GOVERNMENT OF MEGHALAYA

SOCIAL WELFARE DEPARTMENT

(WOMEN & CHILD DEVELOPMENT)

SEPTEMBER 2021
Mobilising collaborative actions to
improve nutrition status of
SAM and MAM children

A Case Study of Meghalaya

 Contents
1. PROBLEM STATEMENT 1

2. HOW DID CHANGE BEGIN? 3

3. PROBLEM DRIVEN ITERATIVE ADAPTATION (PDIA) APPROACH TO SOLVE THE PROBLEM

OF MALNUTRITION IN CHILDREN IN MEGHALAYA 5

4. STEPS TAKEN TO ADDRESS SAM AND MAM CHILDREN THROUGH COLLABORATION

WITH OTHER DEPARTMENTS AND THROUGH LOCAL INNOVATIONS 13

5. IMPACT: DRASTIC REDUCTION IN SAM AND MAM CASES 18

6. THE ROAD AHEAD 20

7. CONCLUSION 22

8. STORIES OF RECOVERY OF SAM CHILDREN 23

9. ANNEXURE 1 26

10. ANNEXURE 2 31
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1. PROBLEM STATEMENT
Historically, the improvement of health and nutrition indicators for pregnant women and young children
has been challenging for Meghalaya, one of the states with the highest percentage of indigenous
population in North-East India. As per NFHS-4 Meghalaya report, only 35.8 percent of children
under six months were exclusively breastfed and only 23.6 percent children (6-23 months) received
an adequate diet (Inadequate complementary feeding during the weaning period is thought to be a
significant contributor to child malnutrition in India) (NFHS-4). In entirety, the critical indicators for health
and nutrition were below the national average.

A 2019 World Bank Pilot Study conducted in Meghalaya titled ‘Community-led Pilot in Meghalaya
to Improve Early Childhood Development Outcomes’1 shows more than 40 percent (43.8 percent) of
under-five children were stunted (low height/age ratio), 15.3 percent wasted (low weight/height ratio)
and 29 percent underweight (low weight/age). Micronutrient deficiencies were high - 48 percent of
children aged 6-59 months were anaemic, 56.2 percent of women in the reproductive age group and
32.4 percent in men were anaemic. Meghalaya fares poorly in critical health indicators as per the
comparison data seen in Table 1.

Table 1: Performance of Meghalaya in health indicators

Health indicators Meghalaya India

Stunting among children 44% 38%

Anemia among pregnant women 53.30% 50.40%

Infant Mortality (infant deaths for every 1000

34 32
live births)

Maternal Mortality
197 113
(Maternal deaths per 100,000 live births)
62.3 70
Life Expectancy

*NFHS-4 Meghalaya Report

The situation demanded immediate attention and Meghalaya sought to turn things around with a
dedicated intervention. On 29th August 2019, the Hon’ble Chief Minister of Meghalaya, Shri. Conrad
K. Sangma held a review meeting with ICDS officials and all Deputy Commissioners for initiating the
Poshan Abhiyan and observing ‘Poshan Maah’ in the State. This also witnessed attendance of Union
Cabinet Minister for Women & Child Development, Smt. Smriti Zubin Irani, who assured all assistance to
the State in this respect. Nutrition was selected as a target area for intervention.

On 8th August 2020, the Hon’ble Chief Minister of Meghalaya along with the Minister, Social Welfare
Department, Shri Kyrmen Shylla held a review meeting with all the Integrated Child Development
Services (ICDS) officials. These events were important for generating focus and much-needed attention on
the issue.

1
Community-led Pilot in Meghalaya to Improve Early Childhood Development Outcomes- a 2019 report by World Bank:
[Link]
Childhood-Development-Outcomes

1
Visit of Hon’ble Union Cabinet Minister for Women & Child Development, Smt. Smriti Zubin Irani at Umdihar
Anganwadi Centre in Meghalaya, along with Hon’ble Chief Minister of Meghalaya Shri. Conrad K. Sangma
in August 2019
Following this, in just 6 months, Meghalaya recorded 93% recovery of Severe Acute Malnourished
(SAM) and 97% recovery of Moderate Acute Malnourished (MAM) children (identified in September
2020). This has been the highest recovery in terms of nutritional indicators in the State so far. While
these figures mark the preliminary success of an ongoing intervention, they also speak of the systemic
improvements within state machinery. The study attempts to highlight unique practices, adaptations and
accountability measures that have proven successful in building state capability while enabling local
agents to become effective problem-solvers in this respect.

This case study is a rare example of how collaboration between

various departments, regular monitoring of target indicators,
building accountability among various actors by promoting
decentralised adaptive leadership and use of data for effective
decision-making led to the overall strengthening of State Capacity
in effectively addressing a complex challenge, like nutrition in
Meghalaya.

2
2. HOW DID CHANGE BEGIN?
A key element responsible for the jumpstart of nutrition intervention in Meghalaya was the sense of
urgency expressed by the leadership, an energetic environment first created by the launch of POSHAN
Abhiyan to combat malnutrition. Since then, the month of September is observed as ‘POSHAN Maah’
with a view to carry out special dedicated activities ushering in behavioural change in the society.

By leveraging the existing environment for momentum, for the first time in Meghalaya, an extensive
drive was held from the month of September 2020 for identification and tracking of children with SAM,
along with the rest of the country. This was a major focus during the third anniversary celebration of
Rashtriya Poshan Maah in September 2020. Improvement of child nutrition as an indicator of Health
was taken up on a mission mode.

This was complemented with weekly granular monitoring of SAM and MAM children at the State level
by the Principal Health Secretary himself, often chaired by the Hon’ble Chief Minister. Again, this
was an exercise that was never done before at the State level, and not with this frequency. These
weekly review meetings witnessed the attendance of representatives of three departments involved
in the process of correction of SAM and MAM children- Social Welfare Department (Women & Child
Development) through the ICDS Officials, Community and Rural Development Department through the
NRLM Programme Staff and the Health Department Officials. A culture of synergy and collaboration
was being created between the three departments.

Following the intensive drives and frequent monitoring as part of Rashtriya Poshan Maah, the status of
SAM and MAM children in Meghalaya was revealed. It also threw light on the fact that more than 80%
of families with SAM and MAM children belonged to the BPL category (based on SECC deprivation
indicators).

