**15.2 TINP I (1980–1989)**

Approximately 1.25–2.40% points per year (ppt/year) drop in underweight prevalence was noted among beneficiaries. On comparing drop in underweight prevalence between TINP areas and non-TINP areas, it was noticed that drop was approximately 0.83–1.12 ppt/year in TINP areas whereas reduction in underweight prevalence was approximately 0.26–1.12 ppt/year in non-TINP areas.

At the same duration, reduction in the underweight prevalence was estimated as 0.7 ppt/year for the whole of India. Therefore it can be stated that quarter to half of the reduction in underweight prevalence was attributable to the TINP project.

Having achieved a significant reduction in severe early childhood malnutrition, TINP-1 became inspiration for others as a 'success story' during the 1980s. Evaluations indicated a decrease in underweight prevalence of about 1.5% points per year in participating districts, twice the rate in non-participating districts. Several factors contributed in the success story of TINP I viz. selective feeding (the careful focus on supplementing the dietary intake of young children when their growth faltered and until their growth resumed), clarity in job responsibilities and description, positive worker-supervisor ratio and robust monitoring system.

### **15.3 TINP II (1990–1997)**

TINP II was rolled out to move beyond reducing severe malnutrition and with a more ambitious objective to significantly reduce the burden of moderate malnutrition. In other words, it shifted towards a more preventive focus. Core strategies adopted in TINP II were regular growth monitoring, nutrition education, health check-ups, supplementary feeding of malnourished children and growth-faltering children, high-risk pregnant and lactating women.

Approximately 6.0 ppt/year drop in underweight prevalence was noted among TINP II beneficiaries. It was also noticed that drop was approximately 1.1 ppt/year in TINP areas. As per estimates of World Bank, the current underlying trend in the state was to be 5.0–7.0 ppt/year, which is most certainly an overestimate.

In the nutshell, TINP II achieved its objective to decrease severe malnutrition but failed to achieve its objective for moderate malnutrition.

A few lessons were learned from TINP II before planning a next phase nutritional intervention. For example, need to work on localized capacity building, improved home-based care by intensifying community mobilization and targeted interpersonal communications, and feeding of 6–24 months old children. Next phase of nutritional programme must incorporate improved service delivery, supportive counselling of caregivers, social mobilization and participatory learning.

Take home massage from TINP I was, interventions that are targeted using nutritional criteria, integrated within a broader health system and effectively supervised and managed can significantly reduce severe malnutrition. TINP II

**15. Case study**

School going children (6–14 years)

Children (0–3 years)

Children (3–6 years)

the way.

**28**

**Table 3.**

The following case study from Tamil Nadu, a southern state of India focuses on the complex challenges faced and the progress made so far as part of efforts towards combating malnutrition. It also demonstrates how lessons are being learned along

The Tamil Nadu Integrated Nutrition Project (TINP), a World Bank assisted intervention program in rural south India, offered nutrition and health services to children under-5 and pregnant and lactating women. TINP-I (1980–1989) eventually covered 174 blocks. It was a forerunner of the Bangladesh Integrated Nutrition

**15.1 The Tamil Nadu integrated nutrition project (TINP)**

**Target group Schemes Major services from schemes**

Rajiv Gandhi National Creche

Rajiv Gandhi National Creche

Total Sanitation Campaign (TSC)/Nirmal Bharat Abhiyan

National Rural Drinking Water Programme (NRDWP)

*Selected nutritional schemes and services rendered as per target group.*

Scheme

*Perspective of Recent Advances in Acute Diarrhea*

Scheme

(NBA)

ICDS ICDS: supplementary nutrition, growth monitoring,

RCH-II, NRHM NRHM: home-based new born care, immunization,

ICDS ICDS: non-formal preschool education, growth

RCH-II, NRHM NRHM: immunization micronutrient

Mid-Day Meals (MDM), Mid-day meal: hot cooked meal to children attending school. Sarva Shiksha Abhiyan (SSA) SSA: support knowledge dissemination on nutrition

acute malnutrition and follow up.

children of working mothers

check-up, mid-day meal.

counselling health education of mothers on child care, promotion of infant and young child feeding, home based counselling for early childhood stimulation, referral and follow up of undernourished and sick children.

micronutrient supplementation, deworming, health check-up, management of childhood illness and severe under-nutrition, referral and cashless treatment for first month of life. Care of sick newborns, facility-based management of severe

Rajiv Gandhi National Creche Scheme: support for the care of children of working mothers.

monitoring, supplementary nutrition, referral, health education and counselling for care givers.

supplementation, deworming, health check-up, management of illnesses and severe undernutrition

Rajiv Gandhi Creche Scheme: support for care of

TSC/NBA: household-level sanitation facilities

NRDWP: availability of safe drinking water

by inclusion of Nutrition related topics in syllabus and curriculums for formal education, school health taught us that going further and preventing children from becoming moderately malnourished is in many ways a tougher task, and demands a significant shift in strategy [34, 35].

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