Nutrition Coalition hosts Policy Seminar on “Nutrition—Policies, Practices, and Governance” in New Delhi

Photo Credit: Aishwarya Pillai
File photo/Photographer: Aishwarya Pillai

The Coalition for Sustainable Nutrition Security in India, in collaboration with the POSHAN project of the International Food Policy Research Institute (IFPRI), organized a policy seminar on “Nutrition—Policies, Practices, and Governance” on November 27 in New Delhi. The seminar touched on key issues in nutrition, such as stunting, governance success stories, and corporate performance on obesity and undernutrition efforts.

Lawrence Haddad from the Institute of Development Studies in Sussex, United Kingdom spoke on India’s nutrition enigmas and why they should not be a distraction from action. He highlighted that India is home to approximately 40 percent of the world’s stunted children and has the fifth-highest stunting rate in the world. “At current rates of progress,” explained Haddad, “India will meet its Millennium Development Goals on nutrition in 2043.”

India’s rates of childhood stunting are higher than Africa’s and have a weak connection to economic growth: When considering its GDP per capita, India’s rate of stunting is higher than would be predicted, although not by a great extent. Haddad laid out several possible causes for this higher than expected rate of stunting, including ineffective nutrition interventions, poor sanitation standards, and the poor status of women, among others. Indian citizens need to put pressure on their government to prioritize nutrition. Undernutrition is invisible and irreversible, requiring action on multiple fronts, he said.

Dr. V. Suresh and Professor Pradip Prabhu of the Barefoot Academy of Governance (BA) spoke on governance and improved nutrition outcomes, specifically building on what works in other sectors in India. They presented their experience with intensive residential ‘change’ retreats, in which participants engaged in personal and collective explorations of their understanding of good governance practices. They found that key to all the change efforts was the ideal of `Collective, Convergent, and Consensual Change.’ A change management experiment completed in Odisha served as an inspiration and a sign of the potential that exists in the country to change the face of public services. It doesn’t take much effort nor is it very expensive, explained the presenters.

Ms. Inge Kauer, Executive Director of the Netherlands-based Access to Nutrition Foundation presented the Access to Nutrition Index (ATNI), a new global initiative that evaluates food and beverage manufacturers on their policies, practices, and performance related to obesity and undernutrition. Formally launched in March, 2013, the next ATNI is planned to be published in 2015. In addition to a global index, ATNI is also working on spotlight indexes for assessing companies in specific markets suffering from a high double burden of malnutrition. India is one of the countries that ATNI is exploring. By providing companies with a tool for benchmarking their nutrition practices and serving as an impartial source of information for interested stakeholders, ATNI aims to encourage companies to increase consumer access to nutritious products and responsibly exercise their influence on consumer choice and behavior.

Please see the presentations below:
India’s Malnutrition Enigmas Why They Must Not Be a Distraction from Action_Policy Seminar_Presentation by Prof Lawrence Haddad-Nutrition Coalition_Nov 27th, 2013:
Convergence for Nutritional Security_Policy Seminar by _Dr. V. Suresh and Professor Pradip Prabhu -Nutrition Coalition_Nov 27th, 2013
Access to Nutrition Index_Policy Seminar_ Presentation by Ms. Inge Kauer-Nutrition Coalition_Nov 27th, 2013

 

 

Knowledge Mobilization Meeting Tackles Tough Issues in Nutrition Program Implementation

Vikas Samvad, a POSHAN knowledge mobilization partner, organized a division-level meeting in Gwalior, Madhya Pradesh where the challenges and successes of working to reduce malnutrition in India were discussed.

Knowledge Mobilization meeting in Gwalior in progress/Photo credit: Vikas Samvad
Knowledge Mobilization meeting in Gwalior in progress/Photo credit: Vikas Samvad

Held at the Regional Media Resource Centre of the Department of Women and Child Development (WCD), the meeting attracted attendees from five districts:  Murena, Bhind, Datia, Shivpuri, and Gwalior. Among the distinguished meeting participants were Shri Suresh Tomar, the Joint Director of WCD in Gwalior District, two District Project Officer (DPO), six Child Development Project Officers (CDPOs) , six supervisors, and seven Anganwadi Workers (AWW).