3
Table 2: Status of SAM & MAM children identified during Poshan Maah in September 2020
Districts No. of SAM SAM children Percentage No. of MAM MAM Percentage
children in BPL children children in
category BPL category
East Khasi
455 411 90.33 3596 3092 85.98
Hills
Ri Bhoi 41 41 100 437 437 100
West Jaintia
423 383 90.54 3642 2493 68.45
Hills
East Jaintia
268 169 63.06 1742 1567 89.95
Hills
West Khasi
258 238 92.25 2070 1987 95.99
Hills
South West
83 75 90.36 1205 1168 96.93
Khasi Hills
West Garo
168 135 80.36 2326 2000 85.98
Hills
South West
39 39 100 760 760 100
Garo Hills
South Garo
39 39 100 381 381 100
Hills
East Garo 9 8 88.89 40 23 57.5
North Garo
5 3 60 128 33 25.78
Hills
TOTAL 1788 1541 86.19 16327 13941 85.39

*Data Source: Social Welfare Department (Women & Child Development), Government of Meghalaya

4
3. PROBLEM DRIVEN ITERATIVE ADAPTATION
(PDIA) APPROACH TO SOLVE THE PROBLEM OF
MALNUTRITION IN CHILDREN IN MEGHALAYA
Meghalaya has used a multi-dimensional, adaptive approach to address low nutritional indicators,
inspired by “Problem Driven Iterative Adaptation” (PDIA), an adaptive management approach
developed by faculty at Harvard Kennedy School of Government. Its key principles can be visualized
as follows:
Local Solutions for Local
Problems
Allowing the local nomination,

1
and prioritization of concrete
problems to be solved.

Pushing Problem Driven

Positive Deviance

2 Complex problems do
not have straight-forward
solutions, but there may be
Four Key Principles of potential solutions in local
Problem-Driven success cases.

Iterative Adaptation
(PDIA)
Try, Learn, Iterate, Adapt

3 Promoting active experimental

learning with feedback built
into regular management that
allows for quick adaptations.

4 Scale through diffusion

Engaging multiple agents across
sectors and organisations to
ensure reforms are viable,
legitimate and relevant.

Figure 1 shows the four principles of Problem Driven Iterative Adaptation (PDIA) used for addressing the
problem of malnutrition among children in Meghalaya

5
The adoption of a PDIA inspired process through weekly reviews of the State’s POSHAN or Nutrition
status among children allowed for surfacing the problems which were leading to malnutrition, ideating
upon potential solutions, and increasing accountability for actions taken to address the problem - 3 core
elements of the PDIA process.

3.1 PDIA in action to solve the challenge of malnutrition among children

“There is a high dependence on State leadership to solve local

problems and there is lack of communication among key officials
and departments”.

As part of POSHAN campaign, the issue of Nutrition was resolved to be targeted on a war footing by
State and the following steps were taken under PDIA:

• Weekly Reviews: A system of Weekly Reviews was instituted where all districts and block-level
officials discussed key challenges with respect to nutrition and provided updates on weekly action
plans. These reviews created a sense of responsiveness and urgency. The officials also took more
ownership of the problem and developed local solutions.

A glimpse of the virtual, weekly review meetings with the Deputy Commissioners and officials of Health
& Family Welfare, Social Welfare (Women & Child Development) and Community & Rural Development
Departments, Government of Meghalaya

6
• Workshops: Two workshops on Problem-Driven Iterative Adaptation (PDIA) for health officials
and Deputy Commissioners were held between December 2020 - January 2021. Through these
workshops, the officials learned some new methods for addressing complex challenges through
weekly action.

Former Chief Secretary of Meghalaya Shri. M.S Rao, IAS alongside Principal Secretary of Health and
Social Welfare (Women & Child Development) Departments, Shri. Sampath Kumar, IAS and Commissioner
& Secretary Smt. Merylin Nampui, IAS, chairing the workshop on SCEP for all Deputy Commissioners held
in December 2020 in Shillong, Meghalaya

• Using Data Effectively: During this extensive drive for identification of SAM and MAM children
during the Rashtriya Poshan Maah Celebrations in September 2020, Anganwadi Workers were
engaged in physically measuring the height and weight of children at the Anganwadi Centres
every month. Based on these data, SAM and MAM children were identified. Of the total number
of 4,20,883 children between 0 to 5 years, 358,056 children were weighed in the month of
September 2020. Anganwadi workers (AWWs) were trained by the district functionaries on the
correct way of using basic instruments like infantometer, stadiometer, and weighing scales. It was
also ensured that handholding support was provided to the field functionaries whereby the District
Project Officers (DPOs), CDPOs, Supervisors were physically present with selected AWWs (those
who still needed guidance) during the weighing and measuring process so that the measurements
were correctly undertaken.

7
 AWW checking the weight of children at the Anganwadi Centre

Since Anganwadi Centres were closed during the peak of the COVID-19 pandemic, efforts were also
made to continue the identification of SAM and MAM children by the AWWs through regular house-
to-house visits. The DPO, CDPOs, Supervisors would often visit the houses along with the AWWs. The
real-time data collected during this process greatly helped with the analysis, which in turn has improved
with informed decision making.

8
 AWW measuring the height of an infant using the infantometer during a house visit

The POSHAN tracker (Common Application Software or CAS) as well as manual format of entering
data by Anganwadis related to child health and nutrition was reviewed minutely and any challenges
faced by the grassroot workers was discussed in the forum. Focus of officials was being shifted from
simply reporting the data to actually analyzing the data. This helped to identify and address problems
that are solvable but do not receive enough attention.

• Tracking Actions: All actions were tracked verbally during weekly review meetings. This also
helped to identify key learnings and ideas from one district that could be scaled across other
districts. A culture of learning and adaptation was built in the process.

• Activating Leadership and Accountability: Focus was laid on the “Decentralized Catalytic
Leadership” (DCL) Model. As per this model, officials in different departments (Social Welfare
(Women and Child Development), Health & Family Welfare, Community & Rural Developments)
take ownership of different aspects of the problem and collaborate across silos to make meaningful
progress. A visual representation of the DCL model in practice in Meghalaya can be seen in the
following figure.

9
 DECENTRALISED CATALYTIC LEADERSHIP MODEL

• PHC/CHC as the node for

healthcare

• PHC/CHC level Maternal

PHC/CHC and Child

• Mortality Reduction Plan to

be developled

• Monthly revieew of
Objectived and Key Results
(OKRs)

BDO MO CDPO

Poverty Clinical Anaemia • Address poverty and

gender issues
Gender Management Nutrition
• Create facilities for
CATALYST ROLE enabling supply and
Public Health Public Health
addressing demand
Action - Immunization
- Joint Visit for
- AAA
ANC and PNC
- VHND
- VH

Enables Supply Side Demand Side

Interventions Interventions

• Create demand for services

through Health & Gender
Forums in every village-
Women SHG Platforms (MOTHER community platforms) level SHG federations
LEADERSHIP ROLE
• Involve community leaders

