Report No: AUS0001183 . India Assam: Improving Nutrition and Development Outcomes in Early Years State Engagement Report . November 2019 . HNP . . . © 2017 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: “World Bank. 2019. India - Assam: Improving Nutrition and Development Outcomes in Early Years. © World Bank.” All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Assam: Improving Nutrition and Development Outcomes in Early Years (P168656) State Engagement Report Ashi Kohli Kathuria, Senior Nutrition Specialist Deepika Anand, Nutrition Specialist THE WORLD BANK November 2019 Contents Acknowledgements……………………………………………………………………….i List of Acronyms…………………………………………………………………………ii 1. Introduction ..................................................................................................................... 1 2. The Context and Rationale for the Technical Assistance ................................................ 2 Nutrition and ECD challenges in India and Assam ................................................................ 2 3. The Technical Assistance Activities and Outcomes ......................................................... 5 Key points of the TA .............................................................................................................. 5 Preparatory activities to initiate the TA................................................................................. 5 TA activities and key outcomes .............................................................................................. 6 4. Challenges and Learnings .............................................................................................. 18 Challenges .......................................................................................................................... 18 Learnings............................................................................................................................ 18 5. Conclusion ...................................................................................................................... 20 Annexure 1A: Outline of multi-sectoral district level action plan…………..………………….21 Annexure 1B: Multi-sectoral District-level action plan (detailed)……………………………….…….23 List of Pictures Pic 1: Capacity Building Workshop at District level for SDG cell Officials ……………………8 Pic 2: Policy Seminars ………………………………………………………………………………..13 Pic 3: State and District Level Consultations (Goalpara and Barpeta) ……………………….14 Pic 4: Joint Training of AAA’s (ASHA-AWW-ANM) ……………………………………..……….15 Pic 5: Glimpses from Eat Right Mela, Barpeta ……………………………………………………16 List of Figures Fig 1: Comparison of nutrition indicators….. ……………………………………...……………... 3 Fig 2: Comparison of IYCF indicators …… ……………………………………...…………………3 Fig 3: Summary of NLTA activities and outcomes and engagement of stakeholders ….…….….7 List of Boxes Box 1: Two key outcomes of the learning visit ……………………………………………………….9 Box 2: Best Practices drawn from Tamil Nadu during the learning visit …………………….…9 Box 3: Key outcomes: Multi-sectoral approaches ………………………………………..…….…11 Box 4: Two key achievements from the policy seminars ………………………………………….12 Box 5: List of Recommendations emerging from Policy Seminars…………….………….….…13 Box6: Prominent decisions taken at district-level consultations ………………………….……14 Box 7: Outcome of training of frontline workers ………………………………………..….……15 Box 8: Outcome of Working Group …………………………………………………….…….……16 Box 9: Social audits ………………………………………………………………………………….19 Acknowledgements The team thanks the Government of Assam for their partnership and support during the course of the design and implementation of this technical assistance (TA). The leadership and guidance of Alok Kumar, Chief Secretary, Government of Assam, Rajiv Bora, Additional Chief Secretary, Department of Transformation and Development, and Dr. John Ekka has been valuable. We are grateful to R.M. Dubey, Head and Professor, Centre for Sustainable Development Goals (CSDG) for anchoring the TA activities, mobilizing stakeholders including district leaders and teams, and in ensuring timely and successful completion of the TA activities. We gratefully acknowledge the key role played by the Government of Assam’s departments of Women and Child Development, Health and Family Welfare, Education, Water and Sanitation, Social Welfare, Food, Civil Supplies and Consumer Affairs, Agriculture and Panchayat and Rural Development and their representatives in the districts of Barpeta, Udalguri and Goalpara to support multi-sectoral planning and convergence. We thank the Coalition for Food and Nutrition Security (CFNS), in particular A. R. Nanda, Bhaskar Baruah and Sujeet Ranjan for their technical support in implementation of the TA activities. We acknowledge the support of Manish Sabharwal and Shubhankar Nath in the development of the online dashboard requested by the Government of Assam. This work has received core financial support from the SAFANSI Trust Fund. We are thankful to the peer reviewers, Deepika Eranjanie Attygalle (Senior Health Specialist, HSAHN), Ziauddin Hyder (Senior Health Specialist, HEAHN) and Emanuela Galasso (Senior Economist, DECPI) for reviewing the draft report and providing valuable inputs to strengthen the report. i List of Acronyms ACS Additional Chief Secretary ASA Advisory Services and Analytics ASHA Accredited Social Health Activist ASRLM Assam State Rural Livelihood Mission ATMA Agricultural Technology Management Agency AWC Anganwadi Centres AWW Anganwadi Worker ANM Auxiliary Nurse Midwife CFNS Coalition for Food and Nutrition Security CSDG Centre for Sustainable Development Goals CSR Corporate Social Responsibility ECD Early Childhood Development FSSAI Food Safety and Standards Authority of India ICDS Integrated Child Development Services ICT Information and Communication Technology IFA Iron Folic Acid IMR Infant Mortality Rate IPC Inter-Personal Counselling IYCF Infant and Young Child Feeding KPIs Key Performance Indicators MGNREGA Mahatma Gandhi National Rural Employment Guarantee Act MoU Memorandum of Understanding NCS National Crèches Scheme NCT Government of The National Capital Territory NFHS National Family Health Survey NIPCCD National Institute of Public Cooperation and Child Development NITI National Institute for Transforming India NLTA Non-lending Technical Assistance NRC Nutrition Rehabilitation Centres PDS Public Distribution System ii PHED Public Health Engineering Department PW Pregnant Women SAM Severely Acute Malnourished SBA Skilled Birth Attendant SDGs Sustainable Development Goals SHG Self-Help Group SHSI Single Holistic Synergized Initiative SIHFW State Institute of Health and Family Welfare T&D Transformation and Development TA Technical Assistance THR Take Home Ration UNDP United Nations Development Program UNICEF The United Nations Children's Fund VHAI Voluntary Health Association of India VHSND Village Health Sanitation and Nutrition Day VO Village Organization WASH Water, Sanitation and Hygiene WHO World Health Organisation YM Young Mothers iii 1. Introduction This report describes the World Bank’s technical assistance (TA) engagement with the Government of Assam during September 2018 to September 2019. The technical assistance was provided in response to a request from the Government of Assam and supported the Government of Assam, in particular the Center for Sustainable Development Goals (CSDG), under the state’s department of Transformation and Development (T&D). The broad objective of the TA was to support the state to adopt, effectively implement and monitor multi-sectoral approaches to strengthen policies, institutions and programs to improve nutrition and early childhood development outcomes in the state. The TA activities supported activities at the state level and in the three of Assam’s seven aspirational districts1, Barpeta, Udalgudi and Goalpara, selected for the TA in consultation with the Government of Assam the Government of Assam. These were designed to specifically contribute to the four key areas of support requested by: i) enhance institutional and human capacity of CSDG at the state level and in its district cells; ii) develop and operationalize multi- sectoral result-based approaches; iii) promote knowledge creation and sharing to improve program effectiveness; and iv) strengthen program management information system and monitoring across sectors. All activities were undertaken with the active engagement of multiple stakeholders that included besides the CSDG, representatives of the Coalition for Food and Nutirtion Security (CFNS), the technical agency appointed by the World Bank: several Government departments such as T&D, Health, Social Welfare, Agriculture, P&RD, Water & Sanitation, Education; development partners; media; independent technical experts and agencies; academia; training organizations; and at the district level engaged district and sub-district officials from various departments; development partners working in the district and frontline workers The engagement with the Government of Assam was one of the three strategic state engagements for multi-sectoral investments in the Early Years, undertaken under the Programmatic Advisory Services and Analytics (ASA), Investing in Early Years: Toward Realizing the Potential of India's Children and was funded through the SAFANSI Trust Fund. The report is structured into four sections. Following this Introduction is a section that provides the context and rationale of the TA, including the situation of key health and nutrition indicators in the state as well as in the three aspirational districts. The third section outlines the key points of the TA – its objectives, activities, outputs and outcomes. The fourth and final section discusses the key learnings from this engagement. 1 Under the ‘Transformation of Aspirational Districts’ Program anchored by NITI Aayog, 115 districts from across 28 states have been identified as ‘Aspirational Districts’. The Program ranks districts based on a composite index comprising of health, nutrition, education, basic infrastructure and poverty. The districts which have shown relatively less progress across different sectors and thus, require focused policy attention – are termed as aspirational districts. 1 2. The Context and Rationale for the Technical Assistance 2.1. Nutrition and Early Childhood Development (ECD) challenges in India and Assam 2.1.1. Although India has shown progress in improving child nutrition, the undernutrition burden in the country remains high. One-fourth of India’s children are born with low birth weight, 35.7 percent of children under five are underweight, 38.4 percent are stunted and 21 percent are wasted. Iron deficiency is wide spread, exists across income quintiles and age groups as over 53 percent of women of child bearing and over 58 percent of children under five are anemic (National Family Health Survey, 2015-16). 