Report - Tracking India's Progress on Addressing Malnutrition and Enhancing the Use of Data to Improve Programs

 
Report - Tracking India's Progress on Addressing Malnutrition and Enhancing the Use of Data to Improve Programs
Tracking India’s Progress on Addressing
Malnutrition and Enhancing the Use of
Data to Improve Programs

                                          Report
                                  No. 12 | December 2020
Written By
Purnima Menon, Rasmi Avula, Esha Sarswat, Sneha Mani, Manita Jangid (IFPRI)
Supreet Kaur, Anamika Singh (NITI Aayog)
Alok Kumar Dubey, Suchita Gupta (previously with NITI Aayog)
Divya Nair, Pulkit Agarwal, Nitya Agrawal (IDinsight)

Suggested Citation
Menon, P., R. Avula, E. Sarswat, S. Mani, M. Jangid, A. Singh, S. Kaur, A. K. Dubey, S. Gupta, D. Nair, P. Agarwal, and
N. Agrawal. 2020. Tracking India’s Progress on Addressing Malnutrition and Enhancing the Use of Data to Improve
Programs. POSHAN Report 12. New Delhi: International Food Policy Research Institute.

About NITI A ayog
NITI Aayog is the premier policy “think tank” of the Government of India, providing both directional and policy inputs.
NITI Aayog designs strategic and long-term policies and programs for the Government of India and provides relevant
technical advice to the central government and the states.

About Idinsight
IDinsight is a global advisory, data analytics, and research organization that helps development leaders maximize their
social impact.

About Datadent
Data for Decisions to Expand Nutrition Transformation (DataDENT) is a four-year initiative that aims to strengthen the
data value chain for nutrition globally and in several focus countries, including India. It is supported by the Bill & Melinda
Gates Foundation and is implemented by IFPRI, Johns Hopkins University, and Results for Development.

About Poshan at Ifpri
POSHAN (Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India) is a multi-year
initiative that aims to build evidence on effective actions for nutrition and to support the use of this evidence in
decisionmaking. It is supported by the Bill & Melinda Gates Foundation and led by IFPRI in India.

About Poshan Reports
POSHAN Reports aim to provide evidence-based guidance to support policy and program actions for nutrition in India.

This Report has been prepared as an output for POSHAN and DataDENT and has not been peer reviewed. Any opinions stated
herein are those of the authors and do not necessarily reflect the policies or opinions of IFPRI.
Copyright © 2020, International Food Policy Research Institute. All rights reserved.
To obtain permission to republish, contact ifpri-copyright@cgiar.org.
Table of Contents

List of Tables...........................................................................................................................................................ii

List of Figures..........................................................................................................................................................ii

List of Abbreviations.............................................................................................................................................. iii

Executive Summary.................................................................................................................................................v

1. Introduction...................................................................................................................................................... 1

2. Mechanisms and Data Systems to Monitor Progress on Nutrition Actions and Outcomes................................... 5

3. Use of Data in the Context of India’s Nutrition Efforts........................................................................................ 8

4. A
    pproach to Assessing Data Availability............................................................................................................10

5. M
    onitoring Progress on Inputs..........................................................................................................................12

6. Monitoring Progress on Intervention Coverage..................................................................................................16

7. Monitoring Progress on Immediate and Underlying Determinants of Malnutrition............................................ 25

8. Data Availability on Nutrition Outcomes.......................................................................................................... 29

9. Aligning Data to Program Theory: An Illustration..............................................................................................31

10. Recommendations.......................................................................................................................................... 33

11. Conclusions.................................................................................................................................................... 35

Annex 1: Aligning Indicators along a Program Theory of Change.......................................................................... 36

Annex 2: O
          rganizing Framework of Indicators for POSHAN Abhiyaan................................................................... 39

Bibliography......................................................................................................................................................... 46

                                                                                                                                                                              i
List of Tables
 Table 1: Summary of major population-based surveys on nutrition in India (1992–2019).......................................... 6

 Table 2: Summary of key administrative data systems on nutrition in India.............................................................. 7

 Table 3: Availability of input and activity indicators from administrative and other data systems.............................12

 Table 4: Potential indicators and data availability on interventions during adolescence...........................................17

 Table 5: Potential indicators and data availability on interventions during preconception........................................18

 Table 6: Potential indicators and data availability on interventions during pregnancy..............................................19

 Table 7: Potential indicators and data availability on interventions during delivery and postnatal period..................21

 Table 8: Potential indicators and data availability on interventions for infants and young children ......................... 23

 Table 9: Data availability on key behaviors and other immediate determinants ..................................................... 25

 Table 10: Data availability on underlying determinants.......................................................................................... 27

 Table 11: Data availability on nutrition outcomes ................................................................................................. 29

 Table 12: Description of broad elements along a program theory..........................................................................31

 Table 13: Indicator framework for iron and folic acid supplementation ................................................................. 32

 Table 14: Example of interventions to address anemia during pregnancy ............................................................. 36

 List of Figures
 Figure 1: P otential theory of change for POSHAN Abhiyaan.................................................................................... 3

 Figure 2: Interventions, immediate and underlying determinants targeted by POSHAN Abhiyaan...........................11

ii
List of Abbreviations

AIDS       Acquired Immune Deficiency Syndrome         ICDS       Integrated Child Development Services
AMB        Anemia Mukt Bharat                          ICDS–AMPR Integrated Child Development Services—
ANC        Antenatal Care                                        AWC Monthly Progress Report

ANM        Auxiliary Nurse Midwife                     ICDS–CAS   Integrated Child Development Service–
                                                                  Common Application Software
ARI        Acute Respiratory Infection
                                                       IDFC       Intensified Diarrhoea Control Fortnight
ARSH       Adolescent, Reproductive and Sexual
           Health                                      IEC        Information, Education and
                                                                  Communication
ASHA       Accredited Social Health Activist
                                                       IFA        Iron and Folic Acid
AWC        Anganwadi Centre
                                                       IFPRI      International Food Policy Research Institute
AWW        Anganwadi Worker
                                                       ILA        Incremental Learning Approach
BCG        Bacillus Calmette–Guérin
                                                       IMCI       Integrated Management of Childhood
BFHI       Baby-Friendly Hospital Initiative
                                                                  Illnesses
BPL        Below Poverty Line
                                                       IMI        Intensified Mission Indradhanush
CBE        Community-Based Events
                                                       IMR        Infant Mortality Rate
CHC        Community Health Centre
                                                       INR        Indian Rupee
CNNS       Comprehensive National Nutrition Survey
                                                       IYCF       Infant and Young Child Feeding
DAP        District Action Plan
                                                       JSSK       Janani Shishu Suraksha Karyakaram
DataDENT   Data for Decisions to Expand Nutrition
           Transformation                              MAA        Mother’s Absolute Affection