Figure 2 shows the “Decentralized Catalytic Leadership” (DCL) Model which is in place in Meghalaya to
address systemic issues related to health and nutrition indicators
The PDIA approach is part of the State Capability Enhancement Project (SCEP), which was launched
in Meghalaya in December 2020 to address complex development challenges through a collaborative
effort to bring about systemic interventions. An SCEP workshop was conducted for all Deputy
Commissioners (DCs) in Shillong on December 17, 2020. Here, the Chief Secretary urged DCs to adopt
a war footing to address the challenge posed by the state’s weak nutritional indicators. The workshop
introduced DCs to the concept of SCEP and focused on application of PDIA approach towards solving
complex issues identified within the various districts in particular and the State in general. As part of
SCEP, a 5-pillar framework was adopted by the State to address malnutrition:
10
 SCEP PILLARS PROCESS RESULTS

Mobilising local administration, field

functionaries and community leaders Nutrition was accorded attention
BUILDING ADAPTIVE LEADERSHIP
to identify adaptive challenges at the State level, causing quick
USING PDIA
and solve local problems through decisions and actions
discussions and structured processes

Collecting real-time data and

Identification of 881 SAM and 6154
feeding it into decision support
DATA ENABLED DECISION MAKING MAM children between October
systems (Poshan Tracker) to facilitate
2020 to May 2021
evidence-based decisions

Identifying roles, responsibilities, Targeted action points for

GRANULAR PERFORMANCE and deliverables of every person, functionaries of each department
MONITORING and implementing outcome-based (Health, C&RD and WCD) was laid
performance evaluation down after deliberations

Weekly review meetings created

Streamlining operations, by removing
a push for functionaries involved in
layers and developing communication
the process, while providing them
CREATING RESPONSIVE SYSTEMS channels; breaking the glass ceiling
a platform to initiate discussions
and generating accountability
and acting as a knowledge sharing
through processes like Social Audit
platform
Each community was faced with its
own set of unique challenges and
they devised unique strategies to
address the problem of Nutrition.

The State brought an enabling policy

for promoting women leadership in
Village Employment Councils. There is
a lot of focus on leveraging the 3-tier
model of women SHGs under NRLM
Addressing the underlying systemic
as ‘social development’ platforms.
issues requires innovative approach
INNOVATIONS FOR SYSTEMS and far-sighted vision. This needs This led to greater participation of
CHANGE new policy formulation and use of women in all development activities.
science and research for removing
For example, Involvement of women
the systemic barriers.
SHGs in not only identification of
SAM children but also providing them
nutrition and supporting the SAM
families with SHG interest-free loans.

Meghalaya has also conceptualised

the State ECD Mission to unleash the
full potential of children by utilising
latest research in the field of science
of early childhood / brain sciences.

11
 Adaptive
Leadership

Incubating Data Enabled

Innovations Decision
Making
5 Pillar
Framework

Granular Restructuring for

Performance Responsiveness
Monitoring

Figure 3 shows the five pillar State Capability Enhancement Project (SCEP) framework conceptualised to
address development challenges in Meghalaya

12
4. Steps Taken to Address SAM and MAM Children
through Collaboration with other Departments and
through Local Innovations
4.1. Capacity building on identification of SAM and MAM children
Under Poshan Abhiyaan, capacity building of the programme functionaries was envisaged as an
important topic, as it would help them become more effective by learning to plan and execute each task
correctly and consistently. To enable this, the Incremental Learning Approach (ILA) was introduced, which
is a system that enables incremental learning where learning agenda are broken into small portions of
doable actions, thus helping the functionaries to internalise the teachings completely.

In Meghalaya, capacity building of functionaries on identification and management of SAM/MAM

children was conducted in collaboration with the National Institute of Public Cooperation and Child
Development (NIPCCD), Guwahati in September 2020. This capacity building programme was conducted
for the State level functionaries and through them the field functionaries were trained. It was through this
training programme that the 5896 AWWs of the State were taught about SAM and MAM children and
their identification and management through Module 8 & 13 of the ILA, which focused on ‘Identification
of undernutrition: Weight and height measurement- management of undernourished children’.

To ensure effective implementation of the tasks (eg, monitoring of weight/height of children, etc), regular
follow-ups are conducted by the CDPOs and Lady Supervisors and it is ensured that necessary training
and support is provided especially to slow learners.

Regular monitoring is also carried out by the State Government through reviews to ascertain correct
data and efficiency of the grassroots workers.

4.2. Mass drive for identification of SAM and MAM children and promotion of nutri-
gardens as part of Poshan Maah celebrations 2020
As part of the Rashtriya Poshan Maah celebrations in September 2020, several activities were carried
out through the Social Welfare Department (Women and Child Development). The theme of Poshan
Maah 2020 as declared by the Government of India focused on two aspects – the identification of SAM
children and promotion of kitchen gardens.

4.2.1. Identification and management of SAM and MAM children

Identification of SAM and MAM children in the State was done through the ICDS, where children were
physically examined by the AWWs. As a result of this exercise, the number of SAM children identified
in September 2020 was 1788 and that of MAM children was 16,327. These identified SAM and
MAM children were reviewed and managed through the Anganwadi Centres (AWCs) or the Nutrition
Rehabilitation Centres (NRCs) as per the requirement. Management of SAM and MAM children was
done through the provision of either supplementary nutrition or through therapeutic supplements at the
NRCs, along with continuous monitoring so as to ensure that these children meet their growth standards.
Special attention was given to the Severely Malnourished Children by supplementing them with double
rations so that their nutritional compensations are met within a shorter time frame. It must be mentioned
here that the State has a total of 6 NRCs only, which are located at the respective district headquarters.
To ensure that SAM children requiring medical care at NRCs have access to the required services,
PHCs and CHCs also have been used as NRCs for those locations that did not have these centres.

13
To boost the identification of the SAM and MAM children, the State took a collaborative approach
of involving the Self-Help Groups (SHGs) and Village Organizations (VOs) of the National Rural
Livelihood Mission in this exercise. The SHG members were mainly involved in the mobilisation of women
with children below 6 years of age, whereby they advised such women to take their children to the
Anganwadi Centres for a physical check-up. Some of the SHGs and VOs were also trained by the
Social Welfare Department (Women and Child Development) on the identification of SAM and MAM
children and were able to identify SAM and MAM children through the support of the ASHA, AWW
and ANM. Based on the recommendation, the SHGs also took the responsibility of taking the referral
cases to the PHCs or CHCs. Apart from this, SHGs were also involved in awareness programmes, rallies
and other programmes during the Poshan Maah celebrations.

Complementary Feeding programme organized by the Iatyllilang Village Organization along with the
AWWs and ASHAs as part of the Poshan Maah Celebrations

4.2.2. Promotion of Kitchen Gardens/Nutri-gardens/PoshanVatikas

Kitchen gardens were widely promoted as part of the PoshanMaah celebration [Link] gardens
were encouraged to be set up in AWCs and also by the AWWs at their homes. As of September 2021,
there were 3897 AWCs where nutri-gardens had been set up against the total number of 5896 active
AWCs in collaboration with the SHGs and MGNREGA. Details of the same are given in the following
table.