2.1.2. Assam is amongst the bottom five states of the country in terms of health and nutrition indicators. The following paragraphs indicate the status of key health and nutrition indicators, underscoring the need for engagement to improve nutrition outcomes in the state: o High undernutrition levels including micronutrient deficiencies - around 37 percent of under-five children are stunted (low height/age ratio), 17 percent are wasted (low weight/height ratio) and around 30 percent are underweight (low weight/age) (Fig 1). Although the figures are better than national average but Assam should strive for improved outcomes especially in terms of stunting and underweight. U5 in all the figures refer to under 5 years of age. More than 35 percent of children aged 6-59 months are anaemic; 46 percent of women in the reproductive age group and 25.4 percent in men are anaemic in the state; o Coverage of health and nutrition remains low. For example, data from the National Family Health Survey 4 (NFHS 4) presented in figure 2 indicates that only around 50 percent of children below five years of age received the due vitamin A doses, and 47 percent were fully immunized; less than 50 percent of pregnant woman received the recommended four antenatal check-ups o Household behaviours and practices critical for health and nutrition are sub-optimal. For example, merely 8.9 percent of children (6-23 months) in the state receive an adequate diet (Inadequate complementary feeding during the weaning period is thought to be a significant contributor to child malnutrition in India); only around 30 percent of pregnant women consumed Iron Folic Acid (IFA) tablets during pregnancy; less than 50 percent of the households have access to improved sanitation facilities (NFHS-4) (Fig 2). 2 2.1.3. The three aspirational districts selected for the TA are amongst the lowest ranking districts of the state in terms of human development and infrastructure and are prioritized for focussed policy and program action across sectors. During the review of the TA for approval, NITI Ayog had urged that the TA also include a few aspirational districts. Assam has seven of the 115 aspirational districts identified by NITI based on a composite index comprising of health, nutrition, education, basic infrastructure and poverty. Of the seven aspirational districts in Assam, in consultation with the Government of Assam, the districts of Barpeta, Udalguri, and Goalpara were selected for district level support. All three districts rank amongst the bottom ten districts of the state for stunting; Goalpara has the highest prevalence of underweight in children in the state and Udalguri has the highest percentage of anemic women and children. Figures 1 and 2 show the nutrition indicators and the status of antenatal care and recommended infant and young child feeding (IYCF) practices in these districts. The situation calls for concerted action across sectors to improve nutrition and health outcomes. Figure 1: Nutrition Indicators in the three selected 70 aspirational districts 60 54.8 50 49.7 42.7 39.7 39.5 39.1 41.7 40 36 35.5 30.2 31.8 33.1 30 22.1 18.3 16.6 20 10 0 Anaemia Anaemia Underweight Wasting Stunting (children) (women) Udalguri Goalpara Barpeta Assam India Figure 2: Antenatal Care and IYCF Indicators in the three 90 80.5 districts selected aspirational 80.5 80 72.2 71.2 68 70.3 70 59.6 56.7 60 51.9 50 40 31.6 29.9 30 18.6 20 12.7 9.7 10 3 0 IFA consumption Institutional births Breastfeeding Exclusive Adequate Diet (6- >100 days within 1 hour of Breastfeeding 12 months) birth Udalguri Goalpara Barpeta Assam India 3 2.1.4. The policy and program environment in Assam indicates high commitment to accelerating progress towards the SDGs. Assam has embraced the SDGs and is the first state in India to have applied the framework of the Global Sustainable Development Agenda 2030 as a guide for the long-term development strategy and plan for the State. The document articulates the focus on people’s engagement, partnerships and innovation, adopting the “whole of government" approach – ensuring that all government agencies work in an interconnected way toward the SDGs. Strategies also include: (i) re-orienting, re-aligning and re-prioritizing existing programs; (ii) Integrating, synergizing and re-energizing the different components of SDGs; and (iii) re-defining the structures, retooling the processes and rejuvenate the people. Assam has also established the Centre for SDGs, a knowledge hub for Single Holistic Synergized Initiative (SHSI), that, inter alia, will use knowledge/tools for strategizing, planning and implementation to move the state towards meeting the SDGs has also been setup. The state also has plans to setup district level SDG cell and a robust technology platform for tracking the progress pertaining to the SDGs. 2.1.5. Nutrition and ECD remain high priorities for the state Government and the request for technical assistance from the Bank specifically requested support for is committed to improve the indicators in the state. As mentioned, the Government of Assam has committed itself to meeting the Sustainable Development Goals (SDGs) in the state, as also to transform the state's food security and nutrition landscape, especially for the vulnerable groups. In February 2016, the Government of Assam released its vision document, Assam 2030 and in October 2016, the Strategic Plan document. In consonance to the vision document, the Assam Government has finalized the ‘Assam Agenda 2030 – Strategies and Actions for Achieving the Sustainable Development Goals.’ 4 3. The Technical Assistance Objectives, Activities and Outcomes 3.1. Key points of the TA 3.1.1. The TA objectives were aligned to support the state’s priority of bringing SDGs into the state’s policy discourse and accelerate progress towards the SDGs. The TA aimed to support the Government of Assam, in particular the Government of Assam’s Center for Sustainable Development Goals (CSDG) to adopt, effectively implement and monitor multi- sectoral approaches for better policies, institutions and programs to improve early childhood development outcomes in the state, particularly nutrition and health Build the capacity of state to enhance its focus on nutrition as a human development issue. Specifically, it aimed to: i) enhance institutional and human capacity of CSDG at the state level and in its district cells to accelerate progress towards the SDGs, especially those contributing to improved child nutrition and health; ii) develop and operationalize multi-sectoral result-based approaches; iii) promote knowledge creation and sharing to improve program effectiveness; and iv) strengthen program management information system and monitoring across sectors. The Government of Assam’s TA request focussed largely on nutrition and food security, therefore the TA focussed largely on the health and nutrition aspects of Early Childhood Development. 3.2. Preparatory activities to initiate the TA: 3.1.1 Three key first steps for the TA initiation were valuable in ensuring quality and timely completion of activities and achieving planned outcomes. One, the appointment of a technical assistance agency with presence in Assam; two, the mapping of key stakeholders in the state who could be brought together for advocacy, capacity and awareness building around issues of food and nutrition; and three, the inception workshop that brought all key players together for joint planning and the demonstration of commitment by the senior officials in the state government, including the Chief Secretary. 3.1.2 The appointment of a technical assistance agency by the Bank: The appointment of the Coalition for Food and Nutrition Security (CFNS) as a technical support agency enabled the Bank to provide intensive support to the CSDG on a day-to-day basis. The CFNS, a network established in 2007 brings together the expertise of multi-stakeholders from diverse backgrounds including key Government representatives on its governing board. With experience of high-level advocacy efforts to promote food and nutrition security in India, CFNS is also recognized as an important partner by the Government of Assam. CFNS also had an existing Memorandum of Understanding (MoU) with CSDG, and an established office in Assam. Thus, the selection of a technical agency with on-the-ground presence to provide intensive support required in the Assam context was a strategic decision that served the TA well. 3.1.3 Mapping of key players in the state for nutrition and ECD: A thorough stakeholder mapping exercise was undertaken to map the various stakeholders working in the area of health, nutrition and ECD in Assam. The purpose was to identify the stakeholder and to engage with them on continuous basis for awareness building, advocacy and for other commitment-building activities. Stakeholder mapping was done through three different methodologies namely: (i) 5 secondary research using web portals; (ii) leveraging databases of various networks working in the state; and by (iii) contacting the government departments. The results revealed that although there are more than 60 organizations including non-government organizations and academic institutes working in the field of Public Health Nutrition in Assam but only few such as include UNICEF, Voluntary Health Association of India (VHAI) and Piramal Foundation are predominantly engaged, and interacted minimally with each other. The exercise also brought out that the actors worked in silos, with each focused on delivering its own set of activities. It reiterated the need for better coordination and communication among the nutrition players in the state, and that the CSDG could play a crucial role in bringing all the players together. Further, the results from this exercise helped in engaging with them and leveraging their expertise and to regular engage with them for various activities at state, district and even at the village level. 3.1.4 Inception workshop and joint planning and agreement on activities, expected outputs and outcomes: The inception workshop, chaired by the Chief Secretary, Government of Assam, brought together senior officials from across departments, representatives from the selected aspirational districts, development partners, technical experts, academia, research and training institutions. It offered an excellent opportunity to get inputs from the participants on the key activities for the TA, develop approaches to achieve the TA objectives and seek commitment for working together to support Ass am’s efforts to accelerate progress towards the SDGs. Figure 3 presents the planning framework that lays out the activities, various stakeholders, and the potential for their engagement to achieve expected outputs and outcomes. Proposed Activities Expected Outputs Expected Outcomes • Policy Seminars • Stakeholder mapping and • Consultation Workshops at the landscape analysis • Strengthened CSDG and state and district level • Policy paper on health and District SDG cells in Assam • Working Group meetings nutrition • Multi-sectoral and multi- • Formulation of District SDG • Compendium of multi- stakeholder engagement on Cells sectoral microplans nutrition issues augmented • Capacity Building activities – • Knowledge sharing • Greater knowledge sharing frontline workers, SDG Cell events/activities prioritizing and outreach • Multi-sectoral plans nutrition at local levels • Strengthened Program • Knowledge documents; Monitoring • Social Audits • Knowledge sharing – Eat Right • Social audit reports Mela • Online dashboard for monitoring Key Stakeholders State level: Department: T&D, Health, Social Welfare, Agriculture, P&RD, Water & Sanitation, Education; Centre for SDG; Development Partners; Media; Independent experts, Academia; Training organizations District Level: District and sub-district officials from various departments; Development Partners; Frontline workers Figure 3: Planning Framework: Activities, Outputs and Outcomes es 3.2 TA activities and key outcomes The TA activities and outcomes in each of the four key areas are described below: 6 3.2.1 TA to enhance institutional and human capacity of CSDG at the state level and its district cells. The TA supported the CSDG in setting up and strengthening the SDG cells in the three aspirational districts of Goalpara, Barpeta and Udalguri. Specific terms of reference for district SDGs cell were developed, clearly articulating