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Re-Imagining India’s anemia management interventions: A policy review


Re-imagining India’s anemia management interventions: A policy review

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1.Introduction


The World Health Organisation (WHO) defines Anemia as a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Anemia in children and adolescents can lead to diminished intellectual capacity, subpar school performance, and hindered physical growth. In adults, anemia often results in fatigue, reduced physical performance, and diminished work productivity, which, in turn, can have economic and national development implications. Among the elderly, anemia is linked to more severe consequences, including cognitive decline, muscular weakness, mobility difficulties, a diminished quality of life, and higher rates of illness and mortality. Hemoglobin levels during pregnancy are connected to the birth weight of newborns.


Severe maternal anemia can lead to unfavorable fetal outcomes such as premature birth, low birth weight, fetal cognitive impairment, and an increased risk of maternal and infant mortality.


Anemia programmes in India have a long-standing history of more than five decades, yet their ability to make a significant dent in reducing anemia across various age groups remains far from the desired global targets. This persistent challenge can be attributed to a multitude of obstacles and limitations that have hindered the programmes' effectiveness. Poor outreach and inadequate coverage, Irregular distribution of necessary supplements, overburdened Frontline Health workers, lack of awareness around adequate nutrition and anemia, and poor patient adherence to treatment. One of the critical shortcomings of the existing programmes lies in their exclusive focus on iron and folic acid supplementation. This approach has overlooked the multifaceted nature of anemia, which can be influenced by a range of contributing factors. The failure to address these underlying issues has impeded progress.


In addition to these operational challenges, there are significant policy-level gaps that require immediate attention. Given the complexity of these challenges, it is imperative to conduct a comprehensive assessment of the landscape of anemia programmes in India. Recognizing the pressing need for substantial reform, this paper aims to provide policy-level recommendations to initiate a coordinated effort in addressing this public health concern.



1.1Prevalence of Anemia in India


According to a Lancet study in 2021, the highest prevalence of anemia was documented in sub-Saharan Africa and South Asia. India contributes to the bulk of the South Asian burden of anemia prevalence because of both large population size and high prevalence across age and sex groups. The National Family Health Survey (NFHS 2015–16) of India estimates that the prevalence of anemia is 58% among children (6–59 months), 29% among adolescent boys, 54% among adolescent girls (15–19 years), 53% among women of reproductive age (WRA), 50% among pregnant women and 58% among lactating mothers.


The situation has worsened during NFHS 2019–21 with a particularly higher increase in prevalence among children (6–59 months) and pregnant women. Even though India had introduced Iron and Folic Acid (IFA) tablet supplementation programs back in the 1970s, these efforts faced a series of challenges, particularly concerning the availability of supplies and the extent of coverage. Consequently, India did not witness any substantial reduction in the prevalence of anemia across various age and gender groups. Recognizing the intricacies of this situation, the anemia control programmes underwent a significant transformation in 2018, drawing on past experiences and global best practices. This reimagined initiative was then reintroduced as the Anemia Mukt Bharat (AMB) strategy, with a primary focus on addressing core issues, including program financing, implementation, and ensuring delivery to even the most remote areas.




Figure 1: Prevalence of Anemia in India



1.2Anemia Programmes' Evolution Leading to the Formation of Anemia Mukt Bharat


India's National Health Policy (2017) and the National Nutrition Strategy (2017) both acknowledge the detrimental impact of anemia on the health and well-being of mothers and children, as well as the overall productivity of the nation. They stress the urgent need to enhance efforts in addressing all anemia causes across all age groups in a coordinated and focused approach rather than through disjointed programs. Additionally, the POSHAN Abhiyaan aims to reduce anemia prevalence among children, adolescents, and women of reproductive age by 3 percentage points annually.


Both global and national experiences indicate that by securing strong political support, setting clear targets across age groups, improving program coverage, addressing procurement and supply chain challenges, establishing robust monitoring and evaluation systems, and delivering targeted behavior change communication, especially in vulnerable areas, it is possible to achieve the desired objectives. In this context, the AMB strategy, referred to as the Intensified National Iron Plus Initiative (I-NIPI), has been developed. It builds upon the technical and operational insights gained from the National Iron Plus Initiative (NIPI) and Weekly Iron and Folic Acid (WIFS) programmes, adopting a comprehensive approach with a more rigorous operational and accountability framework.