14
Table 3: Total number of nutri-gardens set up at AWCs as of September 2021 across Meghalaya

AWCs covered Detail of plantations under Poshan Vatikas

Functional
District for Poshan Medicinal Green
AWCs Fruit trees
Vatikas Plants/herbs vegetables
East Khasi Hills 1288 776 49 34 622
Ri Bhoi 520 279 25 35 279
West Jaintia Hills 426 213 20 0 280
East Jaintia Hills 232 174 25 0 174
West Khasi Hills 584 454 18 101 454
South West Khasi Hills 241 143 25 0 143
West Garo Hills 1059 1059 911 374 944
South West Garo Hills 421 246 240 246 235
South Garo Hills 330 211 122 17 142
East Garo Hills 405 159 104 0 148
North Garo Hills 390 183 183 26 183
Total 5896 3897 1722 833 3604

*Data Source: Social Welfare Department (Women & Child Development), Government of Meghalaya

The Social Welfare Department (Women and Child Development) also took the initiative to involve
the SHGs for the promotion of nutri-gardens at the individual level, especially in those households with
pregnant, lactating women and anemic women and malnourished children. In this regard, a total of
240 VOs were trained in collaboration with Krishi Vigyan Kendra on nutri-gardens. Till date, 3345
household-level nutri-gardens have been started with the support of AWWs and SHGs and 100 nutri-
gardens have been started utilising the resources from MGNREGA.

Distribution of vegetable seed packets to the SHG members at Larbang as part of the nutri-garden
promotion efforts conducted jointly by the field functionaries of the Social Welfare Department (Women
and Child Development), Health Department, NRLM, Agriculture Department, and ATMA during Poshan
Maah Celebrations 2020.

15
It must also be mentioned that through the VOs, support in the form of cash or nutrition kits is also
provided to the SHG members as well as non-SHG members whose children have been diagnosed as
Severely Acute Malnourished, and this is facilitated through the Vulnerability Reduction Fund available
at the disposal of the VO.

SHG members giving support in kind to the SHG member whose son was diagnosed as Severely Acute
Malnourished (SAM)

4.3. Innovation Project: Kitchen Garden and Backyard Poultry

Under Poshan Abhiyaan, the Social Welfare Department (Women and Child Development) also
undertook an innovative project in collaboration with Bethany Society, Meghalaya to promote kitchen
garden and backyard poultry for a “Malnutrition Free Meghalaya” which was initiated from 1st
November 2019. Through this project, kitchen gardens and backyard poultry were activities that were
widely promoted and implemented in all ICDS centres in Meghalaya with the objective of improving
access to good quality nutrients for complementary feeding in poor families; reduction of nutritional
anaemia levels among adolescent girls, women and children; and improvement towards behavioural
change in the community vis a vis food consumption and diet diversity. While this project was started as
a pilot in only one ICDS in each of the 11 districts of the State, this has now been upscaled to all ICDS
projects. Funds for the same have been utilised from the Innovation Component under Poshan Abhiyaan.

16
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Backyard poultry and keyhole kitchen garden promoted under the innovation project for reducing
malnutrition in Meghalaya

17
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~.."..."'.."'.-;~."'.'~- W ith all concerted efforts in place, Megholoya was able to attain a 93% SAM and 97% MAM recovery
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Table 4: Recovery of SAM and MAM children identified in September 2020 as of February 2021 in
Meghalaya
No. of SAM No. of SA No. of MAM No. of MAM
children children Percentage children chlldr.n Percentage
Dlltrld IdentltlM In ,ecoveted 'Y Recovered IdenHfled In recovered by Recovered
Sepl2020 Feb 2021 Sept 2020 Feb 2021
East Khosi 455 431 94.73 3596 3580 99.56
Hills
j 8liol 41 39 . 95,12 .37 437 100
West Jaintio 423 401 94.8 3642 3393 93.16
Hills

West Khosi 258 2070 2070 100

Hills

West Goro 168 94.54

Hills

South Goro 39 33 84.62 381 380 99.74

Hills
East Goro 9 8 . 88,89 '0 40 100
North Goro 5 2 40 128 128 100
Hills

* Data Source: Department o f Women & Child Development, Government of Megha laya

Figure 4 shows recovery of SAM cMldren identified in September 2020 as of February 2021 .

• 800 17811

1780
....
Percentage Recovered is
c:; 176a 93,85%
•
;g 1740
ti
:::E lno
:\ ....
'0 1700

•,
~ 1680

z 1660

'''0
.620
NO_ of SAM (h1dr~ Identified in Sept 2020 No of SAM children I'l!covered bot f~b2021

18
 Figure 5 shows recovery of MAM children identified in September 2020 as of February 2021.

As of February 2021, 100% recovery rate was recorded among the MAM children identified in
September 2020 in six out of eleven districts in Meghalaya including East Garo hills, RiBhoi, West
Khasi Hills, South West Khasi Hills, South West Garo Hills and North Garo Hills (Refer to Table 4). The
POSHAN drive for identification of SAM and MAM children continued post September 2020. From
October 2020 to May 2021 the number of SAM children identified was 881; of these, 696 have
recovered. During the same time period, the number of MAM children identified was 6154, of which
5260 have recovered. This means that the number of children under the process of recovery as of May
2021 is 185 SAM and 894 MAM children, showing a drastic decline in SAM and MAM cases among
children. The POSHAN drives for identification of SAM/MAM children are still ongoing in the State.

Further, in order to validate the recovery rate, the State Government has decided to conduct a Social
Audit on the status of SAM and MAM children, including the impact of services. With respect to this,
between 8-10 September 2021, the training for 247 Social Auditors belonging to Meghalaya Social
Audit and Transparency Society (MSSATS) has been completed in three batches to equip them with skills
and knowledge in identification and basic management of SAM/MAM children. These auditors will soon
conduct the audit.

Shri. Gary Nengnong, State Consultant, POSHAN Abhiyaan,

Meghalaya- “We took up the issue of Nutrition on a mission-mode from the month of
September 2020. The POSHAN campaign coupled with weekly meetings at the State level
put the limelight on the issue like never before. The Chief Minister, Chief Secretary and
Principal Health Secretary themselves reviewed the situation. This caused a huge
turnaround in the numbers’’.

19
6. THE ROAD AHEAD
The sustainability of any policy depends on the long-term implications of the implementation process.
While addressing the immediate areas of concerns pertaining to improving nutritional indicators, the
State is also working towards creating an enabling environment to ensure that the trend in numbers is
maintained.

