Delivery of balanced protein energy supplementation as hot cooked meal during pregnancy through government-led women self-help group platforms remains to be tested. The paper describes the initiation, evidence generation and replication of one full meal scheme in Andhra Pradesh and Telangana, India.
Initiated in 2013, the scheme covers 70,000 pregnant and breastfeeding mothers through 7,594 village nutrition outposts. The hot meal is prepared by frontline workers and provides 40% RDI for protein, energy and calcium. After the meal, on-the-spot iron and folic acid (IFA) supplementation and counselling is provided. Perishable products are purchased through 5,100 women self-help group federations through quarterly grants. Village committees implement and report the activities to government. Pregnancy weight gain, anaemia status and birth weight are monitored using online tracking mechanism. Unit cost of the meal is US$0.25 per woman per day, along with programme funding for IFA supplementation; training and IEC is supported though multi-sector budget pooling.
A 2015 external programme evaluation showed that, from 2013 to 2015, percent women covered increased from 60% to 80%, and percent children born with weights <2.5kgs declined from 19% to 4%. Percent women with anaemia came down to 46% against state average of 72% in Andhra Pradesh and 62% in Telangana (DLHS.4). The model has been replicated by three Indian states - Uttar Pradesh, Maharashtra and Madhya Pradesh.
Nutrition services can be effectively and equitably delivered to tribal women with policy decision to involve community collectives in the design, implementation and supervision.