The figure below showcases the evolution of anemia control programmes in India. The first national anemia control programme started in 1970 which has evolved to currently ongoing I-NIPI over the years. Over the years not only the beneficiary groups have changed, but also the dosage and tablet coating and strategy have changed and evolved. Initially, in 1970 the National Nutritional Anemia Prophylaxis Programme (NNAPP) started with only three target group beneficiaries i.e., Pregnant, Lactating women and Children (1-5 years), but in 2012 WIFS was launched and adolescent girls were also included in the target group. In 2013, the National Nutritional Anemia Control Programme (NNACP) and WIFS Programme, were integrated into the National Iron Plus Initiative that used the lifecycle approach.




Figure 2: Evolution of Anemia Programmes to tackle Anemia



In 2018, to intensify the efforts made towards anemia reduction, NIPI was changed to the I-NIPI, popularly known as Anemia Mukt Bharat (AMB). Employing the 6 × 6 × 6 strategy, AMB focuses on six beneficiary groups, six institutional mechanisms, and six interventions. Its primary goal is to achieve the targets outlined in the POSHAN Abhiyaan (Prime Minister’s Overarching Scheme for Holistic Nutrition Mission), specifically aiming to reduce the prevalence of maternal and child anemia in India. The figure below provides an overview of the Anemia Mukt Bharat Strategy.






2.Policy-Level Gaps Impacting the Anemia Programme


As per WHO in their report "Accelerating Anemia Reduction” – “Anemia is a complex condition that must be addressed comprehensively, demanding strong leadership and collective action among multiple sectors. There are multiple causes of anemia, including micronutrient deficiencies, inflammation, infection, uterine bleeding, and inherited red blood cell disorders. Anemia has primarily been addressed through the nutrition lens, which is critical but not sufficient alone; rather, all causes must be addressed to effectively prevent and treat anemia.”


To achieve 'Anemia Mukt Bharat’, it is crucial to recognize that there exist significant policy-level gaps within the anemia program. These gaps serve as the foundational challenges that require careful consideration and comprehensive solutions. In the subsequent sections, each of these gaps is explored in detail, providing a thorough analysis and recommendations for the same.


1.Exclusion of micronutrients from the anemia programme


The omission of micronutrients from the anemia programme poses a significant challenge in the fight against this widespread health problem. While we've long recognized iron deficiency as a major cause of anemia, the roots of this condition are much more complex and involve more than just iron. Vitamins A, B6, B12, C, D, E, folate, zinc, and copper all play vital roles in maintaining healthy blood and preventing anemia.


As per Chaudhary et al. (2022), micronutrient deficiencies, often referred to as the 'silent epidemic,' remain alarmingly high in developing countries like India. Deficiencies in iron, iodine, zinc, vitamin A, and folate are common worldwide, and India also grapples with high rates of vitamin D and B12 deficiencies. Surprisingly, existing national anemia control programmes have primarily focused on providing iron and folate supplements, largely overlooking the crucial role of vitamin B12.


However, it's essential to recognize that anemia is often caused by deficiencies in all three of these nutrients—iron, folate, and vitamin B12. Current anemia reduction programmes heavily focus on pharmacological interventions involving iron and folate supplements that have limited effectiveness, with the World Health Organization estimating that only a fraction of anemia cases can be addressed through iron supplementation. This exclusion is particularly concerning in countries like India, where anemia affects over 40% of the population, and the contribution of measured iron deficiency in the etiology of anemia is comparatively lower (Kumar et al., 2022).


2.Lack of clear guidelines with regards to the convergence of the ministries under the Anemia Programme


When it comes to the convergence of ministries within the POSHAN Abhiyaan programme, there is some ambiguity. While the 2021 POSHAN Abhiyaan progress report suggests satisfactory convergence, it notably lacks visibility when it comes to anemia-related activities. The AMB strategy highlights the importance of inter-ministerial convergence, with an emphasis on utilizing existing platforms under the POSHAN Abhiyaan. However, it is essential to recognize that anemia, despite being a critical issue, is a relatively smaller component within the POSHAN Abhiyaan.


