scholarly journals India's 2.42 Million Frontline Health Workers Enable Restoration of Health and Nutrition Service Delivery After Early COVID-19 Lockdowns

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 206-206
Author(s):  
Rasmi Avula ◽  
Phuong Nguyen ◽  
Sattvika Ashok ◽  
Sumati Bajaj ◽  
Shivani Kachwaha ◽  
...  
Keyword(s):  
Service Delivery ◽  
Child Nutrition ◽  
Food Policy ◽  
Health Workers ◽  
Policy Research ◽  
Food Supplementation ◽  
Growth Monitoring ◽  
Health And Nutrition ◽  
Nutrition Service ◽  
T1 And T2

Abstract Objectives Modeling studies have estimated impacts of potential service delivery disruptions due to COVID-19 pandemic on maternal and child nutrition outcomes, but little is known about actual delivery status. We studied disruptions and restorations of health and nutrition services by frontline workers (FLWs) in India during COVID-19. Methods We conducted phone surveys with 5500 FLWs in seven states between August–October 2020, asking about service delivery during April 2020 (T1) and in the August-October period (T2) and analyzed changes between T1 and T2. We also analyzed publicly available administrative data (AD) from 704 districts including the pre-pandemic period (T0) to examine disruptions and restoration of services. Results Phone surveys suggest, in T1, opening of village centers, fixed day events, growth monitoring, and immunization services was <50% in several states. In T2, restorations of center-based services were seen, with increases of >33% in >= 3 states. Food supplementation was least disrupted both in T1 and T2. AD highlights geographic variability both in disruptions in T1 compared to T0 and restorations in T2. FLWs’ adaptations to ensure service provision included home delivery (60 to 96%), ensuring physical distancing (33 to 86%), coordinating with other FLWs (7 to 49%), and using phone (∼2 to 65%). Challenges included personal fears, walking long distances, and beneficiaries’ non-cooperation. Conclusions Services to mothers and children were disrupted during lockdown and restored thereafter. Rapid policy guidance and local adaptations by a strong cadre of FLWs likely enabled service resumption. However, gaps remain, and more research is needed on use of services by clients. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

scholarly journals PENERAPAN LAYANAN KESEHATAN DAN GIZI DALAM PENYELENGGARAAN PAUD HOLISTIK INTEGRATIF DI TK ALAM PELOPOR RANCAEKEK

Edukid ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 50-64
Author(s):  
Ghina Salamatu Sadiah ◽  
Nur Faizah Romadhona ◽  
Asep Deni Gustiana
Keyword(s):  
Data Analysis ◽  
Health Workers ◽  
Case Study Research ◽  
Education Institution ◽  
Local Health ◽  
Design Data ◽  
Additional Food ◽  
Nutrition Services ◽  
Health And Nutrition ◽  
Nutrition Service

