The document outlines the development of a nutrition training roadmap for administrators in India, emphasizing the need for improved system commitment and capacity at state and district levels to combat malnutrition. It details past training experiences and the curriculum aimed at empowering district administrators with knowledge and skills related to nutrition, including immediate and underlying determinants of malnutrition and relevant interventions. The document highlights the importance of data-driven diagnostics and collaboration across sectors to enhance nutritional outcomes and address knowledge gaps among administrators.

1. Developing a nutrition
training roadmap for
administrators in India
Rationale, previous experiences, anticipated
outcomes

2. Why a nutrition training roadmap for
administrators?
• The nutrition technical community as well as policy
makers/program designers are increasingly aligned
around some core issues related to nutrition in
India
• India’s programs typically focus on capacity building
for frontline providers and immediate supervisors
• System commitment and capacity are the missing
middle  state, district, sub-district
• But who are the administrators and others in the
“system”? What do they need to know about nutrition?
How does the nutrition community help support this
improvement in system commitment and capacity?

3. What are some core areas of
alignment?
• Multiple forms of malnutrition with multiple consequences
• The importance of the first 1000 days for many forms of malnutrition
(but also windows outside this, such as adolescence)
• The recognition that immediate and underlying determinants both
matter
• Interventions are both nutrition-specific (ICDS, health system) and
nutrition sensitive (poverty reduction, sanitation, food security,
gender, etc.)
• Even interventions in policy and program frameworks are not reaching
everyone – improving coverage, quality and uptake are critical (C2IQ)
• The food system needs to be better aligned with nutrition (and not
just hunger)
• Healthy diets matter for all forms of malnutrition
• Unhealthy foods need to be tackled, both in public programs and in private
sector
• Data use is key to improving programs

4. What have we done on training
administrators?
• Adapted the global Transforming Nutrition: Ideas,
Policies and Outcomes course (developed with
Lawrence Haddad, hosted every July at IDS, UK for
five days)
• Developed a 2 day course in India, focused on
district administrators
• August 2018 [LBSNAA/NGC, IFPRI, EPoD]
• February 2019 [LBSNAA/NGC, MWCD, NITI Aayog,
IFPRI, IDInsight, EPoD, PCI etc.]

5. • To integrate ideas about nutrition from cause to
consequence to intervention to building commitment --
and back again!
• To help marshal the latest evidence better to accelerate
intervention coverage, malnutrition reduction
• To learn from each other, together
• To inspire and energize ourselves in the fight against
malnutrition
What do we aim to do in the
short courses?

6. Day Sessio
n
Topic Day Sessi
on
Topic
Monda
y 6th
Aug
1 Intro + Objectives Tuesda
y7th
Aug
6 Module 3: Nutrition Sensitive
Programmes – Food Security,
Poverty/Social Protection, Gender,
WASH
2 Module 1: Nature of the Problem
and its Distribution and Causes:
Why Nutrition is a Perfect
Systems Issue
7 Module 3: Building Support for
Nutrition
Building an enabling environment
for nutrition-
Leadership, Politics & Policy
Accountability
Financing
Capacity
Evidence
lunch
3 Module 2: What Works (Nutrition
Specific Interventions) lunch
3 Bringing it together: Nutrition stories
of success in India
4 Bringing it together: Nutrition stories
of success in India
4 Taking it forward; Identifying the
critical and specific actions at the
district-level
What does the course look like?

7. Examples of content and
approaches used

8. 8

9. Immediate causes of malnutrition
(especially for children)
Food
Breastfeeding
Complementary feeding
Limiting non-nutritive foods
Care
All activities that assure that family food,
health and other resources reach the child
Attention to the child, care arrangements
Responsive feeding
Psychosocial stimulation
Health
Maternal health and well-being
Preventive and curative health care
Assurance of a healthy and clean environment

10. Underlying causes of poor nutrition for
children
Food-related
resources
• Household food
security
• Household food
diversity
• Healthy/unhealthy
food environment
Care-related
resources
• Support available
to parents
• Time
• Stress
• Workload
Health-related
resources
• Access to and
availability of
health care
• Access to clean
environments
Poverty, social exclusion and lack of agency and opportunity
are underpinnings of these causes
Causes of the causes!

