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                                                Policy changes due to MAHAN

 
 
 
 
 
Research, Analysis, Advocacy& Public Interest Litigation (PIL) by MAHAN& KHOJ over the period, resulted into state govt. framing new policies, improving existing policies & implementing the models developed by MAHAN at other places as follows.

 

  1. Counsellor program for government hospitals:  

        This is the best example of leveraging of government welfare scheme through counselling of tribals for hospitalisation of severely malnourished children and  hospital deliveries along with monitoring & improving   services of 17 government hospitals in Melghat. It has benefitted>1,46,000 poor tribal patients. It has increased hospitalisation of severely malnourished children(12 times) and hospital deliveries (twice). There is statistically significant Improvement in hospitalized severely malnourished babies.P  < 0.0001. Thousands of lives (children, pregnant mothers ,severe malnourished babies) have been saved.  It has improved quality of hospital care, esp. treatment,quality of food served to severely malnourished babies in hospitals, referral services (ambulance) and increased number of serious patients attending higher referral hospitals. It cost <5% of total hospital expenses  with very high leverage potential. It has been replicated in Rajasthan and will be replicated in all tribal hospitals of Maharashtra.

2) Proper surveillance: 

                  'Rajmata Jijau Mother and Child Health &Nutrition Mission’ of Maharashtra Govt., accepted the MAHAN’s finding about real status of severe malnutrition (>9%)& child deaths(IMR> 60 per 1000 live births) in Melghat (September  2005 ) &after our recommendations , later on observed similar findings in all tribal blocks of Maharashtra. This has impact on state level policies for malnutrition management. Initially government plans were for management of 1.2% of severe malnutrition and remaining 8% of severely malnourished  children were not given special treatment. Now after our intervention those ~1 lakh children were given special attention and care. It would have benefitted 1 lakh severely underweight and malnourished children.

3) ‘Village Child Developmental Centers’ (VCDC):

                     A modified version of ‘Home Based Feeding’ concept, devised by MAHAN, is accepted by Rajmata Jijau Mission of Govt. of Maharashtra as state wide policy. MAHAN is part of planning policy committee for the VCDC for the entire state of Maharashtra. It has been implemented throughout Maharashtra since 2008-2009benefitting  >50000 severely and >100000 moderately malnourished children.

4) Hot cook food : 

                    Instead of Take Home Ration (prepared by industries), fresh hot cooked food (prepared by self-help group of tribal/ ICDS workers) is being  given to children below the age of 3 years (> 30000) to prevent malnutrition in whole Melghat. By this change, livesof thousands of malnourished children's are saved & crores of government money has been utilised properly. Many tribal female will get employment and will be empowered.

5)  AIDS detection centre: 

                    It has been started in Melghat due to MAHAN recommendations.

6) Reclassification of severe malnutrition:

                  'WHO' and 'UNICEF' reclassified malnutrition in 2005-06 and advised government of India to give special treatment to only severely acute malnourished (SAM) children. Due to this lakhs of children who were severely underweight (SUW) but not SAM , were denied special care and many of them died.  MAHAN after scientific study in Melghat could convince honourable high court of Maharashtra to give order to Government of Maharashtra to use ‘SAM’ as well as ‘SUW’ criteria for classification and management of severe malnutrition. This has benefited lakhs of children of Maharashtra.

7) Rajmata Jijau Mother and Child Health and Nutrition Mission: 

               It has been restarted by government and UNICEF from 2011-12. This has saved lakhs of children and pregnant mothers of Maharashtra from malnutrition and deaths.There was increment in the funds, number as well as rejuvenation of Village Child Developmental Centres & Child development centres in Maharashtra. It has benefitted >300000  severely malnourished  children.

 

8)The public distribution system (PDS) :

               New ration shopswill be handed over to the self-help groups of tribal female instead of commercial private people. It will empower hundreds of tribal female.

