Nourishing Schools Foundation educates children from lower socio-economic backgrounds about their nutrition with a toolkit of educational games. The result? A higher BMI, and increased fruits and vegetables in their diet.
It is a blistering July afternoon, but the students between Grade 5 and 9 at Government Secondary School (GSS) in Kawani, a 50-minute ride from Bikaner city, are not tired.
Ten-year-old Sangeet holds up a picture of a mango on her forehead. Across her, Sunita reads out clues from its related prompt card. When Sangeeta guesses “Aam” correctly, all the players cheer for her. Twelve-year-old Aisha loves Mera Santulith Bhojan (My Balanced Meal). It is a game where players come together to pair food cards to create a balanced diet. “I remember things more easily when we learn through play,” she confesses.
And that is the point. Less than one year ago, 22% of these students were severely thin as per their body mass index classification. Today, that number has dropped to 12%. In the baseline survey, 0% of students had reported washing their hands with water and soap. Now, a whopping 99% of students do. Similarly, 100% of students now report that they eat fruits and vegetables in the midline survey, compared to 59% and 89% in the baseline survey. The percentage of adequately nourished children has also improved, with 56% of students now falling in the normal category as per their body mass index classification, up from 50%.
The interventions are part of a toolkit designed by Nourishing Schools Foundation, an NGO based in Bengaluru. In nine years, NSF has reached over 95,000 children from lower socio-economic backgrounds across 330 schools in Rajasthan, Assam, Maharashtra, Tamil Nadu, and Puducherry.
The idea to identify gaps in the space of health and nutrition and chart an intervention programme started at Ashoka Innovators for the Public, where Nourishing Schools was incubated, in 2011. This research was from 2012, led by Archana Sinha, an economist with a background in management consultancy. Sinha led a data survey to map the underlying causes of malnutrition among young mothers, as well as pregnant women. The survey studied nutritional status (body mass index and anaemia classification), diet, physical activity among children, hygiene and sanitation and diarrhoea.
In 2012, the results of the National Family Health Survey (2005-2006), gave her further pause. “Almost 58% of pregnant women were anaemic. But there was limited data that attempted to understand why,” she says.
She soon found out why. One of NSF’s surveys conducted in rural Karnataka and Odisha between 2012 and 2014 revealed that in spite of regular distribution of free iron tablets for daily consumption, many women took them only 3-4 times a month. Anaemic women are at an increased risk of birthing children with low birth weight and preterm newborns and dying while giving birth. “There was a gap in understanding the importance of nutrition,” says Sinha.
In Chamrajanagar, South Karnataka, 39% of surveyed mothers relied on their own beliefs or that of a family member rather than a doctor or a community health worker, regarding what to feed their children. “The 1000-day window -- the period from conception till the child is two years of age – is crucial for nutrition,” says Sinha. “We decided to target adolescent girls and boys to improve nutrition awareness and nutritional status as they will grow up to become future parents.”
Armed with all these learnings, in August 2013, a co-creation workshop, which involved donors, social entrepreneurs, designers and nutrition experts, shaped the first version of the Nourishing Schools toolkit. “It was targeted at children, to bring about nutrition-related behaviour change,” says Sinha.
In July 2015, the toolkit was distributed to 14 pilot schools in Pune, Satara and Sangli in Maharashtra. In 2015, they launched a baseline study in 20 schools in the Golaghat district of Assam. By 2016, NSF had become an independent entity in October 2016. In November, they were invited by the Government of Rajasthan to roll out the Nourishing Schools programme in over 1400 schools in the state. In 2017, they commenced rollout in 30 schools in Rajasthan and have covered over 200 schools in the state, to date.
NSF takes a data-driven approach. After a school registers interest in nutrition, the NGO conducts a selection process with a local partner. The school conducts a baseline survey of up to 20 children from each grade between 4 th and 9th grade. Schools then receive an NSF toolkit, followed by an orientation for teachers and students. Local partners monitor the school’s monthly progress. Schools conduct a midline survey six months to one year after the toolkit launch to assess the impact.
The toolkit programme spans two years. It begins with an introductory kit in the first year, and an advanced version in the second. Along with the games, it contains a detailed curriculum, which is spread over 8-12 weeks annually, for activities such as soap making, building a handwashing station and setting up a school garden.
