Evidence base for nutrition action in India: Where are the gaps?

  • Published on
    15-Apr-2017

  • View
    102

  • Download
    1

Embed Size (px)

Transcript

  • 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

Recommended

View more >