9) IAS/ IFS officer as Integrated Tribal Development Project Officer:

              Government is appointing IAS/ IFS officers as PO for eight tribal blocks, who are overall in charge (Additional Collector) of tribal areas& special nodal officer for coordination of all government schemes of tribal areas. It is in practise since 3 years and improved government working system .

 

As a result of above thousands of the severely malnourished babies are now getting supplementary nutrition and hundreds of deaths due to malnutrition have been  prevented.

                               Policy changes in pipe line –will be implemented in near future:
  • Home Based Child Care’ program& Community based management of severe malnutrition  will be replicated  in all tribal blocks of Maharashtra. It will reduce child deaths and malnutrition by 50% thus saving >5000 children per year.

  • After recommendation by MAHAN, High level equal development committee of government of Maharashtra -Kelkar committee and honourable governor of Maharashtra asked government to think of attaching medical colleges to tribal hospitals.  In near future specialist doctors will be regularly available in the tribal areas. It will benefit more than 8 million tribal people.

  • MAHAN developed innovative‘Counsellor’ programfor strengthening systems at govt. hospitals in Melghat.  Government is thinking to  extended this program in  all tribal blocks of Maharashtra. It will benefit more than 5 lakh people of tribal Maharashtra.

 

  • Compulsory rural/tribal practice  for 1 year for MBBS doctors, failing which they will not be given degree for practice.

  • Every year >10000 children are dying due to infectious diseases in tribal area of Maharashtra due to lack  of antibiotic treatment in villages.  After our recommendations, government grass root  ASHA workers or Anganwadi worker’ have  been empowered to treat infectious diseases with the help of antibiotic.  It will prevent 10000 child deaths every year in tribal area.

 

         
              Participation of Dr. Ashish Satav (President, MAHAN) in government  Policy level committees:

  • Member of ‘European Society of Pediatric Research’.

  • Member of ‘Bhavishya Alliance’, an international trisectorial alliance working for reducing malnutrition in Maharashtra. This group has set many recommendations to reduce malnutrition in tribal area of Maharasthra. Government of Maharashtra has implemented few recommendations benefitting >100000 tribal children.

  • Member of Special study group for Tribal health improvement of Vidarbha ‘Statutory Development Board’, appointed by Governor of Maharashtra.

  • Member of state level ‘Village Child Development’ Committee of ‘Rajmata Jijau Mission’ of Govt. of Maharashtra.

  • Member of state level policy making committee for ‘Antibiotic use by ASHA or Anganwadi worker’.

  • Member of tribal subcommittee of high level Maharashtra equal development Kelkar committee-Dr. Satav was given the responsibility to prepare health and nutrition recommendations for reducing child deaths and malnutrition in tribal area of Maharasthra. Government is seriously thinking to implement its various recommendations . It will benefit more than 8 million tribal people of Maharashtra.

  • Regional representative of state advisor to commissioner of honourable supreme court of India for food security bill. Due to our recommendations,   many schemes related to food security, malnutrition and maternal health have been implemented properly in whole Melghat like mid day meal scheme (MDM), PDS,  JananiSurakshaYojana,  etc.

  • Member of high level MDM Joint Review Monitoring committee of Government of India for Maharashtra. It has exposed the real bad situation of MDM and school student health check up programs of Government of Maharashtra and recommendations for its improvement have been given to government of Maharashtra. It will improve status of MDM and school health check up program in Maharasthra.

  • Member of Ashram School Children Death Audit Salunke Committee.

  • Member of district ‘Navsanjeevan Committee’ for monitoring child health and nutrition activities. Due to our regular monitoring many of government schemes like water, road, transport, electricity, agriculture, kitchen garden, MREGS work, ICDS work, PDS distribution, mid day meal schemes  have been streamlined in Melghat. It has benefitted thousands of tribal children.

  • Member of mentoring committee of district ‘National Rural Health Mission’.

  • Secretary of Coordination committee of counsellor program for govt. hospitals in Melghat.

Advocacy for child deaths & Malnutrition: Dr. Ashish with Maharashtra Chief Minister

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