Ways to improve cross-sectoral convergence for nutrition in India. What role can civil society organizations play?



Author: Dr. Antaryami Dash is the Deputy Director of Health and Nutrition at Save the Children, India. He is a trained public health and nutrition professional with over 15 years of experience in program management – designing programs and ensuring their quality implementation, harvesting its outcome to influence policies. He provides thought leadership, technical guidance, and knowledge management support to strengthen program delivery at scale.

Malnutrition among women and children has been a persistent public health issue at the global, national, and local levels. The recent UNICEF-WHO-World Bank Group Joint Malnutrition Estimates show that globally, 149.2 million children under five years were stunted in 2020, and 45.4 million suffered from wasting[1]. Global leaders and agencies are responding to these urgent challenges. Government and Non-Government organizations are implementing programmes and facilitating the uptake of nutritious food in vulnerable populations. However, the progress of nutrition outcomes is not in sync with our telling economic growth.

There has been some improvement in nutritional indicators in India, as seen from the five panels of national family health surveys. There are, of course, states where the reduction has been impressive, but that gets elusive when we see the country average. There is a strong momentum building for improving nutritional outcomes and taking on the challenge of hunger and malnutrition. The Government of India, its development partners, and civil society organizations are committed to achieving the goals set under the national nutrition strategy. The core of this strategy is to anchor a multi-sectoral convergence to address nutritional issues through a framework of relevant interventions, indicators, and targets for programmes implemented by different departments.

The goal of achieving multi-sectoral convergence is to ensure that interventions from different sectors converge on households in the first 1,000 days. It is very well established now that cross-sectoral convergence is essential for considering this multidimensional nature of malnutrition. The Government of India’s Operational guideline for the Convergent Action Plan (CAP) seeks to clarify the multi-sectoral engagement process[2]. The CAP framework has identified the activities and indicators based on the existing services that contribute to improved nutrition. The CAP requires program managers to set targets for the key indicators, identify bottlenecks, plan activities, and define monitoring mechanisms across the key thematic areas. However, studies show no clear operational guidelines for village-level convergence. According to the NITI Aayog monitoring report, Poshan Abhiyaan improved nutritional outcomes for children, pregnant women, and lactating mothers. However, the coverage of POSHAN Abhiyan remains low in most states. This report emphasized expanding coverage and improving the quality of essential health and nutrition interventions[3].
The devolution of financial power at the grassroots level has been a critical systemic barrier in our political space. Hence convergence of line departments and their active role is essential to deliver services on time. Lack of accountability and administrative hierarchy is also a challenge in achieving convergence for nutrition. Insufficient data is a significant barrier to effective planning and driving interventions. Data on the target population at the village level, their need, availability of resources, and a comprehensive plan for its mobilization are essential for delivering nutritional outcomes.

Gram Panchayat is the perfect platform for strategic community-level convergence. It will bring women, social activists, health workers, Anganwadi workers, resource persons, village-level committee members, institutions, and development partners on one page. Civil Society organizations have a significant role to play in facilitating convergence activities at the community level. These organizations can become the partners of choice for identifying the community’s nutritional needs, sharing ideas, and implementing projects in collaboration with the Government. It will also help strategically identify tasks and implement them with agreed plans at the local level.

Poshan Panchayat and other village gatherings provide a better platform for increasing demand side interventions for nutrition and improving public participation. Jan Andolan will succeed when people at the grassroots level truly participate and act as per the policies and programmes. Experts suggest that households can be taken as points of convergence and villages the unit for each programme. Annual and quarterly plans must ensure a cohesive nutrition-sensitive approach and monitoring of the outcomes. Poshan Panchayat is a breakthrough in improving convergence at the grassroots level.

As a part of the convergence strategy, linkages between existing nutrition and sanitation programmes and income support efforts at the community level are essential, along with a robust behavior change communication strategy. As we advance, convergence should bring efficiency to the system through coordinated efforts in nutrition data collection, communication, resource mobilization, monitoring, and evaluation. Convergence at local to national levels shall improve service delivery, ensuring entitlements from all sectors reach the intended beneficiaries.

The Government should lead this movement by enabling civil society organizations, agencies, businesses, and the scientific community to play a crucial role in realizing policy commitments, capacity strengthening, and targeted financing.

References

[1] https://www.who.int/news/item/06-05-2021-the-unicef-who-wb-joint-child-malnutrition-estimates-group-released-new-data-for-2021
[2] https://icds-wcd.nic.in/nnm/NNM-Web-Contents/LEFT-MENU/Guidelines/Operational-Guidelines-for-Convergent-Action-Plan.pdf
[3] https://www.niti.gov.in/sites/default/files/2020-10/AbhiyaanMonitoringReport.pdf