the objective and role of the cells and were approved by the Additional Chief Secretary (ACS), Transformation and Development Department. The ACS also nominated one official each from Barpeta and Udalguri district as the head of District SDGs cells, and representatives from the Social Welfare Department were nominated as members of these cells. The following activities were undertaken to strengthen the newly created district SDG cells in Assam: • Capacity building for district SDG officials: Recognizing the crucial role of district officials in implementation of activities at the ground level, the project aimed to sensitize and build capacity of the SDG officials at the district level on issues pertaining to health and nutrition, including their capacity to convene and lead the development of multi-sectoral nutrition plans and support their implementation and monitoring. For this, a 5-day capacity building workshop on “Adolescent, maternal and child nutrition” was organised at the National Institute of Public Cooperation and Child Development (NIPCCD), Guwahati. The aim of the training was to sensitize the SDG cell officials on the nutrition of women and children, nutrition schemes and programs in the state, management of children with severe acute malnutrition (SAM), growth monitoring, to name a few. The workshop had a strong practical training component wherein the participants were taken to the anganwadi centres, nutrition rehabilitation centres (NRC) and trained in conducting in-depth interviews with the pregnant and lactating women on their dietary and caring practices. The training helped the district level staff to engage with the authorities and with the communities effectively and to contribute richly to the development and review of multi- sectoral plans. It helped them understand the ground-level issues pertaining to health and nutrition. Pic 1: Capacity Building workshop at district level for SDG cell officials • Learning visit to Tamil Nadu: A learning cross-visit of a team of eleven officials from the CSDG and district SDG cells, and the Government of Assam to Tamil Nadu was supported. The purpose was to expose the officials to the numerous good practices and processes being implemented in Tamil Nadu to improve the nutrition of young children including promotion of recommended IYCF practices. In particular, the visit also provided first-hand experience of some of the evidence-based best practices in the implementation of Integrated Child Development Services (ICDS) program in 7 Tamil Nadu. The best practices obsesrved in Tamil Nadu are outlined in Box 2. These highlight the richness of the exposure and learning that was made possible through the cross-visit. Box 2: Best Practices drawn from Tamil Nadu during the learning visit Functional Area Best Practices Infrastructure Location: Anganwadi Centres (AWCs) are located in a central place of the village near the schools and the block/ panchayat office campus. Buildings: RCC built with high rise plinth with attached kitchen and store room including child friendly toilets with running water. Children’s accessibility with ramps. Tiles fitted floors with fans. Kitchen & Cooking area: Well ventilated with cooking slabs and shelves with separate store rooms alongside the kitchen. Separate utensil washing area with platform and Gas connection to every centre. AWC Interiors: Vibrant interior with colourful walls adorning paintings of nature, animals, fruits and vegetables, alphabets and numbers. Timing of the centres: AWCs time 8 am – 4 pm, AWC also acts as a full day care centre cum crèches for the children Akshya Pathram: Common basket for voluntary donation of fruits and vegetables by community for children. Certification: ISO certified AWCs (128 AWCs i.e. 4 each from 32 district in pilot phase). The AWCs compulsorily to obtain a Food Safety certificate for quality assurance of food. Convergence: Convergence with the education department for pre-school English teaching, F&CS, for fortified foods for supplementary nutrition, Municipal Corporation for water in urban centres, PRIs for community engagement, H &FW for trainings, counselling, education and leadership roles. Partnerships: MP/ MLA LADS funds, Corporate Social Responsibility (CSR) funds, Community contributions for building, paintings and other accessories. Tamil Nadu Civil Supplies Corporation and Tamil Nadu Salt Corporation Implementation are the nodal agencies for supply of Rice, Dhal, Oil and Salt at the doorsteps of the Anganwadi Centres in order to ensure quality and quantity. Production of • 25 Women Industrial Cooperative Weaning food manufacturing society weaning food/ registered under Society Act 1860, under the control of ICDS, TN. Take Home • 1450 women from widows, destitute and deserted women belonging to Ration (THR) by poor families enrolled as members of the society. women • Set up production plant of weaning food for THR cooperative in • Raw materials (wheat) allotted from Public Distribution System (PDS) TN quota. • Catering to all 32 districts. 8 Post the learning visit, the officials presented the key learning to the state Box 1: Two key outcomes of the learning visit: leadership. A significant outcome of the 1. The head of District SDG cells, Senior visit was that the state decided to include Planning Officer, department of Transformation and relevant best practices in the 20,000 new Development committed to including a discussion AWCs planned to be constructed across on the multisectoral nutrition plans in the monthly the state, and to also identify the existing meeting with the District Development AWCs where there could be the Commissioner to ensure regular monitoring of nutritional indicators in the presence of all the key possibility to include some of the best departments and deputy commissioner at district practices. The visit gave first-hand level. experience to the SDG officials on the functioning of AWC and the Poshan 2. The best practices gleaned from the Tamil Abhiyan in the state. It helped them Nadu visit were shared with the state officials and a understand the on-ground challenges, decision was made to incorporate these features into solutions found and how various the 20,000 new AWC that are to be constructed activities/actions can be adapted for their across the state. state. 3.2.2 TA to develop and operationalize multi-sectoral result-based approaches: One of the objectives of the technical assistance was to accord nutrition a priority for the state-level leadership. For this, multiple stakeholders working in the area of nutrition were identified through a stakeholder mapping exercise (please refer to 3.2.3 on pages 5, 6), specifically those from the non-nutrition and health sectors that play an important role in shaping nutrition outcomes were reached out through various means. Following activities were carried out to augment capacity for multisectoral nutrition approaches and actions in the state: • Development and Operationalization of district-level multi-sectoral nutrition action plans: The multisectoral nutrition plans are the planning tools to strategize actions across departments and programs in a comprehensive manner for improving nutrition outcomes for children and mothers, and early childhood development outcomes, thereby contributing to accelerating progress towards SDGs 2 and 3. These are mechanisms to ensure strong nutrition focus through institutional and programmatic convergence. The TA adopted a robust methodology (briefly described below) to develop these plans. This included: (i) Secondary research and review of strategic plans and similar national and international planning documents: With the explicit purpose of not re-inventing the wheel, and to learn from existing frameworks, the CFNS team reviewed several existing frameworks. These included the Poshan Abhiyaan multisectoral district planning framework, relevant indicators from NFHS 4, planning documents like multisectoral district nutrition plan from Dungarpur district, Rajasthan, as well as the Aspirational District Plan for districts, Assam Agenda 2030. (ii) Interviews with relevant district officials from various departments as well as with independent domain experts: The CFNS and CSDG teams visited the three TA districts 9 and met with officials from various departments and with community members to gather insights into the local context and issues pertaining to health, nutrition, food security, water and sanitation, social issues, to name a few. Officials met with included Deputy Commissioner; District Development Commissioner & Senior Planning Officer, District Collector, Chief Executive Officer, Zilla panchayat, district officials from the departments of Social Welfare, Health, Agriculture, Public Health Engineering Department (PHED), Agricultural Technology Management Agency (ATMA), Water and Sanitation, Education, Assam Rural Livelihood Mission, Food & Civil Supplies, and representatives of civil society organizations. (iii)Series of state and district level workshops were held to seek inputs from senior government officials and independent experts on the multisectoral nutrition planning framework. Box 3: Key outcomes: Multi- The final plan developed adopted the lifecycle sectoral approaches approach to address child and maternal malnutrition. It had three parts: 1. Multi-sectoral plans adopted by the State Government Part A: covering essential nutrition interventions and integrated in the National for adolescent girls, pregnant and lactating Nutrition Mission (Poshan mothers, and infants and young children addressing Abhiyan). immediate causes of malnutrition. 2. District SDG cells activated Part B: covering multisectoral interventions that and established functional links address underlying and root causes of malnutrition. with the Department of Social Part C: outlinings cross cutting strategies for Welfare., e.g., to provide regular, system strengthening. periodic progress updates to the department. The complete outline of the plan is provided in Annex 1. Consultation workshops in each of three districts to share the final version of the plan. All concerned departments participated and deliberated on strategies and approaches for the implementation of the plan in the districts. As an outcome, the ACS, Department of Social Welfare, Government of Assam issued an order for integrating the plans in Poshan Abhiyan. Further, the district SDG cells were instructed to include the plans as an important agenda point for their monthly meetings and to update the senior department officials on the progress for the same. 10 • Organization of Policy seminars with multiple stakeholders. A series of policy seminars were organized during the course of the TA. These served to engage various stakeholders including the Government and the non- Government players to discuss the critical issues Box 4: Two key achievements from pertaining to maternal and child nutrition, health the policy seminars and early childhood outcomes in Assam. i. Expansion of mobile creches in tea garden areas to support working A total of six policy seminars were organized with mothers by Social Welfare participation of senior Government officials from Department across departments including Health, Education, ii. Village Health Sanitation and Social Welfare and PHED, as well as from the Nutrition Day (VHSND) - a districts of Goalpara, Barpeta and Udalguri, platform for multisectoral convergence development partners, such as UNICEF and at village level - to be organised on United Nations Development Program (UNDP), the non-working day (Tuesday) in UN Women, Piramal Foundation and other civil tea-garden areas (instead of society organizations. Wednesday) The seminars provided a platform to discuss various issues pertaining to nutrition in the state and provided a number of recommendations to the State Government to improve the health and nutrition outcomes in the state. Key recommendations, inter alia included that Social Audits be mainstreamed in public health programs, model AWCs be constructed in every district, an exercise to map local dietary practices be undertaken, a State Nutrition Resource centre to provide technical guidance to the state on issues pertaining to nutrition be set up. Please see Box 5 for the complete list of recommendation that emerged from the policy seminars. The consolidated recommendations were shared with the senior Additional Chief Secretary, Department of Social Welfare, who committed to adopting the recommendations wherever feasible. The policy seminars were attended by the representatives of multiple departments which helped not only to sensitize them on issues pertaining to health and nutrition but also to discuss and deliberate the ways in which various departments can work together Pic 2: Policy seminars 11 Box 5: List of Recommendations emerging from Policy Seminars 1. Undertake a local food mapping exercise to understand the local dietary practises of various communities especially the tribal population. 