GSS (Kawani) has been part of the toolkit programme since 2023. In that time, 231 girls and 221 boys have been exposed to the games. The current batch is in the second year of the programme.
And they love the games. Appointed Student Ministers, who have divided the class into three groups, facilitate a round of games based on nutrition, hygiene and agriculture. Clues such as the ones on Sangeet’s ‘aam’ card inform students about the nutritional content, benefits and cultural references of foods as well as the harmful effects of junk foods. Another group is playing Saap Seedi (Snakes and Ladder). A good habit takes a child ahead in the game, and a bad habit slides them down on a snake.
Twelve-year-old Suresh has already connected the games to what his mother grows in her kitchen garden. He parrots his favourite foods: “bhindi, dal, aloo, chole, dahi, gajar, tinda, ker sangri. These give us a balanced portion of protein, carbohydrates, fats and fibre. My mom grows many of them in our backyard,” he says.
The educational games they play today have been designed to catalyse into the wisdom they will hopefully implement tomorrow.
As part of the toolkit, children also maintain a school garden. NSF took a leaf from one of their partners in Assam and compiled a small manual that gave week-by-week steps to help children start a school garden. “The school garden helps children undertake some simple activities that will improve their access to nutrition,” says Sinha.
Many mothers, whose children are exposed to the toolkit programme at Government Secondary School (GSS) in Rajasar, Bikaner are part of a farmer Self-Help Group that participates in a 13-meeting intervention by NSF. They are introduced to the use of organic fertilisers and given ideas on what to grow within their resources.
“Any conversation around nutrition and food security is futile without recognising climate-smart agriculture aspects with farmers, especially women farmers. “This means involving the community to take an active part in the toolkit programme through climate smart agriculture. The first-year toolkit encourages children to reach out to parents and involve them in the school garden. This can help guide children better. Nutrition becomes everybody's business,” says Sinha.
At the end of each toolkit year, a survey is conducted with the same children covered during the baseline survey. It assesses the improvement in their nutritional status and nutrition- and health-related habits, along with their engagement with the toolkit. This is done using an app on a smartphone or tablet device.
This exercise documents how much the children imbibed, participated and responded to the toolkit. “Based on this data, we also improvise the toolkit,” says Sinha.
This data is then presented in multiple ways for donors, presentations and school reports using Power BI dashboards. “We have also started putting these reports out on our website, for other organisations to get insights from the work,” says Sinha.
Between 2014-2019, the overall midline studies (2500+ responses) have shown an improvement in just 12 months of engaging with the programme. There has been a 14% point decrease in schoolchildren who are undernourished; a 32% point increase in the number of schoolchildren who washed their hands with soap/sanitiser; a 14% point increase in the number of schoolchildren who said that they could take charge of their nutrition.
NSF continues to expand its footprint based on its growing data. Sinha believes acceptance of the programme has been a big step forward in tackling the cause. “We are able to share data we have collected and back how the toolkit can help address it. The conversation starts from a place of solving the issue together,” says Sinha.
Sinha hopes to leverage advanced data analytics and AI to get better insights out of their data and even look to integrate nutrition education into the regular curriculum.
The road ahead is long, but Deepa Amarnath, who leads toolkit development and operations, is positive. “Nutrition-related content, when presented in a fun manner, engages children. A child may not change his/her behaviour right away, but the knowledge is retained to be retrieved later. By the time they become parents, they should be able to change some of their habits significantly and influence the next generation,” she says.
The data has also helped NSF hold themselves accountable. “For us, data itself has been a tool for impact, not just a way to measure impact. You need to gather data to create the toolkit and at various stages of running the toolkit programme,” says Sinha.
They track progress through behaviours by continuously asking questions around their practices related to hygiene, to their diet, to how physically active they are. “We look at the changes over time,” adds Sinha.
As time turns these adolescents into parents, imprints of the toolkit will reflect in their nutritional and hygiene choices.
Thanks to Sahi Aur Galat, a game focused on hygiene and sanitation in the second-year toolkit, Aisha has picked up the habit of washing her hands before meals, and after using the toilet. “The toolkit drew our attention to the quality of water, sanitation, and handwashing amenities in school,” she says with a smile.