Poster presented at the SAIFRN 2015 conference on November 23-24. Visit our webiste for more: www.poshan.ifpri.info

1. Understanding the process and factors of intersectoral
convergence in the delivery of nutrition interventions in
Odisha, India
Sunny S. Kim1, Rasmi Avula2 Rajani Ved3, Neha Kohli2, Kavita Singh2, Mara van den Bold1,
Suneetha Kadiyala4, Purnima Menon2
1International Food Policy Research Institute (IFPRI), Washington, D.C., USA; 2IFPRI, New Delhi,
India; 3National Health Systems Resource Center, New Delhi, India; 4London School
of Hygiene & Tropical Medicine, London, UK
• India faces one of the biggest malnutrition challenges in the world.
• Increasing the coverage of essential nutrition interventions already in place is
suggested to markedly reduce maternal and child nutrition.
• Large-scale implementation often requires different sectors to work together, to
reach all target groups.
• In India, responsibility for the implementation of nutrition interventions is shared
between two ministerial departments – Dept. of Health and Family Welfare
(DHFW) and Dept. of Women and Child Development (DWCD), particularly
through DHFW’s National Health Mission (NHM) and DWCD’s Integrated Child
Development Services (ICDS) with their cadres of frontline workers (FLWs). .
• To examine how intersectoral convergence in nutrition programming is
operationalized between ICDS and health programs at the state to village
levels in Odisha state, and to identify factors influencing convergence in policy
implementation and service delivery at different administrative levels.
ACKNOWLEDGEMENTS
 Smt. Arti Ahuja, Commissioner cum Secretary of the Department of Women and Child Development, Odisha, Smt. Aswathy, Director Social Welfare, Dr. Panda, Team Lead, State Health Resource Center, Department
for International Department’s Technical Management and Support Team for their support to the study;
 Sambodhi Research & Communications Pvt Ltd. staff and the field research staff for data collection;
 All the study participants in Odisha for their time and information;
 Financial support from the Bill & Melinda Gates Foundation, through Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN), managed by IFPRI; and
 Additional financial support from the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by IFPRI.
CORRESPONDING AUTHOR: Sunny S. Kim, IFPRI. Email: sunny.kim@cigar.org
Table 2. Summary of roles, degree and key mechanisms of convergence, and salient
factors by different administrative levels
• There is collaboration among state-level actors, particularly in setting policies
and program guidelines, but little evaluation and resource allocation to
understand the performance of these strategies.
• District-level coordination ex.: “There is an immunization plan for the entire
district... It is prepared with coordination between both the [Health and ICDS]
departments... so that service is provided in a better way, coverage is
expanded, coordination is maintained, and there are no missed cases.”
• There is limited cooperation at the block level, specifically for supervision.
• FLW collaboration ex.: “I [ANM] prepare the [beneficiaries] list, and AWW and
ASHA will call the children, and I immunize them. Suppose I provide
immunization, fill out the cards, and check the tally, it will be a difficult task for
me alone. So, AWW and ASHA help me.” .
Definitions of convergence:
Integration: the highest-order of relationships with shared structures or merged
sectoral remits. Collaboration: enhancing one another’s capacity and sharing of
some resources or personnel to facilitate strategic joint planning and action on
certain issues, while maintaining sectoral remits. Coordination: altering one’s
activities to achieve a common purpose; interactions are often unstructured or
based on a loose goal-oriented agreement and working together on certain issues
while maintaining sectoral remits. Cooperation: sharing or exchanging information
or resources only; continuing to work in separate sectors with little communication
or strategic planning on issues.
Sampling and data collection
• Semi-structured interviews were conducted at state level, 3 districts (one well
performing, one average performing, and one poorly performing), 12 blocks
(subdivision or town), and 12 villages.
• For each village, FLWs included 1 Anganwadi Worker (AWW, honorary female
worker selected from community to deliver health and nutrition services and
preschool education under ICDS), 1 Accredited Social Health Activist (ASHA,
female health worker who serves as community mobilizer to access health
services and community-level care provider), and 1 Auxiliary Nurse Midwife
(ANM, multi-purpose female worker who provides a package of health care
services for women and children). See Table 1 for total number of interviews.
Data analysis
• Data coding on types of services, coordination mechanisms, facilitators and
barriers.
Table 1. Sample size by administrative level and sector
• Different degrees of convergence exist at different levels, with little variation
across sites. Block level showed weakest degrees of cooperation.
• Clear guidelines and regularity of convergent actions across all levels and
sectors are needed.
• Addressing factors to improve mult-sectoral coordination may help to enhance
the quality and coverage of essential interventions already in place to improve
maternal and child health and nutrition.
• Further research: Determine implications of convergence on intervention
quality and coverage.
Level Health ICDS Other sectors
State 4 1 7
(NGO, multilateral, academia)
District 11 6 2
(District collector1, GKS/VHSC2)
Block 23 32 11
(Block development officer3)
Village/Frontline 24
(ANM, ASHA)
12
(AWW)
12
(PRI4)
TOTAL: 63 52 30
1 District collector is the chief administrative and revenue officer, appointed by the state government.
2 Gaon Kalyan Samiti/Village Health and Sanitation Committee is the local management body instituted by the
NRHM, comprised of village representatives and headed by a village ward member. GKS is responsible for
community-based planning and implementation of health and related activities, and creating awareness and
promoting public health and sanitation activities.
3 Block development officer is responsible for monitoring the implementation of all programs related to block
planning and development.
4 Panchayai Raj Institution is the oldest system of local government, the most basic administrative unit or
assembly of community representatives, that is responsible for all matters of community development.
Level Main role/action Convergence
degree and key
mechanism
Salient factor:
(+) facilitators and (-) barriers
State • Establish state-wide
programs and initiatives
• Provide guidelines
• Monitor and assess data
• Allocate resources
Collaboration:
• Developing
guidelines
• Planning and
review
meetings
(+) Shared motivation/goals
(+) Recognized leadership for
coordination
(-) Different priority actions
(-) Little data sharing
(-) Lack of accountability and
feedback mechanisms
District • Prioritize services and
activities
• Plan annually/monthly
• Monitor data reports
• Allocate resources
• Train block staff and
FLWs
Coordination:
• Planning and
review
meetings
• Data sharing
• Join training
sessions
(+) Clear leadership
(+) Mutual understanding of roles
(-) Narrow priority topics
(-) Low participation/poor
attendance
(-) Weak supervision
Block • Plan annually/monthly
• Gather data records and
registers and report
• Supervise and feedback
• Train/orient FLWs
Cooperation:
• Planning and
supervision
(+) Shared motivation
(-) Lack of direction/guidelines
(-) Heavy workload
(-) Inadequate resources
(-) Poor communication
Village/
Frontline
• Schedule and implement
services and activities
• Record/register and
report
• Build rapport and demand
creation
Collaboration:
• Planning and
service delivery
(+) Shared motivation
(+) Close interpersonal
communication and vicinity
(+) Understanding of roles and
responsibilities
(+) Designated platform for
collaboration (i.e., VHND)
(-) Unclear lead/responsible
(-) Unbalanced incentives
Abstract ID: MCN 119
Source: R. Avula
BACKGROUND
STUDY OBJECTIVE
METHODS
RESULTS
CONCLUSIONS