2. Promote kitchen gardens to enhance nutritional security at household level (Social Welfare department with support from Self Help group members of Assam State Rural Livelihood Mission and Horticulture department). 3. Social audit of Integrated Child Development Scheme (ICDS) and other food and nutrition schemes should be promoted by the state Government. 4. Learning modules for AWWs, ASHAs to be developed in local languages 5. Solar electrification of AWC and Health sub centres in char areas (area of Brahmaputra river and its tributaries) 6. Mobility of ASHA in char areas to be improved by providing travel support and other incentives 7. Model Anganwadi Centers to be constructed in every district by merging funds from Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), Social Welfare and other sources including CSR, MP/MLA area fund, Panchayat fund, local interested person (NRIs) to act as a good example for other centres to follow. 8. Convergence between Integrated Child Development Scheme (ICDS) and National Crèches Scheme (NCS) to merge anganwadi centres and crèches in the pockets where women are engaged in large numbers, e.g., tea plantations, large civil construction sites 9. For char and flood affected areas, introduce mobile anganwadi centres and crèches. 10. Monitoring of complementary feeding practices at household level by AWWs and ASHAs (currently the Monthly Progress Report (MPR) submitted to Anganwadi supervisor by AWW do not have provision for capturing information related to complementary feeding). 11. Integration of Self Help Groups under Rural Livelihood Mission with ICDS and Panchayati Raj Institution for effective delivery of Nutrition Services at AWCs and household level. 12. Design business models for SHGs members in nutrition domain. 13. Social Welfare department to collaborate with Assam State Rural Livelihood Mission to work on Nutrition, Health, Sanitation and to generate awareness regarding entitlements of schemes and services . 14. To set up a State Nutrition Resource Center attached to some medical college for technical guidance to the State Government on Nutrition 12 • Series of consultation workshops at the State and District level: To launch the TA and bring together senior officials from various departments, districts and other stakeholders a state inception workshop was organized (please refer to 3.2.4, page 6 for details). Similar consultations were organized in each of the Box 6: Prominent decisions taken at three TA districts. These consultation served district-level consultations as forums to understand the specific district- level challenges and issues in implementing i. Udalguri: Nutrition plans to consider the multi-sectoral plans and to deliberate on the special needs of vulnerable areas ways to address them. These helped to build especially tea gardens. consensus around the critical importance of ii. Barpeta: District authorities to review multisectoral plans to strengthen planning, as the muli-sectoral planning process well as to review and monitor progress of twice a month. programs and actions impinging on health and iii. Goalpara: Setting up of core group to nutrition. These consultations were chaired hasten the progress towards the by the deputy commissioners of the respective development of the plans. districts and thus received high priority. These meetings also helped in bringing about clarity in the roles and responsibilities, and accountability of respective departments in developing and implementing the multi-sectoral nutrition action plans. For example, in Barpeta district, the decision was taken that the district will review the multisectoral plan every 15 days and the District Social Welfare Officer will update the plan with the help of all the concerned departments. Pic 3: State and District level consultations (Goalpara and Barpeta) In summary, these consultations helped build consensus around development and implementation of multisectoral plan at State and District level, their use as tools to review and monitor progress and highlighted the value of using data to improve performance, thereby contribute to improving nutrition and health. • Capacity building of frontline workers: A two-day comprehensive joint training of AAAs (Anganwadi Workers (AWW), ASHA and Auxiliary Nurse Midwife (ANM)) was conducted in two aspirational districts, Barpeta and Udalguri, to develop leadership capacity and a full understanding of the critical importance of and the care required during the ‘first 1,000 days of life’. The objectives of the training were two-fold - firstly, to sensitize frontline workers on the need to focus on the first 1000 days to improve nutrition, and secondly to build their capacities for effective home visits for counselling. Home visits and counselling is an important part of the job description of AAAs. Since most of the time they visit same households, it is important to align the messages from all three so that same message percolates to the mothers and other family members in effective manner. 13 Prior to the training a detailed training curriculum was formulated by resource persons from Social welfare, Health, NIPCCD and Food and Nutrition Board members. The training was conducted by state and district level resource person from social welfare, health department and Food and Nutrition Board. Box 7: Outcome of training of frontline workers A total of 62 participants were trained from 20 1. Created a repository of training health/ICDS sectors. The training also helped material around health, nutrition and create a repository of resource materials like IYCF in vernacular language that could tools, audio visual clips, quizzes material be used by various departments for collected from various resource persons of training their frontline workers. various departments. The resource repository has 2. Recommendation given to the also been shared with NIPCCD, State Institute of respective departments to allocate Health and Family Welfare (SIHFW), Social budgets for the joint training programs. Welfare Department, Health Department and the Food and Nutrition board for use in future trainings. The trainings were helpful in bringing about message alignment on issues pertaining to health and nutrition, role clarity of each worker, including their respective roles in joint events like VHSNDs and how they could complement each other rather than duplicate efforts. Pic 4: Joint training of AAA’s (ASHA-AWW-ANM) 3.2.3 Promote knowledge creation and sharing to improve program effectiveness. The technical assistance contributed towards knowledge creation, assimilation and sharing across various stakeholders and bodies including relevant line departments to help strengthen existing programs, enabling easy access to relevant documents, expertise, and other relevant materials to strengthen the systems for enabling action to improve food and nutrition security. Similarly, the analyses and assessments undertaken focussed on key areas of program improvements. The following activities were conducted to contribute to the knowledge creation and sharing objective: • Nutrition working group created to provide strategic direction in nutrition: the nutrition working group created acted as a think tank for the state to provide technical and operational guidance on various nutrition issues. The group had members from diverse affiliations and backgrounds, e.g., from civil society organizations, academia, government departments, as well as individual technical experts. Majority of the working group members 14 were extensively engaged with community work at ground level and thus these meetings provided insights of field perspectives and challenges at various levels of program implementation. A total of six nutrition group meetings were organized and led to consensus on a position paper on “First 1000 days”. The position paper was based on a desk review of existing policies Box 8: Outcome of Working Group and the evidence-base on ‘essential nutrition interventions in first 1000 Days’. It was Position paper on “First 1000 Days: presented to the Government of Assam and the Essential Nutrition Interventions” was group agreed to continue to advocate for developed to provide technical and incorporating the key recommendations from operational guidance to the Government position paper in the District Implementation of Assam to focus and prioritize first Plan of Health and Social Welfare Department. 1000 days. • ‘Eat Right Mela (health fair) in Barpeta district: The objective of mela was to sensitize the people of Barpeta to safe and healthy eating habits and to educate them on simple ways to improve their health and well-being. The mela began with a cycle rally attended by more than 150 cyclists and yoga session in the morning, followed by main mela activities conducted at the lawns of district library of the district. Around 2,000 people participated in the mela and participated in, and learnt through the organized activities, such as street plays, health checkup camps, nutrition counselling, poster making, nutrition quiz and infotainment programs like screening of films and live music performance. The mela was inaugurated by the District Collector of Barpeta and saw participation from various Government and non-Government agencies including representation from the Department of Rural Development; Health Department, Social Welfare, Indian Dietetic Association, Piramal Foundation, to name a few. The mela celebrations were preceded a press conference and training of 70 street food vendors on issues pertaining to food safety. The mela is an example of leveraging and linking of other nutrition and health related Bank engagements to the TA provided in Assam. The health melas are one of the key public-facing strategies of the recently launched Eat Right India Movement by the Food Safety and Standards Authority of India (FSSAI), with whom the Bank has an engagement. The mela provided a unique platform to communicate messages around food safety and nutrition to the general public. The Eat Right Mela provided opportunity to reach large numbers of people ranging Pic 5: Glimpses from Eat Right Mela, Barpeta 15 from government officials of concerned departments, students, women, families, civil society organizations with key message of safe and healthy eating. The women who came for health check-ups were sensitized to all health issues like anemia, consumption of IFA tablets, ANC check-ups, etc. The stalls by the departments of Social Welfare, Agriculture and Assam State Rural Livelihood Mission sensitized people about all the food and nutrition related government schemes and the benefits available under them. An important outcome of the mela was a decision to undertake monitoring of the street food vendors on regular basis by the Food Inspector to ensure that they continue to follow the food safety norms discussed in the trainings. The district administration also committed to organising a refresher course with support from FSSAI. Post the Barpeta mela, neighbouring districts requested organization of similar events as it helped to bring not only citizens together on issues of health and nutrition but also brought various departments together. 