Strengthening Governance for Nutrition-The Maharashtra Experience…

29th October 2014

Rajalakshmi Nair, Vandana Krishna, Ramani V, and Victor AguayoUNICEF Maharashtra , Government of Maharashtra, and UNICEF ROSA.

Government of Maharashtra

Outline

• Background

• Intervention

• Approaches and methods for collaboration/Research Methods

• Key findings/Results

• Conclusions & implications of your work

• Acknowledgements

Addressing Child Under nutrition in Maharashtra-The Turning Point.. Adversity to Opportunity.

• Media reports child deaths due to malnutrition in two tribal districts.

• High power committee set up under CM to develop the response plan based on the PIL.

• Advocacy based on success of Marathwada Initiative.

• Demonstrated experience in implementing the large-scale Marathwada Initiative to address child undernutrition-(8 most backward later scaled up in 13 other districts)-Response to media reports (2001-2004) - UNICEF-Partnered.

• Release of the NFHS-III report.

• RJMCHN Mission established on 22 February 2005 through the State Cabinet approval.

“The 1st functional Mission in the country to address child under nutrition”

UNICEF had the Opportunity to Partner.

Delivering for the most deprived children

• Phase I - The tribal districts

• Focus on 0-6 years• Establish tracking

system• Strengthen weighing

efficiency• Focus on children with

severe malnutrition (Grade III & IV)

• Special attention to under 3 years

RJMCHN Mission:

Making a difference

• Visibility to the issue

• Recognition of ICDS as a platform of service delivery.

• Systematic capacity building of Health and ICDS.

• Advocacy at the highest level-State steering committees.

• Strengthening existing monitoring systems

• Creating Accountability at all the levels

• Data for decision making

• Establishing Partnerships

• Involving communities through nutrition audits

• Demonstrating evidence base, and scaling up high impact interventions

• Leveraging resources

RJMCHN Mission-Independent platform with

committed team, enjoys the flexibility and the autonomy

• Evidence- Global and State level - the need to focus on (-9to +24months)

• Building on the Political commitment to Make Maharashtra Malnutrition Free.

Election manifesto.

• Unfinished Agenda-Reaching the Urban Poor.

• Data analysis for action.

Approaches and Collaboration based on the

Lessons learned..

Political Commitment Sharpening the Focus – First 1,000 Days

• RJMCHN Mission with renewed focus (-9 to +24

months) endorsed by the CM on 30th September

2010 –(Phase-II-2010-2015).

• “UNICEF requested to partner again”

• Independent Nutrition Survey of children Under

two.

The Key Results..

Trends in prevalence of under nutrition among children under two

39.0

19.9

29.6

23.3

16.3

22.6

Stunting Wasting Underweight

Pe

rce

nta

ge

NFHS 3 CNSM

Under nutrition among children under two by age

0

5

10

15

20

25

30

35

40

45

50

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Pe

rce

nta

ge

Age in Months

Stunting Wasting Underweight

Decline in prevalence of stunting among children under two

41.4 39.0

23.3

0

25

50

1999 2006 2012

0

10

20

30

40

50

60

StuntingAdivasi

StuntingNon Adivasi

UnderweightAdivasi

UnderweightNon Adivasi

WastingAdivasi

WastingNon Adivasi

Pre

vale

nce

(%

)

Prevalence of stunting, underweight and wastingin children 0-23 months old. Maharashtra 2006-2012

2006 2012

The factors that contributed to the significant reduction in stunting….

Infant and young child feeding practices

Care for women before and during pregnancy

Access to health services and healthy environments

Maharashtra: Improvements in 3 key areas

The Gaps…

59.3

53.0

88.1

62.0

0

45

90

Institutional delivery Timely initiation of breastfeeding

2006

2012

Marked improvement in institutional deliveries; however timely initiation of breastfeeding is still sub-optimal

Co

vera

ge (

%)

Source: NFHS-2006, CNSM-2012

Source: CNSM, 2012

Complementary feedingBreastfeeding

Co

vera

ge (

%)

Poor quality of complementary foods in children undertwo

26.629.2

21.0

0

10

20

30

Stunting

SC

ST

Others

Source: NFHS-2006, CNSM-2012

Significant disparities in the prevalence of stunting:Social Groups

Pre

vale

nce

(%

)

Conclusions…

• High level political commitment.-Demonstrated by appointing full time PS rank officer.

