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ANM Auxiliary Nurse Midwifery
ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker
BRG Block Resource Group
C2IQ Coverage, Continuity, Intensity, Quality
CAS Common Application Software
CAP Convergence Action PLan
CBE Community Based Event
CDPO Child Development Project Officer
CHC Community Health Center
CNNS Comprehensive National Nutrition Survey
DAY- NRLM Deendayal Antyodaya Yojana – National Rural Livelihoods Mission
DRG District Resource Group
DWS Drinking Water and Sanitation
EBF Early Breast Feeding
H&FW Health & Family Welfare
HR Human Resource
ICDS Integrated Child Development Scheme
IEC Information, Education and Communication
IFA Iron and Folic Acid
IFPRI International Food Policy Research Institute
ILA Integrated Learning Approach
LBW Low Birth Weight
LS Lady Supervisor
MAM Moderate Acute Malnutrition
NFHS National Family Health Survey
NHM National Health Mission
PFMS Public Financial Management System
PHC Primary Health Center
PMMVY Pradhan Mantri MatruVandanaYojana
PMO Prime Minister’s Office
POSHAN Prime Minister’s Overarching Scheme for Holistic Nourishment
RD Rural Development
SAM Severe Acute Malnutrition
SBCC Social and Behavioral Change Communication
SPMU State Project Management Unit
SHG Self Help Group
SNRC State Nutrition Resource Centre
TSU Technical Support Unit
UT Union Territory
VHSND Village Health Sanitation Nutrition Day
WCD Women and Child Development
ABBREVIATIONS
2 TABLE OF CONTENTS
3
Chapter Content
Chapter 1 Introduction and Outline of POSHAN Abhiyaan
Policy initiatives in Nutrition and Allied Sectors
Chapter 2 Methodology
- Implementation Score
- Computation of Scores
- Process
Chapter 3 Nutrition intervention coverage and OVERALL implementation SCOREs of
States and Union Territories for POSHAN Abhiyaan
Chapter 4
Chapter 5
Chapter 6 Jan Aandolan
Chapter 7 Recommendations
- Coverage of Nutrition Specific Interventions: CNNS data
- Governance and Institutional Mechanism
- Strategy and Planning
- Service Delivery & Capacities
- Programme Activities and Intervention Coverage
Scaling up POSHAN Abhiyaan by delivering core interventions at scale to ensure
Coverage, Continuity, Intensity and Quality - C
2
IQ
Theory of Change for POSHAN Abhiyaan
- Inputs for POSHAN Abhiyaan
- Technology
- Training
- Convergence
- Jan Andolan
Multi-Sectoral convergence and Policy action
- At National Level
- At State level LIST OF FIGURES
4
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
List of Tables
Table 1 Implementation score themes for WCD and Health Department
Table 2 Categorization of States
List of Boxes
BOX 1
BOX 2
BOX 3
BOX 4
BOX 5
BOX 6
Targets of the POSHAN Abhiyaan
Pillars of POSHAN Abhiyaan
Key Government Initiatives in Nutrition and Allied sectors
Important Policy Actions under the ambit of POSHAN Abhiyaan
Trend in number of beneficiary registration Vs payment of instalment (PMMVY)
Trend of beneficiary registration (all India progress) (PMMVY)
Reported utilization of money (PPMVY)
Average minimum dietary diversity score (PPMVY)
Critical c omponents for the evaluation implementation of the POSHAN Abhiyaan
Coverage of a selected set of nutrition interventions in India, CNNS (2016-18)
Overall Implementation Status - National Picture
Governance & Institutional Mechanism: WCD Department-Large States
Governance & Institutional Mechanism: WCD Department- Small States
Governance & Institutional Mechanism: WCD Department- UTs
Service Delivery and Capacity- WCD Department
Service Delivery and Capacity-Health Department
Program activities and intervention coverage-WCD Department
Program activities and intervention coverage- Health Department
Interventions in POSHAN Abhiyaan
Trend of HR vacancy at different level under ICDS in last one year
Participation of the Community during Poshan Maah and Poshan Pakhwada
Top performing States during Poshan Pakhwada
Percentage of CBEs conducted
Steps to generate the implementation score
Challenges reported by State/UT Governments on strengthening inputs needed to
implement POSHAN Abhiyaan actions
State-level challenges related to strengthening technology in the context of
POSHAN Abhiyaan
Challenges reported by States in relation to strengthening training for POSHAN Abhiyaan
Challenges reported by States related to establishing processes related to convergent action
planning
Challenges reported by the States in relation to Jan Andolan EXECUTIVE SUMMARY Background:
POSHAN Abhiyaan is an overarching umbrella
scheme to improve the nutritional outcomes for
children, pregnant women and lactating mothers
by holistically addressing the multiple
determinants of malnutrition and attempts to
prioritize the efforts of all stakeholders on a
comprehensive package of intervention and
services targeted on the first 1000 days of a
child’s life. It seeks to do so through an
appropriate governance structure by leveraging
and intensifying the implementation of existing
programs across multiple Ministries while at the
same time trying to rope in the expertise and
energies of a whole range of other stakeholders –
State Governments, Communities, Think tanks,
Philanthropic Foundations and other Civil
Society Actors. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia among
children (and young females) by 3 percentage
points per annum. It is based on 4 pillars:
• Ensuring access to quality services
across the continuum of care to every
woman and child; particularly during the
first 1000 days of the child’s life.
• Ensuring convergence of multiple
programs and schemes: ICDS, PMMVY,
NHM (with its sub components such as
JSY, MCP card, Anaemia Mukt Bharat,
RBSK, IDCF, HBNC, HBYC, Take Home
Rations), Swachh Bharat Mission, National
Drinking water Mission, NRLM etc.
• Leveraging technology (ICDS-CAS) to
empower the frontline worker with near
real time information to ensure prompt and
preventive action; rather than reactive one.
• Jan Andolan: Engaging the community in
this Mission to ensure that it transcends the
contours of being a mere Government
programme into a peoples’ movement
inducing large scale behaviour change with
the ownership of the efforts being vested in
the community rather than government
delivery mechanisms.
NITI Aayog is in the vanguard of shaping the
contours of the POSHAN Abhiyaan – right from
the conceptualization stage right up to the
execution stage. Vice Chairman, NITI Aayog
Chairs the National Council charged with the
responsibility of steering the Abhiyaan. Moreover,
as per the POSHAN Abhiyaan Guidelines NITI
Aayog has been mandated with the responsibility
of preparing bi-annual Reports to apprise the
Hon’ble Prime Minister with the progress of the
campaign. This is the Second Report on the status
of implementation of the POSHAN Abhiyaan.
Like the previous report, it assesses the readiness/
preparedness of the States and Union Territories to
effectively implement the Abhiyaan. Two major
departures from the last Report are worth noting:
(1) that the preparedness of State Health
Departments (weightage 35%) has been assessed
in addition to the Women and Child Departments
(weightage 65%) unlike last time when only WCD
preparedness was assessed; and (2) We have made
use of the Comprehensive National Nutrition
Survey (CNNS) data to take stock of State wise
coverage of key interventions as also look at the
outcome variables of interest, viz. Stunting,
Wasting, Underweight and Anaemia prevalence.
The sub-set of questions used in the State/
Ministry Response Forms was selected to ensure
continuity with the previous report (Annexure
1a and b) while adding more information
regarding additional aspects of the Abhiyaan.
The Implementation Scores reflected in the
present Report measures the readiness of the
States/UTs to effectively implement and execute
the POSHAN Abhiyaan. It is further grouped
6
under categories which are considered to be
critical for the effective execution of the POSHAN
Abhiyaan: 1. Governance and Institutional
Mechanism; 2. Strategy and Planning; 3. Service
Delivery and Capacities and 4. Programme
Activities and Intervention Coverage. An overall
composite score was created combining all the
four themes to examine the implementation
capabilities of States. Data provided by the States
was digitized, post which weights were assigned
to indicators chosen for the preparedness score in
consultation with Experts. Once the weights were
assigned, subtotals were computed for each
domain. Finally, all the subtotals were summed up
to create the final score. A detail of the rubric is
placed at Annexure 2. It may also not be out of
place to mention that the data reported was
validated and the scores were subjected to a
thorough peer review by our technical partners,
International Food Policy Research Institute
(IFPRI) to ensure the validity of the calculations
arrived at by Technical Support Unit (TSU) of
NITI Aayog.
State of Implementation of the Abhiyaan in
States:
Before we proceed to present our take on the
status of implementation of POSHAN Abhiyaan
in the States and UTs, it would be useful to take
note of the outcome and coverage indicators of
high priority interventions as revealed by the
Comprehensive National Nutrition Survey
(CNNS) conducted by MoHFW in association
with UNICEF. Admittedly the survey
pre-dates the launch of the Abhiyaan, none the
less it holds important lessons for our strategy to
implement this Mission. So far the latest survey
data available regarding outcomes of interest
(stunting, wasting, underweight & Anaemia
prevalence) was NFHS-4 which carries
information relating to the period 2015-16.
Fortunately, we now have authoritative
household level survey data representative at the
State level from CNNS, conducted during the
period 2016-18 and covering more than 110,000
households spread across the country. It
provides the most updated data on the
prevalence, coverage and continuity of a set of
key nutrition and health interventions for India’s
States. We may consider this data as providing
insight into baseline prevalence of the status of
nutritional indicators that have a bearing upon
the POSHAN Abhiyaan and can help States in
finalizing their strategies for pacing their efforts
in obtaining the desired outcomes as well as
targets for intervention coverage.
Although can’t strictly compare, but CNNS showed
stunting decline has accelerated to 1.8 % points per
annum which is almost double of the 0.9 % point
per annum prevailing in the previous decade
(2005-06 to 2015-16); (Figure A). This is perhaps
due to a range of programmes implemented by the
Government in the areas of health, nutrition and
sanitation over the last few years. We are not
comparing the Anaemia prevalence declines due to
reasons mentioned in the note below Figure A.
Overall, the story that emerges from the CNNS is
that even before the launch of the POSHAN
Abhiyaan we have nearly reached or exceeded the
targets that we have set for ourselves in view of the
multiple efforts by the Government of India under
the NHM, ICDS and SBM campaigns.
7
Background:
POSHAN Abhiyaan is an overarching umbrella
scheme to improve the nutritional outcomes for
children, pregnant women and lactating mothers
by holistically addressing the multiple
determinants of malnutrition and attempts to
prioritize the efforts of all stakeholders on a
comprehensive package of intervention and
services targeted on the first 1000 days of a
child’s life. It seeks to do so through an
appropriate governance structure by leveraging
and intensifying the implementation of existing
programs across multiple Ministries while at the
same time trying to rope in the expertise and
energies of a whole range of other stakeholders –
State Governments, Communities, Think tanks,
Philanthropic Foundations and other Civil
Society Actors. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia among
children (and young females) by 3 percentage
points per annum. It is based on 4 pillars:
• Ensuring access to quality services
across the continuum of care to every
woman and child; particularly during the
first 1000 days of the child’s life.
• Ensuring convergence of multiple
programs and schemes: ICDS, PMMVY,
NHM (with its sub components such as
JSY, MCP card, Anaemia Mukt Bharat,
RBSK, IDCF, HBNC, HBYC, Take Home
Rations), Swachh Bharat Mission, National
Drinking water Mission, NRLM etc.
• Leveraging technology (ICDS-CAS) to
empower the frontline worker with near
real time information to ensure prompt and
preventive action; rather than reactive one.
• Jan Andolan: Engaging the community in
this Mission to ensure that it transcends the
contours of being a mere Government
programme into a peoples’ movement
inducing large scale behaviour change with
the ownership of the efforts being vested in
the community rather than government
delivery mechanisms.
NITI Aayog is in the vanguard of shaping the
contours of the POSHAN Abhiyaan – right from
the conceptualization stage right up to the
execution stage. Vice Chairman, NITI Aayog
Chairs the National Council charged with the
responsibility of steering the Abhiyaan. Moreover,
as per the POSHAN Abhiyaan Guidelines NITI
Aayog has been mandated with the responsibility
of preparing bi-annual Reports to apprise the
Hon’ble Prime Minister with the progress of the
campaign. This is the Second Report on the status
of implementation of the POSHAN Abhiyaan.
Like the previous report, it assesses the readiness/
preparedness of the States and Union Territories to
effectively implement the Abhiyaan. Two major
departures from the last Report are worth noting:
(1) that the preparedness of State Health
Departments (weightage 35%) has been assessed
in addition to the Women and Child Departments
(weightage 65%) unlike last time when only WCD
preparedness was assessed; and (2) We have made
use of the Comprehensive National Nutrition
Survey (CNNS) data to take stock of State wise
coverage of key interventions as also look at the
outcome variables of interest, viz. Stunting,
Wasting, Underweight and Anaemia prevalence.
The sub-set of questions used in the State/
Ministry Response Forms was selected to ensure
continuity with the previous report (Annexure
1a and b) while adding more information
regarding additional aspects of the Abhiyaan.
The Implementation Scores reflected in the
present Report measures the readiness of the
States/UTs to effectively implement and execute
the POSHAN Abhiyaan. It is further grouped
under categories which are considered to be
critical for the effective execution of the POSHAN
Abhiyaan: 1. Governance and Institutional
Mechanism; 2. Strategy and Planning; 3. Service
Delivery and Capacities and 4. Programme
Activities and Intervention Coverage. An overall
composite score was created combining all the
four themes to examine the implementation
capabilities of States. Data provided by the States
was digitized, post which weights were assigned
to indicators chosen for the preparedness score in
consultation with Experts. Once the weights were
assigned, subtotals were computed for each
domain. Finally, all the subtotals were summed up
to create the final score. A detail of the rubric is
placed at Annexure 2. It may also not be out of
place to mention that the data reported was
validated and the scores were subjected to a
thorough peer review by our technical partners,
International Food Policy Research Institute
(IFPRI) to ensure the validity of the calculations
arrived at by Technical Support Unit (TSU) of
NITI Aayog.
State of Implementation of the Abhiyaan in
States:
Before we proceed to present our take on the
status of implementation of POSHAN Abhiyaan
in the States and UTs, it would be useful to take
note of the outcome and coverage indicators of
high priority interventions as revealed by the
Comprehensive National Nutrition Survey
(CNNS) conducted by MoHFW in association
with UNICEF. Admittedly the survey
pre-dates the launch of the Abhiyaan, none the
less it holds important lessons for our strategy to
implement this Mission. So far the latest survey
data available regarding outcomes of interest
(stunting, wasting, underweight & Anaemia
prevalence) was NFHS-4 which carries
information relating to the period 2015-16.
Fortunately, we now have authoritative
household level survey data representative at the
State level from CNNS, conducted during the
period 2016-18 and covering more than 110,000
households spread across the country. It
provides the most updated data on the
prevalence, coverage and continuity of a set of
key nutrition and health interventions for India’s
States. We may consider this data as providing
insight into baseline prevalence of the status of
nutritional indicators that have a bearing upon
the POSHAN Abhiyaan and can help States in
finalizing their strategies for pacing their efforts
in obtaining the desired outcomes as well as
targets for intervention coverage.
Although can’t strictly compare, but CNNS showed
stunting decline has accelerated to 1.8 % points per
annum which is almost double of the 0.9 % point
per annum prevailing in the previous decade
(2005-06 to 2015-16); (Figure A). This is perhaps
due to a range of programmes implemented by the
Government in the areas of health, nutrition and
sanitation over the last few years. We are not
comparing the Anaemia prevalence declines due to
reasons mentioned in the note below Figure A.
Overall, the story that emerges from the CNNS is
that even before the launch of the POSHAN
Abhiyaan we have nearly reached or exceeded the
targets that we have set for ourselves in view of the
multiple efforts by the Government of India under
the NHM, ICDS and SBM campaigns. 0
10
20
30
40
50
60
70
80
90
100
38.4
21
35.7
59
34.7
17.3
33.4
41*
Figure A: Progress in reducing undernutrition
NFHS - 4 (2015-16) CNNS (2016-18)
StuntingWasting Underweight Anaemia
[* Prevalence of anaemia was estimated from children in the age group 1-4 years measured using gold standard methods. The two
figures are not comparable since they are arrived by using different methods of drawing blood samples to assess Hb levels]
0
10
20
30
40
50
60
70
80
90
100
Percentage
breastfed within
one hour of birth
Percentage with
minimum dietary
diversity
Percentage with
minimum meal
frequency
Percentage with
minimum
acceptable diet
41.5
22
35.9
9.6
56.6
21
41.9
6.4
Figure B: Infant and Young Child Feeding (IYCF) Indicators
NFHS 4 (2015-2016) CNNS (2016-16)
8 Children need age-specific adequate nutrition of
acceptable quality and quantity to prevent
malnutrition, therefore, infant and young child
feeding (IYCF) practices from CNNS data is
also considered to provide the complete
depiction. There is improvement in few
indicators like the early initiation of
breastfeeding, minimum meal frequency
whereas, marginal decline is observed for
minimum dietary diversity (Figure B).
It is now crucial that the momentum in reducing
malnutrition is maintained and may perhaps be
even accelerated given the unprecedented focus
that POSHAN Abhiyaan has brought upon the
multiple determinants of malnourishment
among India’s women and children.
Additionally, it might be worth considering a
possible upward revision of some of the targets
given the notable levels of decline shown by
CNNS data.
The other story that emerges from the CNNS
data is not so positive and indicates the enormity
of implementation challenge that we are
confronted with on the coverage of a set of key
nutrition and health interventions and policy
initiatives in India’s States and Union
Territories. Figure C provides a snapshot of the
coverage of the high-impact interventions at the
National level and their State wise distribution.
It is striking to note that in terms of the coverage
levels, there is hardly any improvement in any
State or in the relative position of the States
when we compare these to NHFS-4 level. As
would be seen, the highest level of coverage for
receiving IFA is at about 70%. If we look at the
co-coverage of all the required interventions
(that is the percentage of mothers and children
receiving all the required interventions) that
figure would be at a very low one digit figure.
This underlines the challenge for implementing
agencies and the direction for future strategic
shifts in our approach to the Abhiyaan. Another
feature to be noted that CNNS finds substantial
decline in malnutrition levels without the
corresponding increase in coverage of
interventions. We therefore need to the
implementing agencies to place much greater
emphasis in the POSHAN Abhiyaan on the
quality of services provided to the beneficiaries.
9 0
20
40
60
80
100
120
Received IFA
Consumed 100+ IFA
Weighing
Breastfeeding counselling
Food supplementation
Health & nutrition education
Food supplementation
Health & nutrition education
Food supplementation (at least once a week)
Weighing (at least once in 3 months)
PregnancyLactationReceived benefits for child
from AWC
Figure C: Coverage of selected set of health and nutrition interventions in India,
CNNS (2016-18)
India Andhra PradeshBihar Chhattisgarh Gujarat Haryana Himachal PradeshJammu & KashmirJharkhand Karnataka Kerala Madhya PradeshMaharashtra Odisha Punjab Rajasthan Tamil Nadu Telangana Uttar PradeshUttarakhand West Bengal
10
0
10
2030
405060
70
80
90
100
Figure D: Overall Impl ementaion Status-National Picture
Note: Status of Jammu& Kashmir refer to a date prior to bifurcation
ANDHRA PRADESH
CHATTISGARH
MADHYA PRADESH
UTTARANCHAL
HIMACHAL PRADESH
GUJARAT
TAMIL NADU
MAHARASTRA
JHARKHAND
RAJASTHAN
BIHAR
UTTAR PRADESH
PUNJAB
HARYANA
TELANGANA
JAMMU & KASHMIR
KARNATKA
ASSAM
KERALA
MIZORAM
SIKKIM
NAGALAND
MEGHALAYA
ARUNACHAL PRADESH
TRIPURA
MANIPUR
GOA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
ANDAMAN & NICOBAR ISLANDS
DELHI
LAKSHADWEEP
Large States
Small States
Union Territories
11 We now present the inter-se ranking of the States
and Union Territories (UTs) on the overall
implementation status of the Mission (Figure D).
The scores for States and UTs are computed on
the basis of data received from the WCD and
Health Departments on four components with
specific weights. Among the large States, Andhra
Pradesh emerged as the top performing State and
among the small States, Mizoram gets the top
honours. Dadra and Nagar Haveli came out as the
best in so far as UTs are concerned. We would like
to point out a few issues that in our view are
emerging as the key binding constraints in the
implementation of the Abhiyaan:
1. Gaps in Human Resources, particularly at
the supervisory level:
Overall across States, there are huge
vacancies in supervisory cadre positions
including that of Lady Supervisors, CDPOs,
and DPOs. At a national level, the vacancy
rates are in the range of 25% at both the
CDPO and Lady Supervisor levels. This is
the aggregated national scenario that varies
from State to State; however, it is a clear
indication of the relatively higher number of
vacancies at the Supervisor level. For
positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less
than 5% of the sanctioned posts have been
filled up. Gujarat is the only large State
where all SPMU positions have been filled
up. The position in smaller States is even
worse. With the exception of two States
(Meghalaya & Mizoram), in the rest of the
States either the SPMU has not been set up
altogether or even where it has been set up all
positions remain vacant due to
non-completion of the recruitment process.
The UTs are slightly better placed with four
UTs having greater than 75 % of the SPMU
posts filled up. None of the posts were filled
in Puducherry and Delhi. Under the
PMMVY scheme , against the provision of
hiring 60 contractual staffs at State level and
1,434 contractual staffs at District level
across the States and UTs, so far only 42%
and 26% recruitments have been done at
State and District levels respectively (as on
18 February 2019).
2. Procurement & ICDS-CAS:
There are significant challenges with the
procurement and distribution of growth
monitoring devices and smart phones. While
there is a great emphasis in the Abhiyaan on
the procurement of Smartphones and
Growth Monitoring Devices, as per the last
update only 27.6% of AWWs across the
country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales).
Where real time growth monitoring data is
available from the AWW centres, we need to
ensure that the supervisory cadres are trained
in their use. While a dashboard is available at
the State Headquarters, we have not so far
seen it being used for Monitoring and
Evaluation purposes as well as a Decision
Support Tool at the Block, District and State
levels. In the absence of rigorous analytics,
there is every likelihood of attrition in the
quality of data collected through the
ICDS-CAS. MoWCD and MoHFW
currently use different applications for
tracking the same beneficiaries leading to
unnecessary duplication of efforts in data
entry, besides lack of coordination in
due-lists leading to a siloed approach to
service delivery. Although significant
resources have been dedicated to a pilot
project to develop a common platform for
the AAA functionaries and it has been in the
works for some time now, we are yet to see a
fruition of that effort. Another issue that
needs to be addressed for smooth
12 functioning of the ICDS-CAS pertains to
internet connectivity in remote rural areas
and also help-desk facilities for front line
workers to help them navigate the software
as first-time users. Only a few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established such helpdesks in all Districts.
3. Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response
from multiple departments; and (b) Impact
level where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child. As has been pointed
out earlier while discussing the CNNS
results, our success in effective convergence
of critical services at the household level has
been fairly modest. Since the launch of
POSHAN Abhiyaan, several coordinated
policy announcements by concerned
Ministries; strengthening the platforms of
service deliveries such as VHSND and
effective demand side push to drive
behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push
towards the creation of institutional
mechanisms at the State, District, Block
and Village levels for accelerating
convergent action required for the
implementation of POSHAN Abhiyaan.
Some of the learnings from existing State
level convergence models which should be
considered for scale up are listed below:
o Self Help Group federation of JEEViKA
model in the State of Bihar created a
promising platform for engaging the
community through feeding demonstrations
at the SHG meetings as a result of which
complementary feeding which had
remained stagnant for years showed more
than a 2-fold improvement over a two-year
period (both in terms minimum acceptable
diet and minimum dietary diversity).
o Government of Chhattisgarh where
convergence of various schemes like the
State Rural Livelihood Mission in the
District of Surguja, has helped to improve
several indicators at the grass roots levels.
o Similarly, the Ajeevika initiative of the
Government of Jharkhand where they
engage the Sakhi Mandal members as
Business Correspondent (BC). The gradual
decline in prevalence of diseases on account
of micronutrient deficiencies as well as
reduced prevalence of stunting and wasting
among under-5 children point towards a
positive change
o In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
13 demonstrably shown to be an efficient and
effective platform of converged service
delivery at the village level.
4. Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
5. Jan Andolan:
All the Ministries involved in the POSHAN
Abhiyaan need to be complemented for
giving a huge push and visibility to the
Abhiyaan through Poshan Maah (September
2018) and Poshan Pakhwara ( March 2019)
where mobilization through community
based events, door to door campaign and
other related activities were organized with
much greater degree of enthusiasm and
effectiveness. However, it is imperative that
this momentum has to be sustained and
strengthened further to induce behaviour
change at a massive scale. International
evidence has shown that nutrition campaigns
have never been successful without the
campaign being owned and led by the
community. To take the community
ownership and involvement in the Mission to
the next higher level the coming POSHAN
Maah will focus upon the engagement with
elected representatives at all levels – from
the Parliament to Panchayats. Carefully
designed material with appropriate
messaging, content and media has been
created to facilitate this engagement. We
also need to leverage the SHGs and ensure
that they can play a critical catalyzing role in
enrolling the households to desired
behavioural changes. Since lack of
complementary feeding to children in the
age group of 6-23 months has been major
factor in the rampant prevalence of
malnutrition, the upcoming Poshan Maah
(September 2019) will focus on this theme.
A sizeable workforce can be added in this
campaign if we can successfully enroll the
Panchayat representatives and the SHG
members to our cause. A lot of preparatory
work has been done but we need to sort out
some minor budgetary issues to roll this out
effectively.
6. Recommended priorities for the year
2019-20
A successful campaign must prioritize the
high impact interventions taking into
consideration the capacities of our delivery
system. Based on a careful consideration of
the likely impact on outcomes of interest in
the POSHAN Abhiyaan, the capacities of
FLWs to deliver and our experiences from
the Aspirational Districts, we would
recommend that we should concentrate on
the following action items as our key focus
areas for the FY 2019-20
Eliminate Diarrhoeal Deaths by focussing on
prevention, rota virus vaccination, initiating
timely treatment by giving ORS and Zinc
and finally referral to a nearby health facility
in case of complications.
A huge campaign around improving
complementary feeding practices
Improve the quality of home visits through
better implementation of the intensified and
augmented Home-Based Newborn Care
(HBNC) programme
A very strong movement around ‘Anaemia
Mukt Bharat’ Campaign.
14 Taking the agenda of food fortification
ahead.
And lastly, fixing the delivery and supply
logistics of the Take Home Rations (THR) to
pregnant and lactating mothers and children.
A recent study in 27 Aspirational Districts
across 8 States showed that there are
significant gaps in uptake and availability of
THR to the eligible beneficiaries. We need to
plug the gaps in the system to ensure that our
Supplementary Nutrition Program is
delivered more efficiently than what is in
vogue today.
In addition, we would also recommend that
the gap in the guidelines for the
management, treatment and follow up of
Severely Acute Malnutrition (SAM) without
medical complications OR Moderately
Acute Malnourished (MAM) in the
community should be plugged immediately.
Other than the provision of double ration for
SAM children in the Supplementary
Nutrition Program, there is no other
mechanism to follow up with them in the
community. There are also no clear
guidelines for community level frontline
heath workers on this issue.
Conclusion
The present Report Implementation Score is a
useful tool for systematic measurement of
performance across States and UTs as far as their
readiness to implement the Abhiyaan. It serves as
an important aid in understanding the
heterogeneity and complexity of the Nation’s
performance in nutritional indicators. Owing to
the multiplicity of determinants that impact
nutritional outcomes, BOTH WCD AND Health
departments of States and UTs are contacted.
The erudition that have emerged during the
process of development of the implementation
score, will guide the States and UTs in directing
their resources to improve the parameters where
they are lagging behind. It further acts as an
enabling mechanism to locate loop holes in the
system and States/UTs can progress in a more
procedural way to accomplish the target to
combat malnutrition.
15 CHAPTER 1:
INTRODUCTION 1. INTRODUCTION
POSHAN Abhiyaan (National Nutrition
Mission) is India’s flagship programme to
improve nutritional outcomes for children,
pregnant women and lactating mothers. The
programme aims to ensure service-delivery and
interventions by use of technology, behavioural
change through convergence and lays down
specific targets to be achieved across different
monitoring parameters over the next few years.
India embarked on an ambitious effort in 2018 –
the Prime Minister’s Overarching Scheme for
Holistic Nourishment called POSHAN
Abhiyaan -- to address multiple forms of
malnutrition. Recognizing that malnutrition
levels in India are high and have been slow to
change over the last decade, this national
nutrition mission attempts to address 5 key
essential elements recognized to be critical in the
fight against malnutrition –delivery of high
impact interventions with adequate coverage,
continuity, intensity and quality (C2IQ),
including behaviour change communication at
scale, multi-sectoral convergence to address the
underlying drivers of malnutrition, adequate
financing and monitoring to track the progress
and learn, and committed leadership and an
enabling environment. Impact on nutrition
outcomes, such as stunting, wasting, anemia and
low birth weight, can take some years but
changes in these critical elements that can
accelerate the progress on the path to good
nutrition can be achieved in shorter timeframes.
The prominent features of POSHAN Abhiyaan
are:
1. A high impact package of interventions with
a focus on (but not limited to) the first 1000
days of a child’s life.
2. Strengthening delivery of this high impact
package of interventions through
o Remodelling of nutrition monitoring
though the introduction of ICDS-CAS
which leverages technology for
management as well as monitoring.
o Improving capacities of frontline
workers through the Incremental
Learning Approach (ILA) mechanism.
o Emphasizing convergent actions among
the frontline workforce, including
through performance linked joint
incentives for the 3As (ASHA,
Anganwadi & ANM).
3. A focus on cross-sectoral convergence to
emphasize the multidimensional nature of
malnutrition, mapping of various Schemes
contributing towards addressing
malnutrition.
o Convergence committees at the state,
district and block levels will support
decentralized and convergent planning
and implementation, supported by
flexi-pool and innovation funds to
encourage contextualized solutions.
4. Ramping up behaviour change
communication and community
mobilization through through Jan Andolan, a
large-scale national nutrition behaviour
change campaign that uses
community-based events, mass media and
other approaches.
The Abhiyaan focuses on strengthening policy
implementation (at Central and State level) to
improve targeting (identification of high burden
Districts), enhance multi-sectoral convergence,
develop innovative service delivery models and
rejuvenate counselling and community-based
monitoring. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia
among children (and young females) by 3
percentage points per annum (Figure 1).
17 18
•Target: ↓by 6%
@ 2% per annum.
Preven t and reduce
Stunting in children (0-6
years)
•Target: ↓by 6%
@ 2% pe r annum .
Preven t and reduce under-
nutrit ion in children (0-6
years)
•Target: ↓by 9%
@ 3% per annum.
Reduce the preva lence of
Anaemia amon g Children
(6-59 months)
•Target: ↓by 9%
@ 3% per annum.
Reduce the preva lence of
Anaemia among Women
and Adolescent Girls in the
age group of 15-49 years
•Target: ↓by 6%
@ 2% per annum.
Reduce Low Birth Weight
(LBW)
Figure 1: Targets of the POSHAN Abhiyaan
POSHAN Abhiyaan is an umbrella scheme which
covers a host of program and services that target
beneficiaries across 1000 day cycle with nutrition
interventions. These include a take-home ration
from Anganwadi centers; anaemia prevention and
control under the Anaemia Mukt Bharat program;
antenatal care services; dietary counselling through
Village Health Sanitation and Nutrition Day
(VHSND); and schemes such as Pradhan Mantri
Surakshit Matrutva Abhiyaan that provide quality
antenatal check-ups. Institutional Deliveries are
promoted through conditional cash transfer schemes
like Pradhan Mantri Matrtya Vandana Yojna
(PMMVY) and Janani Suraksha Yojna (JSY) and
free services for delivery and early neonatal care
(Janani Shishu Suraksha Karyakram) and provide
an important opportunity to support mothers in
establishing good breastfeeding practices.
POSHAN Abhiyaan explicitly recognizes the
need for convergence and coordination such that
the benefits of multiple Government schemes
and programs reach women and children in the
first 1000 days. It aims to improve synergy
through robust convergence mechanisms. The
programme also aims to ensure service-delivery
of key interventions supported by the use of
technology, and behavioural change. It lays
down specific targets to be achieved across
different parameters over the next few years.
Through these targets, the programme is striving
to reduce the levels of stunting, underweight,
anaemia and low birth weight prevalence in
babies. It also creates synergy among the
Ministries and Departments, ensures better
monitoring, issues alerts for timely action, and
encourages States/UTs to perform, guide and
supervise the line Ministries and States/UTs to
achieve the targeted goals.
Under POSHAN Abhiyaan there is an ambition
to ensure that every child and woman has access
to quality services to address the malnutrition
across the continuum of care. To achieve this, it
is important to strengthen the pillars of the
Abhiyaan in a targeted manner (Figure 2).
ICDS_CAS
Convergenc e
Behavioral
change, IEC
Advocacy
Training
and
capacity
building
Innovations
Incentives
Grievance
Redressal
Figure 2: Pillars of POSHAN Abhiyaan Policy initiatives in Nutrition and
Allied Sectors
The launch of POSHAN Abhiyaan has been a
watershed in the series of enhanced allocations,
policy measures and advisories issued by the
Government of India towards the goal of
eradicating malnutrition in the country (Figure 4).
The Abhiyaan has not only given momentum to
existing programs, reoriented policy choices and
aligned several sectors towards the common goal
of eradication malnutrition from the country, it
has also been instrumental in instigating a range
of policy actions under its ambit within a short
span of time (Figure 4).
19
Figure 3: Key Government Initiatives in Nutrition and Allied sectors
Figure 4: Important Policy Actions under the ambit of POSHAN Abhiyaan 20
The above mentioned initiatives and policies of
the Government are essential but the issue is of
the coverage, continuity, intensity and quality of
the services provided under the ambit of
mentioned programs.
Pradhan Mantri Matru Vandana Yojana
(PMMVY)
It is a Scheme which aims to improve
health-seeking behaviour and nutrition among
first-time pregnant women and lactating mothers
(PW&LM) to reduce the effects of
under-nutrition, the leanings from
implementation is mentioned in details in this
section of the Report.
It is a conditional maternity benefit scheme
which provides Rs. 5,000 to pregnant women
and lactating mothers in three instalments of Rs.
1,000, Rs. 2,000 and Rs. 2,000 respectively. The
conditions for the payment of instalments are
early registration of pregnancy, Antenatal
Check-ups (ANC) and first cycle of
immunization to the new born baby.
Additionally, the women get her entitlement of
around Rs. 1,000 under Janani Suraksha Yojana
(JSY) after Institutional Delivery.
As per the mandate, NITI Aayog does quarterly
concurrent monitoring of the scheme, for this the
field studies are conducted by NITI team and
Development Partners with an objective to
understand Governance issues and get field level
feedback.
I. Status of Implementation
The Scheme is being implemented with
effect from 1st January, 2017; however it has
started implementing on ground since
October, 2017. Till 31st March, 2019, in total
around 82.2 lakh Beneficiaries have been
registered out of which around 83.5% of the
eligible beneficiary have received 1st
instalment with cumulative payment of Rs.
2,611 Crores. The average time taken in
payment of 1st instalment from the date of
registration is around 45 days, but when
calculated with respect to the Last Menstrual
Period (LMP) the average time taken is 234
days. Only 22% of the 1st instalments have
been paid within 150 days with respect to the
date of LMP. Analysing the method of
payments, 66% of the total DBT transfers
were made through Aadhaar based payments
out of which 72% matched with the Bank
Accounts provided by the Beneficiaries. The
Scheme has been successful in registering
around 19,000 beneficiaries per day in the
quarter ending March, 2019. The trend in
registration vis-à-vis payments of
instalments and per day registration of new
beneficiaries in the scheme can be seen in the
below graphs:
In order to simplify the instalment payments
and prevent delays, the Ministry has taken
few corrective measures like- the beneficiary
now can now submit the second claim
application before 180 days of LMPs which
will be automatically processed on
compilation of 180 days of LMP. Also,
Ministry had advised States/UTs to utilise
the flexi funds for incentivising field
personnel, data entry facilitator and for other
innovative uses. 21
3685 303006
2151540
3584261
5166284
6511733
8225780
0
10,00,000
20,00,000
30,00,000
40,00,000
50,00,000
60,00,000
70,00,000
80,00,000
90,00,000
31st Oct 201731st Dec 201731st Mar 201830th June 201830th Sept 201831st Dec 201831st Mar 2019
seiraicifeneB fo .oN
Figure 5: Trend in No. of Beneficiary Registration v/s Payments of
Instalments-PMMVY
1st Instalment
2nd Instalment
3rd Instalment
41
3,326
20,539
15,919
17,578
14,949
19,045
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
22,000
-
2,00,000
4,00,000
6,00,000
8,00,000
10,00,000
12,00,000
14,00,000
16,00,000
18,00,000
20,00,000
31st Oct 201731st Dec 201731st Mar 201830th June 201830th Sept 201831st Dec 201831st Mar 2019
Per day Registrations
snoitartsigeR ylretrauQ
Figure 6: Trend of Beneficiary Registration (All India Progress)-PMMVY
Quarterly ProgressPer day registerations
II. Preliminary Findings
The survey conducted by Development
Partners and field studies conducted during
January 2019 by NITI team has shown in the
following Figures 7 and 8: 22
7
7.2
7.4
7.6
7.8
8
8.2
8.4
8.6
8.8
9
Enrolled but didn't received
money
Money received and used
for food
Figure 8: Average Minimum Dietary
Diversity Score (PPMVY)
29%
17%
42%
12%
Figure 7: Reported Utilization of Money
(PPMVY)
Added to Savings
Additional money
for food
Additional money
for Medicine and
Healthcare
Personal Use
III. Remaining Challenges
The scheme has made impressive progress in
a short duration after its launch and has been
successful in reducing the delays in
payments and enrolment of beneficiaries
compared to its predecessor IGMSY, which
was implemented in selected districts. This
has been only possible because of the use of
DBT mode of payments, constant
monitoring and timely resolution of the
identified bottlenecks in implementation of
the scheme. However, there are still few
challenges that need to be resolved to take
the performance of the scheme to next level.
These challenges are as follows:
• A substantial number of payments (28%
cases of all Aadhaar based payments, i.e. in
case of 31.29 lakh payments) are going to
different Bank Accounts than what had been
provided by the Beneficiaries. Sometimes
these are even untraceable by beneficiaries
and field functionaries. A telephonic survey
of 5,525 beneficiaries was conducted by
MoWCD which has revealed that only 60%
were aware of both the receipt of the benefits
and the bank account to which the money
was reemitted. It is a prime cause of
dissatisfaction amongst beneficiaries which
needs to be addressed on urgent basis.
• There is need for simplification in
documentation and operational rules. For
example, the rule for completion of 180 days
before processing 2nd instalment and
mandatory requirement of Birth Certificate
for 3rd instalment needs to be rationalized
which are unnecessarily causing delays in
payments.
• Incomplete MCP cards are another reason
for delay in payments. ANMs needs to be
trained and directed to properly fill MCP
cards. Also, efforts needs to made to auto
populate Heath Data (Pregnancy detection,
ANC and Immunization) by linking
PMMVY-CAS with Health Portal (RCH).
• Data Entry Operators (DEOs) at Block level
is essential for timely entry of applications,
processing of payments and timely resolving
Correction Queues.
• For effective monitoring, there should be a
dashboard at Block and District level
providing information on critical indicators
like beneficiaries registered against
estimation, delay in payments w.r.t. LMP,
status of beneficiaries eligible but not paid
2nd/3rd instalment etc. in a single window to
encourage course correction.
• In order to minimize/eliminate exclusion,
effective convergence (on sharing
information on 1st pregnancy and
counselling) is required among the AAAs so
that all eligible beneficiaries could get
enrolled in this scheme. CHAPTER 2:
METHODOLOGY 24
This is the Second Report on the status of
implementation of the POSHAN Abhiyaan. The
focus of this Report is on assessing those aspects
of POSHAN Abhiyaan which are crucial for
effectively implementing the Abhiyaan. Various
mechanisms and interventions utilised by the
States/UTs to accelerate the implementation of
the Abhiyaan are also analysed.
2.1 DATA COLLECTION:
Efforts were made to consolidate the
multiple activities which are going on in
different parts of the country under
POSHAN Abhiyaan, by different set of
stakeholders. For this purpose, a
multi-pronged strategy for data collection
was adopted where NITI Aayog reached out
to several Cenral Government Ministries,
States & UTs and development partners to
collect information.
Ministries at the Central Level:
Information was sought from the key
Ministries (Ministry of Women and Child
Development (MWCD), Ministry of Health
and Family Welfare (MoHFW), Ministry of
Rural Development (MoRD), Ministry of
Human Resource Development (MHRD)
and Ministry of Panchayati Raj Institutions
(MoPRI) at the Central level on their various
initiatives launched within the ambit of
POSHAN Abhiyaan focusing on first the
100 day interventions, from conception till 2
year of child’ life.
States & UTs: As mentioned above, for data
from the States & UTs, a detailed format
(Annexure 1a and b) was shared with their
Women and Child Development and Health
Departments to collect information. Details
about indicators used in the templates is
provided in the subsequent section of this
chapter.
Development Partners: Development
partners with direct presence in the field
were encouraged to collect new initiatives,
stories of change, models which can be
scaled-up and replicated and information
about individuals who are doing exceptional
and inspirational work at the ground level to
change the status of nutrition in the country.
Accordingly, these stories have been
compiled and featured in this report.
While the first progress Report focused solely on
preparedness related indicators of POSHAN
Abhiyaan which were about modulation of
systems in place so that work of Abhiyaan can get
geared up, the second Report focuses on
implementation of parameters covering both
WCD schemes Health interventions at State and
UT level and therefore, inputs/Data has been
considered from both State WCD and Health
Departments. A detailed framework of the
indicators was formulated to analyse the data and
information.
IMPLEMENTAION SCORE:
Broadly, Implementation Score measures the
level of implementation of POSHAN Abhiyaan
by the States and UTs. Since in many States and
UTs the POSHAN Abhiyaan is effectively
launched lately, briefly, the preparedness or
readiness of the Sates/UTs for implementing the
Abhiyaan is also captured.
The information received from the WCD and
Health Departments of States/UTs was organized
into the following categories which were
considered to be crucial for generating the
implementation score (Table 1)
25
Table 1: Implementation score themes for WCD and Health Department
Implementation score themes
WCD Department Health Department
Mechanism
Strategy and Planning
Service Delivery & Capacities
Program activities and
intervention coverage
Governance & Institutional • Fund Allocation
• Constitution of Committees &
Resource Groups
• Cross-sectional convergence
• HR
• Supplies [Mobile phones and
growth Monitoring Devices]
Training & capacity building
• Program activities- ICDS
• Infrastructure
• HR
• Supplies(Stock out)
Training & capacity building
• Program activities
Each of these categories comprised a set of
sub-themes, shown separately for WCD and
Health Department (Table 1), which in turn had
several indicators based on the information
received (Annexure 1a and b). It must be noted
that these indicators are proxy indicators
reflecting at best intentions of the State and UTs
with respect to each of these categories.
CATEGORIZATION:
For the purposes of inter-State comparison of
only similar size/kind of States, this report
categorizes the States and UTs into large States,
small States and UTs (Table 2)
2.2 METHODOLOGY
COMPUTATION OF SCORES:
Implementation Score was created with a
maximum score of 100. Maximum possible score
allotted for WCD Departments was 65, whereas
for Health it was 35. The sub-set questions were
selected to ensure continuity with the prior report
and were based on the previous questionnaire as
well as administrative guidance from the Centre.
These elements were common across all the
States and UTs (Figure 9).
Table 2: Categorization of States
Category* Number of States List of States
Large States 21
Small States 8
UTs 7
Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana,
Himachal Pradesh, Jammu & Kashmir, Jharkhand, Karnataka, Kerala,
Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu,
Telangana, Uttar Pradesh, Uttarakhand, West Bengal
Arunachal Pradesh, Goa, Manipur, Meghalaya, Mizoram, Nagaland,
Sikkim, Tripura
Andaman & Nicobar, Chandigarh, Dadra & Nagar Haveli, Daman & Diu,
Delhi, Lakshadweep, Puducherry
* This categorization is similar to the one used for State Health Index Report 26
Figure: 9 Critical components for the evaluation implementation of the POSHAN Abhiyaan
Governance & Institutional
Mechanism
•Weight=19
Strategy and Planning
•Weight=6
Service Delivery & Capacities
•Weight=31
Training and capacity building
•Weight=21
Service Delivery &
Capacities
•Weight=17
Program activities and
intervention coverage
•Weight=18
WCD
TOTAL WEIGHT=65
HEALTH
TOTAL WEIGHT=35
For details on the process of generating the implementation score, please refer to Box 1.
Box 1: Steps to Generate Implementation Score
STEP 1. Developing assessment tool for States/UTs: NITI Aayog prepared two implementation
assessment questionnaires (one for Health and one for WCD) that examined issues related to financing, multi
stakeholder efforts, systems capacity and program implementation. These were finalized with inputs from
several technical stakeholders (Annexure 1a and b).
STEP 2. Data collection at the State/UT level: The implementation assessment questionnaires were sent to
officials in States in the departments of Women and Child Development and Health in April 2019. Officials
in charge in the State gathered all the necessary information to complete the questionnaires and sent them
back to NITI Aayog between April and May 2019.
STEP 3. Data Cleaning: Once the first round of data was received from the States, it was reviewed and
manually cleaned to highlight inconsistencies in responses. These marked State templates were shared back
with the States for revisions and clarifications [May 2019]
STEP 4. Data entry: The second round of data from the States were entered twice using the Survey CTO
interface by 3 independent researchers. Double data entry was applied to ensure there were no data entry
errors. All the discrepancies between the two rounds of data were corrected.
STEP 5. Data processing & analysis: Stata version 15 was used to conduct all logical checks and data
analyses. Using the clean data, weights were assigned to variables chosen to construct the implementation
score rubric and then summary scores were created for each State based on the implementation score rubric.
STEP 6 Data validation by States: Each State was then sent their initial scores and the weights of the
elements used for that score. Comments were added and the States were requested to reconfirm data if there
were any inconsistencies arising from logic checks. Video conferences were held with 18 large States on
6th-7th June 2019 and telephonic follow-up were done with the remaining small States and UTs. All the
States were given an opportunity to provide any updates on their responses to the implementation assessment
questionnaire. [Limitation: Only the data that were used to compute the rubric were validated by the States
for accuracy. Validated data was received from all States except: WCD Department: Assam, Delhi and
Kerala; Health Department: Andhra Pradesh, Arunanchal Pradesh, Bihar, Gujarat, Jharkhand and
Meghalaya]
STEP 7 Data updation & final score calculation: States updated information as necessary in mid-June
2019. These data were then updated in the final dataset and the final scores were generated. 27
Process Validation
Technical Partner of the TSU established at NITI
Aayog, International Food Policy Research
Institute (IFPRI) was engaged to audit the entire
process beginning from the data entry stage to
the computation of the Implementation Scores.
Limitation
While all attempts were made to reach out to
States and UTs and gather updated information,
two States, namely, Odisha and West Bengal,
have not been incorporated into this report due
to unavailability of data from these States. For
Lakshadweep, WCD Department had shared the
required information, but Health Department has
not provided the Data.
POSHAN Abhiyaan has been rolled out in
phased manner in the Country, likewise the
implementation has also moved in a phased
manner. The availability of funds, supplies,
ICDS-CAS roll out and other related indicators
are dependent on the roll-out of the Abhiyaan in
the State/UT. For the preparation of the present
Report, all the States and UTs with their Districts
are not distinguished as per the Phases in which
the POSHAN Abhiyaan was rolled out.
For collating the data especially from the Health
Department of all States and UTs, it was
observed that for the indicators where
information is not available in the HMIS,
States/UTs found it difficult to compile and
share any information. With respect to the
responses/data shared by the States/UTs the
health part of the rubric was given lesser
weightage (35) as compared to the WCD
part(65).
Standardizing denominator: To compute a few
indicators of coverage, total number of 12-23
months old children was required. However,
States provided information for a varied range of
age categories e.g., 9 to 23 months, 6 to 23
months etc. Therefore, to construct the coverage
indicator, the denominator was standardized to
reflect the total number of children to be 12-23
months old. For example, if States provided
information on total number of children for 9 to
59 months, then to standardize the total number
of children to be in 12-23 months old group, that
total number of children was divided by the
difference between 9 and 59 months i.e., 51
months. The resulting number was multiplied
with the number of months between 12-23 i.e.,
12 months. This calculation assumes that equal
number of children were born in each month.
Changing proportions that are greater than
100 percent to 100 percent: When computing
indicators for coverage of interventions, where
there were instances of greater than 100 percent
coverage, the proportions were considered to be
100 percent. As the data from the States were
from the health monitoring information system
(HMIS) where the denominators are projection-
based and not of the actual population, it is
possible that the projected population is
sometimes lower than the actual population
receiving the services.
Brief Outline on the first POSHAN Abhiyaan
Progress Report- (April - October, 2018)
POSHAN Abhiyaan’s first progress report,
submitted in December 2018, mainly
highlighted its implementation status, from the
time it was launched in March 2018. The report
evaluated the Preparedness of the States and UTs
for POSHAN Abhiyaan.
Data was collated from the WCD departments of
the all the States and UTs (except West Bengal
and Odisha). Further, Preparedness Score for
each State and UT was calculated considering
the information and data shared. The entire data
set was organized into three categories:
• Governance and Institutional Mechanism
• Strategy and Planning
• Service Delivery Essentials
Taking into consideration the data for these
categories, each State and UT was ranked on the
Preparedness Score. For ease in comparison, the
findings were presented separately for large
States, small States and UTs. 28
Major findings of this report were that
Chhattisgarh scored highest on the preparedness
levels, while Assam was the least prepared to
enter the implementation phase. Among the
small States, Meghalaya scored the highest
whereas Sikkim was at bottom of the
preparedness level. As far as the UTs are
concerned, Chandigarh was best prepared to
implement the Abhiyaan, while Lakshadweep
scored the lowest in terms of readiness.
Vital information was also provided by various
line ministries at the central level on their
initiatives launched within the ambit of
POSHAN Abhiyaan to reduce malnutrition.
It was the first attempt at establishing a tool for
measurement of preparedness across States and
UTs on a variety of parameters within the three
domains. Owing to the multiplicity of
determinants that impact nutritional outcomes,
some of these actions were outside the ambit of
the WCD department.
The erudition that emerged during the process of
developing the preparedness score, guided the
States in identifying the gap areas and directing
their resources to improve the parameters where
they were lagging. It acted as an enabling
mechanism to locate loopholes in the system to
combat malnutrition. This detailed analysis
presented in the first progress report of
POSHAN Abhiyaan facilitated the States and
UTs to get an overarching view and examine the
factors leading onto the effective
implementation of the Abhiyaan.
In the present Report, India’s progress on the
POSHAN Abhiyaan, focusing on efforts that
commenced with the launch of the Nourishing
India strategy in Sept 2017 is described. This
Report highlights mainly on assessing the State
of Governance and Institutional Mechanisms to
support full-scale implementation of POSHAN
Abhiyaan, convergence and delivery of high
impact interventions, monitoring and learning,
and the rollout of Jan Andolan, India’s flagship
behaviour change and community mobilization
effort for malnutrition. It also looks at some of
the challenges faced by the States and union
territories (UTs) in the implementation of key
health and nutrition interventions, and
innovations developed by the States/UTs, and
discusses the way forward for POSHAN
Abhiyaan.
Focus of the Report is mainly on assessing the
State of leadership and an enabling environment,
convergence and delivery of high impact
interventions, monitoring and learning, the
rollout of the Jan Andolan, India’s flagship
behaviour change and community mobilization
effort for malnutrition. CHAPTER 3:
NUTRITION INTERVENTION COVERAGE
AND OVERALL IMPLEMENTATION
SCORES OF STATES AND UNION
TERRITORIES FOR
POSHAN ABHIYAAN 30
For assessing the progress of the POSHAN
Abhiyaan, the most recent data on the prevalence,
coverage and continuity of a set of key nutrition
and health interventions for India’s States is
available from the Comprehensive National
Nutrition Survey (CNNS, 2016-18). It collects
the data from more than 1,12,000 children in the
age group of birth to 19 years of age across India.
The data also provides a benchmark to the status
of nutritional indicators and can help States in
setting targets for intervention coverage to
achieve under POSHAN Abhiyaan.
CNNS data surely reflects some progress in
bringing down under nutrition levels (Figure A).
Although this data acts as the baseline for the
POSHAN Abhiyaan but it can be intended that
the targets of POSHAN Abhiyaan will be well
achieved with the reduction of stunting and
anaemia in the coming years to come. CNNS also
captures the prevalence of various micronutrient
deficiencies for the children and adolescents in
the age group of 10-18 years. Key findings are
mentioned below:
• Vitamin A deficiency was 16-22% with
geographical variations.
• Vitamin B12 deficiency ranged from 14%
to 31% and it was found to be highest among
adolescents.
• Vitamin D deficiency varied from 14% to
24%.
• Adequate Median Urinary Iodine level in all
states indicating the success of Salt
Iodization program
CNNS provided the vital information on the
coverage and continuity of a set of key nutrition
and health interventions and policy initiatives for
India’s States and Union Territories.
Figure 10 below shows that the highest level of
coverage for key nutrition interventions is barely
70% (for receiving any IFA), and that for most
interventions, coverage is just about 50%. This
provides a clear set of coverage targets at the
national level for these high impact interventions.
18
0
10
20
30
40
50
60
70
80
90
100
Interventions
Received IFA
Consumed 100+ IFA
Deworming
Weighing
Breastfeeding counseling
Food supplementation
Health & nutrition education
Food supplementation
Health & nutrition education
Food supplementation (at least once a week)
Weighing (at least once in 3 months)
Counselling on child growth (among those
who weighed)
Figure 10 : Coverage of a selected set of nutrition interventions in India, CNNS (2016-18) 31
Keeping the CNNS findings in the backdrop data
collated from all States and UTs for the present
report is analysed and, it is observed that the
coverage levels for interventions along the
continuum of care vary tremendously by State
and by intervention within and across States
(Table3; Annexure 3). For example, for a majority
of interventions during pregnancy including
antenatal care (ANC) during the first trimester,
receiving MCP card, IFA supplementation,
weight monitoring, and food supplementation,
the coverage levels are between medium to high
(50 percent to 75 percent). Coverage is lower than
50 percent for 4 or more ANC, consumption of
IFA supplements, breastfeeding counselling, and
health and nutrition education. It is noticeable that
the coverage is higher than 75 percent for any
ANC and TT injection. The variable coverage is
not platform-dependent i.e., the ICDS or the
health platforms. In several large and small
States, coverage for ANC during the first
trimester, 4 or more ANC, IFA supplementation,
and weight monitoring was found to be higher
than the national average.
The rates of institutional delivery and presence of
skilled-birth attendant at birth are high nationally
(83 percent) and across several States. Coverage
of institutional delivery is lower than 75 percent
in a few States but the presence of skilled-birth
attendant at birth is high in such instances except
in Arunachal Pradesh, Jharkhand, and Manipur.
Institutional delivery is particularly low in
Nagaland and Meghalaya. At the national level,
coverage of postnatal care for babies is only 62
percent but it is 90 percent or higher in several
States including Goa, Jammu & Kashmir, Kerala,
Maharashtra, Punjab, Tamil Nadu, and
Telangana.
Nationally, coverage levels for food
supplementation (49 percent) and exposure to
health and nutrition education (33 percent) during
lactation period are low. However, the coverage
is highly variable for these interventions across
States (Figure 10). While coverage of food
supplementation is higher than 75 percent in
some States including in Andhra Pradesh,
Chhattisgarh, Goa, Himachal Pradesh, Odisha,
Telangana, and Uttarakhand, it is lower than 25
percent (ranging from 9 percent to 24 percent) in
some other States including in Arunachal
Pradesh, Delhi, Jammu & Kashmir, Nagaland and
Uttar Pradesh. In case of health and nutrition
education intervention, coverage levels are much
lower in several States compared to the national
average.
Food supplementation during early childhood is
low at 42 percent and is marked by high
inter-State variability. The reach of food
supplements is highest in West Bengal at 91
percent but there are only few States where reach
is higher than 75 percent. Coverage was lower
than 25 percent in ten States (Figure 10).
At the national level, weighing of children at least
once in 3 months was only 60 percent and only 48
percent of mothers of children who were weighed
received counselling. There is high variability in
coverage for these two interventions across the
States. In some States greater than 75 percent of
children were weighed. However, in a majority of
the States, 50 percent or lower proportion of
mothers were counselled on growth after
weighing.
The coverage data indicate huge gaps in the
coverage and continuity across the continuum of
care. Achieving full coverage of interventions for
every woman and every child remains a
significant challenge with significant coverage
gaps for most interventions. It is of concern that
coverage is low for several interventions across
the States although implementation is through the
same national platforms.
3. Overall Implementation Score Computed for
the Second POSHAN Abhiyaan Report
To assess the implementation level of
POSHAN Abhiyaan in all the States and
Union Territories (UTs), data were gathered
using questionnaires from the State/UT
Women and Child Development (WCD) and
Health Departments on four key themes
including: 32
1. Governance and Institutional Mechanism
2. Strategy and Planning
3. Service Delivery and Capacities
4. Programme Activities and Intervention
Coverage.
The process of data collection, compilation and
computation of scores has been explained earlier
in Chapter two. In this Chapter the scores of
States and UTs for the implementation of
POSHAN Abhiyaan, or their readiness for it, have
been discussed.
