Kalindi Tripathi emerges from under a small thatched hut, beaming with happiness.

The expectant mother inside has just told her that she is regularly taking her iron and folic acid supplements – just as Kalindi had recommended.

Kalindi is one of more than 300 Auxiliary Nurse Midwives (ANMs) working in the Gonda district of Uttar Pradesh (UP) in India. Looking after the basic healthcare needs of more than 10,000 people across eight villages, Kalindi works as an ANM at the Jagdishpur health sub-centre in Katara Bazaar block.

In many parts of India, Kalindi – and frontline health workers like her – are often the first and only link that women and children have to basic healthcare.

Home to more than 3.4 million people, Gonda, the district where Kalindi works, faces significant healthcare challenges. Gonda has both a high infant mortality rate (71 per 1,000 live births) as well as a high maternal mortality rate (366 per 100,000 live births).

Given the district’s challenges, Gonda is a priority for the Uttar Pradesh (UP) government’s National Health Mission. The state government is committed to providing accessible, affordable and quality healthcare services within the district, and it is implementing key programs under its broader strategy for reproductive, maternal, newborn, child and adolescent health, through a variety of programs, including the following:

• Rashtriya Bal Swasthya Karyakram (RBSK) for children
• Rashtriya Kishor Swasthya Karyakram (RKSK) for adolescents
• Janani Suraksha Yojana (JSY) for pregnant mothers
• National Iron-plus Initiative (NIPI) for controlling iron deficiency anaemia
• Mothers Absolute Affection (MAA)
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

To support the state’s efforts to improve healthcare for its citizens, the Micronutrient Initiative (MI) has been investing in health and nutrition programs for women, girls and children. Since 2010, MI has been providing technical expertise on training healthcare providers, easing supply chain issues, improving program monitoring and evaluation, educating beneficiaries with IEC/BCC, and engaging in strategic policy advocacy for interventions, including vitamin A supplementation, and zinc & oral rehydration salts (ORS) for childhood diarrhoea management.

In India, the success of public health programs rely on front line health workers who are often the first point of contact for people seeking care. ANMs like Kalindi play a pivotal role by supporting programs to improve access to healthcare and nutrition.

The MI team met Kalindi in 2015 during a routine vitamin A supplementation round in Gonda conducted by the state.

Kalindi had a strong, basic health service skillset but there were gaps in her nutrition and micronutrient knowledge, including about  available government nutrition programs. Kalindi was aware of these knowledge gaps and would tend to shy away from answering questions or discussing nutrition with her peers and community members.

But Kalindi was eager to learn. The MI team worked with her to develop her knowledge on micronutrients and, before long, Kalindi was consulting the Reference Guide on Micronutrients and discussing various micronutrients and their benefits with the team.

To reinforce her growing knowledge base, Kalindi participated in MI-supported trainings on micronutrients and nutrition, which was complemented by systematic supportive supervision and follow-up by the MI team. An enthusiastic student, Kalindi quickly began citing examples from the field and sharing innovative ideas on how to reach more people.

“I felt a new-found confidence and pride when the facilitator would ask questions in the training and I would know the answers,” said Kalindi. “Thanks to the encouragement and support of the MI Divisional Coordinator, my knowledge on nutrition and micronutrients is now very good.”

By the end of her training, Kalindi was confident in discussing nutrition and micronutrients with a variety of stakeholders, including her peers and senior officers, as well as pregnant women and caregivers in her villages.

Just one year later, Kalindi’s expertise is making a profound difference in the lives of the people she serves.

New mothers and elder women praise her understanding of health and nutrition, and say she is proactive in her approach to healthcare.

Kalindi meets girls, women and mothers in their homes or during Village Health Sanitation and Nutrition Days (VHSNDs). She provides counseling, shares information on micronutrients, and encourages them to take advantage of available government nutrition programs.

Kalindi – herself a mother of three – is pleased with the results of her work.

“Most pregnant women in my villages are now consuming iron and folic acid and coming to the VHSNDs,” she said. “Underweight children are being screened and referred to higher health facilities.”

In India, front line healthcare workers like Kalindi are key to implementing sustainable changes at the local level.

Using comprehensive strategies, MI works with the Indian national and state governments, as well as stakeholder organizations and communities to encourage training and on-the-job support for healthcare workers.

Together, MI, key stakeholders and front line healthcare workers are building a brighter future through better nutrition.

Thanks to our contributing MI authors:

Sunil Kumar, State Program Representative, Uttar Pradesh, MI India

Mini Varghese, National Program Manager, Health Systems, MI India

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