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Delivering interventions during the first 1000 days: Implications for achieving India's nutrition goals

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Presented at 'Strengthening National, State and District-level Actions for Nutrition: Insights from the National Family Health Survey Data' on 13th December, 2017 at IIC, New Delhi.

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Delivering interventions during the first 1000 days: Implications for achieving India's nutrition goals

  1. 1. 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
  2. 2. 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 53 54.9 18.6 0 10 20 30 40 50 60 70 Stunting Wasting Anemia among women Exclusive breastfeeding Low birthweight 2005-06 2015-16 Source: NFHS-3; NFHS-4 and RSOC for low birth weight World Health Assembly Nutrition Target Level
  3. 3. Conceptual framework for child nutrition
  4. 4. 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)
  5. 5. Variable coverage of interventions across continuum of care, and among the states in 2016 84.1 58.6 51.2 89 30.3 27.8 78.9 79.7 81.4 24.3 51.0 36.4 20.3 62 60.2 13.4 27.6 49.2 50.6 20.3 0 10 20 30 40 50 60 70 80 90 100 Percentage% 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
  6. 6. 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
  7. 7. IFA consumption New-born checkup 618 districts: <50 percent of children had a newborn checkup <25 percent coverage in 290 districts
  8. 8. Vitamin A supplementation Immunization >75% coverage only in 129 districts >75% coverage only in 150 districts
  9. 9. 63.2 45.1 83.3 32.5 79.8 17 40.1 37.4 32.4 28.3 80.4 13.5 25.5 31.7 29.3 25.8 62.2 66.7 40.7 35 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 Health Health Health ICDS ICDS ICDS Source: NFHS-4 Haryana State ReportIndicate service delivery platformsNote: Implement Review Plan
  10. 10. 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 districts oHuge potential for improving delivery of interventions ▪ Focus on achieving coverage oExamine reasons for gaps in coverage - Plan oIdentify, test, and scale solutions – Implement oRevisit and reflect - Review

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