Dr. P. Dohtdong, Medical Officer (MO) in-charge, NRC, Ganeshdas

Hospital, Shillong, Meghalaya- “Nutrition is an issue that cannot be resolved
by a silo approach and requires active convergence between stakeholders of all the three
departments. The PDIA initiative adopted to solve the problem is a welcome step but more
needs to be done to strengthen the coordination and streamline tasks within and between the
departments concerned”.

In pursuance of instructions from the Government of India for development of a strategy for institutional
convergence for ensuring effective service delivery as well as community action for improving health
and nutritional indicators of the State, Meghalaya has begun Sector Meetings at the PHC/CHC level
in all districts, to be held jointly by the Department of Health & Family Welfare, Department of Social
Welfare and Department of Community & Rural Development Department Government of Meghalaya
(A copy of the issued circular can be found at Annexure 1). As part of the circular, a format for the
agenda of the sector meetings has also been issued, where a key objective is activation of Self-Help
Groups and Village Organizations in taking an active role in identifying and addressing community
health needs. Meghalaya’s recent experience shows that these community groups, especially women-led
groups, have played a critical role in SAM and MAM recovery. (A copy of the Agenda can be found
at Annexure 2).

As part of a long-term sustainable plan, on March 5th, 2021, Meghalaya Cabinet approved its
first ever Health Policy called the MOTHER Policy – Meghalaya’s State Health Policy (For achieving
Measurable Outcomes in Transforming Health sector through a holistic approach with focus on
women’s Empowerment)2. It became the first State to have materialized a State Health Policy during
the COVID-19 pandemic period. The health policy will follow a three-dimensional model with equal
focus on: Preventive Care, Curative Care and Enabling Dimension which can be termed as a lifecycle
approach towards addressing State health State indicators, as seen below:

2
Meghalaya Health Policy 2021- [Link]

20
 Figure 6 shows the three aspects of healthcare as highlighted in the Meghalaya State Health Policy,
bringing a holistic approach with aspects interlinked with each other for overall wellbeing and creating
agency among key stakeholders

In the month of November 2020, the State launched the Rescue Mission to save the lives of mothers and
children. As part of this, biweekly reviews are held and focus is also being laid on improving nutrition
amongst women and adolescent girls, apart from taking extensive steps to improve the Reproductive,
Maternal, Neo-Natal, Child and Adolescent Health indicators.

Further, special emphasis is being laid on the role of community involvement. Under this, communities
are being empowered through creation of Self-Help Group platforms that would act as information
and awareness disseminators. It is also ensured that one active woman from every village household
becomes a member of an SHG. This would greatly help to tackle the high MMR and IMR and other
complex issues. An additional measure has been the policy of reserving 50% of leadership positions for
women in village employment councils, creating greater opportunities for women to influence community
priorities, a policy which was approved by the State Cabinet in 2020.

Shri. Ronald Kynta, Chief Operating Officer, Meghalaya State Rural

Livelihoods Society (MSRLS)- “Village Organizations (VOs) are a federation of
Self Help Groups (SHGs) that act as a platform which brings together communities, especially
women to discuss problems. Sensitisation through discussions about Nutrition as an issue was
extensively taken up by the VOs. They also worked closely with Anganwadi workers to help
identify SAM/MAM children from their respective communities and also helped to deliver
nutritious food to the families. They actively conducted POSHAN rallies, yoga sessions for
children alongside ASHA workers and events such as community events on Nutritious food.
They played the role of active social change agents at the village level”.

21
CONCLUSION
Meghalaya’s case study showing successful intervention in improving Nutrition among children in
just 6 months is testimony of the fact that the State can address complex and difficult development
challenges through collaborative actions by using Problem Driven Iterative Approach (PDIA) brought
under the State Capability Enhancement Project. The key intervention here is bringing a purpose-driven
collaboration among all the stakeholders by generating intrinsic motivation coupled with greater sense
of accountability. This is not a one-time application and it should be an ongoing effort to continuously
learn and improve the results. This approach is being used to address other challenges including the
COVID-19 pandemic, improving overall health scenario and even tackling Climate Change. This is a
systemic intervention and requires a gradual shift in behaviour and culture of Government officials and
all other stakeholders, and this needs to happen organically.

Meghalaya has previously had good experiences with using the PDIA-inspired approaches in addressing
the issue of low immunization coverage, which has been a major challenge for the state. In 2020,
Meghalaya was able to achieve 90 per cent immunization coverage and ranked second alongside
Kerala, only after Telangana, in terms of immunization coverage3 in India. From just 61.4% coverage
between 2015-16 to achieving 90% coverage in July 2020, Meghalaya has been able to turn crisis into
an opportunity. This was made possible through interventions in line with the ones applied in improving
Nutrition indicators in the State.

Miss. L. Phanwar, Nutritionist cum Counsellor, NRC, Ganeshdas

Hospital, Shillong, Meghalaya- “Streamlining synergy between the departments,
and especially strengthening the communities is crucial to tackle the problem of nutrition.
Medical Social Workers can play an important role in this regard”

3
July 2020, Immunization Dashboard, Immunization Technical Support Unit (ITSU), Immunization Division, MOHFW, GOI

22
7. STORIES OF RECOVERY OF SAM CHILDREN

The child (as seen above) was admitted to the Nutrition Resource Centre (NRC) at Ganesh Das Hospital,
Shillong in 2020. The picture on the left was taken in the first week of December 2020 and the picture
on the right was taken just before Christmas. This shows evidence of how the NRCs can play a lifesaving
role.

23
The picture above shows how a SAM child was identified by a VO in remote Jakrem village of South West
Khasi Hills district of Meghalaya. The required intervention was then made following the identification
through the support of the AWW and ASHA. This shows how Village Organizations (VOs) through the
Self Help Groups (SHGs) in Meghalaya played an active role in identifying SAM children within their
communities.

24
The Pictures above show a SAM child identified by an Anganwadi worker in Tura, West Garo Hills district.
The child weighed only 1 kg at the time of identification and was a premature born baby. The Anganwadi
worker conducted repeated home visits and counseling and encouraged the mother to practice Kangaroo
Mother Care (KMC) and exclusive Breastfeeding. In six months, the baby weighs 2 kg and is now healthy.

25
·............
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· '. ,. Annexure 1
........ . .. . Circular on Sector Meetings
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GOVERNMENT OF MEGHALA VA
Health & Fumll~ Welrart Community anti Rural De\elopmcnt Social Welfare & Women ami
Del>artment Dq>artmcnt Child Dc\"e!opment

Room 20 1. Mcgbalana SccrctanallAdJl Bwlding I Shlll(lng

Tel 0364·25000191 Mob : 9918O(X)()79 Emali: sampauI97 L"gmaiicolll

D.O. No. Health. 30912021129

D.O. No. S\~(s)1021202 111
0.0, No. CDDA0I2021f1

Dated Shillong. the 15 th September. 2021

The Deputy Conunissioners,

East Khasi Hills, Shillongl West Khasi Hills, Nongstoinl South West Khasi Hills,
Mawkyrwatl East Jaintia Hills, Khliehriat/ West Jaintia Hills. Jowail Ri-Bhoi District,
Nongpohl West Garo Hills. Tum! South West Garo Hills, Ampatil Enst Garo Hills.
Wi Iliamna sarI South Garo Hills, Baghmaral North Gam Hills, Rcsubclparn.