An overall composite score was created
combining all the four themes to examine
preparedness and implementation capabilities of
States and UTs. In terms of overall
implementation in States and Union Territories
(Figure 11), among the 19 large States, Andhra
Pradesh, Chhattisgarh and Madhya Pradesh
scored the topmost three ranks followed by
Uttarakhand, Himachal Pradesh, Gujarat, Tamil
Nadu and Maharashtra. Ten out of total 19 large
States had an implementation score of over 70
percent. Karnataka, Assam and Kerala were at the
bottom of the list, with an implementation lower
than 55%.
Among the eight small States, Mizoram and
Sikkim scored above 75 percent and were in the
topmost position. Arunachal Pradesh, Tripura,
Manipur and Goa were at the bottom of the list,
with scores below 60%. However, all the small
States had a score above 55%, displaying a fairly
good level of readiness and implementation.
Four out of seven UTs had an implementation
score of over 70 percent. Dadra and Nagar Haveli,
Chandigarh, and Daman and Diu scored above 75
percent and were ranked among the top three
UTs. Delhi, and Lakshadweep were at the bottom
of the list, with implementation scores below 50
percent.
0
10
20
30
40
50
60
70
80
90
100
Figure 11: Overall Implementaion Status of POSHAN Abhiyaan-
National Picture
WCDHealth
ANDHRA PRADESH
CHATTISGARH
MADHYA PRADESH
UTTARANCHAL
HIMACHAL PRADESH
GUJARAT
TAMIL NADU
MAHARASTRA
JHARKHAND
RAJASTHAN
BIHAR
UTTAR PRADESH
PUNJAB
HARYANA
TELANGANA
JAMMU & KASHMIR
KARNATAKA
ASSAM
KERALA
MIZORAM
SIKKIM
NAGALAND
MEGHALAYA
ARUNACHAL PRADESH
TRIPURA
MANIPUR
GOA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
ANDAMAN & NICOBAR…
DELHI
LAKSHADWEEP 33
3.1 Governance and Institutional Mechanism
This theme captures the preparedness of
States/UTs in terms of having the necessary
Governance and Institutional structures in
place, as envisaged under POSHAN
Abhiyaan. One of the essential components
of the Abhiyaan is fund utilization which acts
as an interface to initiate effective
implementation. All the large States have
received funds from the Centre. Except
Assam and Jammu & Kashmir, all large
States, have earmarked funds to implement
POSHAN Abhiyaan. Maharashtra has
utilized maximum funds with close to 54.5
%. This is followed very closely by
Karnataka and Bihar, with utilization rates of
40% and 35%, respectively. Similarly for
small States all of them have received funds
from Centre. Except Sikkim, Tripura and
Manipur all other Small States have
earmarked funds to implement POSHAN
Abhiyaan. With respect to utilization of
funds, Arunachal Pradesh, Meghalaya and
Mizoram, have utilized maximum funds
with more than 60%. This is followed very
closely by Nagaland with utilization rate of
58%.
The Abhiyaan is fully funded in Union
Territories without legislature (Andaman &
Nicobar Islands, Chandigarh and Dadra &
Nagar Haveli), implying that they do not
need to earmark funds especially for this
purpose. Therefore, for this particular
parameter, they have given full scores. UTs
with legislature (two out of seven-
Puducherry and Delhi) have a cost sharing
ratio of 60:40. For these UTs, earmarking of
funds for the implementation of the
Abhiyaan has been given a score on the basis
of their affirmative response to the same.
Findings suggest that all the UTs have
received funds from the Centre. In terms of
utilization of funds, Dadra & Nagar Haveli
have utilized maximum funds with more
than 60% utilization rate. This is followed
very closely Chandigarh and Daman & Diu.
0
2
4
6
8
10
12
14
16
18
20
Figure 12:
Governance & Institutional Mechanism: Large States
Max Score: 19
* Data collated only from WCD Departments of States and UTs Max Score: 19
34
Another crucial institutional mechanism is
convergent approach to ensure different
inter-related schemes move from a siloed
approach to a unified and convergent action
to target malnutrition. For this, Convergence
Committees are envisaged at the State,
District and block levels to develop and
follow Convergent Action Plans (CAPs).
Further under POSHAN Abhiyaan,
Resource Groups are formed for Incremental
Learning Approach (ILA) trainings at
different levels to enhance the capacity of
frontline workers. Finally, the Abhiyaan
proposes a single unified technical set-up,
i.e, Nutrition Resource Centre at National
and State level to enhance and strengthen the
quality of implementation and monitor and
review the programme. These structures and
processes are expected to provide overall
direction, policy and guidance for timely,
effective and smooth implementation of the
Abhiyaan. Under the theme of Governance
and Institutional mechanisms, overall,
among the large States, Himachal Pradesh,
Madhya Pradesh and Rajasthan are best
prepared for implementation. These States
are closely followed by Andhra Pradesh,
Gujarat and Maharashtra (Figure 9). The
States which were least prepared in
Governance and Institutional mechanism
included Kerala, Karnataka, Assam and
Jammu & Kashmir, which scored five and
below on a scale of 0 to 19.
Among the small States, Mizoram is the
best prepared State in the area of Governance
and Institutional mechanism closely
followed by Nagaland and Arunachal
Pradesh (Figure 13). Meghalaya and Goa are
the least prepared States for the mentioned
theme.
*Data collated only from WCD Departments of States and UTs
0
2
4
6
8
10
12
14
16
18
20
MIZORAMARUNACHAL
PRADESH
NAGALANDSIKKIM MANIPUR TRIPURA GOA MEGHALAYA
Figure 13:
Governance & Institutional Mechanism: Small States
Max Score: 19 35
Among the UTs, Dadra & Nagar Haveli
followed by Lakshadweep are the best
prepared UTs on Governance and
Institutional mechanism (Figure 14). Daman
and Diu scored the least in this area, closely
followed by Delhi.
Overall, in terms of Governance and Institutional
mechanism, except a few large States including
Kerala, Karnataka, Assam and Jammu & Kashmir
most other States and UTs scored well
demonstrating preparedness in Governance and
Institutional mechanism.
3.2 Strategy and Planning
This theme examined the elements of
cross-sectoral convergence and included two
indicators-
1. whether a convergence action plan
(CAP) has been submitted as part of the
annual PIP;
2. a proportion of Districts with
convergence action plans.
The score computed based on the information
received from the State/UT WCD
Department indicates that several States and
UTs have not yet taken the initial steps
toward cross-sectoral convergence.
On a scale of 0 to 6, only six large States
ranked high on cross-sectoral convergence.
These included Andhra Pradesh, Chhattisgarh,
Madhya Pradesh, Uttaranchal, Uttar Pradesh
and Punjab. States which scored a zero
included Tamil Nadu, Maharashtra, Rajasthan,
Bihar, Haryana, Telangana, Karnataka, Assam
and Kerala. Remaining four States scored
between 2 and 4 points.
From the eight small States, Sikkim and
Nagaland were at the top of the list for
cross-sectional convergence, closely
followed by Meghalaya. All the others were
least prepared for cross-sectional
convergence, with a nil score.
Among the seven UTs, Chandigarh, Daman
& Diu, and Andaman & Nicobar Islands
ranked highest with a total score of 6. The
remaining four UTs scored a zero on
cross-sectoral convergence theme.
3.3 Service Delivery & Capacities
The theme of Service Delivery and
Capacities was assessed using data from the
State/UT WCD and Health Departments on
human resources, supplies, and training and
capacity building and information on
infrastructure from State health departments.
Detailed indicator results of these
components are discussed in Chapter 4. In
this section the implementation scores for
Service Delivery and Capacities theme have
been analyzed.
0
2
4
6
8
10
12
14
16
18
20
DADRA &
NAGAR HAVELI
LAKSHA-
DWEEP
CHANDIGARH ANDAMAN &
NICOBAR
ISLANDS
PUDUCHERRY DELHI DAMAN & DIU
Figure : 14
Governance & Institutional Mechanism: UTs
Max Score: 19
*Data collated only from WCD Departments of States and UTs
0
2
4
6
8
10
12
14
16
18
20
DADRA &
NAGAR HAVELI
LAKSHA-
DWEEP
CHANDIGARH ANDAMAN &
NICOBAR
ISLANDS
PUDUCHERRY DELHI DAMAN & DIU
Figure : 14
Governance & Institutional Mechanism: UTs
Max Score: 19
*Data collated only from WCD Departments of States and UTs 36
The State scores on this theme, ranging
from 0 to 31, based on the information from
WCD State Departments indicate that
several States need to create strengthened
service delivery system for effective service
delivery (Figure 15).
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
ANDHRA PRADESH
TAMIL NADU
CHATTISGARH
MADHYA PRADESH
RAJASTHAN
UTTARANCHAL
JHARKHAND
BIHAR
GUJARAT
UTTAR PRADESH
MAHARASTRA
HIMACHAL PRADESH
JAMMU & KASHMIR
TELANGANA
HARYANA
PUNJAB
KERALA
KARNATAKA
ASSAM
MIZORAM
MEGHALAYA
SIKKIM
GOA
NAGALAND
MANIPUR
ARUNACHAL PRADESH
TRIPURA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
DELHI
ANDAMAN & NICOBAR ISLANDS
LAKSHADWEEP
Figure 15: Service Delivery and Capacity: WCD Department
HR (Out of 5) Supplies (Out of 5) Training and capacity building (Out of 21)
Max Score: 31
On a scale of 0 to 31, among large States, Andhra
Pradesh scored the highest (30.7) followed by
Tamil Nadu (28.2) and Chhattisgarh (24.7) on
service delivery and capacities. Assam,
Karnataka and Kerala were at the bottom of the
list with a score 10 or less. Nine States that need
to improve their service delivery and capacities
include Himachal Pradesh, Maharashtra, Punjab,
Haryana, Telangana, Jammu & Kashmir,
Karnataka, Assam and Kerala.
In the case of small States, Mizoram, Meghalaya
and Sikkim ranked high on service delivery and
capacities. The remaining five small States scored
less than 15 points and two of those States Tripura
(8.5) and Arunachal Pradesh (9.2) scored less
than 10 points.
Among the UTs , Dadra and Nagar Haveli,
Chandigarh, and Daman & Diu scored the higher
on service delivery and capacities. The remaining
four UTs including Puducherry, Andaman &
Nicobar Islands, Delhi and Lakshadweep scored
less than 20 points.
Overall, most large and small States seemed to be
doing fairly well in terms of health-related service
delivery and capacities. Among large States, six
States including Uttaranchal, Tamil Nadu,
Punjab, Telangana, Assam and Kerala scored the
highest possible score i.e., 17 points. Except
Bihar all the large States scored above 15 points,
which represented a good level of readiness and
implementation in terms of health-related Service
Delivery and Capacities (Figure 16).
Sikkim and Manipur were the two small States
that scored the maximum possible points.
Meghalaya and Goa were at the bottom of the list.
Among the UTs , Andaman & Nicobar Islands
was at the top of the list for health-related Service
Delivery and Capacities. Delhi was at the bottom
of the list and there was no information received
from Lakshadweep. 37
3.4 Program activities and intervention
coverage
To assess the implementation score of
States/UTs on programme activities and
intervention coverage, information from
States' WCD departments was received on a
select set of interventions under ICDS, and
from the health department on a select set of
postnatal (children) and early childhood
interventions. Detailed indicator results have
been discussed in chapter 4. In this section,
only implementation scores for programme
activities and intervention coverage have
been analyzed.
For large States on a scale of 0 to 9 points,
12 States scored the maximum score of 9
points and two States scored 8 points on the
ICDS interventions. Four States including
Tamil Nadu, Jharkhand, Uttar Pradesh, and
Kerala scored 3 points while Punjab scored 2
points.
Other than Sikkim and Goa, all the other
small States scored 9 points. Among the
UTs, except Delhi, all other UTs scored 5 or
more points on programme activities and
intervention coverage pertaining to ICDS
(Figure 17).
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
ASSAM
KERALA
PUNJAB
TAMIL NADU
TELANGANA
UTTARANCHAL
CHATTISGARH
GUJARAT
HIMACHAL PRADESH
KARNATAKA
MAHARASTRA
ANDHRA PRADESH
JHARKHAND
MADHYA PRADESH
RAJASTHAN
HARYANA
JAMMU & KASHMIR
UTTAR PRADESH
BIHAR
MANIPUR
SIKKIM
ARUNACHAL PRADESH
MIZORAM
NAGALAND
TRIPURA
GOA
MEGHALAYA
ANDAMAN & NICOBAR ISLANDS
DADRA & NAGAR HAVELI
CHANDIGARH
PUDUCHERRY
DAMAN & DIU
DELHI
LAKSHADWEEP
Figure 16: Service Delivery and Capacity-Health Department
Infrastructure (Out of 4)HR (Out of 3)Stock Out (Out of 6)Training and capacity building (Out of 4)
Max Score: 17 38
Based on information received from the State/UT
health departments on a selected set of postnatal
(children) and early childhood interventions,
States/UTs were assessed on a scale of maximum
18 points (Figure 18).
Among the large States, Himachal Pradesh and
Maharashtra scored the highest i.e., 18 points on
the health-related programme activities and
intervention coverage. . Andhra Pradesh, Tamil
Nadu and Punjab followed closely. Rajasthan was
at the bottom of the list scoring only 6 points.
Among the small States, Sikkim ranked the
highest scoring 16 points, followed closely by
Goa, Mizoram and Tripura. Meghalaya was at the
bottom of the list with a nil score.
All the UTs, except Delhi and Lakshadweep
scored high on the list of health-related
programme activities and intervention coverage.
There was no information received from
Lakshadweep.
0
1
2
3
4
5
6
7
8
9
10
HIMACHAL PRADESH
MADHYA PRADESH
RAJASTHAN
ANDHRA PRADESH
GUJARAT
MAHARASTRA
BIHAR
UTTARANCHAL
PUNJAB
UTTAR PRADESH
ASSAM
KERALA
CHATTISGARH
TELANGANA JHARKHAND
HARYANA
JAMMU & KASHMIR
KARNATAKA TAMIL NADU
MIZORAM
NAGALAND
SIKKIM
MANIPUR
TRIPURA
MEGHALAYA
ARUNACHAL PRADESH
GOA
ANDAMAN & NICOBAR ISLANDS
DELHI
DAMAN & DIU CHANDIGARH
DADRA & NAGAR HAVELI
LAKSHADWEEP
PUDUCHERRY
Figure 17: Program activities and intervention coverage-WCD
Department
Max Score: 9 39
0
2
4
6
8
10
12
14
16
18
20
HIMACHAL PRADESH
MAHARASTRA
ANDHRA PRADESH
PUNJAB
TAMIL NADU
HARYANA
KARNATAKA
KERALA
CHATTISGARH
JAMMU & KASHMIR
JHARKHAND
ASSAM
UTTAR PRADESH
BIHAR
GUJARAT
UTTARANCHAL
TELANGANA
MADHYA PRADESH
RAJASTHAN
SIKKIM
GOA
MIZORAM
TRIPURA
NAGALAND
ARUNACHAL PRADESH
MANIPUR
MEGHALAYA
DADRA & NAGAR HAVELI
PUDUCHERRY CHANDIGARH DAMAN & DIU
ANDAMAN & NICOBAR ISLANDS
DELHI
LAKSHADWEEP
Figure 18: Program activities and intervention coverage-Health
Department
Max Score: 18 CHAPTER 4:
SCALING UP POSHAN ABHIYAAN
BY DELIVERING CORE
INTERVENTIONS AT SCALE TO
ENSURE COVERAGE, CONTINUITY,
INTENSITY AND QUALITY - C
2
IQ 41
4.1 Background:
POSHAN Abhiyaan aims to reduce stunting,
anemia, and low birthweight across high
malnutrition burden Districts. It recognizes the
need for convergence and coordination such that
the benefits of government schemes and
programs reach women and children in the first
1000 days. The POSHAN Abhiyaan lays out
targeted determinants of nutritional outcomes that
exist in various schemes and programs. These
include maternal nutrition, newborn care
practices, infant feeding and care practices and
underlying determinants, such as age at marriage,
age at first birth and sanitation (Figure 16).
To achieve the ambition of a malnutrition-free
India, it is imperative to ensure that the package
of programmatic interventions is implemented
with adequate coverage, continuity, intensity and
quality (C2IQ). High impact interventions need to
be implemented such that they cover 80-90
percent of eligible populations in a C2IQ
framework and are monitored on a quarterly
basis. The mission-mode approach provides an
impetus to strengthen not just the implementation
but also the monitoring and measurement of
progress.
Although a majority of these interventions are
part of the national health and nutrition programs
in India, the coverage of these interventions is
highly variable - by life stage, by intervention, by
State, and by District.
Figure 19: Interventions in POSHAN Abhiyaan
Interventions for POSHAN Abhiyan
Girl / adolescent / woman Newborn and childSwachh
• Care and education of the girl child:
Beti bachao, beti padao
• Adolescent girl care: Food ,
micronutients, healthcare, life style,
preparation as adult
• Right age for child birth: Marriage
after 18 years, childbirth after 20
years
• Pre-pregnancy care: Food,
micronutrients, contraception
• Birth sapcing: Gap between births
more than 2-3 years
• Antenatal care: checks for
complication detection, food, iron-
folic acid, tetanus immunization,
birth preparedness, treatment of
complications
• Skilled birth attendance and
emergency obstetric care: Facility
birth, emergency obstetric care
• Swachh:
Sanitation,
safe water,
hand
washing,
toilet use
(mother) and
safe disposal
of feces
• Newborn care:
• Care at birth, hygiene, cord care
• Breast feeding: within one hour, exclusive for six months,
cpntinuling for 2 years or more
• Extra care of low birth weight baby
• Kangaroo mother care
• Care of the sick and small neonate
• Complete immunization: Including rotavirus and pneumococcal
Vaccines
• Breast feeding upto 2 years and more
• Complementary feeding: From 6 months onward; culturally
appropriate recupes, hygienc, increaing amount, adequate in nutrition
• Growth monitoring
• Care of the undernourished child
• Care in severe acute malnutrion
• Early stimulation and child development
• Early detection and care of illness: For diarrhea (including ORS and
zinc), pneumonia (including antibiotics) and other illnesses; referral
• Supplements:
• Supplementary nutrition
• Iron-folic acid
• Vitamic A supplementation
• Deworming 42
The efforts behind scaling up POSHAN
Abhiyaan interventions are based on several
assumptions that map to the key pillars of
POSHAN Abhiyaan (using technology,
improving capacities, the convergence of
multiple programs and behaviour change
communication).
• First, it assumes that a set of core POSHAN
Abhiyaan pillars (technology, training,
processes to support convergence, and Jan
Andolan) will trigger a series of changes
that improve the availability and quality of
nutrition interventions in the ICDS and
health system, and interventions to address
underlying challenges of gender, sanitation,
and poverty.
• Second, it assumes that putting these
interventions in place will address both the
immediate and underlying determinants of
poor nutritional outcomes. These
determinants include dietary practices for
women and children, use of micronutrient
supplements and food supplements,
sanitation practices and more.
• Finally, the theory of change assumes that
these will lead to improved outcomes such
as child growth, reduction in anemia and
other targets of the nutrition mission.
In this chapter, we focus on the status of the core
programmatic platform inputs, the roll-out of the
POSHAN Abhiyaan pillars and the coverage of
POSHAN Abhiyaan interventions. In
describing these, we use a combination of data
provided by the State Governments (for inputs
and program roll-out) and from surveys (for
program coverage). In all the results, we present
findings separately for the 19 large States, the 8
small States and the 7 Union Territories (UTs).
4.3 INPUTS
Program inputs related to the ICDS and health
platforms are critical for functioning of
POSHAN Abhiyaan pillars. These include
funding, human resources, supplies, and
infrastructure. Below, we describe the status of
these, using data provided by the State
Governments and data compiled for other
programs under the ambit of POSHAN
Abhiyaan.
a. Fund allocation & utilization
Funds are critical to initiate, implement, and
sustain processes required for delivering
interventions including staffing, supplies
and infrastructure. From the information
shared by the States/UTs, it is evident that
all the large States have received funds
from the Centre. Except Assam and Jammu
& Kashmir, all large States, have
earmarked funds for POSHAN Abhiyaan.
With respect to the utilization of funds,
Maharashtra has utilized the maximum
amount, close to 55 percent, followed by
Karnataka (40 percent) and Bihar (35
4.2 Theory of Change for POSHAN Abhiyaan:
Inputs
•Human
resources
•Supplies
Infrastructure
Process
•POSHAN
Abhiyaan Pillars
-Technology
-Training
-Convergent
actions
-Activities to
stremgthen ICDS-
Health
convergence
-SBCC/Jan
Aandolan
activities
Short-term
outcomes
•Improved
availabality of and
access to POSHAN
Abhiyaan
internetions
•(eg: Improved
ICDS services,
Improved public
sctor services and
nutrition
interventions,
NREGA etc.)
Long term
outcomes
•Improvem,ent in
determinants of
nutrition
•(eg. Better
nutrition during
pregnancy, Better
IYCF practices
especially
complementary
feeding, more IFA
and Ca
supplementation
Impact
•Better child
growth
•Reduce Anemia
Reduce low birth
weight 43
percent). In Punjab, Kerala, Haryana, and
Jharkhand the utilization level of funds has
been 5 percent or less; in Chhattisgarh and
Uttar Pradesh, it was less than 10 percent.
In the remaining large States, fund
utilization ranged between 19 and 33
percent.
All the small States reported receiving
funds from the Centre. Except Sikkim,
Tripura and Manipur, all other small States,
have earmarked funds for POSHAN
Abhiyaan. With respect to utilization of
funds, Arunachal Pradesh, Meghalaya and
Mizoram, utilized more than 60 percent of
funds followed by Nagaland (58 percent).
In the remaining small States, fund
utilization ranged between 20 and 44
percent. None of the funds were utilized in
Goa.
In UTs where there is no State legislature
including Andaman & Nicobar Islands,
Chandigarh, Dadra & Nagar Haveli, Daman
& Diu, and Lakshadweep, POSHAN
Abhiyaan is fully funded, implying that
they do not need to earmark funds. UTs
with legislature including Puducherry and
Delhi have a cost sharing ratio of 60:40
with the Center. All the UTs reported
receiving funds from the Centre. Dadra &
Nagar Haveli utilized more than 60 percent
of funds followed by Chandigarh (58
percent) and Daman & Diu (56 percent).
Funds utilization level was lowest in Delhi
at 4 percent. In the remaining UTs, funds
utilization was lower than 40 percent.
Low level of fund utilization is a matter of
concern in most States and UTs. None of
the large States, except Maharashtra, has
utilized more than 50 percent funds. Only
four out of eight small States, and three out
of seven UTs have reached a utilization
level of more than 50 percent.
b. Human Resources
Human resources are critical for
implementation of any of the interventions.
Here we describe the status of staffing at
multiple levels in the ICDS and health
systems as reported by the States. The
expected steps to ensure overall
convergence at the State/UT level are to
establish State Project Management Units
(SPMUs), set up Convergence Action Plan
(CAP) committees at State, District, block
levels and develop convergent action plans
at these administrative levels. This indicator
is mentioned under Convergence Section of
the Report, however it is critical indicator to
be discussed under HR related issues as
well.
• District Program Officers (DPO), Child
Development Project Officers (CDPOs),
Lady Supervisors (LS), Anaganwadi
Workers (AWWs) and Anganwadi Helper
(AWHs) positions
In eight of the 19 large States, all the DPO
positions were filled. Only in Assam, less
than 50 percent of DPO positions were
filled. In five of the small States, all the
CDPO positions were filled. More than 90
percent of LS positions were filled in five
large States (Assam, Gujarat, Kerala,
Madhya Pradesh) and less than 60 percent
of LS positions were filled in three large
States (Bihar, Rajasthan, Uttar Pradesh).
Between 61 percent to 85 percent of LS
positions were filled in the remaining large
States. More than 90 percent of AWW and
AWH positions were filled in a majority of
the large States. Only in Bihar (82 percent)
and Uttar Pradesh (89 percent) less than 90
percent of AWH positions were filled.
In case of small States, except in Manipur
and Tripura, all the CDPO positions were
filled. In a majority of small States, all the
DPO positions are filled. Similarly, in five
States (Arunachal Pradesh, Goa, Manipur,
Meghalaya, Sikkim) all LS positions were
filled. In Mizoram and Nagaland more than
80 percent of LS positions were filled. In
Tripura, only 52 percent of LS positions 44
were filled. Nearly all small States had all AWW
and AWH positions filled.
• Lady Health Visitor (LHV) & ANM
positions
Among the large States, in 14 States, more
than 75 percent of ANM positions were
filled and a similar situation was observed
for LHV positions in 10 States. In 4 of the
small States, more than 90 percent of ANM
posts were filled; in Arunachal Pradesh all
ANM positions were filled. In Mizoram,
only 32 percent of LHV positions were
filled and information was not available for
Tripura. In the remining small States more
than 85 percent of LHV positions were
filled. In 4 UTs, more than 95 percent ANM
posts were filled.
Adequate staffing is important to ensure
reach of interventions with quality and
intensity. Therefore, there is an urgent need
to close gaps in human resources to
facilitate implementation. The gaps in
supervisory positions particularly impede
delivery of interventions with quality.
• Establishment of State Project
Management Unit (SPMU)
In many States and UTs, State Project
Management Units (SPMUs) were
established. However, the level at which
posts were filled in these SPMUs varied
greatly. SPMUs were established in 17 large
States (except Punjab and Karnataka). In
four large States more than 80 percent of the
SPMU posts were filled while in three
States more than 70 percent posts were
filled. Only in Gujarat 100 percent of the
posts were filled. In Uttar Pradesh and
Haryana, less than 5 percent of the posts are
filled. In the remaining large States less
than 50 percent SPMU posts have been
filled.
Among the 8 small States, the SPMUs
were established in 6 States (except
Manipur and Goa). In Mizoram 73 percent
of the SPMU posts were filled while in
Meghalaya only 25 percent posts were
filled. In the remaining small States none of
the posts were filled. In four UTs more than
75 percent of the SPMU posts were filled.
None of the posts were filled in Puducherry
and Delhi.
• Pradhan Mantri Matru Vandana Yojana
(PMMVY)
In the Pradhan Mantri Matru Vandana
Yojana (PMMVY) of MoWCD, against the
provision of hiring 60 contractual staffs at
State level and 1,434 contractual staffs at
District level across the States and UTs, so
far 42% and 26% recruitments have been
done at State and District levels
respectively (MoWCD data as on 18
February 2019).
Trend in year 2018-19
Analysis of the trend of vacancy at these levels
under ICDS in last one year reveals that progress
has been made to fill-up the vacant positions.
The below figure 20 presents the trend, wherein
it is evident that around 10% decline in the
vacancy of CDPOs and Supervisors has been
observed in last one year. The vacancies of
Supervisors are on constant decline whereas
CDPO vacancy has increased in the last quarter.
The current position of human resource
deployment against the sanctioned position
under ICDS, POSHAN Abhiyaan and PMMVY
has been analysed and few feasible measures
have been suggested that are in conformity with
Guidelines of these Schemes. 45
0
5
10
15
20
25
30
35
40
45
Jan - March'18 April - June'18 July-Sept'18 Oct-Dec'18 Jan-Mar'19
% Vacancy
Figure 20: Trend of HR vacancy at different levels under ICDS in
the last one year
CDPO Supervisor AWW AWH
MoWCD, Data as on 31st March 2019
Measures suggested for improving the vacancy status
The Ministry of Women and Child Development has been communicating with the States and UTs on the
need for filling-up the vacancies under the ICDS/PMMVY/POSHAN Abhiyaan. It has suggested several
measures to provide flexibility so that they could speed-up their recruitment process:-
i) In the letter addressed to all Secretaries dealing with ICDS dated 15th Sept., 2015, the Ministry had
communicated that “50% of vacancies in the posts of Supervisors would be filled up by promotion
from amongst AWWs with 10 years of experience as AWWs and having the prescribed educational
qualification as per the Recruitment Rules for the post of Supervisor”.
On mere implementation of the above Order (subject to adherence of qualification and education
norms), the Lady Supervisory level vacancy will reduce by 50%, whereas vacancy at AWW level
will increase only by 0.5%. Also, this will enhance work efficiency amongst the AWWs to perform
better to graduate to the higher level.
ii) In order to fast track the filling of vacant position of CDPOs, the Ministry in its letter to all Chief
Secretaries of States and UTs dated 06th Feb, 2019 has allowed to recruit the afore mentioned
personnel “on contract basis till such time the vacancies are filled on regular basis”. The selection
procedure and salary norm for such contractual appointment has also been provided in the said letter.
With this measure, all CDPO level vacancies may be filed within 3-6 months timeline on
contract basis.
iii) In the above mentioned letter dated 06th Feb, 2019, the Ministry has also mentioned about its
previous Order where the District Magistrates has been authorised to recruit the AWWs and
Supervisors at his/her level. By implementing this measure, the remaining 50% vacancy at the
Supervisor level and all vacancies at AWW level may be filled within 3 months. 46
For newly launched Schemes of PMMVY and
POSHAN Abhiyaan, MoWCD needs to
persuade the States and UTs to fill-up
contractual positions at State, District and Block
levels so that the Schemes could perform well.
Also, MoWCD should monitor HR vacancy
status under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
c. Supplies
• Growth monitoring devices
The distribution levels of growth
monitoring devices including weighing
scales for infants and adults, and height
measuring instruments - infantometers, and
stadiometers varied across the States and
UTs. Among the large States, 9 States
reported not distributing any of the infant or
adult weighing instruments. Three States
distributed 50 percent or fewer scales.
Among the small States, three of them
distributed 100 percent of the required
weighing scales while 4 others did not
distribute any weighing scales. In four out
of seven UTs , 100 percent of the required
weighing scales were distributed (Table 5;
Annexure 3).
In eight large States and four small States
and in one UT, none of the height
measurement instruments were distributed.
In three large States, and in four small
States and UTs, 100 percent of the required
height measuring devices were distributed.
As availability of a measuring instrument is
the first step in ensuring that measurement
takes place, this huge gap in lack of
instruments at the AWCs needs immediate
attention.
• Stock-out of IFA red tablets, TT injections,
and albendazole in the month of Feb 2019
For an effective implementation of some
pre-pregnancy and postnatal interventions,
it is essential to have an adequate level of
stocks of IFA red tablets, TT injections, and
albendazole. Most of the States and UTs
seemed to have a good level of stocks of
these supplies.
None of the States and UTs reported
stock-out of IFA red tablets in Feb 2019,
except Nagaland (100 percent stockout),
Uttar Pradesh (1 percent stockout) and
Delhi (82 percent stockout). No information
was received from Lakshadweep.
None of the States and UTs reported
stock-out of TT injections in Feb 2019,
except Uttar Pradesh (23 percent). No
information was received from
Lakshadweep.
None of the States and UTs reported
stock-out of albendazole in Feb 2019,
except Madhya Pradesh (11 percent), Uttar
Pradesh (67 percent) and Delhi (100
percent). No information was received from
Lakshadweep.
d. Infrastructure
For some of the health interventions to be
delivered, it is essential to have functional
Community Health Centres (CHCs) and
sub-centres. In nearly all large States, 100
percent of CHCs were reported to be
functional, except in Bihar (33 percent),
Punjab (99 percent), and Uttar Pradesh (87
percent). Similarly, in a majority of large
States all sub-centers were reported to be
functional except in Assam (97 percent),
Bihar (60 percent), Jammu & Kashmir (96
percent), Jharkhand (92 percent), and
Rajasthan (94 percent).
In nearly all small States 100 percent of
CHCs were functional, except in
Meghalaya (information unavailable) and
Tripura (88 percent). Only in 4 small States
100 percent of sub-centers were functional.
In all UTs, except in Delhi and
Lakshadweep, 100 percent of CHCs and
sub-centers were reported to be functional.
No information was received from Delhi
and Lakshadweep. 47
What’s working well
• Most AWW and helper positions and ANM
positions are filled across States. This is
encouraging as they are the key personnel
to ensure the delivery of interventions.
• Growth monitoring devices procurement
and distribution is high.
• Low levels stock-out of supplies across
States is encouraging.
• All CHCs and sub-centres are functional in
a majority of the States.
What needs attention
• Low levels of fund utilization across State and UTs
is a matter of concern. It is important to identify the
reasons for low fund utilization and identify
opportunities to improve it.
• Supervisory cadre positions need to be filled. These
are critical to ensure that the frontline functionaries
are supported to deliver services.
• Attention is needed to close gaps in procurement
and distribution of growth monitoring devices in
some States.
• Remaining State-level supply gaps for IFA, TT, and
albendazole tablets need to be closed. Attention is
needed to ensure that distribution further down the
chain is not hampered.
• Infrastructure challenges linger in some States and
need attention, especially in high burden States like
Bihar.
BOX 2: Challenges reported by State/UT
Governments on strengthening inputs needed
to implement POSHAN Abhiyaan actions
Human Resources
Human resource gaps at different levels were
identified as an impediment by 11 States including
Assam, Bihar, Chhattisgarh, Jammu & Kashmir,
Haryana, Madhya Pradesh, Maharashtra,
Nagaland, Puducherry, Punjab and Uttarakhand.
In the case of Haryana, vacancies could not be
filled due to the imposition of the Model Code of
Conduct.
• With preparation for 2019 General Elections
underway, many skilled personnel were
engaged in election duties in Bihar and
Telangana.
• Bihar reported that in addition to election
duties, personnel were also involved in
invigilating exams.
• Assam mentioned that ICDS field-level
officials and AWWs were engaged in work
related to the National Register of Citizens.
• Tamil Nadu faced several challenges with the
Commcare App which does not allow for data
to be edited or elaborate information of
beneficiaries to be entered which would prevent
duplication and exclusion.
• Uttarakhand specified engagement of resource
group members in other departmental work
because of which rollout was delayed.
• Maharashtra also mentioned delays in overall
rollout of POSHAN Abhiyaan because of
delays in lack of HR personnel, and imposition
of the Model Code of Conduct, resulting in long
administrative processes.
Supplies
Three States/UTs including Andaman and Nicobar
Islands, Chhattisgarh and Jammu & Kashmir
faced issues related to the distribution and
maintenance of growth monitoring devices.
Andaman and Nicobar Islands faced procurement
issues, while Chhattisgarh cited challenges in
maintaining machines as well as the need to
develop the skills necessary to correctly use them.
In Jammu & Kashmir, hilly terrain has led to slow
distribution of devices to AWCs. Maharashtra
also reported challenges related to procuring and
distribution of devices.
Infrastructure
None of the States reported explicit challenges
related to infrastructure.
Source: Data provided by the State/UT governments in response to questionnaires sent out by NITI Aayog, May 2019 48
4.4 TECHNOLOGY
The ICDS-CAS application functions through a
mobile application at the level of AWW and LS
and through a dashboard at the higher levels.
The application digitizes 10 of the 11 registers of
the AWWs, provides a supervisory application
to the LS, and a dashboard application to
CDPOs, DPOs as well as to officials at the State
and at the central level to be able to monitor
Anganwadi Center (AWC) activities.
We examine four major technology-related
implementation components, by State. These
include the availability of mobile devices, the
establishment of technology support, training
of functionaries at multiple levels and the
availability/training in the use of the
dashboard.
The data used to assess these is based on
responses from the State governments to the
questionnaire sent out by NITI Aayog in May
2019.
a. Mobile phone devices
The first step in ICDS-CAS functionality is
availability of the mobile devices. The
distribution level of mobile phones varied
in States and UTs. Among large States,
only in Andhra Pradesh mobile phones
were distributed to all Districts. In ten large
States, the distribution levels were between
19 and 39 percent Districts. Mobile phones
were not distributed to any of the Districts
in Assam, Gujarat, Haryana, Karnataka,
Kerala, Punjab, and Maharashtra. In Jammu
& Kashmir, phones were distributed to only
2 percent of the Districts.
Among small States In Goa and Meghalaya
mobile phones were distributed to all the
Districts. In Mizoram, phones were
distributed to nearly 62 percent of the
Districts. In the remaining five States,
mobile phones were not distributed to any
of the Districts. In four UTs mobile phones
were distributed to more than 85 percent of
the Districts, and in the remaining three
UTs, phones were not distributed to any of
the Districts (Table 6; Annexure 3).
b. Technology support
Establishing a helpdesk provides the
technology support required for the smooth
implementation of ICDS-CAS. Among the
large States, in Gujarat, Maharashtra and
Rajasthan, helpdesks have been established
in almost all the Districts. Of the remaining
16 large States, helpdesks have been
established in less than 50 percent of the
Districts in seven States and in none of the
Districts in nine States. Among the small
States, helpdesks have only been
established in Mizoram and Sikkim.
Among the seven UTs, helpdesks have only
been established in Andaman & Nicobar
Islands and Daman & Diu (Table 6;
Annexure 3).
Access to ICDS-CAS dashboard and training
in the use of the ICDS-CAS dashboard
Data from the ICDS-CAS goes into the State
nutrition dashboards, providing an overall
snapshot for monitoring. Among the large
States, 11 States have access to this ICDS-CAS
dashboard. Only four small States and four UTs
have this access. Much also needs to be done to
complete the training of field functionaries on
the use of the dashboard in ICDS-CAS in the
States and UTs (Table 7; Annexure 3).
More than 75 percent of DPOs and CDPOs were
trained on using ICDS-CAS dashboard only in
three of the large States (Andhra Pradesh, Tamil
Nadu, Jharkhand). None of the DPOs were
trained in seven small States except in
Meghalaya where only 20 percent of the DPOs
were trained. In case of CDPOs training, among
small States, all the CDPOs in Mizoram, 64
percent in Goa, and 28 percent in Meghalaya
were trained in the use of the dashboard. None of
the CDPOs in the remaining five States were
trained. Among the UTs, only in Puducherry all
the DPOs were trained. Only in Dadra & Naga
Haveli, Daman & Diu, and Chandigarh all the 49
BOX 3: State-level challenges related to
strengthening technology in the context of
POSHAN Abhiyaan
Connectivity, procurement and device-related
challenges are the most common problems
reported by the States in rolling out ICDS-CAS.
Connectivity issues
Poor connectivity is cited as the most common
impediment to mobile phone functioning at
ground level. This was reported by States such as
Bihar, Chhattisgarh, Mizoram and Nagaland.
While Bihar, Chhattisgarh and Nagaland face
these issues in remote areas, Mizoram attributes
this connectivity issue to its geographical terrain.
Other States/UTs that report network connectivity
issue hampering the implementation of
ICDS-CAS include Jharkhand, Lakshadweep,
Madhya Pradesh, Meghalaya, and Puducherry.
Procurement and device-related problems
In Haryana, Jammu & Kashmir, Maharashtra and
Punjab, the implementation of ICDS-CAS has
been hampered by delays in training and
procurement. Punjab mentions pending bids as a
problem to the smooth functioning of mobile
phones because of which mobile phones have not
even reached 16 Districts. Issues related to app
and device performance and usability are reported
by Chandigarh, Daman and Diu, Madhya Pradesh,
and Tamil Nadu. Tamil Nadu has encountered
storage issues where the app on the mobile phone
does not allow for recording of details once the
count of beneficiaries crosses 200.
Other State-specific issues
Punjab and Rajasthan face budget constraints,
while in Maharashtra, vacancies posed a
significant challenge for the implementation of
ICDS-CAS. In Himachal Pradesh, ICDS-CAS is
not linked with PMMVVY, leading to the
exclusion of some beneficiary groups. And in
Uttarakhand, discrepancies in paperwork have led
to issues in data collection and phone
configuration.
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
CDPOs were trained in the use of dashboard.
More than 75 percent of LS were trained only in
two large States (Andhra Pradesh, Tamil Nadu).
Among small States, only in Goa all the LS were
trained on using the ICDS-CAS dashboard or
mobile. None of the LS received training in
Arunachal Pradesh, Manipur, Tripura, Nagaland
and in the remaining small States between 50 to
62 percent of LS were trained. In Dadra &
Nagar Haveli, Chandigarh, and Daman & Diu,
all LS were trained in ICDS-CAS dashboard
use. Overall, a high proportion of ICDS
functionaries remain untrained on ICDS-CAS
dashboard/mobile and this requires immediate
attention of the States and UTs.
What’s working well
Mobile phone procurement and distribution is
moving well with variable achievement of reach of
procurement and distribution across States.
What needs attention
- Helpdesk set-up needs attention across the
board as it is critical for frontline worker
support in using ICDS-CAS
- Dashboard access needs to expand across all
States.
- Immediate attention is needed for training ICDS
functionaries on the use of dashboard and
mobiles.
- Connectivity challenges need to be addressed to
ensure ICDS-CAS functioning at the village level.
Summary 50
4.5 TRAINING
Training is an integral component of
POSHAN Abhiyaan. It is intended to
strengthen the capacity of frontline workers
(FLWs) to deliver services in a timely,
efficient and effective manner. Twenty-one
Incremental Learning Approach (ILA)
modules were developed and launched to
train FLWs to improve their knowledge and
skills in an ongoing and incremental
manner. Key capacity building related
components to roll out this training include
the establishment of resource groups for
training, and the actual training of frontline
providers.
a. Establishment of training resource groups
• State-level resource group for ILA
training established
The State-level resource groups for ILA
training were established in all States and
UTs, except in Karnataka.
• District-level Resource Group (DRG) for
ILA training established
Nearly all large States have established all
the required DRGs for ILA training, except
in Assam, Karnataka, Kerala and Jammu &
Kashmir. Jammu & Kashmir had the lowest
proportion of established DRGs at 41
percent. All small States have established
DRGs except in Arunachal Pradesh (84
percent). Except in Daman & Diu, all the
DRGs were established in the UTs.
• ILA training for District Resource
Groups (DRGs)
In most States and UTs, ILA training for
DRGs has been initiated. Except in
Telangana, Jammu & Kashmir, Karnataka,
Assam and Kerala, ILA training has been
initiated for DRGs in 14 large States. In 11
of the States, more than 75 percent of DRG
members have been trained, and in three
States between 50 and 75 percent of DRG
members have been trained.
Except in Tripura and Goa, ILA training has
been initiated for DRGs in six small States.
Of these, in four States, more than 75
percent of DRG members were trained.
Except Daman and Diu, and Lakshadweep,
ILA training has been initiated for DRGs in
five UTs. Of these, in four UTs, more than
75 percent DRG members have been
trained
• Block-level Resource Group (BRG) for
ILA training established
Nearly all large States have established all
the required BRGs, except in Assam,
Karnataka, and Kerala. Jammu & Kashmir
had the lowest proportion of BRGs
established BRGs (49 percent).
All small States have established BRGs,
except in Goa. As there are no blocks in
Andaman & Nicobar and in Chandigarh,
BRGs cannot be established. Except in
Daman & Diu, BRGs were established in
the rest of the UTs.
b. Training of ICDS and MoHFW
functionaries
• Lady Supervisors (LS) and Anganwadi
Workers (AWW) trained in six or more ILA
modules
Data on the training of LS and AWW in six
or more ILA modules show that much is
still desired. The number of LS that were
trained on at least 6 ILA modules was
higher than 75 percent in nine large States,
3 small States and 4 UTs. In the case of
AWWs, this was true in only six large
States, two small States and four UTs (Table
7; Annexure 3).
• Training of ASHAs
Out of 34 States and UTs, 17 States and UTs
have a plan to provide ILA training to
ASHAs. Of the 19 large States, seven have
a plan to provide ILA training to ASHAs.
Four small States, and all except one UT
plan for ILA training for ASHAs. In
subsequent reporting, we will assess
roll-out of the ILA training to ASHAs.
Aside from the ILA modules, the sixth and
seventh modules of the Home-based
Newborn Care (HBNC) training for ASHAs
cover areas related to nutrition. Most States
and UTs are doing well on this training for
ASHAs. More than 75 percent of the
ASHAs were trained on HBNC modules six
and seven in all large and small States,
except in Andhra Pradesh (69 percent).
Among UTs, all ASHAs were trained in
Andaman & Nicobar Islands and
Puducherry while more than 90 percent
ASHAs were trained in Dadra & Nagar
Haveli and Delhi. There was no information
available for Goa, Chandigarh and
Lakshadweep. 51
4.5 TRAINING
Training is an integral component of
POSHAN Abhiyaan. It is intended to
strengthen the capacity of frontline workers
(FLWs) to deliver services in a timely,
efficient and effective manner. Twenty-one
Incremental Learning Approach (ILA)
modules were developed and launched to
train FLWs to improve their knowledge and
skills in an ongoing and incremental
manner. Key capacity building related
components to roll out this training include
the establishment of resource groups for
training, and the actual training of frontline
providers.
a. Establishment of training resource groups
• State-level resource group for ILA
training established
The State-level resource groups for ILA
training were established in all States and
UTs, except in Karnataka.
• District-level Resource Group (DRG) for
ILA training established
Nearly all large States have established all
the required DRGs for ILA training, except
in Assam, Karnataka, Kerala and Jammu &
Kashmir. Jammu & Kashmir had the lowest
proportion of established DRGs at 41
percent. All small States have established
DRGs except in Arunachal Pradesh (84
percent). Except in Daman & Diu, all the
DRGs were established in the UTs.
• ILA training for District Resource
Groups (DRGs)
In most States and UTs, ILA training for
DRGs has been initiated. Except in
Telangana, Jammu & Kashmir, Karnataka,
Assam and Kerala, ILA training has been
initiated for DRGs in 14 large States. In 11
of the States, more than 75 percent of DRG
members have been trained, and in three
States between 50 and 75 percent of DRG
members have been trained.
Except in Tripura and Goa, ILA training has
been initiated for DRGs in six small States.
Of these, in four States, more than 75
percent of DRG members were trained.
Except Daman and Diu, and Lakshadweep,
ILA training has been initiated for DRGs in
five UTs. Of these, in four UTs, more than
75 percent DRG members have been
trained
• Block-level Resource Group (BRG) for
ILA training established
Nearly all large States have established all
the required BRGs, except in Assam,
Karnataka, and Kerala. Jammu & Kashmir
had the lowest proportion of BRGs
established BRGs (49 percent).
All small States have established BRGs,
except in Goa. As there are no blocks in
Andaman & Nicobar and in Chandigarh,
BRGs cannot be established. Except in
Daman & Diu, BRGs were established in
the rest of the UTs.
b. Training of ICDS and MoHFW
functionaries
• Lady Supervisors (LS) and Anganwadi
Workers (AWW) trained in six or more ILA
modules
Data on the training of LS and AWW in six
or more ILA modules show that much is
still desired. The number of LS that were
trained on at least 6 ILA modules was
higher than 75 percent in nine large States,
3 small States and 4 UTs. In the case of
AWWs, this was true in only six large
States, two small States and four UTs (Table
7; Annexure 3).
• Training of ASHAs
Out of 34 States and UTs, 17 States and UTs
have a plan to provide ILA training to
ASHAs. Of the 19 large States, seven have
a plan to provide ILA training to ASHAs.
Four small States, and all except one UT
plan for ILA training for ASHAs. In
subsequent reporting, we will assess
roll-out of the ILA training to ASHAs.
Aside from the ILA modules, the sixth and
seventh modules of the Home-based
Newborn Care (HBNC) training for ASHAs
cover areas related to nutrition. Most States
and UTs are doing well on this training for
ASHAs. More than 75 percent of the
ASHAs were trained on HBNC modules six
and seven in all large and small States,
except in Andhra Pradesh (69 percent).
Among UTs, all ASHAs were trained in
Andaman & Nicobar Islands and
Puducherry while more than 90 percent
ASHAs were trained in Dadra & Nagar
Haveli and Delhi. There was no information
available for Goa, Chandigarh and
Lakshadweep.
What’s working well
• Establishment of State-level resource groups
for ILA training is nearly complete across
States.
• ILA training for District-level resource groups
(DRGs) has been initiated.
• Nearly all States and UTs have established
required block-level resource groups.
What needs attention
• Training is not complete across the DRGs.
• Huge gaps in ILA training of LS and AWWs
across States.
Summary
BOX 4: Challenges reported by States in
relation to strengthening training for POSHAN
Abhiyaan
Twelve States faced delays or challenges in
implementing the Incremental Learning Approach
(ILA) at different levels. Low attendance,
difficulties in record-keeping, insufficient funds,
rough terrain, unavailability of training materials
or equipment, lack of trainers and low quality of
training were variously noted by Chandigarh,
Gujarat, Himachal Pradesh, Jammu & Kashmir,
Jharkhand, Maharashtra, Meghalaya, Punjab and
Uttarakhand. Madhya Pradesh noted that the
e-ILA app is too heavy for most mobile phones.
The State of Assam has not yet been able to
implement training, though plans are in place. In
Himachal Pradesh, training has been pushed back
due to delays in smartphone procurement.
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
4.6 CONVERGENCE
Convergence is a key pillar within the
framework of POSHAN Abhiyaan. The
goal of convergence is to ensure that all
nutrition-related programmes converge on
households with mothers and children in the
first 1,000 days. The expected steps to
ensure overall convergence at the State/UT
level are to establish State Project
Management Units (SPMUs), set up
Convergence Action Plan (CAP)
committees at State, District, block levels
and develop convergent action plans at
these administrative levels. Village Health,
Sanitation & Nutrition Day (VHSND) is
considered as a convergence platform at the
village-level.
Under convergence, the CAP committees
together with the departments
implementing programmes are expected to:
(i) develop a convergent action plan; (ii)
conduct periodic reviews; (iii) monitor and
track progress of the actions in the plan; and
(iv) facilitate efforts to achieve the targets.
Below, we describe the status of the
establishment of the committees and
development of plans, using data provided
by the State governments. In subsequent
reporting, we will assess roll-out of reviews
and monitoring efforts.
a. Establishment of State Project
Management Unit (SPMU)
(Already discussed in HR related issues in
the earlier section of this Chapter).
b. Convergence Action Plan (CAP)
committee
In most States and UTs, CAP committees
were established (except Karnataka and
Meghalaya). The CAP committees were
formed in all the Districts in nearly all large
and small States and UTs, except in Madhya
Pradesh (99 percent), Gujarat (79 percent),
Tamil Nadu (34 percent), Telangana (3
percent), Jammu & Kashmir (41 percent),
Arunachal Pradesh (84 percent), Delhi (90
percent). The CAP committees were not
formed in any of the Districts in Assam and
Kerala (Table 9; Annexure 3).
c. Convergence Action Plan (CAP)
developed and submitted
Overall, in 21 States and UTs, CAPs were
developed. Among the large States, CAPs
were developed in 14 States. The five large
States where these were not developed
include Assam, Haryana, Karnataka, Tamil
Nadu, and Telangana. In the case of small
States, CAPs were developed in just three
States. These were not developed in
Arunachal Pradesh, Goa, Manipur,
Mizoram, and Tripura. In four out of the
seven UTs, CAPs were developed. Delhi,
Lakshadweep, and Puducherry were the only
three UTs where these were not developed.
Even in States and UTs where a CAP was
developed, it was not submitted as part of
the Annual PIP for the year 2019-20, in all
the cases. Nine of the large States, three of
the small States, and three of the UTs
submitted their CAPs as part of the Annual
PIP for the year 2019-20. These included
Andhra Pradesh, Chhattisgarh, Madhya
Pradesh, Uttarakhand, Himachal Pradesh,
Gujarat, Uttar Pradesh, Punjab, Jammu &
Kashmir, Sikkim, Nagaland, Meghalaya,
Chandigarh, Daman and Diu, and Andaman
and Nicobar Islands.
While the convergent action plan efforts
are important for facilitating convergence-
related processes, their purpose can only be
fully realized when such processes trigger
the within- and across-sector actions that
lead to effective reach of an agreed upon
core set of interventions to all households in
the 1,000-day period (Box 5). 52
4.6 CONVERGENCE
Convergence is a key pillar within the
framework of POSHAN Abhiyaan. The
goal of convergence is to ensure that all
nutrition-related programmes converge on
households with mothers and children in the
first 1,000 days. The expected steps to
ensure overall convergence at the State/UT
level are to establish State Project
Management Units (SPMUs), set up
Convergence Action Plan (CAP)
committees at State, District, block levels
and develop convergent action plans at
these administrative levels. Village Health,
Sanitation & Nutrition Day (VHSND) is
considered as a convergence platform at the
village-level.
Under convergence, the CAP committees
together with the departments
implementing programmes are expected to:
(i) develop a convergent action plan; (ii)
conduct periodic reviews; (iii) monitor and
track progress of the actions in the plan; and
(iv) facilitate efforts to achieve the targets.
Below, we describe the status of the
establishment of the committees and
development of plans, using data provided
by the State governments. In subsequent
reporting, we will assess roll-out of reviews
and monitoring efforts.
a. Establishment of State Project
Management Unit (SPMU)
(Already discussed in HR related issues in
the earlier section of this Chapter).
b. Convergence Action Plan (CAP)
committee
In most States and UTs, CAP committees
were established (except Karnataka and
Meghalaya). The CAP committees were
formed in all the Districts in nearly all large
and small States and UTs, except in Madhya
Pradesh (99 percent), Gujarat (79 percent),
Tamil Nadu (34 percent), Telangana (3
percent), Jammu & Kashmir (41 percent),
Arunachal Pradesh (84 percent), Delhi (90
percent). The CAP committees were not
formed in any of the Districts in Assam and
Kerala (Table 9; Annexure 3).
c. Convergence Action Plan (CAP)
developed and submitted
Overall, in 21 States and UTs, CAPs were
developed. Among the large States, CAPs
were developed in 14 States. The five large
States where these were not developed
include Assam, Haryana, Karnataka, Tamil
Nadu, and Telangana. In the case of small
States, CAPs were developed in just three
States. These were not developed in
Arunachal Pradesh, Goa, Manipur,
Mizoram, and Tripura. In four out of the
seven UTs, CAPs were developed. Delhi,
Lakshadweep, and Puducherry were the only
three UTs where these were not developed.
Even in States and UTs where a CAP was
developed, it was not submitted as part of
the Annual PIP for the year 2019-20, in all
the cases. Nine of the large States, three of
the small States, and three of the UTs
submitted their CAPs as part of the Annual
PIP for the year 2019-20. These included
Andhra Pradesh, Chhattisgarh, Madhya
Pradesh, Uttarakhand, Himachal Pradesh,
Gujarat, Uttar Pradesh, Punjab, Jammu &
Kashmir, Sikkim, Nagaland, Meghalaya,
Chandigarh, Daman and Diu, and Andaman
and Nicobar Islands.
While the convergent action plan efforts
are important for facilitating convergence-
related processes, their purpose can only be
fully realized when such processes trigger
the within- and across-sector actions that
lead to effective reach of an agreed upon
core set of interventions to all households in
the 1,000-day period (Box 5).
What’s working well
• State project management units (SPMUs) have
been established in nearly all States and in all
UTs.
o Karnataka, Punjab, Manipur and Goa do not
have SPMUs
• Convergence Action Plan committees
established in nearly all States and UTs.
• Convergence Action Plans (CAPs) developed in
several but not all States and UTs.
What needs attention
• SPMUs staffing gaps exist across several
States.
• Development of CAPs needs attention at the
State and District levels.
• Operationalizing the convergence action plans
in a way that the interventions reach the first
1000-day households.
Summary 53
BOX 5: Challenges reported by States related
to establishing processes related to convergent
action planning
Convergence planning gaps are evident at the
State, District and block levels. For achieving
convergence, unfilled vacancies are a challenge in
both Chhattisgarh and Puducherry, while budget
constraints and the lack of a digital platform are
mentioned by Chhattisgarh and Rajasthan. In
Jammu & Kashmir, many Districts are yet to
receive the Convergence Plan, delaying
State-level convergence planning. Himachal
Pradesh, Maharashtra, Madhya Pradesh and
Meghalaya also reported a lack of cooperation or
participation, manifesting in data sharing issues,
difficulties organizing timely meetings, and
preparing plans with allied departments. This
could be because the implementation of POSHAN
Abhiyaan is viewed as the domain of WCD, as
noted by Himachal Pradesh. Gujarat noted that as
compared to State and District-level convergence,
block-level convergence is more difficult to
implement, as is convergence further down the
line.
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog, May 2019
4.7 JAN ANDOLAN (Community
mobilization)
Poshan Abhiyaan is thus envisioned to be a
“Jan Andolan” and a “Janbhagidaari”
meaning “People’s Movement”. The goal of
Jan Andolan is to build recognition across
sectors for nutrition and to build knowledge
among communities and facilitate intent to
improve nutrition practices to improve
maternal and child nutrition. Multiple
platforms are engaged to facilitate Jan
Andolan including community-based
events (CBEs), social media, mass media,
frontline workers, influencers and
celebrities. Here we describe CBEs
As part of Jan Andolan, community-based
events (CBEs) are routinely organized
across the AWCs in the country. The
purpose of these events is to raise
awareness among the communities and to
influence behaviour changes for better
nutrition health. The first anniversary of
POSHAN Abhiyaan was marked with the
celebration of ‘Poshan Pakhwada’ from
8-22 March 2019. Most States and UTs
organized various CBEs. Further details
received from Central Ministries is
mentioned in Chapter 6.
In the month of March 2019, either all or
most AWCs organized such events in
twelve of the large States. Similarly, more
than 75 percent of AWCs in five small
States organized the events. All AWCs
organized the CBEs in all the UTs other
than in Andaman & Nicobar.
More than 75 percent villages provided all the
activities mandated under VHSND in 14 of the
19 large States. In 5 of the 8 small States, more
than 75 percent villages provided all the
activities mandated under VHSND. In all UTs,
except Chandigarh, all the villages provided
all activities mandated under VHSND.
What’s working well
• There is an enthusiastic response to Jan
Andolan and the community-based events are
being organized across States •
• Ensuring continuity of behaviour change
communication throughout the year and beyond
the designated months and events is critical for
facilitating behaviour change.
• Strengthen existing Village Health, Sanitation,
and Nutrition day platform for the delivery of
interventions.