DH         District Hospital                           MAM        Moderate Acute Malnutrition

DHS        Demographic Health Survey                   MDD–W      Minimum Dietary Diversity–Women

DLHS       District Level Health Survey                MCP        Mother and Child Protection

DPT        Diphtheria, Pertussis and Tetanus Toxoids   MDD        Minimum Dietary Diversity

FP         Family Planning                             MDM        Mid Day Meal

FSSAI      Food Safety and Standards Authority of      MGNREGA Mahatma Gandhi National Rural
           India                                               Employment Guarantee Act

GHI        Global Hunger Index                         MHRD       Ministry of Human Resource Development

GoI        Government of India                         MIS        Management Information System

HBNC       Home-Based Newborn Care                     MLA        Member of the Legislative Assembly
HBYC       Home-Based Care for Young Children          MMR        Maternal Mortality Ratio
HIV        Human Immunodeficiency Virus                MoHFW      Ministry of Health and Family Welfare
HMIS       Health Management Information System        MP         Madhya Pradesh

                                                                                                             iii
MUAC       Mid-Upper Arm Circumference              SAG       Scheme for Adolescent Girls
 MWCD       Ministry of Women and Child              SAG–RRS   Scheme for Adolescent Girls–Rapid
            Development                                        Reporting System
 NA         Not Applicable                           SAM       Severe Acute Malnutrition
 NCR        National Capital Region                  SBA       Skilled Birth Attendant
 NDD        National Deworming Day                   SBCC      Social and Behavior Change
 NFHS       National Family Health Survey                      Communication

 NGO        Non-Governmental Organization            SC        Sub-Centre

 NHM        National Health Mission                  SD        Standard Deviation
 NIN        National Institute of Nutrition          SHG       Self-Help Group
 NIPI       National Iron Plus Initiative            SN        Supplementary Nutrition
 NPPNB due National Prophylaxis Programme against    SNP       Supplementary Nutrition Programme
 to VAD    Nutritional Blindness due to Vitamin A
                                                     SPMU      State Programme Management Unit
           Deficiency
                                                     SSA       Sarva Shiksha Abhiyan
 NRC        Nutrition Rehabilitation Centre
                                                     STI       Sexually Transmitted Infections
 NREGS      National Rural Employment Guarantee
            Scheme                                   TBD       To Be Decided

 NVBDC      National Vector Borne Disease Control    THR       Take-Home Ration
            Program                                  TSC       Total Sanitation Campaign
 OPV        Oral Polio Vaccine
                                                     TT        Tetanus Toxoid
 ORS        Oral Rehydration Salts
                                                     UIP       Universal Immunization Programme
 PDS        Public Distribution System
                                                     UNDP      United Nations Development Programme
 PHC        Primary Health Centre
                                                     UNICEF    United Nations Children’s Fund
 PMMVY      Pradhan Mantri Matru Vandana Yojana
                                                     UPHC      Urban Primary Health Centre
 PMO        Prime Minister’s Office
                                                     VHND      Village Health and Nutrition Day
 PMSMA      Pradhan Mantri Surakshit Matritva
                                                     VHSC      Village Health and Sanitation Committee
            Abhiyaan
                                                     VHSNC     Village Health Sanitation and Nutrition
 POSHAN     Partnerships and Opportunities to
            Strengthen and Harmonize Actions for               Committee
            Nutrition in India                       VHSND     Village Health, Sanitation and Nutrition
 PRI        Panchayati Raj Institutions                        Day

 PW         Pregnant Women                           WCD       Women and Child Development

 RCH        Reproductive and Child Health            WHA       World Health Assembly

 RTF        Right to Food Campaign                   WHO       World Health Organization

 RTI        Reproductive Tract Infections            WIFA      Weekly Iron and Folic Acid

 RUTF       Ready-to-Use Therapeutic Food            WIFS      Weekly Iron and Folic Acid
                                                               Supplementation
 RGSEAG     Rajiv Gandhi Scheme for Empowerment of
            Adolescent Girls                         WRA       Women of Reproductive Age

iv
Executive Summary

Data systems and their usage are of great significance                                    et al. 2013); it also has large-scale national program
in the process of tracking malnutrition and improving                                     platforms in place (Integrated Child Development
programs. The key elements of a data system for                                           Services and National Rural Health Mission) whose
nutrition include (1) data sources such as survey and                                     mandate is to deliver diverse nutrition interventions
administrative data and implementation research,                                          (Avula et al. 2013). The National Nutrition Strategy (NITI
(2) systems and processes for data use, and (3) data                                      Aayog 2017) and POSHAN Abhiyaan (MWCD 2018)
stewardship across a data value chain. The nutrition                                      provide an updated strategic framework for action to
data value chain includes the prioritization of indicators,                               improve nutritional outcomes for children, pregnant
data collection, curation, analysis, and translation to                                   women, and lactating mothers. POSHAN Abhiyaan’s
policy and program recommendations and evidence-                                          mission-mode approach provides an impetus to
based decisions. Finding the right fit for nutrition                                      strengthen not only the implementation but also the
information systems is important and must include                                         monitoring and measurement of progress. The Mission
neither too little nor too much data; finding the data                                    explicitly notes that NITI Aayog has a mandate to lead
system that is the right fit for multiple decisionmakers is                               the monitoring and evaluation of POSHAN Abhiyaan.
a big challenge.

