Nourish To Flourish

Malnutrition remains one of the most pressing public health challenges in India, affecting children and hampering their physical and cognitive development. According to NFHS-5 (2019-21), the percentage of malnourished children in Bhagalpur, Bihar, was above the national average. As per Poshan Tracker, in Bhagalpur district, 10,507 children (0-5 years) were identified under the Severe Acute Malnutrition (SAM) category in July 2024. This is almost 5.13 per cent of the age group population.

In an ambitious effort to address this issue, Mission 45 Care@Door was launched in the Bhagalpur district. The objective has been to eradicate malnutrition among children within a time frame of 45 days. This initiative is designed to identify malnourished children, provide them with essential nutritional & medical support, and ensure continuous health monitoring. With a multi-departmental approach, Mission 45 Care@Door seeks to engage key stakeholders, including health professionals, government officials and community organisations to make Bhagalpur a malnutrition-free district.

The selection of a 45-day timeframe for this mission is based on scientific evidence that the median time to recover from malnutrition is around 16-36 days. Nutritional interventions within this period can show significant improvements in a child’s health. Studies suggest that improvements in weight gain, immunity, and energy levels can be seen within 6-8 weeks of proper nutritional intervention. A focused 45-day timeline allows for regular health check-ups and real-time data collection. Parents are more likely to actively participate when they see quick, positive changes in their child’s health.

The first five years of a child require optimal health and nutrition, as these early years are crucial for their physical and cognitive development. Many studies have revealed that in the first few years of life, more than one million neural connections are formed each second – a pace never repeated again. Rapid neural growth and connection formation lay the foundation for lifelong learning, behaviour and health. This period is marked by high neuroplasticity, meaning the brain is highly adaptable and responsive to experiences. Malnourished children often suffer from stunted growth, weak immune systems and increased susceptibility to infections.

To ensure the effective execution of Mission 45 Care@Door, a structured implementation model has been developed at the district, block, and panchayat levels. Each level has specific roles and responsibilities. A district-level task force has been constituted under the leadership of the District Magistrate. The task force includes officials from ICDS, Health, Panchayati Raj, JEEVIKA and the Education Department. It is responsible for strategy formulation, execution, monitoring and evaluation. Various workshops and training sessions have been conducted at the district level to train the personnel who acted as Master Trainers to train other officials and supporting staff. Doctors and nutritionists were involved in preparing customised diet charts/plans for each severely malnourished child. District-level task force oversees the entire mission, reviews data, and makes necessary interventions.

Block Development Officers serve as nodal officers who monitor and coordinate activities at the block level, ensuring that the mission is successfully implemented in their respective blocks. ASHA and Anganwadi workers conduct door-to-door surveys to identify malnourished children. Regular health check-ups are conducted in Primary Health Centers. A community awareness programme has been initiated to educate and change the behaviour of parents with respect to child nutrition and hygiene.

Panchayat-level officials work closely with Anganwadi workers and ASHAs to implement interventions at the grassroots level. They actively participate in mobilising local resources. Self-Help Groups under JEEVIKA play a key role in providing locally prepared nutritious food. Village-level committees ensure that malnourished children are regularly monitored and supported.

Public representatives like Pramukh, Mukhiya, Sarpanch, Ward Members etc. have played a crucial role in making this mission successful. They are more connected with local people and have a better understanding of their problems and demands. They provided valuable inputs in the implementation and execution of the entire mission. They played an active role in raising awareness among the local people about the mission, the importance of nutrition and the ill effects of malnutrition.

Under Mission 45 Care@Door, the District Administration adopted a unique strategy to categorise malnourished children according to their health conditions and severity. Based on this approach, three categories of children (A, A1, and B) were identified:

Category A: Children who need to be immediately referred to the NRC (Nutrition Rehabilitation Center).

Category A1: Children who should be kept at home and provided with a medical kit to improve their nutritional status.

Category B: Children who should be kept at home, with their nutritional status monitored by frontline workers.

Category A comprised 776 children, Category A1 comprised 1,664 children, and Category B comprised 6,871 children.

Nutrition Rehabilitation Centers have been upgraded with better facilities and increased capacity. A steady supply of fortified food and supplements is maintained to ensure uninterrupted service. More medical camps and health check-up centers have been set up at the block level. Regular capacity-building programmes are conducted to train Anganwadi and ASHA workers.

The response from parents has been overwhelmingly positive, with many reporting noticeable improvements in their children’s health and energy levels. Key changes include better food quality in Anganwadi centers, increased awareness among parents about child nutrition and hygiene, higher enrollment in NRCs as parents become more accepting of medical intervention, and parents actively participating in community nutrition programmes.

At the onset of the Mission in August 2024, a total of 10,507 children—constituting 5.13 per cent of the target population—were identified as suffering from Severe Acute Malnutrition. As of Feb 2025, the number of children in this critical condition has significantly declined, constituting just 0.53 per cent.

This remarkable progress reflects the rescue and recovery of over 9,500 children from the life-threatening grip of malnutrition. Beyond the numerical reduction, the Mission symbolises a profound restoration of health, vitality, and potential among thousands of vulnerable children.

Mission 45 Care@Door represents a paradigm shift in addressing child malnutrition in Bhagalpur. Through its focused 45-day intervention model, multi-sectoral collaboration, and rigorous monitoring framework, the initiative has demonstrated measurable improvements in child health outcomes.

The success of Mission 45 Care@Door, under the inspired leadership of young District Magistrate, Nawal Kishore, positions it as a scalable and replicable model through public-private partnership in the true spirit of Nexus of Good for other Districts in the country facing similar challenges. With sustained governmental commitment and active community participation, this approach has the potential to contribute meaningfully to national goals of eliminating child malnutrition and ensuring holistic child development.

Views expressed are personal