New Delhi: Integration of quality services, convergence of healthcare services at the household level and strategic use of data could further advance public nutrition service delivery in India, experts have said. Noting that the child’s first 1000 days (pregnancy to first two years of life) are often neglected, experts said the focus should be on anemia prevention, diarrhoea management, nutritional foods and WASH (water, sanitisation and hygiene).

Alok Ranjan, Country Lead (Nutrition), Bill and Melinda Gates Foundation, said that during the POSHAN Maah (Nutrition Month) there was an emphasis on maintaining the focus on basics of prevention of maternal and child undernutrition. Focus was also brought on new areas, such as children with Severe Acute Malnutrition (SAM) and promotion of locally-sourced nutrient-rich foods grown in kitchen gardens, Ranjan said. “Food fortification, too, has gained good momentum in India over the last few years. I feel a larger number has been added to the people consuming fortified products in the world from India, than any other country in the last few years. India has almost everything (policies, human resource, funding and political will) in place in terms of what needs to be driven and the focus now more than ever before has to be on strengthening the implementation,” he said.

Ranjan said that in the maternal and child health program, globally as well as in India, quality of intervention is already a priority focus area. “There is no similar momentum around quality of nutritional intervention globally or in India. As the coverage numbers are increasing with the Poshan Abhiyaan, we need to start looking at it, right from the quality of training frontline workers, to quality in food supplementation as well as quality of counselling sessions at anganwadi centres or during home visits,” he said. Ranjan also emphasises on strategic use of data, such as data from supervisor’s field visit, regular MIS systems of various departments, national surveys like National Family Health Survey etc. and to use these data for identifying actionable next steps at various levels like at national, state, district, project, village and household level. He said also given the fact that most of the nutrition focused messaging is around behaviour change (like breastfeeding, diet diversity, IFA consumption etc) it is important to go beyond one-time messaging for high impact and effective social-behavioural change. “The same messaging needs to be delivered repeatedly to the household, through all touch points – mass media, radio, advertisements, local newspapers, self-help groups, opinion leaders, Anganwadi workers, helpers, ASHAs, and ANMs,” he said.

Thomas Forissier, Director Programs, South Asia, Alive & Thrive (FHI 360), said increasing the coverage of nutrition-related services and benefits is often the first step, but increasing the coverage of high quality services and benefits is the necessary second step. “There is no alignment on a simple definition of quality. Most experts would agree that quality involves right inputs: infrastructure, training of frontline workers, commodities, etc.; the right processes: providing key advice to families on how to nourish pregnant women and children, weight and height measurements, provision of various foods and micronutrients, etc.; and the right outputs: starting with client satisfaction,” Forissier said. But none of those experts are likely to agree today on how all of those items fit together, which ones are more important. It is critical for the nutrition community to define what is the quality of nutrition services and benefits and how to measure it as soon as possible. And then to start using those measures in the field, said Forissier.

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