3.2.4 TA to strengthen program management information system and monitoring across sectors. The technical assistance enhanced the capacity of CSDG and district authorities to effectively manage and monitor programs by effective use of data to guide program actions and policy decisions, including those related to food and nutrition. The TA supported the development of an ICT-enabled real-time monitoring dashboard, and efforts to conduct social audits to improve governance and accountability in two districts. The details of these are outlined below: • Online Dashboard to track financial data as well as physical progress of flagship programs contributing to the SDGs: The TA supported the development of a web-based dashboard to assist the State Government in reviewing the progress of all flagship schemes under each of the departments. Key Performance Indicators (KPIs) specific to each department (total of 11 departments2) were finalized in close coordination with the respective department, and these are mapped to the SDG indicators. It also has a complete listing of Head of Accounts, mapped to allocation and release of budget and the achievement of KPIs against targets. This master list includes traffic signal colour coding for performance on both parameters (finance and KPIs). (in relation to the release of budget against allocation and KPI (in relation to achievement against target). It has several useful features such as providing a summary of select KPIs for each department that includes both financial and physical progress, providing trend analysis, sending notifications. • Social Audits: Social Audits are powerful tools to empower the beneficiaries of government programs to hold service providers accountable to the beneficiaries, and improve transparency and accountability at all level. To build the capacity of government officials on Social Audit and its tools, a two-day workshop was organized by the CSDG in collaboration with CFNS and Voluntary Health Association of Assam (VHAA). It was attended by 30 officials from Social Welfare, ICDS, Health and Family Welfare, Agriculture, Education, ASRLM, Public Health Engineering Departments, CSDGs, CFNS and VHAA from both state and districts level. 2 Food and Civil Supplies; Legislative; Disaster Management; PWD (Buildings); Higher Education; Animal Husbandry; Irrigation; Science and Technology; Sericulture; Health and Social Welfare 16 After training, two social audits were also conducted in Udalguri and Goalpara districts on Supplementary Nutrition service delivery under the ICDS and on Water and Sanitation facilities. In both the districts, 12 AWWs along with Anganwadi Helpers (AWHs) were interviewed to collect information in regard to AWC infrastructures, and communities were interviewed as well. FGDs were held to draw inferences from the quantitative data collected through structured interviews of beneficiaries and service providers. This small-scale social audit process in two Box 9: Social audits helped to: districts helped the CSDG team to understand the process. It helped them to understand the • Identify systematic gaps in the importance of this activity and the need to implementation of ongoing projects / mainstream this practice in all concerned schemes related to nutrition departments. It built the capacity of the CSDG • The findings helped feed into the staff to lead and assist various departments in development of the multi sectoral plans measuring and assessing the outcomes & • Generate Community awareness on impact at ground level and hold the system their health and nutrition entitlements accountable. The Social Audit process was and services. intended to make the projects / schemes more effective and efficient to accelerate the progress towards SDGs. A range of communication materials on social audits was developed as part of this TA which formed a rich resource for CSDG and the state government to refer back and to further train the staff on conducting social audits. 17 4 Challenges and Learnings 4.1 Challenges 4.1.1 For several reasons Assam presents several development challenges; at the same time it presents several opportuinties. Assam, the largest amongst the north-eastern states of India, with a population of 31.2 million (Census 2011) provides both challenges and opportunities to development planners. Primarily a rural state, it has not been able to make much progress in agricultural growth. The challenges arise from a combination of several factors – its geography, its proneness to natural disasters (it falls in Zone V – the highest – in terms of environmental vulnerability), a long-running insurgency and ethnic conflict; high unemployment among educated youth and wide variation in development indicators. Of particular concern is the recurring cycle of natural disasters such as flooding, landslides and vulnerability to earthquakes on the one hand and political strife and ethnic violence on the other. Floods have impeded the technological transformation of agriculture in Assam. 4.1.2 The combined result is a serious impact on service delivery and livelihoods of people. Entire communities are displaced and have become more vulnerable to sliding down the poverty spiral. Assam has had a history of civil strife and has been witness to various separatist movements, which have had an impact on development indicators. Amongst the most vulnerable groups are communities working on tea plantations. Forming nearly 20 per cent of the population, they are often marginalized and experience living conditions significantly poorer than for the general population. These communities have limited access to health and education facilities and most marry at a relatively young age. Further, the water quality is poor largely due to arsenic, fluoride and microbial contamination; and use of non-sanitary toilets, particularly in the tea garden areas where the functionality, maintenance and effective use of toilet facilities is poor. 4.1.3 A key challenge for the current TA was the short span of time available for planning and implementing the activities. Due to the delays in the internal Government of Assam and Government of India finalization of the request for TA from the World Bank, the time period for implementation of the TA was considerably shortened resulting in a limited time for the implementation of the activities. However, the team benefitted form the Had time permitted, several activities could have been further replicated. Examples include activities like social audits, joint training, eat right melas, district level consultation, cross-visits to further enrich the learnings from the project. However, the team used the Bank’s institutional knowledge and agile ways to plan and implement the TA activities and achieve substantive outcomes. 4.2 Learnings 4.2.1 While the TA mapped the key stakeholders, the scope of the TA did not permit engagement with several sets of stakeholders. An important learning is that it is important to engage, involve and collaborate with all pillars of democracy- Executive, Legislature, Civil Society including media and business and build them as ‘champions of change’ for an effective people’s movement to improve nutrition outcomes. For example, sensitization of the state legislatures is critical, as is the sensitization of the elected local government bodies – right from the district to the village level. Similarly, a greater engagement with media can be very powerful as is the use of celebrities, champions, influential voices for endorsement of key nutrition and health messages. 18 4.2.2 The district and field level engagement highlighted the critical need to strengthen efforts to promote behavior change around Infant and Young Child Nutrition. For example, making counselling during home visits more intensive is necessary. This would require building capacity of frontline workers on inter-personal counseling (IPC) skills, communicating nutrition messages directly and regularly through IT enabled systems such as smart phones/mobiles, and promoting local and context specific foods, address myths and misconceptions around food consumption are some areas requiring attention and action. 4.2.3 Given the scale of the programs and the widespread lack of capacity, an area that emerged as a priority for future action was to harness IT-enabled systems to improve the access of functionaries to the right information when they need it. While IT-enabled learning cannot replace face-to-face learning opportunities, these could certainly help augment passing on key information and messaging at scale. 4.2.4 The TA was successful in acting as a catalytic force to energize different departments to mobilize various actions to improve the progress towards SDGs. However, there is a need for such catalytic actions on a more sustained basis as the goal post is still distant, and loss of momentum and energy is a potential risk. 19 5 Conclusion 5.1 The TA engagement opportunity with the Government of Assam, while of a short duration, was a valuable partnership. It brought together several stakeholders to discuss and strengthen nutrition policies and programs at the state level and in three aspirational districts. While only eight months were available for implementing the TA, the innovative and agile approaches adopted helped to achieve the planned outcomes. Two key strategic approaches proved valuable: (i) the appointment of a strong technical assistance agency with presence in Assam to enable intensive engagement and lend day-to-day support in the TA delivery; and ii) the mapping of key stakeholders in the state and their mobilization into expert groups early on in the TA to collectively support TA activities such as advocacy, capacity and awareness building around issues of food and nutrition. This proved very valuable in leveraging their expertise and to engage with them for various activities at state, district and even at the village level. 5.2 In the short duration of the TA activities, significant outputs and outcomes were achieved. Some of the most significant ones are: • Strengthening the CSDG at the state level and setting up and operationalizing district level SDG cell in three aspirational districts of Assam. This was accomplished through number of capacity building activities, cross visits for learning and organization of policy dialogues and seminars. • Preparation and implementation of the multi-sectoral nutrition action plans. • Knowledge sharing and policy advocacy through working group meetings, policy dialogues, engagement with media, to name a few. • Strengthen the program management information system through the development of ICT enabled real-time dashboard to track flagship schemes of various departments and through conduct of social audits at the district level. 