Developed together with NITI Aayog, this document                                         WHAT TO MEASURE AND FOR WHAT
covers issues that need to be considered in the                                           PURPOSES?
strengthening of efforts to improve the availability and                                  1.    Programs must track progress on intervention
use of data generated through the work of POSHAN
                                                                                                coverage in order to know whether policy efforts
Abhiyaan,1 India’s National Nutrition Mission. The
                                                                                                are reaching populations throughout the key
paper provides guidance for national-, state-, and
                                                                                                biological periods such as the first 1,000 days.
district-level government officials and stakeholders
regarding the use of data to track progress on nutrition                                  2.    For each intervention type, it is also useful to track
interventions, immediate and underlying determinants,                                           progress on the most relevant immediate and
and outcomes. It examines the availability of data                                              underlying determinants. For example, in relation
across a range of interventions in the POSHAN                                                   to nutritional counseling, it is useful to measure
Abhiyaan framework, including population-based                                                  individual dietary diversity as an immediate
surveys and administrative data systems; it then                                                determinant and household food security as an
makes recommendations for the improvement of data                                               underlying determinant.
availability and use.
                                                                                          3.    National nutrition strategies must track progress
To improve monitoring and data use, this document                                               on indicators on all the target outcomes but must
focuses on three questions: what types of indicators                                            do so in meaningful timeframes.
should be used; what types of data sources can be
used; and with what frequency should progress on
                                                                                          WHAT ARE SOME USES OF DATA IN THE
different indicator domains be assessed.
                                                                                          CONTEXT OF INDIA’S NUTRITION PROGRAMS?
INDIA’S POLICY FRAMEWORK FOR NUTRITION                                                    Potential data uses at different levels (national, state,
                                                                                          and district) include the following:
India has a robust policy framework for nutrition
that covers most evidence-based interventions (Vir                                        1.    Progress tracking, reporting, and assessing impact
1
 The Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyaan or National Nutrition Mission, is Government of India’s flagship programme to improve
nutritional outcomes for children, pregnant women and lactating mothers. Launched by the Prime Minister on the occasion of International Women’s Day on 8 March, 2018
from Jhunjhunu in Rajasthan, POSHAN Abhiyaan directs the attention of the country towards the problem of malnutrition and addresses it in a mission-mode.

                                                                                                                                                                          v
2.   Strategy refinement                                   childhood and adolescence. We focused on immediate
                                                            determinants such as maternal nutrition, infant and
 3.   Program refinements and course correction
                                                            young child feeding (IYCF), and child health, as well as
 Each of these uses requires both the availability of       a range of underlying determinants such as poverty,
 data and careful choices of what data to use, in           food security, sanitation and early marriage. In terms
 what timeframes and for what decisions. To this            of nutritional outcomes, we focused on the goals of
 end, to support effective monitoring of POSHAN             POSHAN Abhiyaan as well as on the nutrition-related
 Abhiyaan activities and improve data use, a range of       Sustainable Development Goals (SDGs) to which India
 mechanisms have been set up at the national, state,        has committed.
 and district levels. And indeed, a number of data
                                                            Using this comprehensive list of indicators for
 systems are available that can be leveraged to assess
                                                            interventions, determinants, and outcomes that is
 progress on nutrition determinants and outcomes
                                                            based on the POSHAN Abhiyaan framework, we then
 and to inform evidence-based decisions and actions.
                                                            examined the availability of data on these indicators
 Data on intervention coverage, determinants, and
                                                            across multiple data sources, including population-
 nutrition outcomes are available from population-
                                                            based household surveys and administrative data. To
 based household surveys such as the National Family
                                                            assess data availability, we reviewed the questionnaires
 Health Survey (IIPS 2015), the Comprehensive National
                                                            used in the National Family Health Survey (IIPS 2015),
 Nutrition Survey (MoHFW, UNICEF, Population Council
                                                            the Comprehensive National Nutrition Survey (MoHFW,
 2019), and surveys conducted under the Aspirational
                                                            UNICEF, Population Council 2019), and the Aspirational
 Districts Programme (NITI Aayog 2018) by third-party
                                                            Districts Programme Survey (first and second rounds
 organizations such as IDinsight and the Tata Trusts.
                                                            2018/2019) by IDinsight and Tata Trusts (NITI Aayog
 Data on program inputs and intervention coverage,
                                                            2018). We also reviewed the currently available
 and even some outcomes, are also available from
                                                            indicators in administrative data sources of the Health
 administrative data systems which gather data from
                                                            Management Information Systems (MoHFW 2015),
 core ministries and departments that deliver a range of
                                                            Integrated Child Development Services–Anganwadi
 health and nutrition services.
                                                            Centre Monthly Progress Report (MWCD 2012), and
 Given the plethora of potential data uses, data            ICDS–Common Application Software (CAS) (IFPRI
 sources, data visualizations and data use mechanisms       2018). We assessed whether the data sources included
 that already exist in India, there is also potential for   the information to create or compute a relevant
 data confusion. We aimed, therefore, to develop a          indicator; if information was available, we then
 comprehensive framework of indicators aligned to           indicated the availability of data against the potential
 India’s nutrition programs and to map available data       indicator.
 to this framework. Our goal was to provide multiple
 potential users of data in India’s nutrition eco-system    WHAT DID WE FIND?
 with an overview of what indicators are useful to
                                                            1.   A number of data systems can be leveraged
 examine, and what data is available to support effective
                                                                 to monitor progress and to inform evidence-
 data use. Our review also highlights gaps in data
                                                                 based decisions and actions.
 availability to enable data producers to close gaps.
                                                                 In India, data on intervention coverage,
 WHAT DID WE DO?                                                 determinants, and outcomes are available from
 We first generated a comprehensive list of evidence-            both population-based household surveys
 based interventions, determinants, and impact                   and administrative data systems; these can be
 indicators that align with POSHAN Abhiyaan’s program            leveraged to monitor progress and to inform
 framework and then identified potential indicators for          evidence-based decisions and actions. Since data
 each of these. POSHAN Abhiyaan’s interventions cut              is available from multiple sources, comparing
 across the life cycle, from preconception, pregnancy,           indicators from different surveys or from survey
 delivery, postnatal and newborn care, through early             and administrative data is challenging. While