Subject: SCEP - Enhancing Collaburntion-Cuidelines ror districts to conduct 'effetth'c' Sector

Mctlings at PHC and C He Icycl to address Matem al & Child Health. Routine
immunization as well as COVrD-19 \'actination

SirlMadnm.
In pursuance of instructions from the Government of India for de,'elopment of a strategy
for institutional convergence for ensuring efTecth 'e scn;ce deli,'ery as well. as community action for
improving hcahh and nutritional indicators of the State, this circular is being issued jointly by the
Department of Health & Family Welfare. Department of Social Welfare and DepartmcnI of
Community & Rural Devclopment Department Government of Meghala}'a to all districts in order to
strengthen collaboration at the field level through Sector Meetings at PHC/CHC level.

The COVlD-19 pandemic has burdened the State Health systems and it has been [Link]
that a siloed approach towards hcalth service delivery seldom proves effective. It is also an
established fact that Meghalaya fares poorly in overall health indicators, below the National average
as seen below:
Health Indicatoo Meghalaya India
Stwlting Among Children 44% 3SOio
Anaemia among pregnam women 53.3% 50.40/.
Infant Moonlity 34 32
(lnfont deathsJor t'very J,000 live binhs)
MatcmalMortaliry 197 11 3
(Matemallkaths per 100,000 live binhs)
LifeExpectancy 62,3 70
•'NFHS·5 Meghala)'a Report
·Mt'ghalaya State Health Policy Documenl 2011

26
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The Mcihalnya Stlte He:lith Policy has established that he:!ollh is 3 subject that is closely linked to
-
other socictJll nnd c n\'ironmental determinnnls and 11 is impontlnt to address issues s uch as gender
incqu:dity and pO\'eTty which inalivenenlly results in poor eductuion and c:Jn cause :1 \;cious cycle of
..
poor hC::Ihh ttmongsc ilS c·itizcns. [Link] nlmerna! dearb analysis 2020-202 1 in Meghalaya re\'e3Js
that 92% of maternal deaths belong 10 the Below Poverty Line (BPL) category

Furthermore. It may be noted that many mate rnal and child deaths occur due to lack of elTecti"c
coordination between de partments. especially at the ground level. The inlage below Illustrates how
many different sectors and individUills each have a role to play in whethe r a "oman survi ves
c hiJdbinh:

Deaths are happening because

collaboration did not happen
Com mon Scena rio
A young, anemic teenage
woman. dtes In childbirth at
home, due to postpartum
hemorrhage
HatN could sIw haw bHn
«Jw<i7

He alth Community
Social Welfare
Could nave Sy stem Groups
. ,wred woman COuld haW!
ensured a safe Such asSHGs, could
W41snotanemk:by Mvoe discou raged
p rovldln<;j her delivoery by
Local providing IcceHto Family teerlllge pregnllncy,
healthy food enCQUl1Iged
Adm inistration a trained [Link]' Could have en::oured
(BDO, V illage thewomln get5 conve rsations on
headman) good n uuitlon and family planning, or
could [Link] brought even hel ped wittl
Could havoe ef15Ured provision of
;II llehid e W4tS
her to a hflllUl
facility earlier nutritious foods
av..[Link]. to drl.... her
to hospital

This rcalif) calls for a syslematic approach 10 address the deep-rOOted problems. and requires a
syneri) bet\\ecn the /)~punml'n r of Ht!U/rn & Fa mily Wd/Uff!, .waul Welfa re De/HIrtmmt (WCD)
and Community find Rural Development 1)e~rtmmL

In view or the abo\"c and in order to Ih 'e up to the spint of the eonverience Il1l1delincs by the G0\1 of
India. a Deccnlrnlized Catnl~1ic Leadership (OCL) Model is in plnce to bwld leadership capacity at
Utc fi eld Ic\'ci in State. This would hclp to not only reail7.e the obJecti\'es o r Rescuc Mission. to
inCtease the Rout ine Immuni:auion coverage as well as CO VID· 19 vaccination uptake. but also to
improve Ihe ovemll health indicators of the SlaiC. and increase the hfe expectanc)' orStale residents

27
 ,

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Hence. in order to affect the above, the following guidelines are to be adhered to:

l. There is to be ideally 2 Sector Meetings per CHC and PHC per month, and a minimum
requirement oj at least 1 Sector Meeting per CHC and PHC.
.. " , ' ... .
...................
...;.,,", ..., " , ...... 2. The Sector Meeting is intended to facilitate teamwork between the Health Dept. C&RD Dept
" " " , , , - , ,.
",',,"',- & Social Welfare Dept, and with communities. Block Development Officers (C&RD), Child
, , ',',",
Development Protection Officers (SWD) and Block Medical Officers (Health) are specifically
requested to attend for those meetings of priority faciljties. Annexure 2 lists the priority
facilities across the state.
3. The Sector Meetings are to be held in-person at the respective facility.
4. DCs are requested to oversee and give approval for the Sector Meeting Schedule of each
block within their district, ensuring that there is a set day and time for these meetings each
month. The Sector Meeting schedule i to be shared \ ith the Principal Secretary, Health
& Family Welfare Department, by 28th eptember, 2021.
5. The attendees for each facilitjes ' meeting will comprise of the following:

PHC / CHC Meeting attendees:

Health & FamUy Welfare MO of facility; BPM (Health); ANM Supervisor; ASHA Facilitator; ANMs
Department BMO (if priority faci lity)

C&RD Department APO or Gram Sevak; BPM (NRLM); Cluster Coordinator;

BDO (if priority facility)

Social Welfare Department CDPO or Lady Supervisors

Community Leadership Village Headmen / VO President or Secretary/ VHC, Faith leaders, and other
community leaders from villages that had a maternal death over the past month

Chair/Convener of meeting: MO of PHC/CHC (or BDO or BMO if present)

6. BPM (Health) shall coordinate meetings. BPM (Health) should audio record the meeting and
share it with the NHM State team, with a list of attendees. BPM (Health) is to share the
schedule of each week's meetings with NHM at the beginning of each week. Where network
permits. state teams may join by zoom, hence zoom link should be provided.
7. Annexure I has the sector meeting agenda. All topics in the agenda are to be covered JOT
each meeting. Additional topics may be added by participallts if deemed neces ary.
8. BPM (Health) to take meeting notes in the agenda document, and to maintain the very same
document for all meetings, so that all meeting records are maintained in the same place. These
meeting notes are to be shared with the NHM State Team following each meeting.
9. MOTHER app is to be installed by BDOs, BMOs, all MOs, and CDPOs, reviewed regularly
and kept up to date.

