Practice Insights

Practice Insight (PI) encapsulates interventions, policies, case studies and innovations on nutrition. Various partners and stakeholders from the nutrition community are leading high-impact initiatives across geographies which are captured creatively as PIs in various forms such as publications, videos, podcasts and photo stories.

The PI series on Micronutrients (MN) Supplementation is a cluster of learnings from interventions aimed at strengthening the MN supplementation programs. The set of learnings underline significance of streamlining supply chain, facilitation by partners, policies formulated at the national and state level.  

The learnings provide an insight into underlying factors affecting MN supplementation programmes and throws light on initiatives that can help in addressing the challenges based on successful interventions implemented by the state governments and development partners in various regions of the country.

The National Health Mission, Jharkhand (NHMJ) identified bottlenecks in supply chain management as one of the major challenges in effective implementation of MN supplementation programs. In response, NHMJ used a multidimensional strategy to strengthen the supply chain management of micronutrients (MNs), namely, IFA Red, IFA Pink, IFA Blue, IFA Syrup, Calcium, Vitamin A and Albendazole in the state. WeCan, supported NHMJ as a facilitating partner in implementing interventions across the state and piloted the initial set of interventions in two districts of Jharkhand. Learnings from these districts are being used to implemented in all the districts of Jharkhand...Read More

State Action Plan for Micronutrient Supplementation in Jharkhand

The National Health Mission Jharkhand is mandated to ensure high coverage and quality of health and nutrition services under RMNCH+A programme, which also includes MN supplements. Under the NHM mandate, Jharkhand has taken an initiative to develop a State Action Plan for Micronutrient Supplementation. WeCan (IPE Global) along with other development partners working in the state, supported the government of Jharkhand and NHM to develop the SAP. The SAP takes a lifecycle approach and includes Iron & Folic Acid (IFA), Albendazole, Calcium and Vitamin ‘A’ under its purview. It was developed after a comprehensive review of the guidelines and research reports on MNs and supplementation programs on MNs. Additionally, several rounds of consultations were held between the development partners and the state government to develop the key aspects of the action plan…Read More

 
 Ensuring Last Mile Supply of Micronutrients in Madhya Pradesh

An independent survey conducted by CHAI with support from the Government of Madhya Pradesh found that about 39% of Anganwadi Centres (AWCs) in 2016 and 35% of schools across the state were completely stocked out of IFA. In order to understand the underlying challenges, CHAI, under the guidance of the Government of MP analyzed both the upstream and downstream supply chains to identify bottlenecks. Based on the findings of the analysis, CHAI devised strategies for streamlining upstream and downstream delivery of MNs in the program areas...Read More

 

The interventions ‘Engaging Panchayati Raj Institutions (PRIs) for POSHAN Abhiyaan’ is a compilation of experiences and learnings from development partners who have designed and implemented programs to tackle malnutrition. The following series of Practice Insight
(PI) reinforces the significance of involving PRI members to focus on the underlying determinants of undernutrition, showcasing how PRIs are instrumental in strengthening of the nutrition programs and working in close coordination with the nutrition partners.

The learnings from PIs will enable stakeholders to understand the processes involved, for them to adopt and build a robust model for bringing maximum impact and leveraging various components of POSHAN Abhiyaan through such interventions. This series of PI captures successful models which can be adapted and scaled-up by different stakeholders.

 Community Engagement and Leadership Development Initiative

GHS recognised PRIs as a platform to promote decentralized health planning, they adopted a bottom-up approach that engages and empowers Gram Pradhans to ensure the availability, accessibility and last mile reach of nutrition and health services. A two-step process involving a cascading model of training was employed under CELD. At the first level, the field staff were trained on a module developed by GHS. This was followed by the trained field staff being sent to the field to further train the Gram Pradhans on a one to one basis…Read More

 Making PRI Champions for Jan Andolan 

To further their ongoing work on malnutrition, AAH initiated a supplementary advocacy intervention in Rajasthan in March 2018 to raise awareness amongst PRI members about their role in achieving the targets of POSHAN Abhiyaan. In collaboration with the NHM and Integrated Child Development Services (ICDS), the new initiative was tailored specifically for PRI members and was rolled out in the eight districts through orientation and sensitisation workshops…Read More

