The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in South Asia’ on Saturday 8 July 2017, at the Yak and Yeti Hotel, Kathmandu, Nepal. Over a hundred participants from NGOs (national and international) and academia working on nutrition, health and public health, rural and social development gathered together with government officials from Nepal, India and Bangladesh, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in South Asia
India currently has the largest number of undernourished people in the world, 212 million – only marginally below the 215 million estimated for 1990–92.
Patrizia Fracassi, Senior Nutrition Analyst and Strategy Advisor for the Scaling-Up Nutrition Movement Secretariat and member of the Transform Nutrition Consortium Advisory Group gives her reflections.
It has been an incredible privilege to be part of the Transform Nutrition Consortium Advisory Group and to have participated in this Symposium in Kathmandu. The work carried out by Transform Nutrition shows that, in order for the research agenda to be cutting edge, opportunities have to be seized upon and worked with through engagement of key stakeholders, such as academia, research, policy makers, implementers and advocates.
The evidence for action in South Asia generated by Transform Nutrition will help to build bridges in the complex and evolving landscape of nutrition. It highlights with lessons from Bangladesh and India how essential it is to integrate nutrition into health systems. But it also demonstrates that the engagement of frontline workers remains challenging. As illustrated by Kavita Chauhan (PHFI), explaining the story behind the data is vital to increase synergies among people and bring delivery at scale. Findings by Shilpa Deshpande (IDS) were helpful to unravel the identity politics among service providers while the presentation by Rasmi Avula (IFPRI) clarified the incentives that are motivating frontline workers in India. If we want to improve the quality of nutrition services and address challenges of low utilization, we need to understand people and get more of this type of evidence.
We know that Governments invest in social protection programmes. But how do we make them work for nutrition? The results from a study in Bangladesh by Akhter Ahmed (IFPRI) confirm that adding intensive Behaviour Change Communication to cash transfer programmes provides the greatest gains for nutrition. Yet, more research is needed on how this can be replicated at scale. The diagnostic by Suman Chakrabarti (IFPRI) on how big drivers of social spending can be analyzed using a nutrition lens could be applied beyond India. If a large-scale programme fulfills its basic mandate, is it feasible to work with implementers and budget holders to incorporate nutrition goals and actions? This type of assessment is timely to explain the politics of financing and ensure that assumptions are studied before important decisions are made.
I had the privilege to chair the session on the Stories of Change together with Zivai Murira (UNICEF) and to hear from the evidence from Nepal, Bangladesh and the Indian State of Odisha. It was an inspiring and motivating session. The Stories of Change led by Stuart Gillespie (IFPRI) have the greatest potential to reach out to communities beyond nutrition. They link together and explain which factors are important in each context. These factors touch upon different sectors, calls for a variety of stakeholders to get engaged and show that multi-disciplinary teams can help to clarify lessons from the past and highlight future scenarios.
It is encouraging to see how the quantitative work by Derek Headey (IFPRI) to analyze the drivers of nutritional change has been applied and customized in the three countries. The presenters – Kendra Cunningham (Nepal), Masum Billah (Bangladesh) and Neha Kohli (India) – demonstrated that the right enabling environment was the required factor in each country but the triggers were specific to each situation. A key take away for me was that a committed and accountable leadership such as the one in Odisha State and Nepal brought together the evidence and the coherence required to enable the change. This would have not been possible, however, without the championship demonstrated by a wide range of stakeholders in moving the nutrition agenda forward.
Transform Nutrition shows that the evidence for action is there and that people can effectively work together to deliver nutrition. This is the time to reach out to all actors with a stake on nutrition. As highlighted throughout the Symposium, a better understanding of the people, be they mothers, caregivers, frontline workers, advocates or leaders, will enable us to act upon every opportunity and bring the change.
From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition.
On the 8th July 2017 in Kathmandu, Nepal, it will host a regional meeting; ‘Evidence for action in South Asia’ the day before the joint ANH Academy Week and Feed the Future Innovation Lab for Nutrition Agriculture-Nutrition Scientific Symposium, to highlight experiential learning from South Asian countries on key drivers to improve nutrition status.
It will feature evidence on what works in nutrition-sensitive interventions, presented to policymakers from Nepal and international donors and NGOs in the South Asia region. The meeting aims to inform and equip attendees in order to address the particular challenges of tackling child undernutrition in their current contexts. See agenda.
Matri Sudha’s mission is to help urban slum children in South East Delhi through social empowerment projects, bringing social change from the grass roots and mobilising people from within the community to uphold their rights.
Putting public health nutrition on the agenda
Public health nutrition is now a key focus area for the organisation but it wasn’t always our approach, nor was it my area of expertise. We came across a government report in 2012 which looked at child malnutrition in Delhi and I started reading more and more journals and learnt about how malnutrition is linked to various other aspects of adolescent health, diarrhoea, pneumonia, and child brain development and we also studied the laws, policies and programmes impacting food security and nutrition in India. It is now my dream, and Matri Sudha’s mission, to improve India’s nutritional status.