• Mission Providing the Leadership for Nutrition focusing on the youngest and most deprived.

• Continuity of Mission team for 5 years contributed to major break through in programs

• High-Credibility of the Mission for providing necessary technical guidance and support

among the front line functionaries especially the ICDS. And Health..

• Proactive role of NRHM-Nutrition interventions mainstreamed .

Conclusions. Way Forward…

• CNSM Survey ,Demonstrated that systems can deliver for children-high level motivated front line functionaries.

• Special focus on high burden districts and blocks .

• Focusing on Nutrition sensitive interventions-Liveli hood,Tribal,Agriculture, Water and sanitation, Food and civil supplies.

• Established Partnerships-Corporations, Academia,Professional bodies, NGO

networks and Citizens Alliance .• Urban Strategy

Implications…

• Larger Role of Business Houses as per their CSR Policy. Clear and Standard guideline to be developed for Partnerships.

• Is Mission the answer to addressing Child Under nutrition in the Country? Yes and No.

• Yes-If the Mission is headed by a Senior Policy maker and who is interested and understands the issue and willing to head it for atleast three years.

• High end Political support.

• Gets complete autonomy and ideally not under any department.

• No-if it is going to be headed by an outsider, or it is a punishment posting or by a technocrat.

SPECIAL INITIATIVE IN 8BACKWARD DISTRICTS OF

AURANAGABAD DIV.THE MARATHWADA INITIATIVE-DIV.COM.MR.RAMANI.UNIC

EF PARTNERED

RJMCHN MISSION PHASE-I ESTABLISHED 2005-2010-MR.RAMANI DG MISSION

AND MS VANDANA KRISHNA-SEC DWCD AND LATER SEC HEALTH.UNICEF

PARTNERED

RJMCHN MISSION PHASE-II ESTABLISHED-2010-2015-MS.VANADANA KRISHNA DG MISSIONFOCUS ON

FIRST 1000 DAYS-UNICEF PARTNERING

The Phases...

The Team that made the difference..RJMCHN MISSION-I-2005-2010

Mr. V. Ramani, EX DG, Dr. Gite, Dr. Pandge, Mr. Khalegaonkar, Mr. Sudame, Mr. Munde , Mr.

Nagargoje

&

RJMCHN MISSION-II- 2010-2015-Focus on First 1000 Days.

Ms Vandana krishna-PS and DG Mission with her team

Government of Maharashtra

Chief Ministers(3), Late Mr. Vilas Rao Deshmukh,Mr.Ashok Chavhan,Mr.Prithvi Raj Chavhan,

Minister women and child Development, Chief Sec (Mr.PremKumar and Mr. Ratnakar Gaikwad),

Dr.J.Kbanthia,PS Pub Health/NRHM ,PS DWCD-UJJWAL UKE, Late Mr. C.B. Turkar

( Architect of both the missions)

Thousands of frontline functionaries from ICDS and Health.

Local leadership.and State leadership..

UNICEF- Ces Adorna,Werner Schultink,GopiMenon,Karin Hulshof,Victor Aguayo,Gayatri

singh,Mohamed,Gopi Menon,Tejinder Sandhu and Rajeshwari Chandrasekar.

Contributors to the Paper..

• Ms.Rajeshwari Chandrasekar.

• Dr.Gayatri Singh.

• Mr.Vikas Kharage-EX MDNRHM-Addl Muni Commissioner MCGM.

Maharashtra Team

• Ms.Vandana Krishna-PS and DG RJMCHN Mission-Governmnet of Maharashtra.

• Ms.Rajeshwari Chandra Sekar-Chief of Field Office –UNICEF Maharashtra.

• Ms.Neerja-Chowdhury-Sr.Journalist and core member of Citizens Alliance.

• Mr.Venkat Ramanan-Excutive Trustee-TATA Trust.

• Ms.Rajalakshmi Nair-Nutrition Specialist-UNICEF.

Thank Youunite for children