Abstrak: Penelitian ini dilatar belakangi oleh situasi dilapangan, dimana layanan kesehatan dan gizi dalam penyelenggaraan Paud Holistik Integratif ini masih jarang diterapkan di setiap lembaga pendidikan anak usia dini, sehingga kebutuhan esensial anak khususnya dalam aspek kesehatan dan gizi belum terpenuhi secara optimal. Tujuan penelitian ini untuk mengetahui penerapan layanan kesehatan dan gizi dalam penyelenggaraan Paud Holistik Integratif di TK Alam Pelopor Rancaekek. Penelitian ini menggunakan pendekatan kualitatif dengan desain penelitian studi kasus. Teknik pengumpulan data menggunakan, wawancara dan studi dokumentasi, dengan narasumber dari kepala sekolah, dua guru dan satu orangtua murid. Analisis data menggunakan analisis data tematik.  Hasil Penelitian menunjukan : pertama perencanaaan pelaksanaan layanan kesehatan dan gizi di TK Alam Pelopor Rancaekek dimulai dengan membuat pedoman pelaksanaan program layanan Holistik Integratif yang didalamnya mencangkup pelaksanaan layanan kesehatan dan gizi, rangsangan pendidikan, pembinaan moral-emosional, pengasuhan dan keamanan. Kedua,  pelaksanaan layanan kesehatan dan gizi di TK Alam Pelopor dilaksanakan dengan menyesuaikan dana operasional yang ada di sekolah. Bentuk layanannya terdiri dari pemeriksaan kesehatan secara rutin oleh petugas kesehatan setempat maupun oleh gurunya sendiri, pemberian makanan tambahan bagi peserta didik, dan pembiasaan hidup sehat di kalangan peserta didik. Melalui pemberian layanan tersebut dapat meminimalisir permasalahan kesehatan dan gizi yang biasa terjadi pada anak, sehingga tingkat kesakitan anak dapat berkurang. Ketiga, evaluasi layanan kesehatan dan gizi yang telah dilaksanakan di TK Alam Pelopor Rancaekek dilakukan berdasarkan indikator pencapaian yang telah dibuat dari pedoman pelaksanaan program Holistik Integratif. Kata Kunci: Layanan kesehatan dan gizi, penerapan Paud Holistik Integratif.  Abstract: This research is motivated by the situation in the field, where health and nutrition services in the implementation of Integrative Holistic Paud are still rarely applied in every early childhood education institution, so that the essential needs of children, especially in aspects of health and nutrition have not been optimally fulfilled. The purpose of this study was to determine the application of health and nutrition services in the implementation of Integrative Holistic Paud at TK Pelopor Rancaekek. This research uses a qualitative approach with a case study research design. Data collection techniques using, interviews and documentation study, with speakers from the principal, two teachers and one parent of students. Data analysis uses thematic data analysis. The results of the study show: first the planning of the implementation of health and nutrition services in Alam Pelopor Rancaekek Kindergarten begins by making guidelines for the implementation of the Integrative Holistic service program which includes health and nutrition service implementation, education stimulation, moral-emotional development, care and security. Second, the implementation of health and nutrition services at Alam Pelopor Kindergarten is carried out by adjusting the operational funds available at the school. The form of service consists of routine health checks by local health workers and by the teacher himself, providing additional food for students, and the habit of healthy living among students. Through the provision of these services can minimize health and nutrition problems that commonly occur in children, so that the level of child pain can be reduced. Third, evaluation of health and nutrition services that have been carried out at Alam Pelopor Rancaekek Kindergarten are based on achievement indicators that have been made from the guidelines for the implementation of the Integrative Holistic program. Keywords: Health and nutrition services, application of Holistic Integratif PAUD.

scholarly journals Exploring Reasons for Low Attendance of Mothers to Growth Monitoring and Promotion Program at Loka Abaya District, Southern Ethiopia: Exploratory Qualitative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Mesfin Tekle ◽  
Befikadu Tariku ◽  
Amsalu Alagaw ◽  
Eshetu Zerihun ◽  
Habtamu Wondiye Bekele
Keyword(s):  
Qualitative Study ◽  
Child Nutrition ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Southern Ethiopia ◽  
Growth Monitoring ◽  
Child Feeding ◽  
Evil Eye ◽  
Growth Monitoring And Promotion ◽  
Depth Interviews

Background. Different organizations in Ethiopia are currently working on prevention and promotion activities to fight malnutrition among children through a community-based nutrition program. One of these activities with little success is growth monitoring and promotion (GMP). Exploring the reason and better understanding of low attendance of mothers to the GMP program can help to improve the program by incorporating finding. The aim of the study was to explore reasons for low attendance to the GMP program among mothers of under-two children. Method. An exploratory qualitative study design was used to unearth reasons for low attendance of mothers with under-2-year-old child to the GMP program. In-depth interviews were carried out with 13 mothers. The data were analyzed using qualitative content analysis approach. Result. Mothers perceived that GMP is (meant) for unhealthy children (only). Again mothers mentioned community dishonor of mothers with wasted children and method of weighing a child as a community-related reason for low attendance to the GMP program. They also indicated that there was no community conversation and weak counseling of the mothers about child feeding and growth. Perception about “evil eye” was also indicated as a reason for lower attendance of the program. Conclusion. Mothers showed that there was lack of knowledge about GMP. Limited community conversation and weak counseling about child nutrition as a GMP program were explored reasons for low attendance. Other reasons mentioned by the mothers were consideration of “evil eye” and method of weighing a child. Further research is needed to explore the implementation of GMP by health workers and to evaluate the extent of the identified reasons for low attendance to the GMP program by the mother.