Summary 54
BOX 6: Challenges reported by the States in
relation to Jan Andolan
Several States, including Chhattisgarh, Himachal
Pradesh, Jharkhand, Madhya Pradesh,
Maharashtra and Meghalaya provided insights
into issues faced in organizing community-based
events (CBEs). Chhattisgarh noted that in the
absence of a digital platform, delays in reporting,
tracking and monitoring such events are
inevitable. In Himachal Pradesh, frequent CBEs
pose logistical problems because of rough terrain.
Organizing CBEs also hampered routine work in
some States, like Jharkhand noted that CBEs
affected home visits and day-to-day activities in
AWCs, and Madhya Pradesh identified them as an
increased burden at the block-level. Maharashtra
reported that implementation was affected by
CDPO vacancies. Meghalaya mentioned low
participation by the community, particularly
husbands of beneficiaries.
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog, May 2019
The Government of India is commited to
improving the nutritional status of children and
women through POSHAN Abhiyaan. The
mission mode approach provides the impetus to
strengthen implementation and its monitoring.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions need to be strengthened in
accordance with the C2IQ framework.
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars
of POSHAN Abhiyaan. CHAPTER 5:
MULTI-SECTORAL CONVERGENCE
AND POLICY ACTION 5. Multi-sectoral convergence and Policy
action- At National Level
Nutrition is fundamental to human survival
and development and is an essential
foundation of National development.
While POSHAN Abhiyaan in itself has an
earmarked three year budget of Rs.9046.17
crore commencing from 2017-18, it really
is an overarching framework that seeks to
leverage funds, functionaries, technical
resources and IEC activities from existing
programs and schemes such as the
Integrated Child Development Services
(ICDS), Pradhan Mantri Matru Vandan
Yojana (PMMVY), National Heath Mission
(NHM), Swacch Bharat Mission
(SBM),National Rural Livelihood Mission
(NRLM) , National Rural Employment
Guarantee Assurance (NREGA) and the
Public Distribution System (PDS). The idea
is to align the efforts of every stakeholder in
a direction that could positively impact
nutrition outcomes.
Over the past few months the involvement
of key partner Ministries in work related to
the POSHAN Abhiyaanhas been quite
evident. And same was quite pronounced
during the celebration of Poshan Maah and
Poshan Pakhwada.
5.1 Specific actions across the multiple
Ministries and Line Departments
supporting POSHAN Abhiyaan
A. Ministry of Women and Child
Development (MWCD)
Ministry of Women and Child Development
(MoWCD), the Nodal Ministry, for POSHAN
Abhiyan is implementing it across the country.
The Abhiyaan was rolled out in phased manner,
as per notification released by the Ministry, the
Abhiyaan is launched in all the Districts w.e.f
December 2018.
The MWCD shared updates like, Fund
utilization which indicates that on an average,
States/UT have utilized only 15.6% of the funds
sanctioned to them since the inception of the
POSHAN Abhiyaan (2017-2019). No fund
utilization is there for the States of Goa,
Jharkhand and Karnataka. For the
Procurements of Growth Monitoring Devices
(GMD) and smart phones/tablets: 11
States/UTs have met the requirements with
regards to the equipment procured. States
namely, Andhra Pradesh, Assam, Gujarat,
Haryana, Jharkhand, Karnataka, Kerala,
Manipur, Meghalaya, Orissa, Punjab, Sikkim,
Tripura and West Bengal haven’t procured any
smartphones under the scheme yet. Another
important component of POSHAN Abhiyaan is
ILA training which has been rolled out in most
the States and UTs. Tamil Nadu has completed
13 modules, the maximum for any State.
Utilising technology for effective
implementation of POSHAN Abhiyaan is done
with the help of ICDS-CAS software. It is
notified by the Ministry that ICDS-CAS has
completed in 16 States and more than 2 Lakh
AWCs are working with ICDS-CAS facility.
Also there is a provision of Flexi funds given to
the States/UTs to conduct some pilot studies or
test new interventions that help in meeting the
objectives of the Abhiyaan. States like
Rajasthan, Tamil Nadu, Mizoram, Maharashtra,
Jharkhand, Daman and Diu, Jammu and
Kashmir are under process of constituting State
Level Sanctioning Committee. Chhattisgarh on
the other hand has decided to use its Flexi Fund
for filling gaps in existing components rather
than to utilize it for other pilots.
► Convergent activities jointly by Line
Ministries to support POSHAN
Abhiyaan
• Executive Committee: Series of
Executive Committee have been held in
the time period of last six months under
the Chairmanship of Secretary WCD.
Sixth executive committee of POSHAN
Abhiyaan was held on 29th March 2019.
Three meetings in the month of
December 2018, January and March
56 2019 was organised by the Ministry.
These meetings have been an important
mechanism for understanding State and
field level challenges and resolving them
in timely manner.
• National Council: The 3rd and 4th
National Council meeting have been
held in the month of November 2018 and
February 2019 to review the progress of
POSHAN Abhiyaan. Various issues on
utilization of funds under POSHAN
Abhiyaan, procurement of devices, rice
fortification roll out were discussed in
detail.
• Optima Workshop: Workshop was
organized with the objective to orient on
the mechanisms to optimize the planning
and financing for nutrition. It was held
from 18-20 Feburary, 2019 at Goa.
Representatives of the NITI Aayog, key
Central Ministries from each of the 36
States/UTs of India participated in the
workshop.
• Lighthouse India Workshop: MWCD in
collaboration with the World Bank had
organized an international knowledge
exchange event – titled “Lighthouse
India: A Drive to Fight Undernutrition”
during 1-5 February, 2019.
• Agri-Nutrition Conference: MoWCD
had organized a one day Agri-Nutrition
Conference on 15th March 2019 to
develop an Agri-Nutrition convergence
action plan to accelerate the progress
towards improving nutrition indicators.
The conference was aimed at deciding
the Agri-Nutrition action plan in India
with policy recommendations.
► Details regarding Supplementary
Nutrition
Almost all States/UTs are doing fairly well
with regards to Supplementary Nutrition.
With regards to Hot Cooked Meals and
THR, most States prepare a mix of regional
dishes and staple food. Some States offer
sweets like kheer, while others resort to
offering a stipulated amount of dry snacks
with meals.
► IEC/SBCC Mass Media Campaigns (1st
October 2018 to 31st March 2019)
Promotion of POSHAN Abhiyaan and
awareness of healthy behaviour is promoted
and communicated through print media
which includes the advertisement in 87
newspapers in 16 States of the country on
9th March 2019. Pan India mass
communication was planned by the
MoWCD for Poshan Abhiyaan during the
month of March 2019 as part of Poshan
Pakhwada. However due to model code of
conduct the approval of PMO was not given
for other mass media campaign.
Promotion of PMMVY scheme is promoted
through Doordarshan and other private
channels. The scheme was promoted on 251
channels across the country. The video in
addition to promotion of scheme also included
message on positive health behavior.
Challenges:
The level of participation in the National
Council and Executive Committee Meetings of
POSHAN Abhiyaan was very low. Odisha and
West Bengal have not started rolling out the
scheme. States have not performed well on
procurement of devices and filling up the
manpower. The fund utilization by States/UTs
has been inefficient.
B. Ministry of Health and Family Welfare
National Health Mission (NHM) under MoHFW
plays a vital role in the success of POSHAN
Abhiyaan as both the missions share similar
goals like reduction of undernutrition, anemia
and prevalence of low birth weight. Various
health sector interventions which are
instrumental in the success of POSHAN
Abhiyaan:
57 ► Working and strengthning Home Based
Care of Young Children, Home Based
New-born Care, Anemia Mukt Bharat,
National De-worming Days (NDDs),
Universal Immunisation, Promotion of
IYCF at Health Facility and Community
(Mother’s Absolute Affection (MAA)
Programme), Control of Childhood
Diarrhoea (IDCF), nutritional deficiency
screening among children, nutrition
counselling and education at schools and
villages, food fortification, and Nutrition
Rehabilitation Centres
► Home Based Care of Young Children-
HBYC programme involves additional
home visits over and above the existing
Home Based Newborn care (HBNC) visits
for nutrition promotion. Ministry of Health
and Family welfare has sanctioned around
Rs 218 crore to cover 240 Districts
including 115 Aspirational Districts for the
HBYC initiative in 2019-20. As far as
capacity building of frontline workers is
concerned, 24 States have completed
training of trainers and 9 States have
initiated ASHA/ANM training. More than
12,000 frontline workers are trained
covering 23 districts in these 9 States.
► Home Based New-born Care (HBNC)- 1.29
Crore newborns have received home visits
by ASHAs in 2018- 19 and 5.3 Lakhs
new-born referred during the year 2018-19.
lt is worth mentioning that there is more
than 100% point increased in sick newborn
referral rate from the last financial year. For
the year 2019-20, Rs.462 Crore has been
sanctioned for this program. Funds were
also approved for Smartphone for 1.24 Lakh
ASHA/ ASHA Facilitators for Supportive
supervision. Around 686 trainers and 16391
ASHAs/ASHA Facilitators have been
certified.
► Anaemia Mukt Bharat- Approximately
Rs.414 crore has been sanctioned for
implementation of Anemia Mukt Bharat
(AMB) in all the 36 States/UTs in 2019-20.
Three resource institutions namely, AIIMS,
lnstitute of Economic Growth and Tarang
Hub-New Concepts Centre for
Development Communication have been
identified to provide technical support at the
national level. AMB has been launched in 9
states so far- Bihar, Chhattisgarh,
Jharkhand, Madhya Pradesh, Maharashtra,
Meghalaya, Punjab, Uttar Pradesh,
Rajasthan and 5 States are likely to launch
the programme soon. These states are
Haryana. Goa, Odisha, Gujarat and Kerala.
More than 2 lakh participants including
District and Block nodal officers, teachers
and AWWs have been oriented on the
programme.
► National Deworming Day (NDD) and
Universal Immunisation Programme - 93%
(22.12 crore) children were covered during
the 8th round of NDD conducted in
February 2019 in 33 States and UTs. For
Mission Indradhanush, a total of 3.39 crore
children and 87.2 lakh pregnant women
were vaccinated. New vaccines such as
Pneumococcal Conjugate Vaccine (PCV) is
introduced in 5 States whereas, Rota Virus
Vaccine (RVV) was introduced in all 36
58
6
pregnant
women
30
million
124
million
Children
(6-59 months)
134
million
Children
(5-9 years)
17
million
women of
reproductive age
(20-24 ears)
27
million
lactation
mothers
115
million
adolescent boys
and girls
(10-19 years)
AMB States and UTs on September 6, 2019. By
the end of year 2018 under Intensified
Diarrhoea Control Fortnight (IDCF), 8.7
crore under-five children were covered
(78%).
► Integration of ICDS-CAS and Reproductive
Child Health (RCH) portal - A platform
would be created by MoHFW to develop a
common beneficiary registration system to
facilitate exchange of data between RCH
portal and ICDS-CAS. This platform is
likely to be completed in the next three
months including pilot in 1 District of
Haryana/Uttar Pradesh.
► Fortification- MoHFW is actively
supporting pilot scheme of both rice
fortification and milk fortification meant for
addressing micronutrient deficiencies and
improve the nutrient quality of diet.
► Mothers’ Absolute Affection (MAA)- to
improve breastfeeding practices, around 4
lakh ASHAs and 82 thousands health staffs
were sensitized for breastfeeding promotion
strategies under this programme.
► Early Childhood Development (ECD) with
focus on 1000 days- MCP card is updated
with developmental milestones. Emphasis
on early childhood development has been
identified a priority component of HBYC
programme. Funds for ECD call
C. Ministry of Human Resource
Development (MHRD)
Through the Mid Day Meal (MDM) scheme,
Ministry of Human Resource Development
ensures an effective convergence with the
Ministry of Women and Child Development to
support the objectives of POSHAN Abhiyaan.
This scheme aims at the enhancement of school
enrolment, retention and attendance and
simultaneously improving nutritional levels
among children. It covers all the children
studying in government, local body and
government-aided primary and upper primary
schools and the Education Guarantee Scheme
(EGS)/ Alternative Innovative Education (AIE)
centres including Madarsa and Maqtabs
supported under Sarva Shiksha Abhiyan (SSA)
of all the States across the country.
The fund utilization information shared by the
ministry indicates that most of the States have
utilised more than 80% of funds earmarked for
MDM and are left with a small proportion of
unspent balance ranging between 3-20%. On the
other hand, States/UTs like Jharkhand (75%),
Puducherry (75%) and West Bengal (63%) have
utilised much lesser than 80% of the funds for
MDM and are left with 25-37% of unspent
balance.
► Tithi Bhojan –A community participation
programme was initiated by the State
Government of Gujarat in mid-day meal
programme by relying on the traditional
practise of providing food to large number
of people on special occasions such as
festivals, days of national importance etc.
Members of the community provide
nutritious and healthy food to the children
as an additional food item or full meal on
such special occasions/festivals.
As per the information provided, by
MHRD, a concept similar to Tithi Bhojan,
with the same name or a different
nomenclature, has been adopted by 12
States/UTs which include Assam (Sampriti
Bhojan), Andhra Pradesh (Vindhu
Bhojanam), Chandigarh (Tithi Bhojan),
Daman & Diu (Pravesh Utsav), Haryana
(Beti ka Janamdin), Karnataka (Shalegagi
Navo-Nivo), Madhya Pradesh (Sneh
Bhojan), Maharashtra (Sneh Bhojan),
Punjab (Priti bhojan), Puducherry (Anna
Dhanam), Tamil Nadu (Nal Virundhu) and
Uttarakhand (Tithi Bhojan). In addition,
States/UT like Jharkhand, Dadra & Nagar
Haveli and Tripura occasionally give
special food items like sweets and chicken
to children.
► Provision of good quality proteins in MDM:
59 As many as 23 States/UTs are making an
effort to enrich the protein quality of the
mid-day meal by providing either egg or
milk to children. Both eggs and milk are a
source of good quality protein which helps
in improving the overall health. In most
cases, egg and milk are provided
alternatively and the frequency varies from
once a week to six times a week. In Tamil
Nadu, eggs are provided on all working
days and Rajasthan provides milk six times
a week. Some of the States/UTs also give
seasonal fruits interchangeably with
milk/egg to children. In Delhi, milk is
distributed by Mother Dairy on a pilot basis
to children in schools that come under the
Directorate of Education
► Fortification:
- Double fortified salt (DFS)- One of the
objectives of POSHAN Abhiyaan is to
reduce the prevalence of anemia among
both children (6-59m) and women (15-49
years) by 9% @ 3% p.a. One cost effective
way of increasing the intake of iron is
fortification of salt with iron in addition to
iodine. Ministry of Health and Family
Welfare has prescribed the legal standards
for DFS.
MHRD had written to all the States/UTs
encouraging them to use DFS in MDM to
correct the iron deficiency among children
and improve their learning and
concentration in school. However, only half
of the States/UTs (18 out of 36) are using
DFS in preparation of MDM.
This needs to be scaled up as the States
which have reported high prevalence of
anaemia among children, like Bihar,
Chhattisgarh, Jharkhand, and Uttar Pradesh
are not using DFS in MDM for children.
► Fortification of commonly consumed
commodities like wheat flour, rice, milk
and edible oil - The MHRD has
communicated to the States the mandate of
using fortified food items to address the
problem of malnutrition in the country. As
per the information received, only
Chandigarh is providing both fortified rice
and wheat flour in MDM. These staples
are fortified with nutrients-Iron, Folic acid
and Vitamin B12 which play an important
role in restoring the iron levels and correct
all forms of anaemia. The State of Haryana
and UT of Dadra and Nagar Haveli are
providing fortified wheat flour to prepare
MDMs. Haryana was the first State in the
country to take up this initiative in March
2018, on a pilot basis and gradually
expanded it to the whole State. Haryana also
provides edible oil fortified with fat soluble
vitamins A and D.
As far as the status of fortified rice is
concerned, 100% of the MDMs are being
prepared with fortified rice in Nagaland,
whereas in Karnataka, Odisha and Uttar
Pradesh it is being done in 5, 2 and 1
Districts, respectively. Eleven out of 36
States/UTs are providing edible oil
fortified with Vitamin A & D. Rajasthan is
the only State which provides fortified milk
(with vitamin A and D) under MDM and the
frequency of milk distribution to children is
also highest in this State, 6 times a week.
► Kitchen Gardens: Kitchen garden is an
excellent opportunity to provide freshly
grown vegetables rich in vitamins and
minerals to children and help address
micronutrient deficiency in them, also
commonly known as “hidden hunger”.
Involvement of children in kitchen garden
can be an educative learning for them and a
medium to teach them cooperation and
teamwork & give them a sense of
ownership. In Assam 87% of the schools
have developed kitchen gardens whose
produce is being used in preparation of
MDMs. This is followed by Dadra & Nagar
Haveli and Nagaland where 80% & 56% of
the schools have developed kitchen
60 gardens, respectively. In rest of the
States/UTs, less than 25% of the schools
have developed kitchen which ranges from
2% in Bihar to 25% in Odisha. While,
MHRD is making an effort in encouraging
States/UTs to develop kitchen gardens but
very little change is seen at the ground level.
► Involvement of mothers in supervision
committee: Mothers are the decision
makers of availability and accessibility of
food to children among other caregiving
practices. MDM guidelines encourage
mothers to oversee the preparation and
feeding of the children, thus ensuring
quality and regularity of the meal. This
intervention also results in community
involvement which is very crucial for the
success of any welfare programme. Only 10
out of the 36 States/UTs involved mothers
as part of supervision committee to monitor
and supervise preparation and serving of
MDM and within these 10 States/UTs,
100% of the schools involved mothers.
Dadra and Nagar Haveli reported about
20-30% of the mother’s involvement in
supervision commitee.
► LPG usage for preparing MDM: Liquefied
Petroleum Gas (L.P.G.) is considered to be
safe, economic, time-saving and smoke-free
fuel for cooking Mid-day Meal in school.
The MHRD insists on the use of LPG under
Cooked Mid-day Meal Programme
(CMDMP). The information received
indicates that in 20 out of 36 States/UTs, the
LPG usage is 80% and more. In 4 States
usage ranges between 40-80% and in 9
States/UTs it is less than 40%. Out of these
9 States/UTs 3 States i.e. Arunachal
Pradesh, Chhatisgarh and Manipur have
reported LPG usage in less than 10% of
schools. An effort should be made to find
out the reason behind the low usage of LPG
and necessary steps may be taken to replace
firewood and smokeless chulla with LPG as
these pose a threat to the health of the cook,
children who are around, and also pollute
the environment.
Coverage of children under MDM
Almost all the States and UTs reported that 80%
and above children are being covered under
MDM as beneficiaries. The coverage period was
from 1st October 2018-31st March 2019. States
like Assam, Mizoram, West Bengal and Delhi
have reported 100% coverage. Twenty-two
States/UTs out of 36 reported 90% and above
coverage. The State of Uttarakhand reported
frequent changes in enrolment and coverage of
beneficiaries. Similarly, in Chandigarh, a 42%
reduction in beneficiaries’ coverage was seen
between February and March 2019. An effort
should be made to find out the reason behind this
and also tap the eligible beneficiaries who are
currently excluded.
Services under School Health Programme
► Referral and healthcare facilities: Almost
all the States/UTs are screening children
and providing them referral and
healthcare facilities. In States/UTs like
Chhattisgarh, Tamil Nadu, Andaman and
Nicobar Islands, Chandigarh, Dadra and
Nagar Haveli, Daman & Diu, Lakshadweep
and Puducherry all the schools are
providing this service. 19 out of 36
States/UTs have reported that more than
80% of the schools are providing this
service to children. It is a matter of concern
that in the State of Uttarakhand only 3% of
the schools are providing this service.
► Except in Tripura and Andaman and
Nicobar Islands, none of the schools are
providing immunisation services to
children.
► Iron and Folic Acid supplementation -
Anemia is a serious public health challenge
in India with more than 50% prevalence
among young children. Thus, it becomes
imperative to provide iron supplementation
to this vulnerable group. Under the anemia
control programmes run by the Government
61 of India, children are provided iron
supplementation.
As per the information shared, in 11
States/UTs all the schools are providing
micronutrient supplementation to children.
In 6 States less than 40% of the schools
provide micronutrient supplementation,
with the access to service being as low as
13% in West Bengal. Even in a State like
Kerala, which is doing well in the
implementation of most welfare
programmes, the administration of
micronutrient supplementation is in only
28% of schools. Bihar and Jharkhand are
providing micronutrient supplementation to
children in just about 35% of schools.
► Deworming- The National Deworming
Day is a single fixed-day approach which is
conducted bi-annually to administer
Albendazole to all children aged 1-19 years.
This intervention is a convergence between
MHRD and Ministry of Health and Family
Welfare. In 23 out of 36 States/UTs,
Albendazole tablets are provided
bi-annually in more than 80% of the
schools. Almost half of these 23 States/UTs
run deworming programme in all the
schools within the State/UT. In West
Bengal, the administration of Albendazole
tablet is reported to be low - only in 14% of
the schools.
D. Ministry of Rural Development:
After the launch of POSHAN Abhiyaan, MoPR
has geared up the communities for nutrition
related activities by organizing Gram Sabhas.
Through Deendayal Antodaya Yojana - National
Rural Livelihood Mission (DAY-NRLM), they
ensure women’s participation through self-help
group (SHG) platforms. As on March 2019,
DAY-NRLM has mobilised 592 lakh households
into more than 52 lakh SHGs covering 5,330
blocks in ALL States/UTs. It has developed more
than 2 lakh community resource persons under
various components including Food, Nutrition,
Health and WASH (FNHW). At the policy level,
NRLM has adopted a ‘Dashasutra’ strategy, i.e. it
has layered FNHW interventions over its
institution building interventions and issued
necessary circulars and advisories to State Rural
Livelihoods Missions (SRLM), for an active
participation during Poshan Maah.
The State Missions, in convergence with the line
departments, conducted several activities under
POSHAN Abhiyaan, viz. collaboration with
Swachh Bharat Mission, Lohia Awas Yojana
(PMAY), etc. The key actions areas are
highlighted below:
► Collaborated with Swachh Bharat Mission,
Lohia Awas Yojana (PMAY), in Bihar.
► Mobilized SHG women and promoted
awareness on VHSND in most of the States,
supported ASHA and Anganwadi workers
in mobilizing women for availing services
like Take Home Rations (THR), distribution
of Iron Folic Acid (IFA) tablet,
immunization etc. in Madhya Pradesh.
► Promoted household level agri-nutri
gardens and nutrition sensitive livelihoods
for year-round supply of nutritive fruits and
vegetables in convergence with the thematic
livelihoods team and department of
agriculture, in Bihar, Chhattisgarh, Odisha,
Jharkhand, Madhya Pradesh etc.
► Involved ANMs and Sahiyyas (ASHA
workers) from Health Department in the
capacity building of VO/SHG members, in
Jharkhand.
► Convergence with the Drinking Water and
Sanitation Department for collaborative
initiatives on Rani Mistri (Women Mason)
training, construction of IHHL, behaviour
change communication of hand washing,
use of toilets, access to clean drinking
water, in Jharkhand.
► Developed backyard poultry and goatery
etc. across the States.
► Convergence with the Health Department,
62 63
under which demonstrative feeding
programme was implemented with the aim
of providing quality nutrition and
supplementary food to all the children,
lactating mothers and pregnant women and
created livelihood opportunities for the
SHGs member. In Gujarat, there are 2,564
villages in which demonstrative feeding
programme was conducted and 48,577
pregnant women and 39,373 lactating
mothers have been benefitted till now.
► Collaborated with the line departments on
nutrition and nutrition linked livelihoods,
e.g. in Assam the State mission has
organized a State level convergence
workshop with 6 line department on
Nutrition and Nutrition Linked livelihoods
in collaboration with UNICEF Assam.
Activities planned for POSHAN Abhiyaan
from 1st October 2018 to 31st March 2019
along with State-wise data:
State wise activities were planned for POSHAN
Abhiyan from “1st October, 2018 to 31" March,
2019. The Dashasutra strategy has been adopted
by all State Missions and FNHW agenda has
been integrated in the institutional structure
across all levels. Most of the States have
dedicated one SHG meeting in a month to
discuss FNHW issues. Modalities to capture
information of meetings held etc. exclusively on
FNHW is not been captured in MIS as of now,
the work is in progress. Hence, consolidated
numbers of the meeting etc. is not available at
this stage. However, few States have evolved
systems for recording such data.
Several States reported high numbers of
Meetings and workshops- Bihar reported
327,051 SHG meetings, 556 CLF meetings,
29,404 VO meetings and 420
workshops/trainings. This was followed by
Jharkhand and Madhya Pradesh. While the same
was least in Haryana- 47,703 SHG meetings, 118
CLF meetings, 2913 VO meetings and 135
workshops; followed by Uttar Pradesh. Apart
from this, platforms like VHSNDs, rallies, and
trainings were used in collaboration with line
department workers with high community
participation. Maharashtra conducted 10,253
rallies, celebrated 10,359 VHNDs and prepared
layouts of 9508 individual and 1005 community
nutri-gardens which is a big achievement. In
Miozoram, SHG members collected their
kitchen gardens products and sold them at the
local market, under anaemia campaign, 10
activities were conducted at the school where
experts like Doctors, nutrition experts had
discussions with school students.
State/UT wise initiatives in training
SHGs/VOs/CLFs on health and nutrition:
Apart from this, MoRD also took initiatives in
training SHGs/VOs/CLFs on health and
nutrition, viz. FNHW modules are being
developed by State Missions on the importance
of breastfeeding, complementary feeding,
maternal, infant, young child nutrition for
integration in trainings at all levels. Orientation
for State, District and block level staff is being
conducted on FNHW including the
above-mentioned topics.
States like Jharkhand are conducting cascade
training for members of Vos and Social Action
Committee (SAC) through the flipbook titled
“Samuh Varta”. Few States have undertaken
training of trainers (TOT), e.g. Bihar reported to
have conducted trainings in 1,29,361 SHGs on
nutrition module.
Few States are involved in ICDS Supplementary
Nutrition Programme (SNP) at Aanganwadi
Centre and schools. Bihar reported to have five
Food Fortification Units running in 3 different
Districts viz., Gaya, Khagaria and Muzaffarpur.
Take Home Ration is supplied to 898 Anganwadi
Centres under an MoU with respective blocks
ICDS projects. Similarly, Mid-Day Meal
(MDM) programme is running in two blocks of
two Districts viz., Muraul (Muzaffarpur) and
Ghosi (Jehanabaad) by VOs. A total of 162
MDM programmes are being monitored by 162
VOs where around 35,000 school children are
benefitted. 64
In Madhya Pradesh, a total of 12,030 SHGs are
involved in Supplementary Nutrition
Programme. Uttar Pradesh reported to have
18,347 SHGs involved in SNP during Poshan
Pakhwada. Total 13,121 SHGs helped
Anganwadi Workers to organize the recipe
demonstration event in which different types of
recipes made of THR (Nutrient Packets) where
shown to mothers and pregnant women. In
Gujarat, two THR units have been set up in
Vadiya and Babra block of Amreli District.
Haryana reported involvement of around 850
SHGs in THR preparation.
New initiatives by SRLMs that can be scaled
for strengthening POSHAN Abhiyaan in all
States/UTs:
Creation of trained resource pool for FNHW:
Some State Missions have identified community
resource person (CRPs) from among the SHG
members for taking forward FNHW issues with
the community. These identified CRPs are
trained periodically on various FNHW issues.
These CRPs are paid by the community
institutions based on the service they provide,
like organizing meetings, mobilizing women to
VHSND, etc.
► Nutrition Sensitive Integrated Farming
System (NSIFS) for diet diversity: For
improving dietary diversity at the household
level and ensuring various kinds of food
availability through-out the year, nutrition
sensitive integrated farming is being
encouraged in many State Missions.
► Micro planning on FNHW for
community ownership, SRLM: SRLMs
like Bihar, Chhattisgarh, Jharkhand and
Odisha are developing micro plans for
improving health and nutrition status of the
community. These plans are developed and
monitored by the communities. This helps
in encouraging community ownership and
making collective efforts for improving the
nutrition status.
► Home visits by SRLM members in Bihar,
Chhattisgarh, and Odisha: Home visits
are being made regularly to the households
identified to be at “nutritional risk”.
Counselling is provided and families are
mobilized for participating in VHSNDs and
accessing services and entitlements.
► Navratan Tool, developed by State
Mission, Bihar: Navratan tool for awarding
the “Champions”, i.e. best performing
mother. First 1000 days’ life has been
categorized into 9 indicators called
Navratna. Out of 9 Ratnas, 7 are on health
and nutrition and 2 are for sanitation
indicators. These include institutional
delivery, maternal diet diversity,
breastfeeding, complementary feeding,
immunization, nutri-gardens, family diet
diversity, hand washing and ORS use and
usage of toilet.
► Sensitization of Gram Sabha, State
Mission, Madhya Pradesh: Gram Sabhas
were sensitized on issues of malnutrition,
community volunteering, community-based
malnutrition management, PDS, linking
Severe Acute Malnourished children with
Nutrition Rehabilitation Centre,
competition on various nutrition issues,
demonstrations and awareness camps.
► Newlywed couples’ Meeting, State
Mission, Odisha: In the tribal dominated
areas, under-18 marriage is still common,
resulting in a vicious circle of malnutrition.
To avoid ‘Too Early, Too Soon & Too
Many’ Pregnancies, newly-wed couples’
meetings are being organized where the
couples are counselled on family planning
measures.
► Mushroom development project, State
Mission, Assam: In order to meet the
nutritional deficits and provide livelihood
opportunities to the SHG members, State
Missions have taken up Mushroom
Development Project with 200 SHG
members.
► Implementation of Food and Feeding
Demonstration sessions at AWCs using 65
F. Ministry of Consumer Affairs & Public
Distribution- Department of Food &
Public Distribution:
local food compendium in Odisha: Four
mothers’ meetings were conducted in each
month on different aspects of
complementary feeding. Recipe
demonstration sessions were conducted at
AWCs using local food compendium,
counselling flip books and videos.
► Health Camps in Odisha: In spite of the
various schemes implemented by health
department, still there are some hard to
reach areas where organizing VHSND is
also not possible at a regular interval.
Keeping those areas in consideration,
cluster level health camps were organized in
Odisha where basic health services were
being provided to the target beneficiaries.
► Multi-sectoral FNHW intervention:
Swabhimaan Programme, State Mission,
Chhattisgarh: SRLM partnered with
UNICEF, Chhattisgarh, to initiate the
Swabhimaan Programme (named as
‘Mocho Mangun’ in the State) with an aim
to improve the nutritional status of
adolescent girls, pregnant women and
mothers of children under two years in
Bastar block of Bastar District, by
increasing the coverage of five essential
nutrition (specific and sensitive)
interventions. It is being implemented in
coordination with the Departments of
Health & Family Welfare, Civil Supplies,
Panchayat & Rural Development, Women
& Child Development, Agriculture,
Horticulture and Public Health Engineering.
Challenges faced:
Some of the challenges faced by SRLMs
included incomplete coverage of target
beneficiaries due to migration, and
misconceptions prevalent in the communities.
There were challenges related to continued
reinforcement of messages and retaining good
practices. There were problems in tracking
behaviour change and issues with uploading data
on POSHAN Abhiyaan MIS portal.
E. Ministry of Panchayati Raj:
MoPR plays an important role in providing
logistics support and facilitating observance of
the POSHAN Abhiyaan activities that are
planned, conceived and implemented by various
Ministries like MoWCD, MoHFW, MHRD,
MoDWS and MoA&FW; and their counterpart
departments in States/UTs. Convergence of line
ministries at the grassroot levels with PRIs is
crucial for the success of respective activities.
These departments are the appropriate agencies
to identify convergent activities for PRI and their
participation in POSHAN Abhiyaan.
During POSHAN Maah, MoPR was earmarked
to conduct Prabhat Pheris and Special Gram
Sabha, which turned out to be very successful.
Besides, the Ministry is advising States/UTs
separately for observing VHSNDs optimally in
all the villages. This is done in compliance to the
guidelines issued by MoWCD, where PRIs are
given specific tasks to be performed on every
VHSND that takes place at least once in a month.
Also, PR departments in the States/UTs are
continuing to organize one Prabhat Pheri every
month with appropriate messages related to
POSHAN Abhiyaan. A record of these activities
is also being maintained.
PRIs are also suggested to organise one special
Gram Sabha on POSHAN Abhiyaan every six
months of which one must be on 2nd October.
Convergence of PRI is an essential component
for the implementation of POSHAN Abhiyaan.
Government of India has approved the centrally
sponsored pilot scheme on ‘Fortification of Rice
and its Distribution under PDS’ for a period of
three years beginning 2019-20 with a total
budget outlay of Rs. 147.61 crores. It would be
funded in the ratio of 90:10 in respect to North
Eastern, Hilly and Island States and 75:25 in 66
respect to the rest of the country. To begin with,
the pilot scheme will focus on 15 Districts,
preferably 1 District per State.
The decentralized model of fortification with
blending at the milling stage has been approved
by States/UTs in the pilot scheme. So far eight
State governments, i.e. Andhra Pradesh, Kerala,
Karnataka, Maharashtra, Odisha, Gujarat, Uttar
Pradesh and Assam have consented and
identified their respective District (s) for
implementation of the pilot scheme.
FSSAI had issued official letters to Food
Secretaries of all the States and union territories
to take steps to promote the use of fortified
edible oils in all their welfare schemes from 1st
October 2018 onwards.
Challenges: The department is insisting all
States/UTs to implement the pilot scheme
"Fortification of Rice and its Distribution under
Public Distribution System". So far only 8 States
have identified their Districts. Further, regarding
distribution of fortified wheat flour through
PDS, despite advisories from this department, it
is being distributed only in 2 States/UTs.
5.2 Multi-sectoral convergence and Policy
action- At State Level
With the launch of POSHAN Abhiyaan last
year, the States/UTs WCD and Health
departments have geared up to tackle the
battle of malnutrition. Many States/UTs
have initiated measures to improve the
health and nutrition outcomes of mothers
and children. This section highlights various
initiatives taken by the States/UTs which
focuses on first 1000 days (from a period of
conception to child’ first two years of life)
to improve the health and nutrition status of
women and children under the following
heads: Convergence, Community Based
Events/ Community Mobilization, Behavior
Change Communication and Other
Initiatives like technology etc. by
States/UTs.
A. Convergence
In Andhra Pradesh the State Government
has taken a few important steps to
operationalize convergence between ICDS
and PRI. They are described in detail in the
following section.
• At the village level under Mahila Shishu
Darshini for increased accountability. At
the village level, both the ICDS and
Panchayat Raj Institutions (PRI) are
responsible for the well-being of the
people. In each District, monthly review
meetings are convened by District
Collector. During these meetings, ICDS
and Health staff reports their reviewed
outcomes, and any gaps which were
assessed.
• Gram Panchayats in Andhra Pradesh,
recently agreed to provide Rs. 5000/- to
all AWCs from their Annual GPs budget.
• Another Initiative taken up by State
Government is Memu Saitham:
Tapping the goodness of community
through a donor-driven initiative. Given
the focus of POSHAN Abhiyaan on
Convergence the State Government has
decided to include donors who can
contribute in terms of infrastructural
support, this will improve the quality of
AWCs. It is worth noting that more than
950 donors contribute to POSHAN
Abhiyaan in the State. The support is
provided in the form of nutritious food
(Raagi, Bajra, Millets, Ground Nuts,
Jaggery, Fruits) and infrastructure items
(tables, chairs, utensils etc.)
• Initiative for Tribal Population named
Chandranna Giri POSHANA Kendra
is also started by Women Development
and Child Welfare department by
providing hot cooked meals to the
children and women of hill top and
remote habitations in tribal areas. The 67
meals are provided daily at the
community level with help of persons
identified in the community to serve the
meals. More than 14,000 pregnant &
lactating women and about 10 thousand
children from 6 months to 6 years are
covered in this scheme.
In Tamil Nadu, as part of convergence,
Department of transportation along with
WCD Department established separate
feeding rooms in 352 Bus stands and
Terminals to enable the feeding mothers to
breast feed their new born child in a safe
enclosed room.
Karnataka has initiated interventions on
Child Health which has resulted in
significant reduction in the quantum of
child deaths and the State is making sincere
efforts made to achieve Sustainable
Development Goal. Karnataka also has 41
Special Newborn Care Units (SNCU) to
manage sick newborns, of which 22 SNCUs
are with Ventilator. A total 61529 annual
admission of which 76.4% newborns were
successfully discharged by Dec 2018.
Adjunct to all SNCUs, Kangaroo Mother
Care Wards & Lactation Clinics are
established to improve the survival of low
birth weight babies and also provide support
to mothers in optimal feeding of newborns.
Karnataka Government has also signed an
MoU with National Neonatology Forum
(NNF) to improve the quality of care in
SNCUs by SNCU & NBSU mentoring.
State resource center for Facility Based
Newborn Care (FBNC) is established at
IGICH Bangalore to have sustainable
mechanism of capacity building, technical
support & mentoring of FBNC across the
State. Basic Newborn Care & Resuscitation
Program (IAP-NNF-NRP- FGM) to build
the capacity of staff nurses & medical
officers of all delivery points across the
State to reduce morbidity & mortality
related to birth asphyxia. State specific,
strategic and time bound Karnataka
Newborn Action Plan has been drafted with
monitoring and evaluation framework and
targets in response to India Newborn Action
plan to accelerate Karnataka’s effort toward
achieving SDG of single digit NMR by
2025, 5 year ahead of Global target. Thus,
Karnataka is setting an example for other
States/UTs to follow.
In Rajasthan, Department of WCD, Health
and TAD (Tribal Area Development
Department) were brought under the
umbrella of PUKAR. ANMs, ASHAs,
AWWs and Swasthyakarmi contractual
workers) were given specific roles.
Household are divided among AWWs,
ASHAs and Swasthyakarmi according to
hamlets/colony for better monitoring,
supervision and updating mother and child
health indices along with nutrition. Block
level workshops were organised to sensitize
all about the roles and responsibilities.
These workers were given printed registers
to list such beneficiaries.
The State of Madhya Pradesh has initiated
many interventions to ensure best health
and nutrition outcomes. Maternal Nutrition
intervention is being pilot tested in Vidisha
District and District Hospital Ujjain. The
objectives of Maternal Nutrition
intervention is to assess the Nutritional
Status of Pregnant women based on which
Nutritional Care will be targeted, to
improve provision of Maternal Nutrition
services at Community & Health facility
Level and to facilitate health care providers
& other stakeholders to engage in
Interpersonal Nutrition & Education
Counseling.
The State has taken ownership for Tracking
of High Risk Pregnancies. Identification of
every pregnant woman is done by ANM at
Community Level and by Medical Officer/ Specialist; fortnightly follow up is done by
multidisciplinary team including sector
MO, CDPO and counselor.
The State Health department of Jammu &
Kashmir in convergence with the ICDS
Department is providing hot meals to
pregnant women. The State is also
providing Dakshata Training for improving
skills of the staff in labour room, to improve
antenatal and perinatal care during and after
delivery.
B Community Based Events
In Bihar, in order to mobilize people for
celebration of Annaprashan Diwas, the
field functionaries of ICDS had developed a
“CBE Invitation Card” for the mother of
the child whose Annaprashan is scheduled
and are being invited through this pictorial
invitation card. Further, to established the
complementary feeding and making it as a
habit for the care giver, a follow up card
has been developed and being implemented
in one District- Sitamarhi as a pilot basis.
In Daman & Diu an effective use of
platforms like “Gram Sabha”,
“Construction Sites”, “Otalni Varta” with
SHGs member to create awareness about
POSHAN ABHIYAAN has been done. This
has created awareness among citizens,
beneficiaries and students about the
benefits, importance and objectives of
POSHAN Abhiyaan and Umbrella ICDS
Scheme. Also they have been sensitized
about correct nutrition and hygiene
practices. This has resulted in increase of
number of beneficiaries by almost 10% in
last one year.
Rajasthan as mentioned in the earlier
section also, the State has made efforts for
Community Partnership under a State
initiate called PUKAR. Each Wednesday, in
each of the panchayat, , Pukar meetings are
held where ANM, ASHA, AWW AND
SWASTHYAKARMI sit at some pregnant
woman’s house and read them a document
about how to take care of health & nutrition
from conception to the time baby turns to 2
year’s age. Importance of the
supplementary food from ICDS is also
being highlighted in these meetings. Around
50 beneficiaries attend a meeting and every
week 346 meetings are held in a District
benefitting around 15 thousand pregnant
women & lactating women.
The State of Haryana has set an example in
Community Mobilization around
Immunization. Recognizing the limitations
of community mobilization through ASHAs
and to resolve the disruptive campaigns
against Routine Immunization, Haryana has
roped in Community Mobilization
Volunteer (CMVs) for better Community
Mobilization and awareness generation to
improve the Routine Immunization
coverage in Mewat & Hathin block of the
District Palwal.
Further, in a first, as pilot project to improve
Immunization coverage in Urban areas under
NUHM, Haryana has introduced a new
intervention called E-Rickshaw for Urban ANM
mobilization, in District Panchkula to ensure
100% immunization coverage in Urban areas.
One E-Rickshaw is hired for alternate Vaccine
delivery system, including mobility support for
ANMs to session sites from Cold Chain Points
and vice-versa. The replication of the project is
also proposed in other four Districts in FY
2019-20 i.e. Ambala, Kurukshetra, Karnal and
Jhajjar.
The State of Sikkim has initiated Proud
Mothers Scheme to ensure that every
pregnant woman (during her first and
second live birth) and her newborn (up to
the age of six years) receive monetary
assistance so that they can avail of better
healthcare facilities and greater support
during and after delivery. The overall aim of
the scheme is to greatly reduce Maternal
deaths and the Infant Mortality Rate
68 69
prevailing in the State. The long term aim of
the Scheme is to improve the Total Fertility
Rate as well as Child Sex Ratio and the
overall health status of all women and
children in the State.
The State of Himachal Pradesh has started
many initiatives to promote healthy
pregnancy which deserves to be
highlighted. The State has launched for the
first time in India “Community Based
distribution of Misoprostol to prevent
postpartum Hemorrhage (PPH)” where the
inaccessible pockets which have high home
delivery rate were provided with
Misoprostol tablets to prevent PPH. The
pilot was recognized both nationally and
internationally and now has been scaled up
to another 11 blocks which is going a long
way in preventing maternal deaths and
thereby decreasing MMR. The State has for
the first time in the country started a
protocol to identify, monitor, and treat High
Risk Pregnancies in one of the remote
blocks of the State.
The initial results are encouraging and there are
plans to scale up. In addition to this, continuous
review of every reported maternal death and a
constitution of State level Committee has enabled
the State to fix responsibility in cases of gross
negligence. The State has also put in a mechanism
to back track cases of Severe Anemia reporting in
the tertiary institutes which would ensure early
detection of Anemia during the ante natal period
and decrease in maternal mortality. Finally, it has
put in a mechanism for audit of un-necessary
referrals to tertiary institutions. This would lead to
un-necessary congestion and better treatment of
complicated pregnancies leading to decrease in
maternal deaths.
C. Behavior Change Communication
The State of Assam has devised Jan
Andolan Strategy for Behavior Change
Communication. The State initiated
meetings with Doordashan Kendra –
Guwahati, One community radio station
(Radio luit), Big FM and Pratidin time
(Local News Channel) etc. for various
community awareness programme on
POSHAN Abhiyaan on a regular basis.
Other activities carried out for Jan Andolan
in the State are: Community based
awareness meetings, Poshan rallies, Prabhat
Phery on Malnutrition and anemia, Street
play on Child marriage, ethnic food melas
etc, celebration of Pratham Aahar day and
Matri Amrit day are also undertaken.
The State of Bihar has nominated Goodwill
Ambassador for POSHAN Abhiyan- Bihar
(Ms. Shreyasi Singh, Indian shooter, Arjun
Awardee). She is promoting key health and
nutrition messages to community for the
improvement of nutrition status of State.
Several innovative approaches and
campaigns are playing a vital role in
connecting communities across the State of
Chhattisgarh. An initiative named ‘Every
Festival, Poshan Festival’ is one initiative
which has been appreciated by Hon’ble
Prime Minister Narendra Modi. Messages
and activities related to awareness on
Malnutrition issues were incorporated
through local festivals and rituals. The local
popular festivals like Rakhi, Kamarchhat,
Pola Utsav, Ganesh Puja, Holi etc. was
dovetailed with malnutrition messages.
In Rajasthan, Community Awareness
activity is done each Wednesday, in each of
the panchayat, in one revenue village of that
panchayat, Pukar meetings are held where
ANM, ASHA, AWW AND
SWASTHYAKARMI sit at some pregnant
woman’s house. Videos relating to mother
and child health care are shown to
beneficiaries through the mobiles of ANMs.
D. Technology
The State of Jharkhand has launched
Sahiya Sangi portal to provide an IT 70
infrastructure, to track the progress of HBNC
(Home Based Newborn Care). This Real
time monitoring will enable to take swift
actions on the most impacted areas, and
decisions can be made based on the reports.
This Dashboard will rank the Districts on
various parameters which will showcase the
best performing Districts while inspire the
lower performing Districts at the same time.
The portal provides Real Time tracking of
monthly/yearly expenditure District/Block
Wise. The portal also defines accountability
for STTs, DPCs, Sahiyas to get better results.
Finally, Real Time SMS to parents/sahiya for
SNCU visits will improve the discipline for
timely visits. The State has also initiated
services for high risk babies which involve
step by step tracking of the high risk babies
from the data, such as weight on the visit
dates. This system not only tracks the high
risk babies but also reminds Sahiyas about
the visit dates of a child via text SMS and
emails.
Goa has initiated measures to improve
health outcomes of pregnant mothers and
newborns. It has launched new born
screening test launched in the month of
August 2018 to detect errors of metabolism
in new born. In order to identify high risk
pregnancies, printed color coded sticker to
stick on MCP cards according to their
criteria. The State has also taken several
initiatives to improve communication and
awareness of health of mothers and
children. For instance, it has provided TV
sets/ LED boards in five delivery points to
display IEC material; posters on ANC/
Breastfeeding/immunization etc.to display
in all health centers and motherhood and
Anaemia booklets to all ANC.
E. Other Initiatives
Bihar has introduced the provision of 150
ml Milk once in a week to all registered
children of age group 3-6 years at AWC.
Also, eggs are being provided twice in a
week to pregnant women and children
registered with AWC. Double fortified salt
(DFS) has been introduced in hot cook meal
of ICDS and MDM currently in Tirhut
division of State. The same may be scalded
up throughout the State.
To ensure the capacity building of ICDS and
Health field functionaries, incremental
learning approach is implemented at Health
Sub Centre (HSC) platform, which is a
unique and one of its kind in country .
The Government of Tamil Nadu is
implementing Dr. Muthulakshmi Reddy
Maternity Benefit Scheme (MRMBS) with
the noble objective of providing assistance
to poor pregnant women / mothers to meet
the expenses on nutritious diet and to
compensate them for the loss of income
during the delivery period, so as to prevent
low birth weight in newborn babies. The
State Government has already enhanced the
assistance from Rs.12,000/ to Rs.18,000/-
per beneficiary.
Under ‘Amma Baby Care Kit’, the
Government of Tamil Nadu is providing
baby kits containing 16 materials for about
6.7 lakh children born annually in the
Government Hospitals to mothers for
improving the hygiene of the post-natal
mothers and newborn babies. The State
Government has also established Breast
Milk Banks in 25 Government Medical
College Hospitals and District Headquarters
Hospitals.
In Telangana Incentives are been given to
Anganwadi Teachers for enrolling SAM
Children to NRCs. The District
Administration, has taken an innovative
approach to bring more number of SAM
children to get enrolled to NRCs located at
Utnoor and Adilabad through incentivizing
the efforts of Anganwadi teachers @ Rs.200
for each SAM Child who was enrolled by
the respective AWTs. With this small 71
intervention, access to the NRCs increased
by the community, CDPOs, Supervisors and
AWTs are taking special interest to bring the
SAM children to NRCs to fight against the
under-nutrition in interior tribal tracts of
Adilabad District.
The State of Uttarakhand has proposed
fortified Milk along with Cooked food
twice in a week in convergence with Milk
Federation- URJA. Provided to all
SAM/MAM children throughout the State
through Self Help Groups. The results are
positive because of high nutritive value.
Maharashtra on the other hand has
developed and initiated a comprehensive
training program for hospital based
counselors which includes RCH component
and other Disease control programmes. It is
also training ASHA workers in tribal blocks
for sepsis, pneumonia and diarrhea for early
identification of high risk newborns,
treatment and timely referral.
Uttar Pradesh has initiated Mentoring of
specialist (Gynecologist, Anesthetist &
Pediatrician) through Regional Resource
training working with Eight medical
colleges. In order to reduce mortality related
indicators. UP Technical Support Unit
envisages to develop selected area-specific
medical colleges as Regional Resource and
Training Centers (RRTCs) to facilitate
area-based teamwork for Maternal,
Neonatal and Child Health care through
continued medical education, mentoring,
and regular supportive supervision ensuring
effective continuum of care. These RRTCs
will in turn, mentor the key personnel
within the District Hospitals (DH) and
identified CHC FRIJs namely obstetrician,
pediatricians, anesthetist and general
surgeons to improve the quality of service
delivery system for maternal, newborn and
child health outcomes.
UP TSU Project has aimed to scale up this
mentoring program in the First Referral
Units (FRU) of Northern Uttar Pradesh with
an objective to complement the existing
community and PHC interventions and
maximize the health outcomes in the region.
The FRU intervention is designed based on
the learning and experience of the
CHC/PHC nurse mentoring program in 25
High Priority Districts (HPDs) of Uttar
Pradesh during 2014-17. The main goal of
the intervention is to improve the quality of
essential and emergency obstetric and
newborn care in 50 identified FRUs of the
region with a focus on improving provider
preparedness, facility systems and client
aspects for quality of care. The intervention
have major focus on the management of
maternal complications i.e. Hemorrhage,
Hypertensive disorders during Pregnancy
and sepsis among women and low birth
weight, birth asphyxia and sepsis among the
newborn. The project aims to cover 87
FRUs (25 DHs and 62 CHC FRUs) of 25
HPDs out of 286 FRUs in the entire State.
This had a positive impact as the initial
results demonstrate increase in the use of
iron sucrose to manage moderate and severe
anemia. 72
Government of Uttar Pradesh with support
from UP-TSU undertook an initiative to
mentor and train staff nurses and ANMs in
mini-skill labs as well as conducting
emergency drills and use of case sheets as
job aids in 200 blocks of 25 High Priority
Districts (HPDs) of UP. The main
objective is to improve the quality of
critical clinical care practices during
labour and immediate postpartum period
and the quality of systems in public health
facilities and to improve the identification,
management, follow-up and referral of
maternal and newborn complications.
Major components of the program are:
A total of 2021 staff nurses and ANMs
were mentored on various skill stations
from November 2017 to October 2018.
Based on the success of Nurse Mentoring
Program in 200 blocks of 25 HPDs,
Government of UP has scaled up the nurse
mentoring program across 620 blocks of
the entire State to bring about substantial
improvements in quality of services in the
high load delivery points and to affect
faster declines in maternal and newborn
morbidities and mortalities across Uttar
Pradesh.
Improving Clinical
Competencies of Staff
Nurse and ANMs:
Quality Improvement of
services in facilities
Referral Strengthening
Uttar Pradesh -TSU initiative on Nurse Mentoring
Mentoring of ANMs in
mini skill labs
Outreach support to
ANMs in VHNDs and
sub-centers to improve
the quality of
RMNCH+A service
Conducting facility
assessment through
Self-assessment process
Preparation of Facility
Action Plan through root
cause analysis by nurse
mentors
A common platform
called Vertical
Integration meetings has
been established for
improving referral
mechanisms.
Referral whatsapp
groups have also been
made functional to
improve communication
of referred cases between
lower and higher level
facilities. 73
Government of Uttar Pradesh in
collaboration with UNICEF, Abhyuday
Sanathan and Kalawati Saran Children’s
Hospital, undertook a pilot of an
integrated model for prevention and
management of severe acute malnutrition
(SAM) and moderately acute malnutrition
(MAM) through community based
demonstration session in Banda District of
Uttar Pradesh. The duration of the pilot is
from December, 2017 to March, 2020.
The approach of the Pilot is explained
diagramatically below:
Uttar Pradesh - Community Based Management of Acute Malnutrition (CMAM)
Strengthen
community facility
linkage for correct
referrals to NRC
Pilot Results
Till now, the outcomes of Pilot have been measured in two phases.
Total Children
Weighed
Identified
Underweight
Children
Identified SAM
Cases
Treatment Outcomes
Cured
435
87 (1.5%)
33(39%)
56074675
353
66 (1.4%)
24(36%)
10282
788
148
57(38%)
Underweight used
as as entry point for
SAM/MAM
identification
Weighing drive
Monthly weighing
of SAM at AWC,
health checkup at
VHND, Home visits
Provision of
antibiotics and
Micronutrient through
ANM and Block MO
Quarterly 12 days Bal
Poshan Star (BPS)
providing Augmented
Supplementary
*Provide
1000-1200 kcal
and 10-13 grams
protein in addition
to his/her daily
diet
Linkage with
MnRage
Horticulture SRLM
and Ration Cards
Monthly VHNDs
and block facility for
medical asessment;
through ANM
Inpatient CareCommunity Outreach
Outpatient Care
Other
Phase I Phase II Combined
Phase I and III CHAPTER 6:
JAN ANDOLAN 6.1 Jan Andolan
The Honourable Prime Minister intended that
the POSHAN Abhiyaan be converted into a Jan
Andolan for effective outreach and
implementation. The Mission strives in
preventing and reducing undernutrition, low
birth weight, and stunting across the life cycle,
but as early as possible, especially in the first
three years of life and with interventions up to
the age of 6 years. Several programmes across
Ministries and Departments have been making
serious effort to tackle the issues of malnutrition
and anemia in the country. POSHAN Abhiyaan
on one hand looks to synergise all these efforts
by Converging to achieve the desired goals and
on the other, intends to convert Awareness level
at community level into a Jan Andolan.
Objectives: Jan Andolan is geared towards
achieving the following objectives:
• Build recognition across sectors in the
country on impact of malnutrition and ‘call
to action’ for each sector’s contribution to
reducing malnutrition.
• To mobilize multiple sectors and
communities in the country on the impact of
malnutrition and contribute to reducing
malnutrition.
• To generate massive awareness to build
knowledge, attitudes and behavioural
change to consume nutrient-rich food,
practice optimal breastfeeding,
complementary feeding, maternal nutrition
and adolescent nutrition practices to
prevent malnutrition, including SAM and
anemia.
During the month of September 2018, POSHAN
Maah has demonstrated the power of convergent
outreach. It garnered 26 crore participation
across 22.5 lakh activities across the country. As
directed by the PMO on 02 February 2019, in an
effort to bolster Jan Andolan and mark the first
anniversary of POSHAN Abhiyaan, Poshan
Pakhwada was launched on International
Women’s Day. Poshan Pakhada was celebrated
on a pattern similar to Poshan Maah but was
enhanced by Poshan Maah’s learning and
knowledge for increasing its efficacy amongst
its audience and the overall system.
There was a tremendous enthusiasm across the
country and impressive participation in various
activities was witnessed. It is imperative to
mention that compared to Poshan Maah, Poshan
Pakhwada covered 2.7 times more people
(reaching out to overall 44.8 crore people) by
undertaking 3.7 times more activities (82.75
lakh activities) in half the time. Using its
learning from Poshan Maah, Poshan Pakhwada
also saw an approximate 280% increase in male
participation across all activities, reaching out to
approximately 8.53 crore men in the Pakhwada
compared to 3.8 crore men during Maah.
The activities were logged in on the Jan Andolan
Dashboard at the Block level. It served as a
useful tool to keep track of activities under
community engagement eve during Poshan
Pakhwada. The total number of activities
recorded on the dashboard were 1.63 crores and
the population reach was 96.09 crore. These
figures are too high compared to the Poshan
Maah (22.5 lakh activities and 25.4 crore reach).
In order to check the authenticity, veracity and
data quality of the records, an extensive data
cleaning exercise was conducted in field.
75 6,39,451
7,81,593
98,694
20,98,28821,46,402
18,48,045
0
5,00,000
10,00,000
15,00,000
20,00,000
25,00,000
Community Mobilization
Platforms
Field Level Meetings Home Visit
Maah Activities Pakhwada Activities
3.3X
2.7X
18.7X
Figure: 21 Participation of the Community during Poshan Maah and Poshan Pakhwada
Figure 21 shows how Poshan Pakhwada used the
learning from Poshan Maah and prioritized its
top three message dissemination platforms of
community mobilization, field-level meetings,
and home visits. Poshan Pakhwada engaged a
greater number of field level health workers for
community mobilization, 20.9 lakh activities
reached out to 13.5 crore people; 3.3 times than
Poshan Maah. 21.5 lakh Field-level meetings
reached 12.9 crore people; 2.7 times more than
in Poshan Maah; 18.6 lakh Home visits were
carried out, which was 18.7 times more than
Poshan Maah.
Poshan Pakhwada also saw an increase in
mobilization of youth and peer groups for
undertaking dissemination of nutrition-based
messages. These groups included School-Based
peer groups -2.85 lakh groups reached out to
1.81 crore students and teachers; Self-Help
Groups - over 77 thousand groups reached 47.2
lakh people; Youth Groups - over 2 lakh groups
reached out to 1.2 crore people. This is
noteworthy not only for the sheer numbers but
also because this is one of the few opportunities
where family members such as the
mother-in-law and husband, usually the decision
makers of the family, engaged in a dialogue for
better nutrition which can lead to a permanent
change for better nutrition-based behavior for
the family. For the first time, ‘Anemia Camps’
were a focus activity in an effort to educate
young girls and women about Anemia. During
the Pakhwada, 2.85 lakh Anemia Camps reached
out to 2.0 crore people.
