District Mayurbhanj, Orissa: Kuni Murmu’s fourth child weighed a whimpering 1.4 kilograms at birth, more than a kilogram below the lower limit of the norm. None in the family dared to hope the infant girl would survive. Luca Murmu not only survived but today, ten months later, has moved into grade I malnutrition from grade IV and anganwadi (child health care) worker Bishnupriya Jena guarantees that she will be out of the woods by her first birthday. This would have astonished many before 2004 but not anymore.
Positive Deviance Approach (
Starting with just three, today seventy four AWCs, including Luca’s village Nuagaon, across the economically backward tribal-dominated Udala block in Orissa’s Mayurbhanj district, and 6200 AWCs across the State, have implemented the PDA to tackle infant and child malnutrition.
PDA) is a developmental approach that is based on the premise that solutions to community problems already exist within the community. This approach is based on the belief that a community will learn by example from the positive child and nutrition care behaviour of mothers from their own community and income group, who manage to rear healthy children using the resources available to them. In Orissa, PDA is being implemented through a headline campaign ‘Ame Bi Paribu’, or ‘We Too Can’, in the Integrated Child Development Services (ICDS) - a flagship programme of the Government of Orissa, supported by UNICEF.
The ‘Ame Bi Paribu’ campaign is already producing tangible results. Pediatrician Dr Laxmikant Pati at the Kaptipada sub-divisional hospital, Udala, substantiates the grassroots level improvement. He has seen referral cases of malnutrition (Grade III and IV specifically) in 0 to 3 years children come down from 7-8 per month in 2001 to just 1-2 in 2008. “The community behavioral change due to PDA has been remarkable here” he asserts.
Harapriya Patra, the Child Development Project Officer - a key field functionary of the ICDS - working here for the last fifteen years observes, “There is a sea-change in the behavior of mothers. This can be seen in the informed handling of their sick children. Awareness about cleanliness and availability of safe and sufficient drinking water has improved, consequently child diarrhea is no longer the major concern it was a few years back. Overall, a psychological change has come about… the earlier fatalistic attitude has given way to ‘Ame Bi Paribu’ - it is no longer a slogan, it is an attitude here.”
Sita Tudu’s case clearly exemplifies this change. In all-tribal Dutikadei village, Sita’s daughter Basanti, conceived after ten years of marriage, was born a precarious 1.5 kgs. When Sita refused to go for work so that she could breastfeed her baby, her husband Naika, a farm labourer, often quarreled with her. But Sita remained adamant. She was determined to have the frail infant survive and she knew how she could succeed in doing this. After Basanti completed six months, she brought her regularly to the Anganwadi Centre (AWC) for the rice-lentil gruel and for her weight check. Today, at three years of age, Basanti’s health has substantially improved as has her chance of survival.
Mothers like Sita walk a kilometer to bring their babies to the PD centre; some like Rajali Baske even cross the Sono River to reach the AWC with her one year old because “at home I have to cajole, distract and carry her around to make her eat half the amount she eats here with the other children.” As Urmila Behera, Supervisor of 25 AWCs points out, “A far cry from the pre-PDA days when we went door to door urging mothers to bring their babies to the Centre.”
The ‘Ame Bi Paribu’ campaign seeks to restore to the community the power of taking control of its nutritional problems and disadvantaged communities are doing surprisingly well at taking charge of their own nutritional needs.
Today mothers ensure nutritional balance in every mid-day meal at the AWCs, through the ‘akhsay patra’ or ‘the vegetable basket that is never empty’ into which every mother contributes – be it a home grown papaya, a slice of gourd, a bunch of beans or leafy greens or even a single potato. All this goes into the rice and lintel gruel that is given to babies one to six years old as well as to those who are in malnourished grades II to IV. The PD Centre mothers too contribute as little as even a rupee when possible, to the community health fund for contingencies.
Older persons in the family are converted too, claims anganwadi worker Sumitra Rout. Harmful traditional practices like giving honey and water to a new-born or bathing them immediately after delivery, putting them at risk of pneumonia, are no longer insisted upon. Elders urge pregnant women to not only eat well but munch on puffed rice between meals – a far cry from earlier restrictions on food, lest the foetus grows and poses a delivery risk. Kitchen gardens, always important to tribal households, are getting increased attention.
The involvement of adolescent girls is particularly heartening. Sabitri Hansda, a Class VI student equipped with life-skill training, goes to her neighbours’ homes checking if the drinking water pots are covered and whether the children use slippers and wash their hands with soap. Soap cakes are in; cleaning with ash is out - thanks to the vigil of youngsters like Sabitri. The Sabitris of Orissa hold out a bright promise that the next generation will see ‘smart mothers’ who will need no more institutional hand-holding.