scholarly journals Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025774 ◽  
Author(s):  
Sneha Nimmagadda ◽  
Lakshmi Gopalakrishnan ◽  
Rasmi Avula ◽  
Diva Dhar ◽  
Nadia Diamond-Smith ◽  
...  
Keyword(s):  
Public Health ◽  
Service Delivery ◽  
Pregnant Women ◽  
Large Scale ◽  
Health Workers ◽  
Matched Pair ◽  
Mhealth Intervention ◽  
Health And Nutrition ◽  
Public Health Programmes ◽  
Health Programmes

IntroductionMillions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes.Methods and analysisThis study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries.Ethics and disseminationEthical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public.Trial registration numberISRCTN83902145

scholarly journals Impacts of COVID-19 on Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights From Phone Surveys and Administrative Data

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 672-672
Author(s):  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Anjali Pant ◽  
Lan Mai Tran ◽  
Monika Walia ◽  
...  
Keyword(s):  
Service Delivery ◽  
Performance Management ◽  
Administrative Data ◽  
Service Provision ◽  
Service Providers ◽  
Uttar Pradesh ◽  
Home Visits ◽  
Food Supplementation ◽  
Nutrition Services ◽  
Health And Nutrition

Abstract Objectives The COVID-19 pandemic has significant potential implications for health systems, but little primary evidence is available on effects on health and nutrition services. We aimed to examine changes in service provision and utilization during the pandemic in Uttar Pradesh, India and identify positive adaptations to service delivery. Methods We conducted longitudinal surveys with frontline workers (FLW, n = 313) and mothers of children &lt; 2 years (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. Results Compared to pre-pandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home-rations (∼30%). Most FLWs (68–90%) resumed service provision in July 2020, except for immunization and hot-cooked meals (&lt; 10%). Administrative data showed similar patterns of disruption and resumption. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service delivery. Key adaptations made to provide services included: delivering services to beneficiary homes (∼40–90%), social distancing (80%), using PPE (40–50%), and telephones for communication (∼20%). On the demand side, service utilization also reduced substantially (40–80pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing challenges of limited travel (30%), non-availability of services (26%), fear of catching virus when leaving the house (22%) or meeting service providers (14%). Conclusions COVID-19 affected the provision and use of health and nutrition services despite efforts at service restoration and adaptations. Strengthening logistics support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Alive & Thrive, led by FHI Solutions.

scholarly journals Routine Growth Monitoring Processes in Nutrition Programs in India Have Multiple Falter Points with Implications for Quality of Care

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 806-806
Author(s):  
Sumati Bajaj ◽  
Rasmi Avula ◽  
Anjali Pant ◽  
Phuong Nguyen ◽  
Marie Ruel ◽  
...  
Keyword(s):  
Food Policy ◽  
Policy Research ◽  
Standing Position ◽  
Child Growth ◽  
Growth Monitoring ◽  
Frontline Workers ◽  
Child Height ◽  
Age Appropriate ◽  
Gates Foundation

Abstract Objectives Growth monitoring (GM) and promotion is a routine part of primary healthcare for children in &gt;80% of countries. In India, 57.5 million children are measured every month by frontline workers to assess their growth and to trigger preventive or curative services. Standard guidance for anthropometry suggests that quality can be compromised by the choice of measurement equipment, placement of equipment, and positioning of children during measurement. Little is known about the quality of measurement processes during GM. We compared child height and weight measurement processes with standards for anthropometry to assess GM quality. Methods We observed the process of measuring weight and height of &lt;5 years-old-children (N = 681) in 4 states using a checklist based on standards for anthropometry. We summarized data along critical measurement falter points that could affect quality. Open-ended interviews were conducted with caregivers to assess how they value GM. Results Most children (75%) were weighed using age-appropriate weighing scales (baby-weighing scales, salter scales, and on adult scales with a caregiver). However, for Salter scales, only 44% of children were placed in a sling/pants appropriate for their age. More than 30% of children wore heavy clothing and 45% were not calm during weighing. Over 60% were weighed in a sitting/standing position on a baby-weighing scale. More than 50% of infants were not measured using age-appropriate height equipment. Height equipment was placed on a stable surface while measuring a majority of children, but a large proportion of children were incorrectly positioned on the equipment. Caregivers valued GM and reported having children weighed to learn about any changes; nearly half the caregivers considered weight as a marker for child growth. Conclusions Multiple measurement-related falter points were observed during GM. Most were measured incorrectly, increasing the potential for under-or over estimation of their weight/height and consequent misclassification for screening and referrals. As routine GM appears to be an assurance of child growth to caregivers, it is imperative to strengthen the quality of measurements, focusing on the falter points to ensure better data for programs and for caregiver use. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

scholarly journals Bridging the Gap Between Intent & Interpretation: Enhancing Survey Questions on Maternal & Child Nutrition Intervention Coverage Through Cognitive Interviewing in India