vi
interpreting findings, it is therefore important to              y    Swachh Bharat Abhiyaan dashboard (Ministry
     consider differences in data collection mechanisms                    of Jal Shakti, 2020)
     across sources; these include differences in                     y    Health management information systems
     sampling, questionnaire design, frequency of                          (HMIS) website (MoHFW 2020)
     data collection, recall periods, and referenced age
                                                                      Information on program inputs is available in a
     groups. While interpreting and using data from                   scattered manner from multiple data sources.
     administrative systems, it is also important to                  For instance, information on nutrition-related
     consider denominators, the accuracy of reporting,                social and behavior change communication
     and differences in reference periods for different               (SBCC) activities is available from the Jan Andolan
     administrative data systems.                                     dashboard; information on the flow of finances
2.   Data can and should be used for a range of                       for POSHAN Abhiyaan inputs is not available in a
     decisions in the context of India’s nutrition                    consolidated manner but could be consolidated
     efforts.                                                         from reported expenditures across ministries and
                                                                      line departments.
     Data can and should be used for tracking
     progress, reporting and assessing impacts, strategy         4.   Data availability on intervention coverage
                                                                      varies by life stage and type of intervention.
     refinement, and program refinement. These
     uses vary depending on whether they are at the                   The availability of data on the coverage of
     national, state, district, or even subdistrict level. For        interventions across life stages is as follows:
     each of these uses, it is critical to ascertain timely           1.   For adolescents, coverage data is scarce in
     availability of data and effective uses of available                  both surveys and administrative systems.
     data.
                                                                      2.   For preconception, limited data is available
3.   Data on program inputs are primarily                                  on the contraception, food fortification,
     available from a range of dashboards and                              and coverage of iron and folic acid (IFA)
     monitoring systems but need consolidation                             supplementation interventions for women of
     and validation.                                                       reproductive age (that is, women between 15
                                                                           and 49 years who are not currently pregnant
     Input indicators refer to the resources needed to
                                                                           or lactating).
     support the implementation of an intervention
     or program; these include financial and human                    3.   For pregnancy, multiple data sources are
     resources, training, and infrastructure. They are                     available on the coverage of interventions,
     primarily tracked by the administrative monitoring                    though the type of coverage indicators varies
     systems of Integrated Child Development Services                      greatly across data sources. While indicators
     (ICDS) and by the health department. Additional                       for measuring the coverage of antenatal
     information on the roll-out of different elements of                  care (ANC) interventions exist in multiple
     POSHAN Abhiyaan is available from the following                       data sources, there is limited information
     administrative dashboards:                                            for measuring the coverage of calcium
                                                                           supplementation, malaria prevention and
     y    Anemia Mukt Bharat (AMB) dashboard
                                                                           treatment, counseling during pregnancy, and
          (MoHFW 2020)                                                     maternity benefits.
     y    Integrated Child Development Services–
                                                                      4.   For delivery and postnatal care, most surveys
          Common Application Software (ICDS–CAS)
                                                                           and administrative systems provide data on
     y    Jan Andolan dashboard (POSHAN Abhiyaan)                          institutional deliveries, deliveries attended by
          (MWCD 2020)                                                      skilled birth attendants, and postnatal care for
     y    Pradhan Mantri Matru Vandana Yojana                              women and babies; information on kangaroo
          (PMMVY) dashboard (MWCD 2020)                                    mother care (KMC), including skin-to-skin

                                                                                                                            vii
carrying of low birth weight infants) and                Data availability on underlying determinants
            breastfeeding counseling is not measured                 is better captured in survey results than in
            across data systems, except in ICDS–CAS, and             administrative data. Information on underlying
            is limited; data is also very limited for newborn        determinants such as food security, poverty, and
            care interventions.                                      gender-related determinants are available from a
       5.   For early childhood, most indicators for                 range of surveys.
            measuring the coverage of interventions for
                                                                6.   Data availability on nutrition outcomes.
            infant and young childcare are covered to
            an extent either in population-based surveys             POSHAN Abhiyaan aims to have an impact on
            or administrative data systems. Coverage                 eight nutrition-related outcomes: low birth
            data on immunization and micronutrients                  weight, stunting, underweight, wasting, childhood
            are embedded in most of the data systems;                overweight, and anemia among children,
            there are, however, limited options for                  adolescents, and women of reproductive age
            tracking progress on the coverage of                     (WRA). In addition, India is a signatory to the
            interventions related to infant and young child
                                                                     nutrition-related SDGs, which include targets for
            feeding counseling and the care of severely
                                                                     reducing the emerging challenges of overweight
            undernourished children.
                                                                     and non-communicable diseases; indicators on
  5.   Data availability on immediate and underlying                 these need to be tracked as well.
       determinants of malnutrition.
                                                                     Outcome indicators are covered in most surveys.
       To achieve the nutrition outcomes under POSHAN                The National Family Health Survey (NFHS) is a
       Abhiyaan, several immediate and underlying                    strong data system for tracking progress on all
       determinants, including nutrition-related behaviors,          outcome indicators, except on anemia among
       need to be improved.
                                                                     adolescents at different levels. Interim data
       1.   Research shows that child undernutrition is              collection efforts (third-party surveys, etc.) could
            caused by inadequacies in food, health and               be useful for tracking the impact on outcomes
            care for infants and young children, especially          in high-burden districts or in sentinel sites which
            in the first two years of life (immediate                are chosen to represent specific areas of concern
            determinants). Mothers’ and infants’ access to           or action. Given both measurement challenges
            nutrition-specific interventions can influence
                                                                     and denominator challenges for outcome
            these immediate determinants.
                                                                     indicators in administrative data systems,
       2.   At the household and community level,                    we recommend that survey data should be
            women’s status, household food security,                 prioritized for tracking progress on the outcomes
            hygiene, and socioeconomic conditions                    of POSHAN Abhiyaan.
            further contribute to children’s nutrition
            outcomes (underlying and basic determinants).       RECOMMENDATIONS
            Interventions such as social safety nets,
            sanitation programs, women’s empowerment,           1.   Data prioritization
            and agriculture programs have the potential to           In order to track progress towards POSHAN
            improve nutrition by addressing the underlying           Abhiyaan goals and targets, a set of core indicators
            and basic determinants.                                  across the life cycle should be prioritized for
       The POSHAN Abhiyaan framework recognizes                      monitoring the progress, diagnosis, and action in
       most of these determinants explicitly and others              both population-based surveys and administrative
       implicitly. Data on immediate determinants are                data systems; these core indicators should be
       available from diverse sources, but data are                  reviewed at national, state, and district levels
       especially limited on nutrition-related behaviors.            across the existing review mechanisms.

viii
2.   Promote data use                                            POSHAN Abhiyaan monitoring and strategic review
                                                                 meetings at all levels (national, state, district).
     There is a need to create a strong culture of data
     appreciation and data use among actors across          6.   Monitoring progress on outcomes
     the nutrition space. To promote awareness around
                                                                 Using population-based survey data for progress
     available data sources and their use, we need to
                                                                 tracking ensures that all nutrition target indicators
     ensure that all data users are aware of the design
                                                                 are covered; efforts to improve the quality of
     elements, challenges, and opportunities of each             data on nutrition outcomes from administrative
     type of data source; to this end, guidance on               systems for program use should be supported but
     different types of data sources and their use needs         we discourage the use of data from administrative
     to be developed.                                            systems to track population-level progress on
3.   Follow the theory of change, program and                    outcomes.
     biological temporality
                                                            7.   Data stewardship
     We recommend that early progress tracking for
                                                                 A primary data stewardship entity such as NITI
     the nutrition mission should focus on system                Aayog should work in combination with related
     preparedness and readiness; in the second year,             state-level entities in order to ensure coordinated
     the focus should be on assessing coverage;                  monitoring of progress, strategy refinement, and
     and only in later years should the focus turn to            support in the use of data for program refinement.
     assessing coverage and changes in determinants              This entity must provide guidance on the use of
     and outcomes that are relevant to the program               data to all major committees and review platforms.
     roll-out. Impacts on outcomes such as stunting
     should only be explored once changes are seen in       CONCLUSIONS
     coverage, immediate and underlying determinants.
                                                            Tracking India’s progress on malnutrition at the
4.   Tracking progress on inputs and intervention           national, state and district levels using timely, relevant
     coverage                                               and high quality data is an achievable goal but it will
                                                            require key investments at different points along the
     Multiple data sources for input and coverage
                                                            nutrition data value chain. Together, these investments
     indicators means that a careful reconciliation of
                                                            can strengthen the strategic use of data in ways that
     findings from survey data and administrative data
                                                            improve the reach and impact of India’s mission to
     systems is required. Strengthening interoperability    address malnutrition.
     of nutrition data across data systems could also
     help to resolve issues with coverage indicators
     and support decisionmaking. Finally, it is also
     recommended that data use cases should be
     developed for survey and administrative data on
     intervention coverage.

