Nutrition and Maternal&Child Health

1. Nutrition and Maternal&Child Health

2. Growth does not equal HDI improvements • Growth alone is not enough • Patterns of growth are important • Enabling environment for health and nutrition must be created for the poor in their sectors • Internal inequities can exacerbate factors related to MCH and Nutrition

3. Reasons for high Levels of Malnutrition • Income poverty • However, studies have shown that malnutrition exists even after removal of poverty. • For example income poverty in India is 26% while child malnutrition is 46%. • The data for India, Bangladesh and some other countries show that malnutrition levels are surprisingly high even in rich income quintiles. • Thus, reduction in malnutrition is going to be a bigger challenge than income poverty.

4. Reasons for high Levels • Therefore, one has to look beyond economic growth, income poverty and food availability • Adequate nutrition during pregnancy and first six months of life are critical because of the impact on birth weight. • Thus, the problems often start before, during and after pregnancy as malnourished mothers are more likely to produce low birth weight babies. • Poor nutritional status at birth is perpetuated by inadequate breastfeeding and supplementary feeding habits. • Subsequently in the first two years, they do not give sufficient quality food –particularly mothers with low education.

5. Health and Nutrition Linkages • Another important proximate cause of malnutri-tion is illness and infection. • Infections reduce the ability of the body to absorb critical nutrients from food. • Data show that children who experienced a diarr-heal episode are significantly more likely to experience malnutrition and severe malnutrition than children who did not suffer from diarrhea. • Of course, the causality also goes the other way– malnutrition increases the risk of infection.

6. Example of Bangladesh programs • While public food transfer programs, such as Food-for-Work, VGF and VGD, have hardly any effect on reducing overall levels of child malnutrition, they have fairly large effects on reducing malnutrition rates among the poorest quintile of children. • This suggests that these programs are well-targeted to the poor.

7. Iron, nutrition, deworming and psycho-social stimulation impact on learning Combining nutrition and education has larger and longer-lasting impact In some cases, impact higher for girls Access to primary school on time, especially for girls Retention in primary school Lower repetition Better language development Higher achievement Early childhood, nutrition and education Nutrition and EducationReinforce Each Other Early Childhood Participation Improves Later Education 19

8. Barriers to Maternal health care • Despite substantial inputs over a number of years from the side of the Nepal government and its safe motherhood partners, significant barriers still exist for women needing to seek maternal health care, on both supply and demand side. • Demand Side Barriers-Lack of understanding, Culture of Silence, Family and Social Restriction, Tradition Beliefs and Practices, Too Shy or Ashamed to Seek Care ,Distance to Health Facilities and Lack of Transport, Cost of Health Care,

9. Reasons for high levels of maternal mortality and morbidity • Micro nutrient deficiency is another reason • Age-specific interventions up to five years are important. But, lack of institutional arrangements for age-specific nutritional programs is another problem. • To conclude, there is a strong association between child malnutrition and women’s health/well being. • For example, one third of Indian women suffer from Chronic Energy Deficiency and BMI of less than 18.5kg • 58% of pregnant women in India suffer from anaemia • About 68% of pregnant women make first ANC visit after 4th Month of pregnancy. • One third of them visit after sixth month of pregnancy • About half of the deliveries take place at home

10. Barrier to Maternal Health Care • Supply Side Barriers- • Availability of Services and Referral, • Quality of Facilities, • Availability of Drugs and Suppliers, • Availability and Ability of staff, • Staff Attitude

11. Innovative programs: Experience of Bangladesh, India and Thailand • Bangladesh Experience: Broad picture is high economic growth, infrastructure development, women’s agency (female secondary education) and NGOs presence for high human development. • Women’s agency in the form of women’s groups and female secondary education (targeted interventions like Female Secondary School Stipend Program) • The contribution of the NGO Gonoshayastha Kendra (GK) in raising health indicators in many areas is noteworthy. • Indian Experience: The regional experience shows that differences in health provisioning, improvements in child care, and health status of women explain malnutrition differences across states.

12. Improving Access of Rural Women forSafe Delivery : Twin Initiatives for Reaching the Unreached • Improvement in institutional delivery rate in remote villages • Improved access of excluded communities to institutional deliveries • Reduced travel time and delay in reaching safe delivery centres • Reduced congestion

13. Innovations • Thailand Experience: Thailand is considered as one of the most outstanding success stories of reducing child malnutrition in the post-1970s. • The success is attributable more to the direct nutritional programs by the govt. than only to rapid economic growth. • The country launched large focused programs on nutrition in 1977. The child malnutrition declined from 51% in 1979-82 to 17% in 1991. • These programs reduced child malnutrition through a mix of interventions including intensive growth monitoring and nutrition education on breastfeeding • and complementary feeding, strong supplementary feeding provision, iron and vitamin supplementation and salt iodisation along with primary health care.

14. Creation of national / state / district level processes for scaling up • Child Survival Partnership: Recommendations • Ensure effective convergence of all departments, public and private sector & developing partners,.. • Prioritize the household and community-level interventions • Face real challenge of reaching high levels of effective coverage with evidence-based interventions among under-privileged community • Address operational bottlenecks & management issues • Work efficiently with community-level private providers. • Public Private partnership efforts, involvement of NGOs • Other Initiatives • Public Private Partnership—in Immunization, Integrated Management of Childhood illnesses (IMNCI)

15. Addressing Micronutrient Deficiencies in Children through the Integrated ChildDevelopment Services (ICDS) in the State of West Bengal • Success Factors • Good Coordination Strong coordination between West Bengal’s ministries and high levels of state government leadership • Stable Funding Stable sources of funding are provided by the Government of West Bengal and other partners • Strong Government & Leadership Champions within the highest levels of government • Strong Technical Capacity & Technical capacity provided by development partners and the private sector • Strong Monitoring System • West Bengal Micronutrient Society established to ensure proper management and monitoring • Well-Designed Program with a clear focus on an intervention that works

16. Some Basic Health System Options

17. Nutrition and MCH Lessons • What has worked? • Investment in need based intervention to address demand • Providing service delivery near community • Investment in training, human resources and infrastructure • Review visit by key decision makers in the Government, donors and partners as they in their feedback decided to replicate the initiative

18. Rapid gains are possible through… Practical approaches to achieve the MDGs- key interventions and policies • Changes in national policies & strategic directions, capacity building, and financial support • Stronger health systems • Complementary actions across sectors (education, water, energy, transport) • Donor mobilization and harmonization

19. Multisectoral collaboration • The health sector can play an important role in intersectoral collaboration. The roles of the other sectors in health should be recognized, monitored and promoted using a common agreed framework and indicators. • Avenues for an interface between the public and private (profit and non-profit) sectors needs emphasis. • Participation of civil society networks can be promoted so that they play an important role in revitalizing PHC. • Innovative ways for community empowerment, especially of women, need to be explored and implemented. One way to do this is to give the community a role in monitoring and supervision. • Governments should explore setting up an institutional mechanism to foster multi-sectoral collaboration at all levels; this will also facilitate effective community-based action.