To effectively combat anemia, a more comprehensive approach is needed, involving an inter-sectoral convergence of schemes, including the Menstrual Hygiene Scheme, Maternal Health Programmes, National Sickle Cell Anemia Elimination Mission, etc. It's crucial to distinguish between the convergence strategies for POSHAN Abhiyaan as a whole and those tailored specifically for the anemia reduction programme. To ensure the success of the AMB strategy, a distinct and well-outlined approach is required to tackle this specific health challenge.


3.Need for Pandemic-Resilient Guidelines for Anemia Mukt Bharat


The lack of clear and comprehensive guidelines for pandemic preparedness in India raises concerns about the potential impact of the AMB programme. Government data reveals that during the COVID-19 pandemic, there was a noticeable slowdown in the delivery of key services. The lockdown measures, put in place to curb the spread of the virus, resulted in the closure of Anganwadi Centers (AWCs), which serve as the primary platform for nutrition-specific interventions.



This affected the core nutrition services that the AMB seeks to provide. Moreover, frontline healthcare workers, including Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), and Auxiliary Nurse Midwives (ANMs), were diverted from their core duties to tackle COVID-19-related responsibilities like contact tracing and public awareness campaigns. This further exacerbated the disruptions to AMB services (Accountability Initiative, Centre for Policy Research, 2020 and Joe et al., 2022).


4.Absence of Public-Private Partnership (PPP) Initiatives to Address Anemia


Despite the government's successful track record of establishing PPPs to combat non-communicable diseases (NCDs), a significant challenge lies in the absence of similar collaborative efforts for tackling anemia. This challenge calls for crucial initial steps. The private sector's potential to offer direct support to the government in executing activities like expanding the reach of IFA supplementation, providing hands-on assistance for point-of-care testing, and implementing digital diagnostics is a call to action. Moreover, leveraging the private sector's extensive supply chain expertise presents an opportunity to develop innovative PPP models.


5.Exclusion of Men as beneficiaries under the Anemia Programme


The prevalence of anemia among men (15-49 years) as per NFHS - 5 (2019-21) is 25%. Additionally, according to a study by Didzun et al. (2019), almost a quarter of surveyed men aged 15–54 years had some degree of anemia. This data showcases that anemia among men is a substantial public health issue in India, which has, thus far, received little attention from both research and a policy perspective.


Furthermore, while anemia among older adults is less well documented, it is known that the prevalence of anemia among adults aged over 50 years rises with advancing age, particularly among men (Kumar et al., 2022).




3.Integration of WHO Guidelines to Accelerate the Reduction in Anemia


The AMB strategy in India can be further strengthened by leveraging WHO's comprehensive guidelines for addressing anemia. WHO's cross-programme initiative combines different areas of work to enhance the prevention, diagnosis, and management of anemia, providing a framework for effective interventions. By incorporating WHO's guidelines, the AMB strategy can improve its approach to reducing anemia prevalence in India and align with global efforts to address this public health challenge.


Combining WHO's insights and recommendations, an integrated program can be developed to efficiently tackle anemia in India. This approach includes interventions related to nutrition, food safety, maternal and child health, reproductive health, and the management of diseases like malaria and neglected tropical diseases. By utilizing these, India can strengthen its efforts to reduce anemia prevalence, improving health, well-being, and economic outcomes for individuals, families, communities, and societies.


WHO’s Accelerating Anemia Reduction: A comprehensive framework for action 


According to WHO, strategies to reduce anemia now require a significantly different approach. The WHO's framework for anemia reduction outlines a comprehensive approach that brings together various sectors and stakeholders. It outlines five key areas of action to enhance the reach and adoption of interventions, resulting in four main desired outcomes.


The need for a comprehensive framework to accelerate anemia reduction arises from the complex nature of anemia's causes, which encompass multiple possible factors. The most prevalent and widely recognized cause is iron deficiency, which is estimated to contribute to anywhere from approximately 10% to over 60% of anemia cases, depending on the population and context. Historically, most efforts to address anemia have focused on preventing and treating iron deficiency. However, other factors such as nutritional deficiencies, malaria, other infections including parasitic diseases, chronic illnesses, inflammation, gynecological and obstetric conditions, and inherited red blood cell disorders also significantly impact anemia prevalence.