11. Using the framework to link interventions to determinants
11

12. Birthspacing-pregnancycare
AntenatalCare
Immunization
Home Based
Newborn Care
Feeding counseling: breast feeding and complementary feeding
Birth
Institutional
Deliveries
6 weeks
Facility Based
Newborn
Care
Integrated Management of Neonatal and Childhood Illnesses
Home-based Young Child Care
(Nutrition and health counseling, early
stimulation
6
months
1
year
2
years
Swachh: Safe water, hand washing, toilet use, safe disposal of feces
Supplementary nutrition: mother >>> baby
Growth monitoring; stimulation and care of the malnourished child
HEALTH*ICDS*
Not to
scale
Pregnancy
Pre-
pregna
ncy
*predominant
role
Care for severe acute malnutrition
Program packages of
Interventions for first 1000 days:
for health, nutrition and development
12
BetiBachao,betipadhao
Adolescentcare
Iron-folic acid; Vitamin A; Deworming
All
Enablers: Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Janani Suraksha Yojana (JSY) Pradhan Mantri Maatru Vandana Yojana (PMMVY),
Janani Shishu Suraksha Yojana (JSSY), Rashtriya Bal Suraksha Karyakram (RBSK)

13. Using data to show how coverage interventions
variable: by life-stage, by intervention, by the delivery
platform …
13
93.3
51
77.7
30.2
83
18
75.4
40.1
52.6
35.1
43.8
81
83.3
36.7
65.1
27.1
47.8
35.137.1
62.6
59.3
26.5
32.2
79.1
50.5
20.2
51.7
42.744.6
28.55
0
10
20
30
40
50
60
70
80
90
100
PREGNANCY DELIVERY & POSTNATAL EARLY CHILDHOOD
Health
ICDS
Health
ICDS
Health
ICDS

14. ….and among states and…
14
0
10
20
30
40
50
60
70
80
90
100
DemandforFPsatisfied
Iodizedsalt
≥4ANCvisits
Consumed100+IFAduring…
Neonataltetanusprotection
Dewormingduringpregnancy
Weighingduringpregnancy
Breastfeedingcounselingduring…
Supplementaryfood-pregnancy
Healthandnutritioneducation-…
Healthcheckup-pregnancy
Institutionaldelivery
Skilledbirthattendant
JSY
Postnatalcareformothers
Postnatalcareforbabies
Supplementaryfood-lactation
Healthandnutritioneducation-…
Healthcheckup-lactation
Fullimmunization
ReceivedvitaminAinthelast6…
PediatricIFA
Dewormingforchildren
Careseekingforpneumonia
ORSduringdiarrhea
Zincduringdiarrhea
Supplementaryfood-children
Healthcheckup-children
Weighing-children
Cousellingonchildgrowth
Prepregnancy Pregnancy Delivery and early postnatal Early childhood
%
Source: National Family Health Survey -4

15. Proportion of mothers receiving any ANC
…among the districts
15
Proportion of mothers receiving 4 or more ANC
Source: National Family Health Survey -4
Take a look
at your
district for
ANC
490 districts ≥75%
women received
any ANC
156 districts ≥75%
women received 4
or more ANC

16. Data, diagnostic work and dialogue are a key
feature of the pedagogical approaches in these
short courses
• Basic approach includes the sharing of concepts and
then some diagnostic work that is grounded in data
that is geographically and topically relevant
• Multiple forms of malnutrition  examine what
malnutrition looks like in your district
• Immediate determinants  see what the data says about
these in your district
• Underlying determinants  see what the data says about
these in your district
• Reach of interventions in ICDS and health  see how your
district is doing on intervention coverage

17. Diagnostic exercises: Do a little
diagnosis for your district!
• What does the burden
of malnutrition look like
in your district? What
forms does it take?
• What do major risk
factors/causes for
malnutrition look like in
the district?
• Start off a causal map
of the components and
their interactions – on
paper

19. Intervention coverage: exercises to prioritize
areas to work on
• 5 mins (individual exercise)
• Take a look at your state
coverage note and focus
on the district dashboard
• Which interventions are
consistently high?
• Which ones are low for all
districts?
• 5 mins - table buzz – what are you
finding
• As you think forward to your district
action plans – think of how you will
achieve C2IQ
• Coverage
• Consistency
• Intensity
• Quality