5.3 Several of the TA outputs have already been adopted by the government to strengthen programs, and tools developed are available for wider use in the state. The TA delivered many outputs, of which several have already been mainstreamed. For example, the multi-sectoral nutrition action plans developed under the TA have already been integrated in the Poshan Abhiyan program by the Government of Assam. Similarly, the capacity built for social audits and range of tools made available can be used by the Government in other districts across the state. The training materials for AAA’s (ASHA, AWW and ANM) have been made available to the apex training institute of the government to expand it to other districts. The online dashboard developed will facilitate the program and other leaders in real-time monitoring of their flagship schemes and programs, thereby helping them make informed decisions. A number of knowledge products contextualized to Assam have been developed under the TA which will serve as knowledge tools for the CSDGs to share with other districts across the state. 20 Annexure 1A Outline of the district level multi-sectoral plan Group Essential Interventions Part A- Essential Nutrition Intervention Adolescent Girls Anemia Screening /IFA Supplement Deworming/ BMI Correction Health, Nutrition, Sanitation, Hygiene Education Pregnant Women ANC Care Iron and Calcium Supplementation Deworming Supplementary Nutrition/Take Home Ration () Family Planning Counselling Weight& Height Measurement- BMI (for weight gain during pregnancy) Institutional Delivery Support for Early initiation of breastfeeding Home Delivery by Skilled Birth Attendant (SBA) Lactating Mothers IFA tablets Calcium tablets ICDS Supplementary Nutrition /Take Home Ration Family Planning Services Low Birth Weight Care/ Kangaroo Mother Care Continuation of Breastfeeding & Exclusive Breastfeeding 0-6 Months Child Diarrhoea Management (ORS, Zinc and access to safe drinking water and sanitation facility) Care / feeding during illness Weight/ Height Monitoring 6-24 Months Children Timely Initiation of Complementary Feeding Appropriate Complementary feeding (Dietary Diversity, appropriate Feeding Frequency and adequate density ) Vitamin A and IFA Supplementation Full Immunization Deworming (as per guidelines) Supplementary Nutrition (THR of ICDS)SAM and MAM Management IFA Supplementation Deworming 24-59 Months Children Supplementary Nutrition (ICDS) Vitamin A, IFA Part B- Interventions addressing underlying and basic causes of Malnutrition Water AWCs, Health Centers, Villages and Households with adequate water supply 21 Sanitation AWCs, Health Centers, Villages and Households with adequate sanitation facilities Behaviour change: Hand washing with soap and hygiene practices appropriate hygiene, sanitation practices High school education of Facilitate girls high school education Girls Right age of Prevention of marriage and conception before 18 years of age marriage/conception Women receiving work for 100 days in a year Women’s Livelihood Livelihood generation support to SHGs Homestead food production through Livelihood programs Regular supply of entitled PDS food Access to pulses ,fish , flesh food Food Security Homestead food production, Kitchen Garden, Poultry keeping PART C- System Strengthening Intervention Systematic Community based events Monthly VHSND sessions Growth Monitoring sessions Organised Home Visit Cross Cutting Strategies Social Behaviour Change Communication strategy Supply Chain Management Human Resources Capacity Building Monitoring Evaluation Accountability and Learning (MEAL) Knowledge Management Convergence 22 Annexure 1B Multi-sectoral District-level action plan (detailed) Group: Adolescent Girls Monitoring Data Indicators Baseline* Target* Essential Interventions Department Scheme Resources Source* 2019- 2020- 2021-22 20 21 School Going Adolescents Lead 3.1 Departments % of adolescent • Mapping of all private Mobile 10-19 years schools, Government Health Block covered with schools and junior Anemia Mukt Health Albendazole in colleges Education Bharat Team at the first round • Ensuring adequate Department (MoHFW,2018) PHC level in February and to cover second round Albendazole supply at the in August each health centers/sub schools, year centers one month prior to the biannual dates Nodal fixed for Albendazole teachers distribution • Maintenance of the track sheet to ensure every adolescent has received the due dosages • Capacity building of AWWs and nodal 1 teachers on program Support issues like stock Department calculations and Social Welfare dissemination, Department conducting IEC at regular interval • IEC materials to be given to teachers to hold education sessions in schools • Dissemination of IEC material to all school’s/juniors college Out of School Adolescents • Listing of all the out of school adolescents by AWW with the help of ASHA • Micro plan for reaching out to out of school children by ASHA and AWW • Ensuring a fixed day distribution of Albendazole to out of school adolescents at AWCs 2 • Capacity building of AWWs on program issues like stock calculations and dissemination, conducting IEC at regular interval School Going Adolescents Lead Department WIFS Mobile 3.2: • Mapping and inclusion of Education, RBSK Block % of adolescent private schools, ICDS Health girls 10-19 Health SAG- (out of Teams years screened Government schools and Department school for junior colleges adolescent ANMs, anemia(school • Regular screening (at least girls) ASHAs going +non- twice a year) for anemia school going ) by teachers/ mobile block (throughout the health team for school year) Support going adolescent Department Social Out of School Adolescents Department • Listing of all the out of Education school adolescents by Department AWW with the help of ASHA 3 • Regular screening (at least twice a year) for anemia by AWWs/ mobile block health teams at AWCs for out of school adolescent • Ensuring Weekly Lead Department WIFS ASHAs, distribution Health SAG-for out of AWWs of IFA tablets with special Department schools adolescent girls Nodal focus on schools in tea Teachers garden areas Support 3.3: • Teachers and AWWs to % of eligible Department ensure consumption of adolescents 10- Education IFA tablets for school Department 19 years who going adolescent and out receive at least of school adolescent girls Social Welfare 4 blue iron respectively. Department folate tablets • Display of pictorial communication materials at school for better consumption outcome. Besides IFA and Deworming Lead Department 3.4: following interventions Health % of adolescent should be ensured: Department 10-19 years whose BMI is • Promote nutrition, health below normal and sanitation education Support at schools and AWCs Department 4 • Regular health camps for Education adolescent girls for Department measuring BMI followed Social Welfare by counselling sessions Department • Delay age of marriage and conception >18 years • Promote education and retentions in schools • Ensure tracking of the Lead Department newly wed girls by ASHAs with the help of AWWs Health Department • Ensuring that newlywed 3.5: adolescent girls enter % of newly wed pregnancy with correct adolescent girls who have BMI and age more than received family 18 years planning • Strengthening of counselling Adolescent Friendly Health Clinics for counselling 5 Group: Pregnant Women Monitoring Data Essential Interventions Department Scheme Indicators Baseline* Target* Resources Source* 2019- 2020- 2021-22 20 21 • AWWs/ASHAs/ANMs to ensure Lead ICDS 5.1: 10.2% Aspirational 100% registration of pregnancies Department NHM % of PW who (NFHS-4) District ASHAs, • SHGs to assist ASHAs to register ASRLM had full Action Plan ANMs Health Antenatal care ( the ‘Unreached” women in Department 4 ANC, at least AWWs community 1 TT, IFA tablet SHGs • Regular organisation of VHSND by or syrup for AWWs/ASHAS and ANMs for Support more than 180 ensuring early registration and Department days) ANC check-ups Social Welfare • ANCs posts to be 100% filled Department • Conduct BCC events on importance of antenatal check- P&RD ups and micronutrients. (ASRLM) • Organise ANC sessions ninth of every month as per the PMSMA policy of NHM Pregnant women to be weighed and weight to be entered in MCP card and weight gain should be encouraged as per BMI based guidelines 6 • ASHAs to ensure 100% Lead ICDS, 5.2: 64.3%(NFHS- Aspirational ASHAs, registration of pregnant women Department PMMVY Out of total 4) District AWWs • SHGs to facilitate in identification ANC registered , Action Plan Health % registered of unreached pregnant women Department within 1st and ensure their registration for trimester(within ANCs 12 weeks) • Ensuring early registration of pregnancy through incentive of PMMVY • Effective implementation and timely fund release of PMMVY Support Department Social Welfare Department P&RD(ASRLM) • Ensuring early registration of Lead pregnancy through incentive of Department 5.3:Out of total PMMVY Social Welfare ANC registered , • AWWs to ensure 100% Department ICDS, % registered ASHAs, registration of pregnant women PMMVY within 1st AWWs • Effective implementation and Health trimester(within timely fund release of PMMVY Department 12 weeks) Lead ICDS 5.4: ASHAs, • Ensuring Regular supply of THR Department P&RD % of PW ANMs Social Welfare (ASRLM) registered who 7 • Ensuring supply of readymade received 21 AWWs nutri mix as THR and not raw rice- days of SNP in SHGs dal last month and have access to • Ensuring safe and hygienic storage diversified food of THR through home • Involve SHGs in production of THR stead food through micro finance activities production P&RD(ASRLM) • Promotion of kitchen gardens at AWCs • Promote establishment of kitchen garden at household level and poultry keeping by linking with SHG activities • Regular screening for anemia Lead NHM 5.5: ASHAs, levels of PW at health centers / Department ICDS % of eligible ANMs VHSND ASRLM pregnant Health women who AWWs • Ensuring adequate availability Department received at SHGs (based on projected population of least 180 IFA Support PW) of IFA supplies at health tablets during Department centers and sub centers the Antenatal • Tracking of all eligible pregnant P&RD/Assam period women to ensure timely RLM distribution of IFA tablets through ANMs or ASHAs • Appropriate counselling by service providers at the time of distributing IFA tablets for improving compliance 8 • Organise treatment of women with severe anemia for treatment • Capacity building of SHGs to engage them in Jan Andolan activities for promoting consumption of IFA. • Regular follow up of PW by ASHA, ANM & AWW for managing side effects and improving IFA compliance • Capacity building of SHGs on basic health & nutrition issues and engaging them for ensuring consumption of IFA • Ensuring adequate availability Lead NHM 5.6: ASHAs, (based projected population of Department ICDS % pregnant AWWs PW) of calcium tablet supplies at ASRLM women who SHGs Health consumed 360 health centers and sub centers. Department calcium tablets • Appropriate counselling by during service providers for promoting pregnancy regular consumption Support • Tracking of all eligible pregnant Department women to ensure timely distribution of calcium tablets Social Welfare through ANMs or ASHAs Department • Regular follow up of PW by ASHA, ANM & AWW for compliance P&RD 9 • Capacity building of SHGs to engage them in Jan Andolan activities for promoting consumption of calcium • Adequate number of tablets to be Lead ICDS, 5.7: ASHAs, made available at all health Department NHM % of PW who AWWs facilities providing ANC were given one Health Albendazole • Health workers to