These direct causes of anemia are further compounded by immediate risk factors, underlying risk factors, and overarching drivers linked to broader social disparities. Both the causes and risk factors must be simultaneously considered and addressed to effectively manage anemia. The specific contribution of each factor will vary from one location to another, necessitating tailored approaches to anemia control in local contexts. The figure below illustrates the complex etiology of anemia.




The framework proposed by WHO has outlined key outcomes that are related to the direct causes of anemia which can be addressed by five action areas. These action areas are:


  1. Analyze data on causes and risk factors for anemia.

  2. Prioritize key preventive and therapeutic interventions.

  3. Optimize service delivery across platforms and sectors.

  4. Strengthen leadership, coordination, and governance at all levels.

  5. Expand research, learning, and innovation.


The figure below illustrates the comprehensive framework proposed by WHO to tackle Anemia.



This framework presents a comprehensive strategy, comprising effective and actionable steps, that aim to decrease the prevalence of anemia. It sheds light on the persistent problem of anemia, proposing essential areas of action and interventions rooted in country-specific data and available delivery platforms. This initiative leverages global guidelines and synthesizes the evidence for decision-makers, offering a range of strategies that countries can adapt to their unique circumstances, advocating for investments in anemia reduction.




4. Cross-continental Perspective on Anemia/Nutrition Programmes: Lessons from South Asia and Africa


In the ever-evolving landscape of public health and nutrition, it is imperative to incorporate best practices to combat anemia and malnutrition. The following examples from South Asian and African Union countries illustrate the strategies they have adopted, taking into account their unique socio-economic structures and dietary traditions. These regions have developed innovative strategies in their battle against anemia and malnutrition, drawing from their distinct experiences. These best practices can offer valuable insights for the development of more effective and sustainable programs aimed at addressing anemia and malnutrition, tailored to meet the specific needs of diverse populations.


While India's Anemia program aligns with international best practices, there is an opportunity to further bolster its effectiveness by embracing the following exemplary approaches.


● Public-Private Partnership: These strategies highlight the critical role of transparent collaboration between the public and private sectors involved in food production, processing, supply, and trade. This partnership can be a game-changer in effectively addressing nutrition challenges. The private sector's resources, expertise, and supply chain capabilities can significantly contribute to the success of the Anemia programme. By fostering transparent public-private partnerships, India can harness these strengths to tackle anemia more efficiently.


 Micronutrient Deficiency: The strategies emphasize the importance of evidence-based interventions to prevent and control micronutrient deficiencies. This encompasses dietary diversification, fortification, supplementation, and nutrition-sensitive programmes. Effective intervention against micronutrient deficiencies requires collaboration among policy makers, government bodies, civil society organizations, researchers, and the private sector. These multi-sectoral partnerships ensure a holistic and sustainable approach to addressing this challenge.


● Emergency Response: The strategies highlight the need to strengthen resilience mechanisms and disaster preparedness plans to ensure the provision of nutrition needs during emergencies, including extreme weather conditions. Empowering relevant stakeholders, such as emergency relief staff and program managers, is essential for ensuring the safe and adequate provision of nutrition during crises. Following operational guidelines is crucial in such situations.


These best practices reflect a comprehensive approach to addressing nutrition-related challenges, from building partnerships and advocating for nutrition to implementing evidence-based interventions and responding effectively to emergencies.


The specifics of nutrition programmes implemented in South Asian and African countries are elaborated in the annexure.




5.Charting a Path Forward: Policy Recommendations to Bridge Anemia Programme gaps


Anemia, a widespread public health concern in India, necessitates immediate attention and the implementation of comprehensive strategies to mitigate its adverse impacts. To effectively tackle the multifaceted challenges posed by anemia, it is crucial to establish a well-defined roadmap for action on anemia. This plan should draw upon the extensive guidelines provided by the WHO for addressing anemia and should incorporate best practices from other nations. By integrating these insights, the AMB strategy can enhance its approach to reducing anemia prevalence in India and align with global initiatives to combat this public health crisis.


The recommended actions encompass conducting a nationwide survey to accurately assess the anemia burden leading to the inclusion of other micronutrients, formulating clear guidelines for intersectoral coordination, enhancing the resilience of vital anemia control programmes to pandemics, exploring the potential of public-private partnerships, and extending anemia control efforts to include men. These recommendations outline a comprehensive approach to address anemia in India, providing a blueprint for more effective and evidence-based interventions.


