ABSTRACT
Improving nutritional outcomes in young children living in the intersectionality of marginalisation requires more than just an understanding of ‘what is good nutrition for a child’ or ‘what are the interventions to promote adequate nutrition for all’. Evidence-based nutrition interventions in resource-constrained communities must consider the complex interactions between social structures, community characteristics, health systems’ knowledge and attitudes, as well as the capacity of all stakeholders to address issues that have a bearing on child nutrition. For a child with special needs and a family with a child at risk of neurodevelopmental delay or disability, the challenges that come with the double whammy of poverty and disability add another dimension to the vulnerability of poor nutrition. Insights and experiential learning gained over two decades of work in the peri-urban settlement colonies of 333Delhi form the basis of this chapter exploring ways to improve ‘Nutrition for ALL’. Health, nutrition and neuro-disability are intimately linked. Communities with high levels of malnutrition and nutritional deficiency also rank low in health studies and often report higher rates of developmental delay and childhood disability. An ecological model of development needs to consider Early Childhood Development (ECD), with nutrition as part of an integrated package for the child and the family. The need for intersectoral coordination for comprehensive childcare in the early years can be met with context-specific, cost-effective and culturally sensitive strategies and interventions to improve the capabilities of several stakeholders to ensure inclusive development. Scaling up successful models of ECD programmes for children with special needs in the community with limited access to health and social systems calls for innovative approaches to generate an evidence base to inform future nutrition policy that is inclusive. The study was conducted in Seelampur, Delhi, which has a population of close to two lakhs and has large peri-urban (slum) resettlement colonies, and predominantly comprises families living below the poverty line (BPL). There is evidence that the development of children with special needs is linked to the adequate training of key care providers for integrated ECCD. Thus, the study adopted the model of community-based inclusive development (CBID). Informed community care workers and mother-caregiver dyads are at the core of the model to build awareness and transfer knowledge and skills towards the delivery of family-centred services for the children. This included training community women and family members of CWSN through a mentoring approach that combined technical support, participatory learning (on-the-job training) and study in a cascade model for capacity building. The results confirmed that collaborative efforts of local care providers, social workers, professionals, and anganwadi workers with an orientation towards special care needs and ECD are more successful when rooted in the context of family and the community. Thus, disability-related programmes with a focus on early intervention services delivered in the community have immense potential to become the entry points to nutrition services in the nurturing care framework advocated for ECD. Similarly, nutrition programmes can integrate policy and services so that malnutrition and disability can be addressed together for Universal Health Coverage, which is critical for achieving SDGs, leaving no one behind.