ensure Department tablet after 1st distribution and consumption of trimester tablet • Appropriate counselling at Support VHSND for disseminating Department information and establishing Social Welfare WASH measures Department • Ensuring age of marriage and Lead NHM 5.8: Aspirational ASHAs conception not less than 18 years Department ICDS, % of children District and • Counselling by health and ICDS on P&RD with low birth Action Plan ANMs Health (ASRLM) weight (< 2.5 adequate and appropriate Department kg) diversified diet • Care and day rest during Support pregnancy Department • Ensure reduction in physical drudgery and domestic violence Social Welfare with help of SHGs Department *Baseline, Target and Data Source to be filled by lead department district officials based on department’s target for subsequ ent years 10 Group: Lactating Mothers Monitoring Baseline Data Indicators Target* Intervention Department Scheme Resources * Source* 2019 2020 2021 -20 -21 -22 • ANM, ASHAs, AWWs to mobilise and Lead ICDS, NHM, ASHAs, 7.1: 51.9 Aspirationa support PW for institutional deliveries Department ASRLM AWWs, % of %(NFHS- l District • Ambulance facility to be strengthened ANMs, institutional 4) Action Plan Health SHGs, deliveries in – Mrityunjoy 108 services, especially at Department Trained the last month tea garden areas. Support staff at • Strengthening the implementation of Department each health JSY and PMMVY center • Timely payment on performance Social level based incentives to ASHAs for Welfare Department institutional deliveries. • Special higher incentives to ASHAs to be institutionalised in hard to reach areas (border areas) • Engagement of SHGs to promote the importance of institutional deliveries. • Increasing the number of SBAs Lead HBNC 7.2: 12.3 % Aspirationa • Regular trainings for SBAs Department % of deliveries (NFHS- l District at home 4) Action Plan • Incentives to SBAs for safe deliveries Health attended by Department skilled birth attendant(Doc tor, nurse, LHV, ANM, 11 Other health personnel) • Ensuring Regular supply of THR Lead ICDS, AWWs 7.3: • Ensuring safe and hygienic storage of Department ASRLM SHGs % of lactating THR mothers Social received 21 • Involve SHGs in production of THR Welfare days of through micro finance activities Department SNP(THR) in last month Support Department P&RD *Baseline, Target and Data Source to be filled by lead department district officials based on department’s target for subsequ ent years 12 Group: Children (0-6 months) Monitoring Baseline Data Essential Intervention Department Scheme Resources Indicators Target* * Source* 2019 2020 2021 -20 -21 -22 • Ensuring early initiation of 9.1: breastfeeding in 100% % of children Lead Department Aspirational institutional deliveries initiated 68%(NF 100 100% 100% Health Department District breastfeed HS-4) % • AWW to support early initiation of Action Plan within one breastfeeding in home deliveries hour birth • No marketing of Infant formula • Lactation Management Training to the SBAs NHM- JSY ASHAs, • Ensure early initiation of Breast PMMVY ANMs, MAA AWWs, Feeding in 100% institutional Support Health deliveries Department AWWs Centers • IEC material on breast-feeding to be displayed on ANC ward/ Social Welfare delivery ward and other health Department facilities. • ANMs/ ASHAs to provide breastfeeding counselling during ANC contact at VHSND Lead Department NHM, 9.2: 56.7%(N Health Department MAA FHS-4) 13 • Educating the mothers and other % of children family members about the under 6 importance of exclusive months exclusively breastfeeding breastfed • Every immunisation contact should be utilised for breastfeeding counselling and assessing status. • 10 steps to breastfeeding to be displayed in every health centres/ Support VHSND forums. Department ANMs, ASHAs, • Lactation support services/ Social Welfare AWWs lactation counsellors to be Department provided at health centers for timely management of any lactation problem • ANMs/ ASHAs to provide breastfeeding counselling during VHSND and ANC check ups • Support for breastfeeding to working mothers in areas like tea garden areas • Ensuring supply of adequate ORS 9.3: Aspirational Lead Department % of children District packets and zinc tablets at AWCs Health Department 0-60 months Action Plan and with ASHAs NHM ANMS, with • VHSND to be used for creating Support PHED ASHAs diarrhoea in knowledge about diarrhoea Department the last two management and preparation of weeks who 14 ORS and minimum 14 days Social Welfare received ORS consumption of zinc tablets. Department and Zinc • Home visits to children with PHED diarrhoea treated by health workers for counselling of family members on diarrhoea management/demonstration • Demonstration on VHSNDs regarding regular hand washing with soap before cooking and eating • Ensuring the coverage of safe drinking water facility • Promote the usage of sanitation toilets • Weighing machine to be made 9.4: available at all AWCs/VHSND Lead Department % of Children forums for regular weight and 0-60 months Social Welfare that have height measures, Department AWWs, their weight • Trainings of all AWWs and ASHAs measured, ASHAs and on weight measurement and ICDS monitored(en VHSNC plotting members tered in • Counselling on promotion of Support growth chart) mothers by AWWs with the help of Department every month Health Department in the last ASHAs on importance of growth quarter monitoring 15 • Prioritised home visits to children whose growth have faltered by AWWs and ASHAs • Identification of children suffering from severe acute malnutrition (SAM) and taking appropriate actions. *Baseline, Target and Data Source to be filled by lead department district officials based on department’s target for subsequ ent years 16 Group: Children (6-24 months) Monitoring Data Intervention Department Scheme Resources Indicators Baseline* Target* Source* 2019-20 2020-21 2021-22 • Organize Annaprashan Diwas ICDS AWWs, 11.1: once in a month in AWCs to Lead NHM ASHAs % of children promote complementary Department and who were VHSNC initiated feeding and demonstrate Social members complementary healthy recipes Welfare feeding(Solid or • AWWs and ASHAs to counsel Department semi- solid mothers and family members food and on adequate diet- quality and Health breast milk) quantity Department after 6 months • Encourage preparation of traditional nutrimix through home level preparation Support • Measles fist dose contact with Department mother to be utilised for assessing the status of Assam RLM complementary feeding of child • Undertake regular home visits for counselling on complementary feeding at home level by ASHAs,as per the policy on Home Based Care in Young Children,NHM 17 • Recipe demonstration by AWWs or in VHSND • List of locally available complementary foods to be given to children • Regular trainings for AWWs and ASHAs to ensure knowledge and skill retention on complementary feeding • Counselling by ICDS and health Lead ICDS, AWWs, 11.2: workers to stress on diet Department ASRLM SHGs % of children diversity consuming at ICDS, least 4+ food • Promote establishment of SSBs Health groups at household level of such P&RD children and poultry keeping by Support linking with SHG activities. Department • Training of SHGs to counsel on adequate diet- dietary diversity Social Welfare and minimum meal frequency department • SHGs to establish kitchen gardens and provide support to AWCs on demonstration days • Ensuring adequate stock Lead NHM AWWs, 11.3: 41.1% availability (based on Department ICDS ASHAs % of children (NFHS-4) population projection) at (9-24months) Health who received health centres department at least one 18 • Institutional Bi-annual Support dose of vitamin distribution of Vitamin-A on Department Ain the two fixed months, 6 months preceding 6 Social months apart from each other Welfare • AWW to prepare due lists of department children 9-60 months with the help of ASHAs and ANMs • Children not covered in 6 monthly drive to be administered vitamin A doses on VHSND • AWW to prepare list of Anemia AWWs, 11.4: beneficiaries with the help of Lead Mukt ASHAs % children 6-24 ASHA and ANM Department Bharat months provided (IFA) • Ensuring adequate stock Social syrup (Bi availability (based on Welfare weekly) in the population projection) at Department preceding health centres Support month • Ensuring mechanism for Department distribution of syrup to Health mothers during VHSNDs by ANM/ASHAs • ASHA to get list of children to Lead NHM, ASHAs, 11.5: 34.1 % be fully immunised from AWW Department ICDS, AWWs Children age (NFHS-4) ASRLM and SHGs 12-23 months • Home visits by ASHAs to follow Health fully up for mobilizing caregivers for Department immunized 19 attending immunization Support (BCG, measles, sessions. Department and 3 doses • Tracking and micro planning to each of polio Social and DPT) (%) reach out all children at Welfare household level- head count Department, survey specially at tea garden areas P&RD • Ensuring migratory population and temporary settlements are also included in the immunization plan • Engagement of SHGs/ community influencers/leaders to promote awareness regarding full immunization and mobilizing caregivers to attend immunization sessions on fixed days • Scaling up eVIN • Introduction of policy for Lead ICDS AWWs, 11.6: production of Nutrimix as THR Department SHGs % children 6-24 supply to ICDS. months Social registered who • Regular supply of THR to ICDS Welfare received SNP and weekly supply to children department (THR) for 21 Capacity building of SHGs to Support days in the last take up THR as a micro finance Department month activity P&RD 20 • Regular growth monitoring at Lead ICDS, AWWs, 11.7: AWCs Department NHM ASHAs % of children 6- • Training of AWWs to identify VHSND 36 months Social committee screened for MAM and SAM cases Welfare members MAM and SAM Department during last Support month Department Health Department • Counselling on home based Lead ICDS, AWWs, 11.8: care and adequate feeding by Department NHM ASHAs % of children AWWs and ASHAs Social with MAM that Welfare receive • Behavioural change sessions on Department appropriate child health and nutrition by Support interventions AWWs Department at community Health level Department • Identifying SAM children who Lead ICDS, AWWs, 11.9: fail appetite test or with Department NHM ASHAs % of children bilateral oedema, with SAM and Health medical • Financial support to mother Support complications bringing child for treatment at treated at Department NRCs Nutrition • Follow up after discharge from Social Rehabilitation NRC Welfare Centres (NRCs) • Ensure availability of dieticians Department at NRC at all times 21 • Induction training for NRC team (doctor, dietitian/ nutritionist, nurses, cook and helpers) to gain proper techniques and skills • Provision of double THR Lead 11.10 ration of ICDS to SAM cases Department % of children with no medical with SAM and Social without complications Welfare medical • Monitoring w eight gain Department complications • Imparting nutrition and treated at health education through Support community food demonstration and Department level preparation Health • Promotion of kitchen garden Department to ensure household level food security • Capacity building of primary caregiver to look after the child at home • Ensuring adequate Albendazole supply Lead ICDS 11.11: • Maintenance of track sheet to Department WIFS % of children ensure every child receives the Social (6-24 months) Welfare who received due 6 monthly dosages Albendazole • Dissemination of IEC material Support to community centres Department Health *Baseline, Target and Data Source to be filled