Approaches:
Convergence for Jan Andolan:
Various Line Ministries like Ministry of Health
& Family Welfare, Drinking Water & Sanitation,
Rural Development, Human Resource &
Development, Information & Broadcasting,
Panchayati Raj, Tribal Affairs, Housing and
Urban Affairs, Electronics and Information
Technology, Minority Affairs, AYUSH, Sports
& Youths Affairs, Social Justice and
Empowerment, Ministry of Agriculture
Cooperation and Farmers Welfare and Ministry
of Consumer Affairs, Food & Public
Distribution partnered with Ministry of Women
and Child Development during the Poshan
Pakhwada. At the grass root level platform like
Gram Sabhas, SHGs, and Field functionaries
across various Ministries & Schemes were used
for optimum spread and coverage.
76 Under the Chairmanship of Member, Health &
Nutrition, NITI Aayog, series of meetings were
conducted to build the synergy between the
Ministries to participate, organize and accelerate
the nutrition awareness level at grassroots level.
Poshan Pakhwada saw an increase in
inter-ministerial convergence for
implementation of activities, collaboration for
greater coordination and reducing duplication of
efforts. Overall, 14 Ministries undertook 17 lakh
joint activities during Poshan Pakhwada.
Following the trend of Poshan Maah, Poshan
Pakhwada showed better results in
human-centered, group activities that supported
demonstration of the positive behavior. The top
performing States are as shown in figure 22.
77
MinistryActivities
Ministry of Women and Child
Development (MoWCD)
Poshan Pakhwada, on the lines of Poshan Maah, was celebrated across the country as a part
of Jan Andolan under POSHAN Abhiyaan from the 8th to 22nd March 2019.
• Total 82.75 lakh activities conducted (3.6 times of Poshan Maah) with a participation of
44.8 crore (1.76 times of Poshan Maah) including 8,90,44,852 male population and
14,99,33,490 female population.
• Focus was on interpersonal communication and home visits.
• States like Rajasthan, Madhya Pradesh, Gujarat, Maharashtra, Chhattisgarh, Punjab,
Bihar, Andhra Pradesh, and Tamil Nadu performed above average whereas Telangana
performed at an average level and the rest below average (Criteria - performance by
activities).
• On the participatory grounds, Uttar Pradesh, Maharashtra, Rajasthan, Andhra Pradesh,
Tamil Nadu, Chhattisgarh, Bihar, Gujarat, and Madhya Pradesh performed well.
• Various activities undertaken were: Nukkad natak/ folk shows, Poshan Melas, cycle rally –
on nutrition, home visits – AWW and mass media campaign.
• Pan India mass communication was planned by the MoWCD for POSHAN Abhiyaan
during the month of March 2019 as part of Poshan Pakhwada. However due to model
code of conduct, the approval of PMO was not given for mass media campaign.
Ministry of Health and Family
Welfare (MoHFW)
• A total of 48 lakhs children covered by home visits during Poshan Pakhwada against a
target of 10 lakhs.
• 1.96 lakhs “Test, Treat and Talks (T-3)” Anaemia camps organized during Poshan
Pakhwada and 1.65 crore beneficiaries covered against a target of 1 crore.
• Counselling on nutrition rich food and the importance of dietary diversity etc. was given at
the camps along with creating awareness on various interventions under Anemia Mukt
Bharat strategy.
Ministry of Rural Development/
(MoRD)
Self Help Group meetings, Haat Bazaar activities and mass media campaign.
Ministry of Housing and Urban
Affairs (H&UA)
Cooperative/Federation meetings, urban SHG mela, counselling camps.
Ministry of Drinking Water and
Sanitation (MoDWS)
Swachhata Jagaran, cycle rally – on hygiene and mass media campaign.
Ministry of Youth Affairs and Sports
(MoYAS)
Poshan rally and youth group meeting.
Ministry of Panchayati Raj
(MoPR)
Panchayat meetings, Poshan walks, Prabhat Pheree and mass media campaign.
Ministry of Agriculture and
Farmers’ Welfare (MoAFW)
Farmer club meeting, fruits & vegetable exhibition.
District and Block Admin with Support
from Department of Women and Child
Development/Social Welfare + Ministry
of Health and Family Welfare
(MoWCD + MoHFW)
Community radio activities and mass media campaign.
Ministry of Human Resource
Development and Department of
Education (MHRD, DoE)
School-based activities, awareness campaign for adolescent girls and mass media
campaigns. Figure 23: percentage of CBEs conducted
Good
Chandigarh
Delhi
Gujarat
Madhya Pradesh
Telangana
Jharkhand
Rajasthan
Chattisgarh
Uttarakhand
Tamil Nadu
Karnatka
Maharashtra
Jammu and Kashmir
Bihar
Tripura
Himachal Pradesh
Punjab
Goa
Arunanchal Pradesh
Andaman and Nicobar Islands
Kerala
Assam
Lakshadweep
Odisha
Sikkim
West Bengal
Dadra & nagar Haveli
Uttar Pradesh
Andhra Pradesh
Nagaland
Puducherry
Manipur
Mizoram
Meghalaya
Damanand Diu
Haryana
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
89%
76%
4%4%
14%
19%
26%
29%29%30%32%
34%35%35%37%
42%
48%48%49%
55%
58%
64%66%
68%70%69%
80%
AveragepoorNot
Initiated
Percentage of CBEs conducted
April 2018 to April 2019
6.3 Community based Events for Jan
Andolan:
Community Based Events (CBEs) are being
conducted for awareness generation on issues
like care during pregnancy, infant and young
child feeding practices, maternal nutrition etc.
During the third Meeting of National Council on
India’s Nutrition Challenges in November 2018,
it was inter alia decided to conduct two CBEs
each month. In this light, all States/UTs are
organizing CBEs on a regular basis, especially
Godbharaai and Annaprasaan. State-wise
percentage of CBEs conducted during April
2018-April 2019 is mentioned in Figure 23.
-
5
10
15
20
25
30
MAHARASHTRA
ANDHRA PRADESH
GUJARAT
MADHYA PRADESH
CHHATTISGARH
BIHAR
TAMIL NADU
-
200
400
600
800
1,000
1,200
1,400
Activities (In Lakhs)
Participation (In Lakhs)
Figure 22: Top performing States during Poshan Pakhwada
78 • Chandigarh, Delhi, Gujarat, Madhya
Pradesh, Telangana, Jharkhand, Rajasthan,
Chhattisgarh and Uttarakhand performed
well. States/UTs like Tamil Nadu,
Karnataka, Maharahstra, Jammu &
Kashmir, Himachal Pradesh, Punjab, Goa,
Arunachal Pradesh, Kerala, Andaman &
Nicobar Islands and Assam need to improve
in planning and organising theme based
community based event to optimise the
awareness level at targeted beneficiaries
level.
• In addition to this, many States/UTs
conducted various IEC/SBCC/mass media
campaigns on issues like maternal health
and nutrition, infant and young child
feeding practices and menstrual hygiene,
sanitation and hygiene. Jharkhand
developed IEC materials in the form of
posters, leaflets etc. VOs participated in
VHSND, SBM-G and conducted Nukkad
Nataks. Short clip videos on essential health
and nutrition intervention like family
planning, 1000 days window, ANC
check-ups, IFA consumption, institutional
delivery, exclusive breastfeeding,
complementary feeding etc. were
developed. Bihar reported to have
distributed total 20,000 (two pager) leaflets
in 400 blocks and 500 banners, and flip
charts to 35,000 SHGs and conducted
campaign on family dietary diversity
among pregnant and lactating mothers
during the given period. Madhya Pradesh
organized various IEC/SBCC/mass media
campaigns on the promotion of
breastfeeding practices, tiranga thali for diet
diversity, Ratri Chaupal, and radio
messages etc. Uttar Pradesh reported taking
Suposhan Shapath (pledge on nutrition by
children, adolescents and women),
disseminated messages on ‘Sahi Poshan
Desh Roshan’, conducted rangoli designs
specimens on nutrition and sanitation for
SHGs and short films.
Conclusion: NITI Aayog has been consistently
providing technical support to MoWCD and
other line Ministries to leverage their existing
platforms and campaigns to accelerate
POSHAN Abhiyaan. Poshan Maah and
Pakhwada celebrations in the country have set a
positive momentum to make this mission into a
Jan Andolan. It has made an attempt to change
the way people look at nutrition and make it an
intrinsic part of their lives. Many central
government and State government schemes,
such as Swachh Bharat Abhiyaan, DAY-NRLM,
WASH, MAA, Beti Padhao Beti Bachao etc.
played a crucial aspect during Poshan
Pakhwada. This special campaign on POSHAN
Abhiyaan succeeded in creating a special buzz
at all levels, from the national level down to the
village level.
79 CHAPTER 7:
RECOMMENDATIONS
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 81
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 82
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 83
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
84
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
85
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
86 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
ANNEXURES
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 88
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
ANNEXURE 1A:
Second POSHAN Abhiyaan Monitoring Report: Data Collection Form
WCD TEMPLATE
[Kindly fill information as on 31st March, 2019 and share
latest by 20th April, 2019]
1. Name of the State/UT:
2. Total number of Districts in the State:
3. Total number of Blocks in the State:
4. Total number of Villages in the State:
5. Total number of Anganwadi Centers in the State/UT:
6. If UT, does the UT have a State Legislature? Yes || No
SECTION I: GOVERNANCE AND INSTITUTIONAL MECHANISMS
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
SN
INFORMA TION REQUI RED
RESPONSE
A
UTILIZATION O F FUNDS under POSHAN Abhiyaan (2018 - 19)
1.1
1.2
1.3
Utilization of Funds under other related Schemes (2018 - 201 9)
Amount of Funds available from
(2018 - 19) :
Central Govt Share
(in Lakhs)
a. ICDS Scheme
a) Amount of Funds received from GoI
(in lakhs)
b) Funds Earmarked by the State/UT
(in lakhs)
c) Funds utilized at the State/UT level
(in lakhs; as on 31st March 2019) –
Note: Can specify unaudited funds
also
d) % of funds utilised
If any of the above figures is “zero”, give
reasons
State Govt Share
(in Lakhs) 89
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
SN
INFORMA TION REQUI RED
RESPONSE
b. Pradhan Mantri Matryu Vandana Yojna
(PMMVY)
1.4 Provide the amount and % fund utilization for (2018-19):
a. ICDS Scheme
b. Pradhan Mantri Matryu Vandana Yojna
(PMMVY)
1.5 Applied for flexi funds for innovations
and pilot
Yes || No || Not Aware about flexi-
funds
1.6 Has the State/UT Project Management
Unit been established?
Yes || No
1.7 If yes, staff details No. of posts
sanctioned
No. of posts filled
1.8 Has a Convergence Action Plan
Committee been formed at State/UT
level?
Yes || No || In process
1.9 Provide details. No. of Districts in
which Convergence
Action Plan Committee
has been formed
No. of Blocks in which
Convergence Action
Plan Committee has
been formed
1.10 Has State/UT level Resource Group for
ILA training been established?
Yes || No
1.11 Have District level Resource Groups
(DRGs) for ILA training been established?
Yes || No
If yes, provide details
No. of DRGs required
No. of DRGs
established
1.12 Have Block level Resource Groups (BRGs)
for ILA training been established?
Yes || No
If yes, provide details
No. of BRGs required
CONSTITUTION OF COMMITTEES AND RESOURCE GROUPS B 90
SN
INFORMA TION REQUI RED
RESPONSE
No. of BRGs
established
1.13
a) Number of Districts in which the help
desks have been established
at District
level?
b) Number of Districts in which the help
desks have been established
at Block
level?
SECTION II: STRATEGY AND PLANNIN G
SN
INFORMA TION REQUI RED
RESPONSE
A CROSS-SECTO RAL CONVERGENCE
2.1 Has the State/UT level Convergence action
plan been developed?
Yes || No
2.2 Has the State/UT level Convergence action
plan been submitted as part of the Annual
PIP for the year 2019 - 20
Yes || No
If yes, provide details
No. of Districts which
have developed District
Convergence action
plan
No. of Blocks which
have developed Block
Convergence action
plan
91
SECTION III: SERVICE DELIVERY INPUTS
SN
INFORMA TION REQUI RED
RESPONSE
A HUMAN RESOURCE: Provide following details
3.1 a) DPO No. of posts sanctioned
No. of posts filled
3.2 b) CDPO No. of posts sanctioned
No. of posts filled
3.3 c) Lady Supervisor No. of posts sanctioned
No. of posts filled
3.4 d) AWW No. of posts sanctioned
No. of posts filled
3.5 e) AWH No. of posts sanctioned
No. of posts filled
B SUPPLIES
3.6 a) Mobile phones No. required
No. procured
No. configured
No. distributed to
Districts
No. functional at ground
level
3.7 b) SIM cards for mobile phones No. required
No. procured
3.8 c) Data connectivity plans No. of data plans
required
No. of data plans
activated
3.9 Please specify the concerns related to mobile phone functioning at ground level (If any) 92
SN INFORMA TION REQUI RED
RESPONSE
Kindly attach it as an annexure
3.10 Growth Monitoring Devices No.
required
No. procured No. distributed
a) Weighing Scale (Infant)
b) Weighing Scale (adult)
c) Infantometer
d) Stadiometer
C
TRAINING AND CAPA CITY BUILDING
3.11 Has ILA training has been initiated for
State/UT Resource group?
Yes || No
3.12 Has the ILA training been initiated for
the District Resource groups
Yes || No
3.13 If yes, provide the details No. of DRG members to be
trained
No. of DRG members trained
3.14 Provide the details of the ILA training No. of
Modules
No. of LS
trained
No. of AWW
trained
Less than 5
6-10
More than
10
3.15 Has State/UT translated the ILA
modules to ALL the State languages
other than Hindi and English?
Yes || No || NA
3.16 Has State/UT printed the ILA modules
as per the guidelines and specification
given by MWCD?
Yes || No
3.17 Is the State/UT planning to provide ILA
trainings to ASHA workers?
Yes || No
3.18 If yes, specify no. of ASHA s trained till
31
st March, 2019
No. of ASHA s to be trained
No. of ASHA s trained
3.19 Does the State/UTs have access to ICDS-
CAS Dashb oard?
Yes || No 93
SN
INFORMA TION REQUI RED
RESPONSE
3.20 Who at the State/UT level is authorized
to review and use ICDS-CAS dashboard?
3.21 Staff trained on ICDS-CAS
Dashboard/Mobile
Personnel No. to be
trained
No. Trained
DPOs
CDPOs
LSs
AWWs
SECTION IV: PROGRAM ACTIVI TIES AND INTERVENTION COVERAGE
A PROGRAM ACTIVITES
-
ICDS
4.1 Total number of beneficiaries from
1
st
April 2018 to 31
st March 2019.
Pregnant women
Lactating women
Children 6 to <36
months of age
Children 3-6 years of
age
4.2 Data Entry in ICDS-CAS
a) No. of Districts where ICDS-CAS is
functional
b) No. of AWWs who have started
entry in ICDS-CAS
c) No. of AWWs who have completed
beneficiary data in ICDS-CAS
d) No. of AWWs who have used ICDS-
CAS to submit their Monthly
Progress Report through CAS in the
previous month.
4.3 Has State/UT started the process of
providing Incentives to AWW/AWH as
per the MWCD Guidelines?
Yes || No
4.4 If yes, provide the following details
a) Number of workers who received No. of AWW 94
Incentives (till 31st March 2019) No. of AWH
b) Number of Districts received award
for the best performance in the year
2018-19
No. of Districts
4.5
Details of
Communit y Based Events under POSHAN Abhiyaan (held in the month of
March 2019):
a) Percentage of AWCs in State/UTs
that organised community based
events in the month of March
2019
b) Average number of participants
per event
c) Themes covered
4.6
Details on VHSND organised in the Month of March
2019
a) Total no. of VHSND organized in the
State/UT events in the month of
March 2019
No. of VHSNDs
planned
No. of VHSNDs
organized
b) % of villages in State/UT provide
ALL the activities mandated under
VHSND namely:
Antenatal Check-up; Growth
Monitoring of children upto 2 yrs;
Immunization; Supplementary
nutrition; Health and Nutritional
Counselling and Referral
4.7
Take Home Rations/ Food Supplementation under ICDS Program
r
What is the State/UT
policy on frequency and
amount of THR to be
distributed per month
per beneficiary
(please provide details as
attachment if space is
insufficient)
Pregnant
Women
Lactating
Women
Children 6-
36 months
of age
4.8
No. of beneficiaries
who received mandated
THR from 1
st
April 2018
to 31
st
March 2019.
Beneficiary
No. of
beneficiaries who received THR as
mandated
Pregnant
Women
Lactating 95
Women
Children 6-
36 months
of age
4.9 Does fortified foods
being used in
preparation of hot
cooked meals? (eg: Oil,
Salt, Rice, wheat
products)
YES || NO
If yes, in how
many AWCs
4.10
Growth Surveillance and Management: 1st April 2018 to 31st March 2019
a) No. of beneficiaries
who were we ighed:
No. of pregnant
women
No. of children 6-
<36 months
No. of children 3-6
years of age
b) No. of children from
6-59 months who are
Children
Identified
Referred
Treated
Severely Acute
Malnourished
Children (SAM)
Moderately Acute
Malnourished
Children (MAM)
c) No. of malnourished
children who received
increased Supplementary
Nutrition.
Severely Acute
Malnourished
Children (SAM)
Moderately Acute
Malnourished
Children (MAM)
B HOM E VISITS by AWW
4.11 Out of the mandated number of home
visits (as per the home visit planner, or
the home visit scheduler in CAS), the % of
home visits made by AWWs during the
month of March 2019
4.12
4.13 PMMVY scheme during the month of till
March 2019
No. of pregnant
women targeted
No. of pregnant
women benefited as
per the entitlement
4.14 % of home visits to household with young
infant (less than 1 month) to counsel on
%of home visits to household with pregnant
mothers to counsel on
appropriate practices during pregnancy
during the month of March 2019 96
Importance of immediate breastfeeding
March 2019
4.15
%
of home visits to household with infants
(5-6 months of age)
to counsel on
Importance of initiation of
complementary feeding and continued
breastfeeding
March
2019
SECTION V: ADDITIONAL INFORMATION
SN
INFORMA TION REQUI RED
5.1
Specify the main challeng es faced in implementation of POSHAN Abhiyaan at State/UT level
with respect to:
(Provide details as attachment)
(i) ICDS_CAS
(ii) ILA
(iii) HR
(iv) Growth Monitoring Devices
(v) Convergence
(vi) Jan Aandolan/Community based events
(vii) Any other
5.2 Specify the good practices or innovations State/UT has done in the year 2018-19 to improve
the nutrition indicators during the first 1000 days life cycle :
(Provide details as attachment)
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
WCD template
TOTAL-65
1 Governance & Institutional Mechanism 19
1.1 Fund Allocation 4
1 if <25%
% utilized by the State/ UT 2 if 25%-<50%
(as on 31st March 2019 – A. Q1.1 d 3 if 50%-<75%
% 4 if ≥ 75%
1.2 Constitution of Committees 15
and Resource Groups
0 if <25%
% of posts filled in the SPMU – B.Q1.7 1 if 25%-<50%
(No. of posts filled/No. of posts sanctioned) % 2 if 50%-<75%
3 if ≥ 75%
0 if <25%
% of districts where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of districts 3 if ≥ 75%
0 if <25%
% of blocks where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of blocks 3 if ≥ 75%
0 if <25%
% of districts where DRGs have been 1 if 25%-<50%
formed – Q1.11 No. of DRGs established/ 2 if 50%-<75%
No. of DRGs required 3 if ≥ 75%
0 if <25%
% of blocks where BRGs have been formed 1 if 25%-<50%
- Q1.12 No. of BRGs established/ 2 if 50%-<75%
No. of BRGs required 3 if ≥ 75%
97
ANNEXURE 1B:
Second POSHAN Abhiyaan Monitoring Report: Data Collection Form
HEALTH TEMPLATE
[Kindly fill information as on 28th February, 2019
and share latest by 20th April, 2019]
1. Name of the State/UT:
2. Total number of Districts in the State:
3. Total number of Blocks in the State:
4. Total number of Villages in the State:
5. Total number of Anganwadi Centers in the State/UT:
6. If UT, does the UT have a State Legislature? Yes || No
SECTION I: SERVICE DELIVERY ESSENTIALS
SN
INFORMA TION REQUI RED
RESPONSE
A
INFRASTRUC TURE
1.1 Number of Health Facilities in the State/UT
a) CHCs No. sanctioned
No. functional
No. functional as FRU
b) PHCs No. sanctioned
No. functional
c) Additional PHCs No. sanctioned
No. functional
d) Sub Centres No. sanctioned
No. functional
e) Health and Wellness Centres No. sanctioned
No. functional
1.2 Provide details for Health and Wellness Centres (HWCs)
a) Total no. HWCs planned
b) No. of HWCs operational
c) No. of HWCs providing ALL the
proposed services
98
B
HUMAN RESOURCES
1.3 Lady Health Visitor (LHV) No. of posts sanctioned
No. of LHVs in position
ANM No. of posts sanctioned
No. of ANMs in position
ASHA Facilitators Total no. in State/UT
No. of ASHA s per
facilitator
ASHA Total no. of ASHA s
working in State/UTs
No. of villages with one
ASHA
No. of villages with two
or more ASHA
No. of villages without
ASHA
C SUPPLIES INFORMATION FOR THE MONTH OF FEB 2019 (Feb 1 to Feb 28, 2019)
1.4 Number of Districts which reported STOCK-OUT of the following for the month of Feb 2019
(Feb 1 to Feb 28, 2019):
a) IFA Red tablets (adult)
b) Pregnancy detection kit
c) IFA syrup
d) Calcium tablets
e) Albendazole tablets
f) TT injections
g) Any modern contraceptives
(OCPs, condoms etc.)
No. of Districts
reporting stock-out
Specify which items
were stock-out
h) Consumables for anaemia
detection kits
i) Iron-Sucrose injections
j) Oxytocin
k) Oral Misoprostol
l) ORS packets/sachets
m) Zinc syrup/tablets 99
n)
MCP Card
D
TRAINING AND CAPA CITY BUILDING
1.5 Provide the details of the ASHA s
trained in module 6 and 7 which
pertain to Home Based New Born Care
(HBNC) till 28
th
Feb 2019
No. of ASHAs targeted
No. of ASHA trained
1.6 In which year was the last round of
HBNC training conducted in the
State/UT
1.7 Provide details for the Skilled Birth
Attendant (SBA) trainings for ANMs.
No. who have received
SBA training
No. who have received
refresher SBA training
No. of SBA trainings
conducted from 1
st
April
2018 to 28
th
Feb 2019
SECTION II: PROGRAM ACTIVITES AND INTERVENTION COVERAGE
Information is required for ONE YEAR (1
st
April 2018 to 28
th
Feb 2019)
SN
INFORMATION REQUIRED
RESPONSE
A
PROGRAM ACTIVITES- NHM
2.1 Total number of beneficiaries
registered (for the period of 1
st
April
2018 to 28
th
Feb 2019)
Pregnant
women
registered for
ANC
I trimester
II trimester
III trimester
Children 0-59
months of
age
0-6 month
6-59 month
Children 12-
23 months of
age
2.2 Health interventions in first 1000 days
(Provide data for the period of 1st April 2018 to 28
th
Feb 2019)
a)
No. of registered pregnant women
who
Received MCP cards
Had MCP cards filled
b) No. of pregnant women who
registered for ANC in the first
trimester (i.e. in the first 12
weeks of pregnancy)
100
c) No. of pregnant women who
received 4 or more ANC
check-ups
d) No. of pregnant women given
180 IFA tablets
e) No. of pregnant women who had
their weight gain monitored
during pregnancy
f) No. of pregnant women with
adequate weight gain (9-12 kg)
during pregnancy
g) No. of pregnant women given
TT2/booster
h) No. of pregnant women given one
Albendazole tablet after
first trimester
i) No. of pregnant women who
received counselling on birth
preparedness and complication
readiness during pregnancy
j) No. of pregnant women tested
for Haemoglobin 4 or more times
during pregnancy
k) No. of pregnant women detected
to have severe anemia
(Hb level <7 gm%) in any trimester
l) No. of pregnant women detected
with severe anaemia treated
m) No. of high risk pregnancies
identified
n) No. of high risk pregnancies
referred
2.3 Total number of reported deliveries for the period of 1
st
April 2018 to 28
th
Feb 2019
a) No. of home deliveries attended by
Skilled Birth Attendant (SBA)
b) No. of home deliveries attended by
non-SBA/ Trained Birth Attendant
(TBA)
c) No. of institutional deliveries Normal
C-section
2.4 Provide details of live births for the period of 1
st
April 2018 to 28
th
Feb 2019
a) Total no. of live births 101
b) No. of newborns weighed
at birth
c) No. of newborns with weight
less than 2.5 kg at birth
d) No. of new borns breastfed
within one hour of birth
e) No. of newborns who received 6 in case of
mandated Home Based Newborn institutional
Care (HBNC) visits by ASHA* deliveries
7 in case of
home deliveries
2.5 Provided the following details for children 12-59 months of age for the period of
1
st
April 2018 to 28
th
Feb 2019
a) No. of children 12-23 months
completely immunized
b) No. of children 12-23 months
who were provided at least 8 doses
of IFA syrup per month
c) No. of children 12-23 months who
have received at least one dose of
Vitamin A
d) % of children 12-23 months who
received at least one dose of
Albendazole
2.6 Provide the following information for the period of 1
st
April 2018 to 28
th
Feb 2019
a) No. of diarrhea episodes reported
in children 0 to 59 months of age
b) No. of diarrhea episodes reported
in children 0 to 59 months of age
where only ORS was given
c) No. of diarrhea episodes reported
in children 0 to 59 months of age
where both ORS and zinc were
given
SECTION III: ADDITIONAL INFORMATION
SN INFORMATION REQUIRED RESPONSE
3.1 Specify the good practices or innovations State/UT has done in the year 2018-19
to improve the health indicators during the first 1000 days life cycle:
(Provide details as attachment) 102
Annexure 2: Implementation Score Rubric
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
WCD template
TOTAL-65
1 Governance & Institutional Mechanism 19
1.1 Fund Allocation 4
1 if <25%
% utilized by the State/ UT 2 if 25%-<50%
(as on 31st March 2019 – A. Q1.1 d 3 if 50%-<75%
% 4 if ≥ 75%
1.2 Constitution of Committees 15
and Resource Groups
0 if <25%
% of posts filled in the SPMU – B.Q1.7 1 if 25%-<50%
(No. of posts filled/No. of posts sanctioned) % 2 if 50%-<75%
3 if ≥ 75%
0 if <25%
% of districts where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of districts 3 if ≥ 75%
0 if <25%
% of blocks where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of blocks 3 if ≥ 75%
0 if <25%
% of districts where DRGs have been 1 if 25%-<50%
formed – Q1.11 No. of DRGs established/ 2 if 50%-<75%
No. of DRGs required 3 if ≥ 75%
0 if <25%
% of blocks where BRGs have been formed 1 if 25%-<50%
- Q1.12 No. of BRGs established/ 2 if 50%-<75%
No. of BRGs required 3 if ≥ 75%
103
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
2 Strategy and Planning 6
2.1 Cross-sectional convergence 6
Has the State/UT level Convergence
action plan been submitted as part of the Y/N 3 if YES; 0 if NO
Annual PIP for the year 2019-20- Q2.2
% of districts that developed CAP - Q2.2/ 0 if <25%
Total number of districts % 1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
3 Service Delivery & Capacities 31
3.1 HR 5
% of DPO positions filled – Q3.1 – 0.25 if <25%
No. of DPO positions filled/No. of DPO 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of CDPO positions filled - Q3.2 – 0.25 if <25%
No. of CDPO positions filled/No. of CDPO 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of LS positions filled - Q3.3 – No. of 0.25 if <25%
LS positions filled/No. of LS positions % 0.5 if 25%-<50%
sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of AWW positions filled- Q3.4 – No. 0.25 if <25%
of AWW positions filled/No. of AWW 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of AWH positions filled - Q3.5 – No. 0.25 if <25%
of AWH positions filled/No. of AWH 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
104
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
3.2
Supplies
5
Mobile phones
% of mobile phones distributed to districts
- Q3.6 – No. of mobile phones
distributed /No. of mobile phones
required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Growth monitoring devices
Weighing
scale- infant
% distributed to districts- Q3.10 a– No. of
weighing scales-infant distributed /No.
of weighing scales-infant required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Weighing
scale- adult
% distributed to districts Q3.10 b – No. of
weighing scales-adult distributed /No.
of weighing scales-adult required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Infantometer
% distributed to districts Q3.10c – No. of
infantometers distributed /No. of
infantometers required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Stadiometer
% distributed to districts Q3.10 d – No. of
stadiometers distributed /No. of
stadiometers required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
3.3
Training and capacity building
21
% DRGs trained in ILA Q3.13 – No. of
DRGs trained /No. of DRGs to be
trained
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
% of LS trained on 6 or more modules Q3.14 – (No. of LS trained on 6-10
modules + No. of LS trained on 10 or
more modules)/ No. of LS posts filled
(Q3.3c)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
% of AWW trained on 6 or more modules Q3.14
–
(No. of AWW trained on 6
-
10
1 if <25%
2 if 25%
-
<50%
105
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
modules + No. of AWW
trained on 10
or more modules)/ No. of AWW posts filled (Q3.3d)
3 if 50%
-
<75%
4 if ≥ 75%
% DPOs trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of DPOs
trained on ICDS-CAS/ No. of DPO
posts filled (Q3.1a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
%
C
DPOs trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of
CDPOs trained on ICDS-CAS/ No. of
CDPO posts filled (Q3.1b)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
%
LS
trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of
CDPOs trained on ICDS-CAS/ No. of
CDPO posts filled (Q3.1c)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
4
Program activities and intervention coverage
9
4.1
Program activities
-
ICDS
9
% of pregnant women who received THR Q4.8 – No. of pregnant women received THR/ Q4.1 Total number of pregnant women
%
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
% of lactating women who received THR Q4.8 – No. of lactating women received THR/ Q4.1 Total number of lactating women
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
% of children 6-36 months who received THR Q4.8 – No. of 6-36 mo children received THR/ Q4.1 Total number of 6-36 mo children
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
Health template
TOTAL
-
35
106
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
1
Service delivery essentials
17
1.1
Infrastructure
4
% of sub-centres functional -Q1.1 d No.
of sub-centers functional/No. of sub-
centers sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
% of CHCs functional--Q1.1 a No. of
CHCs functional/No. of CHCs
sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
1.2
Human Resource
3
% of LHV posts filled -Q1.3 No. of
LHVs in position/No. of LHV posts
sanctioned
0 if <25%
0.5 if 25%-<50%
1 if 50%-<75%
1.5 if ≥ 75%
% of ANM posts filled- Q1.3 No. of
ANMs in position/No. of ANM posts
sanctioned
0 if <25%
0.5 if 25%-<50%
1 if 50%-<75%
1.5 if ≥ 75%
1.3
Stock out
6
% districts that reported stock
-
out of IFA
red tablets in the month of Feb 2019 -
Q1.4 a No. of IFA tablets stock-out
districts/Total number of districts in the
state (Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
% districts that reported stock
-
out of TT
injections in the month of Feb 2019--
Q1.4 f No. of TT injection stock-out
districts/Total number of districts in the
state (Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
% districts that reported stock
-
out of
albendazole in the month of Feb 2019 -- Q1.4 e No. of
albendazole
stock
-
out
2 if <25%
1.5 if 25%-<50% 1 if 50%
-
<75%
107
Rubric
Theme
Sub- Theme
Sub Sub- Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
districts/Total number of districts in the state (Q2)
0.5 if ≥ 75%
1.4
Training and capacity building
4
% of ASHAs training on HBNC modules 6 and 7-- Q1.5 No. of ASHAs
trained/Total number of ASHAs in the
state (QB1.3)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
2
Program activities and intervention coverage
18
2.1
Program activities
18
% of newborns weighed at birth – Q2.4b
No. of newborns weighed at birth/Total
number of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of newborns breastfed within one hour of birth- Q2.4d No. of newborns
breastfed immediately after birth/Total
number of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) fully
immunized- Q2.5a No. of children 12-2
3
months completely immunized /Total number of 12
-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who were
provided at least 8 IFA syrup per month--
Q2.5b No. of children 12-23 months
who were provided at least 8 doses of
IFA syrup per month /Total number of
12
-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who have
received at least one dose of Vitamin A--
Q2.5c No. of children 12-23 months
who have received at least one dose of
Vitamin A
/Total number of 12
-
23 mo
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75% 108
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
old children (Q2.1)
% of children (12-23) who have received
at least one dose of Albendazole -- Q2.5d
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
109
Health template TOTAL-35
1
Service delivery esse ntials
17
1.1
Infrastructure
4
% of sub-centres functional -Q1.1 d No. of
sub-centers functional/No. of sub- centers
sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
% of CHCs functional-Q1.1 a No. of CHCs
functional/No. of CHCs sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
1.2
Human Resource
3
% of LHV posts filled -Q1.3 No. of LHVs in
position/No. of LHV posts sanctioned
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of ANM posts filled- Q1.3 No. of ANMs in
position/No. of ANM posts sanctioned
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of villages with ASHA posts vacant – Q1.3
No. of villages without ASHA/ Q4 Total
number of villages in the State
1 if < 25%
0.75 if 25%-<50%
0.5 if 50%-<75%
0.25 if ≥ 75%
1.3
Stock out
6
%
District
s that reported stock
-
out of IFA red
tablets in the month of Feb 2019 - Q1.4 a No.
of IFA tablets stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
%
District
s that reported stock
-
out of TT
injections in the month of Feb 2019-- Q1.4 f
No. of TT injection stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
%
District
s that reported stock
-
out of
albendazole in the month of Feb 2019 -- Q1.4
e No. of albendazole stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
110
1.4
Training and capacity building
4
% of ASHAs training on HBNC modules 6 and
7-- Q1.5 No. of ASHAs trained/Total number
of ASHAs in the State (QB1.3)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
2
Program activities and intervention coverage
18
2.1
Program activities
18
% of newbo rns weighed at birth – Q2.4b No.
of newborns weighed at birth/Total number
of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of newbo rns breastfed within one hour of birth- Q2.4d No. of newborns breastfed
immediately after birth/Total number of live
births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) fully immunized
-
Q2.5a No. of children 12-23 months
completely immunized /Total number of 12-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who were
provided at least 8 IFA syrup per month--
Q2.5b No. of children 12-23 months who
were provided at least 8 doses of IFA syrup
per month /Total number of 12-23 mo old
children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo
old) who have
received at least one dose of Vitamin A--
Q2.5c No. of children 12-23 months who
have received at least one dose of Vitamin A
/Total number of 12-23 mo old children
(Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12-23) who have received at
least one dose of Albendazole -- Q2.5d
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
111
<25%
25-<50%
50-<75%
≥75%
Annexure 3
Table 3: Coverage of health interventions during pregnancy and delivery-CNNS Data
State
Pregnancy
Delivery & Postnatal
Any ANC
ANC in 1st
trimester
4 or more ANC
Received MCP
card
Blood pressure
measured
Urine sample
taken
Blood sample
taken
Abdomen
examined
TT injection
Institutional birth
Skilled birth
attendant
Postnatal care for
babies
India
81
58
47
72
67
67
67
67
87
80
83
62
Andhra Pradesh
89
75
48
85
88
88
88
88
88
83
86
87
Arunachal Pradesh
70
40
32
61
66
63
63
56
77
62
64
55
Assam
86
60
36
85
85
81
82
80
83
73
76
86
Bihar
68
42
20
54
35
37
36
37
91
69
76
28
Chhattisgarh
86
63
56
80
81
77
79
80
91
72
77
75
Delhi
93
72
72
61
90
88
88
90
94
83
86
73
Goa
97
89
92
84
96
96
95
95
98
97
99
95
Gujarat
82
70
69
85
80
78
80
80
90
94
95
89
Haryana
81
60
45
75
78
77
77
77
89
78
81
73
Himachal Pradesh
94
81
66
85
91
90
90
91
94
75
80
82
Jammu & Kashmir
95
85
81
85
92
94
93
92
87
87
89
90
Jharkhand
83
60
33
69
57
56
51
54
90
63
72
40
Karnataka
94
81
87
76
92
91
91
91
91
94
91
88
Kerala
99
95
95
58
99
98
98
99
96
99
100
97
Madhya Pradesh
84
53
38
75
70
64
71
64
90
76
80
40
Maharashtra
94
78
83
87
93
92
92
93
95
89
94
95
Manipur
82
68
59
30
80
77
78
77
85
62
67
60
112
State
Pregnancy
Delivery & Postnatal
Any ANC
ANC in 1st
trimester
4 or more ANC
Received MCP
card
Blood pressure
measured
Urine sample
taken
Blood sample
taken
Abdomen
examined
TT injection
Institutional birth
Skilled birth
attendant
Postnatal care for
babies
Meghalaya
81
48
46
74
77
75
74
77
80
44
50
63
Mizoram
85
54
53
73
82
68
79
79
83
81
83
71
Nagaland
55
28
14
26
40
35
38
45
68
32
46
27
Odisha
96
70
70
90
92
87
89
86
95
83
87
86
Punjab
81
76
46
74
80
80
80
79
90
90
95
91
Rajasthan
79
52
40
71
72
73
73
74
87
85
88
71
Sikkim
93
72
50
89
91
92
91
88
95
95
96
89
Tamil Nadu
95
82
84
87
94
94
94
94
75
98
99
92
Telangana
96
87
67
84
95
95
95
95
91
93
96
98
Tripura
66
42
54
52
63
64
63
60
87
80
84
74
Uttar Pradesh
62
35
16
59
33
34
34
37
79
72
75
34
Uttarakhand
95
77
49
82
78
81
81
86
92
76
78
60
West Bengal
94
54
74
86
93
92
91
87
87
89
90
82
Source: Comprehensive Nati onal Nu trition Survey, 2016-18. 113
<25%
25-<50%
50-<75%
≥75%
Table 4: Coverage of health and nutrition interventions during pregnancy, lactation, and early childhood-CNNS Data
State
Pregnancy
Lactation
Received benefits for child from AWC
Received IFA
Consumed 100+
IFA
Weighing
Breastfeeding
counselling
Food
supplementation
Health & nutrition
education
Food
supplementation
Health & nutrition
education
Food
supplementation
(at least once a
week)
Weighing (at least
once in 3 months)
Counselling on
child growth
(among those who
weighed)
India
73
27
69
38
52
35
49
33
42
60
48
Andhra Pradesh
83
47
89
68
85
81
86
81
72
90
51
Arunachal Pradesh
70
12
65
9
9
3
9
2
24
27
31
Assam
86
24
86
65
58
31
63
31
15
72
32
Bihar
50
5
42
16
33
12
31
13
14
43
44
Chhattisgarh
86
30
82
54
81
65
76
62
61
90
54
Delhi
87
47
89
41
18
16
15
12
61
43
43
Goa
94
75
96
55
81
55
82
54
23
77
42
Gujarat
84
36
80
57
59
54
52
47
18
90
55
Haryana
78
29
78
32
31
25
28
21
47
67
30
Himachal Pradesh
92
43
89
38
86
38
83
35
30
57
32
Jammu & Kashmir
76
11
89
41
23
10
13
7
60
58
41
Jharkhand
72
18
68
37
71
31
69
33
18
71
45
Karnataka
88
53
91
54
74
56
74
59
33
79
36
Kerala
98
85
98
38
46
22
36
16
25
77
32 114
State
Pregnancy
Lactation
Received benefits for child from AWC
Received IFA
Consumed 100+
IFA
Weighing
Breastfeeding
counselling
Food
supplementation
Health & nutrition
education
Food
supplementation
Health & nutrition
education
Food
supplementation
(at least once a
week)
Weighing (at least
once in 3 months)
Counselling on
child growth
(among those who
weighed)
Madhya Pradesh
80
20
72
34
78
50
72
48
61
84
62
Maharashtra
84
53
93
56
49
38
45
35
42
85
47
Manipur
73
24
80
10
32
3
29
2
4
13
20
Meghalaya
74
40
78
44
61
43
58
40
55
68
48
Mizoram
77
50
82
32
68
43
62
40
79
71
23
Nagaland
39
2
38
7
13
1
9
0
2
10
13
Odisha
92
31
95
65
90
81
90
75
48
84
58
Punjab
86
38
79
49
48
35
39
31
33
52
48
Rajasthan
62
22
73
30
43
28
37
23
47
44
42
Sikkim
90
48
91
56
47
38
45
36
17
77
72
Tamil Nadu
92
56
94
60
58
43
59
45
38
73
43
Telangana
91
57
95
59
75
70
77
72
66
77
51
Tripura
83
19
64
42
65
43
58
41
85
60
36
Uttar Pradesh
56
10
32
15
26
11
24
9
23
57
41
Uttarakhand
81
27
78
46
76
59
80
59
25
86
61
West Bengal
86
Dewormin
93
54
62
46
54
40
91
77
48
Source: Comprehensive Nati onal Nu trition Survey, 2016-18. 115
<25% 25-<50% 50-<75% ≥75%
State/UT % of infant weighing
scales distributed
% of adult weighing
scales distributed
% of infantometers
distributed
% of stadiometers
distributed
Large States
Andhra Pradesh 100 100 100 100
Assam 0 0 0 0
Bihar 87 80 26 86
Chhattisgarh 47 49 1 8
Gujarat 0 0 0 0
Haryana 0 0 0 0
Himachal Pradesh 42 42 42 42
Jammu & Kashmir 93 93 93 93
Jharkhand 51 51 51 51
Karnataka 0 0 0 0
Kerala 0 0 0 0
Madhya Pradesh 0 100 100 100
Maharashtra 73 77 82 78
Punjab 0 0 0 0
Rajasthan 0 35 51 51
Tamil Nadu 34 34 34 34
Telangana 0 0 0 0
Uttar Pradesh 0 0 0 0
Uttarakhand 100 100 100 100
Small States
Arunachal Pradesh 0 0 0 0
Goa 0 0 0 0
Manipur 0 0 0 0
Meghalaya 100 100 100 100
Mizoram 100 68 100 100
Nagaland 100 100 100 100
Sikkim 0 0 0 0
Tripura 13 13 13 13
Union Territories
Andaman & Nicobar 0 0 0 0
Chandigarh 100 100 100 100
Dadra & Nagar Haveli 100 100 100 100
Daman & Diu 100 100 100 100
Delhi 0 -- -- --
Lakshadweep 0 0 0 100
Puducherry 100 100 100 100
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog,
May 2019
Table 5: Availability of growth monitoring instruments at Anganwadi centers across States 116
Table 6: Availability of mobile devices and technology support across States
State
Mobile Hardware Technology support
Procurement
(%)
Distribution (%) District helpdesk
(%)
Block helpdesk
(%)
Large States
Andhra Pradesh 100 100 23 2
Assam 0 0 0 0
Bihar 38 38 16 1
Chhattisgarh 52 19 44 5
Gujarat 0 0 97 99
Haryana 0 0 19 0
Himachal Pradesh 39 39 0 0
Jammu & Kashmir 2 2 0 0
Jharkhand 30 28 29 4
Karnataka 0 0 0 0
Kerala 0 0 0 0
Madhya Pradesh 29 29 29 38
Maharashtra 23 0 100 7
Punjab 0 0 0 0
Rajasthan 34 33 100 11
Tamil Nadu 34 32 34 34
Telangana 29 29 0 0
Uttar Pradesh 31 30 0 0
Uttarakhand 100 35 0 0
Small States
Arunachal Pradesh 0 0 0 0
Goa 100 100 0 0
Manipur 22 0 0 --
Meghalaya 100 100 0 0
Mizoram 95 62 63 70
Nagaland 100 0 0 0
Sikkim 61 0 100 100
Tripura 0 0 0 0
Union Territories
Andaman & Nicobar 100 0 100 60
Chand igarh 100 0 0 0
Dadra & Nagar Haveli 100 92 0 0
Daman & Diu 100 90 100 0
Delhi 96 0 0 0
Lakshadweep 86 86 0 0
Puducherry 91 91 0 0
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
<25% 25-<50% 50-<75% ≥75% 117
Table 7: Training of ICDS functionaries on ICDS-CAS dashboard/mobile use
State
% of DPOs
trained
% of CDPOs
trained
% of LS trained % of AWWs trained
Large States
Andhra Pradesh 77 76 100 88
Assam 6 1 0 0
Bihar 18 22 15 12
Chhattisgarh 58 71 57 23
Gujarat 0 0 0 0
Haryana 0 0 0 0
Himachal Pradesh 0 0 6 --
Jammu & Kashmir 0 0 0 0
Jharkhand 100 100 16 17
Karnataka 0 0 0 0
Kerala 29 0 1 0
Madhya Pradesh 30 27 28 29
Maharashtra 0 0 0 0
Punjab -- 6 1 --
Rajasthan 27 59 16 32
Tamil Nadu 100 100 100 100
Telangana 32 32 29 31
Uttar Pradesh 42 38 -- 8
Uttarakhand 0 0 43 2
Small States
Arunachal Pradesh 0 0 0 0
Goa NA 64 100 0
Manipur 0 0 0 0
Meghalaya 20 28 50 0
Mizoram 0 100 63 68
Nagaland 0 0 0 0
Sikkim 0 0 60 63
Tripura 0 0 0 0
Union Territories
Andaman & Nicobar NA 0 8 0
Chand igarh NA 100 100 100
Dadra & Nagar Haveli NA 100 100 100
Daman & Diu NA 100 100 100
Delhi -- -- -- --
Lakshadweep 0 0 0 0
Puducherry 100 0 NA 100
Source : Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
<25% 25-<50% 50-<75% ≥75% 118
<25% 25-<50% 50-<75% ≥75%
Table 8: Training of ICDS supervisors and frontline workers on incremental learning
approach modules
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
State % of Lady Supervisors trained
on 6 or more ILA modules
% of Anganwadi workers trained
on 6 or more ILA modules
Large States
ANDHRA PRADESH 100 100
ASSAM 0 0
BIHAR 84 64
CHATTISGARH 98 100
GUJARAT 80 83
HARYANA 0 0
HIMACHAL PRADESH 24 16
JAMMU & KASHMIR 0 0
JHARKHAND 0 0
KARNATAKA 0 0
KERALA 0 0
MADHYA PRADESH 100 98
MAHARASTRA 0 0
PUNJAB 0 0
RAJASTHAN 100 99
TAMIL NADU 100 100
TELANGANA 0 0
UTTAR PRADESH 87
UTTARANCHAL 90 57
Small States
ARUNACHAL PRADESH 0 0
GOA 0 0
MANIPUR 0 0
MEGHALAYA 100 64
MIZORAM 100 100
NAGALAND 0 0
SIKKIM 90 100
TRIPURA 0 0
Union Territories
ANDAMAN & NICOBAR ISLANDS 0 0
CHANDIGARH 100 100
DADR A & NAGAR HAVELI 100 100
DAMAN & DIU 100 100
DELHI 95 100
LAKSHADWEEP 0 0
PUDUCHERRY 0 119
<25% 25-<50% 50-<75% ≥75%
Table 9: Convergence-related activities by State
State % of Districts with
convergence
action plan
committees
% of blocks with
convergence action
plan committees
% of Districts
with
convergence
action plans
% of blocks with
convergence
action plans
Large States
ANDHRA PRADESH
100 100 77 79
ASSAM 0 0 --
BIHAR 100 100 --
CHATTISGARH 100 100 100 100
GUJARAT 79 82 27 0
HARYANA 100 100 --
HIMACHAL PRADESH
100 100 42 44
JAMMU & KASHMIR 41 49 23 21
JHARKHAND 100 86 67 34
KARNATAKA --
KERALA 0 0 --
MADHYA PRADESH 98 100 98 100
MAHARASTRA
100 100 --
PUNJAB 100 100 100 100
RAJASTHAN 100 100 0 --
TAMIL NADU 34 34 0 --
TELANGANA 3 0 --
UTTAR PRADESH 100 100 100 100
UTTARANCHAL
100 100 100 100
Small States
ARUNACHAL PRADESH 84 100 --
GOA 100 100 --
MANIPUR 100 61 --
MEGHALAYA 27 89
MIZORAM
100 100 4
NAGALAND 100 81 100 81
SIKKIM 100 100 100 100
TRIPURA 100 97 --
Union Territories
ANDAMAN & NICOBAR
ISLANDS
100 100 100 100
CHANDIGARH
100 100 100 0
DADR A & NAGAR
HAVELI
100 100 100 120
State % of Districts with
convergence
action plan
committees
% of blocks with
convergence action
plan committees
% of Districts
with
convergence
action plans
% of blocks with
convergence
action plans
DAMAN & DIU 100 100 100 0
DELHI 91 100 --
LAKSHADWEEP
100 100 --
PUDUCHERRY 100 100 --
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May
2019
ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker
BRG Block Resource Group
C2IQ Coverage, Continuity, Intensity, Quality
CAS Common Application Software
CAP Convergence Action PLan
CBE Community Based Event
CDPO Child Development Project Officer
CHC Community Health Center
CNNS Comprehensive National Nutrition Survey
DAY- NRLM Deendayal Antyodaya Yojana – National Rural Livelihoods Mission
DRG District Resource Group
DWS Drinking Water and Sanitation
EBF Early Breast Feeding
H&FW Health & Family Welfare
HR Human Resource
ICDS Integrated Child Development Scheme
IEC Information, Education and Communication
IFA Iron and Folic Acid
IFPRI International Food Policy Research Institute
ILA Integrated Learning Approach
LBW Low Birth Weight
LS Lady Supervisor
MAM Moderate Acute Malnutrition
NFHS National Family Health Survey
NHM National Health Mission
PFMS Public Financial Management System
PHC Primary Health Center
PMMVY Pradhan Mantri MatruVandanaYojana
PMO Prime Minister’s Office
POSHAN Prime Minister’s Overarching Scheme for Holistic Nourishment
RD Rural Development
SAM Severe Acute Malnutrition
SBCC Social and Behavioral Change Communication
SPMU State Project Management Unit
SHG Self Help Group
SNRC State Nutrition Resource Centre
TSU Technical Support Unit
UT Union Territory
VHSND Village Health Sanitation Nutrition Day
WCD Women and Child Development
ABBREVIATIONS
2 TABLE OF CONTENTS
3
Chapter Content
Chapter 1 Introduction and Outline of POSHAN Abhiyaan
Policy initiatives in Nutrition and Allied Sectors
Chapter 2 Methodology
- Implementation Score
- Computation of Scores
- Process
Chapter 3 Nutrition intervention coverage and OVERALL implementation SCOREs of
States and Union Territories for POSHAN Abhiyaan
Chapter 4
Chapter 5
Chapter 6 Jan Aandolan
Chapter 7 Recommendations
- Coverage of Nutrition Specific Interventions: CNNS data
- Governance and Institutional Mechanism
- Strategy and Planning
- Service Delivery & Capacities
- Programme Activities and Intervention Coverage
Scaling up POSHAN Abhiyaan by delivering core interventions at scale to ensure
Coverage, Continuity, Intensity and Quality - C
2
IQ
Theory of Change for POSHAN Abhiyaan
- Inputs for POSHAN Abhiyaan
- Technology
- Training
- Convergence
- Jan Andolan
Multi-Sectoral convergence and Policy action
- At National Level
- At State level LIST OF FIGURES
4
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
List of Tables
Table 1 Implementation score themes for WCD and Health Department
Table 2 Categorization of States
List of Boxes
BOX 1
BOX 2
BOX 3
BOX 4
BOX 5
BOX 6
Targets of the POSHAN Abhiyaan
Pillars of POSHAN Abhiyaan
Key Government Initiatives in Nutrition and Allied sectors
Important Policy Actions under the ambit of POSHAN Abhiyaan
Trend in number of beneficiary registration Vs payment of instalment (PMMVY)
Trend of beneficiary registration (all India progress) (PMMVY)
Reported utilization of money (PPMVY)
Average minimum dietary diversity score (PPMVY)
Critical c omponents for the evaluation implementation of the POSHAN Abhiyaan
Coverage of a selected set of nutrition interventions in India, CNNS (2016-18)
Overall Implementation Status - National Picture
Governance & Institutional Mechanism: WCD Department-Large States
Governance & Institutional Mechanism: WCD Department- Small States
Governance & Institutional Mechanism: WCD Department- UTs
Service Delivery and Capacity- WCD Department
Service Delivery and Capacity-Health Department
Program activities and intervention coverage-WCD Department
Program activities and intervention coverage- Health Department
Interventions in POSHAN Abhiyaan
Trend of HR vacancy at different level under ICDS in last one year
Participation of the Community during Poshan Maah and Poshan Pakhwada
Top performing States during Poshan Pakhwada
Percentage of CBEs conducted
Steps to generate the implementation score
Challenges reported by State/UT Governments on strengthening inputs needed to
implement POSHAN Abhiyaan actions
State-level challenges related to strengthening technology in the context of
POSHAN Abhiyaan
Challenges reported by States in relation to strengthening training for POSHAN Abhiyaan
Challenges reported by States related to establishing processes related to convergent action
planning
Challenges reported by the States in relation to Jan Andolan EXECUTIVE SUMMARY Background:
POSHAN Abhiyaan is an overarching umbrella
scheme to improve the nutritional outcomes for
children, pregnant women and lactating mothers
by holistically addressing the multiple
determinants of malnutrition and attempts to
prioritize the efforts of all stakeholders on a
comprehensive package of intervention and
services targeted on the first 1000 days of a
child’s life. It seeks to do so through an
appropriate governance structure by leveraging
and intensifying the implementation of existing
programs across multiple Ministries while at the
same time trying to rope in the expertise and
energies of a whole range of other stakeholders –
State Governments, Communities, Think tanks,
Philanthropic Foundations and other Civil
Society Actors. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia among
children (and young females) by 3 percentage
points per annum. It is based on 4 pillars:
• Ensuring access to quality services
across the continuum of care to every
woman and child; particularly during the
first 1000 days of the child’s life.
• Ensuring convergence of multiple
programs and schemes: ICDS, PMMVY,
NHM (with its sub components such as
JSY, MCP card, Anaemia Mukt Bharat,
RBSK, IDCF, HBNC, HBYC, Take Home
Rations), Swachh Bharat Mission, National
Drinking water Mission, NRLM etc.
• Leveraging technology (ICDS-CAS) to
empower the frontline worker with near
real time information to ensure prompt and
preventive action; rather than reactive one.
• Jan Andolan: Engaging the community in
this Mission to ensure that it transcends the
contours of being a mere Government
programme into a peoples’ movement
inducing large scale behaviour change with
the ownership of the efforts being vested in
the community rather than government
delivery mechanisms.
NITI Aayog is in the vanguard of shaping the
contours of the POSHAN Abhiyaan – right from
the conceptualization stage right up to the
execution stage. Vice Chairman, NITI Aayog
Chairs the National Council charged with the
responsibility of steering the Abhiyaan. Moreover,
as per the POSHAN Abhiyaan Guidelines NITI
Aayog has been mandated with the responsibility
of preparing bi-annual Reports to apprise the
Hon’ble Prime Minister with the progress of the
campaign. This is the Second Report on the status
of implementation of the POSHAN Abhiyaan.
Like the previous report, it assesses the readiness/
preparedness of the States and Union Territories to
effectively implement the Abhiyaan. Two major
departures from the last Report are worth noting:
(1) that the preparedness of State Health
Departments (weightage 35%) has been assessed
in addition to the Women and Child Departments
(weightage 65%) unlike last time when only WCD
preparedness was assessed; and (2) We have made
use of the Comprehensive National Nutrition
Survey (CNNS) data to take stock of State wise
coverage of key interventions as also look at the
outcome variables of interest, viz. Stunting,
Wasting, Underweight and Anaemia prevalence.
The sub-set of questions used in the State/
Ministry Response Forms was selected to ensure
continuity with the previous report (Annexure
1a and b) while adding more information
regarding additional aspects of the Abhiyaan.
The Implementation Scores reflected in the
present Report measures the readiness of the
States/UTs to effectively implement and execute
the POSHAN Abhiyaan. It is further grouped
6
under categories which are considered to be
critical for the effective execution of the POSHAN
Abhiyaan: 1. Governance and Institutional
Mechanism; 2. Strategy and Planning; 3. Service
Delivery and Capacities and 4. Programme
Activities and Intervention Coverage. An overall
composite score was created combining all the
four themes to examine the implementation
capabilities of States. Data provided by the States
was digitized, post which weights were assigned
to indicators chosen for the preparedness score in
consultation with Experts. Once the weights were
assigned, subtotals were computed for each
domain. Finally, all the subtotals were summed up
to create the final score. A detail of the rubric is
placed at Annexure 2. It may also not be out of
place to mention that the data reported was
validated and the scores were subjected to a
thorough peer review by our technical partners,
International Food Policy Research Institute
(IFPRI) to ensure the validity of the calculations
arrived at by Technical Support Unit (TSU) of
NITI Aayog.
State of Implementation of the Abhiyaan in
States:
Before we proceed to present our take on the
status of implementation of POSHAN Abhiyaan
in the States and UTs, it would be useful to take
note of the outcome and coverage indicators of
high priority interventions as revealed by the
Comprehensive National Nutrition Survey
(CNNS) conducted by MoHFW in association
with UNICEF. Admittedly the survey
pre-dates the launch of the Abhiyaan, none the
less it holds important lessons for our strategy to
implement this Mission. So far the latest survey
data available regarding outcomes of interest
(stunting, wasting, underweight & Anaemia
prevalence) was NFHS-4 which carries
information relating to the period 2015-16.
