POSHAN UPDATE
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Transcript of POSHAN UPDATE
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POSHAN UPDATE
Dr. Suneetha Kadiyala/Research Fellow/IFPRI/March 5, 2013
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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]
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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)
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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
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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
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An assessment of convergence between health and ICDS to improve maternal and child nutrition in Madhya Pradesh and Odisha
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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)
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Coverage of direct interventions is low in India
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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
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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?
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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
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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
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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
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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?
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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
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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
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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
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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