Critical for achieving good nutrition outcomes is ensuring that interventions address all the multi-sectoral determinants contributing to it. The convergence pillar under the POSHAN Abhiyaan, through the Convergent Nutrition Action Plans at state, district and block levels, promotes coordinated and cross-sectoral efforts involving all critical line departments that contribute to nutrition, such as health and family welfare, water and sanitation, and rural develop-ment. This learning note outlines this approach and shares the experience of innovations implemented in some states through convergence between departments.

Background

POSHAN Abhiyaan aims to reduce malnutrition, through a life-cycle concept, adopting a synergised and result-oriented approach. Implemented by the Ministry of Women and Child Development (MWCD), Government of India, the target of the mission is to bring down stunting in children 0-6 years of age from 38.4% to 25% by 2022. It also aims to reduce anaemia among women and adolescent girls in the age group of 15-49 years and reduce low birth weight.

Convergence Platforms

The POSHAN Abhiyaan introduces a convergence platform where different ministries and departments that implement interventions impacting nutrition outcomes, come together to achieve a synergy of all interventions to effectively target undernutrition. These platforms exist at different administrative levels starting from the centre to the state, district, block and village levels. Convergence at the centre is achieved through the constitution of the National Council for Nutrition and the Executive Committee for the POSHAN Abhiyaan. Both these forums draw members from all the different departments contributing to the Abhiyaan. At the state level, this convergence is facilitated through the state, district and block level convergence committees that have been constituted, each led by the senior most administrative head of that level. At the village level, the Village Health Sanitation and Nutrition Day provides the convergence platform for service delivery by frontline functionaries of the two most critical departments – health and family welfare, and women and child development. Figure 1 illustrates the converging platforms at various levels.

Convergence Initiatives for Improved Nutrition

National• National Council for Nutrition• Executive Committee for POSHAN Abhiyaan

State

District

Block

Village

• Convergence Action Plan

• Village Health, Sanitation and Nutrition Day• Community Based Event

Figure 1: Convergence Platforms

I N D I A’ S P O S H A N A B H I YA A N

2LEARNING NOTE

Implementing the Convergence Innovations

The Rashtriya Poshan Maah (National Nutrition Month) In order to steer convergence, 12 ministries of the Government of India came together and organised Rashtriya Poshan Maah in the month of September 2018. The aim was to ensure converged service delivery and messaging across the different schemes. Through this effort, 270 million people were reached, of which about one-third were men. Over 23 lakh activities were organised across 12 ministries and their respective schemes (Figure 2). The Poshan Maah

of nutrition.

“During Poshan Maah, we focused on inter-departmental conver-gence for families with malnourished children through interven-tions like provision of job cards, Ujjwala (LPG cylinders) connection and ration cards, pension bene ts, uPay card for farmers e paid special attention on improving awareness and hygienic condi-tions in anganwadis and schools by conducting hand wash training and ensuring availability of functional toilets - Pulkit hare, District Magistrate, Hardoi, Uttar Pradesh

Case Study 1: Andhra Pradesh

Objective

women to improve their nutritional status, focusing on anemia reduction.

Key stakeholders and roles/responsibilities (i) Department of Women and Child Development (DWCD): lead department; project implemented through its frontline Anganwadi workers (AWWs), who provided eggs, milk and peanut-jaggery sweet for pregnant mothers; (ii) Department of Health: responsible for procurement and supply of Iron Folic Acid (IFA) and Calcium supplements; (iii) Panchayati Raj Department: supported AWWs in monitoring, generating awareness and resolving issues; (iv) Department of Rural Development: supported in monitoring and generating awareness through Self-Help Groups (SHGs); and (v) Integrated Tribal Development Authority: ensured coordination between different stakeholders.

Convergence Action Plans

Operationalising convergence under the POSHAN Abhiyaan

schemes being implemented by different departments (Figure 2). The same also recognises the role of state, district and block administration and the local governments in facilitating this convergence through the platforms outlined above.