1.Inclusion of other micronutrients in the current Anemia Programme: To address the significant challenge of anemia in India, the government must conduct a nationwide survey aimed at accurately estimating the true burden of anemia. It is highly recommended that district-level estimates be included in this endeavor. This nationwide survey should encompass the collection of venous blood samples from individuals to measure hemoglobin (Hb) concentration.


Additionally, this survey needs to identify the root causes of anemia in India. Currently, India lacks estimates of the clinical determinants of anemia, which are fundamental for designing effective interventions. While conducting such a nationwide survey is a resource-intensive effort, the 2016–2018 Comprehensive National Nutrition Survey (CNNS) can serve as a valuable reference and guideline for its execution. The CNNS successfully measured anemia, iron-deficiency anemia, and various micronutrient deficiencies (e.g., vitamin A, vitamin D, zinc, vitamin B12, folate, and urinary iodine status) using whole blood samples, which were then analyzed in standardized laboratories.


By following a phased approach, the government can feasibly conduct nationwide tests for Hb levels and relevant biomarker tests. As observed in the CNNS survey, the measurement of anemia should be adjusted for various biochemical parameters such as inflammation, enabling a more accurate assessment of an individual's anemia status. The "Anemia Mukt Bharat" initiative necessitates a comprehensive population-based strategy, which is currently absent from its current framework. The existing national strategy lacks a robust scientific approach for both assessing the actual burden and the determinants of anemia. Over the past five decades, India's anemia policies have often focused on food fortification and IFA supplementation, overlooking the multifaceted nature of anemia.


Recent research has unveiled promising interventions and opportunities for a holistic approach to address anemia, while also questioning the existing standards for measuring anemia. Going forward, India's national anemia reduction policy should be firmly grounded in scientifically validated measures that are attuned to the Indian context and capable of addressing the various entry points for anemia in an individual's life.


2.Separate guidelines for intersectoral convergence in the Anemia Programme: Clear and comprehensive guidelines should be established for intersectoral coordination and convergence to ensure that various programmes and initiatives aimed at tackling anemia in India work together cohesively.


3.Resilience to Pandemics for Anemia Mukt Bharat and Nutrition Schemes: The Anemia Mukt Bharat and Nutrition programmes must be resilient to pandemics. This requires several proactive steps, including:


o   Creating a dedicated Health Emergency Task Force to manage health crises, specifically appointing leadership to oversee the AMB programme during emergencies, and empowering District Magistrates and Panchayats to ensure effective coordination, monitoring, and adequate financing of anemia-specific interventions during emergencies.


o   Developing and implementing emergency response plans tailored to maintain anemia control efforts during pandemics, including guidelines for healthcare providers and emergency supply distribution.


o   Strengthening anemia data collection and surveillance by improving the quality and routine update of administrative data, implementing real-time anemia data collection, and utilizing data analytics and digital tools to monitor anemia prevalence and trends, thereby identifying high-risk areas and vulnerable populations during pandemics.


o   Allocating sufficient financial resources to support the Anemia Mukt Bharat and Nutrition programmes during emergencies.


o   Leveraging public-private partnerships to make use of their resources and expertise in areas such as telemedicine, digital tools, and supply chain management for effective anemia control during pandemics.


4. Exploring Public-Private Partnerships (PPPs) for Anemia Programme: Considering the use of PPPs in anemia programmes holds significant potential for addressing anemia-related challenges, especially in vulnerable populations. The private sector, including food producers, processors, and suppliers, possesses significant resources, infrastructure, and expertise in food production and distribution. These resources can be harnessed to ensure a consistent and diverse supply of nutritious foods, including those rich in iron, to vulnerable populations. Private sector companies are known for their supply chain capabilities. They can play a pivotal role in ensuring the efficient distribution of fortified foods, supplements, and fresh produce, reaching remote and underserved areas where anemia prevalence may be higher. This efficiency can help prevent spoilage and wastage of food items, ensuring that more people benefit from them.


Private companies can contribute to public awareness campaigns by using their marketing and communication expertise. They can help educate the public about the importance of a balanced diet, the risks of anemia, and how to incorporate iron-rich foods into their daily meals. Collaborations with private sector organizations can provide financial support for the anemia programme. Donors and investors from the private sector can be engaged to provide funding for initiatives, making it possible to scale up interventions and reach more people.


