SWABHIMAAN 2.0


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Background

Women’s groups based interventions have emerged as prominent strategies to tackle malnutrition. Swabhimaan (2017 – 2021) was one such maternal nutrition intervention led by women’s groups under the National Rural Livelihoods Mission in three Indian states; Bihar, Chhattisgarh and Odisha. This received technical support from UNICEF India and has a nested impact evaluation.

The COVID-19 pandemic and multiple lockdowns however, disrupted women’s groups led counseling and awareness interactions. In the context of restricted mobility, tele-based awareness generation and monitoring of programme activities through women group members emerged as programmatic adaptations. It was recognized that such interventions can help continued key messaging during lockdowns and can supplement face-to-face interventions through increased coverage of target groups. However, the effectiveness of systematically combining tele-based awareness and counseling with face-to-face group/door step counseling is yet to be evaluated at scale. Further, the pandemic has also underscored the need to address gender disadvantage and psychosocial determinants of mental health and nutrition.


Objectives

The current intervention ‘Swabhimaan 2.0’ seeks to build upon lessons from Swabhimaan. It aims to:

I. Adapt existing multi-sectoral nutrition programmes operational through women self-help groups to be COVID-19 sensitive and have greater reach with the addition of 3 new elements

(i) integrated counseling for nutrition, obstetric and mental health

(ii) using tele-based methods and

(iii) gender transformative interventions

II. To develop programmatic know-how, assess the “added value” and challenges of engaging community-based resource persons to do the following, at scale:

  • Improve nutritional status, reduce gender disadvantage, improve mental health and wellbeing of adolescent girls, pregnant women (including pregnant adolescents), mothers of and children under two
  • Support adaptation of ongoing community-led nutrition programmes for tele-mode.
  • Capacitate frontline workers and CRPs to recognize and report gender based discriminatory practices, violence, abuse and signs of psychological distress among target groups through simple and culturally acceptable screening methods
  • Capacitate frontline workers and CRPs to support referrals to existing programs in the state like the District Mental Health Programme and WCD One Stop Centers

Geographies

StateDistrictPoverty Block
BIHAR12
CHHATTISGARH69
ODISHA33
TELANGANA33
ASSAM1330
MADHYA PRADESH24
Total2851

Evaluation Sites
Name of the StateName of the DistrictBlock Names
CHHATTISGARHBastar DistrictBakawand and Bastar Block
TELANGANASangareddyZeherabad ULB and Sangareddy ULB

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Target Groups

Primary Target Groups
1.Adolescent girls (10-19 years)
2.Newlywed couple (within 1st year of marriage)
3.Pregnant Women (including pregnant adolescent girls)
4.Mothers and their children under 2 years of age
Secondry Target Groups
1.Husbands of Pregnant Women
2.Husbands of Mothers of children under 2
3.Mothers-in-law
4.Fathers of adolescent girls
5.Adolescent boys

Strategies

The intervention will test three broad strategies

Face to face group-based interventions

Using tele-based counseling

A gender transformative approach


Interventions

Programming will address both the supply and demand.

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Systems strengthening interventions:

  • Building enabling environment
    1. VHSND/PMSMA strengthening
    2. Ensuring supply in place - IFA red, calcium, de-worming, IUCD, oral pills, condom, injectable contraceptive MPA (under Antara Programme) etc
  • Capacity building
    1. Sensitisation and training of District Mental Health Programme (DMHP), One stop Centre Counsellors (OSC), Medical Officers, ANM, ASHA on use of tools for depression and anxiety risk assessment.
    2. Promotion of women's helpline (WCD anchored).
    3. Development of guidelines for psycho-social support during peri-natal phase.
  • Monitoring and review
    1. Monthly review meetings at block/ district level on system strengthening initiatives.
    2. Generating biannual score cards using government systems data and tele-monitoring in sentinel sites.

Community-led interventions

  • Capacity building
    1. Online and face-to-face training of FLWs/CRPs on health, nutrition, gender and mental health to conduct participatory meetings, identification of at-risk (using videos, and case-based vignettes).
    2. Self-taught call-based refresher modules for FLWs/CRPs.
    3. Shakti Aunty’chatbot for FLWs to share information, support referral to the DMHP and follow-up.
    4. Training FLWs/CRPs to maintain a database of primary target groups to support enrolment into m-health programmes
    5. Developing a core group of trainers on the integrated package at national, state and community levels to support training and provide on-ground hand-holding support for FLWs/CRPs
Interventions

Adolescent Girl

Newly Wed Couples

Pregnant Women, Mothers of children under 2

Husbands

Adolescent Boys
Face to Face Interventions
Group-based meetings using counselling cards and other participatory methods
Monthly group meetings ‘Parivaar chaupal’ or family meetings
Monthly Screening and assessment for at-risk women (thin, obese, anemic, anxiety, depression)
Monthly home visits to those at-risk and their family members
Mobilisation to adolescent health day/ VHSND services
Linkage to referral services such as NRC, DMHP, OSC
Linkage support to access addressing vulnerabilities set-up of backyard poultry from Village Organisations SHGs
Linkage support to access addressing vulnerabilities set-up of backyard poultry from Village Organisations SHGs
Tele-Based Interventions
Linkage to Kilkari calls with peri-natal care
Weekly out-bound calls (Maitri-Kishori calls) on messages on health, nutrition, gender and mental health
Linkage to (mental health professional) telephonically – at least one a month
Linkage to gynaecologist telephonically – at least one a month
Linkage to paediatrician telephonically – at least one a month

Impact evaluation sites (Chattisgarh and Telangana) and indicators

  • Low Body Mass Index
    1. Adolescent girls (10-19 years) and Mothers of children under two with Body Mass Index <18.5 kg/m2 (%)
    2. 2. Pregnant women with MUAC <23 cms (%)
  • High Body Mass Index
    1. Pregnant women and Mothers of children under two with Body Mass Index >=25 kg/m2 (%)
  • Mental Health
    1. Adolescent girls (10-19 years), Pregnant women and Mothers of children under two reporting Patient Health Questionnaire-9 score >=10 (%)
    2. Adolescent girls (10-19 years), Pregnant women and Mothers of children under two reporting Generalized Anxiety Disorder-7 score >=10 (%)
  • Gender Disadvantage
    1. Adolescent girls (10-19 years), Pregnant women and Mothers of children under two reporting score >=1 on Checklist for Assessment of Gender Disadvantage (CAGED) (%)
  • Resilience
    1. Adolescent girls (10-19 years), Pregnant women and Mothers of children under two reporting score <=2.99 (low resilience) on Brief Resilience Scale (%)
  • Family Support
    1. Pregnant women and Mothers of children under two who reported change in family support (Maternity Social Support Scale) (%)

Stakeholders and Roles

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