For India, undernutrition is a persistent problem. To address this, the Indian government has made several policy and programmatic efforts, including the launch of Poshan Abhiyaan, the flagship program of the Ministry of Women and Child Development (WCD). The overarching goal of all these efforts is to improve nutrition outcomes for children, adolescents, lactating mothers and pregnant women by focusing on capacity building, improved service delivery, community mobilization and participation, the use of technology, and interdepartmental and interdepartmental convergent planning and review. of progress.
The quality of nutrition service delivery remains a major challenge in India, negatively affecting nutrition outcomes for women and children. To achieve the ambitious goals and fully exploit the opportunities created by the Poshan Abhiyaan, there is a need for greater emphasis on delivering high-impact nutritional interventions, especially in the first 1,000 days – from pregnancy to the age of two – for children, with full coverage and quality. . Government programs regularly monitor coverage indicators, but the focus on quality needs to be strengthened.
In its latest report, the Lancet Global Health Commission on High Quality Health Systems in the SDG Era estimated that in low- and middle-income countries, 60% of deaths are due to poor quality care and the remaining deaths result from non-use of the health system. Evaluation of maternal nutrition programs in Bangladesh found that improving the quality of childbirth has more than twice the impact of improving coverage.
Poshan Abhiyaan’s Third Progress Report highlighted the need and importance of quality improvements in the delivery of Integrated Child Development Program (ICDS) interventions, including home visits, follow-up growth and take-home rations. The report also highlighted the need to improve the quality of nutrition services provided during visits for programs related to antenatal care, home-based neonatal care and home-based care for young children under the National Mission of health. Quality implies that infants, young children and women receive the effective, timely, adequate, affordable, culturally appropriate and respectful nutritional care they need for optimal health and well-being. It encompasses both the dimensions of caregiving and the experience of care.
Over the past few years, WCD has taken a multi-pronged approach to improving the quality of nutrition services under the Poshan Abhiyaan, including a step-by-step learning approach to building the capacity of frontline workers. It even launched a tracking app, Poshan Tracker, to enable real-time monitoring and tracking of all Anganwadi centres, Anganwadi workers and beneficiaries on defined indicators. As part of the drive to improve quality, the Ministry of Health and Family Welfare has launched several initiatives such as Labor Ward Quality Improvement Initiative (LaQshya), MusQan (for quality assurance) and Absolute Mothers’ Affection (MAA) to prioritize quality improvement for nutrition interventions such as early and exclusive breastfeeding and feeding sick newborns.
A comprehensive nutrition quality program requires responsive and accountable leadership, generating a community and beneficiary centered culture of quality with clear structures and clarity of roles for each cadre as well as mechanisms to enable the implementation of three quality management approaches like quality planning, quality assurance and quality improvement. Institutional mechanisms are needed to enable continuous improvement in the quality of nutrition services across ICDS and health systems.
Firstly, it is crucial to make quality assurance efforts by defining quality standards and guidelines for nutrition services provided at community level during home visits, community events and in Anganwadi centers as well as in health facilities. Care should be measured against these standards by developing plans to address identified gaps, conducting follow-up assessments, and putting in place mechanisms to recognize and make visible achievement of the standards.
To measure quality, three sets of information must be captured: inputs in terms of training, equipment, infrastructure and product availability; adequate processes followed by frontline nutrition and health workers to provide services and benefits to families; and level of satisfaction and knowledge of families about the services received. To institutionalize the quality assessment and improvement process, it is important to understand that data, which illuminates issues, should be seen as an asset rather than a liability. The focus of data review should be the identification of gaps and the support required for improvement rather than punitive measures. Additionally, data quality can really improve significantly when data collectors see the value of data for service delivery and improvement. Using data for programmatic improvement must be part of the DNA of our system at all levels.
Second, mechanisms must be in place to embed quality improvement methods – management approaches that team members involved in delivering, overseeing and enabling service delivery can use to solve problems at their level in order to improve care – in the system. They have been successful in health care and have shown encouraging results when used to improve the delivery of nutrition services in health facilities and promote early initiation of breastfeeding in childbirth. normal and caesarean section. This type of approach has the potential to transform the delivery of nutrition services in community settings as well as through service quality reviews using data, team discussions on the root causes of quality gaps and problem-solving processes.
Third, systematic and regular measurement of the quality of service delivery – including inputs, processes and outcomes – across ICDS and the health system is the call of the hour. The system should build visibility on how service delivery processes are implemented on the ground and how they are perceived by beneficiaries.
Finally, it is critical to strengthen the role of the community in helping to create an enabling environment for improving the quality of nutrition services through engagement in program design and delivery.
It is time to strengthen these efforts and develop and implement a comprehensive approach, combining both quality assurance and quality improvement for government-led nutrition service delivery. Only this will help the country realize Suposhit Bharat’s vision and unleash the immense potential of India’s human capital.
(Dr Sebanti Ghosh is a public health and nutrition expert and a member of several technical expert committees on maternal and newborn health and nutrition constituted by the Ministry of Health and Family Welfare She is also part of the World Health Organization South East Asia Regional Office Women’s and Children’s Health Technical Group Ghosh is currently Senior Technical Advisor – Nutrition, South Asia, Alive & Thrive, India, FHI Solutions.)