PUSHTi: Promoting Nutrition, Health, Sanitation, and Hygiene in Northern India

Punjab. Map Credit: CC-by-sa PlaneMad/Wikimedia

PUSHTi* is a JSI community-centered initiative to address the immediate and underlying causes of undernutrition among women, adolescent girls, and children in northern India. It is implemented in Nabha, one of the eight development blocks in Patiala district, Punjab.

Nabha’s population of 202,000 is predominantly rural and male, with only 891 females for every 1,000 males. There are 171 villages in the block, each with an average population of 1,100 people. Nearly 40% of the population belongs to the Scheduled Caste— a government-recognized, historically disadvantaged population— and only 64% of the population can read and write.

While disaggregated data on nutritional status and its determinants are unavailable at the block level, estimates from Patiala are telling of the overall situation in the region. Almost 18% of children under five are chronically undernourished and are unlikely to meet their growth, development, and cognitive potential. Nearly half the children in this age group suffer from anemia, as do over 40% of women of reproductive age. PUSHTi aims to support “the right nutrition at the right time” by targeting the following five groups through age-appropriate,context-specific, and evidence-based nutrition interventions.

The project’s objectives align with the national targets outlined in the recently launched National Nutrition Mission, which aims to reduce undernutrition across a spectrum of target groups by 2022 (Table 1). India is also committed to meeting the Global Health Assembly 2025 targets, which include a 50% reduction in anemia among women of reproductive age, lowering and maintaining childhood wasting to less than 5%, and decreasing the number of children who are stunted by 50%, among other targets. To meet these targets, a combination of nutrition-specific and nutrition-sensitive interventions are required. In Nabha, PUSHTi will facilitate increased access to these interventions in alignment with the Government of India’s provisions through various nutrition; health; water, sanitation, and hygiene (WASH); and rural development programs.

The project will have two phases: a nine-month pilot testing phase in seven of the 171 villages and a scale-up phase. In the first phase, JSI will conduct formative research to finalize the project design for scale up.  To gain an in-depth understanding of health, nutrition, sanitation, and hygiene practices, the research will include focus group discussions with pregnant women; mothers of children under two; adolescent girls; newly married women; last-mile health service providers; and local leaders. We will also conduct key informant interviews.

The PUSHTi team conducts village resource mapping in Bauran Kala to inform project design. Photo Credit: Swinder Kaur, JSI India.

The research findings will be centered on identifying barriers to and facilitators of key health, dietary, sanitation, and hygiene practices relevant to the various target groups. These barriers and facilitators will be used to finalize the project design and ensure that interventions are context-specific and sustainable. It is estimated that the project will reach nearly 3,000 newly married and pregnant women, as well as 30,000 adolescent girls and children under two once it is taken to scale.

*PUSHTi is a Hindi term meaning validation or confirmation. The project, funded through GlaxoSmithKline Consumer Healthcare, aims to validate that the integration of nutrition-specific and sensitive interventions is achievable in a field setting. Pushti also means sustenance or nourishment, something that supports life.

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