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 869-869
Author(s):  
Sattvika Ashok ◽  
Sunny S Kim ◽  
Rasmi Avula ◽  
Rebecca A Heidkamp ◽  
Melinda K Munos ◽  
...  
Keyword(s):  
Child Nutrition ◽  
Large Scale ◽  
Food Policy ◽  
Survey Design ◽  
Policy Research ◽  
Meat Products ◽  
Nutrition Intervention ◽  
Cognitive Interviewing ◽  
Intervention Coverage ◽  
Survey Questions

Abstract Objectives Designing survey questions that clearly and precisely communicate the question's intent and elicit responses based on the intended interpretation is critical but often undervalued. We used cognitive interviewing to qualitatively assess respondents’ interpretation and responses to questions pertaining to maternal and child nutrition intervention coverage. Methods We conducted interviews with mothers (N = 21) with children less than one year in Madhya Pradesh, India, to cognitively test 25 survey questions. Each question was followed by probes to capture information on four cognitive stages - comprehension, retrieval, judgement, and response. Interviews were recorded and notes were taken on verbal and non-verbal cues. Data were analyzed for common and unique patterns across the survey questions within the cognitive domains and grouped into challenges. Results We identified four types of cognitive challenges: 1) Poor retention of multiple concepts in long questions: difficulty in comprehending and retaining questions with three or more key concepts; 2) Temporal confusion: difficulty in conceptualizing recall periods such as “in the last 6 months” as compared to life stages such as pregnancy; 3) Misinterpretation of concepts: misinterpretation of the information being asked; meaning of certain terms such as “animal-source foods” was considered as referring to meat products only and not milk and eggs; scope of intervention using the phrase “talk with you” in referring to counseling was interpreted in different ways by respondents; and 4) Poor understanding of technical terms: difficulty in understanding even commonly-used technical words such as “breastfeeding” and “antenatal care” requiring the use of plain and simple alternative language. Conclusions Findings from this study will be useful for stakeholders involved in survey design and implementation, especially those conducting large-scale household surveys to improve coverage data of essential nutrition interventions, which is critical for policy actions Funding Sources Bill & Melinda Gates Foundation through the DataDENT initiative and the Improving Measurement and Program Design grant, and the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute.

scholarly journals Predictors of Essential Health and Nutrition Service Delivery in Bihar, India: Results From Household and Frontline Worker Surveys

2015 ◽  
Vol 3 (2) ◽  
pp. 255-273 ◽  
Author(s):  
Katrina Kosec ◽  
Rasmi Avula ◽  
Brian Holtemeyer ◽  
Parul Tyagi ◽  
Stephanie Hausladen ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health And Nutrition ◽  
Nutrition Service ◽  
Frontline Worker

Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia

2012 ◽  
Vol 33 (2_suppl1) ◽  
pp. S27-S50 ◽  
Author(s):  
Lisa S. Saldanha ◽  
Laura Buback ◽  
Jessica M. White ◽  
Afework Mulugeta ◽  
Solomon G. Mariam ◽  
...  
Keyword(s):  
Program Implementation ◽  
Maternal Nutrition ◽  
Health Workers ◽  
Background Information ◽  
Nutrition Interventions ◽  
District Health ◽  
Community Based ◽  
Maternal Undernutrition ◽  
Health And Nutrition ◽  
Nutrition Service

Background Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited. Objective This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in Ethiopia Methods Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region. Results Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels. Conclusions Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.

scholarly journals INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA

2019 ◽  
Vol 4 (2) ◽  
pp. 67-71
Author(s):  
S. Kaur ◽  
R. Gupta ◽  
I. D. Khan ◽  
S. Jindal ◽  
S. Prajapati ◽  
...  
Keyword(s):  
Child Development ◽  
Service Delivery ◽  
Adolescent Health ◽  
Health Program ◽  
Preschool Education ◽  
Outreach Program ◽  
Growth Monitoring ◽  
Growth Standards ◽  
Health And Nutrition ◽  
Supplementary Nutrition

Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi. Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics. Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health. Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.

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