TRACKING INDIA’S PROGRESS ON ADDRESSING MALNUTRITION: WHAT WILL IT TAKE?

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India has a robust nutrition policy framework that includes several evidence-based interventions. These are delivered through large-scale national program platforms – the Integrated Child Development Services (ICDS) and the National Health Mission. The National Nutrition Strategy and POSHAN Abhiyaan, India’s national nutrition mission launched in early 2018, provide an updated strategic framework for action to improve nutritional outcomes for children, pregnant women, and lactating mothers. However, there are issues related to the availability of data to monitor progress on key nutrition interventions, and their coverage.

In this Policy Note on “Tracking India’s progress on addressing malnutrition: What will it take?”, developed jointly by the International Food Policy Research Institute, NITI Aayog, and IDinsight, we highlight a range of issues that need to be considered in strengthening efforts to improve data availability and data use in the context of POSHAN Abhiyaan. This Note aims to provide guidance to national, state, and district level government officials/stakeholders on issues to consider on the use of data to track progress on nutrition interventions, immediate and underlying determinants, and outcomes. It also proposes a comprehensive indicator framework for POSHAN Abhiyaan and examines the availability of data on these indicators across population-based surveys and administrative data systems.

In this Note, we generated a comprehensive list of evidence-based interventions, determinants, and outcomes that align with POSHAN Abhiyaan’s framework. Then we identified potential indicators for each of these. POSHAN Abhiyaan’s interventions cut across the lifecycle from adolescence, preconception, pregnancy, delivery, postnatal, newborn care, all the way through early childhood. For determinants, they focused both on immediate determinants, such as maternal nutrition, infant and young child feeding and child health, and underlying determinants, such as sanitation, early marriage, and others. Finally, for outcomes, we focused on the stated targets of POSHAN Abhiyaan as well as the nutrition-related Sustainable Development Goals to which India has committed.

Based on the indicator list, we examined a range of data sources to assess the extent to which data might be available to track progress on nutrition.  Across all sources, we assessed whether the data sources have information to create/compute a relevant indicator. These findings were summarized across domains (interventions, determinants, and outcomes) and by data source.

Our key findings are:

• In India, data on intervention coverage, determinants, and outcomes are available from both population-based household surveys and administrative data systems, which can be leveraged to monitor progress and to inform evidence-based decisions and actions.
• Data can and should be used for tracking progress, reporting, assessing impact, strategy, and program refinement.
• Data on program inputs are primarily available from a range of dashboards and monitoring systems but need consolidation and validation.
• Data on intervention coverage varies by life-stage and type of intervention. The availability of data on the coverage of interventions across life stages are:
  • For adolescents, coverage data is scarce both in surveys and administrative systems.
  • For pregnancy, multiple data sources are available on antenatal care, but gaps exist for nutrition interventions such as calcium supplementation, counseling, and maternity benefits.
  • For delivery and postnatal care, data is available on institutional deliveries and postnatal care but is limited for kangaroo mother care and breastfeeding counseling.
  • Data is very limited for newborn care interventions. For early childhood, 9 of 13 interventions are available from different data sources.
• Data on immediate determinants are available from diverse sources but limited data is available on nutrition-related behaviors.
• Data on underlying determinants are stronger and better measured in surveys than in administrative data.
• Outcome indicators are covered in most surveys, and the NFHS surveys are a strong data system to track progress on all outcome indicators, except anemia among adolescents.

Our key recommendations are:

• Prioritize the right indicators: A set of core indicators across the lifecycle should be prioritized and reviewed at all levels (national, state, district, and block). In addition, different states and districts may need to prioritize a few other indicators, depending on their starting point for POSHAN Abhiyaan.
• Promote data use: Develop guidance on different types of data sources and their use to promote awareness. Strengthen capacities of officials at all levels to effectively use data to improve planning and decision making.
• Resolve data challenges related to tracking progress on inputs and intervention coverage: Multiple data sources for coverage indicators require careful reconciliation of findings from survey data and administrative data systems which support various dashboards. Ensure interoperability of nutrition data across data systems to support better-informed decision making. Develop data use cases for survey and administrative data on intervention coverage.
• Use survey data to monitor progress on determinants: Use population-based survey data when available and continue to strengthen data on nutrition behaviors from administrative systems.
• Use survey data to track progress on outcomes: Use population-based survey data for progress tracking. Strengthen data on nutrition outcomes from administrative systems for program use.
• Strengthen data stewardship: A single data stewardship entity is essential to ensure coordinated monitoring of progress, strategy refinement, and to support data use for program refinement.

Why is this work even more relevant today?  COVID-19 and the associated policy actions are already having impacts on health and nutrition services, on food security and other drivers of malnutrition.  Tracking impacts on immediate and underlying determinants and the reach of interventions in this context can help identify areas where urgent actions are needed. The proposed indicator framework in this Policy Note offers a base upon which to prioritize and align indicators to enable tracking of the impacts of COVID-19 and to assess the extent to which COVID-19 is disrupting progress on POSHAN Abhiyaan itself.

To know more about the indicator framework, assess availability of data across different sources, and read our recommendations for strengthening data use for nutrition, download and explore our Policy Note on “Tracking India’s progress on addressing malnutrition: What will it take?”.

Written by Purnima Menon, IFPRI; Supreet Kaur, NITI Aayog; Alok Kumar Dubey, National Nutrition Resource Center (previously with NITI Aayog); and Divya Nair, IDinsight