Nutrition Center

Introduction
The magnitude of malnutrition shows that:
• About 47% of children under the age of three are underweight and
46% are stunted
• 74% of children between the ages of 6-35 months suffer from anemia
• About 36% of women 15-49 years are undernourished
• Prevalence of anemia among women is about 52%

Causes of Malnutrition
Maternal MALNUTRITION <5 MALNUTRITION Manifestations

Immediate
Inadequate dietary intake Disease
causes

Insufficient Inadequate Insufficient Health

Household Maternal and Services & Unhealthy
Underlying
Food Security Child Care Environment causes

Inadequate Education

RESOURCES & CONTROL

Human, Economic, & Organizational

Basic causes
Political and Ideological Superstructure

Economic Structure

Source: Adapted from UNICEF

Potential Resources

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 Malnutrition began before mother become pregnant
Child growth failure

Low birth Early Low weight and

weight babies Pregnancy height in teens

Small adult women

The Maternal and Child Nutrition Link

Mother
Mother’s nutrition is important for practicing child-rearing,care and household
economic tasks,and for recovery for future pregnancies

Lactation
Adequate nutrition for the
mother should be maintained
during breast feeding.
Pregnancy
Mother’s nutrition before and
during pregnancy influences
growth and development of the
fetus and its birth weight,
it affects her chances of surviving
the delivery.
At birth
Birth weight is closely associated with child survival and growth
,which influences nutrition in adolescence and determines how
well nourished mother is when she enters pregnancy
At 2 years
Prevention of stunting in girl children during
the first 2 years can help to break the cycle of malnutrition
Adolescence
Nutrient stores built up in adolescence help the
nutrition of women during and between
pregnancies.

Maternal under nutrition can lead to an undernourished baby

• Most of the weight gain of the baby in the womb occurs in the last few
months of pregnancy
• Poor diet and heavy physical work with inadequate rest
• Mother is not well-nourished during pregnancy, she is unable to provide
sufficient nutrients for the body stores of the child

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 • Iron deficiency causes anemia and severe anemia can lead to maternal
and perinatal deaths
• Folic acid deficiency in early pregnancy leads to birth defects (neural tube
defects)
• Vitamin C deficiency leads to anemia
• Dietary iodine deficiency during pregnancy hinders development of the
fetus
Way to address malnutrition: Life cycle pproach
Establishment of Nutrition Center where pregnant women, lactating
mothers and children up to two years of age are provided with nutritious diet
everyday. The center mainly aims for a holistic development of the women by
centrally focusing on improvement of health and nutritional status. The nutrition
center caters to the needs of the most vulnerable classes of the society i.e.
women and children especially from POP and poor families.
In the initial stages, the nutrition center is to cater the nutritional needs of
pregnant and lactating women and children up to two years. In the subsequent
stages its focus will be on extension of Nutrition cum Day care center. The
ultimate vision is to see the center as a forum for Nutrition and health care cum
learning center for women and children to address the issues of malnutrition in
the entire life cycle.
Vision: Center for social and behavior change
All pregnant women, from the day of enrollment of their pregnancy till
6months of lactation period and children between 6months to 2years of age
(i.e.,12 months for the mothers + 18 months for children) can get benefit from
the center by having a nutritious diet everyday. The center must ensure that the
most vulnerable and disadvantaged get the maximum benefit out of it. By
becoming a member at the center, the status of malnutrition and deaths can be
averted especially among infants and pregnant women. The results would slowly
influence the intra household behaviors to provide special attention to women

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and children who are most vulnerable and on demand due to changes in the
physiology.
o Initially the nutrition center is expected to provide nutritious diet as well as
health education sessions for pregnant and lactating women. Health
education sessions will be imparted for pregnant and lactating women,
adolescent girls (would be mothers) and other women from the community.
It is aimed at preparing these women as change agents in the community for
advocacy of preventive and promotive health care measures.
o Enrolled members can get training in some vocational skills which involves
less physical stress and can start an income generating activity.
o The crèche is open for children who do not have support to take care of them
at home when their parents go to filed. Preference shall be given to children
from POP/poor families.
o Finally, this center shall become a center for social change with the
counseling sessions conducted for husbands and mother-in-laws of the
members attending the center.
How to Operationalise?
1. Pre requisites to start a Nutrition center:
a. VOs with strong Institution Building: regular SHG meetings, regular
internal lending and repayments, participation in social activities in the
community.
b. VOs with Food security in place.
c. VOs with regular savings for health and health risk fund in place.
2. Cost estimates to start a Nutrition Center
As per NFHS-2, the percentage of pregnant and lactating mothers in 1000
population is 3.51. In a VO with 25 SHGs, approximately 1500 population will
be present. Of them approximately 50% of them will be from POP and Poor
families. So, each VO will have approximately 26 pregnant and lactating
mothers together. But it may vary from district to district.

