Presented by Dr. Rasmi Avula, IFPRI at "Delivering for Nutrition in India: Learnings from Implementation Research", November 9–10, 2016, New Delhi

1. Evidence base for nutrition action
Rasmi Avula, Sunny S. Kim, Neha Kohli, Suman Chakrabarti, Parul Tyagi,
Kavita Singh, Mara van den Bold, Suneetha Kadiyala, Purnima Menon
November 9, 2016

2. Coverage of maternal, newborn and child health and
nutrition interventions vary tremendously across India
93.6 83.7 91.8 78.8
47.3 45.7
99.3 97.5 80.4
58.7
96.7
54.6
30.5
76.3
55.3
23.3 27.7 42.3
68.7
0
10
20
30
40
50
60
70
80
90
100
0
10
20
30
40
50
60
70
80
90
100
BIHAR
UTTAR PRADESH
NAGALAND
GOA
KERALA
SIKKIM
SIKKIM
WEST BENGAL
GOA
SIKKIM
WB
ASSAM GOA
SIKKIM
TAMIL NADU
GOA
KARNATAKA
TAMIL NADU
ANDHRA PRADESH
HIMACHAL P
CHHATTISGARH
GOA
KERALA
TAMIL NADU
GOA
TAMIL NADU
MIZORAM
SIKKIM
WEST BENGAL
GOA
ANDHRA P
MAHARASHTRA
TAMIL NADU
TAMIL NADU
GOA
KERALA
MIZORAM
ODISHA
ASSAM
CHHATTISGARH
ODISHA
JHARKHAND
GOA
KERALA
HIMACHAL PRADESH
GOA
MIZORAM
KERALA
GOA
MAHARASHTRA
ODISHA
BIHAR
NAGALAND
MANIPUR
UTTAR PRADESH
BIHAR
NAGALAND
JHARKHAND
BIHAR
NAGALAND
JHARKHAND
UTTAR PRADESH
NAGALAND
PUNJAB
UTTARAKHAND
DELHI
JHARKHAND
CHHATTISGARH
NAGALAND
UTTAR PRADESH
JHARKHAND
MANIPUR
ARUNACHAL P
UTTAR PRADESH
NAGALAND
RAJASTHAN
DELHI
NAGALAND
ASSAM
GUJARAT
DELHI
MANIPUR
HARYANA
DELHI
NAGALAND
UTTAR PRADESH
MEGHALAYA
NAGALAND
JHARKHAND
UTTARAKHAND
NAGALAND
Prepared by a team at POSHAN, IFPRI-New Delhi, February 2016, based on data from the RSOC, 2014;
%

3. Is India ready to achieve at-scale delivery?
• Vision /Leadership
• Policy guidance
• Program / delivery
platforms
• Delivery of evidence-based
interventions
• Capacity
• Financing
Gillespie et al, 2015

4. Policy frameworks, interventions,
operational contexts
• Policies exist for most of the essential nutrition
interventions
• CMAM guidelines
• Operational guidelines and/or monitoring indicators are
not available for all interventions
• Program platforms in place for delivering at scale
• Two national programs are designed to deliver all the core
interventions
• Strategy for achieving continuum of care needed
• Weak operational evidence on implementation at scale
• Few published studies on how best to deliver nutrition
interventions across continuum of care
• NGO program experiences are limited to few interventions
• Limited by poor evaluation designs and little investment in
documentation
Avula et al., 2013

5. Evidence gap on actions to improve
infant feeding practices
Intervention: Counseling
• Efficacy studies: main focus
is on breastfeeding
counseling; few studies on
improving complementary
feeding (esp. diet quality)
• Program models: Several
exist, but few operational
and impact evaluations on
complementary feeding
models
Intervention: Complementary
food supplements
• Efficacy studies: only one
study that tested added
value of energy-protein
food supplements.
• Program models: Massive
investment in food
supplements, huge
variability in models used
across states, but few
operational or impact
evaluations
Almost no evidence on integrated models addressing both
counseling and food supplements!

6. Potential areas of implementation research
to support action on infant feeding
• Understand current practices and determinants
• Understand acceptability, use and perceptions
about different food supplements
• Test impact on feeding practices of different
models of behavior change and food
supplements
• Assess training, supervision and incentive
approaches for frontline workers who deliver
counseling
• Test different decentralized/models of production
and distribution of complementary food
supplements

7. Summary & conclusions
• Coverage of interventions lags behind
despite favorable policy commitments and
existing program platforms
• Gaps exist in operational guidelines,
monitoring mechanisms, and evidence to
action
• Urgent need to invest in implementation
research to identify, optimize, and
strengthen the models for delivery and
uptake of the essential nutrition
interventions
Photo: Rasmi Avula, 2015