Multi Nutrition PDF

Addressing
India’s Nutrition Challenges

Report of the Multistakeholder Retreat
New Delhi 7-8 August 2010
Planning Commission
Government of India
Addressing India’s
Nutrition Challenges
7-8 August 2010

New Delhi
Planning Commission
Government of India
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MONTEK SINGH AHLUWALIA ;kstuk vk;ksx
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DEPUTY CHAIRMAN
PLANNING COMMISSION
INDIA
Message
India faces a unique development paradox of being in the front ranks of fast growing
global economies, with vibrant economic growth rates and yet, in stark contrast
– around 40% of India’s children under three years of age are undernourished.
India’s Nutrition Challenges call for urgent action, as a critical development
imperative for ensuring faster, more inclusive and sustainable growth.
I extend my appreciation to Member Planning Commission, Dr. Syeda Hameed

for her leadership in evolving a consensus on multisectoral interventions to
address India’s Nutrition Challenges. The strategy focuses on preventive early
action – prenatally, in the neonatal period, early infancy and in the first two
years of life, which is critical for addressing a vicious cycle of undernutrition,
disease/infections, related mortality and risks to maternal and child survival and
development. The girl child is especially vulnerable, and high priority will be
accorded to improving the female/male ratio in children under 6 years, which is
914 girls for every 1000 boys as per Census 2011 Provisional Population
Totals. The strategy recommendations also provide the foundation for a more
comprehensive approach to Universal Health Care, Women’s Empowerment and
Child Development, with a continuum of care across the life cycle and from the
family/community, to the anganwadi, to health centres and facilities.
The decisions of the PM’s National Council on India’s Nutrition Challenges, informed
by the Recommendations for Action that emerged from the Multistakeholder
Retreat on Nutrition, provide us with a roadmap as we make the transition to the
Twelfth Plan.
I am confident that the Twelfth Plan will demonstrate the change that has
already begun and extend my support and best wishes to all those involved in
this endeavour.
(Montek Singh Ahluwalia)

Deputy Chairman
Planning Commission
iii
iv
Foreword
Nutrition is crucial for the fulfillment of human rights – especially those of the most vulnerable
children, girls and women, locked in an intergenerational cycle of multiple deprivation. It
constitutes the foundation for human development, by reducing susceptibility to infections,
reducing related morbidity, disability and mortality, enhancing cumulative lifelong learning
capacities, and adult productivity. It is critical to prevent undernutrition, as early as possible,
across the life cycle, to avert irreversible cumulative growth and development deficits that
compromise maternal and child health and survival, achievement of optimal learning outcomes
in education and gender equality.
According the highest priority to combating malnutrition, Planning Commission was mandated to
anchor a Multistakeholder Retreat on India’s Nutrition Challenges, to evolve Recommendations
for Action for the consideration of the Prime Minister’s National Council on India’s Nutrition
Challenges.
This was organised by the Planning Commission, in New Delhi on 7-8 August, 2010. Over
200 participants from 16 states participated in the two day consultation which brought together
representatives from a wide spectrum of stakeholder groups – especially voices from the field.
These included ANMs, Anganwadi workers, ASHAs, representatives of Panchayati Raj Institutions,
Women’s Self-Help Groups and other community groups.
The Multistakeholder Retreat was a significant milestone as it evolved a consensus on how to

move forward. The outcome of this participatory consultative process was a Framework for a
Multisectoral National Plan of Action to prevent and reduce undernutrition – especially maternal
and child undernutrition in India. Extensive preparatory work was undertaken in partnership with
the Ministry of Women and Child Development and the Ministry of Health and Family Welfare.
Recommendations for Action that emerged from this process were placed for consideration of the
first meeting of the Prime Minister’s National Council on India’s Nutrition Challenges, held on 24th
November, 2010.
I take this opportunity to extend my appreciation to all of those who shaped this initiative – the
many voices we heard from the field, the resource facilitators’ team, all the participants, the design
and leadership teams. I would especially like to acknowledge the contribution of the core group
that brought these diverse views together and that continues to work on taking this forward.
I look forward to this initiative touching the lives of around one fifth of the world’s children
– fulfilling the rights of India’s children and women to survival, development, protection and
participation, towards more inclusive growth and sustainable human development.
We all derive wisdom from the words of Jalauddin Rumi:
Constant, slow movement teaches us to keep working