5.   Monitoring progress on determinants

     It is recommended that population-based survey
     data be used both for progress tracking and
     diagnostic exercises to decide on which immediate
     and underlying determinants, including nutrition
     behaviors, are major challenge areas for the region.
     It is important to include implementers and sectors
     that are addressing underlying determinants such
     as poverty, food security, sanitation and gender in

                                                                                                                         ix
1. Introduction

The key elements of a data system for nutrition include:       2.   What types of data sources can be used?
(1) data sources, including survey data, administrative
                                                               3.   With what frequency should progress on different
data, and implementation research; (2) systems and
                                                                    indicator domains be assessed?
processes for data use; and (3) data stewardship across
a nutrition data value chain. The nutrition data value         This document focuses on these questions and does
chain includes elements of prioritization of indicators,       the following.
data collection, curation, analysis, translation to policy     1.   To address the question of what to measure, it
and program recommendations, and evidence-based                     proposes a comprehensive framework of indicators
decisions. Finding the right fit for nutrition information          that is based on relevant nutrition conceptual
systems is important and there should be neither much               frameworks, the POSHAN Abhiyaan administrative
nor too little data; finding the right fit for a data system        framework and a theory of change for POSHAN
that works for multiple decisionmakers is an even                   Abhiyaan.
bigger challenge.
                                                               2.   To answer what data sources to use, it draws on a
Developed together with NITI Aayog—which is                         review of data availability for the set of indicators
primarily responsible for monitoring POSHAN Abhiyaan,               and indicator domains included in the framework.
India’s National Nutrition Mission launched in early
                                                               3.   To address the question of with what frequency
2018—this document lays out issues to consider in
                                                                    progress on different indicator domains should
strengthening efforts to improve the availability and
                                                                    be addressed, it draws on the nutrition evaluation
use of data. This “approach paper” provides guidance
                                                                    literature and on the potential theory of change for
that can be used by national-, state-, and district-level
                                                                    POSHAN Abhiyaan.
stakeholders on issues that should be considered
with regard to the use of data to track progress on
                                                               INDIA’S POLICY FRAMEWORK FOR NUTRITION:
nutrition interventions, immediate and underlying
                                                               FROM INPUTS TO IMPACT
determinants, and outcomes. It aims to serve POSHAN
Abhiyaan, the government’s flagship initiative, but is         POSHAN Abhiyaan aims to reduce stunting, anemia,
also applicable to a range of other efforts to improve         and low birth weight across high malnutrition burden
nutrition. It specifically examines the availability of data   districts. It recognizes the need for convergence and
from both population-based surveys and administrative          coordination such that the benefits of government
data systems in the context of POSHAN Abhiyaan’s               schemes and programs reach women and children in
                                                               the first 1,000 days. The Abhiyaan aims to improve
intervention framework. In addition, it lays out issues to
                                                               service delivery and interventions using technology,
be considered in strengthening efforts to improve the
                                                               behavioral change, and convergence.
use of data in the context of POSHAN Abhiyaan, and
makes key recommendations related to improving data            POSHAN Abhiyaan builds on a robust policy framework
availability and improving the use of currently available      for nutrition that covers most evidence-based
data.                                                          interventions (Vir et al. 2013); it also has large-scale
                                                               national program platforms in place (Integrated
To improve nutrition monitoring and strengthen data
                                                               Child Development Services and the National Health
use, it is useful to ask and address the following
                                                               Mission) whose mandate is to deliver diverse nutrition
questions:
                                                               interventions (Avula et al. 2013). The National Nutrition
1.   What types of indicators should be used, and for          Strategy (NITI Aayog 2017) and POSHAN Abhiyaan
     what purpose?                                             now provide an updated strategic framework for

                                                                                                                            1
action to improve nutritional outcomes for children,               convergence-related actions will help to address
pregnant women, and lactating mothers. The POSHAN                  the underlying challenges of gender, sanitation,
Abhiyaan’s mission-mode approach provides an                       and poverty.
impetus to strengthen not only the implementation but
                                                              3.   Finally, the theory of change assumes that
also the monitoring and measurement of progress.
                                                                   changing these determinants will in turn lead to
The POSHAN Abhiyaan framework also lays out                        improved outcomes on POSHAN Abhiyaan targets
determinants of nutritional outcomes that are                      including child growth and anemia.
targeted by various interventions, schemes and
programs included in the overall framework. These             ASSUMPTIONS IN THE THEORY OF CHANGE
include maternal nutrition, newborn care practices,           Some key assumptions in the overall theory of change
and infant feeding, as well as care practices, and            are related to:
underlying determinants, such as age at marriage and
childbearing, and sanitation. And finally, it articulates a   1.   Improving capacities of frontline workers:
clear set of targeted outcomes.                                    Through Incremental Learning Approach (ILA)
                                                                   training, is it assumed that there will be an
From the perspective of developing a comprehensive                 improvement in the quality of public sector
framework of indicators, the conceptual framing of                 health and nutrition services and an enhanced
interventions leading to determinants which then lead              capacity for supporting the delivery of high impact
to improved outcomes is central to what is proposed                interventions such as counseling and growth
in this document. This theory of change for POSHAN                 monitoring.
Abhiyaan and the linked interventions and programs
                                                              2.   Use of technology: The assumption is that
are, therefore, used to define the full set of indicators
                                                                   technology adoption by frontline workers,
and indicator domains in this approach paper.
                                                                   including the use of smartphones, dashboards, and
                                                                   other features of the technology, will lead to better
THEORY OF CHANGE FOR POSHAN ABHIYAAN                               coverage and quality of service delivery.
The theory of change for POSHAN Abhiyaan outcomes
                                                              3.   Cross-sectoral convergence actions: The
is based on several assumptions that map to the
                                                                   assumption is that establishing convergence
key components of POSHAN Abhiyaan: improving
                                                                   committees at the state, district, and block
capacities, using technology, the convergence
                                                                   levels will facilitate decentralized and convergent
of multiple programs, and behavior change
                                                                   planning, implementation, and review of actions
communications. (Details on assumptions related to
                                                                   at the community level; this, in turn, assumes that
specific components are given in Figure 1)
                                                                   convergent planning activities can bring together the
1.   It assumes that core components related to                    actions of different sectors to address determinants
     technology, capacity building, and social and                 of undernutrition at the household level.
     behavior change will trigger a series of changes         4.   Social and behavior change communication
     that will improve the availability and quality of             (SBCC): It is assumed that SBCC actions, especially
     nutrition interventions in the ICDS and health                Jan Andolan related activities such as community-
     system. It also assumes that the multisectoral                based events and mass media, will lead to improved
     convergence component will induce collective                  knowledge, motivation, and skills, and that
     action in multiple sectors.                                   households will adopt behaviors to achieve impact.
2.   It assumes that putting these interventions in place     5.   Linked to this, there is an overarching assumption
     will address both the immediate and underlying                that, especially at the district level, delivering
     determinants of poor nutritional outcomes; these              all these components together, will lead to an
     include behaviors such as dietary practices for               improvement in the reach, quality, and intensity
     women and children, the use of micronutrient                  of high impact nutrition-specific interventions in
     supplements and food supplements, and sanitation              the first 1,000 days of life and other interventions
     practices. It also assumes that multisectoral                 addressing underlying drivers.

