The focus of the programme is on providing information on best practices in breastfeeding, complementary feeding, dietary modification, early childhood development, hygiene and sanitation and family planning. The audience for the programme includes the primary caregiver (who is usually the mother) and the intervention is delivered via weekly live telephonic calls.

Programme Design

Infants are enrolled in the community after verification of their weight and age and confirming eligibility for the programme. Infants who are found to be severely underweight or who are found to be having underlying medical conditions are referred for medical follow up. For the enrolled children, weight gain is monitored every two months till six months. Enrolments are being made through two channels:

• As the programme has been linked to the mMitra database, subscribers with infants in the relevant age-group are called, interest in the programme ascertained and consent obtained for home-visit. The field team them conducts the home- visit. If the infant fits the eligibility criteria, the caregiver is enrolled after obtaining consent.
• High prevalence areas are surveyed periodically. All infants in the relevant age-group are evaluated and caregivers of those who fit the eligibility criteria are enrolled in the programme after obtaining consent.

There are four key functions within the process flow of the programme

1. Counselling: Weekly calls are made to the primary caregiver (usually the mother). We also intend to start a parallel programme for the fathers who will receive multi-media content on WhatsApp and fortnightly calls.
2. Service Call Centre: Service calls are made to the caregivers at various points in the cycle to confirm the phone number, address, age of the child and willingness to participate. Service calls are also sent to those at risk of drop out.
3. Surveillance: Members of the field team visit areas and identify infants as per the list provided. They ascertain the infant’s eligibility for enrolment and conduct bimonthly visits to evaluate weight and health status of those enrolled.
4. Follow up: Field staff follows up on caregivers who have been referred for medial attention and/or are at risk of dropping out and not contactable by phone.

Salient Features

• Regular counseling to mothers for ensuring adherence to treatment protocol and access to critical information on nutrition, hygiene, sanitation, infections and stimulation to prevent relapse.
• Empowers mothers directly to take informed decisions, enabling rapid local action and prompt attention in an emergency.
• Improved regular case-based monitoring and timely tracking of the child through trained nutrition counselors to complement existing service delivery through frontline health workers.

Scalability and Sustainability

The intervention is designed to be cost-effective as it leverages telecom and technology to reach out to women. Linking this programme to mMitra will enable us to reach 10,000 women annually. This will form the prototype for a hybrid programme, (with on-field weight monitoring and online counselling), complementing existing service delivery through NRCs and ICDS (Integrated Child Development Services) and can be made available to each malnourished child availing treatment through the health system.

Impact

We conducted a proof-of-concept to study the effectiveness of a telephonic counselling service to handhold mothers of children who are moderately underweight while they adopt best practices in feeding, hygiene and health. The results revealed some significant differences in the secondary outcomes – knowledge and behaviour change – between the intervention and target groups.