by lead department district officials based on department’s target for subsequ ent years 22 Group: Children (24-59 months) Monitoring Data Intervention Department Scheme Resources Indicators Baseline* Target* Source* 2019-20 2020-21 2021-22 • Organising biannual administration Lead of vitamin A supplements Department • AWW to prepare due lists of 13.1: children with the help of ASHA and Social % of children ANM Welfare NHM AWWs, (24- 41.1% • Left out children to be given doses Department ICDS ASHAs 59months) (NFHS-4) on VHSND who received Support • Ensuring adequate stock Vitamin A Department availability (based on population projection) at health centres 13.2: • AWW to prepare list of Lead % children beneficiaries with the help of Department 24-59 ASHA and ANM Social NHM : months • Ensuring adequate stock Welfare Anemia provided availability (based on population Department Mukt (IFA) syrup projection) at health centres Support Bharat (Bi weekly) in • Ensuring mechanism for Department last month distribution of syrup to mothers Heath during VHSND Department 13.3: Lead % children • Ensuring supplementary feeding to Department 24-36 ICDS enrolled children 24-36 Social months months Welfare registered Department who received 23 • Engagement of SHGs to ensure SNP (THR) for production of vegetables as micro 21 days in finance activity the last • etc for SNP for 24-36 months month children enrolled with ICDS Provision of additional SNP to severe underweight children *Baseline, Target and Data Source to be filled by lead department district officials based on department’s target for subsequ ent years 24 Part B: Multi-sectoral Interventions Monitoring Intervention Department Scheme Resources Indicators Baseline Target Data Source 2019- 2020- 2021- 20 21 22 Wash Drinking Water • Categorization of AWCs based on Lead Department 14.1: Out of 100% 100% 100% ICDS current status- Drinking facility NRDWP % of 2970 Barpeta available, available but not PHED Anganwadi AWCs in functional and not available. In first with Barpeta phase dysfunctional supplies can adequate, only 1689 be made functional and in second functional AWCs phase new supplies could be and safe have Support installed Department drinking proper • Testing of water supply at AWCs water supply access to Social Welfare adequate, functional Department and safe drinking water • Categorization of health Centers Lead Department NRDWP 14.2: 321 100% 100% 100% based on current status- Drinking % of health health facility available, available but not PHED centres with centres functional and not available. In adequate, first phase dysfunctional supplies functional 25 can be made functional and in Support and safe second phase new supplies could Department drinking be installed water supply Health Department • Water purification units to be set Lead Department NRDWP 14.3: up. PHED SKPY % of • Workshops and trainings of villages/wards village water committee to with undertake minor repair work and adequate, Support functional maintenance of water systems Department and safe P&RD drinking water supply • Categorization of households Lead Department NRDWP 14.4: 97.8% 100% 100% 100% PHED based on current status- Drinking % of (NFHS-4) facility available, available but not PHED households functional and not available. In with first phase dysfunctional supplies improved can be made functional and in drinking second phase new supplies could water sources be installed • Strengthening the implementation Swatch Khuwa Pani Yojana particularly in the riverine/ char areas. Sanitation • Mapping and prioritizing the left SBM 14.5: 100% 100% 100% PHED out pockets Lead Department % of villages/ 100% wards which 26 • SBCC activities to promote usage PHED are open of sanitation facilities defecation • Plan for maintenance of free community toilets • Hands on trainings on sanitation to village masons • Mapping and prioritizing the left SBM 14.6: 34.9% 100% 100% 100% PHED out pockets with special focus on Lead Department % of (NFHS 4) tea garden areas PHED Households • SBCC activities to promote usage with access to sanitation facilities safe sanitation facilities • Construction of toilets in AWCs SBM 14.7: Out of 100% 100% 100% ICDS under Swachh Bharat Mission Lead Department MGNREGA % of 2970 Barpeta • Categorization of AWCs based on Anganwadi AWCs in current status- Sanitation facility, PHED and with Barpeta available and functional, available adequate and only 1689 but not functional and not functional AWCs available. In first phase Support sanitation have dysfunctional facilities can be Department facilities proper made functional and in second access to phase new facilities could be Social Welfare adequate, constructed Department functional • Convergence with MGNREGA for and safe construction and maintenance of Education drinking sanitation facility water P& RD 14.8: % of schools with adequate and functional 27 sanitation facilities • Categorization of health centers Lead Department 14.9: 321 100% 100% 100% based on current status- % of health Health Sanitation facility-available and PHED centres with facilities functional, available but not adequate and functional and not available. In Support functional first phase dysfunctional facilities Department sanitation can be made functional and in facilities second phase new facilities could Health be constructed Department Personal Hygiene • Providing adequate supplies (soap, ICDS SHGs, 14.10: 100% 100% 100% ICDS bucket and mugs) to every AWCs Lead Department AWWs % of Barpeta • Hand washing posters to be Social Welfare Anganwadis demonstrated at AWCs Department with • Community radio to generate Support adequate and awareness among people Department functional • SHGs to create awareness Hand washing regarding hygiene practices at facilities with community level water and • Swachhagrahis to demonstrate soap available hygiene practices on VHSND • Hand washing posters to be 14.11: 100% 100% 100% Department demonstrated at health centres Lead Department % of health of Health, • Community radio to generate Health centres with Barpeta awareness among people Department adequate and • SHGs members to be part of functional monitoring team in health centres Handwashing facilities with 28 water and soap available Education • Awareness programs through SSA SSA 14.12 23.9 % Assam • Counselling of girls parents by Lead Department % of women (NFHS-4) Agenda members of SHGs on importance of with 10 or 2030 girl education Education more years of • Improvement of sanitation facilities Department schooling at schools for girls • Addressing the root cause for high girls dropout rate Social Causes • SHGs should be sensitised and 14.13: 43.2 % linked to local NGOs & CBOs for Lead Department % of women (NFHS-4) creating awareness in the age 20-24 community for the subject Social Welfare years married • BCC activities in the vulnerable Department before 18 communities like tea garden areas years • Promotion of higher education Support among adolescent girls Department P&RD Livelihood • Generating awareness of MGNREGA 14.14: MGNREGA among women - Lead Department % of women P&RD with job cards who worked 29 • Strengthening of Women's for 100 days participation in Gram Sabha in last year Planning Meeting Food and Nutrition Security • Inclusion of all eligible families in Lead Department PDS 14.15: PDS % of families Food & Civil linked with Supplies PDS 30 PART C: Cross-cutting strategies Program Management Activities Accountability • Conduct regular joint VHSNC meeting by Lead Role ANM,AWW for execution of health and nutrition Health Department activities • Ensure participation of ICDS supervisors and Panchayati Raj members in the meeting • Identify all households with pregnant women and children 0-24 months and mobilise them to attend VHNSDs • Promote regular use of mother-child protection (MCP) card (renaming it “Mother and Child Health Support Department and Nutrition Card (MCHNC)”) for entry of data and Social Welfare Department 15.1: monitoring progress as well as for counselling VHSND Lead Role Social Welfare Department • Establish procurement system and ensure functional weighing machines at all AWCs • Undertake Weight and height measurement of all the children at regular interval – every month for children aged between 6-24 months and once in 3 months for children aged above 24 months. 15.2: • Identify SAM children with and without medical Growth Monitoring complications and actions for their management • Organise regular training to AWWs for recording , plotting and interpretation of growth • ICDS and health functionaries to educate, counsel and support mothers and families for optimal nutrition, healthcare and development of children • Home visit calendar of AWW, ASHA and ANM should be planned and reviewed • Home visit tools should be designed for AAAs for effective communication, counselling and information gathering 15.3: • AWW and ASHAS to make home visits for Lead Role Quality Home Visits educating mothers and other family members to Social Welfare and Health play an effective role in child’s growth and Department development with special emphasis on 0-24 months child. 31 15.4: Social Behaviour Change Communication(SBCC) • Development of SBCC strategy for the state’ • Hire a special expert team /organisation to develop SBCC strategy and provide rollout support. SBCC support training, advocacy and Lead Role communication materials to be standardised Health and Social Welfare Department • Filling up the positions of all health and ICDS functionaries at all level • Appointment of a consultant District Nutrition Lead Role 15.5: Coordinator for 5 years. Health and Social Welfare Human Resources • Appointment of Block Nutrition Coordinators Department • Population based estimates for stock planning of 15.6: health supplies Supply Chain • Streamlining system for timely procurement of Lead Role Management required supplies Concerned Department • Establishment a state Nutrition Resource Centre (SNRC) --Identification of such an institute to conduct capacity building trainings 15.7: • Training of HR team including Capacity Building • mid-level managers of health and ICDS Lead Role functionaries Social Welfare and Health • Roll out of ILA module in local languages/ Department exposure visits • Establish an MIS system and link to SNRC for analysis of MPR and HMIS data • Ensure inclusion of nutrition linked Multisectoral indicators in the line department monthly progress report 15.8: • Deputy Commissioner to review the status of Lead Role Monitoring Evaluation indicators as a part of regular monitoring with Deputy Commissioner and Accountability and health, ICDS and Multisectoral departments. heads of in line department Learning (MEAL) • Documentation of progress made and analysis of on-going best practices Lead Role 15.9: • Regular dissemination of information on analysis Concerned departments Knowledge Management of local data ,progress and way forward • Formation of convergence committee for nutrition at district and block levels • Coordination meeting of all the line departments including Health, Social Welfare, PHED, Lead Role Agriculture, Education, P&RD, Food and Civil Office of Commissioner 15.10: Supplies in the presence of Principal Secretary, Convergence BTC 32 This material has been funded thanks to the contributions of (1) UK Aid from the UK government, and (2) the European Commission (EC) through the South Asia Food and Nutrition Security Initiative (SAFANSI), which is administered by the World Bank. The views expressed do not necessarily reflect the EC or UK government’s official policies or the policies of the World Bank and its Board of Executive Directors.