Flour for Health
Udaipur: “The children in my village are now actively participating in sports and they all love running. I have noticed this change ever since they started eating the special ‘rotis’,” says Vijay Joshi, a physical training instructor at a government school in Sheshpur village.
* “I don’t get tired very soon these days and even my husband’s knee pain has reduced considerably. It’s great to be healthy and energetic,” shares Sumitra, 30, the anganwadi worker of Singhavat village.
* “Till just a few months back, there was not a day when I didn’t feel listless or feverish. Carrying out my duties as a government school teacher and helping out in serving the mid day meal, one of the tasks assigned to me, wasn’t easy. Thankfully, I feel much better and stronger,” reports Varsha Sevak, 26, a government school teacher in Banora village.
There is a quiet health revolution underway across several villages in the tribal-dominated Salumbar and Sarada blocks of Udaipur district in Rajasthan, where widespread malnutrition, especially among the women and children, has had devastating effects on their physical well-being. Since September 2012, households dotting the arid countryside have been motivated to consume wheat flour fortified with micronutrients, such as iron, folic acid and vitamin B12, as part of a novel initiative introduced in the region by Global Alliance for Improved Nutrition (GAIN) and Institute of Health Management Research (IHMR), Jaipur, which is being implemented by the Bhoruka Charitable Trust (BCT).
Nutritional deficiencies are rampant in Rajasthan. The National Family Health Survey-3 has noted high levels of anaemia among both women and men in the state, in addition to registering very high rates of stunting and wasting. That’s because a typical home-cooked meal here is imbalanced: it includes high quantities of cereal - that are cheap and provide energy - and very little pulses and fruits and vegetables, which are rich sources of vitamins and minerals, critical for proper growth and building immunity.
“Considering that the diets of these population groups are not diversified, provision of staple foods, such as wheat, oil and milk, that have been fortified with vitamins and minerals has been recognised as one of the best ways of improving the overall health indicators of a population. Not only is food fortification easy and cost-effective for the food producers to implement, it is also an inexpensive way to provide good nutrition to the consumers, too. This is one way of ensuring that people get sufficient vitamins and minerals through their diets, to improve their health in a short period of time,” points out Deepti Gulati, Senior Associate, GAIN.
In Udaipur, Salumbar and Sarada blocks were identified for action after a baseline survey indicated that the locals were suffering from high levels of micronutrient deficiencies. Rahul Sharma, Director, Food Fortification Project, IHMR, elaborates: “We chose wheat flour as the vehicle for fortification because it is the major staple cereal and its consumption is very high in this region.”
The next step was to make sure that people in the villages start using fortified flour (‘atta’). For this, reaching out to the friendly neighbourhood ‘chakki wallahs’, or millers, from where the households generally their wheat grains milled, became imperative. The idea was to convince them of the advantages of adding the micronutrient-rich premix to the flour so that they could become “agents of change” and lead the community in improving their health and by recommending fortification of wheat flour to their regular customers.
Two hundred chakki-owners were identified from Salumbar and Sarada blocks of Udaipur district and were actively engaged on the nutrition and health issues through the formal and informal discussions. These discussions also highlighted the role in reduction of malnutrition reduction through the fortification of wheat flour milled at their chakkis was highlighted. “We trained the millers on how and when to add the premix while grinding, and provided them with 10 kilos of the premix along with two spoons, calibrated to fortify five kilos and one kilo of grain, respectively, so that the quantity of micronutrient premix added to the grains added is accurate and consistent – one spoonful to five kilos of flour,” explains Sharma.
Adds Shivendra Kumar Jha, BCT Project Manager, who is supervising the implementation of the intervention on the ground, “Initially, the millers had several questions and apprehensions like ‘why should I do it?’; ‘do I get anything for doing it?’; ‘will the quality of flour get affected such that my business would get impacted?’; etc. So even as we gave them all the requisite information that would enable them to motivate their customers to go in for fortified flour, we also made them realise that it was their social duty to contribute in this fight against malnutrition.” Apart from explaining to the millers about why the premix was good for health and training them on its proper use, the millers were trained on the proper way of storing the premix and keeping a record of the premix utilisation at their ‘chakki’.
Of course, simply teaching them the right way to use the premix was not enough. As is common in any community-based projects, there were many challenges that started emerging soon enough. Some people (started complaining that the dough made from the fortified flour was turning black and that the ‘rotis’ were very dry in texture. “At first, we found it quite baffling. But, when we looked into the matter we realised that a few millers, in their enthusiasm of improving nutrition, were mixing higher quantity of premix to the wheat flour, as they felt that if it is good for health then why stop at adding just one spoon!. It was then explained to the millers that adding higher quantity of premix would affect the colour and texture of flour and hence would impact the acceptability. It was reiterated that it was of utmost importance to adhere to the correct dosing of premix while milling the grains to ensure that the quality of flour is not compromised. These issues have been successfully addressed and now both the millers and the consumers are happy and satisfied,” he informs.
To fill in the information gaps the BCT has been conducting various awareness building activities. “In addition to the millers who directly talk to the people, we have put up wall writings and posters to publicise the advantages of consuming fortified wheat flour to improve health and reduce anaemia. Along with this we organise community meetings, school-level campaigns and street plays to discuss this issue,” says Jha.
Despite all these concerted efforts, in some villages the usage of fortified flour is taking time to pick up. “I serve about 100 households and only 60-65 of them regularly ask for their flour to be fortified,” says Khajhrulal Jain, 55, who is one of the three millers in Jhallara village of Salumber block. “I add the premix when customers ask for it. Therefore, those who consume fortified wheat flour are generally the ones who are more educated and aware and have learnt about these through the wall writings or from the flex board at the ‘chakki’,” he adds.
On their part, the anganwadi workers and Accredited Social Health Activists (ASHAs), who give valuable nutritional advice to village women, are pitching in to increase the usage of fortified flour. After going through capacity building sessions organised by the BCT, Anita, 25, a committed ASHA of Dhoodhar, a small village in Salumbar, is a changed woman. Of all the critical responsibilities that fall on her as a grassroots government health worker, she takes on the task of counselling families on the importance of eating nutritious meals very seriously. In fact, since the last two years she has played a key role in convincing women of the benefits of consuming the fortified wheat flour. “I tell them how it helps in reducing anaemia among women and gives ‘takat’ (strength) to their children. And the best part: there are no extra costs involved yet people can enjoy better health,” she says. Like Anita, in Singhavat village, Sumitra, 30, an anganwadi worker, has not only been making ‘rotis’ from fortified wheat for her own family but has been conscientiously motivating others to follow her example.
Today, Jha is happy to share that in the last eight-nine months, usage of fortified flour has stabilised. “There are altogether 6,600 homes in Salumbar and Sarada where fortified flour is being used regularly. All those people who have felt its health benefits are recommending it to their friends and acquaintances,” he concludes.
(Women's Feature Service)