2
Figure 1: Potential theory of change for POSHAN Abhiyaan

                                      Improved availability
                                                                          Improvements in
         POSHAN Abhiyaan                of, and access to,
                                                                           determinants of
             actions                   POSHAN Abhiyaan
                                                                            undernutrition
                                          interventions

     • Train Integrated Child      • Improved public sector           • Better diets during
       Development Services           and antental care (ANC)           pregnancy
       (ICDS) workers in service      services and nutrition          • More IFA and calcium
       delivery using an              interventions                     during pregnancy
       Incremental Learning           (counseling, weight gain
                                                                      • Better breastfeeding
       Approach (ILA)                 monitoring, iron and
                                      folic acid [IFA], calcium)      • More postnatal care
     • Train ICDS workers in
       use of technology and       • Private sector ANC               • Better complementary
       ensure availability and                                          feeding
                                   • Improved ICDS services
       functioning of                 (SNP, growth                    • Higher consumption of
       technology                     monitoring, home visits)          micronutrient
     • Address other ICDS                                               supplements
                                   • Micronutrient
       challenge areas,               supplements for                 • Consumption of
       including the                                                    fortified food                  • Better child
                                      children at Village
       Supplementry Nutrition                                                                            growth
                                      Health, Sanitation and          • Improved handwashing
       Program (SNP)                  Nutrition Days (VHSNDs)                                          • Better
                                                                      • Improved use of toilets
     • Activities to strengthen                                                                          hemoglobin
                                   • More frequent and
       health ICDS                    better community-based                                           • Low birth
       convergence                    events                                                             weight
       (team-based incentives,
                                    • Mass media campaigns
       joint planning, etc.)
                                    • Sanitation information
     • Convergent actions -
                                      and subsidies
       sectors identify key
       actions and put in the       • Mahatma Gandhi
       place mechanisms to            National Rural
       implement, review,             Employment Guarantee
       monitor                        Act (MGNREGA)
     • Social and behavior
       change communication
       (SBCC)/Jan Andolan
       activities - materials,
       messages, planning and
       support for
       community-based
       events

6.    It is assumed that these will lead to improvements           interventions at critical biological periods, there will
      in household practices, such as dietary diversity,           be improvements in nutritional outcomes.
      care during pregnancy and early childhood,
      and household conditions including improved             ADDRESSING TEMPORALITY IN THE THEORY OF
      sanitation.                                             CHANGE
7.    Finally, an ultimate assumption around the              In addition to the considerations above, there are two
      biological theory of change is that over                major issues related to temporality that should be
      time, for women and children exposed to these           considered in assessing which indicators to monitor

                                                                                                                          3
at what time. The first is biological and the second is     2.   The level of hemoglobin, which is used to assess
programmatic.                                                    the population prevalence of anemia, can improve
                                                                 in short periods of time—months rather than
From a biological perspective, each nutritional
                                                                 years—because the red blood cells that carry
outcome as specified in POSHAN Abhiyaan takes a
                                                                 hemoglobin are formed continuously in the body
different amount of time to respond to interventions;            and have a short life cycle. If interventions to
this temporal variability in the biological response of          address all major causes of low hemoglobin (iron,
different outcomes has implications for how to think             B vitamins, intestinal worms, and inflammation)
about monitoring.                                                are put into place, then the impact on anemia
                                                                 outcomes can be seen within a much shorter
Below, we offer two examples:
                                                                 timeframe than interventions that address
1.   Child linear growth, which is used to assess                outcomes such as child growth.
     the prevalence of population-level stunting, is
                                                            From a programmatic perspective, systems
     a process that begins in utero and continues
                                                            strengthening efforts can take time, especially to
     throughout childhood. For children under the
                                                            deploy interventions at scale. Each of the core pillars of
     age of five years, it is well established that peak    POSHAN Abhiyaan—capacity building, technological
     responsiveness to interventions occurs in the          interventions, convergence planning and action, and
     first 1,000 days. This means that for a woman          social and behavior change interventions—takes
     who entered her pregnancy in the first month of        time to design, develop, deploy at scale, strengthen,
     POSHAN Abhiyaan’s launch (April 2018), the full        and sustain. This has implications for what should be
     impact of all interventions delivered to her and her   monitored at what point in the Mission. We suggest
     child in the first 1,000 days should be assessed       that in its first year, the Mission should focus on
     only in January 2021. Furthermore, if the systems      monitoring preparedness and readiness; in the second
     are not fully ready to deliver all interventions in    year it should be on assessing coverage; and in later
     the first 1,000 days to all women and children,        years the focus should be on assessing both coverage
     then their full impact on child growth can only be     and changes in determinants and outcomes that are
     assessed in later years. Full impacts should only      relevant to the program roll-out.
     be assessed among children born to women who           Hence, paying attention to both biological and
     entered the 1,000 days period when all major           programmatic issues related to temporality is central to
     interventions were fully in place.                     the pragmatic tracking of progress.