Opening the meeting, Shri. Tomar recognized the key role of AWW and the need for them to play an even bigger role in raising nutrition awareness at the community level. He said that the focus of ICDS (Integrated Child Development Services) program has been on food distribution, however, ICDS must work towards developing AWWs’ communication skills so they can engage community leaders, mothers, and especially men, in discussions around nutrition.

Mr. Sachin Kumar, from Vikas Samvad, said that despite difficulties there are approximately 1.34 million Aanganwadi Centres (AWC) and 1.27 million AWWs to address the problem of malnutrition. He emphasized that while new research evidence on reducing malnutrition abounds, it is not reaching the grass roots level, where it can be applied.

Some discussion revolved around the Take Home Ration (THR) program. Rations of food and cooking oil intended for children under two years old are distributed to families to combat malnutrition. However, without demonstrating the importance of nutrition and the purpose of the program to families who do not consider malnutrition a problem, the entire ration is being cooked and consumed in a single sitting by both children and adults in many households.

Initially, meeting participants felt that some parents were not concerned about the health of their children. However, after one attendee shared the story of a mother who kept a piece of iron to protect her malnourished child from the evil eye, participants agreed that many parents don’t believe their children are in any danger unless they have observable symptoms, like a fever. Gender dimensions can further complicate the situation; if other family members, like the father, do not support a mother’s concerns, it will be difficult for the mother to proceed with any further action.

Attendees unanimously agreed that the chief problem they faced were ever-changing implementation activities and strategies. The AWW, for instance, are given additional duties like raising voter awareness, counting village animals, conducting economic surveys, etc. which compete with the time they are able to address malnutrition. Some participants felt the program has moved away from the ICDS focus of addressing malnutrition.

Mr. Kumar asked if attendees have a forum where they regularly discuss ICDS program implementation. Participants agreed that they lack a platform on which to share experiences, and that an environment, where officials and staff at different levels of the program are able to ask questions, identify problems, and discuss possible solutions, potentially on topics outside of ICDS, would be helpful. While it was recognized that not every problem has a solution, the ability to call upon a technical expert, would still be highly valued. Participants did not propose a specific platform, but did suggest that regular meetings between representatives from all levels would enable a Question & Answer-type discussion.

Further discussion concerned the initiatives offering toll-free phone numbers which ICDS functionaries can call when they have questions on issues they address while implementing the ICDS program. Participants agreed some problems cannot be addressed through hotlines, and one attendee described an Anganwadi Resource Centre in Andhra Pradesh which is developing documentation on various innovative initiatives.

Finally, successful AWC and AWW were shared. An example of an AWC from a place called Atri (district Balaghat, Madhya Pradesh) was shared where the AWW delivered her duties very well and had a great acceptance in the community. The AWW even got recognized in a district level program meeting.

It was suggested that such examples must be documented and shared with all the ICDS functionaries to learn and adopt from the successes of their counterparts. The documentation can be further shared at the State level and national level for inter-district and inter-state learnings.

The POSHAN Nutrition Knowledge Conveners Network on Stakeholder Engagement

Photo credit: Aishwarya Pillai
Photo credit: Aishwarya Pillai

In May 2013, POSHAN (Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India) hosted a meeting, bringing together various networks that are working to mobilize research evidence on nutrition in India.

Following the meeting, a Nutrition Knowledge Conveners Network (NKCN) was established on the Eldis Communities website in September 2013. Formed in response to suggestions that a virtual community be established to serve as a knowledge-sharing platform, the objective of the network is for key stakeholders to share lessons learned, promote linkages, and reflect on the best strategies for nutrition knowledge mobilization.

 Mr. Gopi Ghosh from the Food and Agriculture Organisation (FAO)  initiated the first discussion on the issue of engaging stakeholders in knowledge mobilization. Participants exchanged perspectives on how India can strengthen knowledge mobilization to support development.

There was a rich discussion on the factors that facilitate, as well as inhibit, stakeholder engagement in knowledge mobilization. Contributors emphasized it is essential that stakeholders believe in the principle and strength of knowledge mobilization and are self-motivated to remain engaged in discussions in both virtual and physical networks.

Accurately identifying stakeholders encourages the presentation of information in user-friendly formats that meet both stakeholders’ needs and preferences, suggested the participants. This, in turn, increases the likelihood that stakeholders will apply knowledge that has been generated within the network.