28
 ,\",........ " I'
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10. Use the log of actions in the meeting notes to plan for next steps & track whether these steps
are implemented.
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Also. attached as Annexure 2 are the data on matemal deaths at PHCs and CHCs for the period 2017- .. .. .. .. .. .. ..... ........ ...,' .........................
.. .. .. .. .. .... 'II. .........
.....

2021 . Prioritization of some facilities has been done based on the Bottom 50 PHCs/CHC where a .. .. .. .. .. .. .. ...........'
high number of maternal deaths was reported. These meetings are to be attended by the BDO, ....... ' .........' ...
....................
BMO & CDPO. During these Priority Sector Meetings, the Principal Secretary; MD, NHM; CEO "," .. " ..
MSRLS; DHS (MIIMCHlResearch); Director. Social Welfare; Director, Community & Rural
Development; and respective Deputy Commissioner.

The tentative schedule of the first week of Sector Meetings to be attended is attached as Annexure 3.
It is also recommended that all Sector Meetings are reviewed at the monthly District level Health
Review Meetings.

Orientation meetings will be held to familiarize all responsible parties with the purpose of Sector
Meetings and their roles. We look forward to your active involvement in taking forward this process.

SdI- Sd/- d/-

(Sanlpath Kumar, lAS) (Sampath Kumar, lAS) (Sampath Kumar, lAS)
Principal Secretary Principal Secretary Principal ecretary
Health & Family Welfare Community & Rural Development Social Welfare Department
Department Department

29
 _ _- _ • I ••• , . , •• ",','
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Mr mo NoJlealt h.

Cop) 10
J09I2021 n9~A Oatt(1Shillong, the 15'" Stluembu, 2021.

".'
~ ...
.. P.S. 10 the Chief [Link]. Goycnunent ofMcghaln}ll. for informntuXl oCthe Chicf Minister.

·. 2. PS 10 Deputy Chief Minister lie Health and Family Wei fore. Go\'ernmcnt of Mcgbn\aya.. for
information O[lhe Deputy Minister
3. PS 10 Minister ifc of Community and [Link] Dtwe]opment DeJXUlmenl (C&RD). Government
of MeghaJaya, for mformation aCthe Minister.
4. PS 10 Minister i1c Social Welfare DepanmclII. Govcmmcnl of Me~llla)a, for infomUltion of
the Minister.
5. PS to Chief Secretary. Government of Meghalo)3, for information crlhe Chief Secretary.
6. Conllnissioncr & Secretary, Planning Depanmcnt. Go"emmelll or Meghnlaya ror inrormation.
7. Director, Community & Rural Development Department (C&RD) and MD. SRES for
inrorm::nion.
8 Mission Director, National Health Mission (NHM) for inrormlliion.
9 Director of Health Sen'ice5 (MI)I(MCH&FW)/(R) ror inrormation.
10. Director. Social Welrare Department for inrormation.
II . CEO. Meghalaya Slate Rural Lh'Clihood Society (MSRLS) ror information.

B)' order etc.,

Joim s.."J ~":,:':VrM'gh'I""

Health & Family Welrare Department

30
9. Annexure 2
Format for the Agenda for the Sector Meetings
Meeting attendees should use the following agenda to guide each meeting. Additional topics may be added
if desired, but the below must be covered. BPM is responsible for taking notes in this agenda for each
meeting. Copy a new version of the template each time.

A. Review previous actions

Anchor: BMO / BDO / MO, with assistance from BPM (who takes notes on each person’s tasks)

Key Document to Review: Notes from the previous Sector Meeting

Questions:

For each set of officials, what were the key actions discussed in the last Sector Meeting? What has been
the progress? Any challenges or learnings?

Official Response
MO
CDPO
APO
GS
BPM (NHM)
BPM (NRLM)
Lady Supervisor
ANM Supervisor
ASHA Facilitator
Cluster Coordinator
Community Gender and Health Activist (CGHA)
Others (specify who)

31
B. Institutional Delivery Review
Anchor: MO

Key Document to Review: Institutional Delivery by SC

Goal: Ensure steady progress towards increasing institutional delivery

Percentage Number of Number of High-
Percentage
increase in pregnant women Risk PW with
of Institutional
Facility Name institutional with EDD in next EDD in next 30
Delivery in past
delivery from 30 days, under days, under this
30 days
previous 30 days this facility facility
1
2
3
4

In advance of the meeting, please prepare the following information for all SCs under PHC/ CHC:

Questions to discuss:

1. Are all our SCs functional and conducting deliveries?

2. Which SCs are facing the most challenges in institutional delivery? Why?

3. What can we do to improve the status of our SCs and the PHC/CHC?

4. For all facilities, how do we increase demand from the people for institutional delivery?

5. List specific actions to be taken to increase institutional delivery and specify timeline for completion
of those actions.

C. Upcoming Deliveries
Anchor: MO

Key Document to Review: MOTHER App

Goal: Ensure that all high-risk pregnant women have an institutional delivery.

For each high-risk woman with an EDD in the next 4 weeks, the following information should be reviewed
& discussed:
6. Basic Information (name, village, reason for high-risk, expected date of delivery)
7. When was the last visit by ANM or ASHA? (date, key findings)
8. Is she willing to go for institutional delivery? Yes/No

32
9. If Yes
• Name of facility she plans to go to
• Is she able and willing to travel some days in advance? (Yes/No)
• If no, state the reason why not:
• Does the facility have a place for the woman to stay in case she comes in advance? (Yes/No)
• Does she need any help with transport?
• Any support needed from the BDO’s office? Any support needed from the SHGs?
• Is there a need to send someone to the household to verify if they need any support?

10. If No
• Why is she not willing?
• Does the MO need to visit/speak with her/the household?
• Has the village headman or the VO been informed that the family has refused institutional
delivery?
• If No, who will reach out to the headman and by when?
• If Yes, what action has been taken by the headman?
• Is any childcare support needed? Y/N
• If yes, how will the childcare support be provided? Have SHGs been engaged on this matter?
• Does she need any help with transport?
• Any support needed from the BDO’s office? Any support needed from the SHGs?

11. What is the back-up plan for transporting her from her village to the health facility, in the event that
an ambulance is not available or if the delivery happens at night time? *Note that this plan should be
prepared even in cases where the woman has refused institutional delivery, just in case an emergency
arises.
• Back-up car details (driver name, location, phone number)
• Who is the point person who is coordinating between the family and the driver?
• List any follow-up tasks and persons responsible regarding transportation

D. Maternal & Child Death Reviews

Anchor: MO

Goal: Understand how these deaths could have been prevented, and how best to reduce chances of
future deaths.