5. Extending Anemia Control Efforts to Men: Given the cost-effectiveness of treating common forms of anemia and its impact on economic productivity, policymakers in India should consider extending certain components of the AMB program to men, particularly in regions with a high prevalence of anemia in men. This could involve including men in household visits by community health workers or community meetings, with a special focus on poorer households in rural areas and on adolescent and older men. Given the high prevalence of anemia and its adverse health and economic consequences, there is an urgent need to further enhance efforts to reduce the burden of anemia in the country.




6.Conclusion


The recommendations outlined in this paper aim to complement and enhance existing practices in addressing the issue of anemia in India. By incorporating these suggestions into current initiatives, India can see beyond previous policy limitations, adopting a more comprehensive and scientifically informed approach that acknowledges the complexities and consequences of anemia. If planned and implemented correctly India has the opportunity to significantly alleviate the burden of anemia, fostering improved health and well-being among its population and subsequently contributing to its overall societal progress.


Note: India and the World Health Organization (WHO) use different spellings for anemia. In India, the preferred spelling is "anemia," while WHO uses the spelling "anaemia".




Annexure: Nutrition Programmes in South Asian and African Countries



Sri Lanka National Nutrition Policy 2021-2030

Aims to eradicate malnutrition by 2030 through strategies ensuring optimal nutrition, food security, legal protection, ethical marketing, and six priority areas. It encompasses various strategic directions in six priority areas.

  1. Food & Nutrition Security: Enhance food availability, access, and financing for healthy eating and reduce food waste.

  2. Multi-Sector Collaboration: Strengthen government systems for nutrition interventions, establish coordinated systems, and ensure accountability at all levels.

  3. Legal Framework & Ethical Marketing: Improve food legislation, control unethical marketing, and enhance monitoring of food safety.

  4. Nutrition Across the Lifecycle: Provide nutrition care for couples, pregnant women, infants, children, adolescents, adults, and elders, addressing specific needs.

  5. Nutrition in Emergencies: Strengthen resilience mechanisms for disaster preparedness and nutrition needs during emergencies.

  6. Information & Research Management: Enhance information and research systems for effective policy implementation.

Sri Lanka National Strategy for Prevention and Control of Micronutrient Deficiencies in Sri Lanka (2017-2022)

The strategy was introduced to provide guidance to improve population nutrition by preventing micronutrient deficiencies with six strategic objectives.

  1. To strengthen the regulatory mechanism for enforcement of relevant legislation, policies, and guidelines

  2. To strengthen advocacy and awareness to improve the consumption of micronutrient-rich food and micronutrient supplementations among the target populations

  3. To promote sustainable partnerships and multi-sectoral involvement in improving micronutrient status of the population

  4. To empower relevant stakeholders and communities with regard to knowledge, skills, and service delivery to improve micronutrient status of the population

  5. To implement evidence-based nutrition interventions throughout the life cycle at individual and population levels

6. To monitor and evaluate the current interventions and promote operational research

National Strategy for Prevention and Control of Micronutrient Deficiencies in Bangladesh 2015-2024

It provides guidance on interventions and actions for a coordinated and comprehensive approach to prevent and control micronutrient deficiencies focusing on vulnerable population groups utilizing the six components: 1. Policy & Legislation: Develop, revise, and enact policies and legislation to improve micronutrient status by 2016. 2. Intervention Programs: Implement long-term (diversification), medium-term (fortification), and short-term (supplementation) interventions for micronutrient deficiency control. 3. Partnership & Coordination: Enhance collaboration among stakeholders for efficient program implementation. 4. Capacity Building: Improve the skills of healthcare workers and government institutes for monitoring and enforvement. 5. Advocacy & Awareness: Increase awareness and demand for deficiency control programs.

6. Monitoring & Evaluation: Strengthen institutional frameworks and reporting for program evaluation at all levels.

Africa Regional Nutrition Strategy (ARNS) 2015-2025

The African Union Commission (AUC) is committed to working with its member states and partners to achieve and potentially exceed their objectives by utilizing the following strategic activities will be undertaken:

  1. AUC will define standards, norms, policies, and frameworks for AU member state adoption and ratification, ensuring alignment with the ARNS 2015-2025 and other international initiatives.

