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State Level ConsultationOn

Child Nutrition – Innovations andChallenges

Inaugural Presentation

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Consultation on multisectorchild nutrition initiatives

Background

Barun KanjilalFuture Health Systems Programme

Purpose of the workshop

Bring the stakeholders from various sectors on one platform

Stress the importance of integrated systems rather than simple technical fixes to combat malnutrition.

Set a stage for cross learning Reinforce the policy dialogue on this issue

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Partner organizers

Future Health Systems (FHS), IIHMR

Welthungerhilfe (WHH) UNICEF DRCSC And several non-government

agencies

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Future Health Systems (FHS)

A multi-country research consortium funded by DFID and led by Johns Hopkins University

In India, it is implemented by IIHMR University

Working in Sundarban with the aim of improving child health care system through knowledge intervention

Working closely with the NGOs, development partners, government agencies, and other related stakeholders to build a network and trigger actions for improving child health

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FHS Research Objective

What would be the most feasible & sustainable strategy to reach the excluded children with quality appropriate basic health and nutrition care package?

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Nutrition – through a multi-sector lens

7Source: Levinson & Balarajan (2013)

Nutrition-sensitive strategies increase the impact ofspecific actions for nutrition

Strategies

Nutrition-specific

Feeding practices

& behaviours

Food fortificatio

n

Micronutrient

supplement

Treat-ment of acute

malnutr-ition

Nutrition-sensitive

Agriculture Water & sanitation

Education &

employment

Health care

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ROOTED IN

PovertyDisempowerment

of womenPolitical & Cultural

Environment

Insufficient access to affordable, nutritious

FOODthroughout the year

Lack of good

CAREfor mothers &

children & support for mothers on

appropriate child feeding practices

Inadequateaccess to

HEALTHsanitation & clean

water services

The causes of malnutrition are interconnected

Some evidence from FHS research

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FHS evidence (2009): Level of chronic child malnutrition in Sundarbans

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52%

23%

45%

18%

48%

24%

0%

10%

20%

30%

40%

50%

60%

Stunted Severely stunted

Estimated percentage of stunted children (<5 years) in the Sundarbans, West Bengal (NFHS-3), and India (NFHS-3)

Sunderban West Bengal India

FHS Evidence (2012): Open defecation and malnutrition

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44.5

13

43.9

14.1

32.8

11.2

36.6

11.2

<-2sd <-3sd <-2sd <-3sd

Stunted Underweight

Malnutrition and Household level Open Defecation Practice

Open Defacation Not Open Defecation

FHS evidence (2012): livelihood and malnutrition

43.8

33.6

44.237.5

Food insecured Others

% of children with adequate foodStunted Underweight

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Evidence on inequity

A little more than one-third of the children are chronically malnourished. However, the prevalence is astoundingly high, almost 60%, for the girls of 1-3 years belonging to the poorer households.

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41.5

34.3

24.5

0

5

10

15

20

25

30

35

40

45

<18.5 18.6 - 24.99 >25

% o

f ch

ild

ren

Mothers’ BMI

FHS evidence (2012) : Nutritional chord between mothers and their children

% of children underweight

Convergent / integrated approach: lessons learned

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Few lessons from case studies (Levinson & Balarajan, 2013)

Nutrition-sensitive strategies increase the impact of nutrition-specific actions.

It is not necessary that ALL sectors should be equally explicit in nutrition-sensitivity.

‘Plan multisectorally, implement sectorally, and review multisectorally’ seems to be the most effective mechanism for convergence.

Convergence does not necessarily require complex interaction among the actors

Targeting is necessary

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MDG-F programme: An example from Bangladesh

Implemented in one division (Barishal) – the division with highest poverty and malnutrition rates - with support from several global aid agencies

The intervention basket includes: Targeting acute malnutrition by CMAM through NGO – GO

combination Improving food security through agriculture, homestead

food production and nutrition training School feeding and school gardening Blanket iron supplementation to children 6-23 months

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Proposed format for the consultation

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Thematic sessions

Three separate sessions on (1) Health and nutrition, (2) WASH and nutrition, and (3) Livelihoods, rights and nutrition

Presentations and discussions in each session will primarily focus on the gaps and solutions

The moderator in each session will summarize and present the key points to all after the session.

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Panel discussion

The concluding session will be an open panel discussions on “Multi sectoralapproach in addressing child nutrition” led by a team of eminent experts.

The outputs from the thematic sessions and the panel discussion will be documented and shared with all policy actors for necessary actions.

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Thank you!

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