A sharp focus needed on tracking intervention coverage and drivers of health and nutrition outcomes to manage progress

Image courtesy: Countdown to 2030

The recently launched 2017 Countdown to 2030 report has reported mixed results stating that the 81 Countdown countries have made progress but remain far from universal coverage for most essential interventions for reproductive, maternal, newborn, child health and nutrition. It presents detailed country and equity profiles on women’s, children’s and adolescents’ health for the 81 Countdown countries that together account for 95% of maternal deaths and 90% of deaths among children under five years of age.

To galvanize attention and mobilize action around priorities in maternal and child nutrition, various global targets have been set, including the United Nation’s 2030 Agenda for Sustainable Development and the World Health Organization’s Every Woman Every Child Global Strategy for Women's, Children's and Adolescent's Health (2016–2030). The Countdown to 2030 report systematically tracks progress towards achieving these. IFPRI is a member of the Countdown to 2030 collaboration.

In the accompanying Countdown to 2030 paper published in The Lancet on tracking progress towards universal coverage for reproductive, maternal, newborn, and child health, Countdown collaborators have underscored the need to accelerate the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than five years of age, to achieve the Sustainable Development Goals by 2030. Such accelerations will require a rapid scale-up of effective interventions to all population groups within countries, supported by improvements in underlying socioeconomic conditions, including women’s empowerment.

India is one of the priority Countdown countries, and as the findings of this report reflect, is still a long way from achieving universal coverage for most essential interventions for reproductive, maternal, newborn, and child health and nutrition.  The Countdown work has been an inspiration for POSHAN’s research and data visualization work on coverage of interventions across continuum of care among states. POSHAN’s state-level Policy Notes, based on updated coverage data now available in NFHS-4 (2016), reveal that the coverage of interventions for mothers and children in the first 1,000 days has improved substantially over time, but challenges remain. There are significant state-level variabilities in the coverage for some interventions. Coverage during pregnancy is generally high, up to 75 percent for some interventions, like pregnancy registration.  However, coverage of nutrition interventions integrated into pregnancy care is low at less than 33 percent for women who consumed iron and folic acid supplements. During delivery, coverage is high at nearly 80 percent for interventions pertaining to institutional delivery, skilled birth attendance, and birth registration. However, coverage of interventions for lactating women is much lower than 50 percent.

An effective way to track a country’s progress towards any global goals is to apply them at the national level. In India, there is much optimism pegged on the recently launched National Nutrition Mission, which targets to reduce stunting, undernutrition, and low birth weight by two percent per annum, and anaemia by three percent annually, covering states and districts in a phased manner over a period of three years (2017-20), benefiting more than 10 crore people.  Meeting these goals, will require that India deploy the interventions already in the policy framework at high coverage, reaching across states and districts.  Analyzing coverage levels and trends is an important first step in prioritizing interventions where gaps are large and where efforts need to be scrutinized and accelerated.

As pointed in the 2017 Countdown to 2030 Report, to address the targets at the global and national levels, it is important to focus on the strengthening of vital statistics, understanding drivers of coverage change, and obtaining better data on early childhood development and adolescent health. In India, the NITI Aayog now has a Nutrition Dashboard that provides nutrition charts of India's states and districts and examines coverage of some (but not all) critical interventions. POSHAN’s district-level interactive maps and 640 District Nutrition Profiles also provide disaggregated data and detailed in-depth analyses.

In addition to outcomes and coverage, it is also important to focus on the indirect and underlying determinants, like sanitation and hygiene, access to drinking water, women’s literacy, girls’ age at marriage, etc.  Countdown’s national profiles and POSHAN’s state and district profiles provide ready reckoners for an assessment of these underlying drivers and help to identify the gaps that need to be closed to accelerate change in health and nutrition outcomes.

Changes in health outcomes will only ensue with changes in coverage of interventions and in the drivers of these outcomes.  Promising beginnings have been made on the nutrition and health landscape and there is much anticipation on the horizon. However, efforts to address coverage and drivers now need to be strategically navigated to catalyse progress towards 2030, both globally and in India.

- Purnima Menon[1], Stuart Gillespie[2] and Pratima Mathews



[1] Purnima Menon, senior research fellow at IFPRI, is a member of the Countdown to 2030 Collaboration, participating in the Coverage Technical Working Group.

[2] Stuart Gillespie, senior research fellow at IFPRI, is a member of the Countdown to 2030 Collaboration, participating in the overall Technical Review Group.