From Preventing Malnutrition to Promoting Child Survival
CINI was founded in 1974 in Kolkata (former Calcutta), West Bengal, India. In the early 70’s, we started treating malnourished and ill children, whose numbers were rampant in villages and slums areas, with an aim to contrast high child mortality. Field research backed by medical practice, progressively revealed a fundamental truth about childhood malnutrition. Much before being a health problem, malnutrition is a social issue. Rooted in a myriad of social, economic and cultural causes, child malnutrition cannot be solved via a mere clinical solution. On the contrary, it requires a multi-pronged approach, where multi-disciplinary teams of doctors, nurses, nutritionists and social scientists work along with key caregivers, mainly mothers and other women, to address the determinants of child malnutrition, disease and death.
CINI sought to improve mother and child health by tackling the vicious cycle of malnutrition and infection to address its root causes, such as poverty, powerlessness, low status of women, illiteracy, and inadequate health and sanitation practices. In a historical climate leading to the development of the Primary Health Care Movement, we mobilised women to improve the health conditions of their communities. Locally trained child health workers reached out to underserved communities to promote immunisation, exclusive breastfeeding, early care of illnesses, and raise awareness on appropriate feeding and care practices, including growth monitoring and promotion. Training and capacity building, especially of community mobilisers and frontline workers, grew into a prime focus of CINI, which set up its training facility for health and development workers, CINI Chetana Training Centre, in the late ’70s. Prevention of malnutrition and promotion of community health, through the progressive creation of mahila mandals (women’s groups) as a vehicle for local development, has remained a major thrust of our programme activities throughout our history till the present day.
Work in health and nutrition was carried out not only in our project areas but also in emergency settings. Starting from that time onward, we became involved in relief work. We intervened in Cambodian Refugee Camps in Thailand treating malnutrition in children and among the cyclone-affected population of the Sunderbans providing food and shelter in the ’70s; among earthquake-hit population of Bhuj in Gujarat in 1991; among victims of communal violence in Tangra, Kolkata, building houses and creating education and community development centres to bring about communal harmony in the early 2000; among fishermen communities in the 2004 tsunami affected coastal area of Southern India and Sri Lanka; and among victims of the 2005 Kashmir earthquake. Regular relief work has been carried out in flood-prone areas of West Bengal. We also did relief work during the Nepal Earthquake in 2015.
Learning from field experience was supported in parallel by research activities. In the early 80s, we initiated collaborative research projects establishing partnerships with the Indian Council of Medical Research, the Nutrition Foundation of India, the National Institute of Nutrition, and the International Development Research Centre, Canada.
Beyond Survival, Educating and Protecting Children
Over the years, experiences with poor communities taught us that improving nutrition and health alone does not do full justice to the multiplicity of problems that affect children living in poverty. Evidence showed that a majority of deprived children who had benefited from the services of the CINI Nutrition Rehabilitation Centre (NRC) and other health care interventions actually failed to move on in their natural development trajectory, thus dropping out or never enrolling in school, ending up as child labour, being trafficked or married off early, or being exploited and abused in several other ways. Such understanding led us to re-define the scope of the interventions necessary to serve the ‘Child in Need’. In the late 80s, CINI’s mission was re-stated toward moving beyond the realms of nutrition and health to embrace the child protection and education spheres as well with the objective of providing a comprehensive package of child-centred services.
In those years, the city of Kolkata was becoming a major hub for those who were known as ‘street children’. We started experimenting on establishing protective measures in areas where vulnerable children would gather in large numbers, such as the platforms of Sealdah train station. We first set up drop-in centres and halfway houses for run-away, trafficked and missing children and, later on, expanded our work to slum and red-light areas where child labour and abuse was widespread. A special focus has been kept all along on gender issues, focussing in particular on problems affecting child and adolescent girls in Indian communities. CINI Urban Unit (formerly known as CINI ASHA) was established in 1989 to develop and implement programmes in urban areas where safety nets for children were weaker. In low-income urban communities, remedial education centres sought to mainstream and retain children in school. Networking with local NGOs, the police and the government, CINI Urban Unit has provided day and night shelter, sick bay facilities, education and all round services, while seeking family reunification, especially through a dedicated toll-free telephone line, the national Childline programme, which helps track, rescue, counsel and restore missing and run away children.