Discuss all maternal deaths that happened across all facilities since the last review

33
 12. Details (Name, gravida, whether high-risk)

13. What was the medical cause of death?

14. Where did the death occur? (Home, Health Facility, In transit)

15. When did the death occur? (During pregnancy/delivery/within 42 days of delivery)

16. Did any of the following factors contribute to the death:

• Delay in woman/ family seeking help (If yes, why)

• Refusing to go to a facility (If yes, why)
• Willing to go but lack of transport from home to facility (If yes, why did this happen)
• Refusal of treatment at a facility (If yes, why)
• Lack of childcare for other children (If yes, why did this happen)
• Lack of transport from one facility to another (If yes, why did this happen)
• Delay in referral (If yes, why)
• Lack of equipment at health facility (If yes, please indicate which equipment)
• Absence of personnel at health facility (If yes, indicate who was absent)

17. How could the death have been prevented?

18. Was the woman identified as high risk? If yes then what actions were taken to enable her to
come to an institution in advance? What more should have been done?

19. Any input from or messages to the community leaders present?

Discuss one child death that has happened since the last review

20. What were the causes of death?

21. Where did the death occur? (Home, Facility, In transit)

22. Did the family go to a health facility or a doctor? If not, why not? If yes, then what was
prescribed?

23. Did the family approach a traditional healer? If yes, then what was prescribed?

24. Did the family face any issues reaching a facility or a doctor? Describe

25. How could the death have been prevented?

E. Anaemia & Nutrition

Anchor: CDPO / Lady Supervisor

Goal: Ensure that every anemic woman has received in-person check up by the ICDS team or ANM

34
 26. What percent of pregnant women have been tested for anaemia in the past 1 month?

27. How many moderate anaemic pregnant women are there in the area?

28. How many severe anaemic pregnant women are there in the area?

29. What percent of them (26) and (27) have been treated or followed up in the past 1 month?

30. Is the ICDS team aware of this list of women in (26) and (27)?

31. What percent of them (26) and (27) have been visited/helped by ICDS team or ANM?

• If in-person check up has not happened for 100% of anemic women, then why not? How
can we reach 100% in-person check ups?

32. How have the SHGs, Village organizations or VHCs been engaged to address nutrition and
combat anemia in the villages served by this facility? Describe specific actions taken. What more
can be done? Specify action, place, who is responsible, and the timeline for completion.

33. What are our strategies to improve nutrition in this area? Specify action, who is responsible
and the timeline for completion?

34. How can VO contribute in this area?

35. How many Nutri-Garden been set up by the SHGs?

F. Institution Building and Capacity Building

Anchor: BPM, NRLM

Goal: Awareness and Capacity Building of Community Base Organization (VOs and SHGs)

36. How many VO are within the CHC area of Operation?

37. How many CGHA has been identified for each VO?

38. How many CGHA has been trained under Health and Nutrition?

39. Has the VO formed the Health and Nutrition Sub-Committee?

40. Have the VO been trained on aspect of Health and Nutrition?

41. Does the VO maintain any record on women in the village?

42. What role can VO play? Specify action, who is responsible and the timeline for completion?

G. COVID-19

Anchor: BDO / BMO / MO

Key Document to Review: Notes from previous Sector Meeting

Goal: Identify any actions to be taken regarding the COVID-19 pandemic

35
 [Link] status of COVID-19 cases and deaths in the block

[Link] any actions that have being taken by the respective departments over the past month

[Link] strategies are working to reduce spread of infection, and to find and treat sick people
early?

H. Key Actions for the next few weeks

Anchor: BMO/ BDO/ MO, with assistance from BPM (who has taken notes on each person’s tasks)

Key Document to Review: Today’s meeting notes

Goal: Identify key actions to be taken by officials for the next few weeks.

1. Tracking Pregnancies 2. Anemia & Antenatal Care 3. Safe Delivery

1. Early ANC registration 1. Identify anaemic women in the 1st 1. Ensure that all high-risk pregnant
trimester and correct anemia by the women deliver at a health facility.
2. Track every pregnant women whose 2nd trimester Women should reach institutions 1-2
due date is within next four months weeks before due date.
2. Provision and consumption of IFA,
3. For each pregnant women identify Deworming and Calcium tablets 2. Facilitate transport and stay so as
responsible ASHA, TBA, SBA, ANM, to encourage women for institutional
MO, CDPO and BDO 3. Ensure TD injection is given on time delivery.

4. Identify and track high-risk 4. Counseling on nutrition 3. If households insist on home delivery
pregnancies through ANCs ensure presence of an SBA-trained
ANM
Women with high blood pressure,
diabetes, anaemia, elderly 4. Identify all TBAs and train them on
primigravida, multipara, teenage common complications during delivery,
pregnancies, etc. and when to refer women to healthcare
facilities.

5. Provide checklist and basic medicines

to TBA
4. Right to Birth Spacing & Teenage 5. Mobilizing Community Leadership 6. Mobilizing Community Leadership
Pregnancy
[Link] all eligible couples on birth 1. Activate VHSNCs and SHGs in every 1. Conduct Sector Meetings at every
spacing and family planning methods village Facility that include MOs, ICDS team,
MSRLS representative and APOs/
2. Counsel teenagers on safe sex and 2. Guide & support SHGs to discuss BDOs/Gram Sevak
the risks of teenage pregnancy maternal health issues
2. The team should set action targets to
3. Involve village headman to convince ensure full ANC and safe delivery
households to increase ANC and
institutional delivery 3. Involve village leadership and BDO
to mobilize villages with low healthcare
demand. Health team and MSRLS to
activate VHSNCs and mobilize SHGs.
CDPOs are responsible for anaemic
women.

36
I. Rescue Mission Buckets Covered in this Meeting
Anchor: BMO/ BDO/ MO, with assistance from BPM

Goal: Make note of larger Rescue Mission priorities that were addressed in this meeting.

BPM to highlight those Rescue Mission issues addressed in today’s meeting:

37
 .....
, ...

.. .

38
Documented by:
State Capability Enhancement Project Team
Knowledge Management Division, Meghalaya Basin Development Authority
(MBDA)-
Shweta Raj Kanwar, Alvareen Kharwanlang, Rebecca Trupin, Prateek Mittal
and Jackie R. L Bantho (MHSSP)
Document designed by Malcolm Lyndem, MBDA
Under the guidance of Shri. Sampath Kumar, IAS, Principal Secretary to the
Government of Meghalaya, Social Welfare (Women and Child Development),
Health and Family Welfare and Community and Rural Development
Departments

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Thank you
September 2021