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 Cost estimation shall be made keeping in view the recommended dietary
intake by pregnant and lactating women, the present cost of food items in
the market and cost of other activities involved such as fire wood and a
helper for cooking.
a. The diet prescribed for pregnant and lactating women
recommended by Indian Council for Medical Research (ICMR):
Pregnant Women Lactating mother
Quantity per day Quantity per day
Food items (in grams) (in grams)
Cereals 400 450
Pulses 55 65
Leafy 150 150
Vegetables 75 75
Roots and tubers 75 75
Fruits 30 30
Milk 225 225
Oil & fats 40 50
Sugar/jaggry 30 50
Meat, fish, egg 40 60

b. Cost estimates: ( where comprehensive Food security is in place)

Ready reckner for cost estimates to run a Nutrition center by Village
organisation- Pregnant women_lactating women

Food provided for 25 days

Food cost per member per day is Rs 16/day

FSL cost is Rs 8/member/day 50%of FSL income Rs4/-member contribtuion

Member contribution@Rs4 per day per member

S.No Particulars 10 members 20 members 30 members

1 Total cost per month 16*10*25= 4000 8000 12000

2 FSL component 8*10*25=2000 4000 6000

Effective cost per month
3 towards additional diet & 2000 4000 6000
Contribution from member
4 @Rs4/member/day 4*10*25=1000 2000 3000

5 Expected FSL net income 2000 4000 6000

50% of FSL net income as
6 contribution to Nutrition center 1000 2000 3000
Funds availabiltiy to meet the
9 effective cost=4+6 1000+1000=2000 2000+2000=4000 3000+3000=6000

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Ready reckner for cost estimates to run a Nutrition center by Village organisation -
Pregnant women_lactating mother_Children

Food provided for 25 days

Food cost per member per day is Rs 16/day

FSL cost is Rs 8/member/day; 50%of FSL income ;Rs4/-member contribtuion; Rs2/-ICDS support

Member contribution@Rs4 per day per member

S.No Particulars 10 members 20 members 30 members

1 Total cost per month 16*10*25= 4000 8000 12000

2 FSL component 8*10*25=2000 4000 6000

Effective cost per month
towards additional diet &
3 overheads(Mother) 2000 4000 6000
Effective cost per month
towards additional diet &
overheads(6months-
24months) 3*4*25=300;
4 4*5*25=500 300+500=800 1600 2400
Effective cost per month
towards additional diet
5 +overheads(Mother+Child) 2000+800=2800 5600 8400
Contribution from member
6 @Rs4/member/day 4*10*25=1000 2000 3000

7 Expected FSL net income 2000 4000 6000

50% of FSL net income as
8 contribution to Nutrition center 1000 2000 3000

9 JSY 834 1668 2502

10 60%of Janani Suraksha Yojana 500 1000 1500

Expected funds from ICDS
11 @Rs2/child/day 2*7*25=350 2*14*25= 700 2*21*25=1050
Funds availabiltiy to meet the 1000+1000+850 2000+2000+1000+700 3000+3000+1500+1050=
12 effective cost (6+8+9+10+11) =2850 =5700 8550

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 c. Sources of finance :
i. Social CIF: Release of HRF @ 100000 per VO with 25 SHGs.
ii. Beneficiary contribution:
o In the form of dry ration as a member share in the family taken
under FSL ( @Rs 8/day for 2 meals)
o Contribution as cash @Rs 2/ meal (Rs 4/day for 2 meals)
iii. Use 50% of the profits available with VO due to
implementation of comprehensive food security line.
iv. From the interest on corpus available at VO (or ) on HRF
amount/grant released
v. Source of funds to be tapped from line departments
a. From ICDS :
o @Rs 2.00 per beneficiary per day
b. From Janai suraksha Yojana (JSY)
o @Rs 1000 per pregnant women = 1000
3. Options for sustainability
i. Integrating with comprehensive food security line: obtain
contribution in the form of kind from their regular ration allocated as
a member of the family and a minimum beneficiary contribution per
meal to have foods during pregnancy/lactation. It covers 2/3rd of the
budget required and the rest 1/3rd can be tapped from line depts.
such as ICDS and health dept or can meet from the interest
accumulated /50% of the profit gained due to implementation of
comprehensive food security programme at VO. (Vizag model)
ii. Use of interest generated on the corpus available under HRF in a VO
and give it as loan to pregnant and lactating mothers
iii. Sanction of social CIFSP @2.50lakhs to establish Nutrition centers
as per need based.