  2. AUC will convene and facilitate consensus on nutrition security matters in Africa, including conferences, research studies, and technical working groups.

  3. AUC will advocate for the implementation of nutrition security policies and programs, providing regular progress reports and launching advocacy and communication initiatives.

4. AUC will establish the architecture for decision-making on the ARNS 2015-2025 implementation, including management structures, a Management Information System, and stakeholder mapping and monitoring in collaboration with other nutrition coordinating agencies and partners.

Multi-sector Nutrition Plan for Accelerating the Reduction of Maternal and Child Under-nutrition in Nepal 2013-2017 (2023)

This plan aims to significantly reduce chronic malnutrition within the next 10 years, ensuring improved human capital and socio-economic development.

This plan concentrates on the critical first 1,000 days of life and essential interventions, complementing other sector policies and strategies. The plan has three main outcomes:

  1. Enhanced national and local policies, plans, and multi-sector coordination.

  2. Improved practices promoting optimal use of nutrition services, resulting in better maternal and child nutrition.

  3. Strengthened central and local government capacity to provide inclusive and equitable nutrition services.

Bhutan National Nutrition Strategy and Action Plan (2021-2025)

The main objective of the NNSAP is to improve nutritional security, especially for those at higher risk of malnutrition such as children, women, adolescents, the elderly, and people with special needs in collaboration with multiple sectors to achieve the national and global targets for malnutrition across all age groups by 2025. The strategy focuses on eight areas, including special attention to the first 1,000 golden years, school-aged children, women of reproductive age, healthy diets, WASH, clinical nutrition, governance, and monitoring.




Meet The Thought Leader



Ms. Laboni Singh is a mentor at GGI and is currently working at The Bridgespan Group as an Associate Consultant. She takes a keen interest in socioeconomic development issues, public policy, and equity across different vectors of gender, caste, class, and ability, which in turn fueled her transition from working at a global bank to the social sector. She is an Urban Fellow from the Indian Institute for Human Settlements, Bangalore and has a bachelor's degree in Economics from St. Stephen's College, University of Delhi.





Meet The Authors (GGI Fellows)



Dr. Subhashree Meher is a Public Health consultant with a passion for improving healthcare systems. Her journey began with a Bachelor of Dental Surgery (BDS) degree, providing her with a solid foundation in healthcare. She then pursued a Post Graduate Diploma in Management (PGDM) in healthcare management, equipping her with the skills needed to make a real impact in public health. Beyond her professional life, she enjoys creating unique art and crafts, traveling to new places, and exploring the world of anime, providing balance to her busy and fulfilling career.



If you are interested in applying to GGI's Impact Fellowship program, you can access our application link here.


 

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18.   Rai RK, Kumar SS, Sen Gupta S, Parasannanavar DJ, Anish TSN, Barik A, Varshney RK, Rajkumar H. Shooting shadows: India's struggle to reduce the burden of anemia. Br J Nutr. 2023 Feb 14;129(3):416-427 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9876813/

19.   NUTRITION SITUATION IN INDIA DURING COVID-19 PANDEMIC: SYNTHESIS OF EVIDENCE - https://poshancovid19.in/wp-content/uploads/2022/08/Nutrition-Situation-in-India-during-COVID19-pandemic_Final.pdf

20.   Didzun, O., De Neve, J.-W., Awasthi, A., Dubey, M., Theilmann, M., Bärnighausen, T., Vollmer, S., & Geldsetzer, P. (2019). Anemia among men in India: A nationally representative cross-sectional study. The Lancet Global Health, 7(12). - https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30440-1/fulltext

21.   Sri Lanka National Nutrition Policy 2021-2030

22.   Sri Lanka National Strategy for Prevention and Control of Micronutrient Deficiencies in Sri Lanka (2017-2022)

23.   National Strategy for Prevention and Control of Micronutrient Deficiencies in Bangladesh 2015-2024

24.   Africa Regional Nutrition Strategy (ARNS) 2015-2025

25.   Multi-sector Nutrition Plan for Accelerating the Reduction of Maternal and Child Under-nutrition in Nepal 2013-2017 (2023)

26.   Bhutan National Nutrition Strategy and Action Plan (2021-2025)

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