 Mentoring EWRS as Health and Nutrition Champions

This intervention was built on the Chief Minister’s focus on promoting the agency of women leaders in Bihar. The overarching focus was to mentor women ward members and Mukhiyas to play a strong role as Health and Nutrition (H&N) champions in their villages. The advocacy intervention – Hum Hain Champion – was implemented across 10 districts with over 2000 elected women representatives (EWRs) in Bihar. The key components of ‘Hum Hain Champion’ was capacity-building, mentoring and participatory strategizing and action…Read More

 Saksham PRI Convergence Initiative 

Saksham introduced organisational development module for PRI members and adopted an intensive two-pronged strategy. Firstly, this helped them understand and engage with issues related to nutrition and strengthen local governance and communities for nutrition action. Secondly, the strategy aimed towards bringing about the convergence of nutrition-specific and nutrition-sensitive schemes…Read More

The use of Agri-nutrition based models is emerging as an effective way to counter undernutrition, especially in regions where agriculture is the main source of livelihood. The PI series on Agri-nutrition captures learnings from implementations using this model. It captures processes and approaches that when combined with agri-nutrition models, assist in improving the nutrition status and practices. The stakeholders can use these learnings to understand the strategies applied and how can these models be replicated and adapted in other regions to yield desired results.

Countering undernutrition through Community-based approaches

Living Farms combined a community led approach with nutrition-sensitive agriculture, and natural resources – to address the underlying causes behind high prevalence of undernutrition in Rayagada and Kalahandi districts of Odisha. The NGO used participatory learning and action approach to create awareness and build capacity of the community, while encouraging them to cultivate and use naturally occurring nutrient rich food in their daily diet. The program evolved to include 2,000 villages, leading to improved nutritional status for more than 1,00,000 households under the Food and Agroecological Approaches to Reduce Malnutrition (FAARM) project in 2016…Read more

The Practice Insights (PIs) on Community Engagement captures partnerships and coalitions across India that has aid different communities to influence systems, change relationships among partners, and serve as catalysts for changing policies, programs, and practices. The learnings from PIs should enable stakeholders to link ‘community’ with ‘engagement’, denoting the shift from the individual to the collective, with the associated implications for inclusiveness to ensure maximum participation within any community.

Systemic Capacity Building on Nutrition and Advisory Skills of Anganwadi Workers and Supervisors through E-learning in Madhya Pradesh

PI Madhya Pradesh

Anganwadi Workers (AWWs) form the backbone of India’s Public Health and Nutrition System and the Integrated Child Development Services (ICDS) scheme of Department of Women and Child Development (DWCD). AWWs are responsible for the health/nutrition of women and children, for example, by providing hot cooked meals for preschool children aged 3–6 years at local Anganwadi centres, monitoring children’s growth, conducting home visits to counsel or to provide take-home rations for pregnant women and children under three years of age. They play an important role in the delivery of essential services at the village level which has been highlighted even more during the times of COVID-19 pandemic. ….Read more
 

 

Participatory Learning and Action (PLA) approach to address the community behaviours on health and nutrition-based issues in Rajasthan

PI Rajasthan

This practice insight captures the intervention undertaken in Udaipur by Project Rajpusht in collaboration with National Health Mission (NHM), Rajasthan, through the support of Children Investment Fund Foundation (CIFF) and technical partner- Ekjut. The document highlights the key approach of the intervention – Participatory Learning and Action (PLA) – implemented by Rajpusht aimed at influencing the community behaviours by enabling the dialogue on health and nutrition-based issues. It generated awareness on the intergenerational cycle of malnutrition amongst the members of the community and increased the participation of pregnant and lactating women, especially mothers-in-law of the women participating….Read more
 

 

Social & Behaviour Change Communication (SBCC) For Effective Nutrition Interventions

PLA Rajasthan

How can state governments create an enabling environment for nutrition programs and interventions to succeed? Social & Behaviour Change Communication (SBCC) can be one of the answers. This practice insight captures processes, methods and tools involved in creating a data driven SBCC strategy developed in Rajasthan, adopted by both the state government and development partners with a focus on what contributed to the strategy’s success and how were the hurdles crossed…..Read more

