POSHAN UPDATE

Dr. Suneetha Kadiyala/Research Fellow/IFPRI/March 5, 2013

Goal of POSHAN

POSHAN’s goal is to support and strengthen policy and programme decisions and actions to accelerate reductions in maternal and child under nutrition in India, through an inclusive process of:

evidence synthesis knowledge generation knowledge mobilization

National and State-Level Effort[Madhya Pradesh, Uttar Pradesh, A.P, Bihar, Odisha]

Partnerships are central to POSHAN

POSHAN is led by IFPRI, with— Public Health Foundation of India’s Health Communications group— Institute for Development Studies’ Knowledge Services group — Other knowledge mobilization partners

— Save the Children, India — Coalition for Sustainable Nutrition Security in India— UN Solution Exchange — Right to Food Network— OneWorld South Asia — Others ( We are exploring and open to other collaborations)

POSHAN’s inception activities : (2011-12)

Landscape of actors, policies, programs and knowledge networks in nutrition , with a focus on use of evidence

Diverse methods used:—Document review —Stakeholder interviews —Net-Map

Key findings shared at a large multistakeholder consultation on June 19th, 2012

POSHAN’s strategic focus (2013-2015)

Core knowledge mobilization for all thematic areas (research and policy briefs, events to facilitate learning)

Mobilization of knowledge from non-POSHAN activities (abstract digests, e-consultations)

Media engagement, support to existing knowledge networks, etc.

Intersectoral convergence between health services and ICDS

Assessing multisectoral planning and action for nutrition

Strengthening evidence for improving implementation of direct interventions

Strengthening generation and use of nutrition data

Key thematic areas for knowledge generation

Knowledge mobilization activities

An assessment of convergence between health and ICDS to improve maternal and child nutrition in Madhya Pradesh and Odisha

There is broad agreement on direct interventions1. Timely initiation of breastfeeding within

one hour of birth2. Exclusive breastfeeding during the first

six months of life3. Timely introduction of complementary

foods at six months4. Age appropriate complementary feeding,

adequate in terms of quality, quantity, and frequency for children 6-24 months

5. Prevention of anaemia6. Safe handling of complementary foods

and hygienic complementary feeding practices

7. Full immunization

8. Reducing vitamin A deficiency

9. Reducing burden of intestinal parasite

10. Prevention /Treatment of diarrhoea

11. Timely and quality therapeutic feeding and care for all children with severe acute malnutrition

12. Improved food and nutrition intake for adolescent girls particularly to prevent anaemia

13. Improved food and nutrients intake for adult women, including during pregnancy and lactation

14. Prevention /Treatment of malaria

Compiled based on recommendations from the Lancet Series on Maternal and Child Under-nutrition (2008); The Coalition for Nutrition Security in India Leadership Agenda for Action (2010); The Scaling Up Nutrition Framework (2011)

Coverage of direct interventions is low in India

Coverage of direct interventions varies by state

Early

initiation of B

F

Exclusiv

e BF < 6 mo

Intro of C

F at 6

-9 mo

3 IYCF prac

tices 6

-23 mo

Iron-ri

ch fo

ods (6-23 m

o)

All basic

Immunisa

tions

Safe

stool d

isposal

(0-5 y)

Vitamin A su

pplementation (1

2-35 mo)

Adequately iodise

d salt i

n HH

Diarrh

ea: child

ren fed >= Usu

al0

10

20

30

40

50

60

70

80

Madhya PradeshOrissa

Some reasons for low coverage

Implementation mechanisms are not able to deliver

Interventions are not part of any programme platforms or guidelines

Interventions are not listed in policies at allX

X

?

Interventions not effectively utilized by target population?

Policies do focus on direct interventions

Large number of policies address major areas of public health nutrition need; substantial focus on essential actions

Most policies/guidelines are quite strongly based on scientific evidence

Interventions are included in programme guidelines - ICDS and NRHM provide for all direct interventions

1. Timely initiation of breastfeeding within one hour of birth

2. Exclusive breastfeeding during the first six months of life

3. Timely introduction of complementary foods at six months

4. Age appropriate complementary feeding, adequate in terms of quality, quantity, and frequency for children 6-24months

5. Prevention of anaemia6. Safe handling of complementary

foods and hygienic complementary feeding practices

7. Full immunization

8. Reducing vitamin A deficiency9. Reducing burden of intestinal

parasite*10. Prevention /Treatment of diarrhoea11. Timely and quality therapeutic

feeding and care for all children with severe acute malnutrition

12. Improved food and nutrition intake for adolescent girls particularly to prevent anaemia**

13. Improved food and nutrients intake for adult women, including during pregnancy and lactation

14. Prevention /Treatment of malaria* *NRHM only; **ICDS only

Operational guidelines highlight complementarities and redundancies:

suggest critical role of convergence for effective service deliveryTYPES OF CONVERGENCE REQUIRED TO DELIVER NUTRITION INTERVENTION

Role complementarity

• Pediatric anemia• Immunization• Vitamin A

supplementation• Management of

SAM• Diarrhea

Role reinforcement

• Promotion of breastfeeding and complementary feeding practices

None

• Reducing burden of intestinal parasites

• Prevention of malaria

Research questions How is convergence articulated by the health and

nutrition sectors in policies and guidelines? What mechanisms for convergence are operationalized

at different levels within the health and nutrition sectors, for each of the essential interventions?

What is the role of intersectoral convergence in determining access [of households] and coverage of essential nutrition interventions?

Which institutional and operational factors and processes enable or hinder effective intersectoral convergent actions?

Methods: Choice of states

Ongoing efforts to strengthen convergence as part of new nutrition mission

Strengthening convergence across health, water and sanitation is a key goal

Madhya Pradesh Odisha

State

District1

25 AWCs

District 2 District 3

Block 2Block 1 Block 4 Block 3

4 households/ AWC

Purposive sample

Random sample

Random sample

Random sample

Methods: SamplingDistrict selection will be based on its representativeness to the state nutrition, health, and service delivery indicators 1. Best performance district2. Average performance district3. Poor performance district

Methods: Types of data collection

Document review of action plans, program operational guidelines, and checklists at state, district, and block levels.

Semi-structured interviews with state, district, and block-level officials

Observations of Village Health and Nutrition Days (VHNDs)

Surveys with the ICDS and NRHM frontline workers

Short surveys with mothers of children under-two

Qualitative Quantitative

Timeline

January-March 2013: Protocol review and study planning

April-June 2013: Data collection July-September 2013: Data processing October-November 2013: Analysis and

dissemination of early findings