Fortunately, we now have authoritative
household level survey data representative at the
State level from CNNS, conducted during the
period 2016-18 and covering more than 110,000
households spread across the country. It
provides the most updated data on the
prevalence, coverage and continuity of a set of
key nutrition and health interventions for India’s
States. We may consider this data as providing
insight into baseline prevalence of the status of
nutritional indicators that have a bearing upon
the POSHAN Abhiyaan and can help States in
finalizing their strategies for pacing their efforts
in obtaining the desired outcomes as well as
targets for intervention coverage.
Although can’t strictly compare, but CNNS showed
stunting decline has accelerated to 1.8 % points per
annum which is almost double of the 0.9 % point
per annum prevailing in the previous decade
(2005-06 to 2015-16); (Figure A). This is perhaps
due to a range of programmes implemented by the
Government in the areas of health, nutrition and
sanitation over the last few years. We are not
comparing the Anaemia prevalence declines due to
reasons mentioned in the note below Figure A.
Overall, the story that emerges from the CNNS is
that even before the launch of the POSHAN
Abhiyaan we have nearly reached or exceeded the
targets that we have set for ourselves in view of the
multiple efforts by the Government of India under
the NHM, ICDS and SBM campaigns.
7
Background:
POSHAN Abhiyaan is an overarching umbrella
scheme to improve the nutritional outcomes for
children, pregnant women and lactating mothers
by holistically addressing the multiple
determinants of malnutrition and attempts to
prioritize the efforts of all stakeholders on a
comprehensive package of intervention and
services targeted on the first 1000 days of a
child’s life. It seeks to do so through an
appropriate governance structure by leveraging
and intensifying the implementation of existing
programs across multiple Ministries while at the
same time trying to rope in the expertise and
energies of a whole range of other stakeholders –
State Governments, Communities, Think tanks,
Philanthropic Foundations and other Civil
Society Actors. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia among
children (and young females) by 3 percentage
points per annum. It is based on 4 pillars:
• Ensuring access to quality services
across the continuum of care to every
woman and child; particularly during the
first 1000 days of the child’s life.
• Ensuring convergence of multiple
programs and schemes: ICDS, PMMVY,
NHM (with its sub components such as
JSY, MCP card, Anaemia Mukt Bharat,
RBSK, IDCF, HBNC, HBYC, Take Home
Rations), Swachh Bharat Mission, National
Drinking water Mission, NRLM etc.
• Leveraging technology (ICDS-CAS) to
empower the frontline worker with near
real time information to ensure prompt and
preventive action; rather than reactive one.
• Jan Andolan: Engaging the community in
this Mission to ensure that it transcends the
contours of being a mere Government
programme into a peoples’ movement
inducing large scale behaviour change with
the ownership of the efforts being vested in
the community rather than government
delivery mechanisms.
NITI Aayog is in the vanguard of shaping the
contours of the POSHAN Abhiyaan – right from
the conceptualization stage right up to the
execution stage. Vice Chairman, NITI Aayog
Chairs the National Council charged with the
responsibility of steering the Abhiyaan. Moreover,
as per the POSHAN Abhiyaan Guidelines NITI
Aayog has been mandated with the responsibility
of preparing bi-annual Reports to apprise the
Hon’ble Prime Minister with the progress of the
campaign. This is the Second Report on the status
of implementation of the POSHAN Abhiyaan.
Like the previous report, it assesses the readiness/
preparedness of the States and Union Territories to
effectively implement the Abhiyaan. Two major
departures from the last Report are worth noting:
(1) that the preparedness of State Health
Departments (weightage 35%) has been assessed
in addition to the Women and Child Departments
(weightage 65%) unlike last time when only WCD
preparedness was assessed; and (2) We have made
use of the Comprehensive National Nutrition
Survey (CNNS) data to take stock of State wise
coverage of key interventions as also look at the
outcome variables of interest, viz. Stunting,
Wasting, Underweight and Anaemia prevalence.
The sub-set of questions used in the State/
Ministry Response Forms was selected to ensure
continuity with the previous report (Annexure
1a and b) while adding more information
regarding additional aspects of the Abhiyaan.
The Implementation Scores reflected in the
present Report measures the readiness of the
States/UTs to effectively implement and execute
the POSHAN Abhiyaan. It is further grouped
under categories which are considered to be
critical for the effective execution of the POSHAN
Abhiyaan: 1. Governance and Institutional
Mechanism; 2. Strategy and Planning; 3. Service
Delivery and Capacities and 4. Programme
Activities and Intervention Coverage. An overall
composite score was created combining all the
four themes to examine the implementation
capabilities of States. Data provided by the States
was digitized, post which weights were assigned
to indicators chosen for the preparedness score in
consultation with Experts. Once the weights were
assigned, subtotals were computed for each
domain. Finally, all the subtotals were summed up
to create the final score. A detail of the rubric is
placed at Annexure 2. It may also not be out of
place to mention that the data reported was
validated and the scores were subjected to a
thorough peer review by our technical partners,
International Food Policy Research Institute
(IFPRI) to ensure the validity of the calculations
arrived at by Technical Support Unit (TSU) of
NITI Aayog.
State of Implementation of the Abhiyaan in
States:
Before we proceed to present our take on the
status of implementation of POSHAN Abhiyaan
in the States and UTs, it would be useful to take
note of the outcome and coverage indicators of
high priority interventions as revealed by the
Comprehensive National Nutrition Survey
(CNNS) conducted by MoHFW in association
with UNICEF. Admittedly the survey
pre-dates the launch of the Abhiyaan, none the
less it holds important lessons for our strategy to
implement this Mission. So far the latest survey
data available regarding outcomes of interest
(stunting, wasting, underweight & Anaemia
prevalence) was NFHS-4 which carries
information relating to the period 2015-16.
Fortunately, we now have authoritative
household level survey data representative at the
State level from CNNS, conducted during the
period 2016-18 and covering more than 110,000
households spread across the country. It
provides the most updated data on the
prevalence, coverage and continuity of a set of
key nutrition and health interventions for India’s
States. We may consider this data as providing
insight into baseline prevalence of the status of
nutritional indicators that have a bearing upon
the POSHAN Abhiyaan and can help States in
finalizing their strategies for pacing their efforts
in obtaining the desired outcomes as well as
targets for intervention coverage.
Although can’t strictly compare, but CNNS showed
stunting decline has accelerated to 1.8 % points per
annum which is almost double of the 0.9 % point
per annum prevailing in the previous decade
(2005-06 to 2015-16); (Figure A). This is perhaps
due to a range of programmes implemented by the
Government in the areas of health, nutrition and
sanitation over the last few years. We are not
comparing the Anaemia prevalence declines due to
reasons mentioned in the note below Figure A.
Overall, the story that emerges from the CNNS is
that even before the launch of the POSHAN
Abhiyaan we have nearly reached or exceeded the
targets that we have set for ourselves in view of the
multiple efforts by the Government of India under
the NHM, ICDS and SBM campaigns. 0
10
20
30
40
50
60
70
80
90
100
38.4
21
35.7
59
34.7
17.3
33.4
41*
Figure A: Progress in reducing undernutrition
NFHS - 4 (2015-16) CNNS (2016-18)
StuntingWasting Underweight Anaemia
[* Prevalence of anaemia was estimated from children in the age group 1-4 years measured using gold standard methods. The two
figures are not comparable since they are arrived by using different methods of drawing blood samples to assess Hb levels]
0
10
20
30
40
50
60
70
80
90
100
Percentage
breastfed within
one hour of birth
Percentage with
minimum dietary
diversity
Percentage with
minimum meal
frequency
Percentage with
minimum
acceptable diet
41.5
22
35.9
9.6
56.6
21
41.9
6.4
Figure B: Infant and Young Child Feeding (IYCF) Indicators
NFHS 4 (2015-2016) CNNS (2016-16)
8 Children need age-specific adequate nutrition of
acceptable quality and quantity to prevent
malnutrition, therefore, infant and young child
feeding (IYCF) practices from CNNS data is
also considered to provide the complete
depiction. There is improvement in few
indicators like the early initiation of
breastfeeding, minimum meal frequency
whereas, marginal decline is observed for
minimum dietary diversity (Figure B).
It is now crucial that the momentum in reducing
malnutrition is maintained and may perhaps be
even accelerated given the unprecedented focus
that POSHAN Abhiyaan has brought upon the
multiple determinants of malnourishment
among India’s women and children.
Additionally, it might be worth considering a
possible upward revision of some of the targets
given the notable levels of decline shown by
CNNS data.
The other story that emerges from the CNNS
data is not so positive and indicates the enormity
of implementation challenge that we are
confronted with on the coverage of a set of key
nutrition and health interventions and policy
initiatives in India’s States and Union
Territories. Figure C provides a snapshot of the
coverage of the high-impact interventions at the
National level and their State wise distribution.
It is striking to note that in terms of the coverage
levels, there is hardly any improvement in any
State or in the relative position of the States
when we compare these to NHFS-4 level. As
would be seen, the highest level of coverage for
receiving IFA is at about 70%. If we look at the
co-coverage of all the required interventions
(that is the percentage of mothers and children
receiving all the required interventions) that
figure would be at a very low one digit figure.
This underlines the challenge for implementing
agencies and the direction for future strategic
shifts in our approach to the Abhiyaan. Another
feature to be noted that CNNS finds substantial
decline in malnutrition levels without the
corresponding increase in coverage of
interventions. We therefore need to the
implementing agencies to place much greater
emphasis in the POSHAN Abhiyaan on the
quality of services provided to the beneficiaries.
9 0
20
40
60
80
100
120
Received IFA
Consumed 100+ IFA
Weighing
Breastfeeding counselling
Food supplementation
Health & nutrition education
Food supplementation
Health & nutrition education
Food supplementation (at least once a week)
Weighing (at least once in 3 months)
PregnancyLactationReceived benefits for child
from AWC
Figure C: Coverage of selected set of health and nutrition interventions in India,
CNNS (2016-18)
India Andhra PradeshBihar Chhattisgarh Gujarat Haryana Himachal PradeshJammu & KashmirJharkhand Karnataka Kerala Madhya PradeshMaharashtra Odisha Punjab Rajasthan Tamil Nadu Telangana Uttar PradeshUttarakhand West Bengal
10
0
10
2030
405060
70
80
90
100
Figure D: Overall Impl ementaion Status-National Picture
Note: Status of Jammu& Kashmir refer to a date prior to bifurcation
ANDHRA PRADESH
CHATTISGARH
MADHYA PRADESH
UTTARANCHAL
HIMACHAL PRADESH
GUJARAT
TAMIL NADU
MAHARASTRA
JHARKHAND
RAJASTHAN
BIHAR
UTTAR PRADESH
PUNJAB
HARYANA
TELANGANA
JAMMU & KASHMIR
KARNATKA
ASSAM
KERALA
MIZORAM
SIKKIM
NAGALAND
MEGHALAYA
ARUNACHAL PRADESH
TRIPURA
MANIPUR
GOA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
ANDAMAN & NICOBAR ISLANDS
DELHI
LAKSHADWEEP
Large States
Small States
Union Territories
11 We now present the inter-se ranking of the States
and Union Territories (UTs) on the overall
implementation status of the Mission (Figure D).
The scores for States and UTs are computed on
the basis of data received from the WCD and
Health Departments on four components with
specific weights. Among the large States, Andhra
Pradesh emerged as the top performing State and
among the small States, Mizoram gets the top
honours. Dadra and Nagar Haveli came out as the
best in so far as UTs are concerned. We would like
to point out a few issues that in our view are
emerging as the key binding constraints in the
implementation of the Abhiyaan:
1. Gaps in Human Resources, particularly at
the supervisory level:
Overall across States, there are huge
vacancies in supervisory cadre positions
including that of Lady Supervisors, CDPOs,
and DPOs. At a national level, the vacancy
rates are in the range of 25% at both the
CDPO and Lady Supervisor levels. This is
the aggregated national scenario that varies
from State to State; however, it is a clear
indication of the relatively higher number of
vacancies at the Supervisor level. For
positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less
than 5% of the sanctioned posts have been
filled up. Gujarat is the only large State
where all SPMU positions have been filled
up. The position in smaller States is even
worse. With the exception of two States
(Meghalaya & Mizoram), in the rest of the
States either the SPMU has not been set up
altogether or even where it has been set up all
positions remain vacant due to
non-completion of the recruitment process.
The UTs are slightly better placed with four
UTs having greater than 75 % of the SPMU
posts filled up. None of the posts were filled
in Puducherry and Delhi. Under the
PMMVY scheme , against the provision of
hiring 60 contractual staffs at State level and
1,434 contractual staffs at District level
across the States and UTs, so far only 42%
and 26% recruitments have been done at
State and District levels respectively (as on
18 February 2019).
2. Procurement & ICDS-CAS:
There are significant challenges with the
procurement and distribution of growth
monitoring devices and smart phones. While
there is a great emphasis in the Abhiyaan on
the procurement of Smartphones and
Growth Monitoring Devices, as per the last
update only 27.6% of AWWs across the
country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales).
Where real time growth monitoring data is
available from the AWW centres, we need to
ensure that the supervisory cadres are trained
in their use. While a dashboard is available at
the State Headquarters, we have not so far
seen it being used for Monitoring and
Evaluation purposes as well as a Decision
Support Tool at the Block, District and State
levels. In the absence of rigorous analytics,
there is every likelihood of attrition in the
quality of data collected through the
ICDS-CAS. MoWCD and MoHFW
currently use different applications for
tracking the same beneficiaries leading to
unnecessary duplication of efforts in data
entry, besides lack of coordination in
due-lists leading to a siloed approach to
service delivery. Although significant
resources have been dedicated to a pilot
project to develop a common platform for
the AAA functionaries and it has been in the
works for some time now, we are yet to see a
fruition of that effort. Another issue that
needs to be addressed for smooth
12 functioning of the ICDS-CAS pertains to
internet connectivity in remote rural areas
and also help-desk facilities for front line
workers to help them navigate the software
as first-time users. Only a few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established such helpdesks in all Districts.
3. Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response
from multiple departments; and (b) Impact
level where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child. As has been pointed
out earlier while discussing the CNNS
results, our success in effective convergence
of critical services at the household level has
been fairly modest. Since the launch of
POSHAN Abhiyaan, several coordinated
policy announcements by concerned
Ministries; strengthening the platforms of
service deliveries such as VHSND and
effective demand side push to drive
behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push
towards the creation of institutional
mechanisms at the State, District, Block
and Village levels for accelerating
convergent action required for the
implementation of POSHAN Abhiyaan.
Some of the learnings from existing State
level convergence models which should be
considered for scale up are listed below:
o Self Help Group federation of JEEViKA
model in the State of Bihar created a
promising platform for engaging the
community through feeding demonstrations
at the SHG meetings as a result of which
complementary feeding which had
remained stagnant for years showed more
than a 2-fold improvement over a two-year
period (both in terms minimum acceptable
diet and minimum dietary diversity).
o Government of Chhattisgarh where
convergence of various schemes like the
State Rural Livelihood Mission in the
District of Surguja, has helped to improve
several indicators at the grass roots levels.
o Similarly, the Ajeevika initiative of the
Government of Jharkhand where they
engage the Sakhi Mandal members as
Business Correspondent (BC). The gradual
decline in prevalence of diseases on account
of micronutrient deficiencies as well as
reduced prevalence of stunting and wasting
among under-5 children point towards a
positive change
o In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
13 demonstrably shown to be an efficient and
effective platform of converged service
delivery at the village level.
4. Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
5. Jan Andolan:
All the Ministries involved in the POSHAN
Abhiyaan need to be complemented for
giving a huge push and visibility to the
Abhiyaan through Poshan Maah (September
2018) and Poshan Pakhwara ( March 2019)
where mobilization through community
based events, door to door campaign and
other related activities were organized with
much greater degree of enthusiasm and
effectiveness. However, it is imperative that
this momentum has to be sustained and
strengthened further to induce behaviour
change at a massive scale. International
evidence has shown that nutrition campaigns
have never been successful without the
campaign being owned and led by the
community. To take the community
ownership and involvement in the Mission to
the next higher level the coming POSHAN
Maah will focus upon the engagement with
elected representatives at all levels – from
the Parliament to Panchayats. Carefully
designed material with appropriate
messaging, content and media has been
created to facilitate this engagement. We
also need to leverage the SHGs and ensure
that they can play a critical catalyzing role in
enrolling the households to desired
behavioural changes. Since lack of
complementary feeding to children in the
age group of 6-23 months has been major
factor in the rampant prevalence of
malnutrition, the upcoming Poshan Maah
(September 2019) will focus on this theme.
A sizeable workforce can be added in this
campaign if we can successfully enroll the
Panchayat representatives and the SHG
members to our cause. A lot of preparatory
work has been done but we need to sort out
some minor budgetary issues to roll this out
effectively.
6. Recommended priorities for the year
2019-20
A successful campaign must prioritize the
high impact interventions taking into
consideration the capacities of our delivery
system. Based on a careful consideration of
the likely impact on outcomes of interest in
the POSHAN Abhiyaan, the capacities of
FLWs to deliver and our experiences from
the Aspirational Districts, we would
recommend that we should concentrate on
the following action items as our key focus
areas for the FY 2019-20
Eliminate Diarrhoeal Deaths by focussing on
prevention, rota virus vaccination, initiating
timely treatment by giving ORS and Zinc
and finally referral to a nearby health facility
in case of complications.
A huge campaign around improving
complementary feeding practices
Improve the quality of home visits through
better implementation of the intensified and
augmented Home-Based Newborn Care
(HBNC) programme
A very strong movement around ‘Anaemia
Mukt Bharat’ Campaign.
14 Taking the agenda of food fortification
ahead.
And lastly, fixing the delivery and supply
logistics of the Take Home Rations (THR) to
pregnant and lactating mothers and children.
A recent study in 27 Aspirational Districts
across 8 States showed that there are
significant gaps in uptake and availability of
THR to the eligible beneficiaries. We need to
plug the gaps in the system to ensure that our
Supplementary Nutrition Program is
delivered more efficiently than what is in
vogue today.
In addition, we would also recommend that
the gap in the guidelines for the
management, treatment and follow up of
Severely Acute Malnutrition (SAM) without
medical complications OR Moderately
Acute Malnourished (MAM) in the
community should be plugged immediately.
Other than the provision of double ration for
SAM children in the Supplementary
Nutrition Program, there is no other
mechanism to follow up with them in the
community. There are also no clear
guidelines for community level frontline
heath workers on this issue.
Conclusion
The present Report Implementation Score is a
useful tool for systematic measurement of
performance across States and UTs as far as their
readiness to implement the Abhiyaan. It serves as
an important aid in understanding the
heterogeneity and complexity of the Nation’s
performance in nutritional indicators. Owing to
the multiplicity of determinants that impact
nutritional outcomes, BOTH WCD AND Health
departments of States and UTs are contacted.
The erudition that have emerged during the
process of development of the implementation
score, will guide the States and UTs in directing
their resources to improve the parameters where
they are lagging behind. It further acts as an
enabling mechanism to locate loop holes in the
system and States/UTs can progress in a more
procedural way to accomplish the target to
combat malnutrition.
15 CHAPTER 1:
INTRODUCTION 1. INTRODUCTION
POSHAN Abhiyaan (National Nutrition
Mission) is India’s flagship programme to
improve nutritional outcomes for children,
pregnant women and lactating mothers. The
programme aims to ensure service-delivery and
interventions by use of technology, behavioural
change through convergence and lays down
specific targets to be achieved across different
monitoring parameters over the next few years.
India embarked on an ambitious effort in 2018 –
the Prime Minister’s Overarching Scheme for
Holistic Nourishment called POSHAN
Abhiyaan -- to address multiple forms of
malnutrition. Recognizing that malnutrition
levels in India are high and have been slow to
change over the last decade, this national
nutrition mission attempts to address 5 key
essential elements recognized to be critical in the
fight against malnutrition –delivery of high
impact interventions with adequate coverage,
continuity, intensity and quality (C2IQ),
including behaviour change communication at
scale, multi-sectoral convergence to address the
underlying drivers of malnutrition, adequate
financing and monitoring to track the progress
and learn, and committed leadership and an
enabling environment. Impact on nutrition
outcomes, such as stunting, wasting, anemia and
low birth weight, can take some years but
changes in these critical elements that can
accelerate the progress on the path to good
nutrition can be achieved in shorter timeframes.
The prominent features of POSHAN Abhiyaan
are:
1. A high impact package of interventions with
a focus on (but not limited to) the first 1000
days of a child’s life.
2. Strengthening delivery of this high impact
package of interventions through
o Remodelling of nutrition monitoring
though the introduction of ICDS-CAS
which leverages technology for
management as well as monitoring.
o Improving capacities of frontline
workers through the Incremental
Learning Approach (ILA) mechanism.
o Emphasizing convergent actions among
the frontline workforce, including
through performance linked joint
incentives for the 3As (ASHA,
Anganwadi & ANM).
3. A focus on cross-sectoral convergence to
emphasize the multidimensional nature of
malnutrition, mapping of various Schemes
contributing towards addressing
malnutrition.
o Convergence committees at the state,
district and block levels will support
decentralized and convergent planning
and implementation, supported by
flexi-pool and innovation funds to
encourage contextualized solutions.
4. Ramping up behaviour change
communication and community
mobilization through through Jan Andolan, a
large-scale national nutrition behaviour
change campaign that uses
community-based events, mass media and
other approaches.
The Abhiyaan focuses on strengthening policy
implementation (at Central and State level) to
improve targeting (identification of high burden
Districts), enhance multi-sectoral convergence,
develop innovative service delivery models and
rejuvenate counselling and community-based
monitoring. It aims to reduce child stunting,
underweight and low birth weight by 2
percentage points per annum and anaemia
among children (and young females) by 3
percentage points per annum (Figure 1).
17 18
•Target: ↓by 6%
@ 2% per annum.
Preven t and reduce
Stunting in children (0-6
years)
•Target: ↓by 6%
@ 2% pe r annum .
Preven t and reduce under-
nutrit ion in children (0-6
years)
•Target: ↓by 9%
@ 3% per annum.
Reduce the preva lence of
Anaemia amon g Children
(6-59 months)
•Target: ↓by 9%
@ 3% per annum.
Reduce the preva lence of
Anaemia among Women
and Adolescent Girls in the
age group of 15-49 years
•Target: ↓by 6%
@ 2% per annum.
Reduce Low Birth Weight
(LBW)
Figure 1: Targets of the POSHAN Abhiyaan
POSHAN Abhiyaan is an umbrella scheme which
covers a host of program and services that target
beneficiaries across 1000 day cycle with nutrition
interventions. These include a take-home ration
from Anganwadi centers; anaemia prevention and
control under the Anaemia Mukt Bharat program;
antenatal care services; dietary counselling through
Village Health Sanitation and Nutrition Day
(VHSND); and schemes such as Pradhan Mantri
Surakshit Matrutva Abhiyaan that provide quality
antenatal check-ups. Institutional Deliveries are
promoted through conditional cash transfer schemes
like Pradhan Mantri Matrtya Vandana Yojna
(PMMVY) and Janani Suraksha Yojna (JSY) and
free services for delivery and early neonatal care
(Janani Shishu Suraksha Karyakram) and provide
an important opportunity to support mothers in
establishing good breastfeeding practices.
POSHAN Abhiyaan explicitly recognizes the
need for convergence and coordination such that
the benefits of multiple Government schemes
and programs reach women and children in the
first 1000 days. It aims to improve synergy
through robust convergence mechanisms. The
programme also aims to ensure service-delivery
of key interventions supported by the use of
technology, and behavioural change. It lays
down specific targets to be achieved across
different parameters over the next few years.
Through these targets, the programme is striving
to reduce the levels of stunting, underweight,
anaemia and low birth weight prevalence in
babies. It also creates synergy among the
Ministries and Departments, ensures better
monitoring, issues alerts for timely action, and
encourages States/UTs to perform, guide and
supervise the line Ministries and States/UTs to
achieve the targeted goals.
Under POSHAN Abhiyaan there is an ambition
to ensure that every child and woman has access
to quality services to address the malnutrition
across the continuum of care. To achieve this, it
is important to strengthen the pillars of the
Abhiyaan in a targeted manner (Figure 2).
ICDS_CAS
Convergenc e
Behavioral
change, IEC
Advocacy
Training
and
capacity
building
Innovations
Incentives
Grievance
Redressal
Figure 2: Pillars of POSHAN Abhiyaan Policy initiatives in Nutrition and
Allied Sectors
The launch of POSHAN Abhiyaan has been a
watershed in the series of enhanced allocations,
policy measures and advisories issued by the
Government of India towards the goal of
eradicating malnutrition in the country (Figure 4).
The Abhiyaan has not only given momentum to
existing programs, reoriented policy choices and
aligned several sectors towards the common goal
of eradication malnutrition from the country, it
has also been instrumental in instigating a range
of policy actions under its ambit within a short
span of time (Figure 4).
19
Figure 3: Key Government Initiatives in Nutrition and Allied sectors
Figure 4: Important Policy Actions under the ambit of POSHAN Abhiyaan 20
The above mentioned initiatives and policies of
the Government are essential but the issue is of
the coverage, continuity, intensity and quality of
the services provided under the ambit of
mentioned programs.
Pradhan Mantri Matru Vandana Yojana
(PMMVY)
It is a Scheme which aims to improve
health-seeking behaviour and nutrition among
first-time pregnant women and lactating mothers
(PW&LM) to reduce the effects of
under-nutrition, the leanings from
implementation is mentioned in details in this
section of the Report.
It is a conditional maternity benefit scheme
which provides Rs. 5,000 to pregnant women
and lactating mothers in three instalments of Rs.
1,000, Rs. 2,000 and Rs. 2,000 respectively. The
conditions for the payment of instalments are
early registration of pregnancy, Antenatal
Check-ups (ANC) and first cycle of
immunization to the new born baby.
Additionally, the women get her entitlement of
around Rs. 1,000 under Janani Suraksha Yojana
(JSY) after Institutional Delivery.
As per the mandate, NITI Aayog does quarterly
concurrent monitoring of the scheme, for this the
field studies are conducted by NITI team and
Development Partners with an objective to
understand Governance issues and get field level
feedback.
I. Status of Implementation
The Scheme is being implemented with
effect from 1st January, 2017; however it has
started implementing on ground since
October, 2017. Till 31st March, 2019, in total
around 82.2 lakh Beneficiaries have been
registered out of which around 83.5% of the
eligible beneficiary have received 1st
instalment with cumulative payment of Rs.
2,611 Crores. The average time taken in
payment of 1st instalment from the date of
registration is around 45 days, but when
calculated with respect to the Last Menstrual
Period (LMP) the average time taken is 234
days. Only 22% of the 1st instalments have
been paid within 150 days with respect to the
date of LMP. Analysing the method of
payments, 66% of the total DBT transfers
were made through Aadhaar based payments
out of which 72% matched with the Bank
Accounts provided by the Beneficiaries. The
Scheme has been successful in registering
around 19,000 beneficiaries per day in the
quarter ending March, 2019. The trend in
registration vis-à-vis payments of
instalments and per day registration of new
beneficiaries in the scheme can be seen in the
below graphs:
In order to simplify the instalment payments
and prevent delays, the Ministry has taken
few corrective measures like- the beneficiary
now can now submit the second claim
application before 180 days of LMPs which
will be automatically processed on
compilation of 180 days of LMP. Also,
Ministry had advised States/UTs to utilise
the flexi funds for incentivising field
personnel, data entry facilitator and for other
innovative uses. 21
3685 303006
2151540
3584261
5166284
6511733
8225780
0
10,00,000
20,00,000
30,00,000
40,00,000
50,00,000
60,00,000
70,00,000
80,00,000
90,00,000
31st Oct 201731st Dec 201731st Mar 201830th June 201830th Sept 201831st Dec 201831st Mar 2019
seiraicifeneB fo .oN
Figure 5: Trend in No. of Beneficiary Registration v/s Payments of
Instalments-PMMVY
1st Instalment
2nd Instalment
3rd Instalment
41
3,326
20,539
15,919
17,578
14,949
19,045
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
22,000
-
2,00,000
4,00,000
6,00,000
8,00,000
10,00,000
12,00,000
14,00,000
16,00,000
18,00,000
20,00,000
31st Oct 201731st Dec 201731st Mar 201830th June 201830th Sept 201831st Dec 201831st Mar 2019
Per day Registrations
snoitartsigeR ylretrauQ
Figure 6: Trend of Beneficiary Registration (All India Progress)-PMMVY
Quarterly ProgressPer day registerations
II. Preliminary Findings
The survey conducted by Development
Partners and field studies conducted during
January 2019 by NITI team has shown in the
following Figures 7 and 8: 22
7
7.2
7.4
7.6
7.8
8
8.2
8.4
8.6
8.8
9
Enrolled but didn't received
money
Money received and used
for food
Figure 8: Average Minimum Dietary
Diversity Score (PPMVY)
29%
17%
42%
12%
Figure 7: Reported Utilization of Money
(PPMVY)
Added to Savings
Additional money
for food
Additional money
for Medicine and
Healthcare
Personal Use
III. Remaining Challenges
The scheme has made impressive progress in
a short duration after its launch and has been
successful in reducing the delays in
payments and enrolment of beneficiaries
compared to its predecessor IGMSY, which
was implemented in selected districts. This
has been only possible because of the use of
DBT mode of payments, constant
monitoring and timely resolution of the
identified bottlenecks in implementation of
the scheme. However, there are still few
challenges that need to be resolved to take
the performance of the scheme to next level.
These challenges are as follows:
• A substantial number of payments (28%
cases of all Aadhaar based payments, i.e. in
case of 31.29 lakh payments) are going to
different Bank Accounts than what had been
provided by the Beneficiaries. Sometimes
these are even untraceable by beneficiaries
and field functionaries. A telephonic survey
of 5,525 beneficiaries was conducted by
MoWCD which has revealed that only 60%
were aware of both the receipt of the benefits
and the bank account to which the money
was reemitted. It is a prime cause of
dissatisfaction amongst beneficiaries which
needs to be addressed on urgent basis.
• There is need for simplification in
documentation and operational rules. For
example, the rule for completion of 180 days
before processing 2nd instalment and
mandatory requirement of Birth Certificate
for 3rd instalment needs to be rationalized
which are unnecessarily causing delays in
payments.
• Incomplete MCP cards are another reason
for delay in payments. ANMs needs to be
trained and directed to properly fill MCP
cards. Also, efforts needs to made to auto
populate Heath Data (Pregnancy detection,
ANC and Immunization) by linking
PMMVY-CAS with Health Portal (RCH).
• Data Entry Operators (DEOs) at Block level
is essential for timely entry of applications,
processing of payments and timely resolving
Correction Queues.
• For effective monitoring, there should be a
dashboard at Block and District level
providing information on critical indicators
like beneficiaries registered against
estimation, delay in payments w.r.t. LMP,
status of beneficiaries eligible but not paid
2nd/3rd instalment etc. in a single window to
encourage course correction.
• In order to minimize/eliminate exclusion,
effective convergence (on sharing
information on 1st pregnancy and
counselling) is required among the AAAs so
that all eligible beneficiaries could get
enrolled in this scheme. CHAPTER 2:
METHODOLOGY 24
This is the Second Report on the status of
implementation of the POSHAN Abhiyaan. The
focus of this Report is on assessing those aspects
of POSHAN Abhiyaan which are crucial for
effectively implementing the Abhiyaan. Various
mechanisms and interventions utilised by the
States/UTs to accelerate the implementation of
the Abhiyaan are also analysed.
2.1 DATA COLLECTION:
Efforts were made to consolidate the
multiple activities which are going on in
different parts of the country under
POSHAN Abhiyaan, by different set of
stakeholders. For this purpose, a
multi-pronged strategy for data collection
was adopted where NITI Aayog reached out
to several Cenral Government Ministries,
States & UTs and development partners to
collect information.
Ministries at the Central Level:
Information was sought from the key
Ministries (Ministry of Women and Child
Development (MWCD), Ministry of Health
and Family Welfare (MoHFW), Ministry of
Rural Development (MoRD), Ministry of
Human Resource Development (MHRD)
and Ministry of Panchayati Raj Institutions
(MoPRI) at the Central level on their various
initiatives launched within the ambit of
POSHAN Abhiyaan focusing on first the
100 day interventions, from conception till 2
year of child’ life.
States & UTs: As mentioned above, for data
from the States & UTs, a detailed format
(Annexure 1a and b) was shared with their
Women and Child Development and Health
Departments to collect information. Details
about indicators used in the templates is
provided in the subsequent section of this
chapter.
Development Partners: Development
partners with direct presence in the field
were encouraged to collect new initiatives,
stories of change, models which can be
scaled-up and replicated and information
about individuals who are doing exceptional
and inspirational work at the ground level to
change the status of nutrition in the country.
Accordingly, these stories have been
compiled and featured in this report.
While the first progress Report focused solely on
preparedness related indicators of POSHAN
Abhiyaan which were about modulation of
systems in place so that work of Abhiyaan can get
geared up, the second Report focuses on
implementation of parameters covering both
WCD schemes Health interventions at State and
UT level and therefore, inputs/Data has been
considered from both State WCD and Health
Departments. A detailed framework of the
indicators was formulated to analyse the data and
information.
IMPLEMENTAION SCORE:
Broadly, Implementation Score measures the
level of implementation of POSHAN Abhiyaan
by the States and UTs. Since in many States and
UTs the POSHAN Abhiyaan is effectively
launched lately, briefly, the preparedness or
readiness of the Sates/UTs for implementing the
Abhiyaan is also captured.
The information received from the WCD and
Health Departments of States/UTs was organized
into the following categories which were
considered to be crucial for generating the
implementation score (Table 1)
25
Table 1: Implementation score themes for WCD and Health Department
Implementation score themes
WCD Department Health Department
Mechanism
Strategy and Planning
Service Delivery & Capacities
Program activities and
intervention coverage
Governance & Institutional • Fund Allocation
• Constitution of Committees &
Resource Groups
• Cross-sectional convergence
• HR
• Supplies [Mobile phones and
growth Monitoring Devices]
Training & capacity building
• Program activities- ICDS
• Infrastructure
• HR
• Supplies(Stock out)
Training & capacity building
• Program activities
Each of these categories comprised a set of
sub-themes, shown separately for WCD and
Health Department (Table 1), which in turn had
several indicators based on the information
received (Annexure 1a and b). It must be noted
that these indicators are proxy indicators
reflecting at best intentions of the State and UTs
with respect to each of these categories.
CATEGORIZATION:
For the purposes of inter-State comparison of
only similar size/kind of States, this report
categorizes the States and UTs into large States,
small States and UTs (Table 2)
2.2 METHODOLOGY
COMPUTATION OF SCORES:
Implementation Score was created with a
maximum score of 100. Maximum possible score
allotted for WCD Departments was 65, whereas
for Health it was 35. The sub-set questions were
selected to ensure continuity with the prior report
and were based on the previous questionnaire as
well as administrative guidance from the Centre.
These elements were common across all the
States and UTs (Figure 9).
Table 2: Categorization of States
Category* Number of States List of States
Large States 21
Small States 8
UTs 7
Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana,
Himachal Pradesh, Jammu & Kashmir, Jharkhand, Karnataka, Kerala,
Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu,
Telangana, Uttar Pradesh, Uttarakhand, West Bengal
Arunachal Pradesh, Goa, Manipur, Meghalaya, Mizoram, Nagaland,
Sikkim, Tripura
Andaman & Nicobar, Chandigarh, Dadra & Nagar Haveli, Daman & Diu,
Delhi, Lakshadweep, Puducherry
* This categorization is similar to the one used for State Health Index Report 26
Figure: 9 Critical components for the evaluation implementation of the POSHAN Abhiyaan
Governance & Institutional
Mechanism
•Weight=19
Strategy and Planning
•Weight=6
Service Delivery & Capacities
•Weight=31
Training and capacity building
•Weight=21
Service Delivery &
Capacities
•Weight=17
Program activities and
intervention coverage
•Weight=18
WCD
TOTAL WEIGHT=65
HEALTH
TOTAL WEIGHT=35
For details on the process of generating the implementation score, please refer to Box 1.
Box 1: Steps to Generate Implementation Score
STEP 1. Developing assessment tool for States/UTs: NITI Aayog prepared two implementation
assessment questionnaires (one for Health and one for WCD) that examined issues related to financing, multi
stakeholder efforts, systems capacity and program implementation. These were finalized with inputs from
several technical stakeholders (Annexure 1a and b).
STEP 2. Data collection at the State/UT level: The implementation assessment questionnaires were sent to
officials in States in the departments of Women and Child Development and Health in April 2019. Officials
in charge in the State gathered all the necessary information to complete the questionnaires and sent them
back to NITI Aayog between April and May 2019.
STEP 3. Data Cleaning: Once the first round of data was received from the States, it was reviewed and
manually cleaned to highlight inconsistencies in responses. These marked State templates were shared back
with the States for revisions and clarifications [May 2019]
STEP 4. Data entry: The second round of data from the States were entered twice using the Survey CTO
interface by 3 independent researchers. Double data entry was applied to ensure there were no data entry
errors. All the discrepancies between the two rounds of data were corrected.
STEP 5. Data processing & analysis: Stata version 15 was used to conduct all logical checks and data
analyses. Using the clean data, weights were assigned to variables chosen to construct the implementation
score rubric and then summary scores were created for each State based on the implementation score rubric.
STEP 6 Data validation by States: Each State was then sent their initial scores and the weights of the
elements used for that score. Comments were added and the States were requested to reconfirm data if there
were any inconsistencies arising from logic checks. Video conferences were held with 18 large States on
6th-7th June 2019 and telephonic follow-up were done with the remaining small States and UTs. All the
States were given an opportunity to provide any updates on their responses to the implementation assessment
questionnaire. [Limitation: Only the data that were used to compute the rubric were validated by the States
for accuracy. Validated data was received from all States except: WCD Department: Assam, Delhi and
Kerala; Health Department: Andhra Pradesh, Arunanchal Pradesh, Bihar, Gujarat, Jharkhand and
Meghalaya]
STEP 7 Data updation & final score calculation: States updated information as necessary in mid-June
2019. These data were then updated in the final dataset and the final scores were generated. 27
Process Validation
Technical Partner of the TSU established at NITI
Aayog, International Food Policy Research
Institute (IFPRI) was engaged to audit the entire
process beginning from the data entry stage to
the computation of the Implementation Scores.
Limitation
While all attempts were made to reach out to
States and UTs and gather updated information,
two States, namely, Odisha and West Bengal,
have not been incorporated into this report due
to unavailability of data from these States. For
Lakshadweep, WCD Department had shared the
required information, but Health Department has
not provided the Data.
POSHAN Abhiyaan has been rolled out in
phased manner in the Country, likewise the
implementation has also moved in a phased
manner. The availability of funds, supplies,
ICDS-CAS roll out and other related indicators
are dependent on the roll-out of the Abhiyaan in
the State/UT. For the preparation of the present
Report, all the States and UTs with their Districts
are not distinguished as per the Phases in which
the POSHAN Abhiyaan was rolled out.
For collating the data especially from the Health
Department of all States and UTs, it was
observed that for the indicators where
information is not available in the HMIS,
States/UTs found it difficult to compile and
share any information. With respect to the
responses/data shared by the States/UTs the
health part of the rubric was given lesser
weightage (35) as compared to the WCD
part(65).
Standardizing denominator: To compute a few
indicators of coverage, total number of 12-23
months old children was required. However,
States provided information for a varied range of
age categories e.g., 9 to 23 months, 6 to 23
months etc. Therefore, to construct the coverage
indicator, the denominator was standardized to
reflect the total number of children to be 12-23
months old. For example, if States provided
information on total number of children for 9 to
59 months, then to standardize the total number
of children to be in 12-23 months old group, that
total number of children was divided by the
difference between 9 and 59 months i.e., 51
months. The resulting number was multiplied
with the number of months between 12-23 i.e.,
12 months. This calculation assumes that equal
number of children were born in each month.
Changing proportions that are greater than
100 percent to 100 percent: When computing
indicators for coverage of interventions, where
there were instances of greater than 100 percent
coverage, the proportions were considered to be
100 percent. As the data from the States were
from the health monitoring information system
(HMIS) where the denominators are projection-
based and not of the actual population, it is
possible that the projected population is
sometimes lower than the actual population
receiving the services.
Brief Outline on the first POSHAN Abhiyaan
Progress Report- (April - October, 2018)
POSHAN Abhiyaan’s first progress report,
submitted in December 2018, mainly
highlighted its implementation status, from the
time it was launched in March 2018. The report
evaluated the Preparedness of the States and UTs
for POSHAN Abhiyaan.
Data was collated from the WCD departments of
the all the States and UTs (except West Bengal
and Odisha). Further, Preparedness Score for
each State and UT was calculated considering
the information and data shared. The entire data
set was organized into three categories:
• Governance and Institutional Mechanism
• Strategy and Planning
• Service Delivery Essentials
Taking into consideration the data for these
categories, each State and UT was ranked on the
Preparedness Score. For ease in comparison, the
findings were presented separately for large
States, small States and UTs. 28
Major findings of this report were that
Chhattisgarh scored highest on the preparedness
levels, while Assam was the least prepared to
enter the implementation phase. Among the
small States, Meghalaya scored the highest
whereas Sikkim was at bottom of the
preparedness level. As far as the UTs are
concerned, Chandigarh was best prepared to
implement the Abhiyaan, while Lakshadweep
scored the lowest in terms of readiness.
Vital information was also provided by various
line ministries at the central level on their
initiatives launched within the ambit of
POSHAN Abhiyaan to reduce malnutrition.
It was the first attempt at establishing a tool for
measurement of preparedness across States and
UTs on a variety of parameters within the three
domains. Owing to the multiplicity of
determinants that impact nutritional outcomes,
some of these actions were outside the ambit of
the WCD department.
The erudition that emerged during the process of
developing the preparedness score, guided the
States in identifying the gap areas and directing
their resources to improve the parameters where
they were lagging. It acted as an enabling
mechanism to locate loopholes in the system to
combat malnutrition. This detailed analysis
presented in the first progress report of
POSHAN Abhiyaan facilitated the States and
UTs to get an overarching view and examine the
factors leading onto the effective
implementation of the Abhiyaan.
In the present Report, India’s progress on the
POSHAN Abhiyaan, focusing on efforts that
commenced with the launch of the Nourishing
India strategy in Sept 2017 is described. This
Report highlights mainly on assessing the State
of Governance and Institutional Mechanisms to
support full-scale implementation of POSHAN
Abhiyaan, convergence and delivery of high
impact interventions, monitoring and learning,
and the rollout of Jan Andolan, India’s flagship
behaviour change and community mobilization
effort for malnutrition. It also looks at some of
the challenges faced by the States and union
territories (UTs) in the implementation of key
health and nutrition interventions, and
innovations developed by the States/UTs, and
discusses the way forward for POSHAN
Abhiyaan.
Focus of the Report is mainly on assessing the
State of leadership and an enabling environment,
convergence and delivery of high impact
interventions, monitoring and learning, the
rollout of the Jan Andolan, India’s flagship
behaviour change and community mobilization
effort for malnutrition. CHAPTER 3:
NUTRITION INTERVENTION COVERAGE
AND OVERALL IMPLEMENTATION
SCORES OF STATES AND UNION
TERRITORIES FOR
POSHAN ABHIYAAN 30
For assessing the progress of the POSHAN
Abhiyaan, the most recent data on the prevalence,
coverage and continuity of a set of key nutrition
and health interventions for India’s States is
available from the Comprehensive National
Nutrition Survey (CNNS, 2016-18). It collects
the data from more than 1,12,000 children in the
age group of birth to 19 years of age across India.
The data also provides a benchmark to the status
of nutritional indicators and can help States in
setting targets for intervention coverage to
achieve under POSHAN Abhiyaan.
CNNS data surely reflects some progress in
bringing down under nutrition levels (Figure A).
Although this data acts as the baseline for the
POSHAN Abhiyaan but it can be intended that
the targets of POSHAN Abhiyaan will be well
achieved with the reduction of stunting and
anaemia in the coming years to come. CNNS also
captures the prevalence of various micronutrient
deficiencies for the children and adolescents in
the age group of 10-18 years. Key findings are
mentioned below:
• Vitamin A deficiency was 16-22% with
geographical variations.
• Vitamin B12 deficiency ranged from 14%
to 31% and it was found to be highest among
adolescents.
• Vitamin D deficiency varied from 14% to
24%.
• Adequate Median Urinary Iodine level in all
states indicating the success of Salt
Iodization program
CNNS provided the vital information on the
coverage and continuity of a set of key nutrition
and health interventions and policy initiatives for
India’s States and Union Territories.
Figure 10 below shows that the highest level of
coverage for key nutrition interventions is barely
70% (for receiving any IFA), and that for most
interventions, coverage is just about 50%. This
provides a clear set of coverage targets at the
national level for these high impact interventions.
18
0
10
20
30
40
50
60
70
80
90
100
Interventions
Received IFA
Consumed 100+ IFA
Deworming
Weighing
Breastfeeding counseling
Food supplementation
Health & nutrition education
Food supplementation
Health & nutrition education
Food supplementation (at least once a week)
Weighing (at least once in 3 months)
Counselling on child growth (among those
who weighed)
Figure 10 : Coverage of a selected set of nutrition interventions in India, CNNS (2016-18) 31
Keeping the CNNS findings in the backdrop data
collated from all States and UTs for the present
report is analysed and, it is observed that the
coverage levels for interventions along the
continuum of care vary tremendously by State
and by intervention within and across States
(Table3; Annexure 3). For example, for a majority
of interventions during pregnancy including
antenatal care (ANC) during the first trimester,
receiving MCP card, IFA supplementation,
weight monitoring, and food supplementation,
the coverage levels are between medium to high
(50 percent to 75 percent). Coverage is lower than
50 percent for 4 or more ANC, consumption of
IFA supplements, breastfeeding counselling, and
health and nutrition education. It is noticeable that
the coverage is higher than 75 percent for any
ANC and TT injection. The variable coverage is
not platform-dependent i.e., the ICDS or the
health platforms. In several large and small
States, coverage for ANC during the first
trimester, 4 or more ANC, IFA supplementation,
and weight monitoring was found to be higher
than the national average.
The rates of institutional delivery and presence of
skilled-birth attendant at birth are high nationally
(83 percent) and across several States. Coverage
of institutional delivery is lower than 75 percent
in a few States but the presence of skilled-birth
attendant at birth is high in such instances except
in Arunachal Pradesh, Jharkhand, and Manipur.
Institutional delivery is particularly low in
Nagaland and Meghalaya. At the national level,
coverage of postnatal care for babies is only 62
percent but it is 90 percent or higher in several
States including Goa, Jammu & Kashmir, Kerala,
Maharashtra, Punjab, Tamil Nadu, and
Telangana.
Nationally, coverage levels for food
supplementation (49 percent) and exposure to
health and nutrition education (33 percent) during
lactation period are low. However, the coverage
is highly variable for these interventions across
States (Figure 10). While coverage of food
supplementation is higher than 75 percent in
some States including in Andhra Pradesh,
Chhattisgarh, Goa, Himachal Pradesh, Odisha,
Telangana, and Uttarakhand, it is lower than 25
percent (ranging from 9 percent to 24 percent) in
some other States including in Arunachal
Pradesh, Delhi, Jammu & Kashmir, Nagaland and
Uttar Pradesh. In case of health and nutrition
education intervention, coverage levels are much
lower in several States compared to the national
average.
Food supplementation during early childhood is
low at 42 percent and is marked by high
inter-State variability. The reach of food
supplements is highest in West Bengal at 91
percent but there are only few States where reach
is higher than 75 percent. Coverage was lower
than 25 percent in ten States (Figure 10).
At the national level, weighing of children at least
once in 3 months was only 60 percent and only 48
percent of mothers of children who were weighed
received counselling. There is high variability in
coverage for these two interventions across the
States. In some States greater than 75 percent of
children were weighed. However, in a majority of
the States, 50 percent or lower proportion of
mothers were counselled on growth after
weighing.
The coverage data indicate huge gaps in the
coverage and continuity across the continuum of
care. Achieving full coverage of interventions for
every woman and every child remains a
significant challenge with significant coverage
gaps for most interventions. It is of concern that
coverage is low for several interventions across
the States although implementation is through the
same national platforms.
3. Overall Implementation Score Computed for
the Second POSHAN Abhiyaan Report
To assess the implementation level of
POSHAN Abhiyaan in all the States and
Union Territories (UTs), data were gathered
using questionnaires from the State/UT
Women and Child Development (WCD) and
Health Departments on four key themes
including: 32
1. Governance and Institutional Mechanism
2. Strategy and Planning
3. Service Delivery and Capacities
4. Programme Activities and Intervention
Coverage.
The process of data collection, compilation and
computation of scores has been explained earlier
in Chapter two. In this Chapter the scores of
States and UTs for the implementation of
POSHAN Abhiyaan, or their readiness for it, have
been discussed.
An overall composite score was created
combining all the four themes to examine
preparedness and implementation capabilities of
States and UTs. In terms of overall
implementation in States and Union Territories
(Figure 11), among the 19 large States, Andhra
Pradesh, Chhattisgarh and Madhya Pradesh
scored the topmost three ranks followed by
Uttarakhand, Himachal Pradesh, Gujarat, Tamil
Nadu and Maharashtra. Ten out of total 19 large
States had an implementation score of over 70
percent. Karnataka, Assam and Kerala were at the
bottom of the list, with an implementation lower
than 55%.
Among the eight small States, Mizoram and
Sikkim scored above 75 percent and were in the
topmost position. Arunachal Pradesh, Tripura,
Manipur and Goa were at the bottom of the list,
with scores below 60%. However, all the small
States had a score above 55%, displaying a fairly
good level of readiness and implementation.
Four out of seven UTs had an implementation
score of over 70 percent. Dadra and Nagar Haveli,
Chandigarh, and Daman and Diu scored above 75
percent and were ranked among the top three
UTs. Delhi, and Lakshadweep were at the bottom
of the list, with implementation scores below 50
percent.
0
10
20
30
40
50
60
70
80
90
100
Figure 11: Overall Implementaion Status of POSHAN Abhiyaan-
National Picture
WCDHealth
ANDHRA PRADESH
CHATTISGARH
MADHYA PRADESH
UTTARANCHAL
HIMACHAL PRADESH
GUJARAT
TAMIL NADU
MAHARASTRA
JHARKHAND
RAJASTHAN
BIHAR
UTTAR PRADESH
PUNJAB
HARYANA
TELANGANA
JAMMU & KASHMIR
KARNATAKA
ASSAM
KERALA
MIZORAM
SIKKIM
NAGALAND
MEGHALAYA
ARUNACHAL PRADESH
TRIPURA
MANIPUR
GOA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
ANDAMAN & NICOBAR…
DELHI
LAKSHADWEEP 33
3.1 Governance and Institutional Mechanism
This theme captures the preparedness of
States/UTs in terms of having the necessary
Governance and Institutional structures in
place, as envisaged under POSHAN
Abhiyaan. One of the essential components
of the Abhiyaan is fund utilization which acts
as an interface to initiate effective
implementation. All the large States have
received funds from the Centre. Except
Assam and Jammu & Kashmir, all large
States, have earmarked funds to implement
POSHAN Abhiyaan. Maharashtra has
utilized maximum funds with close to 54.5
%. This is followed very closely by
Karnataka and Bihar, with utilization rates of
40% and 35%, respectively. Similarly for
small States all of them have received funds
from Centre. Except Sikkim, Tripura and
Manipur all other Small States have
earmarked funds to implement POSHAN
Abhiyaan. With respect to utilization of
funds, Arunachal Pradesh, Meghalaya and
Mizoram, have utilized maximum funds
with more than 60%. This is followed very
closely by Nagaland with utilization rate of
58%.
The Abhiyaan is fully funded in Union
Territories without legislature (Andaman &
Nicobar Islands, Chandigarh and Dadra &
Nagar Haveli), implying that they do not
need to earmark funds especially for this
purpose. Therefore, for this particular
parameter, they have given full scores. UTs
with legislature (two out of seven-
Puducherry and Delhi) have a cost sharing
ratio of 60:40. For these UTs, earmarking of
funds for the implementation of the
Abhiyaan has been given a score on the basis
of their affirmative response to the same.
Findings suggest that all the UTs have
received funds from the Centre. In terms of
utilization of funds, Dadra & Nagar Haveli
have utilized maximum funds with more
than 60% utilization rate. This is followed
very closely Chandigarh and Daman & Diu.
0
2
4
6
8
10
12
14
16
18
20
Figure 12:
Governance & Institutional Mechanism: Large States
Max Score: 19
* Data collated only from WCD Departments of States and UTs Max Score: 19
34
Another crucial institutional mechanism is
convergent approach to ensure different
inter-related schemes move from a siloed
approach to a unified and convergent action
to target malnutrition. For this, Convergence
Committees are envisaged at the State,
District and block levels to develop and
follow Convergent Action Plans (CAPs).
Further under POSHAN Abhiyaan,
Resource Groups are formed for Incremental
Learning Approach (ILA) trainings at
different levels to enhance the capacity of
frontline workers. Finally, the Abhiyaan
proposes a single unified technical set-up,
i.e, Nutrition Resource Centre at National
and State level to enhance and strengthen the
quality of implementation and monitor and
review the programme. These structures and
processes are expected to provide overall
direction, policy and guidance for timely,
effective and smooth implementation of the
Abhiyaan. Under the theme of Governance
and Institutional mechanisms, overall,
among the large States, Himachal Pradesh,
Madhya Pradesh and Rajasthan are best
prepared for implementation. These States
are closely followed by Andhra Pradesh,
Gujarat and Maharashtra (Figure 9). The
States which were least prepared in
Governance and Institutional mechanism
included Kerala, Karnataka, Assam and
Jammu & Kashmir, which scored five and
below on a scale of 0 to 19.
Among the small States, Mizoram is the
best prepared State in the area of Governance
and Institutional mechanism closely
followed by Nagaland and Arunachal
Pradesh (Figure 13). Meghalaya and Goa are
the least prepared States for the mentioned
theme.
*Data collated only from WCD Departments of States and UTs
0
2
4
6
8
10
12
14
16
18
20
MIZORAMARUNACHAL
PRADESH
NAGALANDSIKKIM MANIPUR TRIPURA GOA MEGHALAYA
Figure 13:
Governance & Institutional Mechanism: Small States
Max Score: 19 35
Among the UTs, Dadra & Nagar Haveli
followed by Lakshadweep are the best
prepared UTs on Governance and
Institutional mechanism (Figure 14). Daman
and Diu scored the least in this area, closely
followed by Delhi.
Overall, in terms of Governance and Institutional
mechanism, except a few large States including
Kerala, Karnataka, Assam and Jammu & Kashmir
most other States and UTs scored well
demonstrating preparedness in Governance and
Institutional mechanism.
3.2 Strategy and Planning
This theme examined the elements of
cross-sectoral convergence and included two
indicators-
1. whether a convergence action plan
(CAP) has been submitted as part of the
annual PIP;
2. a proportion of Districts with
convergence action plans.
The score computed based on the information
received from the State/UT WCD
Department indicates that several States and
UTs have not yet taken the initial steps
toward cross-sectoral convergence.
On a scale of 0 to 6, only six large States
ranked high on cross-sectoral convergence.
These included Andhra Pradesh, Chhattisgarh,
Madhya Pradesh, Uttaranchal, Uttar Pradesh
and Punjab. States which scored a zero
included Tamil Nadu, Maharashtra, Rajasthan,
Bihar, Haryana, Telangana, Karnataka, Assam
and Kerala. Remaining four States scored
between 2 and 4 points.
From the eight small States, Sikkim and
Nagaland were at the top of the list for
cross-sectional convergence, closely
followed by Meghalaya. All the others were
least prepared for cross-sectional
convergence, with a nil score.
Among the seven UTs, Chandigarh, Daman
& Diu, and Andaman & Nicobar Islands
ranked highest with a total score of 6. The
remaining four UTs scored a zero on
cross-sectoral convergence theme.
3.3 Service Delivery & Capacities
The theme of Service Delivery and
Capacities was assessed using data from the
State/UT WCD and Health Departments on
human resources, supplies, and training and
capacity building and information on
infrastructure from State health departments.
Detailed indicator results of these
components are discussed in Chapter 4. In
this section the implementation scores for
Service Delivery and Capacities theme have
been analyzed.
0
2
4
6
8
10
12
14
16
18
20
DADRA &
NAGAR HAVELI
LAKSHA-
DWEEP
CHANDIGARH ANDAMAN &
NICOBAR
ISLANDS
PUDUCHERRY DELHI DAMAN & DIU
Figure : 14
Governance & Institutional Mechanism: UTs
Max Score: 19
*Data collated only from WCD Departments of States and UTs
0
2
4
6
8
10
12
14
16
18
20
DADRA &
NAGAR HAVELI
LAKSHA-
DWEEP
CHANDIGARH ANDAMAN &
NICOBAR
ISLANDS
PUDUCHERRY DELHI DAMAN & DIU
Figure : 14
Governance & Institutional Mechanism: UTs
Max Score: 19
*Data collated only from WCD Departments of States and UTs 36
The State scores on this theme, ranging
from 0 to 31, based on the information from
WCD State Departments indicate that
several States need to create strengthened
service delivery system for effective service
delivery (Figure 15).