Through care and education of extremely deprived children we learned that education was possibly the most powerful tool to protect children from exploitation and abuse. Working with teachers, parents and communities, we strengthened our education programmes starting from the early ’90s, with the aim of contributing to universal enrolment and retention by involving out-of-school children. The idea was promoted that child protection could be best achieved in the family, school and community where children live, by weaving safety nets, such as child-friendly schools and spaces, removing abuse and violence from families, preventing child labour, creating mechanisms for stopping child trafficking. Later on, the scope of education expanded to the young child as well to include early childhood care and stimulation and pre-primary education in our programmes. Recently, the CINI Education Resource Centre has been established to support CINI and its partners in the government and the community to make India’s Right to Education Act (2009) a reality for all, especially for those who have been unable to access school so far.
Impacting on the Critical Phases of the Human Life Cycle
To maximize the impact of our interventions in the integrated areas of health, nutrition, education and child protection, we have focused our efforts on the critical periods of the life cycle, i.e., women’s pregnancy and life in the womb, the first two years of life and adolescence, by adopting a Life Cycle Approach (LCA). Specifically, on the nutrition front, we realised the immense potential of concentrating our energies on the vital period spanning from pregnancy to the first two years of life, when up to 80 per cent of brain growth of a human being takes place, to achieve pregnancy weight gain, prevent low birth weight and ensure safe delivery. Services continued to support the new-born with exclusive breast feeding, immunisation, solid food supplements after 6 months of age and timely seeking of health care during childhood ailments. To fulfill such urgent goals, we initiated the ‘Adopt a Mother and Save Her Child’ programme in 1992, seeking individual sponsorships to support needy pregnant mothers during the vital period of intrauterine growth, and the physical and mental growth during the first two years of life of the child. A long standing focus on the first 1,000 days of a child’s life has made CINI a pioneer in what has been recently recognised as an undisputed development priority worldwide.
To move beyond the scope of our direct interventions, we forged strong partnerships with large child nutrition and development government programmes, such as the Integrated Child Development Services (ICDS), and playing a training and support role for anganwadi workers and supervisors.
To address issues relating to the adolescent child, CINI Adolescent Resource Centre (formerly known as Yuva) was initiated in 2000, soon followed by the creation of CINI HIV/AIDS resource centre, (formerly known as Bandhan) to address critical health needs of women and children affected by the disease within the family and the community where they live.
The work of these years attracted attention on CINI’s methodology and capacity to innovate and pioneer sustainable solutions to reach out to a large number of communities in need. National and international recognitions marked the growth of our work in the field. CINI is likely to be the only organisation to have received the National Award for Child Welfare from the Ministry of Women Child Development, Government of India twice, in 1985 and 2004.
Sustaining Child-Friendly Governance Processes
Realising that vertical sectoral approaches tend to be costly and ineffective, CINI has made all attempts to converge efforts in the realms of health, nutrition, education and child protection at the level of the community. An ideal point of convergence has been found in primary caregivers – women. Women organised in self-help groups, strengthened in their capacity to act as agents of change, have been engaging as primary movers in community development action. Convergent and sustainable development processes are being carried forward with the joint participation of the principal governance stakeholders active at the local level – the community, led by female leaders organised in self-help groups, service providers from a variety of sectors, and people representatives of rural Panchayat Institutions and Urban Local Bodies. Children’s groups are active in representing their interests in local decision-making. Available resources are leveraged to ensure fulfillment of human rights at the local level, mobilising communities to claim entitlements from the government, recognising that the government holds the statutory power and duty to care for citizens, especially the most disadvantaged. In such processes aimed to influence local governance agendas to serve children’s needs, CINI acts as a facilitator, rather than a mere implementer. Strengthening governance mechanisms to build Child Friendly Communities is CINI’s core approach to ensure that the Child in Need’s fundamental rights are fully respected, protected and fulfilled within the family and community where the child grows up.