4
2. Mechanisms and Data Systems to
    Monitor Progress on Nutrition Actions
    and Outcomes

Effective monitoring needs mechanisms and data to                most senior principal secretary, who is nominated
enable informed decisions. Below we have summarized              by the chief secretary—is expected to facilitate
several review and monitoring mechanisms that are                sectoral departments to create their action plans;
available in POSHAN Abhiyaan to track progress.                  this includes monitoring of interventions under
                                                                 POSHAN Abhiyaan. There is no guidance in the
EXISTING NUTRITION MONITORING                                    public domain as to what should be monitored by
MECHANISMS UNDER POSHAN ABHIYAAN                                 the states.
To support effective monitoring of POSHAN Abhiyaan          3.   District administrators are required to monitor
activities and outcomes, various institutional                   progress at that level through a quarterly review
mechanisms have been set up at the national, state,              meeting; meetings are convened by the district
and district levels.                                             collector, who is expected to use a set of indicators
1.   A national council has been established under               across the continuum of care to review the data
     the vice chair of NITI Aayog, and an executive              available from programs like the ICDS, the National
     committee has been set up which is chaired by               Health Mission (NHM), and other sectors. Data for
     the secretary of the Ministry of Women and                  the quarterly reviews is to be provided by frontline
     Child Development. Both these committees have               workers, cross-checked at the block level, and
     representation from all the aligned line ministries,        validated by a district validation committee. Other
     partners, selected states, and districts; they are          mechanisms include reviews by sectoral officials,
     scheduled to meet every three months and a                  block dashboards (ICDS–CAS), the Jan Andolan
     progress report is to be submitted to the prime             dashboard, the Swachh Bharat dashboards,
     minister every six months. NITI Aayog, which is the         and data from third-party surveys such as the
     Government of India’s policy think tank, provides           Aspirational Districts Programme Survey.
     oversight of monitoring and evaluation activities.
     A technical support unit (TSU) and a monitoring        EXISTING DATA SYSTEMS TO SUPPORT DATA
     and data analytics cell have been established at       USE FOR NUTRITION
     NITI Aayog to periodically assess progress and         In India, data on intervention coverage, determinants,
     impacts; also, formal partnerships with technical      and nutrition outcomes is available from both
     experts (Tata Trusts, Harvard University, IFPRI,       population-based household surveys and administrative
     IDinsight) support monitoring and data analytics.      data systems.
     Partnerships with district-level support partners
                                                            Population-based household surveys include
     such as Tata Trusts and the Piramal Foundation
                                                            the National Family Health Survey (NFHS), the
     strengthen the use of data.
                                                            Comprehensive National Nutrition Survey (CNNS), and
2.   State Project Management Units (SPMUs) are             surveys conducted under the Aspirational Districts
     expected to function as State Nutrition Resource       Programme by third-party organizations such as
     Centres, monitoring activities and providing           IDinsight and the Tata Trusts. Table 1 summarizes
     direction for effective program implementation.        some key features of these surveys, and highlights
     A state convergence committee—headed by the            the differences in geographic representativeness,

                                                                                                                         5
temporality, frequency, and data availability.                                                    nutrition. In India, these include the data systems from
Population-based surveys need to ensure the availability                                          ICDS and the NHM for nutrition-specific interventions,
of data on relevant indicators in order to assess the                                             and from other systems such as the Swachh
coverage of interventions, key determinants, and levels                                           Bharat Mission for sanitation, which can support
of outcome. This data, obtained in given timeframes                                               improvements in underlying determinants of nutrition.
and with geographic representativeness, can be used                                               Table 2 summarizes the key features of different
to support appropriate decisions.                                                                 administrative monitoring information systems. These
                                                                                                  administrative systems should generate data around
Administrative data systems include data from the
                                                                                                  common administrative boundaries such as blocks,
core ministries and departments that deliver public
                                                                                                  districts, and supervisory service areas, and should
services for health and nutrition. These also support
                                                                                                  support effective reviews and action.
improvements in the underlying determinants of

    Table 1: Summary of major population-based surveys on nutrition in India (1992–2019)

      Survey name            Survey rounds                 Geographic scope                    Frequency              Data availability                               Comparability

                                                                                                                                                             anthropometry
                                                                                                                                                             group for child
                                                                                                                     and full report
                                                                             representative
                                                                             Level at which

                                                                                                    Time between

                                                                                                                     Time between
                                                                                                    survey rounds

                                                                                                                                          Access to data
                                                                                                                     end of survey

                                                                                                                                                                                   Target group
                                                                             the survey is

                                                                                                                                                                                   respondents
                                                            Geographic

                                                                                                                                                                                   of women
                                                                                                                                                             Reference
                                                            coverage

                                NFHS 1                All India—24          National                                2 years            DHS                 < 4 years           Ever-married
                                (1992—1993)           states and            State                                   (1995)             website                                 women age
                                                      Delhi National                                                                                                           13—49 years
                                                      Capital
                                                      Region (NCR)

                                NFHS 2                All India— 25                            6 years              1 year                                 < 3 years           Ever-married
     National Family            (1998—1999)           states                                                        (2000)                                                     women age
     Health Surveys                                                                                                                                                            15—49 years
     (NFHS)
                                NFHS 3                All India— 29                            7 years              1 year                                 < 5 years           All women age
                                (2005—2006)           states                                                        (2007)                                                     15—49 years

                                NFHS 4                All India—29          National           > 9 years            1 year                                 < 5 years           All women age
                                (2015—2016)           states and            State                                   (2017)                                                     15—49 years
                                                      6 union               District
                                                      territories

     Comprehensive              CNNS                  All India— 30         National           NA                   Published          NHM                 0–4 years           All women age
     National                   (2017–2018)           states                State                                                      website                                 15—19 years
                                                                                                                                                           5–9 years
     Nutrition
     Survey (CNNS)                                                                                                                                         10–14 years

                                Round 1               27 districts          District           6 months             Unknown            On                  < 5 years           Pregnant
                                (May–Aug              (IDinsight)                                                                      request                                 women,
                                2018)                                                                                                                                          mothers of
                                                      85 districts
     Aspirational                                                                                                                                                              children < 5
     Districts                                        (Tata Trusts)                                                                                                            years
     Programme                  Round 2               27 districts          District           6 months             Unknown            On                  < 5 years           Pregnant
     (ADP) Surveys1             (Jan–Feb 2019)        (IDinsight)                                                                      request                                 women,
                                                                                                                                                                               mothers of
                                                      85 districts
                                                                                                                                                                               children < 5
                                                      (Tata Trusts)                                                                                                            years

    Note: 1The Aspirational Districts Programme Surveys are ongoing; NHM = National Health Mission; DHS = Demographic Health Survey.
    Source: NFHS Rounds 1, 2, 3 and 4; CNNS 2017-18; ADP Survey by IDinsight (Rounds 1 & 2).