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
ANDHRA PRADESH
TAMIL NADU
CHATTISGARH
MADHYA PRADESH
RAJASTHAN
UTTARANCHAL
JHARKHAND
BIHAR
GUJARAT
UTTAR PRADESH
MAHARASTRA
HIMACHAL PRADESH
JAMMU & KASHMIR
TELANGANA
HARYANA
PUNJAB
KERALA
KARNATAKA
ASSAM
MIZORAM
MEGHALAYA
SIKKIM
GOA
NAGALAND
MANIPUR
ARUNACHAL PRADESH
TRIPURA
DADRA & NAGAR HAVELI
CHANDIGARH
DAMAN & DIU
PUDUCHERRY
DELHI
ANDAMAN & NICOBAR ISLANDS
LAKSHADWEEP
Figure 15: Service Delivery and Capacity: WCD Department
HR (Out of 5) Supplies (Out of 5) Training and capacity building (Out of 21)
Max Score: 31
On a scale of 0 to 31, among large States, Andhra
Pradesh scored the highest (30.7) followed by
Tamil Nadu (28.2) and Chhattisgarh (24.7) on
service delivery and capacities. Assam,
Karnataka and Kerala were at the bottom of the
list with a score 10 or less. Nine States that need
to improve their service delivery and capacities
include Himachal Pradesh, Maharashtra, Punjab,
Haryana, Telangana, Jammu & Kashmir,
Karnataka, Assam and Kerala.
In the case of small States, Mizoram, Meghalaya
and Sikkim ranked high on service delivery and
capacities. The remaining five small States scored
less than 15 points and two of those States Tripura
(8.5) and Arunachal Pradesh (9.2) scored less
than 10 points.
Among the UTs , Dadra and Nagar Haveli,
Chandigarh, and Daman & Diu scored the higher
on service delivery and capacities. The remaining
four UTs including Puducherry, Andaman &
Nicobar Islands, Delhi and Lakshadweep scored
less than 20 points.
Overall, most large and small States seemed to be
doing fairly well in terms of health-related service
delivery and capacities. Among large States, six
States including Uttaranchal, Tamil Nadu,
Punjab, Telangana, Assam and Kerala scored the
highest possible score i.e., 17 points. Except
Bihar all the large States scored above 15 points,
which represented a good level of readiness and
implementation in terms of health-related Service
Delivery and Capacities (Figure 16).
Sikkim and Manipur were the two small States
that scored the maximum possible points.
Meghalaya and Goa were at the bottom of the list.
Among the UTs , Andaman & Nicobar Islands
was at the top of the list for health-related Service
Delivery and Capacities. Delhi was at the bottom
of the list and there was no information received
from Lakshadweep. 37
3.4 Program activities and intervention
coverage
To assess the implementation score of
States/UTs on programme activities and
intervention coverage, information from
States' WCD departments was received on a
select set of interventions under ICDS, and
from the health department on a select set of
postnatal (children) and early childhood
interventions. Detailed indicator results have
been discussed in chapter 4. In this section,
only implementation scores for programme
activities and intervention coverage have
been analyzed.
For large States on a scale of 0 to 9 points,
12 States scored the maximum score of 9
points and two States scored 8 points on the
ICDS interventions. Four States including
Tamil Nadu, Jharkhand, Uttar Pradesh, and
Kerala scored 3 points while Punjab scored 2
points.
Other than Sikkim and Goa, all the other
small States scored 9 points. Among the
UTs, except Delhi, all other UTs scored 5 or
more points on programme activities and
intervention coverage pertaining to ICDS
(Figure 17).
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
ASSAM
KERALA
PUNJAB
TAMIL NADU
TELANGANA
UTTARANCHAL
CHATTISGARH
GUJARAT
HIMACHAL PRADESH
KARNATAKA
MAHARASTRA
ANDHRA PRADESH
JHARKHAND
MADHYA PRADESH
RAJASTHAN
HARYANA
JAMMU & KASHMIR
UTTAR PRADESH
BIHAR
MANIPUR
SIKKIM
ARUNACHAL PRADESH
MIZORAM
NAGALAND
TRIPURA
GOA
MEGHALAYA
ANDAMAN & NICOBAR ISLANDS
DADRA & NAGAR HAVELI
CHANDIGARH
PUDUCHERRY
DAMAN & DIU
DELHI
LAKSHADWEEP
Figure 16: Service Delivery and Capacity-Health Department
Infrastructure (Out of 4)HR (Out of 3)Stock Out (Out of 6)Training and capacity building (Out of 4)
Max Score: 17 38
Based on information received from the State/UT
health departments on a selected set of postnatal
(children) and early childhood interventions,
States/UTs were assessed on a scale of maximum
18 points (Figure 18).
Among the large States, Himachal Pradesh and
Maharashtra scored the highest i.e., 18 points on
the health-related programme activities and
intervention coverage. . Andhra Pradesh, Tamil
Nadu and Punjab followed closely. Rajasthan was
at the bottom of the list scoring only 6 points.
Among the small States, Sikkim ranked the
highest scoring 16 points, followed closely by
Goa, Mizoram and Tripura. Meghalaya was at the
bottom of the list with a nil score.
All the UTs, except Delhi and Lakshadweep
scored high on the list of health-related
programme activities and intervention coverage.
There was no information received from
Lakshadweep.
0
1
2
3
4
5
6
7
8
9
10
HIMACHAL PRADESH
MADHYA PRADESH
RAJASTHAN
ANDHRA PRADESH
GUJARAT
MAHARASTRA
BIHAR
UTTARANCHAL
PUNJAB
UTTAR PRADESH
ASSAM
KERALA
CHATTISGARH
TELANGANA JHARKHAND
HARYANA
JAMMU & KASHMIR
KARNATAKA TAMIL NADU
MIZORAM
NAGALAND
SIKKIM
MANIPUR
TRIPURA
MEGHALAYA
ARUNACHAL PRADESH
GOA
ANDAMAN & NICOBAR ISLANDS
DELHI
DAMAN & DIU CHANDIGARH
DADRA & NAGAR HAVELI
LAKSHADWEEP
PUDUCHERRY
Figure 17: Program activities and intervention coverage-WCD
Department
Max Score: 9 39
0
2
4
6
8
10
12
14
16
18
20
HIMACHAL PRADESH
MAHARASTRA
ANDHRA PRADESH
PUNJAB
TAMIL NADU
HARYANA
KARNATAKA
KERALA
CHATTISGARH
JAMMU & KASHMIR
JHARKHAND
ASSAM
UTTAR PRADESH
BIHAR
GUJARAT
UTTARANCHAL
TELANGANA
MADHYA PRADESH
RAJASTHAN
SIKKIM
GOA
MIZORAM
TRIPURA
NAGALAND
ARUNACHAL PRADESH
MANIPUR
MEGHALAYA
DADRA & NAGAR HAVELI
PUDUCHERRY CHANDIGARH DAMAN & DIU
ANDAMAN & NICOBAR ISLANDS
DELHI
LAKSHADWEEP
Figure 18: Program activities and intervention coverage-Health
Department
Max Score: 18 CHAPTER 4:
SCALING UP POSHAN ABHIYAAN
BY DELIVERING CORE
INTERVENTIONS AT SCALE TO
ENSURE COVERAGE, CONTINUITY,
INTENSITY AND QUALITY - C
2
IQ 41
4.1 Background:
POSHAN Abhiyaan aims to reduce stunting,
anemia, and low birthweight across high
malnutrition burden Districts. It recognizes the
need for convergence and coordination such that
the benefits of government schemes and
programs reach women and children in the first
1000 days. The POSHAN Abhiyaan lays out
targeted determinants of nutritional outcomes that
exist in various schemes and programs. These
include maternal nutrition, newborn care
practices, infant feeding and care practices and
underlying determinants, such as age at marriage,
age at first birth and sanitation (Figure 16).
To achieve the ambition of a malnutrition-free
India, it is imperative to ensure that the package
of programmatic interventions is implemented
with adequate coverage, continuity, intensity and
quality (C2IQ). High impact interventions need to
be implemented such that they cover 80-90
percent of eligible populations in a C2IQ
framework and are monitored on a quarterly
basis. The mission-mode approach provides an
impetus to strengthen not just the implementation
but also the monitoring and measurement of
progress.
Although a majority of these interventions are
part of the national health and nutrition programs
in India, the coverage of these interventions is
highly variable - by life stage, by intervention, by
State, and by District.
Figure 19: Interventions in POSHAN Abhiyaan
Interventions for POSHAN Abhiyan
Girl / adolescent / woman Newborn and childSwachh
• Care and education of the girl child:
Beti bachao, beti padao
• Adolescent girl care: Food ,
micronutients, healthcare, life style,
preparation as adult
• Right age for child birth: Marriage
after 18 years, childbirth after 20
years
• Pre-pregnancy care: Food,
micronutrients, contraception
• Birth sapcing: Gap between births
more than 2-3 years
• Antenatal care: checks for
complication detection, food, iron-
folic acid, tetanus immunization,
birth preparedness, treatment of
complications
• Skilled birth attendance and
emergency obstetric care: Facility
birth, emergency obstetric care
• Swachh:
Sanitation,
safe water,
hand
washing,
toilet use
(mother) and
safe disposal
of feces
• Newborn care:
• Care at birth, hygiene, cord care
• Breast feeding: within one hour, exclusive for six months,
cpntinuling for 2 years or more
• Extra care of low birth weight baby
• Kangaroo mother care
• Care of the sick and small neonate
• Complete immunization: Including rotavirus and pneumococcal
Vaccines
• Breast feeding upto 2 years and more
• Complementary feeding: From 6 months onward; culturally
appropriate recupes, hygienc, increaing amount, adequate in nutrition
• Growth monitoring
• Care of the undernourished child
• Care in severe acute malnutrion
• Early stimulation and child development
• Early detection and care of illness: For diarrhea (including ORS and
zinc), pneumonia (including antibiotics) and other illnesses; referral
• Supplements:
• Supplementary nutrition
• Iron-folic acid
• Vitamic A supplementation
• Deworming 42
The efforts behind scaling up POSHAN
Abhiyaan interventions are based on several
assumptions that map to the key pillars of
POSHAN Abhiyaan (using technology,
improving capacities, the convergence of
multiple programs and behaviour change
communication).
• First, it assumes that a set of core POSHAN
Abhiyaan pillars (technology, training,
processes to support convergence, and Jan
Andolan) will trigger a series of changes
that improve the availability and quality of
nutrition interventions in the ICDS and
health system, and interventions to address
underlying challenges of gender, sanitation,
and poverty.
• Second, it assumes that putting these
interventions in place will address both the
immediate and underlying determinants of
poor nutritional outcomes. These
determinants include dietary practices for
women and children, use of micronutrient
supplements and food supplements,
sanitation practices and more.
• Finally, the theory of change assumes that
these will lead to improved outcomes such
as child growth, reduction in anemia and
other targets of the nutrition mission.
In this chapter, we focus on the status of the core
programmatic platform inputs, the roll-out of the
POSHAN Abhiyaan pillars and the coverage of
POSHAN Abhiyaan interventions. In
describing these, we use a combination of data
provided by the State Governments (for inputs
and program roll-out) and from surveys (for
program coverage). In all the results, we present
findings separately for the 19 large States, the 8
small States and the 7 Union Territories (UTs).
4.3 INPUTS
Program inputs related to the ICDS and health
platforms are critical for functioning of
POSHAN Abhiyaan pillars. These include
funding, human resources, supplies, and
infrastructure. Below, we describe the status of
these, using data provided by the State
Governments and data compiled for other
programs under the ambit of POSHAN
Abhiyaan.
a. Fund allocation & utilization
Funds are critical to initiate, implement, and
sustain processes required for delivering
interventions including staffing, supplies
and infrastructure. From the information
shared by the States/UTs, it is evident that
all the large States have received funds
from the Centre. Except Assam and Jammu
& Kashmir, all large States, have
earmarked funds for POSHAN Abhiyaan.
With respect to the utilization of funds,
Maharashtra has utilized the maximum
amount, close to 55 percent, followed by
Karnataka (40 percent) and Bihar (35
4.2 Theory of Change for POSHAN Abhiyaan:
Inputs
•Human
resources
•Supplies
Infrastructure
Process
•POSHAN
Abhiyaan Pillars
-Technology
-Training
-Convergent
actions
-Activities to
stremgthen ICDS-
Health
convergence
-SBCC/Jan
Aandolan
activities
Short-term
outcomes
•Improved
availabality of and
access to POSHAN
Abhiyaan
internetions
•(eg: Improved
ICDS services,
Improved public
sctor services and
nutrition
interventions,
NREGA etc.)
Long term
outcomes
•Improvem,ent in
determinants of
nutrition
•(eg. Better
nutrition during
pregnancy, Better
IYCF practices
especially
complementary
feeding, more IFA
and Ca
supplementation
Impact
•Better child
growth
•Reduce Anemia
Reduce low birth
weight 43
percent). In Punjab, Kerala, Haryana, and
Jharkhand the utilization level of funds has
been 5 percent or less; in Chhattisgarh and
Uttar Pradesh, it was less than 10 percent.
In the remaining large States, fund
utilization ranged between 19 and 33
percent.
All the small States reported receiving
funds from the Centre. Except Sikkim,
Tripura and Manipur, all other small States,
have earmarked funds for POSHAN
Abhiyaan. With respect to utilization of
funds, Arunachal Pradesh, Meghalaya and
Mizoram, utilized more than 60 percent of
funds followed by Nagaland (58 percent).
In the remaining small States, fund
utilization ranged between 20 and 44
percent. None of the funds were utilized in
Goa.
In UTs where there is no State legislature
including Andaman & Nicobar Islands,
Chandigarh, Dadra & Nagar Haveli, Daman
& Diu, and Lakshadweep, POSHAN
Abhiyaan is fully funded, implying that
they do not need to earmark funds. UTs
with legislature including Puducherry and
Delhi have a cost sharing ratio of 60:40
with the Center. All the UTs reported
receiving funds from the Centre. Dadra &
Nagar Haveli utilized more than 60 percent
of funds followed by Chandigarh (58
percent) and Daman & Diu (56 percent).
Funds utilization level was lowest in Delhi
at 4 percent. In the remaining UTs, funds
utilization was lower than 40 percent.
Low level of fund utilization is a matter of
concern in most States and UTs. None of
the large States, except Maharashtra, has
utilized more than 50 percent funds. Only
four out of eight small States, and three out
of seven UTs have reached a utilization
level of more than 50 percent.
b. Human Resources
Human resources are critical for
implementation of any of the interventions.
Here we describe the status of staffing at
multiple levels in the ICDS and health
systems as reported by the States. The
expected steps to ensure overall
convergence at the State/UT level are to
establish State Project Management Units
(SPMUs), set up Convergence Action Plan
(CAP) committees at State, District, block
levels and develop convergent action plans
at these administrative levels. This indicator
is mentioned under Convergence Section of
the Report, however it is critical indicator to
be discussed under HR related issues as
well.
• District Program Officers (DPO), Child
Development Project Officers (CDPOs),
Lady Supervisors (LS), Anaganwadi
Workers (AWWs) and Anganwadi Helper
(AWHs) positions
In eight of the 19 large States, all the DPO
positions were filled. Only in Assam, less
than 50 percent of DPO positions were
filled. In five of the small States, all the
CDPO positions were filled. More than 90
percent of LS positions were filled in five
large States (Assam, Gujarat, Kerala,
Madhya Pradesh) and less than 60 percent
of LS positions were filled in three large
States (Bihar, Rajasthan, Uttar Pradesh).
Between 61 percent to 85 percent of LS
positions were filled in the remaining large
States. More than 90 percent of AWW and
AWH positions were filled in a majority of
the large States. Only in Bihar (82 percent)
and Uttar Pradesh (89 percent) less than 90
percent of AWH positions were filled.
In case of small States, except in Manipur
and Tripura, all the CDPO positions were
filled. In a majority of small States, all the
DPO positions are filled. Similarly, in five
States (Arunachal Pradesh, Goa, Manipur,
Meghalaya, Sikkim) all LS positions were
filled. In Mizoram and Nagaland more than
80 percent of LS positions were filled. In
Tripura, only 52 percent of LS positions 44
were filled. Nearly all small States had all AWW
and AWH positions filled.
• Lady Health Visitor (LHV) & ANM
positions
Among the large States, in 14 States, more
than 75 percent of ANM positions were
filled and a similar situation was observed
for LHV positions in 10 States. In 4 of the
small States, more than 90 percent of ANM
posts were filled; in Arunachal Pradesh all
ANM positions were filled. In Mizoram,
only 32 percent of LHV positions were
filled and information was not available for
Tripura. In the remining small States more
than 85 percent of LHV positions were
filled. In 4 UTs, more than 95 percent ANM
posts were filled.
Adequate staffing is important to ensure
reach of interventions with quality and
intensity. Therefore, there is an urgent need
to close gaps in human resources to
facilitate implementation. The gaps in
supervisory positions particularly impede
delivery of interventions with quality.
• Establishment of State Project
Management Unit (SPMU)
In many States and UTs, State Project
Management Units (SPMUs) were
established. However, the level at which
posts were filled in these SPMUs varied
greatly. SPMUs were established in 17 large
States (except Punjab and Karnataka). In
four large States more than 80 percent of the
SPMU posts were filled while in three
States more than 70 percent posts were
filled. Only in Gujarat 100 percent of the
posts were filled. In Uttar Pradesh and
Haryana, less than 5 percent of the posts are
filled. In the remaining large States less
than 50 percent SPMU posts have been
filled.
Among the 8 small States, the SPMUs
were established in 6 States (except
Manipur and Goa). In Mizoram 73 percent
of the SPMU posts were filled while in
Meghalaya only 25 percent posts were
filled. In the remaining small States none of
the posts were filled. In four UTs more than
75 percent of the SPMU posts were filled.
None of the posts were filled in Puducherry
and Delhi.
• Pradhan Mantri Matru Vandana Yojana
(PMMVY)
In the Pradhan Mantri Matru Vandana
Yojana (PMMVY) of MoWCD, against the
provision of hiring 60 contractual staffs at
State level and 1,434 contractual staffs at
District level across the States and UTs, so
far 42% and 26% recruitments have been
done at State and District levels
respectively (MoWCD data as on 18
February 2019).
Trend in year 2018-19
Analysis of the trend of vacancy at these levels
under ICDS in last one year reveals that progress
has been made to fill-up the vacant positions.
The below figure 20 presents the trend, wherein
it is evident that around 10% decline in the
vacancy of CDPOs and Supervisors has been
observed in last one year. The vacancies of
Supervisors are on constant decline whereas
CDPO vacancy has increased in the last quarter.
The current position of human resource
deployment against the sanctioned position
under ICDS, POSHAN Abhiyaan and PMMVY
has been analysed and few feasible measures
have been suggested that are in conformity with
Guidelines of these Schemes. 45
0
5
10
15
20
25
30
35
40
45
Jan - March'18 April - June'18 July-Sept'18 Oct-Dec'18 Jan-Mar'19
% Vacancy
Figure 20: Trend of HR vacancy at different levels under ICDS in
the last one year
CDPO Supervisor AWW AWH
MoWCD, Data as on 31st March 2019
Measures suggested for improving the vacancy status
The Ministry of Women and Child Development has been communicating with the States and UTs on the
need for filling-up the vacancies under the ICDS/PMMVY/POSHAN Abhiyaan. It has suggested several
measures to provide flexibility so that they could speed-up their recruitment process:-
i) In the letter addressed to all Secretaries dealing with ICDS dated 15th Sept., 2015, the Ministry had
communicated that “50% of vacancies in the posts of Supervisors would be filled up by promotion
from amongst AWWs with 10 years of experience as AWWs and having the prescribed educational
qualification as per the Recruitment Rules for the post of Supervisor”.
On mere implementation of the above Order (subject to adherence of qualification and education
norms), the Lady Supervisory level vacancy will reduce by 50%, whereas vacancy at AWW level
will increase only by 0.5%. Also, this will enhance work efficiency amongst the AWWs to perform
better to graduate to the higher level.
ii) In order to fast track the filling of vacant position of CDPOs, the Ministry in its letter to all Chief
Secretaries of States and UTs dated 06th Feb, 2019 has allowed to recruit the afore mentioned
personnel “on contract basis till such time the vacancies are filled on regular basis”. The selection
procedure and salary norm for such contractual appointment has also been provided in the said letter.
With this measure, all CDPO level vacancies may be filed within 3-6 months timeline on
contract basis.
iii) In the above mentioned letter dated 06th Feb, 2019, the Ministry has also mentioned about its
previous Order where the District Magistrates has been authorised to recruit the AWWs and
Supervisors at his/her level. By implementing this measure, the remaining 50% vacancy at the
Supervisor level and all vacancies at AWW level may be filled within 3 months. 46
For newly launched Schemes of PMMVY and
POSHAN Abhiyaan, MoWCD needs to
persuade the States and UTs to fill-up
contractual positions at State, District and Block
levels so that the Schemes could perform well.
Also, MoWCD should monitor HR vacancy
status under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
c. Supplies
• Growth monitoring devices
The distribution levels of growth
monitoring devices including weighing
scales for infants and adults, and height
measuring instruments - infantometers, and
stadiometers varied across the States and
UTs. Among the large States, 9 States
reported not distributing any of the infant or
adult weighing instruments. Three States
distributed 50 percent or fewer scales.
Among the small States, three of them
distributed 100 percent of the required
weighing scales while 4 others did not
distribute any weighing scales. In four out
of seven UTs , 100 percent of the required
weighing scales were distributed (Table 5;
Annexure 3).
In eight large States and four small States
and in one UT, none of the height
measurement instruments were distributed.
In three large States, and in four small
States and UTs, 100 percent of the required
height measuring devices were distributed.
As availability of a measuring instrument is
the first step in ensuring that measurement
takes place, this huge gap in lack of
instruments at the AWCs needs immediate
attention.
• Stock-out of IFA red tablets, TT injections,
and albendazole in the month of Feb 2019
For an effective implementation of some
pre-pregnancy and postnatal interventions,
it is essential to have an adequate level of
stocks of IFA red tablets, TT injections, and
albendazole. Most of the States and UTs
seemed to have a good level of stocks of
these supplies.
None of the States and UTs reported
stock-out of IFA red tablets in Feb 2019,
except Nagaland (100 percent stockout),
Uttar Pradesh (1 percent stockout) and
Delhi (82 percent stockout). No information
was received from Lakshadweep.
None of the States and UTs reported
stock-out of TT injections in Feb 2019,
except Uttar Pradesh (23 percent). No
information was received from
Lakshadweep.
None of the States and UTs reported
stock-out of albendazole in Feb 2019,
except Madhya Pradesh (11 percent), Uttar
Pradesh (67 percent) and Delhi (100
percent). No information was received from
Lakshadweep.
d. Infrastructure
For some of the health interventions to be
delivered, it is essential to have functional
Community Health Centres (CHCs) and
sub-centres. In nearly all large States, 100
percent of CHCs were reported to be
functional, except in Bihar (33 percent),
Punjab (99 percent), and Uttar Pradesh (87
percent). Similarly, in a majority of large
States all sub-centers were reported to be
functional except in Assam (97 percent),
Bihar (60 percent), Jammu & Kashmir (96
percent), Jharkhand (92 percent), and
Rajasthan (94 percent).
In nearly all small States 100 percent of
CHCs were functional, except in
Meghalaya (information unavailable) and
Tripura (88 percent). Only in 4 small States
100 percent of sub-centers were functional.
In all UTs, except in Delhi and
Lakshadweep, 100 percent of CHCs and
sub-centers were reported to be functional.
No information was received from Delhi
and Lakshadweep. 47
What’s working well
• Most AWW and helper positions and ANM
positions are filled across States. This is
encouraging as they are the key personnel
to ensure the delivery of interventions.
• Growth monitoring devices procurement
and distribution is high.
• Low levels stock-out of supplies across
States is encouraging.
• All CHCs and sub-centres are functional in
a majority of the States.
What needs attention
• Low levels of fund utilization across State and UTs
is a matter of concern. It is important to identify the
reasons for low fund utilization and identify
opportunities to improve it.
• Supervisory cadre positions need to be filled. These
are critical to ensure that the frontline functionaries
are supported to deliver services.
• Attention is needed to close gaps in procurement
and distribution of growth monitoring devices in
some States.
• Remaining State-level supply gaps for IFA, TT, and
albendazole tablets need to be closed. Attention is
needed to ensure that distribution further down the
chain is not hampered.
• Infrastructure challenges linger in some States and
need attention, especially in high burden States like
Bihar.
BOX 2: Challenges reported by State/UT
Governments on strengthening inputs needed
to implement POSHAN Abhiyaan actions
Human Resources
Human resource gaps at different levels were
identified as an impediment by 11 States including
Assam, Bihar, Chhattisgarh, Jammu & Kashmir,
Haryana, Madhya Pradesh, Maharashtra,
Nagaland, Puducherry, Punjab and Uttarakhand.
In the case of Haryana, vacancies could not be
filled due to the imposition of the Model Code of
Conduct.
• With preparation for 2019 General Elections
underway, many skilled personnel were
engaged in election duties in Bihar and
Telangana.
• Bihar reported that in addition to election
duties, personnel were also involved in
invigilating exams.
• Assam mentioned that ICDS field-level
officials and AWWs were engaged in work
related to the National Register of Citizens.
• Tamil Nadu faced several challenges with the
Commcare App which does not allow for data
to be edited or elaborate information of
beneficiaries to be entered which would prevent
duplication and exclusion.
• Uttarakhand specified engagement of resource
group members in other departmental work
because of which rollout was delayed.
• Maharashtra also mentioned delays in overall
rollout of POSHAN Abhiyaan because of
delays in lack of HR personnel, and imposition
of the Model Code of Conduct, resulting in long
administrative processes.
Supplies
Three States/UTs including Andaman and Nicobar
Islands, Chhattisgarh and Jammu & Kashmir
faced issues related to the distribution and
maintenance of growth monitoring devices.
Andaman and Nicobar Islands faced procurement
issues, while Chhattisgarh cited challenges in
maintaining machines as well as the need to
develop the skills necessary to correctly use them.
In Jammu & Kashmir, hilly terrain has led to slow
distribution of devices to AWCs. Maharashtra
also reported challenges related to procuring and
distribution of devices.
Infrastructure
None of the States reported explicit challenges
related to infrastructure.
Source: Data provided by the State/UT governments in response to questionnaires sent out by NITI Aayog, May 2019 48
4.4 TECHNOLOGY
The ICDS-CAS application functions through a
mobile application at the level of AWW and LS
and through a dashboard at the higher levels.
The application digitizes 10 of the 11 registers of
the AWWs, provides a supervisory application
to the LS, and a dashboard application to
CDPOs, DPOs as well as to officials at the State
and at the central level to be able to monitor
Anganwadi Center (AWC) activities.
We examine four major technology-related
implementation components, by State. These
include the availability of mobile devices, the
establishment of technology support, training
of functionaries at multiple levels and the
availability/training in the use of the
dashboard.
The data used to assess these is based on
responses from the State governments to the
questionnaire sent out by NITI Aayog in May
2019.
a. Mobile phone devices
The first step in ICDS-CAS functionality is
availability of the mobile devices. The
distribution level of mobile phones varied
in States and UTs. Among large States,
only in Andhra Pradesh mobile phones
were distributed to all Districts. In ten large
States, the distribution levels were between
19 and 39 percent Districts. Mobile phones
were not distributed to any of the Districts
in Assam, Gujarat, Haryana, Karnataka,
Kerala, Punjab, and Maharashtra. In Jammu
& Kashmir, phones were distributed to only
2 percent of the Districts.
Among small States In Goa and Meghalaya
mobile phones were distributed to all the
Districts. In Mizoram, phones were
distributed to nearly 62 percent of the
Districts. In the remaining five States,
mobile phones were not distributed to any
of the Districts. In four UTs mobile phones
were distributed to more than 85 percent of
the Districts, and in the remaining three
UTs, phones were not distributed to any of
the Districts (Table 6; Annexure 3).
b. Technology support
Establishing a helpdesk provides the
technology support required for the smooth
implementation of ICDS-CAS. Among the
large States, in Gujarat, Maharashtra and
Rajasthan, helpdesks have been established
in almost all the Districts. Of the remaining
16 large States, helpdesks have been
established in less than 50 percent of the
Districts in seven States and in none of the
Districts in nine States. Among the small
States, helpdesks have only been
established in Mizoram and Sikkim.
Among the seven UTs, helpdesks have only
been established in Andaman & Nicobar
Islands and Daman & Diu (Table 6;
Annexure 3).
Access to ICDS-CAS dashboard and training
in the use of the ICDS-CAS dashboard
Data from the ICDS-CAS goes into the State
nutrition dashboards, providing an overall
snapshot for monitoring. Among the large
States, 11 States have access to this ICDS-CAS
dashboard. Only four small States and four UTs
have this access. Much also needs to be done to
complete the training of field functionaries on
the use of the dashboard in ICDS-CAS in the
States and UTs (Table 7; Annexure 3).
More than 75 percent of DPOs and CDPOs were
trained on using ICDS-CAS dashboard only in
three of the large States (Andhra Pradesh, Tamil
Nadu, Jharkhand). None of the DPOs were
trained in seven small States except in
Meghalaya where only 20 percent of the DPOs
were trained. In case of CDPOs training, among
small States, all the CDPOs in Mizoram, 64
percent in Goa, and 28 percent in Meghalaya
were trained in the use of the dashboard. None of
the CDPOs in the remaining five States were
trained. Among the UTs, only in Puducherry all
the DPOs were trained. Only in Dadra & Naga
Haveli, Daman & Diu, and Chandigarh all the 49
BOX 3: State-level challenges related to
strengthening technology in the context of
POSHAN Abhiyaan
Connectivity, procurement and device-related
challenges are the most common problems
reported by the States in rolling out ICDS-CAS.
Connectivity issues
Poor connectivity is cited as the most common
impediment to mobile phone functioning at
ground level. This was reported by States such as
Bihar, Chhattisgarh, Mizoram and Nagaland.
While Bihar, Chhattisgarh and Nagaland face
these issues in remote areas, Mizoram attributes
this connectivity issue to its geographical terrain.
Other States/UTs that report network connectivity
issue hampering the implementation of
ICDS-CAS include Jharkhand, Lakshadweep,
Madhya Pradesh, Meghalaya, and Puducherry.
Procurement and device-related problems
In Haryana, Jammu & Kashmir, Maharashtra and
Punjab, the implementation of ICDS-CAS has
been hampered by delays in training and
procurement. Punjab mentions pending bids as a
problem to the smooth functioning of mobile
phones because of which mobile phones have not
even reached 16 Districts. Issues related to app
and device performance and usability are reported
by Chandigarh, Daman and Diu, Madhya Pradesh,
and Tamil Nadu. Tamil Nadu has encountered
storage issues where the app on the mobile phone
does not allow for recording of details once the
count of beneficiaries crosses 200.
Other State-specific issues
Punjab and Rajasthan face budget constraints,
while in Maharashtra, vacancies posed a
significant challenge for the implementation of
ICDS-CAS. In Himachal Pradesh, ICDS-CAS is
not linked with PMMVVY, leading to the
exclusion of some beneficiary groups. And in
Uttarakhand, discrepancies in paperwork have led
to issues in data collection and phone
configuration.
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
CDPOs were trained in the use of dashboard.
More than 75 percent of LS were trained only in
two large States (Andhra Pradesh, Tamil Nadu).
Among small States, only in Goa all the LS were
trained on using the ICDS-CAS dashboard or
mobile. None of the LS received training in
Arunachal Pradesh, Manipur, Tripura, Nagaland
and in the remaining small States between 50 to
62 percent of LS were trained. In Dadra &
Nagar Haveli, Chandigarh, and Daman & Diu,
all LS were trained in ICDS-CAS dashboard
use. Overall, a high proportion of ICDS
functionaries remain untrained on ICDS-CAS
dashboard/mobile and this requires immediate
attention of the States and UTs.
What’s working well
Mobile phone procurement and distribution is
moving well with variable achievement of reach of
procurement and distribution across States.
What needs attention
- Helpdesk set-up needs attention across the
board as it is critical for frontline worker
support in using ICDS-CAS
- Dashboard access needs to expand across all
States.
- Immediate attention is needed for training ICDS
functionaries on the use of dashboard and
mobiles.
- Connectivity challenges need to be addressed to
ensure ICDS-CAS functioning at the village level.
Summary 50
4.5 TRAINING
Training is an integral component of
POSHAN Abhiyaan. It is intended to
strengthen the capacity of frontline workers
(FLWs) to deliver services in a timely,
efficient and effective manner. Twenty-one
Incremental Learning Approach (ILA)
modules were developed and launched to
train FLWs to improve their knowledge and
skills in an ongoing and incremental
manner. Key capacity building related
components to roll out this training include
the establishment of resource groups for
training, and the actual training of frontline
providers.
a. Establishment of training resource groups
• State-level resource group for ILA
training established
The State-level resource groups for ILA
training were established in all States and
UTs, except in Karnataka.
• District-level Resource Group (DRG) for
ILA training established
Nearly all large States have established all
the required DRGs for ILA training, except
in Assam, Karnataka, Kerala and Jammu &
Kashmir. Jammu & Kashmir had the lowest
proportion of established DRGs at 41
percent. All small States have established
DRGs except in Arunachal Pradesh (84
percent). Except in Daman & Diu, all the
DRGs were established in the UTs.
• ILA training for District Resource
Groups (DRGs)
In most States and UTs, ILA training for
DRGs has been initiated. Except in
Telangana, Jammu & Kashmir, Karnataka,
Assam and Kerala, ILA training has been
initiated for DRGs in 14 large States. In 11
of the States, more than 75 percent of DRG
members have been trained, and in three
States between 50 and 75 percent of DRG
members have been trained.
Except in Tripura and Goa, ILA training has
been initiated for DRGs in six small States.
Of these, in four States, more than 75
percent of DRG members were trained.
Except Daman and Diu, and Lakshadweep,
ILA training has been initiated for DRGs in
five UTs. Of these, in four UTs, more than
75 percent DRG members have been
trained
• Block-level Resource Group (BRG) for
ILA training established
Nearly all large States have established all
the required BRGs, except in Assam,
Karnataka, and Kerala. Jammu & Kashmir
had the lowest proportion of BRGs
established BRGs (49 percent).
All small States have established BRGs,
except in Goa. As there are no blocks in
Andaman & Nicobar and in Chandigarh,
BRGs cannot be established. Except in
Daman & Diu, BRGs were established in
the rest of the UTs.
b. Training of ICDS and MoHFW
functionaries
• Lady Supervisors (LS) and Anganwadi
Workers (AWW) trained in six or more ILA
modules
Data on the training of LS and AWW in six
or more ILA modules show that much is
still desired. The number of LS that were
trained on at least 6 ILA modules was
higher than 75 percent in nine large States,
3 small States and 4 UTs. In the case of
AWWs, this was true in only six large
States, two small States and four UTs (Table
7; Annexure 3).
• Training of ASHAs
Out of 34 States and UTs, 17 States and UTs
have a plan to provide ILA training to
ASHAs. Of the 19 large States, seven have
a plan to provide ILA training to ASHAs.
Four small States, and all except one UT
plan for ILA training for ASHAs. In
subsequent reporting, we will assess
roll-out of the ILA training to ASHAs.
Aside from the ILA modules, the sixth and
seventh modules of the Home-based
Newborn Care (HBNC) training for ASHAs
cover areas related to nutrition. Most States
and UTs are doing well on this training for
ASHAs. More than 75 percent of the
ASHAs were trained on HBNC modules six
and seven in all large and small States,
except in Andhra Pradesh (69 percent).
Among UTs, all ASHAs were trained in
Andaman & Nicobar Islands and
Puducherry while more than 90 percent
ASHAs were trained in Dadra & Nagar
Haveli and Delhi. There was no information
available for Goa, Chandigarh and
Lakshadweep. 51
4.5 TRAINING
Training is an integral component of
POSHAN Abhiyaan. It is intended to
strengthen the capacity of frontline workers
(FLWs) to deliver services in a timely,
efficient and effective manner. Twenty-one
Incremental Learning Approach (ILA)
modules were developed and launched to
train FLWs to improve their knowledge and
skills in an ongoing and incremental
manner. Key capacity building related
components to roll out this training include
the establishment of resource groups for
training, and the actual training of frontline
providers.
a. Establishment of training resource groups
• State-level resource group for ILA
training established
The State-level resource groups for ILA
training were established in all States and
UTs, except in Karnataka.
• District-level Resource Group (DRG) for
ILA training established
Nearly all large States have established all
the required DRGs for ILA training, except
in Assam, Karnataka, Kerala and Jammu &
Kashmir. Jammu & Kashmir had the lowest
proportion of established DRGs at 41
percent. All small States have established
DRGs except in Arunachal Pradesh (84
percent). Except in Daman & Diu, all the
DRGs were established in the UTs.
• ILA training for District Resource
Groups (DRGs)
In most States and UTs, ILA training for
DRGs has been initiated. Except in
Telangana, Jammu & Kashmir, Karnataka,
Assam and Kerala, ILA training has been
initiated for DRGs in 14 large States. In 11
of the States, more than 75 percent of DRG
members have been trained, and in three
States between 50 and 75 percent of DRG
members have been trained.
Except in Tripura and Goa, ILA training has
been initiated for DRGs in six small States.
Of these, in four States, more than 75
percent of DRG members were trained.
Except Daman and Diu, and Lakshadweep,
ILA training has been initiated for DRGs in
five UTs. Of these, in four UTs, more than
75 percent DRG members have been
trained
• Block-level Resource Group (BRG) for
ILA training established
Nearly all large States have established all
the required BRGs, except in Assam,
Karnataka, and Kerala. Jammu & Kashmir
had the lowest proportion of BRGs
established BRGs (49 percent).
All small States have established BRGs,
except in Goa. As there are no blocks in
Andaman & Nicobar and in Chandigarh,
BRGs cannot be established. Except in
Daman & Diu, BRGs were established in
the rest of the UTs.
b. Training of ICDS and MoHFW
functionaries
• Lady Supervisors (LS) and Anganwadi
Workers (AWW) trained in six or more ILA
modules
Data on the training of LS and AWW in six
or more ILA modules show that much is
still desired. The number of LS that were
trained on at least 6 ILA modules was
higher than 75 percent in nine large States,
3 small States and 4 UTs. In the case of
AWWs, this was true in only six large
States, two small States and four UTs (Table
7; Annexure 3).
• Training of ASHAs
Out of 34 States and UTs, 17 States and UTs
have a plan to provide ILA training to
ASHAs. Of the 19 large States, seven have
a plan to provide ILA training to ASHAs.
Four small States, and all except one UT
plan for ILA training for ASHAs. In
subsequent reporting, we will assess
roll-out of the ILA training to ASHAs.
Aside from the ILA modules, the sixth and
seventh modules of the Home-based
Newborn Care (HBNC) training for ASHAs
cover areas related to nutrition. Most States
and UTs are doing well on this training for
ASHAs. More than 75 percent of the
ASHAs were trained on HBNC modules six
and seven in all large and small States,
except in Andhra Pradesh (69 percent).
Among UTs, all ASHAs were trained in
Andaman & Nicobar Islands and
Puducherry while more than 90 percent
ASHAs were trained in Dadra & Nagar
Haveli and Delhi. There was no information
available for Goa, Chandigarh and
Lakshadweep.
What’s working well
• Establishment of State-level resource groups
for ILA training is nearly complete across
States.
• ILA training for District-level resource groups
(DRGs) has been initiated.
• Nearly all States and UTs have established
required block-level resource groups.
What needs attention
• Training is not complete across the DRGs.
• Huge gaps in ILA training of LS and AWWs
across States.
Summary
BOX 4: Challenges reported by States in
relation to strengthening training for POSHAN
Abhiyaan
Twelve States faced delays or challenges in
implementing the Incremental Learning Approach
(ILA) at different levels. Low attendance,
difficulties in record-keeping, insufficient funds,
rough terrain, unavailability of training materials
or equipment, lack of trainers and low quality of
training were variously noted by Chandigarh,
Gujarat, Himachal Pradesh, Jammu & Kashmir,
Jharkhand, Maharashtra, Meghalaya, Punjab and
Uttarakhand. Madhya Pradesh noted that the
e-ILA app is too heavy for most mobile phones.
The State of Assam has not yet been able to
implement training, though plans are in place. In
Himachal Pradesh, training has been pushed back
due to delays in smartphone procurement.
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
4.6 CONVERGENCE
Convergence is a key pillar within the
framework of POSHAN Abhiyaan. The
goal of convergence is to ensure that all
nutrition-related programmes converge on
households with mothers and children in the
first 1,000 days. The expected steps to
ensure overall convergence at the State/UT
level are to establish State Project
Management Units (SPMUs), set up
Convergence Action Plan (CAP)
committees at State, District, block levels
and develop convergent action plans at
these administrative levels. Village Health,
Sanitation & Nutrition Day (VHSND) is
considered as a convergence platform at the
village-level.
Under convergence, the CAP committees
together with the departments
implementing programmes are expected to:
(i) develop a convergent action plan; (ii)
conduct periodic reviews; (iii) monitor and
track progress of the actions in the plan; and
(iv) facilitate efforts to achieve the targets.
Below, we describe the status of the
establishment of the committees and
development of plans, using data provided
by the State governments. In subsequent
reporting, we will assess roll-out of reviews
and monitoring efforts.
a. Establishment of State Project
Management Unit (SPMU)
(Already discussed in HR related issues in
the earlier section of this Chapter).
b. Convergence Action Plan (CAP)
committee
In most States and UTs, CAP committees
were established (except Karnataka and
Meghalaya). The CAP committees were
formed in all the Districts in nearly all large
and small States and UTs, except in Madhya
Pradesh (99 percent), Gujarat (79 percent),
Tamil Nadu (34 percent), Telangana (3
percent), Jammu & Kashmir (41 percent),
Arunachal Pradesh (84 percent), Delhi (90
percent). The CAP committees were not
formed in any of the Districts in Assam and
Kerala (Table 9; Annexure 3).
c. Convergence Action Plan (CAP)
developed and submitted
Overall, in 21 States and UTs, CAPs were
developed. Among the large States, CAPs
were developed in 14 States. The five large
States where these were not developed
include Assam, Haryana, Karnataka, Tamil
Nadu, and Telangana. In the case of small
States, CAPs were developed in just three
States. These were not developed in
Arunachal Pradesh, Goa, Manipur,
Mizoram, and Tripura. In four out of the
seven UTs, CAPs were developed. Delhi,
Lakshadweep, and Puducherry were the only
three UTs where these were not developed.
Even in States and UTs where a CAP was
developed, it was not submitted as part of
the Annual PIP for the year 2019-20, in all
the cases. Nine of the large States, three of
the small States, and three of the UTs
submitted their CAPs as part of the Annual
PIP for the year 2019-20. These included
Andhra Pradesh, Chhattisgarh, Madhya
Pradesh, Uttarakhand, Himachal Pradesh,
Gujarat, Uttar Pradesh, Punjab, Jammu &
Kashmir, Sikkim, Nagaland, Meghalaya,
Chandigarh, Daman and Diu, and Andaman
and Nicobar Islands.
While the convergent action plan efforts
are important for facilitating convergence-
related processes, their purpose can only be
fully realized when such processes trigger
the within- and across-sector actions that
lead to effective reach of an agreed upon
core set of interventions to all households in
the 1,000-day period (Box 5). 52
4.6 CONVERGENCE
Convergence is a key pillar within the
framework of POSHAN Abhiyaan. The
goal of convergence is to ensure that all
nutrition-related programmes converge on
households with mothers and children in the
first 1,000 days. The expected steps to
ensure overall convergence at the State/UT
level are to establish State Project
Management Units (SPMUs), set up
Convergence Action Plan (CAP)
committees at State, District, block levels
and develop convergent action plans at
these administrative levels. Village Health,
Sanitation & Nutrition Day (VHSND) is
considered as a convergence platform at the
village-level.
Under convergence, the CAP committees
together with the departments
implementing programmes are expected to:
(i) develop a convergent action plan; (ii)
conduct periodic reviews; (iii) monitor and
track progress of the actions in the plan; and
(iv) facilitate efforts to achieve the targets.
Below, we describe the status of the
establishment of the committees and
development of plans, using data provided
by the State governments. In subsequent
reporting, we will assess roll-out of reviews
and monitoring efforts.
a. Establishment of State Project
Management Unit (SPMU)
(Already discussed in HR related issues in
the earlier section of this Chapter).
b. Convergence Action Plan (CAP)
committee
In most States and UTs, CAP committees
were established (except Karnataka and
Meghalaya). The CAP committees were
formed in all the Districts in nearly all large
and small States and UTs, except in Madhya
Pradesh (99 percent), Gujarat (79 percent),
Tamil Nadu (34 percent), Telangana (3
percent), Jammu & Kashmir (41 percent),
Arunachal Pradesh (84 percent), Delhi (90
percent). The CAP committees were not
formed in any of the Districts in Assam and
Kerala (Table 9; Annexure 3).
c. Convergence Action Plan (CAP)
developed and submitted
Overall, in 21 States and UTs, CAPs were
developed. Among the large States, CAPs
were developed in 14 States. The five large
States where these were not developed
include Assam, Haryana, Karnataka, Tamil
Nadu, and Telangana. In the case of small
States, CAPs were developed in just three
States. These were not developed in
Arunachal Pradesh, Goa, Manipur,
Mizoram, and Tripura. In four out of the
seven UTs, CAPs were developed. Delhi,
Lakshadweep, and Puducherry were the only
three UTs where these were not developed.
Even in States and UTs where a CAP was
developed, it was not submitted as part of
the Annual PIP for the year 2019-20, in all
the cases. Nine of the large States, three of
the small States, and three of the UTs
submitted their CAPs as part of the Annual
PIP for the year 2019-20. These included
Andhra Pradesh, Chhattisgarh, Madhya
Pradesh, Uttarakhand, Himachal Pradesh,
Gujarat, Uttar Pradesh, Punjab, Jammu &
Kashmir, Sikkim, Nagaland, Meghalaya,
Chandigarh, Daman and Diu, and Andaman
and Nicobar Islands.
While the convergent action plan efforts
are important for facilitating convergence-
related processes, their purpose can only be
fully realized when such processes trigger
the within- and across-sector actions that
lead to effective reach of an agreed upon
core set of interventions to all households in
the 1,000-day period (Box 5).
What’s working well
• State project management units (SPMUs) have
been established in nearly all States and in all
UTs.
o Karnataka, Punjab, Manipur and Goa do not
have SPMUs
• Convergence Action Plan committees
established in nearly all States and UTs.
• Convergence Action Plans (CAPs) developed in
several but not all States and UTs.
What needs attention
• SPMUs staffing gaps exist across several
States.
• Development of CAPs needs attention at the
State and District levels.
• Operationalizing the convergence action plans
in a way that the interventions reach the first
1000-day households.
Summary 53
BOX 5: Challenges reported by States related
to establishing processes related to convergent
action planning
Convergence planning gaps are evident at the
State, District and block levels. For achieving
convergence, unfilled vacancies are a challenge in
both Chhattisgarh and Puducherry, while budget
constraints and the lack of a digital platform are
mentioned by Chhattisgarh and Rajasthan. In
Jammu & Kashmir, many Districts are yet to
receive the Convergence Plan, delaying
State-level convergence planning. Himachal
Pradesh, Maharashtra, Madhya Pradesh and
Meghalaya also reported a lack of cooperation or
participation, manifesting in data sharing issues,
difficulties organizing timely meetings, and
preparing plans with allied departments. This
could be because the implementation of POSHAN
Abhiyaan is viewed as the domain of WCD, as
noted by Himachal Pradesh. Gujarat noted that as
compared to State and District-level convergence,
block-level convergence is more difficult to
implement, as is convergence further down the
line.
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog, May 2019
4.7 JAN ANDOLAN (Community
mobilization)
Poshan Abhiyaan is thus envisioned to be a
“Jan Andolan” and a “Janbhagidaari”
meaning “People’s Movement”. The goal of
Jan Andolan is to build recognition across
sectors for nutrition and to build knowledge
among communities and facilitate intent to
improve nutrition practices to improve
maternal and child nutrition. Multiple
platforms are engaged to facilitate Jan
Andolan including community-based
events (CBEs), social media, mass media,
frontline workers, influencers and
celebrities. Here we describe CBEs
As part of Jan Andolan, community-based
events (CBEs) are routinely organized
across the AWCs in the country. The
purpose of these events is to raise
awareness among the communities and to
influence behaviour changes for better
nutrition health. The first anniversary of
POSHAN Abhiyaan was marked with the
celebration of ‘Poshan Pakhwada’ from
8-22 March 2019. Most States and UTs
organized various CBEs. Further details
received from Central Ministries is
mentioned in Chapter 6.
In the month of March 2019, either all or
most AWCs organized such events in
twelve of the large States. Similarly, more
than 75 percent of AWCs in five small
States organized the events. All AWCs
organized the CBEs in all the UTs other
than in Andaman & Nicobar.
More than 75 percent villages provided all the
activities mandated under VHSND in 14 of the
19 large States. In 5 of the 8 small States, more
than 75 percent villages provided all the
activities mandated under VHSND. In all UTs,
except Chandigarh, all the villages provided
all activities mandated under VHSND.
What’s working well
• There is an enthusiastic response to Jan
Andolan and the community-based events are
being organized across States •
• Ensuring continuity of behaviour change
communication throughout the year and beyond
the designated months and events is critical for
facilitating behaviour change.
• Strengthen existing Village Health, Sanitation,
and Nutrition day platform for the delivery of
interventions.
Summary 54
BOX 6: Challenges reported by the States in
relation to Jan Andolan
Several States, including Chhattisgarh, Himachal
Pradesh, Jharkhand, Madhya Pradesh,
Maharashtra and Meghalaya provided insights
into issues faced in organizing community-based
events (CBEs). Chhattisgarh noted that in the
absence of a digital platform, delays in reporting,
tracking and monitoring such events are
inevitable. In Himachal Pradesh, frequent CBEs
pose logistical problems because of rough terrain.
Organizing CBEs also hampered routine work in
some States, like Jharkhand noted that CBEs
affected home visits and day-to-day activities in
AWCs, and Madhya Pradesh identified them as an
increased burden at the block-level. Maharashtra
reported that implementation was affected by
CDPO vacancies. Meghalaya mentioned low
participation by the community, particularly
husbands of beneficiaries.
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog, May 2019
The Government of India is commited to
improving the nutritional status of children and
women through POSHAN Abhiyaan. The
mission mode approach provides the impetus to
strengthen implementation and its monitoring.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions need to be strengthened in
accordance with the C2IQ framework.
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars
of POSHAN Abhiyaan. CHAPTER 5:
MULTI-SECTORAL CONVERGENCE
AND POLICY ACTION 5. Multi-sectoral convergence and Policy
action- At National Level
Nutrition is fundamental to human survival
and development and is an essential
foundation of National development.
While POSHAN Abhiyaan in itself has an
earmarked three year budget of Rs.9046.17
crore commencing from 2017-18, it really
is an overarching framework that seeks to
leverage funds, functionaries, technical
resources and IEC activities from existing
programs and schemes such as the
Integrated Child Development Services
(ICDS), Pradhan Mantri Matru Vandan
Yojana (PMMVY), National Heath Mission
(NHM), Swacch Bharat Mission
(SBM),National Rural Livelihood Mission
(NRLM) , National Rural Employment
Guarantee Assurance (NREGA) and the
Public Distribution System (PDS). The idea
is to align the efforts of every stakeholder in
a direction that could positively impact
nutrition outcomes.
Over the past few months the involvement
of key partner Ministries in work related to
the POSHAN Abhiyaanhas been quite
evident. And same was quite pronounced
during the celebration of Poshan Maah and
Poshan Pakhwada.
5.1 Specific actions across the multiple
Ministries and Line Departments
supporting POSHAN Abhiyaan
A. Ministry of Women and Child
Development (MWCD)
Ministry of Women and Child Development
(MoWCD), the Nodal Ministry, for POSHAN
Abhiyan is implementing it across the country.
The Abhiyaan was rolled out in phased manner,
as per notification released by the Ministry, the
Abhiyaan is launched in all the Districts w.e.f
December 2018.
The MWCD shared updates like, Fund
utilization which indicates that on an average,
States/UT have utilized only 15.6% of the funds
sanctioned to them since the inception of the
POSHAN Abhiyaan (2017-2019). No fund
utilization is there for the States of Goa,
Jharkhand and Karnataka. For the
Procurements of Growth Monitoring Devices
(GMD) and smart phones/tablets: 11
States/UTs have met the requirements with
regards to the equipment procured. States
namely, Andhra Pradesh, Assam, Gujarat,
Haryana, Jharkhand, Karnataka, Kerala,
Manipur, Meghalaya, Orissa, Punjab, Sikkim,
Tripura and West Bengal haven’t procured any
smartphones under the scheme yet. Another
important component of POSHAN Abhiyaan is
ILA training which has been rolled out in most
the States and UTs. Tamil Nadu has completed
13 modules, the maximum for any State.
Utilising technology for effective
implementation of POSHAN Abhiyaan is done
with the help of ICDS-CAS software. It is
notified by the Ministry that ICDS-CAS has
completed in 16 States and more than 2 Lakh
AWCs are working with ICDS-CAS facility.
Also there is a provision of Flexi funds given to
the States/UTs to conduct some pilot studies or
test new interventions that help in meeting the
objectives of the Abhiyaan. States like
Rajasthan, Tamil Nadu, Mizoram, Maharashtra,
Jharkhand, Daman and Diu, Jammu and
Kashmir are under process of constituting State
Level Sanctioning Committee. Chhattisgarh on
the other hand has decided to use its Flexi Fund
for filling gaps in existing components rather
than to utilize it for other pilots.
► Convergent activities jointly by Line
Ministries to support POSHAN
Abhiyaan
• Executive Committee: Series of
Executive Committee have been held in
the time period of last six months under
the Chairmanship of Secretary WCD.
Sixth executive committee of POSHAN
Abhiyaan was held on 29th March 2019.
Three meetings in the month of
December 2018, January and March
56 2019 was organised by the Ministry.
These meetings have been an important
mechanism for understanding State and
field level challenges and resolving them
in timely manner.
• National Council: The 3rd and 4th
National Council meeting have been
held in the month of November 2018 and
February 2019 to review the progress of
POSHAN Abhiyaan. Various issues on
utilization of funds under POSHAN
Abhiyaan, procurement of devices, rice
fortification roll out were discussed in
detail.
• Optima Workshop: Workshop was
organized with the objective to orient on
the mechanisms to optimize the planning
and financing for nutrition. It was held
from 18-20 Feburary, 2019 at Goa.
Representatives of the NITI Aayog, key
Central Ministries from each of the 36
States/UTs of India participated in the
workshop.
• Lighthouse India Workshop: MWCD in
collaboration with the World Bank had
organized an international knowledge
exchange event – titled “Lighthouse
India: A Drive to Fight Undernutrition”
during 1-5 February, 2019.
• Agri-Nutrition Conference: MoWCD
had organized a one day Agri-Nutrition
Conference on 15th March 2019 to
develop an Agri-Nutrition convergence
action plan to accelerate the progress
towards improving nutrition indicators.
The conference was aimed at deciding
the Agri-Nutrition action plan in India
with policy recommendations.
► Details regarding Supplementary
Nutrition
Almost all States/UTs are doing fairly well
with regards to Supplementary Nutrition.
With regards to Hot Cooked Meals and
THR, most States prepare a mix of regional
dishes and staple food. Some States offer
sweets like kheer, while others resort to
offering a stipulated amount of dry snacks
with meals.
► IEC/SBCC Mass Media Campaigns (1st
October 2018 to 31st March 2019)
Promotion of POSHAN Abhiyaan and
awareness of healthy behaviour is promoted
and communicated through print media
which includes the advertisement in 87
newspapers in 16 States of the country on
9th March 2019. Pan India mass
communication was planned by the
MoWCD for Poshan Abhiyaan during the
month of March 2019 as part of Poshan
Pakhwada. However due to model code of
conduct the approval of PMO was not given
for other mass media campaign.
Promotion of PMMVY scheme is promoted
through Doordarshan and other private
channels. The scheme was promoted on 251
channels across the country. The video in
addition to promotion of scheme also included
message on positive health behavior.
Challenges:
The level of participation in the National
Council and Executive Committee Meetings of
POSHAN Abhiyaan was very low. Odisha and
West Bengal have not started rolling out the
scheme. States have not performed well on
procurement of devices and filling up the
manpower. The fund utilization by States/UTs
has been inefficient.
B. Ministry of Health and Family Welfare
National Health Mission (NHM) under MoHFW
plays a vital role in the success of POSHAN
Abhiyaan as both the missions share similar
goals like reduction of undernutrition, anemia
and prevalence of low birth weight. Various
health sector interventions which are
instrumental in the success of POSHAN
Abhiyaan:
57 ► Working and strengthning Home Based
Care of Young Children, Home Based
New-born Care, Anemia Mukt Bharat,
National De-worming Days (NDDs),
Universal Immunisation, Promotion of
IYCF at Health Facility and Community
(Mother’s Absolute Affection (MAA)
Programme), Control of Childhood
Diarrhoea (IDCF), nutritional deficiency
screening among children, nutrition
counselling and education at schools and
villages, food fortification, and Nutrition
Rehabilitation Centres
► Home Based Care of Young Children-
HBYC programme involves additional
home visits over and above the existing
Home Based Newborn care (HBNC) visits
for nutrition promotion. Ministry of Health
and Family welfare has sanctioned around
Rs 218 crore to cover 240 Districts
including 115 Aspirational Districts for the
HBYC initiative in 2019-20. As far as
capacity building of frontline workers is
concerned, 24 States have completed
training of trainers and 9 States have
initiated ASHA/ANM training. More than
12,000 frontline workers are trained
covering 23 districts in these 9 States.
► Home Based New-born Care (HBNC)- 1.29
Crore newborns have received home visits
by ASHAs in 2018- 19 and 5.3 Lakhs
new-born referred during the year 2018-19.
lt is worth mentioning that there is more
than 100% point increased in sick newborn
referral rate from the last financial year. For
the year 2019-20, Rs.462 Crore has been
sanctioned for this program. Funds were
also approved for Smartphone for 1.24 Lakh
ASHA/ ASHA Facilitators for Supportive
supervision. Around 686 trainers and 16391
ASHAs/ASHA Facilitators have been
certified.
