DELIVERING FOR NUTRITION IN INDIA: LEARNINGS FROM IMPLEMENTATION RESEARCH

The first-ever nutrition implementation research conference in India, “Delivering for Nutrition in India: Learnings from Implementation Research”, was held in New Delhi on November 9-10, 2016. This two-day event convened researchers, implementers, civil society partners and policymakers around discussions related to the coverage and quality of a variety of nutrition services. The conference was based on the theme of achieving full coverage of interventions across the continuum of care. The agenda was packed with implementation research on pre-pregnancy through the early childhood interventions. Critical upstream issues affecting implementation scale and quality, such as financing, frontline worker performance, policy issues related to supplementary foods and the use of emerging platforms (e.g., self-help groups and technology platforms) for nutrition were also featured.

The first day of the conference began with a welcome address by IFPRI’s South Asia Regional Office Director, Dr. P.K. Joshi. Following this, Dr. Purnima Menon from IFPRI set the stage for the conference with an overview of the role of implementation research in nutrition.  She emphasized how implementation research needs to be a core component of a larger nutrition research agenda in India as it can help improve coverage, quality, and equity of essential nutrition interventions. Dr. N.K. Arora, a renowned public health expert and Executive Director of The INCLEN Trust, presented key findings from a recent national nutrition research prioritization exercise that resonated with the conference theme. In his remarks, he highlighted how the prioritization exercise had also reiterated the need for implementation research to bridge delivery gaps in maternal and child nutrition interventions. Speaking from a policy perspective, Mr. Alok Kumar, Senior Health Advisor to the NITI Aayog, called upon researchers and technical experts to bring simplicity and certainty to their recommendations because “complications can spur debate” and “lead to inaction”.  In his closing remarks at the opening session, co-chair Dr. Chandrakant Pandav, Professor, Community Medicine, All India Institute of Medical Sciences, stressed the current disconnect between policies and implementation challenges and also called on for investments in implementation research. Below are some highlights from day one of the conference:

• Several presentations highlighted gaps in overall coverage, and emphasized large interstate variability and limited uptake of nutrition interventions across India. There were discussions on the challenges in implementing large surveys and rapid survey tools that can be used to do a quick assessment of local-level supply- and demand-side gaps.
• Two sessions were dedicated to research on the delivery of interventions from pre-pregnancy through lactation that focused maternal diet quality, micronutrient supplementation and breastfeeding practices.
• A session on the early childhood covered the spectrum of preventive and curative care. Conditional cash transfers, micronutrient supplementation, and day-care center models were all found to have beneficial effects on the uptake of services, child anemia status, and growth, in different contexts.
• Research on treatment models to address acute malnutrition was discussed in the final session, including experiences from Rajasthan, Bihar, and Jharkhand. Mr. Naveen Jain, MD NHM, Rajasthan, who co-chaired the session, identified practical challenges in utilizing the current facility-based curative services and emphasized the need for identifying appropriate community-based strategies.

The first day ended with much to ponder and with no doubt, in the participants' minds, on the need for implementation research.

The second day brought together experts on the issues of nutrition financing, food supplementation program, and frontline worker performance, issues that are central to achieving at-scale, equitable coverage with quality. Below are some highlights from day two:

• Dr. Harold Alderman of IFPRI kick-started the day with a forceful argument on how to convince finance ministries to invest in nutrition. Other presentations shed light on the cost estimates and gaps in financing for delivering nutrition interventions at scale in India.
• During a session focused on FLW performance, which is important for ensuring the coverage of interventions, speakers noted positive influence of mobile phone applications and performance-based incentives on FLW motivation and service delivery.
• During a session on food supplementation, a group of experts discussed the current composition, quantity, quality and appropriateness and gaps in the coverage of the food supplements provided under the supplementary nutrition program. There was a unanimous call for the review of the program.
• A panel of experts discussed emerging platforms for delivering nutrition impacts including via self-help groups (SHG). The power of collective action was highlighted in achieving maternal health outcomes through SHG-based interventions.
• Dr. Suneetha Kadiyala from the London School of Hygiene and Tropical Medicine, applauded the significant shift in the discourse from a fragmented approach to systems-thinking as demonstrated by the two-day conference. She, however, recognized that such a shift poses a challenge to all of us on how communication of such complexity (with “mindboggling” detail) can be simplified.

The deliberations during the conference re-affirmed a felt need to invest in implementation research to support India’s substantial investments in nutrition programs and ensure that programs reach scale and equity. The conference working group and POSHAN intend to take the agenda forward through expert group consultations on specific thematic areas, coordination with existing expert groups and active implementation research in India. Stay tuned!

Written by: Rasmi Avula, Research Fellow, IFPRI

We are happy to share the presentations with you! You can find presentations from both days here. You can also find the press release here.

If you are looking to connect with someone you had met at the conference, then please drop us an email with his/her name and we’ll be happy to share their contact details with you.