20. Using administrative data to diagnose program challenges
Led by IDInsight
Data case studies, including the use of administrative data mapped to theory of change
Diagnostic work on what data revealed about issues to address

21. Strategy clinics: One-on-one sessions to help
review district diagnostics, provided tailored
inputs to individual district administrators

22. Course participant
reflections
Insights from previous workshops
(6th-7th August 2018)
(13th-15th February 2019)

23. Immediate post-workshop feedback was largely
positive with various suggestions for improvement
• OVERALL:
• On a scale of 1 to 5, all 21 respondents rated the effectiveness of day 1
as 3 or more. 13 respondents rated the effectiveness as 5.
• Session: Nature of the Problem and its Distribution and Causes: Why
Nutrition is a Perfect Systems Issue
• On a scale of 1 to 5, all 21 respondents rated the effectiveness of the
session as 3 or more. 10 respondents rated the effectiveness as 5.
• Session: Tackling the Immediate Drivers of Malnutrition (Nutrition-Specific
Interventions)
• On a scale of 1 to 5, all 21 respondents rated the effectiveness of the
session as 3 or more. 14 respondents rated the effectiveness as 5.
• Session: Scaling up interventions: district-by-district: What will it take?
• On a scale of 1 to 5, all 21 respondents rated the effectiveness of the
session as 3 or more. 15 respondents rated the effectiveness as 5.

24. Follow-up interviews on course take-
aways (6 months later)
• Every district is different (District Profiles)
• First 1000 days should be considered “Window of Opportunity”
• Significance of diagnosing the immediate & underlying determinants of
malnutrition in a region
• Early registration of pregnancy is important
• Data can be extremely insightful for problem diagnosis (Antenatal Care example)
• Ensuring effective convergence during the 1000-day window

25. Putting
Theory to
Action…
• “I used the story of the
undernourished child story in creating
awareness of among the AWWs and
LSs”
• “I have started to organize
convergence meetings between the
WCD & Health department officials in
my district”
• “I have started including data in our
meetings with senior officials. I have
used NFHS data for certain indicators
pertaining to my district”
• I used Vajan Tyohar data to assess the
status of malnutrition in my district. I
identified the block with the highest
levels of malnutrition and organized
medical check-ups there”

26. Participant Recommendations
Sensitization of all actors (AWWs, LS, CDPOs) in a similar manner
More targeted trainings with homogenous cohorts
More technical knowledge of malnutrition (“We know about the broad causes of stunting but not
about its impact on brain development.”)
Sharpening data analysis skills (“To be able to draw maximum insights from minimum reports”)
Sharing district nutrition profiles with district level staff
Communication skills for more effective interaction with communities
Group work & case studies encourage valuable dialogue between participants

27. Back to why WE are here today
• It is not enough to be harmonized within the
technical community and national policy
community
• It is not enough to invest in capacity building of
frontline providers
• It is critical we invest in system commitment and
capacity in the middle
• Content knowledge
• Role-related knowledge
• Role-relevant skills

28. Who is here today?
People with experience and expertise in diverse
areas and many already engaging with many people
in the “system middle”:
• Technical
• Policy
• Program implementation/support to
implementation
• Data and data use
• Capacity building

29. What do we hope to achieve
together?
• Identify who’s in the missing middle
• Think about what they need to know about
nutrition and for their roles
• Think about what skills they may need
• Brainstorm how we might start to close gaps
• Initiate a collective of people and organizations
building system-level capacity

30. Results of the pre-
workshop survey

31. Participant affiliation (n=17)

32. All the respondents engage with the
administrators (n=17)

33. Level of engagement: >60% respondents engage with administrators
at national, state and district level.

34. Nature of engagement: >80% respondents provide technical inputs to
the administrators at national and state level; ≥65% respondents
provide capacity building to the state and district level administrators.

35. Knowledge or skill gaps identified: All the respondents
mentioned gap in use of data for program decisions
among the administrators
Knowledge about determinants
of malnutrition
Use of data for strategy
development
Knowledge about existing nutrition
programs/interventions