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)
Key thematic areas for
knowledge generation
Knowledge mobilization
activities
 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
 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.
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 interventions
1.
2.
3.
4.
5.
6.
7.
Timely initiation of breastfeeding within
one hour of birth
Exclusive breastfeeding during the first
six months of life
Timely introduction of complementary
foods at six months
Age appropriate complementary feeding,
adequate in terms of quality, quantity,
and frequency for children 6-24 months
Prevention of anaemia
Safe handling of complementary foods
and hygienic complementary feeding
practices
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
80
70
60
50
40
30
20
10
0
Madhya Pradesh
Orissa
Some reasons for low coverage
Interventions are not listed in policies at all
X
Interventions are not part of any programme platforms or
guidelines
X
Implementation mechanisms are not able to deliver
?
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.
2.
3.
4.
5.
6.
7.
Timely initiation of
breastfeeding within one hour
of birth
Exclusive breastfeeding during
the first six months of life
Timely introduction of
complementary foods at six
months
Age appropriate
complementary feeding,
adequate in terms of quality,
quantity, and frequency for
children 6-24months
Prevention of anaemia
Safe handling of
complementary foods and
hygienic complementary
feeding practices
Full immunization
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*
*NRHM only; **ICDS only
8.
Operational guidelines highlight complementarities and
redundancies: suggest critical role of convergence for
effective service delivery
TYPES OF CONVERGENCE REQUIRED TO DELIVER NUTRITION INTERVENTION
Role
complementarity
Role
reinforcement
None
• Pediatric anemia
• Immunization
• Vitamin A
supplementation
• Management of
SAM
• Diarrhea
• Promotion of
breastfeeding
and
complementary
feeding practices
• 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
Madhya Pradesh
Odisha
Ongoing efforts to
strengthen convergence
as part of new nutrition
mission
Strengthening
convergence across
health, water and
sanitation is a key goal
Methods: Sampling
District selection will be based on its
representativeness to the state
nutrition, health, and service delivery
indicators
1. Best performance district
2. Average performance district
3. Poor performance district
State
Purposive sample
District1
District 2
Random sample
Block 1
Block 2
Random sample
25 AWCs
Random sample
4 households/ AWC
Block 3
Block 4
District 3
Methods: Types of data collection
Qualitative
Quantitative




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
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