Evidence base for nutrition action
Rasmi Avula, Sunny S. Kim, Neha Kohli, Suman Chakrabarti, Parul Tyagi, Kavita Singh, Mara van den Bold, Suneetha Kadiyala, Purnima Menon
November 9, 2016
Coverage of maternal, newborn and child health and nutrition interventions vary tremendously across India
93.6 83.7 91.8 78.847.3 45.7
99.3 97.5 80.458.7
96.754.6
30.5
76.355.3
23.3 27.7 42.368.7
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
BIHARUTTAR PRADESH
NAGALAND
GOA
KERALASIKKIM
SIKKIMWEST BENGAL
GOASIKKIM
WBASSAM GOA
SIKKIMTAMIL NADU
GOA
KARNATAKATAMIL NADU
ANDHRA PRADESH
HIMACHAL PCHHATTISGARH
GOAKERALA
TAMIL NADU
GOATAMIL NADU
MIZORAM
SIKKIMWEST BENGAL
GOA
ANDHRA P
MAHARASHTRA
TAMIL NADU
TAMIL NADUGOA
KERALA
MIZORAM
ODISHA
ASSAM
CHHATTISGARH
ODISHA
JHARKHAND
GOA
KERALA
HIMACHAL PRADESH
GOAMIZORAM
KERALA
GOA
MAHARASHTRA
ODISHA
BIHAR
NAGALAND
MANIPUR
UTTAR PRADESH
BIHAR
NAGALAND
JHARKHAND
BIHARNAGALAND
JHARKHAND
UTTAR PRADESHNAGALAND
PUNJABUTTARAKHAND
DELHI
JHARKHANDCHHATTISGARH
NAGALAND
UTTAR PRADESH
JHARKHAND
MANIPUR
ARUNACHAL P
UTTAR PRADESH
NAGALAND
RAJASTHAN
DELHI
NAGALAND
ASSAM
GUJARATDELHI
MANIPUR
HARYANA
DELHINAGALAND
UTTAR PRADESHMEGHALAYA
NAGALAND
JHARKHANDUTTARAKHAND
NAGALAND
Prepared by a team at POSHAN, IFPRI-New Delhi, February 2016, based on data from the RSOC, 2014;
%
Is India ready to achieve at-scale delivery?
• Vision /Leadership
• Policy guidance
• Program / delivery platforms
• Delivery of evidence-based interventions
• Capacity
• Financing
Gillespie et al, 2015
Policy frameworks, interventions, operational contexts
• Policies exist for most of the essential nutrition interventions• CMAM guidelines• Operational guidelines and/or monitoring indicators are
not available for all interventions• Program platforms in place for delivering at scale
• Two national programs are designed to deliver all the core interventions
• Strategy for achieving continuum of care needed
• Weak operational evidence on implementation at scale• Few published studies on how best to deliver nutrition
interventions across continuum of care• NGO program experiences are limited to few interventions• Limited by poor evaluation designs and little investment in
documentation
Avula et al., 2013
Evidence gap on actions to improve infant feeding practices
Intervention: Counseling
• Efficacy studies: main focus is on breastfeeding counseling; few studies on improving complementary feeding (esp. diet quality)
• Program models: Several exist, but few operational and impact evaluations on complementary feeding models
Intervention: Complementary food supplements
• Efficacy studies: only one study that tested added value of energy-protein food supplements.
• Program models: Massive investment in food supplements, huge variability in models used across states, but few operational or impact evaluations
Almost no evidence on integrated models addressing both counseling and food supplements!
Potential areas of implementation research to support action on infant feeding• Understand current practices and determinants• Understand acceptability, use and perceptions
about different food supplements• Test impact on feeding practices of different
models of behavior change and food supplements
• Assess training, supervision and incentive approaches for frontline workers who deliver counseling
• Test different decentralized/models of production and distribution of complementary food supplements
Summary & conclusions
• Coverage of interventions lags behind despite favorable policy commitments and existing program platforms
• Gaps exist in operational guidelines, monitoring mechanisms, and evidence to action
• Urgent need to invest in implementation research to identify, optimize, and strengthen the models for delivery and uptake of the essential nutrition interventions
Photo: Rasmi Avula, 2015
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