► Anaemia Mukt Bharat- Approximately
Rs.414 crore has been sanctioned for
implementation of Anemia Mukt Bharat
(AMB) in all the 36 States/UTs in 2019-20.
Three resource institutions namely, AIIMS,
lnstitute of Economic Growth and Tarang
Hub-New Concepts Centre for
Development Communication have been
identified to provide technical support at the
national level. AMB has been launched in 9
states so far- Bihar, Chhattisgarh,
Jharkhand, Madhya Pradesh, Maharashtra,
Meghalaya, Punjab, Uttar Pradesh,
Rajasthan and 5 States are likely to launch
the programme soon. These states are
Haryana. Goa, Odisha, Gujarat and Kerala.
More than 2 lakh participants including
District and Block nodal officers, teachers
and AWWs have been oriented on the
programme.
► National Deworming Day (NDD) and
Universal Immunisation Programme - 93%
(22.12 crore) children were covered during
the 8th round of NDD conducted in
February 2019 in 33 States and UTs. For
Mission Indradhanush, a total of 3.39 crore
children and 87.2 lakh pregnant women
were vaccinated. New vaccines such as
Pneumococcal Conjugate Vaccine (PCV) is
introduced in 5 States whereas, Rota Virus
Vaccine (RVV) was introduced in all 36
58
6
pregnant
women
30
million
124
million
Children
(6-59 months)
134
million
Children
(5-9 years)
17
million
women of
reproductive age
(20-24 ears)
27
million
lactation
mothers
115
million
adolescent boys
and girls
(10-19 years)
AMB States and UTs on September 6, 2019. By
the end of year 2018 under Intensified
Diarrhoea Control Fortnight (IDCF), 8.7
crore under-five children were covered
(78%).
► Integration of ICDS-CAS and Reproductive
Child Health (RCH) portal - A platform
would be created by MoHFW to develop a
common beneficiary registration system to
facilitate exchange of data between RCH
portal and ICDS-CAS. This platform is
likely to be completed in the next three
months including pilot in 1 District of
Haryana/Uttar Pradesh.
► Fortification- MoHFW is actively
supporting pilot scheme of both rice
fortification and milk fortification meant for
addressing micronutrient deficiencies and
improve the nutrient quality of diet.
► Mothers’ Absolute Affection (MAA)- to
improve breastfeeding practices, around 4
lakh ASHAs and 82 thousands health staffs
were sensitized for breastfeeding promotion
strategies under this programme.
► Early Childhood Development (ECD) with
focus on 1000 days- MCP card is updated
with developmental milestones. Emphasis
on early childhood development has been
identified a priority component of HBYC
programme. Funds for ECD call
C. Ministry of Human Resource
Development (MHRD)
Through the Mid Day Meal (MDM) scheme,
Ministry of Human Resource Development
ensures an effective convergence with the
Ministry of Women and Child Development to
support the objectives of POSHAN Abhiyaan.
This scheme aims at the enhancement of school
enrolment, retention and attendance and
simultaneously improving nutritional levels
among children. It covers all the children
studying in government, local body and
government-aided primary and upper primary
schools and the Education Guarantee Scheme
(EGS)/ Alternative Innovative Education (AIE)
centres including Madarsa and Maqtabs
supported under Sarva Shiksha Abhiyan (SSA)
of all the States across the country.
The fund utilization information shared by the
ministry indicates that most of the States have
utilised more than 80% of funds earmarked for
MDM and are left with a small proportion of
unspent balance ranging between 3-20%. On the
other hand, States/UTs like Jharkhand (75%),
Puducherry (75%) and West Bengal (63%) have
utilised much lesser than 80% of the funds for
MDM and are left with 25-37% of unspent
balance.
► Tithi Bhojan –A community participation
programme was initiated by the State
Government of Gujarat in mid-day meal
programme by relying on the traditional
practise of providing food to large number
of people on special occasions such as
festivals, days of national importance etc.
Members of the community provide
nutritious and healthy food to the children
as an additional food item or full meal on
such special occasions/festivals.
As per the information provided, by
MHRD, a concept similar to Tithi Bhojan,
with the same name or a different
nomenclature, has been adopted by 12
States/UTs which include Assam (Sampriti
Bhojan), Andhra Pradesh (Vindhu
Bhojanam), Chandigarh (Tithi Bhojan),
Daman & Diu (Pravesh Utsav), Haryana
(Beti ka Janamdin), Karnataka (Shalegagi
Navo-Nivo), Madhya Pradesh (Sneh
Bhojan), Maharashtra (Sneh Bhojan),
Punjab (Priti bhojan), Puducherry (Anna
Dhanam), Tamil Nadu (Nal Virundhu) and
Uttarakhand (Tithi Bhojan). In addition,
States/UT like Jharkhand, Dadra & Nagar
Haveli and Tripura occasionally give
special food items like sweets and chicken
to children.
► Provision of good quality proteins in MDM:
59 As many as 23 States/UTs are making an
effort to enrich the protein quality of the
mid-day meal by providing either egg or
milk to children. Both eggs and milk are a
source of good quality protein which helps
in improving the overall health. In most
cases, egg and milk are provided
alternatively and the frequency varies from
once a week to six times a week. In Tamil
Nadu, eggs are provided on all working
days and Rajasthan provides milk six times
a week. Some of the States/UTs also give
seasonal fruits interchangeably with
milk/egg to children. In Delhi, milk is
distributed by Mother Dairy on a pilot basis
to children in schools that come under the
Directorate of Education
► Fortification:
- Double fortified salt (DFS)- One of the
objectives of POSHAN Abhiyaan is to
reduce the prevalence of anemia among
both children (6-59m) and women (15-49
years) by 9% @ 3% p.a. One cost effective
way of increasing the intake of iron is
fortification of salt with iron in addition to
iodine. Ministry of Health and Family
Welfare has prescribed the legal standards
for DFS.
MHRD had written to all the States/UTs
encouraging them to use DFS in MDM to
correct the iron deficiency among children
and improve their learning and
concentration in school. However, only half
of the States/UTs (18 out of 36) are using
DFS in preparation of MDM.
This needs to be scaled up as the States
which have reported high prevalence of
anaemia among children, like Bihar,
Chhattisgarh, Jharkhand, and Uttar Pradesh
are not using DFS in MDM for children.
► Fortification of commonly consumed
commodities like wheat flour, rice, milk
and edible oil - The MHRD has
communicated to the States the mandate of
using fortified food items to address the
problem of malnutrition in the country. As
per the information received, only
Chandigarh is providing both fortified rice
and wheat flour in MDM. These staples
are fortified with nutrients-Iron, Folic acid
and Vitamin B12 which play an important
role in restoring the iron levels and correct
all forms of anaemia. The State of Haryana
and UT of Dadra and Nagar Haveli are
providing fortified wheat flour to prepare
MDMs. Haryana was the first State in the
country to take up this initiative in March
2018, on a pilot basis and gradually
expanded it to the whole State. Haryana also
provides edible oil fortified with fat soluble
vitamins A and D.
As far as the status of fortified rice is
concerned, 100% of the MDMs are being
prepared with fortified rice in Nagaland,
whereas in Karnataka, Odisha and Uttar
Pradesh it is being done in 5, 2 and 1
Districts, respectively. Eleven out of 36
States/UTs are providing edible oil
fortified with Vitamin A & D. Rajasthan is
the only State which provides fortified milk
(with vitamin A and D) under MDM and the
frequency of milk distribution to children is
also highest in this State, 6 times a week.
► Kitchen Gardens: Kitchen garden is an
excellent opportunity to provide freshly
grown vegetables rich in vitamins and
minerals to children and help address
micronutrient deficiency in them, also
commonly known as “hidden hunger”.
Involvement of children in kitchen garden
can be an educative learning for them and a
medium to teach them cooperation and
teamwork & give them a sense of
ownership. In Assam 87% of the schools
have developed kitchen gardens whose
produce is being used in preparation of
MDMs. This is followed by Dadra & Nagar
Haveli and Nagaland where 80% & 56% of
the schools have developed kitchen
60 gardens, respectively. In rest of the
States/UTs, less than 25% of the schools
have developed kitchen which ranges from
2% in Bihar to 25% in Odisha. While,
MHRD is making an effort in encouraging
States/UTs to develop kitchen gardens but
very little change is seen at the ground level.
► Involvement of mothers in supervision
committee: Mothers are the decision
makers of availability and accessibility of
food to children among other caregiving
practices. MDM guidelines encourage
mothers to oversee the preparation and
feeding of the children, thus ensuring
quality and regularity of the meal. This
intervention also results in community
involvement which is very crucial for the
success of any welfare programme. Only 10
out of the 36 States/UTs involved mothers
as part of supervision committee to monitor
and supervise preparation and serving of
MDM and within these 10 States/UTs,
100% of the schools involved mothers.
Dadra and Nagar Haveli reported about
20-30% of the mother’s involvement in
supervision commitee.
► LPG usage for preparing MDM: Liquefied
Petroleum Gas (L.P.G.) is considered to be
safe, economic, time-saving and smoke-free
fuel for cooking Mid-day Meal in school.
The MHRD insists on the use of LPG under
Cooked Mid-day Meal Programme
(CMDMP). The information received
indicates that in 20 out of 36 States/UTs, the
LPG usage is 80% and more. In 4 States
usage ranges between 40-80% and in 9
States/UTs it is less than 40%. Out of these
9 States/UTs 3 States i.e. Arunachal
Pradesh, Chhatisgarh and Manipur have
reported LPG usage in less than 10% of
schools. An effort should be made to find
out the reason behind the low usage of LPG
and necessary steps may be taken to replace
firewood and smokeless chulla with LPG as
these pose a threat to the health of the cook,
children who are around, and also pollute
the environment.
Coverage of children under MDM
Almost all the States and UTs reported that 80%
and above children are being covered under
MDM as beneficiaries. The coverage period was
from 1st October 2018-31st March 2019. States
like Assam, Mizoram, West Bengal and Delhi
have reported 100% coverage. Twenty-two
States/UTs out of 36 reported 90% and above
coverage. The State of Uttarakhand reported
frequent changes in enrolment and coverage of
beneficiaries. Similarly, in Chandigarh, a 42%
reduction in beneficiaries’ coverage was seen
between February and March 2019. An effort
should be made to find out the reason behind this
and also tap the eligible beneficiaries who are
currently excluded.
Services under School Health Programme
► Referral and healthcare facilities: Almost
all the States/UTs are screening children
and providing them referral and
healthcare facilities. In States/UTs like
Chhattisgarh, Tamil Nadu, Andaman and
Nicobar Islands, Chandigarh, Dadra and
Nagar Haveli, Daman & Diu, Lakshadweep
and Puducherry all the schools are
providing this service. 19 out of 36
States/UTs have reported that more than
80% of the schools are providing this
service to children. It is a matter of concern
that in the State of Uttarakhand only 3% of
the schools are providing this service.
► Except in Tripura and Andaman and
Nicobar Islands, none of the schools are
providing immunisation services to
children.
► Iron and Folic Acid supplementation -
Anemia is a serious public health challenge
in India with more than 50% prevalence
among young children. Thus, it becomes
imperative to provide iron supplementation
to this vulnerable group. Under the anemia
control programmes run by the Government
61 of India, children are provided iron
supplementation.
As per the information shared, in 11
States/UTs all the schools are providing
micronutrient supplementation to children.
In 6 States less than 40% of the schools
provide micronutrient supplementation,
with the access to service being as low as
13% in West Bengal. Even in a State like
Kerala, which is doing well in the
implementation of most welfare
programmes, the administration of
micronutrient supplementation is in only
28% of schools. Bihar and Jharkhand are
providing micronutrient supplementation to
children in just about 35% of schools.
► Deworming- The National Deworming
Day is a single fixed-day approach which is
conducted bi-annually to administer
Albendazole to all children aged 1-19 years.
This intervention is a convergence between
MHRD and Ministry of Health and Family
Welfare. In 23 out of 36 States/UTs,
Albendazole tablets are provided
bi-annually in more than 80% of the
schools. Almost half of these 23 States/UTs
run deworming programme in all the
schools within the State/UT. In West
Bengal, the administration of Albendazole
tablet is reported to be low - only in 14% of
the schools.
D. Ministry of Rural Development:
After the launch of POSHAN Abhiyaan, MoPR
has geared up the communities for nutrition
related activities by organizing Gram Sabhas.
Through Deendayal Antodaya Yojana - National
Rural Livelihood Mission (DAY-NRLM), they
ensure women’s participation through self-help
group (SHG) platforms. As on March 2019,
DAY-NRLM has mobilised 592 lakh households
into more than 52 lakh SHGs covering 5,330
blocks in ALL States/UTs. It has developed more
than 2 lakh community resource persons under
various components including Food, Nutrition,
Health and WASH (FNHW). At the policy level,
NRLM has adopted a ‘Dashasutra’ strategy, i.e. it
has layered FNHW interventions over its
institution building interventions and issued
necessary circulars and advisories to State Rural
Livelihoods Missions (SRLM), for an active
participation during Poshan Maah.
The State Missions, in convergence with the line
departments, conducted several activities under
POSHAN Abhiyaan, viz. collaboration with
Swachh Bharat Mission, Lohia Awas Yojana
(PMAY), etc. The key actions areas are
highlighted below:
► Collaborated with Swachh Bharat Mission,
Lohia Awas Yojana (PMAY), in Bihar.
► Mobilized SHG women and promoted
awareness on VHSND in most of the States,
supported ASHA and Anganwadi workers
in mobilizing women for availing services
like Take Home Rations (THR), distribution
of Iron Folic Acid (IFA) tablet,
immunization etc. in Madhya Pradesh.
► Promoted household level agri-nutri
gardens and nutrition sensitive livelihoods
for year-round supply of nutritive fruits and
vegetables in convergence with the thematic
livelihoods team and department of
agriculture, in Bihar, Chhattisgarh, Odisha,
Jharkhand, Madhya Pradesh etc.
► Involved ANMs and Sahiyyas (ASHA
workers) from Health Department in the
capacity building of VO/SHG members, in
Jharkhand.
► Convergence with the Drinking Water and
Sanitation Department for collaborative
initiatives on Rani Mistri (Women Mason)
training, construction of IHHL, behaviour
change communication of hand washing,
use of toilets, access to clean drinking
water, in Jharkhand.
► Developed backyard poultry and goatery
etc. across the States.
► Convergence with the Health Department,
62 63
under which demonstrative feeding
programme was implemented with the aim
of providing quality nutrition and
supplementary food to all the children,
lactating mothers and pregnant women and
created livelihood opportunities for the
SHGs member. In Gujarat, there are 2,564
villages in which demonstrative feeding
programme was conducted and 48,577
pregnant women and 39,373 lactating
mothers have been benefitted till now.
► Collaborated with the line departments on
nutrition and nutrition linked livelihoods,
e.g. in Assam the State mission has
organized a State level convergence
workshop with 6 line department on
Nutrition and Nutrition Linked livelihoods
in collaboration with UNICEF Assam.
Activities planned for POSHAN Abhiyaan
from 1st October 2018 to 31st March 2019
along with State-wise data:
State wise activities were planned for POSHAN
Abhiyan from “1st October, 2018 to 31" March,
2019. The Dashasutra strategy has been adopted
by all State Missions and FNHW agenda has
been integrated in the institutional structure
across all levels. Most of the States have
dedicated one SHG meeting in a month to
discuss FNHW issues. Modalities to capture
information of meetings held etc. exclusively on
FNHW is not been captured in MIS as of now,
the work is in progress. Hence, consolidated
numbers of the meeting etc. is not available at
this stage. However, few States have evolved
systems for recording such data.
Several States reported high numbers of
Meetings and workshops- Bihar reported
327,051 SHG meetings, 556 CLF meetings,
29,404 VO meetings and 420
workshops/trainings. This was followed by
Jharkhand and Madhya Pradesh. While the same
was least in Haryana- 47,703 SHG meetings, 118
CLF meetings, 2913 VO meetings and 135
workshops; followed by Uttar Pradesh. Apart
from this, platforms like VHSNDs, rallies, and
trainings were used in collaboration with line
department workers with high community
participation. Maharashtra conducted 10,253
rallies, celebrated 10,359 VHNDs and prepared
layouts of 9508 individual and 1005 community
nutri-gardens which is a big achievement. In
Miozoram, SHG members collected their
kitchen gardens products and sold them at the
local market, under anaemia campaign, 10
activities were conducted at the school where
experts like Doctors, nutrition experts had
discussions with school students.
State/UT wise initiatives in training
SHGs/VOs/CLFs on health and nutrition:
Apart from this, MoRD also took initiatives in
training SHGs/VOs/CLFs on health and
nutrition, viz. FNHW modules are being
developed by State Missions on the importance
of breastfeeding, complementary feeding,
maternal, infant, young child nutrition for
integration in trainings at all levels. Orientation
for State, District and block level staff is being
conducted on FNHW including the
above-mentioned topics.
States like Jharkhand are conducting cascade
training for members of Vos and Social Action
Committee (SAC) through the flipbook titled
“Samuh Varta”. Few States have undertaken
training of trainers (TOT), e.g. Bihar reported to
have conducted trainings in 1,29,361 SHGs on
nutrition module.
Few States are involved in ICDS Supplementary
Nutrition Programme (SNP) at Aanganwadi
Centre and schools. Bihar reported to have five
Food Fortification Units running in 3 different
Districts viz., Gaya, Khagaria and Muzaffarpur.
Take Home Ration is supplied to 898 Anganwadi
Centres under an MoU with respective blocks
ICDS projects. Similarly, Mid-Day Meal
(MDM) programme is running in two blocks of
two Districts viz., Muraul (Muzaffarpur) and
Ghosi (Jehanabaad) by VOs. A total of 162
MDM programmes are being monitored by 162
VOs where around 35,000 school children are
benefitted. 64
In Madhya Pradesh, a total of 12,030 SHGs are
involved in Supplementary Nutrition
Programme. Uttar Pradesh reported to have
18,347 SHGs involved in SNP during Poshan
Pakhwada. Total 13,121 SHGs helped
Anganwadi Workers to organize the recipe
demonstration event in which different types of
recipes made of THR (Nutrient Packets) where
shown to mothers and pregnant women. In
Gujarat, two THR units have been set up in
Vadiya and Babra block of Amreli District.
Haryana reported involvement of around 850
SHGs in THR preparation.
New initiatives by SRLMs that can be scaled
for strengthening POSHAN Abhiyaan in all
States/UTs:
Creation of trained resource pool for FNHW:
Some State Missions have identified community
resource person (CRPs) from among the SHG
members for taking forward FNHW issues with
the community. These identified CRPs are
trained periodically on various FNHW issues.
These CRPs are paid by the community
institutions based on the service they provide,
like organizing meetings, mobilizing women to
VHSND, etc.
► Nutrition Sensitive Integrated Farming
System (NSIFS) for diet diversity: For
improving dietary diversity at the household
level and ensuring various kinds of food
availability through-out the year, nutrition
sensitive integrated farming is being
encouraged in many State Missions.
► Micro planning on FNHW for
community ownership, SRLM: SRLMs
like Bihar, Chhattisgarh, Jharkhand and
Odisha are developing micro plans for
improving health and nutrition status of the
community. These plans are developed and
monitored by the communities. This helps
in encouraging community ownership and
making collective efforts for improving the
nutrition status.
► Home visits by SRLM members in Bihar,
Chhattisgarh, and Odisha: Home visits
are being made regularly to the households
identified to be at “nutritional risk”.
Counselling is provided and families are
mobilized for participating in VHSNDs and
accessing services and entitlements.
► Navratan Tool, developed by State
Mission, Bihar: Navratan tool for awarding
the “Champions”, i.e. best performing
mother. First 1000 days’ life has been
categorized into 9 indicators called
Navratna. Out of 9 Ratnas, 7 are on health
and nutrition and 2 are for sanitation
indicators. These include institutional
delivery, maternal diet diversity,
breastfeeding, complementary feeding,
immunization, nutri-gardens, family diet
diversity, hand washing and ORS use and
usage of toilet.
► Sensitization of Gram Sabha, State
Mission, Madhya Pradesh: Gram Sabhas
were sensitized on issues of malnutrition,
community volunteering, community-based
malnutrition management, PDS, linking
Severe Acute Malnourished children with
Nutrition Rehabilitation Centre,
competition on various nutrition issues,
demonstrations and awareness camps.
► Newlywed couples’ Meeting, State
Mission, Odisha: In the tribal dominated
areas, under-18 marriage is still common,
resulting in a vicious circle of malnutrition.
To avoid ‘Too Early, Too Soon & Too
Many’ Pregnancies, newly-wed couples’
meetings are being organized where the
couples are counselled on family planning
measures.
► Mushroom development project, State
Mission, Assam: In order to meet the
nutritional deficits and provide livelihood
opportunities to the SHG members, State
Missions have taken up Mushroom
Development Project with 200 SHG
members.
► Implementation of Food and Feeding
Demonstration sessions at AWCs using 65
F. Ministry of Consumer Affairs & Public
Distribution- Department of Food &
Public Distribution:
local food compendium in Odisha: Four
mothers’ meetings were conducted in each
month on different aspects of
complementary feeding. Recipe
demonstration sessions were conducted at
AWCs using local food compendium,
counselling flip books and videos.
► Health Camps in Odisha: In spite of the
various schemes implemented by health
department, still there are some hard to
reach areas where organizing VHSND is
also not possible at a regular interval.
Keeping those areas in consideration,
cluster level health camps were organized in
Odisha where basic health services were
being provided to the target beneficiaries.
► Multi-sectoral FNHW intervention:
Swabhimaan Programme, State Mission,
Chhattisgarh: SRLM partnered with
UNICEF, Chhattisgarh, to initiate the
Swabhimaan Programme (named as
‘Mocho Mangun’ in the State) with an aim
to improve the nutritional status of
adolescent girls, pregnant women and
mothers of children under two years in
Bastar block of Bastar District, by
increasing the coverage of five essential
nutrition (specific and sensitive)
interventions. It is being implemented in
coordination with the Departments of
Health & Family Welfare, Civil Supplies,
Panchayat & Rural Development, Women
& Child Development, Agriculture,
Horticulture and Public Health Engineering.
Challenges faced:
Some of the challenges faced by SRLMs
included incomplete coverage of target
beneficiaries due to migration, and
misconceptions prevalent in the communities.
There were challenges related to continued
reinforcement of messages and retaining good
practices. There were problems in tracking
behaviour change and issues with uploading data
on POSHAN Abhiyaan MIS portal.
E. Ministry of Panchayati Raj:
MoPR plays an important role in providing
logistics support and facilitating observance of
the POSHAN Abhiyaan activities that are
planned, conceived and implemented by various
Ministries like MoWCD, MoHFW, MHRD,
MoDWS and MoA&FW; and their counterpart
departments in States/UTs. Convergence of line
ministries at the grassroot levels with PRIs is
crucial for the success of respective activities.
These departments are the appropriate agencies
to identify convergent activities for PRI and their
participation in POSHAN Abhiyaan.
During POSHAN Maah, MoPR was earmarked
to conduct Prabhat Pheris and Special Gram
Sabha, which turned out to be very successful.
Besides, the Ministry is advising States/UTs
separately for observing VHSNDs optimally in
all the villages. This is done in compliance to the
guidelines issued by MoWCD, where PRIs are
given specific tasks to be performed on every
VHSND that takes place at least once in a month.
Also, PR departments in the States/UTs are
continuing to organize one Prabhat Pheri every
month with appropriate messages related to
POSHAN Abhiyaan. A record of these activities
is also being maintained.
PRIs are also suggested to organise one special
Gram Sabha on POSHAN Abhiyaan every six
months of which one must be on 2nd October.
Convergence of PRI is an essential component
for the implementation of POSHAN Abhiyaan.
Government of India has approved the centrally
sponsored pilot scheme on ‘Fortification of Rice
and its Distribution under PDS’ for a period of
three years beginning 2019-20 with a total
budget outlay of Rs. 147.61 crores. It would be
funded in the ratio of 90:10 in respect to North
Eastern, Hilly and Island States and 75:25 in 66
respect to the rest of the country. To begin with,
the pilot scheme will focus on 15 Districts,
preferably 1 District per State.
The decentralized model of fortification with
blending at the milling stage has been approved
by States/UTs in the pilot scheme. So far eight
State governments, i.e. Andhra Pradesh, Kerala,
Karnataka, Maharashtra, Odisha, Gujarat, Uttar
Pradesh and Assam have consented and
identified their respective District (s) for
implementation of the pilot scheme.
FSSAI had issued official letters to Food
Secretaries of all the States and union territories
to take steps to promote the use of fortified
edible oils in all their welfare schemes from 1st
October 2018 onwards.
Challenges: The department is insisting all
States/UTs to implement the pilot scheme
"Fortification of Rice and its Distribution under
Public Distribution System". So far only 8 States
have identified their Districts. Further, regarding
distribution of fortified wheat flour through
PDS, despite advisories from this department, it
is being distributed only in 2 States/UTs.
5.2 Multi-sectoral convergence and Policy
action- At State Level
With the launch of POSHAN Abhiyaan last
year, the States/UTs WCD and Health
departments have geared up to tackle the
battle of malnutrition. Many States/UTs
have initiated measures to improve the
health and nutrition outcomes of mothers
and children. This section highlights various
initiatives taken by the States/UTs which
focuses on first 1000 days (from a period of
conception to child’ first two years of life)
to improve the health and nutrition status of
women and children under the following
heads: Convergence, Community Based
Events/ Community Mobilization, Behavior
Change Communication and Other
Initiatives like technology etc. by
States/UTs.
A. Convergence
In Andhra Pradesh the State Government
has taken a few important steps to
operationalize convergence between ICDS
and PRI. They are described in detail in the
following section.
• At the village level under Mahila Shishu
Darshini for increased accountability. At
the village level, both the ICDS and
Panchayat Raj Institutions (PRI) are
responsible for the well-being of the
people. In each District, monthly review
meetings are convened by District
Collector. During these meetings, ICDS
and Health staff reports their reviewed
outcomes, and any gaps which were
assessed.
• Gram Panchayats in Andhra Pradesh,
recently agreed to provide Rs. 5000/- to
all AWCs from their Annual GPs budget.
• Another Initiative taken up by State
Government is Memu Saitham:
Tapping the goodness of community
through a donor-driven initiative. Given
the focus of POSHAN Abhiyaan on
Convergence the State Government has
decided to include donors who can
contribute in terms of infrastructural
support, this will improve the quality of
AWCs. It is worth noting that more than
950 donors contribute to POSHAN
Abhiyaan in the State. The support is
provided in the form of nutritious food
(Raagi, Bajra, Millets, Ground Nuts,
Jaggery, Fruits) and infrastructure items
(tables, chairs, utensils etc.)
• Initiative for Tribal Population named
Chandranna Giri POSHANA Kendra
is also started by Women Development
and Child Welfare department by
providing hot cooked meals to the
children and women of hill top and
remote habitations in tribal areas. The 67
meals are provided daily at the
community level with help of persons
identified in the community to serve the
meals. More than 14,000 pregnant &
lactating women and about 10 thousand
children from 6 months to 6 years are
covered in this scheme.
In Tamil Nadu, as part of convergence,
Department of transportation along with
WCD Department established separate
feeding rooms in 352 Bus stands and
Terminals to enable the feeding mothers to
breast feed their new born child in a safe
enclosed room.
Karnataka has initiated interventions on
Child Health which has resulted in
significant reduction in the quantum of
child deaths and the State is making sincere
efforts made to achieve Sustainable
Development Goal. Karnataka also has 41
Special Newborn Care Units (SNCU) to
manage sick newborns, of which 22 SNCUs
are with Ventilator. A total 61529 annual
admission of which 76.4% newborns were
successfully discharged by Dec 2018.
Adjunct to all SNCUs, Kangaroo Mother
Care Wards & Lactation Clinics are
established to improve the survival of low
birth weight babies and also provide support
to mothers in optimal feeding of newborns.
Karnataka Government has also signed an
MoU with National Neonatology Forum
(NNF) to improve the quality of care in
SNCUs by SNCU & NBSU mentoring.
State resource center for Facility Based
Newborn Care (FBNC) is established at
IGICH Bangalore to have sustainable
mechanism of capacity building, technical
support & mentoring of FBNC across the
State. Basic Newborn Care & Resuscitation
Program (IAP-NNF-NRP- FGM) to build
the capacity of staff nurses & medical
officers of all delivery points across the
State to reduce morbidity & mortality
related to birth asphyxia. State specific,
strategic and time bound Karnataka
Newborn Action Plan has been drafted with
monitoring and evaluation framework and
targets in response to India Newborn Action
plan to accelerate Karnataka’s effort toward
achieving SDG of single digit NMR by
2025, 5 year ahead of Global target. Thus,
Karnataka is setting an example for other
States/UTs to follow.
In Rajasthan, Department of WCD, Health
and TAD (Tribal Area Development
Department) were brought under the
umbrella of PUKAR. ANMs, ASHAs,
AWWs and Swasthyakarmi contractual
workers) were given specific roles.
Household are divided among AWWs,
ASHAs and Swasthyakarmi according to
hamlets/colony for better monitoring,
supervision and updating mother and child
health indices along with nutrition. Block
level workshops were organised to sensitize
all about the roles and responsibilities.
These workers were given printed registers
to list such beneficiaries.
The State of Madhya Pradesh has initiated
many interventions to ensure best health
and nutrition outcomes. Maternal Nutrition
intervention is being pilot tested in Vidisha
District and District Hospital Ujjain. The
objectives of Maternal Nutrition
intervention is to assess the Nutritional
Status of Pregnant women based on which
Nutritional Care will be targeted, to
improve provision of Maternal Nutrition
services at Community & Health facility
Level and to facilitate health care providers
& other stakeholders to engage in
Interpersonal Nutrition & Education
Counseling.
The State has taken ownership for Tracking
of High Risk Pregnancies. Identification of
every pregnant woman is done by ANM at
Community Level and by Medical Officer/ Specialist; fortnightly follow up is done by
multidisciplinary team including sector
MO, CDPO and counselor.
The State Health department of Jammu &
Kashmir in convergence with the ICDS
Department is providing hot meals to
pregnant women. The State is also
providing Dakshata Training for improving
skills of the staff in labour room, to improve
antenatal and perinatal care during and after
delivery.
B Community Based Events
In Bihar, in order to mobilize people for
celebration of Annaprashan Diwas, the
field functionaries of ICDS had developed a
“CBE Invitation Card” for the mother of
the child whose Annaprashan is scheduled
and are being invited through this pictorial
invitation card. Further, to established the
complementary feeding and making it as a
habit for the care giver, a follow up card
has been developed and being implemented
in one District- Sitamarhi as a pilot basis.
In Daman & Diu an effective use of
platforms like “Gram Sabha”,
“Construction Sites”, “Otalni Varta” with
SHGs member to create awareness about
POSHAN ABHIYAAN has been done. This
has created awareness among citizens,
beneficiaries and students about the
benefits, importance and objectives of
POSHAN Abhiyaan and Umbrella ICDS
Scheme. Also they have been sensitized
about correct nutrition and hygiene
practices. This has resulted in increase of
number of beneficiaries by almost 10% in
last one year.
Rajasthan as mentioned in the earlier
section also, the State has made efforts for
Community Partnership under a State
initiate called PUKAR. Each Wednesday, in
each of the panchayat, , Pukar meetings are
held where ANM, ASHA, AWW AND
SWASTHYAKARMI sit at some pregnant
woman’s house and read them a document
about how to take care of health & nutrition
from conception to the time baby turns to 2
year’s age. Importance of the
supplementary food from ICDS is also
being highlighted in these meetings. Around
50 beneficiaries attend a meeting and every
week 346 meetings are held in a District
benefitting around 15 thousand pregnant
women & lactating women.
The State of Haryana has set an example in
Community Mobilization around
Immunization. Recognizing the limitations
of community mobilization through ASHAs
and to resolve the disruptive campaigns
against Routine Immunization, Haryana has
roped in Community Mobilization
Volunteer (CMVs) for better Community
Mobilization and awareness generation to
improve the Routine Immunization
coverage in Mewat & Hathin block of the
District Palwal.
Further, in a first, as pilot project to improve
Immunization coverage in Urban areas under
NUHM, Haryana has introduced a new
intervention called E-Rickshaw for Urban ANM
mobilization, in District Panchkula to ensure
100% immunization coverage in Urban areas.
One E-Rickshaw is hired for alternate Vaccine
delivery system, including mobility support for
ANMs to session sites from Cold Chain Points
and vice-versa. The replication of the project is
also proposed in other four Districts in FY
2019-20 i.e. Ambala, Kurukshetra, Karnal and
Jhajjar.
The State of Sikkim has initiated Proud
Mothers Scheme to ensure that every
pregnant woman (during her first and
second live birth) and her newborn (up to
the age of six years) receive monetary
assistance so that they can avail of better
healthcare facilities and greater support
during and after delivery. The overall aim of
the scheme is to greatly reduce Maternal
deaths and the Infant Mortality Rate
68 69
prevailing in the State. The long term aim of
the Scheme is to improve the Total Fertility
Rate as well as Child Sex Ratio and the
overall health status of all women and
children in the State.
The State of Himachal Pradesh has started
many initiatives to promote healthy
pregnancy which deserves to be
highlighted. The State has launched for the
first time in India “Community Based
distribution of Misoprostol to prevent
postpartum Hemorrhage (PPH)” where the
inaccessible pockets which have high home
delivery rate were provided with
Misoprostol tablets to prevent PPH. The
pilot was recognized both nationally and
internationally and now has been scaled up
to another 11 blocks which is going a long
way in preventing maternal deaths and
thereby decreasing MMR. The State has for
the first time in the country started a
protocol to identify, monitor, and treat High
Risk Pregnancies in one of the remote
blocks of the State.
The initial results are encouraging and there are
plans to scale up. In addition to this, continuous
review of every reported maternal death and a
constitution of State level Committee has enabled
the State to fix responsibility in cases of gross
negligence. The State has also put in a mechanism
to back track cases of Severe Anemia reporting in
the tertiary institutes which would ensure early
detection of Anemia during the ante natal period
and decrease in maternal mortality. Finally, it has
put in a mechanism for audit of un-necessary
referrals to tertiary institutions. This would lead to
un-necessary congestion and better treatment of
complicated pregnancies leading to decrease in
maternal deaths.
C. Behavior Change Communication
The State of Assam has devised Jan
Andolan Strategy for Behavior Change
Communication. The State initiated
meetings with Doordashan Kendra –
Guwahati, One community radio station
(Radio luit), Big FM and Pratidin time
(Local News Channel) etc. for various
community awareness programme on
POSHAN Abhiyaan on a regular basis.
Other activities carried out for Jan Andolan
in the State are: Community based
awareness meetings, Poshan rallies, Prabhat
Phery on Malnutrition and anemia, Street
play on Child marriage, ethnic food melas
etc, celebration of Pratham Aahar day and
Matri Amrit day are also undertaken.
The State of Bihar has nominated Goodwill
Ambassador for POSHAN Abhiyan- Bihar
(Ms. Shreyasi Singh, Indian shooter, Arjun
Awardee). She is promoting key health and
nutrition messages to community for the
improvement of nutrition status of State.
Several innovative approaches and
campaigns are playing a vital role in
connecting communities across the State of
Chhattisgarh. An initiative named ‘Every
Festival, Poshan Festival’ is one initiative
which has been appreciated by Hon’ble
Prime Minister Narendra Modi. Messages
and activities related to awareness on
Malnutrition issues were incorporated
through local festivals and rituals. The local
popular festivals like Rakhi, Kamarchhat,
Pola Utsav, Ganesh Puja, Holi etc. was
dovetailed with malnutrition messages.
In Rajasthan, Community Awareness
activity is done each Wednesday, in each of
the panchayat, in one revenue village of that
panchayat, Pukar meetings are held where
ANM, ASHA, AWW AND
SWASTHYAKARMI sit at some pregnant
woman’s house. Videos relating to mother
and child health care are shown to
beneficiaries through the mobiles of ANMs.
D. Technology
The State of Jharkhand has launched
Sahiya Sangi portal to provide an IT 70
infrastructure, to track the progress of HBNC
(Home Based Newborn Care). This Real
time monitoring will enable to take swift
actions on the most impacted areas, and
decisions can be made based on the reports.
This Dashboard will rank the Districts on
various parameters which will showcase the
best performing Districts while inspire the
lower performing Districts at the same time.
The portal provides Real Time tracking of
monthly/yearly expenditure District/Block
Wise. The portal also defines accountability
for STTs, DPCs, Sahiyas to get better results.
Finally, Real Time SMS to parents/sahiya for
SNCU visits will improve the discipline for
timely visits. The State has also initiated
services for high risk babies which involve
step by step tracking of the high risk babies
from the data, such as weight on the visit
dates. This system not only tracks the high
risk babies but also reminds Sahiyas about
the visit dates of a child via text SMS and
emails.
Goa has initiated measures to improve
health outcomes of pregnant mothers and
newborns. It has launched new born
screening test launched in the month of
August 2018 to detect errors of metabolism
in new born. In order to identify high risk
pregnancies, printed color coded sticker to
stick on MCP cards according to their
criteria. The State has also taken several
initiatives to improve communication and
awareness of health of mothers and
children. For instance, it has provided TV
sets/ LED boards in five delivery points to
display IEC material; posters on ANC/
Breastfeeding/immunization etc.to display
in all health centers and motherhood and
Anaemia booklets to all ANC.
E. Other Initiatives
Bihar has introduced the provision of 150
ml Milk once in a week to all registered
children of age group 3-6 years at AWC.
Also, eggs are being provided twice in a
week to pregnant women and children
registered with AWC. Double fortified salt
(DFS) has been introduced in hot cook meal
of ICDS and MDM currently in Tirhut
division of State. The same may be scalded
up throughout the State.
To ensure the capacity building of ICDS and
Health field functionaries, incremental
learning approach is implemented at Health
Sub Centre (HSC) platform, which is a
unique and one of its kind in country .
The Government of Tamil Nadu is
implementing Dr. Muthulakshmi Reddy
Maternity Benefit Scheme (MRMBS) with
the noble objective of providing assistance
to poor pregnant women / mothers to meet
the expenses on nutritious diet and to
compensate them for the loss of income
during the delivery period, so as to prevent
low birth weight in newborn babies. The
State Government has already enhanced the
assistance from Rs.12,000/ to Rs.18,000/-
per beneficiary.
Under ‘Amma Baby Care Kit’, the
Government of Tamil Nadu is providing
baby kits containing 16 materials for about
6.7 lakh children born annually in the
Government Hospitals to mothers for
improving the hygiene of the post-natal
mothers and newborn babies. The State
Government has also established Breast
Milk Banks in 25 Government Medical
College Hospitals and District Headquarters
Hospitals.
In Telangana Incentives are been given to
Anganwadi Teachers for enrolling SAM
Children to NRCs. The District
Administration, has taken an innovative
approach to bring more number of SAM
children to get enrolled to NRCs located at
Utnoor and Adilabad through incentivizing
the efforts of Anganwadi teachers @ Rs.200
for each SAM Child who was enrolled by
the respective AWTs. With this small 71
intervention, access to the NRCs increased
by the community, CDPOs, Supervisors and
AWTs are taking special interest to bring the
SAM children to NRCs to fight against the
under-nutrition in interior tribal tracts of
Adilabad District.
The State of Uttarakhand has proposed
fortified Milk along with Cooked food
twice in a week in convergence with Milk
Federation- URJA. Provided to all
SAM/MAM children throughout the State
through Self Help Groups. The results are
positive because of high nutritive value.
Maharashtra on the other hand has
developed and initiated a comprehensive
training program for hospital based
counselors which includes RCH component
and other Disease control programmes. It is
also training ASHA workers in tribal blocks
for sepsis, pneumonia and diarrhea for early
identification of high risk newborns,
treatment and timely referral.
Uttar Pradesh has initiated Mentoring of
specialist (Gynecologist, Anesthetist &
Pediatrician) through Regional Resource
training working with Eight medical
colleges. In order to reduce mortality related
indicators. UP Technical Support Unit
envisages to develop selected area-specific
medical colleges as Regional Resource and
Training Centers (RRTCs) to facilitate
area-based teamwork for Maternal,
Neonatal and Child Health care through
continued medical education, mentoring,
and regular supportive supervision ensuring
effective continuum of care. These RRTCs
will in turn, mentor the key personnel
within the District Hospitals (DH) and
identified CHC FRIJs namely obstetrician,
pediatricians, anesthetist and general
surgeons to improve the quality of service
delivery system for maternal, newborn and
child health outcomes.
UP TSU Project has aimed to scale up this
mentoring program in the First Referral
Units (FRU) of Northern Uttar Pradesh with
an objective to complement the existing
community and PHC interventions and
maximize the health outcomes in the region.
The FRU intervention is designed based on
the learning and experience of the
CHC/PHC nurse mentoring program in 25
High Priority Districts (HPDs) of Uttar
Pradesh during 2014-17. The main goal of
the intervention is to improve the quality of
essential and emergency obstetric and
newborn care in 50 identified FRUs of the
region with a focus on improving provider
preparedness, facility systems and client
aspects for quality of care. The intervention
have major focus on the management of
maternal complications i.e. Hemorrhage,
Hypertensive disorders during Pregnancy
and sepsis among women and low birth
weight, birth asphyxia and sepsis among the
newborn. The project aims to cover 87
FRUs (25 DHs and 62 CHC FRUs) of 25
HPDs out of 286 FRUs in the entire State.
This had a positive impact as the initial
results demonstrate increase in the use of
iron sucrose to manage moderate and severe
anemia. 72
Government of Uttar Pradesh with support
from UP-TSU undertook an initiative to
mentor and train staff nurses and ANMs in
mini-skill labs as well as conducting
emergency drills and use of case sheets as
job aids in 200 blocks of 25 High Priority
Districts (HPDs) of UP. The main
objective is to improve the quality of
critical clinical care practices during
labour and immediate postpartum period
and the quality of systems in public health
facilities and to improve the identification,
management, follow-up and referral of
maternal and newborn complications.
Major components of the program are:
A total of 2021 staff nurses and ANMs
were mentored on various skill stations
from November 2017 to October 2018.
Based on the success of Nurse Mentoring
Program in 200 blocks of 25 HPDs,
Government of UP has scaled up the nurse
mentoring program across 620 blocks of
the entire State to bring about substantial
improvements in quality of services in the
high load delivery points and to affect
faster declines in maternal and newborn
morbidities and mortalities across Uttar
Pradesh.
Improving Clinical
Competencies of Staff
Nurse and ANMs:
Quality Improvement of
services in facilities
Referral Strengthening
Uttar Pradesh -TSU initiative on Nurse Mentoring
Mentoring of ANMs in
mini skill labs
Outreach support to
ANMs in VHNDs and
sub-centers to improve
the quality of
RMNCH+A service
Conducting facility
assessment through
Self-assessment process
Preparation of Facility
Action Plan through root
cause analysis by nurse
mentors
A common platform
called Vertical
Integration meetings has
been established for
improving referral
mechanisms.
Referral whatsapp
groups have also been
made functional to
improve communication
of referred cases between
lower and higher level
facilities. 73
Government of Uttar Pradesh in
collaboration with UNICEF, Abhyuday
Sanathan and Kalawati Saran Children’s
Hospital, undertook a pilot of an
integrated model for prevention and
management of severe acute malnutrition
(SAM) and moderately acute malnutrition
(MAM) through community based
demonstration session in Banda District of
Uttar Pradesh. The duration of the pilot is
from December, 2017 to March, 2020.
The approach of the Pilot is explained
diagramatically below:
Uttar Pradesh - Community Based Management of Acute Malnutrition (CMAM)
Strengthen
community facility
linkage for correct
referrals to NRC
Pilot Results
Till now, the outcomes of Pilot have been measured in two phases.
Total Children
Weighed
Identified
Underweight
Children
Identified SAM
Cases
Treatment Outcomes
Cured
435
87 (1.5%)
33(39%)
56074675
353
66 (1.4%)
24(36%)
10282
788
148
57(38%)
Underweight used
as as entry point for
SAM/MAM
identification
Weighing drive
Monthly weighing
of SAM at AWC,
health checkup at
VHND, Home visits
Provision of
antibiotics and
Micronutrient through
ANM and Block MO
Quarterly 12 days Bal
Poshan Star (BPS)
providing Augmented
Supplementary
*Provide
1000-1200 kcal
and 10-13 grams
protein in addition
to his/her daily
diet
Linkage with
MnRage
Horticulture SRLM
and Ration Cards
Monthly VHNDs
and block facility for
medical asessment;
through ANM
Inpatient CareCommunity Outreach
Outpatient Care
Other
Phase I Phase II Combined
Phase I and III CHAPTER 6:
JAN ANDOLAN 6.1 Jan Andolan
The Honourable Prime Minister intended that
the POSHAN Abhiyaan be converted into a Jan
Andolan for effective outreach and
implementation. The Mission strives in
preventing and reducing undernutrition, low
birth weight, and stunting across the life cycle,
but as early as possible, especially in the first
three years of life and with interventions up to
the age of 6 years. Several programmes across
Ministries and Departments have been making
serious effort to tackle the issues of malnutrition
and anemia in the country. POSHAN Abhiyaan
on one hand looks to synergise all these efforts
by Converging to achieve the desired goals and
on the other, intends to convert Awareness level
at community level into a Jan Andolan.
Objectives: Jan Andolan is geared towards
achieving the following objectives:
• Build recognition across sectors in the
country on impact of malnutrition and ‘call
to action’ for each sector’s contribution to
reducing malnutrition.
• To mobilize multiple sectors and
communities in the country on the impact of
malnutrition and contribute to reducing
malnutrition.
• To generate massive awareness to build
knowledge, attitudes and behavioural
change to consume nutrient-rich food,
practice optimal breastfeeding,
complementary feeding, maternal nutrition
and adolescent nutrition practices to
prevent malnutrition, including SAM and
anemia.
During the month of September 2018, POSHAN
Maah has demonstrated the power of convergent
outreach. It garnered 26 crore participation
across 22.5 lakh activities across the country. As
directed by the PMO on 02 February 2019, in an
effort to bolster Jan Andolan and mark the first
anniversary of POSHAN Abhiyaan, Poshan
Pakhwada was launched on International
Women’s Day. Poshan Pakhada was celebrated
on a pattern similar to Poshan Maah but was
enhanced by Poshan Maah’s learning and
knowledge for increasing its efficacy amongst
its audience and the overall system.
There was a tremendous enthusiasm across the
country and impressive participation in various
activities was witnessed. It is imperative to
mention that compared to Poshan Maah, Poshan
Pakhwada covered 2.7 times more people
(reaching out to overall 44.8 crore people) by
undertaking 3.7 times more activities (82.75
lakh activities) in half the time. Using its
learning from Poshan Maah, Poshan Pakhwada
also saw an approximate 280% increase in male
participation across all activities, reaching out to
approximately 8.53 crore men in the Pakhwada
compared to 3.8 crore men during Maah.
The activities were logged in on the Jan Andolan
Dashboard at the Block level. It served as a
useful tool to keep track of activities under
community engagement eve during Poshan
Pakhwada. The total number of activities
recorded on the dashboard were 1.63 crores and
the population reach was 96.09 crore. These
figures are too high compared to the Poshan
Maah (22.5 lakh activities and 25.4 crore reach).
In order to check the authenticity, veracity and
data quality of the records, an extensive data
cleaning exercise was conducted in field.
75 6,39,451
7,81,593
98,694
20,98,28821,46,402
18,48,045
0
5,00,000
10,00,000
15,00,000
20,00,000
25,00,000
Community Mobilization
Platforms
Field Level Meetings Home Visit
Maah Activities Pakhwada Activities
3.3X
2.7X
18.7X
Figure: 21 Participation of the Community during Poshan Maah and Poshan Pakhwada
Figure 21 shows how Poshan Pakhwada used the
learning from Poshan Maah and prioritized its
top three message dissemination platforms of
community mobilization, field-level meetings,
and home visits. Poshan Pakhwada engaged a
greater number of field level health workers for
community mobilization, 20.9 lakh activities
reached out to 13.5 crore people; 3.3 times than
Poshan Maah. 21.5 lakh Field-level meetings
reached 12.9 crore people; 2.7 times more than
in Poshan Maah; 18.6 lakh Home visits were
carried out, which was 18.7 times more than
Poshan Maah.
Poshan Pakhwada also saw an increase in
mobilization of youth and peer groups for
undertaking dissemination of nutrition-based
messages. These groups included School-Based
peer groups -2.85 lakh groups reached out to
1.81 crore students and teachers; Self-Help
Groups - over 77 thousand groups reached 47.2
lakh people; Youth Groups - over 2 lakh groups
reached out to 1.2 crore people. This is
noteworthy not only for the sheer numbers but
also because this is one of the few opportunities
where family members such as the
mother-in-law and husband, usually the decision
makers of the family, engaged in a dialogue for
better nutrition which can lead to a permanent
change for better nutrition-based behavior for
the family. For the first time, ‘Anemia Camps’
were a focus activity in an effort to educate
young girls and women about Anemia. During
the Pakhwada, 2.85 lakh Anemia Camps reached
out to 2.0 crore people.
Approaches:
Convergence for Jan Andolan:
Various Line Ministries like Ministry of Health
& Family Welfare, Drinking Water & Sanitation,
Rural Development, Human Resource &
Development, Information & Broadcasting,
Panchayati Raj, Tribal Affairs, Housing and
Urban Affairs, Electronics and Information
Technology, Minority Affairs, AYUSH, Sports
& Youths Affairs, Social Justice and
Empowerment, Ministry of Agriculture
Cooperation and Farmers Welfare and Ministry
of Consumer Affairs, Food & Public
Distribution partnered with Ministry of Women
and Child Development during the Poshan
Pakhwada. At the grass root level platform like
Gram Sabhas, SHGs, and Field functionaries
across various Ministries & Schemes were used
for optimum spread and coverage.
76 Under the Chairmanship of Member, Health &
Nutrition, NITI Aayog, series of meetings were
conducted to build the synergy between the
Ministries to participate, organize and accelerate
the nutrition awareness level at grassroots level.
Poshan Pakhwada saw an increase in
inter-ministerial convergence for
implementation of activities, collaboration for
greater coordination and reducing duplication of
efforts. Overall, 14 Ministries undertook 17 lakh
joint activities during Poshan Pakhwada.
Following the trend of Poshan Maah, Poshan
Pakhwada showed better results in
human-centered, group activities that supported
demonstration of the positive behavior. The top
performing States are as shown in figure 22.
77
MinistryActivities
Ministry of Women and Child
Development (MoWCD)
Poshan Pakhwada, on the lines of Poshan Maah, was celebrated across the country as a part
of Jan Andolan under POSHAN Abhiyaan from the 8th to 22nd March 2019.
• Total 82.75 lakh activities conducted (3.6 times of Poshan Maah) with a participation of
44.8 crore (1.76 times of Poshan Maah) including 8,90,44,852 male population and
14,99,33,490 female population.
• Focus was on interpersonal communication and home visits.
• States like Rajasthan, Madhya Pradesh, Gujarat, Maharashtra, Chhattisgarh, Punjab,
Bihar, Andhra Pradesh, and Tamil Nadu performed above average whereas Telangana
performed at an average level and the rest below average (Criteria - performance by
activities).
• On the participatory grounds, Uttar Pradesh, Maharashtra, Rajasthan, Andhra Pradesh,
Tamil Nadu, Chhattisgarh, Bihar, Gujarat, and Madhya Pradesh performed well.
• Various activities undertaken were: Nukkad natak/ folk shows, Poshan Melas, cycle rally –
on nutrition, home visits – AWW and mass media campaign.
• Pan India mass communication was planned by the MoWCD for POSHAN Abhiyaan
during the month of March 2019 as part of Poshan Pakhwada. However due to model
code of conduct, the approval of PMO was not given for mass media campaign.
Ministry of Health and Family
Welfare (MoHFW)
• A total of 48 lakhs children covered by home visits during Poshan Pakhwada against a
target of 10 lakhs.
• 1.96 lakhs “Test, Treat and Talks (T-3)” Anaemia camps organized during Poshan
Pakhwada and 1.65 crore beneficiaries covered against a target of 1 crore.
• Counselling on nutrition rich food and the importance of dietary diversity etc. was given at
the camps along with creating awareness on various interventions under Anemia Mukt
Bharat strategy.
Ministry of Rural Development/
(MoRD)
Self Help Group meetings, Haat Bazaar activities and mass media campaign.
Ministry of Housing and Urban
Affairs (H&UA)
Cooperative/Federation meetings, urban SHG mela, counselling camps.
Ministry of Drinking Water and
Sanitation (MoDWS)
Swachhata Jagaran, cycle rally – on hygiene and mass media campaign.
Ministry of Youth Affairs and Sports
(MoYAS)
Poshan rally and youth group meeting.
Ministry of Panchayati Raj
(MoPR)
Panchayat meetings, Poshan walks, Prabhat Pheree and mass media campaign.
Ministry of Agriculture and
Farmers’ Welfare (MoAFW)
Farmer club meeting, fruits & vegetable exhibition.
District and Block Admin with Support
from Department of Women and Child
Development/Social Welfare + Ministry
of Health and Family Welfare
(MoWCD + MoHFW)
Community radio activities and mass media campaign.
Ministry of Human Resource
Development and Department of
Education (MHRD, DoE)
School-based activities, awareness campaign for adolescent girls and mass media
campaigns. Figure 23: percentage of CBEs conducted
Good
Chandigarh
Delhi
Gujarat
Madhya Pradesh
Telangana
Jharkhand
Rajasthan
Chattisgarh
Uttarakhand
Tamil Nadu
Karnatka
Maharashtra
Jammu and Kashmir
Bihar
Tripura
Himachal Pradesh
Punjab
Goa
Arunanchal Pradesh
Andaman and Nicobar Islands
Kerala
Assam
Lakshadweep
Odisha
Sikkim
West Bengal
Dadra & nagar Haveli
Uttar Pradesh
Andhra Pradesh
Nagaland
Puducherry
Manipur
Mizoram
Meghalaya
Damanand Diu
Haryana
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
89%
76%
4%4%
14%
19%
26%
29%29%30%32%
34%35%35%37%
42%
48%48%49%
55%
58%
64%66%
68%70%69%
80%
AveragepoorNot
Initiated
Percentage of CBEs conducted
April 2018 to April 2019
6.3 Community based Events for Jan
Andolan:
Community Based Events (CBEs) are being
conducted for awareness generation on issues
like care during pregnancy, infant and young
child feeding practices, maternal nutrition etc.
During the third Meeting of National Council on
India’s Nutrition Challenges in November 2018,
it was inter alia decided to conduct two CBEs
each month. In this light, all States/UTs are
organizing CBEs on a regular basis, especially
Godbharaai and Annaprasaan. State-wise
percentage of CBEs conducted during April
2018-April 2019 is mentioned in Figure 23.
-
5
10
15
20
25
30
MAHARASHTRA
ANDHRA PRADESH
GUJARAT
MADHYA PRADESH
CHHATTISGARH
BIHAR
TAMIL NADU
-
200
400
600
800
1,000
1,200
1,400
Activities (In Lakhs)
Participation (In Lakhs)
Figure 22: Top performing States during Poshan Pakhwada
78 • Chandigarh, Delhi, Gujarat, Madhya
Pradesh, Telangana, Jharkhand, Rajasthan,
Chhattisgarh and Uttarakhand performed
well. States/UTs like Tamil Nadu,
Karnataka, Maharahstra, Jammu &
Kashmir, Himachal Pradesh, Punjab, Goa,
Arunachal Pradesh, Kerala, Andaman &
Nicobar Islands and Assam need to improve
in planning and organising theme based
community based event to optimise the
awareness level at targeted beneficiaries
level.
• In addition to this, many States/UTs
conducted various IEC/SBCC/mass media
campaigns on issues like maternal health
and nutrition, infant and young child
feeding practices and menstrual hygiene,
sanitation and hygiene. Jharkhand
developed IEC materials in the form of
posters, leaflets etc. VOs participated in
VHSND, SBM-G and conducted Nukkad
Nataks. Short clip videos on essential health
and nutrition intervention like family
planning, 1000 days window, ANC
check-ups, IFA consumption, institutional
delivery, exclusive breastfeeding,
complementary feeding etc. were
developed. Bihar reported to have
distributed total 20,000 (two pager) leaflets
in 400 blocks and 500 banners, and flip
charts to 35,000 SHGs and conducted
campaign on family dietary diversity
among pregnant and lactating mothers
during the given period. Madhya Pradesh
organized various IEC/SBCC/mass media
campaigns on the promotion of
breastfeeding practices, tiranga thali for diet
diversity, Ratri Chaupal, and radio
messages etc. Uttar Pradesh reported taking
Suposhan Shapath (pledge on nutrition by
children, adolescents and women),
disseminated messages on ‘Sahi Poshan
Desh Roshan’, conducted rangoli designs
specimens on nutrition and sanitation for
SHGs and short films.
Conclusion: NITI Aayog has been consistently
providing technical support to MoWCD and
other line Ministries to leverage their existing
platforms and campaigns to accelerate
POSHAN Abhiyaan. Poshan Maah and
Pakhwada celebrations in the country have set a
positive momentum to make this mission into a
Jan Andolan. It has made an attempt to change
the way people look at nutrition and make it an
intrinsic part of their lives. Many central
government and State government schemes,
such as Swachh Bharat Abhiyaan, DAY-NRLM,
WASH, MAA, Beti Padhao Beti Bachao etc.
played a crucial aspect during Poshan
Pakhwada. This special campaign on POSHAN
Abhiyaan succeeded in creating a special buzz
at all levels, from the national level down to the
village level.
