-5) has documented that the number of children under five who are stunted, wasted, underweight and the number of anaemic women and children in the district are higher than the national average — anaemia being a major determinant of maternal and child health.
These were corroborated by Project Saubhagya that was designed to reduce the maternal mortality rate and infant mortality rate of the district. A real time data sheet is updated by field-level doctors as and when a high risk pregnancy is identified, which is then followed up till safe delivery. The project has yielded encouraging results; maternal deaths for six months (April 1, 2020 to September 30, 2020 compared to April 1, 2021 to September 30, 2021) have fallen from 16 to three and infant deaths from 130 to 63.
Addressing child nutrition
The highest risk factor for high risk pregnancy is anaemia which is usually nutritional. The vicious cycle of a malnourished child growing into an unhealthy adolescent, and then further into an anaemic pregnant young woman giving birth to an asphyxiated low birth weight baby; this baby then facing possible developmental delays, only to grow into a malnourished child; and this child who struggles further for nutrition and appropriate care while the world around her barely makes ends meet is the one that sucks in all possibilities of a healthy society.
This portrays the worst-case scenarios, but truth is indeed stranger than fiction. In order to break out of this vicious cycle, the low-hanging fruit had to be targeted — children’s nutrition.
Bongaigaon has 1,116 Anganwadis with a total of 63,041 children below five. The massive exercise of plotting their weights and heights in World Health Organization growth charts revealed a total of 2,416 malnourished children; 246 cases of Severe Acute Malnutrition (SAM) and 2,170 instances of Moderate Acute Malnutrition (MAM).
District Nutritional Rehabilitation Centres, or NRCs, usually have up to 20 beds; and a monthly intake of 200 SAM children is not practical. Also, parents of the children who are admitted forgo their daily wages (which to an extent is compensated by the Government) and abandon their farmlands for 10 days. Back home, siblings of the SAM child are not taken care of and may become malnourished. The treated child could also slip back to a SAM state after being discharged and if not cared for.
We needed to innovate now. Based on the success of the community-based COVID-19 management model (Project Mili Juli), we launched Project Sampoorna targeting the mothers of SAM/MAM children, the tagline being ‘Empowered Mothers, Healthy Children’. In addition, we identified the mother of a healthy child of the same Anganwadi Centre (AWC) and paired her with the target mother; they would be ‘Buddy Mothers’ (2,416 pairs). They were usually neighbours and shared similar socio-economic backgrounds. The pairs were given diet charts to indicate the daily food intake of their children; they would have discussions about this on all Tuesdays at the AWC. Local practices related to nutrition would also be discussed.
The major hindrance to the project was patriarchy. Mothers had to be empowered financially for sustained results. Therefore, they were enrolled in Self Help Groups (SHGs) under the National Rural Livelihoods Mission (NRLM). By the end of three months, 74.3% of mothers were enrolled in SHGs; by the end of six months, enrollment went up to 75.6% and by the end of a year, it was 90%. Meanwhile, we arranged for 100 millilitres of milk and an egg on alternate days for all 2,416 children for the first three months, giving time for their mothers to stabilise themselves in the newly found jobs. The large hearted people of Bongaigaon adopted Anganwadis and filled the tiny stomachs with the much needed proteins and their hearts with love.
A sea change
After three months of Project Sampoorna, out of 246 SAM children, 27 (11%) continued to be SAM, 28 (11.4%) improved to MAM and a whooping 189 (76.8%) became normal. Out of 2,170 MAM children, 12 (0.6%) deteriorated to SAM, 132 (6.08%) stayed MAM and an unbelievable 2,015 (92.8%) became normal. The best was yet to come. Milk and eggs were stopped after three months but we continued to follow up to see how our Buddy Mothers Model and Women Empowerment Model were working. Mothers had done what institutions could not do for years. By March 2021, 84.96% of SAM children and 97.3% MAM children were normal; and by September 2021, 92.3% SAM and 98.9% MAM children were normal. Project Sampoorna had stood the test of time. Children who had not improved were checked and treated by doctors under the Rashtriya Bal Swasthya Karyakram (RBSK). UNICEF, IIT Guwahati, Tezpur University and the Social Welfare Department lent their support in periodic course correction.
Project Sampoorna had prevented at least 1,200 children from becoming malnourished over the last year. The National Nutrition Mission and the State government recognised our project in the ‘Innovation Category’. The Chief Minister of Assam, Himanta Biswa Sharma, has written an encouraging message for the project report which will be released soon. The model can easily be implemented anywhere in the world. We believe children everywhere have the right to stay healthy, and hope that the vicious cycle is broken sooner rather than later.
Dr. M.S. Lakshmi Priya, District Collector, Bongaigaon district, Assam, is a medical doctor turned IAS officer (2014 batch), from Kerala. The views expressed are personal. E-mail: email@example.com