More than half of global deaths in children under-5 years of age is attributable to undernutrition. Most of these children are from low-income and middle-income countries, including India. Malnutrition has been a major contributor to disease burden in the country. According to The Lancet study on The burden of child and maternal malnutrition and trends in its indicators in the states of India , malnutrition was the leading risk factor for death in under-5 children- in 2017, malnutrition accounted for 68·2% of the total under-5 deaths.
Responding to the daunting challenge, several policy and programmatic efforts have been made to tackle malnutrition in India. In early 2018, the Prime Minister of India launched the National Nutrition Mission (NNM), also known as POSHAN Abhiyaan , to bring focus and momentum to this effort, with an overarching goal to improve nutritional outcomes for children, adolescents, lactating mothers and pregnant women, by leveraging technology, targeted approach, and inter-ministerial/ inter-departmental convergence. All 36 States/UTs and districts are being covered under the programme, in a phased manner.
Multi-sectoral convergence and productive partnerships were the key components to roll out the interventions effectively and achieve the ambitious targets of POSHAN Abhiyaan. While the programme provided the guidance on the various aspects of nutrition interventions, it was time to foster strategic partnerships in the nutrition community at all levels for rolling out and implementation of the key interventions. Additionally, to accelerate the pace of POSHAN Abhiyaan, convergence was required to take place at all levels- national, state, district, and block. Different development partners were already supporting the government at central, state and district level to deliver these interventions, using different strategies and approaches. It was realized that to increase efficiencies and optimize the potential of nutrition partners to support government, there is an immense need to bring all the partners together.
Inception of C²IQ:
Considering the need and call for focused approach and concerted efforts among development partners to emphasise on the need for Coverage, Continuity, Intensity and Quality (C²IQ) for delivering high impact nutrition interventions, We Collaborate for Nutrition (WeCan) , along with key nutrition partners including the Bill & Melinda Gates Foundation, UNICEF, World Bank, Alive & Thrive had conceptualized C²IQ – Nutrition Partners Forum, and organized its first national level Nutrition Partners Meet in June 2019 in New Delhi. The convening witnessed participation from 22 organizations with representatives from both national and state levels. The meeting was convened to build partnerships to achieve C²IQ, which in turn will strengthen coordination and collaboration between nutrition partners in support of government efforts to roll out high impact nutrition interventions. The meet focused on measurable targets to improve nutrition indicators as per the overarching goals of the POSHAN Abhiyaan.
Since June 2019, there has been no looking back and C²IQ has achieved great momentum in the country. The convening has evolved as a Nutrition Partners Forum and cascaded to 5 states namely, Uttar Pradesh, Jharkhand, Madhya Pradesh, Rajasthan, and Gujarat. WeCan has spearheaded the efforts to cascade the C²IQ momentum across states in collaboration with key development partners. The nutrition platform acted as a catalyst, effectively bringing together nutrition partners in various states to collaborate with each other and support the respective state governments to achieve their nutrition targets.
WeCan used an inclusive approach for cascading the C²IQ in the states through encompassing state level nutrition partners mapping for preliminary discussions, followed by engaging with concerned government departments, mostly with Department of Women and Child Development (DWCD), for rolling out a C²IQ meet in the state. WeCan ensures that C²IQ meets are holistically captured and thoroughly documented with key actionable points or way forward in the form of proceedings report and circulated among all the partners and the state government departments involved in the meet. In a span of 5 months (September 2019- February 2020), WeCan has successfully completed 5 state level C²IQ meets in the five states. While WeCan was leading the convenings, other key national partners including Alive & Thrive (A&T) and Coalition for Food and Nutrition Security (CFNS) have also joined in to support the movement, and the C²IQ meets have trickled down to the district level in Jharkhand and Uttar Pradesh.
These meets have been enablers for developing strategic action plans to fight undernutrition and monitor their progress at regular intervals, and are structured to provide a space for nutrition partners, government, and policymakers to share knowledge, existing platforms and engage in exercises to find the way forward.
Senior state government officials as well as officials from the DWCD and Integrated Child Development Services (ICDS) who attended the C²IQ in Rajasthan, Madhya Pradesh and Gujarat not only set the tone for discussions, but also shared their expectations from the nutrition partners active in the states.
However, in February 2020 the global as well as the Indian public health scenario was turned around due to COVID-19 outbreak, followed by the nation-wide lockdown, forcing partners to seek alternative ways to come together. In this scenario, the C²IQ convenings became even more relevant in the context of nutrition services and partners response to the pandemic.
To deal with this, the WeCan team along with their key nutrition partners CFNS and Alive & Thrive immediately adopted digital/online platforms to organize C²IQ e-convenings. In a span of three weeks, a series of C²IQ- online partners meet was rolled out in Jharkhand, Madhya Pradesh, Gujarat and Rajasthan, with a clear mandate to support national and state government attempts to identify challenges in nutrition service delivery.
Prior to these online meets, WeCan developed a digital tool to gather relevant information from partners across various health & nutrition related systems (aligned with POSHAN Abhiyaan framework),to create an understanding of the current situation, issues & challenges faced.
The objective of these meetings was to do a situational analysis of key nutrition services during COVID-19,with a special focus on Maternal, Infant and Young Child Nutrition, Public Distribution Systems, and other nutrition and health services. These meetings encouraged the partners to talk about the key challenges faced by beneficiaries in the field, and share their experiences of good practices for cross learning. They also provided a platform for a common understanding about nutrition issues, COVID-19 response guidelines issued by government and nutrition vulnerabilities faced by women and children during COVID-19. There were intense deliberations on key nutrition priorities for each state to address the current situation and come up with a response strategy or an advocacy/white paper for the government. The possible solutions /mitigation strategies were developed in a way to seamlessly feed into the planning process being undertaken by the state governments. In every state, the online meetings had representations from about 20 or more partner organizations.
Considering the effectiveness of these online meets, the partners felt they should be held more frequently, as it helps to understand what each other are doing and learn from each other experiences. These gatherings also provide opportunity for timely collaborative support to the government to respond to such challenges.
The journey of C²IQ since June 2019 till now has been exceptional. In the first phase, the forum started in a conventional way with partners and in the second phase it adapted itself togatherings on online platforms and enable the partners to respond rapidly to the crisis caused by the pandemic. This also helped ensure adherence to the norms of social distancing while being efficient and effective in our work.
Welcome to the new normal!
(Binu Anand is the National Team Leader and Noveena Swapnabh is Communication Lead of WeCan-IPE Global)