The convergence committees are expected to develop annual convergence action plans taking into account key nutrition actions to be carried out by the different departments. To support the convergence committees in this role, a nutrition framework has been developed listing key nutrition related indicators and targets to be monitored

their schemes. The committees review and monitor progress against these indicators quarterly, identify gaps and introduce effective interventions or innovations to address these gaps. While the process of development of convergence action plans under the Abhiyaan has just started, the recent experience of implementing a convergent campaign approach and of multi-sectoral innovations to address gaps from the earlier ICDS Systems Strengthening and Nutrition Improvement Project phase has useful lessons.

State specific innovationsUnder the earlier ICDS Systems Strengthening and Nutrition Improvement Project phase, states were encouraged to prepare convergence projects with one or more departments. Among the innovative concepts, pilots in three states, Andhra Pradesh, Madhya Pradesh and Chhattisgarh, showed progress within a year and provided learnings for future work under POSHAN Abhiyaan. Three of these are discussed in detail below.

Figure 2: Inter-Ministerial Convergence underPOSHAN Abhiyaan

Ministry of Health and Family Welfare

• National Health Mission• Janani Surakha Yojana• Home Based Newborn Care• Home Based Young Child Care• Anaemia Mukt Bharat• Indradhanush

Ministry of Women and Child Development

• POSHAN Abhiyaan• Anganwadi Services• Pradhan Mantri Matru Vandana Yojana• Scheme for Adolescent Girls

Ministry of Housing and Urban Affairs

• Swacch Bharat Urban (SBU)• AWCs - Pradhan Mantri Awas Yojana• Toilets and Water - SBU

Ministry of Rural Development

• Mahatma Gandhi National Rural Unemployment Guarantee Scheme• Deendayal Antyoday Yojana - National Rural Livelihood Mission

Ministry of Panchayati Raj

• Mobilisation of Gram Panchayats• Village Health Sanitation and Nutrition Day

Ministry of Drinking Water and Sanitation

• Swacch Bharat Mission - Gramin• Safe Drinking Water, Sanitation & Hygiene• Toilets

Ministry of Human Resource Development

• Mid-Day Meal Scheme

System for Education (UDISE)

Ministry of Information and Broadcasting

• Behaviour Change Communication• Jan Andolan• Song and Drama Division

Ministry of Consumer Affairs, Food & Public Distribution

• Public Distribution System

Ministry of Renewable Energy

• Solar Energy - AWCs

Ministry of Tribal Affairs

• Special requirements in Tribal Areas

Ministry of Minority Affairs

• Requirements of Minority Communities• AWCs in case of gaps

Inter-Ministerial Convergence

Design and delivery modalities

maternal nutrition items, and messages to facilitate compliance. The items were delivered for spot feeding through the Anaganwadi center (AWC), with pregnant women being mobilised by AWW.

Key result

from the outreach.

What worked• AWC as the single distribution point for this nutrition

package ensured regular monitoring and consistent messaging.

• Continuous focus on nutrition education was achieved through the daily spot-feeding programme.

• Other agencies like PRIs and SHG members supported the AWW in monitoring and creating awareness in the community.

Challenges• It was a constant challenge to ensure the necessary

stock of nutrition supplies at the AWC, especially the procurement of peanut-jaggery sweet which was bought locally by the ICDS department (unlike milk and eggs, which were centrally procured) and the supply of calcium and IFA tablets, which required regular follow-ups and coordination with the health department.

•

numbers of each item consumed by a woman at the end of her pregnancy period.

• IFA tablets were the only items not consumed under the

bimonthly and the AWW had to rely on self-reporting by the pregnant women.

“ t s not just these ve items, but it s also the knowledge that she ( ) gives us about why we should consume each of these ve items La mi, a pregnant woman

Case Study 2: Madhya Pradesh ObjectiveTo increase dietary diversity among pregnant women and children of six to 24 months of age through the promotion of POSHAN Vatikas (PV) or nutrition gardens.