Compendium on Learnings from Anemia Mukt Bharat (AMB) Implementation GoI launched the Anemia Mukt Bharat (AMB) Program in 2018 as a part of the POSHAN Abhiyaan to intensify its efforts for tackling anemia prevalence in the country.
The program adopts a system strengthening approach and aims to provide a multi-pronged strategy with lucid operational guidelines to reduce anemia. Implementation of AMB in various Indian states based on a systems approach has generated some interesting insights and practices that hold significance for charting the future course of action and cross-learning. The compendium presents learnings captured from Chhattisgarh, Jharkhand, Madhya Pradesh, and Uttar Pradesh on components of MIS & Reporting, Nutrition Financing, Supply Chain Strengthening, Governance and Demand Generation respectively in the form of five practice insights. In addition to these, the compendium includes an innovative case study based on normative approaches from Odisha and a synthesis document that presents the essence of captured learnings. ….Read more

Governance:

In Madhya Pradesh, developing a clear policy adoption framework at all levels- state, districts and blocks paved the road for effective implementation. The AMB program requires convergence among nodal and other line departments. The experience in MP shows that, joint directives issued by Health, Education and other line departments such as Water and Sanitation, Tribal Welfare and Women and Child development, coupled with review meetings at state level involving senior officials became the cornerstone in development of the policy adoption framework as well as its execution till the block level.. ….Read more
 

Nutrition Financing

Adopting a research informed approach as the foundation for improving budgetary allocations helped Jharkhand with efficient budgeting for the AMB program. The analysis conducted by AMB technical support unit housed at IEG, Delhi helped in identifying challenges. A deep dive into Program Implementation Plans and their approval process by the National Program Coordination Committee (NPCC) as well as record of proceedings helped the NHM in leveraging these procedures and identifying line items that could be used to allocate funds for activities under the program…..Read more
 

MIS Reporting:

Availability of good quality data depends on reporting and management of information systems. Learnings from Chhattisgarh show that data management plans have to be an integral part of the program implementation since the initial stages. Also, various touchpoints for reporting of coverage and distribution have been leveraged to ensure data collection. For instance, in order to improve reporting on the WIFS component of the AMB program, NHM Chhattisgarh has tapped into the Sankul samanvayaks and Block Education Officers to gather data on the distribution and coverage of IFA supplements……Read more
 

Demand Generation:

A state level orientation and extensive communication campaign, helped in generating awareness and developing ownership for the program in Uttar Pradesh. IEC campaign before program roll-out and timely availability of IEC materials proved useful during the first phase of the communication campaign. Another key learning from the campaign was involvement of community leaders, school nodal teachers and community members at the grassroots to strengthen demand for the program…….Read more
 

Supply Chain Strengthening:

The experience in Jharkhand shows that inclusion of IFA supplements in DVDMS/e-Aushadhi (online portal) under the essential drug list coupled with other interventions helped in increasing efficiencies and decreasing the lead time for procurement. Uptake of the portal was supported by capacity building of personnel at all levels and customizing the portal as per programmatic requirements based on the feedback by the nodal officers of the Health Department…….Read more
 

RANI-An innovative Case Study:

With more than half of Women of Reproductive Age anemic in India, the Reduction in Anemia through Normative Innovations (RANI) project was a randomised control trial conducted in the Angul district of Odisha to address anemia by targeting positive social norms and thereby influencing IFA consumption among WRAs. This practice insight aims to capture the key methodology, approach, processes, and learnings from the RANI intervention that successfully reduced the rate of anemia in the treatment arm by 13%……..Read more
 
 
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Nutrition programs in India that aim to address undernutrition, are highly commodity driven and heavily depend on products including the micronutrient supplements. Hence, a robust supply chain management becomes crucial for effective implementation of programs. In recent years, success stories have emerged from multiple states, where the NHM and development partners have played a vital role by implementing a slew of interventions. Alive & Thrive (A&T), Bill & Melinda Gates Foundation (BMGF), Clinton Health Access Initiative (CHAI) and WeCan-IPE Global are among key partners working on strengthening the nutrition supply chain at the national level, as well as in states such as Jharkhand, Madhya Pradesh and Uttar Pradesh. This handbook is a joint effort by the nutrition partners to capture learnings and best practices on supply chain of micronutrients for dissemination and diffusion across India, enabling wider adoption and adaptation of learnings……..Read more