79 CHAPTER 7:
RECOMMENDATIONS
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 81
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 82
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 83
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
84
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
85
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
86 7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
ANNEXURES
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation. 88
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
ANNEXURE 1A:
Second POSHAN Abhiyaan Monitoring Report: Data Collection Form
WCD TEMPLATE
[Kindly fill information as on 31st March, 2019 and share
latest by 20th April, 2019]
1. Name of the State/UT:
2. Total number of Districts in the State:
3. Total number of Blocks in the State:
4. Total number of Villages in the State:
5. Total number of Anganwadi Centers in the State/UT:
6. If UT, does the UT have a State Legislature? Yes || No
SECTION I: GOVERNANCE AND INSTITUTIONAL MECHANISMS
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
SN
INFORMA TION REQUI RED
RESPONSE
A
UTILIZATION O F FUNDS under POSHAN Abhiyaan (2018 - 19)
1.1
1.2
1.3
Utilization of Funds under other related Schemes (2018 - 201 9)
Amount of Funds available from
(2018 - 19) :
Central Govt Share
(in Lakhs)
a. ICDS Scheme
a) Amount of Funds received from GoI
(in lakhs)
b) Funds Earmarked by the State/UT
(in lakhs)
c) Funds utilized at the State/UT level
(in lakhs; as on 31st March 2019) –
Note: Can specify unaudited funds
also
d) % of funds utilised
If any of the above figures is “zero”, give
reasons
State Govt Share
(in Lakhs) 89
7. Recommendations:
The Government of India is committed to
improving the nutritional status of children and
women through POSHAN Abhiyaan. It prioritise
on the first 1000 days which is a critical window
of opportunity to eradicate malnutrition. The
journey of first 1000 days starts from woman’s
pregnancy to her child’s second birthday. It is
critical that they receive essential services for
improved nutrition of mother and child. Under
POSHAN Abhiyaan Government of India is
committed to improve the coverage and quality of
the evidence based, most critical and effective
interventions which are discussed in this Report
in detail in Chapter 4.
To achieve malnutrition-free India,
implementation of health and nutrition
interventions needs to be strengthened. Context
specific solutions to prevent children from
developing malnutrition must be the priority.
These solutions should be grounded in an
understanding of the specific cause and drivers
that lead to malnutrition. The high prevalence of
underweight and wasting in India suggests the
need to improve the nutritional status of women
before or during pregnancy and ensure mothers to
have skilled support to promote the early,
exclusive breastfeeding and continued
breastfeeding. These interventions are already
part of existing health and nutrition schemes and
programs, but not reaching children and women
with desired Coverage, Continuity, Intensity and
Quality (C2IQ).
A set of POSHAN Abhiyaan pillars (technology,
training, processes to support convergence, and
Jan Andolan) have been identified under the
assumption that efforts put forth in strengthening
these pillars will trigger a series of changes that
improve the availability and quality of nutrition
interventions in the ICDS and health system.
There are core programmatic inputs including
funding, human resources, supplies, and
infrastructure that are critical to functioning of
these POSHAN Abhiyaan pillars. Overall across
the States, there are gaps that require immediate
attention to strengthen the inputs and the pillars of
POSHAN Abhiyaan.
Given that nutritional outcomes are impacted by
multi-dimensional factors, successfully tackling
malnutrition requires a systems approach wherein
multiple agents align their actions through
cross-sectoral convergence. It requires setting up
Governance structures that enable contextualized
planning at each level of implementation process
and information flows that enable real time
feedback to continuously improve supply side
responses. It also requires taking a realistic view
of the capabilities of the delivery systems; and
prioritize and sequence the interventions
accordingly. After one year of the launch of the
Abhiyaan, we have taken stock of its progress (or
the lack of it) on multiple fronts. On the basis of
our assessment, we would recommend the
following course of action to be prioritized by the
Central and the State Governments, District
Administrations and the Development Partners to
synchronize our efforts to accelerate the
effectiveness of POSHAN Abhiyaan in the
coming time to come:
• Human Resource:
Overall across States, there are few gaps in
the frontline worker positions in the ICDS
and health systems, but gaps exist in
supervisory cadre positions including LS,
CDPOs, and DPOs. At a national level, the
vacancy rates are in the range of 25% at both
the CDPO and Lady Supervisor levels. This
is the aggregated national scenario that
varies from State to State; however, it is a
clear indication of the relatively higher
number of vacancies at the Supervisor level.
For positions sanctioned under the POSHAN
Abhiyaan, State Project Management Units
(SPMUs) have not been established in two of
the 19 large States (Punjab and Karnataka).
Even where SPMUs have been established,
10 States have vacancy rates in the excess of
30%. In Uttar Pradesh and Haryana, less than
5% of the sanctioned posts have been filled
up. Gujarat is the only large State where all
SPMU positions have been filled up. The
position in smaller States is even worse. With
the exception of two States (Meghalaya &
Mizoram), in the rest of the States either the
SPMU has not been set up altogether or even
where it has been set up all positions remain
vacant due to non-completion of the
recruitment process. The UTs are slightly
better placed with four UTs having greater
than 75 % of the SPMU posts filled up. None
of the posts were filled in Puducherry and
Delhi. Thus, it is recommended that these
gaps need to be closed at the earliest and they
are critical to ensuring support to the
frontline workers.
For few other schemes like PMMVY, it is
recommended to fill-up contractual positions
at State, District and Block levels so that the
Schemes could perform well. So far only
42% and 26% recruitments have been done
at State and District levels respectively Also,
MoWCD should monitor HR vacancy status
under these Schemes constantly and
communicate to the States/UTs raising the
concerns at the highest levels.
Convergence action plan committees have
been established in nearly all States and UTs
but CAPs have not been developed in all
States and UTs. Gujarat is the only state
where all the SPMU staff positions were
filled. Development of these plans needs
attention. More importantly, focus is needed
on operationalizing the convergence action
plans in a way that the interventions across
sectors reach the same mother, same child,
and same households in the first 1000-days.
• Technology and Procurement:
There are huge gaps in the procurement and
distribution of growth monitoring devices.
As per the last update only 27.6% of AWWs
across the country have been provided with
Smartphones and about 35% of AWWs have
Growth Monitoring Devices (Infantometer,
Stadiometer & Weighing Scales). Given that
growth monitoring is one of the key
activities under POSHAN Abhiyaan and it is
being closely monitored at multiple
administrative levels across the country, it is
imperative to ensure that the basic equipment
required to conduct growth monitoring is
procured and distributed urgently. There is
variability in coverage and reach. States and
UTs including Assam, Gujarat, Haryana,
Karnataka, Kerala, Punjab, Maharashtra,
Jammu & Kashmir, Manipur, Tripura,
Nagaland, Sikkim, Arunachal Pradesh,
Andaman & Nicobar, Chandigarh, and Delhi
need to close the distribution gaps urgently.
While a Dashboard is available at the State
Headquarters, we have not so far seen it
being used for Monitoring and Evaluation
purposes as well as a Decision Support Tool
at the Block, District and State levels. In the
absence of rigorous analytics, there is every
likelihood of attrition in the quality of data
collected through the ICDS-CAS.
MoWCD and MoHFW currently use
different applications for tracking the same
beneficiaries leading to unnecessary
duplication of efforts in data entry, besides
lack of coordination in due-lists leading to a
siloed approach to service delivery. Although
significant resources have been dedicated to
a pilot project to develop a common platform
for the AAA functionaries and it has been in
the works for some time now, we are yet to
see a fruition of that effort.
Data Monitoring: For improved Service
Delivery and Effective Monitoring
POSHAN Abhiyaan thrust is on Integrated
Child Development Services
(ICDS)-Common Application Services
(CAS) application. Within the provided
limited procurement of the Smart phones, the
data collated by Anganwadi Worker is
required to be monitored closely at highest
level. It is recommended that the raw Data
should be made available for Monitoring and
Evaluation purposes. Also, exploring
innovative ways to support data use for
decision making will be key especially at
Block, District and State levels.
MoWCD and MoHFW currently use
different approaches to track common
beneficiary. Although the pilot project is
under consideration where common
platform can be designed and utilised by all
the frontline health workers at ground level.
It is required to fasten the process so as to
ensure stronger service delivery
convergence.
It’s an urgent need to address challenges
pertaining to connectivity and the software
issues to ensure ICDS-CAS operations
function smoothly. Only few States like
Maharashtra, Rajasthan, Sikkim, Andaman
& Nicobar Islands, and Daman & Diu have
established helpdesks in all the Districts.
Currently the whole spectrum of energy of
Abhiyaan is towards the procurement of
Smartphones. On the other hand, essential
component of quality of training and
assessment of capabilities of AWW is not
focused upon. It is highly recommended that,
the aforesaid critical issues to be escalated at
highest level to ensure the quality and
reliability of data collected.
Nearly all States report that they are
well-equipped with the basic stocks of IFA,
TT injections, and albendazole. There are
some exceptions including Nagaland, Delhi,
Madhya Pradesh, Uttar Pradesh, which
report stockouts of either IFA or albendazole.
An urgent investigation is needed to examine
the reasons for such high levels of stockouts
in some States and actions are needed to
close these gaps. IFA and albendazole are
critical preventive approaches to anemia and
stockouts of these drugs cannot be ignored.
• Convergence:
Convergence can be seen at two levels: (a)
Governance level which creates institutional
mechanism to ensure coherent response from
multiple departments; and (b) Impact level
where “effective convergence” implies
successful reach of programs from relevant
sectors that address the key determinants of
undernutrition for the same household, same
woman and same child.
As has been pointed out earlier while
discussing the CNNS results, our success in
effective convergence of critical services at
the household level has been fairly modest.
Since the launch of POSHAN Abhiyaan,
several coordinated policy announcements
by concerned Ministries; strengthening the
platforms of service deliveries such as
VHSND and effective demand side push to
drive behavioural change in health seeking
behaviour of households through the high
voltage Jan-Andolan campaign during the
preceding year are likely to improve
convergence as well as coverage of
interventions, but in the absence of validated
real time data we can only speculate. We
would have a much clearer picture of this
when NFHS 5 results are released later this
year. However, early results in the
Household Survey carried out by the NITI
Aayog in the 27 Aspirational District in July
18 (Round1) and January 19 (Round 2) have
shown over 15.7% and 19.1% increase in
use of ORS and Zinc Treatment for
Diarrhoea respectively; a 9.54% increase in
Early initiation of Breastfeeding and 3.47%
increase in ANC registration in the first
trimester. This shows that it is possible to
have big gains in coverage in relatively short
periods of time with determined efforts.
Along the lines of the recommendations
stated in the earlier Report, we would like to
reiterate that continued engagement with
Chief Ministers and Chief Secretaries on
issues that require cross-sectoral efforts and
monitoring at the highest levels, must be
ensured. We further need a renewed push for
creation of institutional mechanisms at the
State, District, Block and Village levels to
accelerate convergent action required for the
implementation of POSHAN Abhiyaan. We
would need to ensure that as a team to
implement them effectively at the ground
level; keeping in mind the capacities for
delivery of those services.
Leanings from the existing State level
convergence models should be considered to
scale up should. For eg: Self Help Group
federation of JEEViKA model in the State
of Bihar created a promising platform for
reaching the community. Around 8.5 lakh
SHGs are created to reach more than 1 Crore
households. JEEViKA’s Health, Nutrition
and Sanitation Strategy focuses on the most
critical period i.e 1000 day life cycle
approach. They impact evaluation of the
project revealed that in the matter of 2 years
the indicator of complimentary feeding
which remained stagnant for years showed
more than 2 fold improvement (both in
minimal acceptable diet and minimum
dietary diversity).
Another model shown by Government of
Chhattisgarh where convergence of various
schemes by like State Rural Livelihood
Mission in the District of Surguja showed an
enhancement of many indicators at grass
root levels. It showed a decline of about 23%
in malnutrition rates from 12.7%; functional
utilization from 61% to 100% are some of
the achievements of this model.
Similarly, Ajeevika initiative of
Government of Jharkhand where
engagement of the Sakhi Mandal members
as Business Correspondent (BC) Sakhi is
done. Currently, the practice of Poshan
Vatika is prominently being observed in
three districts of Jharkhand, namely
Hazaribagh, Ramgarh and East Singhbhum.
Members of Sakhi Mandals are being
provided special trainings focused on
"Importance of Nutrition Garden and
Cultivation Techniques". The food plates of
the rural families in these regions contain
nutrient rich foods. Further, the gradual
decline in terms of deficiency prone diseases
as well as less number of cases of stunting
and wasting among under-5 children point
towards positive change. It is recommended
to consider these interventions for scaling-up
at higher levels.
In several Aspirational Districts the
strengthening of Village Health Sanitation &
Nutrition Days (VHSNDs) have been
demonstrably proved to be an efficient
platform of converged service delivery at the
village level. As per our assessment, a large
number of services comprising the package
of interventions can be delivered through the
VHSND and it would also help streamline
the due lists of the ASHA, Anganwadi, ANM
trio. We need to scale it up and ensure that
high quality service delivery can happen
through these VHSNDs. We also need to
expedite issue of Guidelines relating to the
disbursal of joint incentives for the frontline
line workers.
• Coverage and Quality of Nutrition Related
Interventions:
For the implementation of health and
nutrition interventions to be strengthened, in
accordance with the C
2
IQ framework, it is
important that the gap areas identified under
each of the four POSHAN Abhiyaan pillars
are adequately addressed. The key elements
of these four pillars need to be strengthened
to facilitate implementation of interventions
with full coverage, continuity, intensity and
quality.
As per the data from latest Comprehensive
National Nutrition Survey
(CNNS)-discussed in detail in the earlier
sections, the current coverage of
interventions is sub-optimal. Given that there
are national platforms available to deliver all
the interventions under POSHAN Abhiyaan,
the potential for reach of these interventions
is 100 percent. However, the current
coverage rates are lower than 55 percent for
several interventions. In addition, there is a
high variability across States for the
coverage of various interventions.
The supplementary nutrition program (SNP)
is one of the six services provided under the
Integrated Child Development Services
(ICDS), Within this, the Take Home
Rations (THR), provided to pregnant and
lactating mothers and children (7 months-3
years) is a crucial component and covers a
substantial proportion of the ICDS budgetary
allocation. As identified in recent research
efforts and program experiences, several
challenges remain in ensuring that the
ICDS-THR is effective in its quality, reach
and impact. Also, in Aspirational District
Program, it is observed that the uptake of
THR is as low as 6% in some Districts.
These challenges are suggested to review for
the composition and nutritional quality of
THR; Production and Distribution model of
THR and Coverage and Consumption of
THR.
To make POSHAN Abhiyaan reach out to
the most unreachable, it is utmost important
at this stage to improve the coverage of
nutritional interventions with quality,
intensity and continuity.
• Fund Utilization:
Utilization of funds for any program is one
of the proxy indicators of its successful
implementation. Variation in terms of
utilization is observed across the country.
The cumulative utilization rate is about 20%
in the Large States; Small States and UTs
have utilised on an average about 42% of the
allocated funds. Haryana, Tamil Nadu,
Punjab, Kerala, Delhi and Goa have a
utilization rate of less than 5%. Even where
funds have been released by the Government
of India, tardiness in completing the
procurement process of Growth Monitoring
devices and Smart phones through the GeM
portal precludes us from reaping the full
benefit of scheme by the frontline workers
and intended beneficiaries.
• Jan Andolan:
While the Jan Andolan activities are being
organized with great enthusiasm, it is
imperative that such enthusiasm continues
throughout the years and beyond the
designated months to ensure behaviour
change. The spirit of Poshan Maah was
continued to be visible in Poshan Pakhwada
held in the month of March 2019.
Marking the annual event of POSHAN
Maah, the enthusiasm should be maintained
and the efforts are required to reach the
masses with information and importance of
nutrition through various events and
activities. The upcoming Poshan Maah will
be celebrated with a theme
‘Complementary Feeding’. There is an
urgent need to improve the behaviour which
can lead to better complementary feeding
practices. Standardised messages which can
be adopted specific to the region and
language should be developed so that it can
reach the beneficiaries in accurate manner.
As a next phase of community engagement,
the engagement with elected representatives
at all levels – from the Parliament to the
Panchayats is already initiated. It is critical
at this stage is to carefully design the
appropriate messaging, content and media
from the already existing resources to
facilitate this engagement. MWCD, MoRD
and Ministry of Panchayati Raj are working
closely together to jointly plan this
campaign. Development Partners and NITI
Aayog can be used as facilitators to develop
a sustained movement around this work
stream. This could also be used a platform to
engage with the SHGs to ensure that they can
be roped in to play a role in the Abhiyaan.
• Training:
It is not complete across all the DRGs and
there are huge gaps in ILA training of LS and
AWWs across multiple States and UTs.
Without training, the frontline functionaries
are not adequately equipped to deliver
services. Therefore, there is an urgent need to
pay attention to State-specific challenges
pertaining to low attendance at trainings,
insufficient funds, unavailability of training
materials or equipment, lack of trainers and
low quality of training. Only few States and
UTs where all LS and AWWs have been
trained on 6 or more ILA modules are
Andhra Pradesh, Tamil Nadu, Mizoram,
Chandigarh, Dadra & Nagar Haveli, and
Daman & Diu.
• Infrastructure:
State like Bihar, which are high-burden
States that are lagging behind in several
health and nutrition indicators are also facing
lingering issues pertaining to infrastructure
including availability of functional CHCs
and sub enters. It is important that such
States are prioritized in building the required
infrastructure.
The setting up and recruitment of personnel
of State and District Nutrition Management
units needs to be expedite since they will
make a difference to the quality and speed of
program implementation.
SN
INFORMA TION REQUI RED
RESPONSE
b. Pradhan Mantri Matryu Vandana Yojna
(PMMVY)
1.4 Provide the amount and % fund utilization for (2018-19):
a. ICDS Scheme
b. Pradhan Mantri Matryu Vandana Yojna
(PMMVY)
1.5 Applied for flexi funds for innovations
and pilot
Yes || No || Not Aware about flexi-
funds
1.6 Has the State/UT Project Management
Unit been established?
Yes || No
1.7 If yes, staff details No. of posts
sanctioned
No. of posts filled
1.8 Has a Convergence Action Plan
Committee been formed at State/UT
level?
Yes || No || In process
1.9 Provide details. No. of Districts in
which Convergence
Action Plan Committee
has been formed
No. of Blocks in which
Convergence Action
Plan Committee has
been formed
1.10 Has State/UT level Resource Group for
ILA training been established?
Yes || No
1.11 Have District level Resource Groups
(DRGs) for ILA training been established?
Yes || No
If yes, provide details
No. of DRGs required
No. of DRGs
established
1.12 Have Block level Resource Groups (BRGs)
for ILA training been established?
Yes || No
If yes, provide details
No. of BRGs required
CONSTITUTION OF COMMITTEES AND RESOURCE GROUPS B 90
SN
INFORMA TION REQUI RED
RESPONSE
No. of BRGs
established
1.13
a) Number of Districts in which the help
desks have been established
at District
level?
b) Number of Districts in which the help
desks have been established
at Block
level?
SECTION II: STRATEGY AND PLANNIN G
SN
INFORMA TION REQUI RED
RESPONSE
A CROSS-SECTO RAL CONVERGENCE
2.1 Has the State/UT level Convergence action
plan been developed?
Yes || No
2.2 Has the State/UT level Convergence action
plan been submitted as part of the Annual
PIP for the year 2019 - 20
Yes || No
If yes, provide details
No. of Districts which
have developed District
Convergence action
plan
No. of Blocks which
have developed Block
Convergence action
plan
91
SECTION III: SERVICE DELIVERY INPUTS
SN
INFORMA TION REQUI RED
RESPONSE
A HUMAN RESOURCE: Provide following details
3.1 a) DPO No. of posts sanctioned
No. of posts filled
3.2 b) CDPO No. of posts sanctioned
No. of posts filled
3.3 c) Lady Supervisor No. of posts sanctioned
No. of posts filled
3.4 d) AWW No. of posts sanctioned
No. of posts filled
3.5 e) AWH No. of posts sanctioned
No. of posts filled
B SUPPLIES
3.6 a) Mobile phones No. required
No. procured
No. configured
No. distributed to
Districts
No. functional at ground
level
3.7 b) SIM cards for mobile phones No. required
No. procured
3.8 c) Data connectivity plans No. of data plans
required
No. of data plans
activated
3.9 Please specify the concerns related to mobile phone functioning at ground level (If any) 92
SN INFORMA TION REQUI RED
RESPONSE
Kindly attach it as an annexure
3.10 Growth Monitoring Devices No.
required
No. procured No. distributed
a) Weighing Scale (Infant)
b) Weighing Scale (adult)
c) Infantometer
d) Stadiometer
C
TRAINING AND CAPA CITY BUILDING
3.11 Has ILA training has been initiated for
State/UT Resource group?
Yes || No
3.12 Has the ILA training been initiated for
the District Resource groups
Yes || No
3.13 If yes, provide the details No. of DRG members to be
trained
No. of DRG members trained
3.14 Provide the details of the ILA training No. of
Modules
No. of LS
trained
No. of AWW
trained
Less than 5
6-10
More than
10
3.15 Has State/UT translated the ILA
modules to ALL the State languages
other than Hindi and English?
Yes || No || NA
3.16 Has State/UT printed the ILA modules
as per the guidelines and specification
given by MWCD?
Yes || No
3.17 Is the State/UT planning to provide ILA
trainings to ASHA workers?
Yes || No
3.18 If yes, specify no. of ASHA s trained till
31
st March, 2019
No. of ASHA s to be trained
No. of ASHA s trained
3.19 Does the State/UTs have access to ICDS-
CAS Dashb oard?
Yes || No 93
SN
INFORMA TION REQUI RED
RESPONSE
3.20 Who at the State/UT level is authorized
to review and use ICDS-CAS dashboard?
3.21 Staff trained on ICDS-CAS
Dashboard/Mobile
Personnel No. to be
trained
No. Trained
DPOs
CDPOs
LSs
AWWs
SECTION IV: PROGRAM ACTIVI TIES AND INTERVENTION COVERAGE
A PROGRAM ACTIVITES
-
ICDS
4.1 Total number of beneficiaries from
1
st
April 2018 to 31
st March 2019.
Pregnant women
Lactating women
Children 6 to <36
months of age
Children 3-6 years of
age
4.2 Data Entry in ICDS-CAS
a) No. of Districts where ICDS-CAS is
functional
b) No. of AWWs who have started
entry in ICDS-CAS
c) No. of AWWs who have completed
beneficiary data in ICDS-CAS
d) No. of AWWs who have used ICDS-
CAS to submit their Monthly
Progress Report through CAS in the
previous month.
4.3 Has State/UT started the process of
providing Incentives to AWW/AWH as
per the MWCD Guidelines?
Yes || No
4.4 If yes, provide the following details
a) Number of workers who received No. of AWW 94
Incentives (till 31st March 2019) No. of AWH
b) Number of Districts received award
for the best performance in the year
2018-19
No. of Districts
4.5
Details of
Communit y Based Events under POSHAN Abhiyaan (held in the month of
March 2019):
a) Percentage of AWCs in State/UTs
that organised community based
events in the month of March
2019
b) Average number of participants
per event
c) Themes covered
4.6
Details on VHSND organised in the Month of March
2019
a) Total no. of VHSND organized in the
State/UT events in the month of
March 2019
No. of VHSNDs
planned
No. of VHSNDs
organized
b) % of villages in State/UT provide
ALL the activities mandated under
VHSND namely:
Antenatal Check-up; Growth
Monitoring of children upto 2 yrs;
Immunization; Supplementary
nutrition; Health and Nutritional
Counselling and Referral
4.7
Take Home Rations/ Food Supplementation under ICDS Program
r
What is the State/UT
policy on frequency and
amount of THR to be
distributed per month
per beneficiary
(please provide details as
attachment if space is
insufficient)
Pregnant
Women
Lactating
Women
Children 6-
36 months
of age
4.8
No. of beneficiaries
who received mandated
THR from 1
st
April 2018
to 31
st
March 2019.
Beneficiary
No. of
beneficiaries who received THR as
mandated
Pregnant
Women
Lactating 95
Women
Children 6-
36 months
of age
4.9 Does fortified foods
being used in
preparation of hot
cooked meals? (eg: Oil,
Salt, Rice, wheat
products)
YES || NO
If yes, in how
many AWCs
4.10
Growth Surveillance and Management: 1st April 2018 to 31st March 2019
a) No. of beneficiaries
who were we ighed:
No. of pregnant
women
No. of children 6-
<36 months
No. of children 3-6
years of age
b) No. of children from
6-59 months who are
Children
Identified
Referred
Treated
Severely Acute
Malnourished
Children (SAM)
Moderately Acute
Malnourished
Children (MAM)
c) No. of malnourished
children who received
increased Supplementary
Nutrition.
Severely Acute
Malnourished
Children (SAM)
Moderately Acute
Malnourished
Children (MAM)
B HOM E VISITS by AWW
4.11 Out of the mandated number of home
visits (as per the home visit planner, or
the home visit scheduler in CAS), the % of
home visits made by AWWs during the
month of March 2019
4.12
4.13 PMMVY scheme during the month of till
March 2019
No. of pregnant
women targeted
No. of pregnant
women benefited as
per the entitlement
4.14 % of home visits to household with young
infant (less than 1 month) to counsel on
%of home visits to household with pregnant
mothers to counsel on
appropriate practices during pregnancy
during the month of March 2019 96
Importance of immediate breastfeeding
March 2019
4.15
%
of home visits to household with infants
(5-6 months of age)
to counsel on
Importance of initiation of
complementary feeding and continued
breastfeeding
March
2019
SECTION V: ADDITIONAL INFORMATION
SN
INFORMA TION REQUI RED
5.1
Specify the main challeng es faced in implementation of POSHAN Abhiyaan at State/UT level
with respect to:
(Provide details as attachment)
(i) ICDS_CAS
(ii) ILA
(iii) HR
(iv) Growth Monitoring Devices
(v) Convergence
(vi) Jan Aandolan/Community based events
(vii) Any other
5.2 Specify the good practices or innovations State/UT has done in the year 2018-19 to improve
the nutrition indicators during the first 1000 days life cycle :
(Provide details as attachment)
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
WCD template
TOTAL-65
1 Governance & Institutional Mechanism 19
1.1 Fund Allocation 4
1 if <25%
% utilized by the State/ UT 2 if 25%-<50%
(as on 31st March 2019 – A. Q1.1 d 3 if 50%-<75%
% 4 if ≥ 75%
1.2 Constitution of Committees 15
and Resource Groups
0 if <25%
% of posts filled in the SPMU – B.Q1.7 1 if 25%-<50%
(No. of posts filled/No. of posts sanctioned) % 2 if 50%-<75%
3 if ≥ 75%
0 if <25%
% of districts where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of districts 3 if ≥ 75%
0 if <25%
% of blocks where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of blocks 3 if ≥ 75%
0 if <25%
% of districts where DRGs have been 1 if 25%-<50%
formed – Q1.11 No. of DRGs established/ 2 if 50%-<75%
No. of DRGs required 3 if ≥ 75%
0 if <25%
% of blocks where BRGs have been formed 1 if 25%-<50%
- Q1.12 No. of BRGs established/ 2 if 50%-<75%
No. of BRGs required 3 if ≥ 75%
97
ANNEXURE 1B:
Second POSHAN Abhiyaan Monitoring Report: Data Collection Form
HEALTH TEMPLATE
[Kindly fill information as on 28th February, 2019
and share latest by 20th April, 2019]
1. Name of the State/UT:
2. Total number of Districts in the State:
3. Total number of Blocks in the State:
4. Total number of Villages in the State:
5. Total number of Anganwadi Centers in the State/UT:
6. If UT, does the UT have a State Legislature? Yes || No
SECTION I: SERVICE DELIVERY ESSENTIALS
SN
INFORMA TION REQUI RED
RESPONSE
A
INFRASTRUC TURE
1.1 Number of Health Facilities in the State/UT
a) CHCs No. sanctioned
No. functional
No. functional as FRU
b) PHCs No. sanctioned
No. functional
c) Additional PHCs No. sanctioned
No. functional
d) Sub Centres No. sanctioned
No. functional
e) Health and Wellness Centres No. sanctioned
No. functional
1.2 Provide details for Health and Wellness Centres (HWCs)
a) Total no. HWCs planned
b) No. of HWCs operational
c) No. of HWCs providing ALL the
proposed services
98
B
HUMAN RESOURCES
1.3 Lady Health Visitor (LHV) No. of posts sanctioned
No. of LHVs in position
ANM No. of posts sanctioned
No. of ANMs in position
ASHA Facilitators Total no. in State/UT
No. of ASHA s per
facilitator
ASHA Total no. of ASHA s
working in State/UTs
No. of villages with one
ASHA
No. of villages with two
or more ASHA
No. of villages without
ASHA
C SUPPLIES INFORMATION FOR THE MONTH OF FEB 2019 (Feb 1 to Feb 28, 2019)
1.4 Number of Districts which reported STOCK-OUT of the following for the month of Feb 2019
(Feb 1 to Feb 28, 2019):
a) IFA Red tablets (adult)
b) Pregnancy detection kit
c) IFA syrup
d) Calcium tablets
e) Albendazole tablets
f) TT injections
g) Any modern contraceptives
(OCPs, condoms etc.)
No. of Districts
reporting stock-out
Specify which items
were stock-out
h) Consumables for anaemia
detection kits
i) Iron-Sucrose injections
j) Oxytocin
k) Oral Misoprostol
l) ORS packets/sachets
m) Zinc syrup/tablets 99
n)
MCP Card
D
TRAINING AND CAPA CITY BUILDING
1.5 Provide the details of the ASHA s
trained in module 6 and 7 which
pertain to Home Based New Born Care
(HBNC) till 28
th
Feb 2019
No. of ASHAs targeted
No. of ASHA trained
1.6 In which year was the last round of
HBNC training conducted in the
State/UT
1.7 Provide details for the Skilled Birth
Attendant (SBA) trainings for ANMs.
No. who have received
SBA training
No. who have received
refresher SBA training
No. of SBA trainings
conducted from 1
st
April
2018 to 28
th
Feb 2019
SECTION II: PROGRAM ACTIVITES AND INTERVENTION COVERAGE
Information is required for ONE YEAR (1
st
April 2018 to 28
th
Feb 2019)
SN
INFORMATION REQUIRED
RESPONSE
A
PROGRAM ACTIVITES- NHM
2.1 Total number of beneficiaries
registered (for the period of 1
st
April
2018 to 28
th
Feb 2019)
Pregnant
women
registered for
ANC
I trimester
II trimester
III trimester
Children 0-59
months of
age
0-6 month
6-59 month
Children 12-
23 months of
age
2.2 Health interventions in first 1000 days
(Provide data for the period of 1st April 2018 to 28
th
Feb 2019)
a)
No. of registered pregnant women
who
Received MCP cards
Had MCP cards filled
b) No. of pregnant women who
registered for ANC in the first
trimester (i.e. in the first 12
weeks of pregnancy)
100
c) No. of pregnant women who
received 4 or more ANC
check-ups
d) No. of pregnant women given
180 IFA tablets
e) No. of pregnant women who had
their weight gain monitored
during pregnancy
f) No. of pregnant women with
adequate weight gain (9-12 kg)
during pregnancy
g) No. of pregnant women given
TT2/booster
h) No. of pregnant women given one
Albendazole tablet after
first trimester
i) No. of pregnant women who
received counselling on birth
preparedness and complication
readiness during pregnancy
j) No. of pregnant women tested
for Haemoglobin 4 or more times
during pregnancy
k) No. of pregnant women detected
to have severe anemia
(Hb level <7 gm%) in any trimester
l) No. of pregnant women detected
with severe anaemia treated
m) No. of high risk pregnancies
identified
n) No. of high risk pregnancies
referred
2.3 Total number of reported deliveries for the period of 1
st
April 2018 to 28
th
Feb 2019
a) No. of home deliveries attended by
Skilled Birth Attendant (SBA)
b) No. of home deliveries attended by
non-SBA/ Trained Birth Attendant
(TBA)
c) No. of institutional deliveries Normal
C-section
2.4 Provide details of live births for the period of 1
st
April 2018 to 28
th
Feb 2019
a) Total no. of live births 101
b) No. of newborns weighed
at birth
c) No. of newborns with weight
less than 2.5 kg at birth
d) No. of new borns breastfed
within one hour of birth
e) No. of newborns who received 6 in case of
mandated Home Based Newborn institutional
Care (HBNC) visits by ASHA* deliveries
7 in case of
home deliveries
2.5 Provided the following details for children 12-59 months of age for the period of
1
st
April 2018 to 28
th
Feb 2019
a) No. of children 12-23 months
completely immunized
b) No. of children 12-23 months
who were provided at least 8 doses
of IFA syrup per month
c) No. of children 12-23 months who
have received at least one dose of
Vitamin A
d) % of children 12-23 months who
received at least one dose of
Albendazole
2.6 Provide the following information for the period of 1
st
April 2018 to 28
th
Feb 2019
a) No. of diarrhea episodes reported
in children 0 to 59 months of age
b) No. of diarrhea episodes reported
in children 0 to 59 months of age
where only ORS was given
c) No. of diarrhea episodes reported
in children 0 to 59 months of age
where both ORS and zinc were
given
SECTION III: ADDITIONAL INFORMATION
SN INFORMATION REQUIRED RESPONSE
3.1 Specify the good practices or innovations State/UT has done in the year 2018-19
to improve the health indicators during the first 1000 days life cycle:
(Provide details as attachment) 102
Annexure 2: Implementation Score Rubric
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
WCD template
TOTAL-65
1 Governance & Institutional Mechanism 19
1.1 Fund Allocation 4
1 if <25%
% utilized by the State/ UT 2 if 25%-<50%
(as on 31st March 2019 – A. Q1.1 d 3 if 50%-<75%
% 4 if ≥ 75%
1.2 Constitution of Committees 15
and Resource Groups
0 if <25%
% of posts filled in the SPMU – B.Q1.7 1 if 25%-<50%
(No. of posts filled/No. of posts sanctioned) % 2 if 50%-<75%
3 if ≥ 75%
0 if <25%
% of districts where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of districts 3 if ≥ 75%
0 if <25%
% of blocks where the convergence action 1 if 25%-<50%
plan committees have been formed - 2 if 50%-<75%
B Q.1.9/Total number of blocks 3 if ≥ 75%
0 if <25%
% of districts where DRGs have been 1 if 25%-<50%
formed – Q1.11 No. of DRGs established/ 2 if 50%-<75%
No. of DRGs required 3 if ≥ 75%
0 if <25%
% of blocks where BRGs have been formed 1 if 25%-<50%
- Q1.12 No. of BRGs established/ 2 if 50%-<75%
No. of BRGs required 3 if ≥ 75%
103
Rubric
Theme Sub- Theme Sub Sub-Theme Indicators (as per Template) Type Weights (TOTAL- 100)
2 Strategy and Planning 6
2.1 Cross-sectional convergence 6
Has the State/UT level Convergence
action plan been submitted as part of the Y/N 3 if YES; 0 if NO
Annual PIP for the year 2019-20- Q2.2
% of districts that developed CAP - Q2.2/ 0 if <25%
Total number of districts % 1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
3 Service Delivery & Capacities 31
3.1 HR 5
% of DPO positions filled – Q3.1 – 0.25 if <25%
No. of DPO positions filled/No. of DPO 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of CDPO positions filled - Q3.2 – 0.25 if <25%
No. of CDPO positions filled/No. of CDPO 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of LS positions filled - Q3.3 – No. of 0.25 if <25%
LS positions filled/No. of LS positions % 0.5 if 25%-<50%
sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of AWW positions filled- Q3.4 – No. 0.25 if <25%
of AWW positions filled/No. of AWW 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
% of AWH positions filled - Q3.5 – No. 0.25 if <25%
of AWH positions filled/No. of AWH 0.5 if 25%-<50%
positions sanctioned 0.75 if 50%-<75%
1 if ≥ 75%
104
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
3.2
Supplies
5
Mobile phones
% of mobile phones distributed to districts
- Q3.6 – No. of mobile phones
distributed /No. of mobile phones
required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Growth monitoring devices
Weighing
scale- infant
% distributed to districts- Q3.10 a– No. of
weighing scales-infant distributed /No.
of weighing scales-infant required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Weighing
scale- adult
% distributed to districts Q3.10 b – No. of
weighing scales-adult distributed /No.
of weighing scales-adult required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Infantometer
% distributed to districts Q3.10c – No. of
infantometers distributed /No. of
infantometers required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
Stadiometer
% distributed to districts Q3.10 d – No. of
stadiometers distributed /No. of
stadiometers required
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
3.3
Training and capacity building
21
% DRGs trained in ILA Q3.13 – No. of
DRGs trained /No. of DRGs to be
trained
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
% of LS trained on 6 or more modules Q3.14 – (No. of LS trained on 6-10
modules + No. of LS trained on 10 or
more modules)/ No. of LS posts filled
(Q3.3c)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
% of AWW trained on 6 or more modules Q3.14
–
(No. of AWW trained on 6
-
10
1 if <25%
2 if 25%
-
<50%
105
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
modules + No. of AWW
trained on 10
or more modules)/ No. of AWW posts filled (Q3.3d)
3 if 50%
-
<75%
4 if ≥ 75%
% DPOs trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of DPOs
trained on ICDS-CAS/ No. of DPO
posts filled (Q3.1a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
%
C
DPOs trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of
CDPOs trained on ICDS-CAS/ No. of
CDPO posts filled (Q3.1b)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
%
LS
trained on ICDS
-
CAS
Dashboard/Mobile Q3.21 – (No. of
CDPOs trained on ICDS-CAS/ No. of
CDPO posts filled (Q3.1c)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
4
Program activities and intervention coverage
9
4.1
Program activities
-
ICDS
9
% of pregnant women who received THR Q4.8 – No. of pregnant women received THR/ Q4.1 Total number of pregnant women
%
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
% of lactating women who received THR Q4.8 – No. of lactating women received THR/ Q4.1 Total number of lactating women
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
% of children 6-36 months who received THR Q4.8 – No. of 6-36 mo children received THR/ Q4.1 Total number of 6-36 mo children
0 if <25%
1 if 25%-<50% 2 if 50%-<75% 3 if ≥ 75%
Health template
TOTAL
-
35
106
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
1
Service delivery essentials
17
1.1
Infrastructure
4
% of sub-centres functional -Q1.1 d No.
of sub-centers functional/No. of sub-
centers sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
% of CHCs functional--Q1.1 a No. of
CHCs functional/No. of CHCs
sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
1.2
Human Resource
3
% of LHV posts filled -Q1.3 No. of
LHVs in position/No. of LHV posts
sanctioned
0 if <25%
0.5 if 25%-<50%
1 if 50%-<75%
1.5 if ≥ 75%
% of ANM posts filled- Q1.3 No. of
ANMs in position/No. of ANM posts
sanctioned
0 if <25%
0.5 if 25%-<50%
1 if 50%-<75%
1.5 if ≥ 75%
1.3
Stock out
6
% districts that reported stock
-
out of IFA
red tablets in the month of Feb 2019 -
Q1.4 a No. of IFA tablets stock-out
districts/Total number of districts in the
state (Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
% districts that reported stock
-
out of TT
injections in the month of Feb 2019--
Q1.4 f No. of TT injection stock-out
districts/Total number of districts in the
state (Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
% districts that reported stock
-
out of
albendazole in the month of Feb 2019 -- Q1.4 e No. of
albendazole
stock
-
out
2 if <25%
1.5 if 25%-<50% 1 if 50%
-
<75%
107
Rubric
Theme
Sub- Theme
Sub Sub- Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
districts/Total number of districts in the state (Q2)
0.5 if ≥ 75%
1.4
Training and capacity building
4
% of ASHAs training on HBNC modules 6 and 7-- Q1.5 No. of ASHAs
trained/Total number of ASHAs in the
state (QB1.3)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
2
Program activities and intervention coverage
18
2.1
Program activities
18
% of newborns weighed at birth – Q2.4b
No. of newborns weighed at birth/Total
number of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of newborns breastfed within one hour of birth- Q2.4d No. of newborns
breastfed immediately after birth/Total
number of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) fully
immunized- Q2.5a No. of children 12-2
3
months completely immunized /Total number of 12
-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who were
provided at least 8 IFA syrup per month--
Q2.5b No. of children 12-23 months
who were provided at least 8 doses of
IFA syrup per month /Total number of
12
-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who have
received at least one dose of Vitamin A--
Q2.5c No. of children 12-23 months
who have received at least one dose of
Vitamin A
/Total number of 12
-
23 mo
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75% 108
Rubric
Theme
Sub- Theme
Sub Sub
-
Theme
Indicators (as per Template)
Type
Weights (TOTAL- 100)
old children (Q2.1)
% of children (12-23) who have received
at least one dose of Albendazole -- Q2.5d
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
109
Health template TOTAL-35
1
Service delivery esse ntials
17
1.1
Infrastructure
4
% of sub-centres functional -Q1.1 d No. of
sub-centers functional/No. of sub- centers
sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
% of CHCs functional-Q1.1 a No. of CHCs
functional/No. of CHCs sanctioned
0.5 if <25%
1 if 25%-<50%
1.5 if 50%-<75%
2 if ≥ 75%
1.2
Human Resource
3
% of LHV posts filled -Q1.3 No. of LHVs in
position/No. of LHV posts sanctioned
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of ANM posts filled- Q1.3 No. of ANMs in
position/No. of ANM posts sanctioned
0.25 if <25%
0.5 if 25%-<50%
0.75 if 50%-<75%
1 if ≥ 75%
% of villages with ASHA posts vacant – Q1.3
No. of villages without ASHA/ Q4 Total
number of villages in the State
1 if < 25%
0.75 if 25%-<50%
0.5 if 50%-<75%
0.25 if ≥ 75%
1.3
Stock out
6
%
District
s that reported stock
-
out of IFA red
tablets in the month of Feb 2019 - Q1.4 a No.
of IFA tablets stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
%
District
s that reported stock
-
out of TT
injections in the month of Feb 2019-- Q1.4 f
No. of TT injection stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
%
District
s that reported stock
-
out of
albendazole in the month of Feb 2019 -- Q1.4
e No. of albendazole stock-out Districts/Total
number of
District
s in the
State
(Q2)
2 if <25%
1.5 if 25%-<50%
1 if 50%-<75%
0.5 if ≥ 75%
110
1.4
Training and capacity building
4
% of ASHAs training on HBNC modules 6 and
7-- Q1.5 No. of ASHAs trained/Total number
of ASHAs in the State (QB1.3)
1 if <25%
2 if 25%-<50%
3 if 50%-<75%
4 if ≥ 75%
2
Program activities and intervention coverage
18
2.1
Program activities
18
% of newbo rns weighed at birth – Q2.4b No.
of newborns weighed at birth/Total number
of live births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of newbo rns breastfed within one hour of birth- Q2.4d No. of newborns breastfed
immediately after birth/Total number of live
births (Q2.4a)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) fully immunized
-
Q2.5a No. of children 12-23 months
completely immunized /Total number of 12-
23 mo old children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo old) who were
provided at least 8 IFA syrup per month--
Q2.5b No. of children 12-23 months who
were provided at least 8 doses of IFA syrup
per month /Total number of 12-23 mo old
children (Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12
-
23 mo
old) who have
received at least one dose of Vitamin A--
Q2.5c No. of children 12-23 months who
have received at least one dose of Vitamin A
/Total number of 12-23 mo old children
(Q2.1)
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
% of children (12-23) who have received at
least one dose of Albendazole -- Q2.5d
0 if <25%
1 if 25%-<50%
2 if 50%-<75%
3 if ≥ 75%
111
<25%
25-<50%
50-<75%
≥75%
Annexure 3
Table 3: Coverage of health interventions during pregnancy and delivery-CNNS Data
State
Pregnancy
Delivery & Postnatal
Any ANC
ANC in 1st
trimester
4 or more ANC
Received MCP
card
Blood pressure
measured
Urine sample
taken
Blood sample
taken
Abdomen
examined
TT injection
Institutional birth
Skilled birth
attendant
Postnatal care for
babies
India
81
58
47
72
67
67
67
67
87
80
83
62
Andhra Pradesh
89
75
48
85
88
88
88
88
88
83
86
87
Arunachal Pradesh
70
40
32
61
66
63
63
56
77
62
64
55
Assam
86
60
36
85
85
81
82
80
83
73
76
86
Bihar
68
42
20
54
35
37
36
37
91
69
76
28
Chhattisgarh
86
63
56
80
81
77
79
80
91
72
77
75
Delhi
93
72
72
61
90
88
88
90
94
83
86
73
Goa
97
89
92
84
96
96
95
95
98
97
99
95
Gujarat
82
70
69
85
80
78
80
80
90
94
95
89
Haryana
81
60
45
75
78
77
77
77
89
78
81
73
Himachal Pradesh
94
81
66
85
91
90
90
91
94
75
80
82
Jammu & Kashmir
95
85
81
85
92
94
93
92
87
87
89
90
Jharkhand
83
60
33
69
57
56
51
54
90
63
72
40
Karnataka
94
81
87
76
92
91
91
91
91
94
91
88
Kerala
99
95
95
58
99
98
98
99
96
99
100
97
Madhya Pradesh
84
53
38
75
70
64
71
64
90
76
80
40
Maharashtra
94
78
83
87
93
92
92
93
95
89
94
95
Manipur
82
68
59
30
80
77
78
77
85
62
67
60
112
State
Pregnancy
Delivery & Postnatal
Any ANC
ANC in 1st
trimester
4 or more ANC
Received MCP
card
Blood pressure
measured
Urine sample
taken
Blood sample
taken
Abdomen
examined
TT injection
Institutional birth
Skilled birth
attendant
Postnatal care for
babies
Meghalaya
81
48
46
74
77
75
74
77
80
44
50
63
Mizoram
85
54
53
73
82
68
79
79
83
81
83
71
Nagaland
55
28
14
26
40
35
38
45
68
32
46
27
Odisha
96
70
70
90
92
87
89
86
95
83
87
86
Punjab
81
76
46
74
80
80
80
79
90
90
95
91
Rajasthan
79
52
40
71
72
73
73
74
87
85
88
71
Sikkim
93
72
50
89
91
92
91
88
95
95
96
89
Tamil Nadu
95
82
84
87
94
94
94
94
75
98
99
92
Telangana
96
87
67
84
95
95
95
95
91
93
96
98
Tripura
66
42
54
52
63
64
63
60
87
80
84
74
Uttar Pradesh
62
35
16
59
33
34
34
37
79
72
75
34
Uttarakhand
95
77
49
82
78
81
81
86
92
76
78
60
West Bengal
94
54
74
86
93
92
91
87
87
89
90
82
Source: Comprehensive Nati onal Nu trition Survey, 2016-18. 113
<25%
25-<50%
50-<75%
≥75%
Table 4: Coverage of health and nutrition interventions during pregnancy, lactation, and early childhood-CNNS Data
State
Pregnancy
Lactation
Received benefits for child from AWC
Received IFA
Consumed 100+
IFA
Weighing
Breastfeeding
counselling
Food
supplementation
Health & nutrition
education
Food
supplementation
Health & nutrition
education
Food
supplementation
(at least once a
week)
Weighing (at least
once in 3 months)
Counselling on
child growth
(among those who
weighed)
India
73
27
69
38
52
35
49
33
42
60
48
Andhra Pradesh
83
47
89
68
85
81
86
81
72
90
51
Arunachal Pradesh
70
12
65
9
9
3
9
2
24
27
31
Assam
86
24
86
65
58
31
63
31
15
72
32
Bihar
50
5
42
16
33
12
31
13
14
43
44
Chhattisgarh
86
30
82
54
81
65
76
62
61
90
54
Delhi
87
47
89
41
18
16
15
12
61
43
43
Goa
94
75
96
55
81
55
82
54
23
77
42
Gujarat
84
36
80
57
59
54
52
47
18
90
55
Haryana
78
29
78
32
31
25
28
21
47
67
30
Himachal Pradesh
92
43
89
38
86
38
83
35
30
57
32
Jammu & Kashmir
76
11
89
41
23
10
13
7
60
58
41
Jharkhand
72
18
68
37
71
31
69
33
18
71
45
Karnataka
88
53
91
54
74
56
74
59
33
79
36
Kerala
98
85
98
38
46
22
36
16
25
77
32 114
State
Pregnancy
Lactation
Received benefits for child from AWC
Received IFA
Consumed 100+
IFA
Weighing
Breastfeeding
counselling
Food
supplementation
Health & nutrition
education
Food
supplementation
Health & nutrition
education
Food
supplementation
(at least once a
week)
Weighing (at least
once in 3 months)
Counselling on
child growth
(among those who
weighed)
Madhya Pradesh
80
20
72
34
78
50
72
48
61
84
62
Maharashtra
84
53
93
56
49
38
45
35
42
85
47
Manipur
73
24
80
10
32
3
29
2
4
13
20
Meghalaya
74
40
78
44
61
43
58
40
55
68
48
Mizoram
77
50
82
32
68
43
62
40
79
71
23
Nagaland
39
2
38
7
13
1
9
0
2
10
13
Odisha
92
31
95
65
90
81
90
75
48
84
58
Punjab
86
38
79
49
48
35
39
31
33
52
48
Rajasthan
62
22
73
30
43
28
37
23
47
44
42
Sikkim
90
48
91
56
47
38
45
36
17
77
72
Tamil Nadu
92
56
94
60
58
43
59
45
38
73
43
Telangana
91
57
95
59
75
70
77
72
66
77
51
Tripura
83
19
64
42
65
43
58
41
85
60
36
Uttar Pradesh
56
10
32
15
26
11
24
9
23
57
41
Uttarakhand
81
27
78
46
76
59
80
59
25
86
61
West Bengal
86
Dewormin
93
54
62
46
54
40
91
77
48
Source: Comprehensive Nati onal Nu trition Survey, 2016-18. 115
<25% 25-<50% 50-<75% ≥75%
State/UT % of infant weighing
scales distributed
% of adult weighing
scales distributed
% of infantometers
distributed
% of stadiometers
distributed
Large States
Andhra Pradesh 100 100 100 100
Assam 0 0 0 0
Bihar 87 80 26 86
Chhattisgarh 47 49 1 8
Gujarat 0 0 0 0
Haryana 0 0 0 0
Himachal Pradesh 42 42 42 42
Jammu & Kashmir 93 93 93 93
Jharkhand 51 51 51 51
Karnataka 0 0 0 0
Kerala 0 0 0 0
Madhya Pradesh 0 100 100 100
Maharashtra 73 77 82 78
Punjab 0 0 0 0
Rajasthan 0 35 51 51
Tamil Nadu 34 34 34 34
Telangana 0 0 0 0
Uttar Pradesh 0 0 0 0
Uttarakhand 100 100 100 100
Small States
Arunachal Pradesh 0 0 0 0
Goa 0 0 0 0
Manipur 0 0 0 0
Meghalaya 100 100 100 100
Mizoram 100 68 100 100
Nagaland 100 100 100 100
Sikkim 0 0 0 0
Tripura 13 13 13 13
Union Territories
Andaman & Nicobar 0 0 0 0
Chandigarh 100 100 100 100
Dadra & Nagar Haveli 100 100 100 100
Daman & Diu 100 100 100 100
Delhi 0 -- -- --
Lakshadweep 0 0 0 100
Puducherry 100 100 100 100
Source: Responses provided by State/UT governments to questionnaires sent by NITI Aayog,
May 2019
Table 5: Availability of growth monitoring instruments at Anganwadi centers across States 116
Table 6: Availability of mobile devices and technology support across States
State
Mobile Hardware Technology support
Procurement
(%)
Distribution (%) District helpdesk
(%)
Block helpdesk
(%)
Large States
Andhra Pradesh 100 100 23 2
Assam 0 0 0 0
Bihar 38 38 16 1
Chhattisgarh 52 19 44 5
Gujarat 0 0 97 99
Haryana 0 0 19 0
Himachal Pradesh 39 39 0 0
Jammu & Kashmir 2 2 0 0
Jharkhand 30 28 29 4
Karnataka 0 0 0 0
Kerala 0 0 0 0
Madhya Pradesh 29 29 29 38
Maharashtra 23 0 100 7
Punjab 0 0 0 0
Rajasthan 34 33 100 11
Tamil Nadu 34 32 34 34
Telangana 29 29 0 0
Uttar Pradesh 31 30 0 0
Uttarakhand 100 35 0 0
Small States
Arunachal Pradesh 0 0 0 0
Goa 100 100 0 0
Manipur 22 0 0 --
Meghalaya 100 100 0 0
Mizoram 95 62 63 70
Nagaland 100 0 0 0
Sikkim 61 0 100 100
Tripura 0 0 0 0
Union Territories
Andaman & Nicobar 100 0 100 60
Chand igarh 100 0 0 0
Dadra & Nagar Haveli 100 92 0 0
Daman & Diu 100 90 100 0
Delhi 96 0 0 0
Lakshadweep 86 86 0 0
Puducherry 91 91 0 0
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
<25% 25-<50% 50-<75% ≥75% 117
Table 7: Training of ICDS functionaries on ICDS-CAS dashboard/mobile use
State
% of DPOs
trained
% of CDPOs
trained
% of LS trained % of AWWs trained
Large States
Andhra Pradesh 77 76 100 88
Assam 6 1 0 0
Bihar 18 22 15 12
Chhattisgarh 58 71 57 23
Gujarat 0 0 0 0
Haryana 0 0 0 0
Himachal Pradesh 0 0 6 --
Jammu & Kashmir 0 0 0 0
Jharkhand 100 100 16 17
Karnataka 0 0 0 0
Kerala 29 0 1 0
Madhya Pradesh 30 27 28 29
Maharashtra 0 0 0 0
Punjab -- 6 1 --
Rajasthan 27 59 16 32
Tamil Nadu 100 100 100 100
Telangana 32 32 29 31
Uttar Pradesh 42 38 -- 8
Uttarakhand 0 0 43 2
Small States
Arunachal Pradesh 0 0 0 0
Goa NA 64 100 0
Manipur 0 0 0 0
Meghalaya 20 28 50 0
Mizoram 0 100 63 68
Nagaland 0 0 0 0
Sikkim 0 0 60 63
Tripura 0 0 0 0
Union Territories
Andaman & Nicobar NA 0 8 0
Chand igarh NA 100 100 100
Dadra & Nagar Haveli NA 100 100 100
Daman & Diu NA 100 100 100
Delhi -- -- -- --
Lakshadweep 0 0 0 0
Puducherry 100 0 NA 100
Source : Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
<25% 25-<50% 50-<75% ≥75% 118
<25% 25-<50% 50-<75% ≥75%
Table 8: Training of ICDS supervisors and frontline workers on incremental learning
approach modules
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May 2019
State % of Lady Supervisors trained
on 6 or more ILA modules
% of Anganwadi workers trained
on 6 or more ILA modules
Large States
ANDHRA PRADESH 100 100
ASSAM 0 0
BIHAR 84 64
CHATTISGARH 98 100
GUJARAT 80 83
HARYANA 0 0
HIMACHAL PRADESH 24 16
JAMMU & KASHMIR 0 0
JHARKHAND 0 0
KARNATAKA 0 0
KERALA 0 0
MADHYA PRADESH 100 98
MAHARASTRA 0 0
PUNJAB 0 0
RAJASTHAN 100 99
TAMIL NADU 100 100
TELANGANA 0 0
UTTAR PRADESH 87
UTTARANCHAL 90 57
Small States
ARUNACHAL PRADESH 0 0
GOA 0 0
MANIPUR 0 0
MEGHALAYA 100 64
MIZORAM 100 100
NAGALAND 0 0
SIKKIM 90 100
TRIPURA 0 0
Union Territories
ANDAMAN & NICOBAR ISLANDS 0 0
CHANDIGARH 100 100
DADR A & NAGAR HAVELI 100 100
DAMAN & DIU 100 100
DELHI 95 100
LAKSHADWEEP 0 0
PUDUCHERRY 0 119
<25% 25-<50% 50-<75% ≥75%
Table 9: Convergence-related activities by State
State % of Districts with
convergence
action plan
committees
% of blocks with
convergence action
plan committees
% of Districts
with
convergence
action plans
% of blocks with
convergence
action plans
Large States
ANDHRA PRADESH
100 100 77 79
ASSAM 0 0 --
BIHAR 100 100 --
CHATTISGARH 100 100 100 100
GUJARAT 79 82 27 0
HARYANA 100 100 --
HIMACHAL PRADESH
100 100 42 44
JAMMU & KASHMIR 41 49 23 21
JHARKHAND 100 86 67 34
KARNATAKA --
KERALA 0 0 --
MADHYA PRADESH 98 100 98 100
MAHARASTRA
100 100 --
PUNJAB 100 100 100 100
RAJASTHAN 100 100 0 --
TAMIL NADU 34 34 0 --
TELANGANA 3 0 --
UTTAR PRADESH 100 100 100 100
UTTARANCHAL
100 100 100 100
Small States
ARUNACHAL PRADESH 84 100 --
GOA 100 100 --
MANIPUR 100 61 --
MEGHALAYA 27 89
MIZORAM
100 100 4
NAGALAND 100 81 100 81
SIKKIM 100 100 100 100
TRIPURA 100 97 --
Union Territories
ANDAMAN & NICOBAR
ISLANDS
100 100 100 100
CHANDIGARH
100 100 100 0
DADR A & NAGAR
HAVELI
100 100 100 120
State % of Districts with
convergence
action plan
committees
% of blocks with
convergence action
plan committees
% of Districts
with
convergence
action plans
% of blocks with
convergence
action plans
DAMAN & DIU 100 100 100 0
DELHI 91 100 --
LAKSHADWEEP
100 100 --
PUDUCHERRY 100 100 --
Source: Responses provided by State governments to questionnaires sent by NITI Aayog, May
2019