6
Box 1: Broad issues to consider while using and interpreting data from different data sources

  • Survey design elements such as sampling, questionnaire design, and questions that were used to create the
    indicators, can differ for population-based surveys; this has implications for interpretation.

  • Population coverage can differ across data sources. Sample surveys intend to cover the entire population
    whereas monitoring information systems (MIS) data are limited to those who access government services; also,
    denominators in MIS data may need to be updated, for example estimates of pregnant women in a district.

  • Reference periods can also differ; survey questions, for example, often ask for different reference periods than
    what is reported in MIS data.

  • Administrative data entered by frontline workers may have several biases, both random and systematic, that
    can lead to inaccurate reporting; also, if training and field monitoring are limited, the survey data that is
    obtained can be of poor quality.

  • If the indicators for intervention coverage are missing, it may mean that for some areas the data may be
    unavailable from either surveys or administrative data systems.

Table 2: Summary of key administrative data systems on nutrition in India
    Administrative                      Responsible             Geographic scope                              Access         Web
                                                                                               Frequency
     data system                         ministry                                                             to data        link
                                                         Geographic          Level at which
                                                         coverage            the data is
                                                                             reported

  Health                          Health and Family      All India—29         National        Monthly      Public       www.nrhm-
  Management                      Welfare, National      states and 6         State                                     mis.nic.in
  Information                     Health Mission (NHM)   union territories    District
  Systems (HMIS)

 Integrated Child                 Women and Child        All India—29        National         Monthly      Government   https://icds-
 Development                      Development, ICDS      states and 6        State                                      wcd.nic.in/
 Services Monitoring                                     union territories   District
 Information                                                                 Block
 Systems (ICDS MIS)

 ICDS-CAS                         Women & Child          All India—29        National         Real-time    Government   www.icds-
 dashboard                        Development, ICDS      states and 6        State                                      cas.gov.in/a/
                                                         union territories   District                                   icds-cas/login/
                                                                             Block
                                                                             AWC

 Jan Andolan                      Women & Child          All India—29        National         Real-time    Public       www.poshan
 dashboard                        Development, ICDS      states and 6        State                                      abhiyaan.
                                                         union territories   District                                   gov.in/#/

                                  Health and Family      All India—29        National         Quarterly    Public       www.anemia
 Anemia Mukt                      Welfare, NHM           states and 6        State                                      muktbharat.
 Bharat dashboard                                        union territories   District                                   info/
                                                                                                                        dashboard/#/

 Pradhan Mantri                   Women & Child          All India—29        National         Real-time    Government   https://
 Matru Vandana                    Development, ICDS      states and 6        State                                      pmmvy-cas.
 Yojana (PMMVY)                                          union territories   District                                   nic.in
 dashboard

 Swachh Bharat                    Drinking water and     All India—29        National         Real-time    Public       https://
 Mission dashboard                sanitation             states and 6        State                                      sbm.gov.in/
                                                         union territories   District                                   sbmdashboard/
                                                                             Village

Source: The web links provided in the table above.

                                                                                                                                          7
3. Use of Data in the Context of India’s
    Nutrition Efforts

In India, as noted above, nutrition information is                    POSHAN Abhiyaan actions and on benchmarking
accessed from multiple data sources, including surveys                intervention coverage. Subsequent reports should
and routine administrative data systems. Data can and                 focus on the coverage of nutrition interventions
should be used for tracking progress, reporting and                   and related behaviors.
assessing impact, strategy refinement, and program
                                                                 6.   The impact of the various components of
refinement. These uses vary by levels, including
                                                                      POSHAN Abhiyaan and its linked programs can be
national, state, district, and even subdistrict. For each
                                                                      effectively assessed with the help of well-designed
of these uses, it is critical to ascertain timely availability
                                                                      impact evaluations; impact evaluation procedures
of data and effective uses of available data. Below, we
                                                                      should be planned early, but the impact
lay out key considerations for different data use cases.
                                                                      assessment itself should not be done so early in
                                                                      the implementation that it could underestimate
TRACKING PROGRESS, REPORTING,
                                                                      impact on major outcomes such as anthropometry.
AND ASSESSING IMPACT
1.   Tracking helps to establish priorities and to monitor
                                                                 STRATEGY REFINEMENT
     efforts aimed at achieving targets.
                                                                 1.   The policy community needs timely data to enable
2.   Reliable data to monitor progress must be available              refinement of nutrition strategies.
     in timeframes necessary for reporting.
                                                                 2.   Strategy refinement is needed only periodically
3.   To track progress, data on program inputs and on                 and should be undertaken by a broad range
     coverage of interventions is useful in a short-term              of stakeholders who have the analytic and
     timeframe; data on immediate and underlying                      programmatic experience necessary to develop
     determinants is useful in a medium-term                          effective strategies.
     timeframe; and data on outcomes is useful in a
     long-term timeframe.                                        3.   While considering a strategy, along with assessing
                                                                      which nutrition outcomes and determinants
4.   Data from both administrative systems and                        should be focused on, data on intervention
     surveys can be used to track progress in the                     coverage is also needed to guide refinement. In
     implementation of planned activities and can help
                                                                      states or districts, for example, examining the
     prioritize actions in different geographies and
                                                                      data on intervention coverage can provide clear
     timeframes.
                                                                      insights into which specific interventions should be
5.   Currently, one of the primary reporting                          targeted.
     mechanisms is the report on the progress of
                                                                 4.   A range of data related to nutrition outcomes, the
     POSHAN Abhiyaan that is submitted to the
                                                                      immediate and underlying causes of malnutrition
     Prime Minister’s Office (PMO) every six months
                                                                      and the reach of interventions are vital to an
     by NITI Aayog. This includes tracking progress
                                                                      analysis of the nature of the nutrition challenge, its
     and reporting on actions that are relevant
                                                                      potential determinants, target groups and to the
     to the timeframe of the Mission and to the
                                                                      prioritization of interventions.
     progress anticipated in that time period. The
     first report to the PMO focused on reporting                5.   In POSHAN Abhiyaan, national strategy
     the states’ readiness, while the second report                   development was conducted in the 2017/2018
     focused on reporting the implementation of                       timeframe, prior to the development of the

8
You can also read