Key stakeholders and roles/responsibilities (i) DWCD: lead department for establishing the gardens; (ii) Department of Horticulture: provided good quality seeds and saplings; (iii) Panchayati Raj Department: supported AWWs in monitoring, generating awareness and resolving issues; (iv) Department of Agriculture: provided technical support in meetings and exposure visits and training AWWs in Krishi Vigyan Kendra to learn good agricultural practices.

Design and delivery modalities of the project The project was implemented in Agar district from July 2017 to May 2018. About 1,200 families with pregnant women and children between 6-24 months were taught not just how to grow vegetables, but also the nutritional relevance of the vegetables and importance of key nutrition practices.

own use and is not used for selling.

Key result Of the 1,200 households, 1,198 gardens were functioning at

consumption of vegetables.

What worked• The ICDS department at state and district levels formed

working groups to provide guidance for the smooth implementation of the project and the District Collector ensured inter-departmental coordination of planned activities and their periodic review.

• The technical content and training addressed local issues such as water scarcity.

•

funds for fencing took care of apprehensions of safety and animal intrusions.

Photo 1: Spot Feeding Session at AWC Putturu 1

Photo 2: Kitchen Garden in Village Khelagaon, Nalkheda

Challenges•

However, the use of kitchen and laundry waste-water, and earthen pots/ plastic bottles for drip irrigation helped address the issue.

• The planned Behaviour Change Communication (BCC) activities could not be executed as envisaged due to delay in content development and other administrative delays.

“ o be honest, earlier would not consume vegetables regularly mean, once in say a week but now that have it right outside

my house, it’s so easy! I just pluck and use them almost every day! - antabai, mother-in-law of pregnant woman

Case Study 3: Chhattisgarh

Objective

and counselling services.

Key stakeholders and roles/ responsibilities (i) DWCD: led the project and was responsible for data collection and outreach to pregnant women and children up to two years of age; (ii) Department of Health: supported in mobilising government/ private hospitals for data on pregnant women; and, (iii) Samarthan, an NGO was the implementing partner.

Design and delivery modalities

personalised counselling on optimal nutrition practices to pregnant women and parents of children from birth to two years of age. The platform served as a two-way

as per the list provided by ICDS and health departments.

in need of immediate care and counselling.

Key resultAbout 8,085 malnourished children and 4,055 pregnant and

What worked

helped many parents get the right information for their undernourished children as well as access the necessary services from the AWC and health sub-centre.

Challenges• The agency selected for implementing the intervention

had limited technical and infrastructure capacity, resulting in poor implementation. An experienced partner is critical to success.

• There was no standard system for obtaining data on

• Limited involvement of ICDS Directorate resulted in loopholes in overall planning and implementation. Some of the key issues were:O awareness about the scheme, thus the innovation lacked the visibility required to generate awareness

toll-free call-in number. O Monitoring visits and reviews with the implementing

during such visits were not addressed in a timely manner.

• nutrition, did not possess knowledge and understanding

counselling, especially early on, when the advice given would be more theoretical than practical. A system to periodically train the staff on technical aspects as well as to build their communication skills is necessary for such a service.

Lessons Learnt

These innovations provide three critical insights for planned innovations under convergent action plans:

1. State/ district working groups It is critical to have working groups at state/ district levels with participation from relevant departments, to provide oversight and regular guidance to these innovations.

2. Developing and operationalising monitoring frameworks A well-developed monitoring framework to record and report on innovations for timely corrective actions is the key. If possible, there should be an in-built component of measuring outcomes, along with output indicators, to be able to assess impact of the intervention lending credibility for scale up.

3. Behaviour Change Communication component All interventions require a well-developed BCC

and community.

the kitchen gardens in Madhya Pradesh are being scaled up state-wide under the POSHAN Abhiyaan, while the innovation in Chhattisgarh lends important lessons for the Grievance Redressal system proposed under the POSHAN Abhiyaan