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Malnutrition has become a situation that haunts the lives of millions of children in India. With 1 in every 3 children malnourished in the country, India has the maximum number of malnourished children in the world. The effects of malnourishment is dangerous and irreversible if it occurs at a young age leading to permanent disabilities which will render the child ill for the rest of their lives.

Our Approach

As we designed the TSU work in 2014, we postulated that in addition to direct technical assistance at frontline operational levels, sustainable change required that we catalytically engage the two programs to

  • a) Improve public health leadership and managerial skills
  • b) Sharpen focus on outcomes and gain ability to use data and be driven by evidence and strengthened internal accountability
  • c) Strengthen core systems within both programs to provide an enabling environment for effective implementation of RMNCHN interventions.

Scale of Intervention on the groundNutrition Intervention on the ground

The mandate during 2010- 2013 was to engage with Health programs of the GoB to improve the coverage of a range of RMNCHN interventions at a scale of eight districts (~28 m population), using creative yet replicable ways of improving frontline worker performance, appropriate to the challenging context: sharply defined intervention priorities, better tools, job aids, skill-building, improved last-mile supervision.

It became equally clear by 2013 that the responsiveness of the FLWs and nurses to our interventions were not matched by more than a lukewarm response from the program leadership itself. Thus, the scale-up technical assistance plans evolved into a Technical Support Unit, with work under a fresh grant kicking in effectively in mid-2014 and spreading across all 38 districts of Bihar.



Weak New Born Tracking : Including mechanisms of mentoring, supervising and supporting FLWs to focus on delivering services and support equitably to all families, robust name based tracking systems, logistics for ensuring supplies at the last mile.


VHSND platform: The TSU, under a smaller separate grant attempted to explore another channel to promote FLW-family interactions, besides home visits, since FLWs could not be persuaded to increase home visits. The monthly VHSND platform was redesigned with the help of a number of partner agencies (BBC, CKS) in an attempt to make the platform attractive for mothers and children to attend, and more reliable in terms of the availability of a range of supplies including nutritional supplements, contraceptives and ORS-Zn.