Delivering interventions during the first 1000 Delivering interventions during the first 1000 days:...
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Delivering interventions during the first 1000 days: Implications for achieving India’s nutrition goals Rasmi Avula, Phuong Nguyen, Sneha Mani, Neha Kohli, Purnima Menon International Food Policy Research Institute December 13, 2017
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Transcript of Delivering interventions during the first 1000 Delivering interventions during the first 1000 days:...
Delivering interventions during the first 1000 days: Implications for achieving India’s nutrition goals
Rasmi Avula, Phuong Nguyen, Sneha Mani, Neha Kohli, Purnima Menon
International Food Policy Research Institute
December 13, 2017
Trends in key global nutrition targets and nutrition outcomes in India, 2005-06 to 2015-16
48
19.8
55
46.4
21.5
38.4
21
5354.9
18.6
0
10
20
30
40
50
60
70
Stunting Wasting Anemia amongwomen
Exclusivebreastfeeding
Low birthweight
2005-06 2015-16
Source: NFHS-3; NFHS-4 and RSOC for low birth weightWorld Health Assembly Nutrition Target Level
Conceptual framework for child nutrition
Interventions across continuum of care in the Indian policy and programmatic framework
PRECONCEPTION
- IFA
- Deworming
- Fortification (Iodized salt)
PREGNANCY
- IFA, Calcium
- Food supplements
- Counseling
- Weighing
- Malaria prevention
- Deworming
- Maternity benefits
DELIVERY & POSTNATAL
- Conditional cash transfer
- Delay cord clamping
- New-born care counseling
- IFA, Calcium
- Food supplements
EARLY
CHILDHOOD
Counseling on IYCF
Immunization
IFA, Vitamin A supplements
Food supplements
Growth monitoring
Double ration
SAM management
ORS & Zinc
Deworming
90% coverage 20% reduction in stunting (Bhutta et al. 2008)
Variable coverage of interventions across continuum of care, and among the states in 2016
84.1
58.6
51.2
89
30.327.8
78.9 79.781.4
24.3
51.0
36.4
20.3
6260.2
13.4
27.6
49.2 50.6
20.3
0
10
20
30
40
50
60
70
80
90
100
Perc
enta
ge %
Sources: NFHS-4. RSoC data was used for indicators on pregnancy registration, food supplementation during pregnancy, lactating and for children, visits by health worker,
pediatric IFA and deworming for children. Note: Bars are the national average and the dots are the state averages
PREGNANCY DELIVERY & POSTNATAL EARLY CHILDHOOD
Pregnancy registration Received at least 4 ANC check-ups
593 districts: > 75% pregnancy registration Only in 158 of 640 districts > 75% received at least 4 ANC visits
Bringing the focus to the action centers: Districts
IFA consumption New-born checkup
618 districts: <50 percent of children had a newborn checkup
<25 percent coverage in 290 districts
Vitamin A supplementation Immunization
>75% coverage only in 129 districts >75% coverage only in 150 districts
63.2
45.1
83.3
32.5
79.8
17
40.137.4
32.428.3
80.4
13.5
25.531.7 29.3
25.8
62.266.7
40.735
60.6
21.9
44.4
37.7 40.1
27.4
91
0
10
20
30
40
50
60
70
80
90
100
%
Points of investment and encouragement to improve delivery of interventions: An example of Haryana
PREGNANCY DELIVERY & POSTNATAL EARLY CHILDHOOD
HealthHealth
Health
ICDSICDS
ICDS
Source: NFHS-4 Haryana State ReportIndicate service delivery platforms Note:
Implement
Review
Plan
Closing thoughts
▪ Targets are set for improving nutrition outcomes
▪Policies and programs exist for improving the determinants
▪ India’s nutrition strategy and the mission rightly focus on the districtsoHuge potential for improving delivery of interventions
▪ Focus on achieving coverageoExamine reasons for gaps in coverage - Plan
o Identify, test, and scale solutions – Implement
oRevisit and reflect - Review