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 iv. Providing IGAs to the member/husband and to collect user fee on
daily/weekly /monthly basis.
v. Purchase of land under land development component: This is for
development of Community gardens and use the profits for running
nutrition centers.( long term approach).
vi. Inviting donations for development Nutrition centers as centers for
social change in all the VOs as project has limitations to provide
immediately to all the VOs . This is to continue till all the VOs have
comprehensive food security is in place.
4. Extension of Nutrition cum Day care centers
d. Once the Nutrition centers are stabilized, it can be extended as day
care centers to keep the children till their mothers come back from the
field.
e. The services of aged women who receives pensions in the village and
have no family support may be kept as incharge by providing lunch at
the nutrition center or by giving payment (@200/month by VO as they
decide).
f. Play equipment can be provided for the children to develop their motor
and intellectual skills before they enter in the primary school.
g. Feasible option would be the convergence with dept of WD&CW to
extend the services of AWW who are trained in pre-school Education
for which the VO can give honorarium for the extended hours beyond
1.00pm at AWC.
So, the budget requirement for the pre-school activities may not be
required immediately as there is every possibility for the other depts to
come and converge with the VOs after demonstrating the models on
community managed Nutrition centers. Otherwise, the donations received
shall be utilized for development of day care centers.

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5. Monitoring and monthly MIS
a. Progress of the beneficiaries can be measured by using indicators like:
o Hemoglobin levels
o Birth weight of the child
o Health awareness levels
b. Baseline Data and monthly progress relating to these indicators can be
measured and analyze the progress of the beneficiaries.
c. Maintenance of separate accounts in case of donations received and send
a copy of both physical and financial progress of the center to the donor.
d. Encourage the children of donors in case of NRIs to come and spend time
during their vacation and evaluate the progress along with the
community.
6. Responsibilities of Health activist and Health sub communities for
smooth functioning of Nutrition centers
a. The roles to be performed by HA:
o Should identify the eligible beneficiaries (pregnant and lactating women
and children in the age group of 6months to 2 years belong to PoP and
Poor groups) in the village and bring them to the notice of Health Sub-
committee.
o Should conduct training programs on health and nutrition topics using
effective audio-visual means of communications.
o Should also monitor the progress of the beneficiaries and their children at
the center.
o Should conduct home visits and induce behavior change at household
levels, to promote health.
o Should organize counseling sessions to the husbands and mother-in-laws
of the members attending the center.
o Should maintain Daily attendance register, stock register, expenditure
register and ANC register.
o Should assist in preparation of weekly menu at the center.

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 b. The responsibility of the Health Sub-committee members:

o Selection of a SHG member to cook food at Nutrition center with wage

compensation for the time dedicated.
o Maintenance of a separate bank account for the CIF amount deposited
on the names of one health subcommittee member and one VO –OB
member.
o Monitoring of Daily attendance register, stock register, expenditure
register and ANC register.

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 Sequence of activities to be accomplished to
establish Nutrition centers
1. Dialogue with VO to introduce the concept of Nutrition center and discuss
the options for sustainable models such as:
a. Vizag model ( 2 meals @ Rs 16/day): Integration with
comprehensive food security programme.
• Integrating with comprehensive food security and additional cash
contribution @Rs 2 per meal ( Rs 8+ Rs4=Rs 12)
• Interest accumulated on social health fund released and the VO will
also use profit from implementation of comprehensive food security for
any other expenditure considering it as a social cause.
• Facilitating funds from ICDS (Rs 1.40/pregnant women/day)
• Release of funds available under Janani suraskha yojana to VO and
use of 80% of funds towards diet (Rs 800/per women/year: @
Rs2.60/day ) (ICDS and JSY funds will fill the gap of Rs4/day)
b. Release of exclusive grant to VO for establishment of Nutrition
centers.
c. Release of more amount of Social health fund to VO where they
have regular health savings and interested to run nutrition
centers.
d. Sanction of IGAs for generating income to sustain its activities
beyond project period.
e. Inviting donations from NRIs
2. Develop operational plans for implementation of the scheme
3. Orientation to VO EC members, health sub committee members and Health
activist.
4. Identify the other related activities that can be implemented using the same
forum such as:
• Nutrition and health education sessions by HA,AWW and ANM

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 • Skill building sessions to enable them to take up IGA activities that are
involved with less physical activity.
• Extension center for child care
5. Training of personnel identified for cooking on hygienic preparation and
nutritious recipes.
6. Preparation of a menu using locally available food items.
7. Regular and transparency in the accounts to be maintained
8. Submission of monthly MIS by HA in consultation with Health sub committee
members on functioning of Nutrition center.

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