Participants also believed that it is important for knowledge to reach those who can apply it in practice; political and scientific knowledge alone is not sufficient. It is, therefore, essential to engage the people working at the operational level. However, at present, there are no forums or knowledge platforms geared towards the needs of those working on the ground and in the field.

 At the same time, participants cited several barriers to maintaining stakeholder engagement, including limited government participation, a lack of credible data, a lack of financial sustainability, and the under-promotion of a spirit and culture of sharing. Efforts to overcome these barriers would go a long way toward  ensuring a sustainable and vibrant stakeholder network on nutrition.

Above all, participants emphasized the importance of engaging senior experts from various disciplines, government officials, and members of civil society and non-governmental organizations to continue to facilitate rich discussions within the virtual network.

 

The Coalition for Sustainable Nutrition Security Discusses Amending the Leadership Agenda for Action in India

Photographer: Aishawarya Pillai
Photographer: Aishawarya Pillai

The Coalition for Sustainable Nutrition Security (The Coalition) convened an online discussion from October 16-18, 2013 to engage experts in a dialogue about the Leadership Agenda for Action¹ (LAA) and the need to amend the agenda to account for recent nutrition evidence.

The online expert discussion was led by The Coalition with support from the Institute of Development Studies (IDS), a POSHAN partner, and was hosted in a private group on the Eldis Communities website². Nearly 75 experts from India took part in the online deliberations, including representatives from government and civil society organizations, along with senior experts in nutrition and public health.

The event was initiated under the leadership of Prof. M.S. Swaminathan, chair of The Coalition, and facilitated by Drs. Sheila Vir and Rasmi Avula.

Over the course of three intensive days of discussion, experts exchanged perspectives in response to the following key questions:

  • What revisions are needed, if any, to the existing list of direct interventions for reducing maternal and child undernutrition in the LAA?
  • How can we effectively scale up implementation of the direct interventions to improve maternal and child nutrition?
  • What pieces of the new and emerging evidence base are most relevant in the Indian context to create an enabling environment that improves maternal and child nutrition?

At the end of each day, the contributions were collated, summarised, and shared with the group.

The level of participation was relatively strong for this type of online forum - 45% of participants actively contributed at least once and nearly 20% contributed several times. Each post was, on average, more than 300 words long, highlighting the substantive nature of the conversation and time invested by participants.

Key discussion points

Many participants felt that the LAA currently addresses the majority of the interventions needed to improve maternal and child nutrition. Participants also suggested that the LAA could be strengthened by incorporating some additional interventions (described below) informed by the latest evidence from the Lancet 2013, Cochrane reviews, state-specific studies, HUNGaMA, and NHFS-3.

Participants suggested that more attention be paid to interventions in Water, Sanitation and Hygiene (WASH), beyond what is currently included in the LAA, which is primarily focused on food hygiene and safe handling. Participants also felt that environmental health should to be prioritized in the LAA recommendations, given the associations between stunting prevalence and adequate food, care, and environmental health.


¹The LAA was developed by The Coalition in 2010.
²community.edlis.org

Evidence Review in Focus

A critical look at interventions in place to address maternal and child nutrition in India

Photo credit Aishwarya Pillai
Photo credit Aishwarya Pillai

In this blog post, we share some key findings from POSHAN’s review of evidence-based direct nutrition interventions.

POSHAN reviewed the design documents of two national nutrition programs, Integrated Child Development Services (ICDS) and the National Rural Health Mission (NRHM), published literature, grey literature and the program models of 22 NGO programs in order to assess the extent to which existing nutrition programs address the 14 essential nutrition inputs.

The results of the desk review demonstrate that, from a design perspective, ICDS and NRHM together address all of the 14 essential inputs to improve maternal and child nutrition. While a majority of program models implemented by NGOs address essential inputs pertaining to breastfeeding and complementary feeding, few address vitamin A deficiency, pediatric anemia, severe and acute malnutrition (SAM), and none address reducing intestinal parasitic burden and the prevention of anemia. The results of this review further indicate that there is an overwhelming need to build operational evidence to ensure high quality delivery of evidence-based interventions, which already operate at national scale. To conclude, the evidence base around how best to operationalize evidence-based interventions for nutrition in India is weak. Overall, it will be essential to institutionalize documentation and learning processes around nutrition programs to ensure that ongoing efforts to address undernutrition are tapping into the best available evidence and knowledge to ensure the best possible future for India’s children.

Please click on Evidence Review to access the document.

 

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