We started working at the grass roots level to improve the child and maternal welfare centres usually called ‘Anganwadi centres’ under the government’s Integrated Child Development Services (ICDS) scheme and to strengthen their linkages with the wider health systems. We work with adolescents, pregnant women, lactating mothers and children below the age of six on both preventive and curative aspects of malnutrition in early childhood years.
At Matri Sudha, I lead our work with families to improve their nutritional status, our research work, and our advocacy efforts to improve the nutrition governance issues in Delhi. As a result of Matri Sudha’s research, we filed a Public Interest Litigation in the Delhi High Court to implement the Food Security Act of 2013 and constitution of State Food Commission as an independent body to monitor the nutrition issues in Delhi.
Knowledge, Networks and Nutrition Champions
I enrolled in the Transform Nutrition Short Course in 2015 to deepen my knowledge and I remember on the very first day there was a moment when everyone stood up to introduce themselves – and then it was my turn. I stood up and I said I am neither a public health nutritionist nor a doctor, I am a social worker and I am here for 7 days to understand exactly what public health nutrition is all about.
I knew I wouldn’t understand everything in 7 days but I knew I could take whatever I did learn and incorporate it with my own work to improve our programing at Matri Sudha.
For example, on the third and fourth day of the course we had in-depth discussions about how to evaluate community based programmes. On my return, I discussed with my colleagues in Matri Sudha how our own programme could be revised to make sure the objectives were clear, that we understand why we are implementing the programme and how it can be evaluated. We now have a clear set of goals, objectives, outcomes and outputs so that we can monitor and evaluate its progress, identify challenges, and adapt our approach as we learn.
We have also adopted Transform Nutrition’s approach to supporting Nutrition Champions, who could be the primary care giver, school based nutrition champion or community health worker, or anyone promoting the overall goal of child nutrition within the community. We have developed a programme to identify and highlight the good work of people within the community in order to support their efforts and encourage others to do the same. So far, 12 such Nutrition Champions have been created as our first step toward improving the nutritional status within the community.
One of the key features of the Transform Nutrition course was that it provided a platform to express your views, share your opinions and an excellent opportunity to come into the network of people with different backgrounds and make good friends. For example, I have recently authored a review paper on Infant and Young Child Feeding Practices in India with a colleague I met on the Transform Nutrition short course.
In SouthAsia, social accountability practitioners have been addressing failures in the ‘standard’ health and nutrition model. What can we learn from them? New research report Social accountability initiatives in health and nutrition: lessons from India, Pakistan and Bangladesh from Transform Nutrition and the Institute of Development Studies.
by Neha Raykar, Public Health Foundation of India
Recently, I attended a policy seminar titled ‘Transforming Food and Nutrition Landscape in Assam’ on 29th March 2017 in Guwahati, Assam. The dialogue was co-organized by the Inter-Agency Group, Assam and Coalition for Food & Nutrition Security and was attended by about 50 stakeholders comprising senior policymakers from Government of Assam and Government of India, as well as representatives from local NGOs, educational institutes, and bilateral agencies.
The purpose of the seminar [Read more…]
By Shilpa Deshpande, PhD Candidate, Institute of Development Studies, University of Sussex
Ten years before I joined the ICDS as an anganwadi worker, my cousin mother-in-law used to work here. At that time, the division of the village population between anganwadi workers was such that lower caste households were served by my mother-in-law whereas only the higher caste households were served by Lata madam, this was her rule….so… my mother-in-law’s field area was scattered across the village. Then when I joined, Lata madam said that just like my mother-in-law I should be given the lower caste communities. I refused…. I said give me any part of the village but I want half and I want it along a continuous line then only will I be able to work. This led to a fight, which continued for several days.
Meena, Anganwadi worker [Read more…]
We were delighted that one of our 2016 Transform Nutrition Champions, Basanta Kumar Kar was recently awarded an Odisha Living Legend Award for excellence in public policy. This is in recognition of his tireless work on nutrition in South Asia.
Basanta said of his award “It is very satisfying to receive this award in Odisha where I am rooted. This is the state where I experienced multiple deprivations and developed the courage and conviction to overcome these challenges. It is also where I formed my passion for helping people to make changes in their lives. I am confident that Odisha, endowed with rich human and natural resources, can move out of the clutches of a undernutrition and emerge as a talent state; a global nutrition pioneer”.
by Aparna John, PhD candidate, Institute of Development Studies at University of Sussex
Child undernutrition rates in India are among the highest in the world (Raykar et.al, 2015). Despite the decline in undernutrition indicators such as stunting (low height for age), underweight (low weight for age) and wasting (low weight for height), India is home to 40 million stunted and 17 million wasted children. The Government of India has invested in efforts to reduce childhood undernutrition and improve maternal and child health through one of its flagship programmes — the Integrated Child Development Services (ICDS) Scheme. ICDS, the world’s largest community nutrition programme, is delivered by 1.34 million village based female workers, Anganwadi workers (AWWs). [Read more…]