Like a small creek that stays clear
That doesn’t stagnate but finds a way
Through numerous details; deliberately
That is what gives us hope.
(Syeda Hameed)
Member
Planning Commission
vi Addressing India’s Nutrition Challenges
Contents
Abbreviations ix
I. Executive Summary 1
II. Background 7
III. Introduction 11
The Multistakeholder Retreat 12
Objectives of the Retreat 12
Participants’ Profile 12
Methodology 13
Outcomes 14
IV Proceedings of the Multistakeholder Retreat 19

i. 7 August 2010 19
ii. 8 August 2010 43
V. Presentation of Key Recommendations 54
VI. Summing Up and Way Forward 56
VII. Synthesis of Major Recommendations for Action 60
VIII. Annexures
i. Agenda 71
ii. List of Participants 75
iii. Terms of Reference for Group Work - 7 August 2010 86
iv. Terms of Reference for Group Work - 8 August 2010 93
IX. The Exhibition 107

Abbreviations
ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker
BMI Body Mass Index
CBO Community Based Organisation
CCT Conditional Cash Transfer
CDPO Child Development Project Officer
CHC Community Health Centre
CMB Conditional Maternity Benefit
DLHS District Level Household and Facility Survey
DOTS Directly Observed Treatment Short Course
EBF Exclusive Breastfeeding
GIS Geographic Information System
ICAR Indian Council of Agricultural Research
ICDS Integrated Child Development Services
ICT Information and Communications Technology
IEC Information, Education and Communication
IFA Iron and Folic Acid
IGMSY Indira Gandhi Matritva Sahyog Yojana
IMR Infant Mortality Rate
IYCF Infant and Young Child Feeding
JNNURM Jawaharlal Nehru National Urban Renewal Mission
JSY Janani Suraksha Yojana
MDM Mid-Day Meal
MGNREGS Mahatma Gandhi National Rural Employment Guarantee Scheme
MoHFW Ministry of Health and Family Welfare
MIS Management Information System
MMR Maternal Mortality Ratio
MTC Malnutrition Treatment Centre
MoWCD Ministry of Women and Child Development
ix
NCAER National Council of Applied Economic Research
NFHS National Family Health Survey
NFSA National Food Security Act
NMR Neonatal Mortality Rate
NNMB National Nutrition Monitoring Bureau
NRC Nutrition Rehabilitation Centre
NRHM National Rural Health Mission
NRLM National Rural Livelihoods Mission
NSV No-Scalpel Vasectomy
NUHM National Urban Health Mission
PHC Primary Health Centre
PRI Panchayati Raj Institution
RCH Reproductive Child Health
RGSEAG Rajiv Gandhi Scheme for Empowerment of Adolescent Girls
RSBY Rashtriya Swasthya Bima Yojana
SC Scheduled Caste
SHG Self-Help Group
SHSRC State Health Systems Resource Centre
SIHFW State Institute of Health and Family Welfare
SNP Supplementary Nutrition Programme
SSA Sarva Shiksha Abhiyan
ST Scheduled Tribe
THR Take Home Ration
TPDS Targeted Public Distribution System
TSC Total Sanitation Campaign
UID India Unique Identification Authority of India
ULB Urban Local Body
VHND Village Health and Nutrition Day
VHSC Village Health and Sanitation Committee
VIPP Visualisation of Participatory Programming
WHO World Health Organization
I. Executive Summary
India has accorded the highest priority to combating malnutrition, since it

remains persistently and unacceptably high, in spite of a multitude of efforts of
the Government. The key issue is preventing and reducing maternal and child
undernutrition as early as possible, across the life cycle- especially in utero and
the first two years of life, in adolescent girls and women. In order to accelerate
improvements across states, the Government of India has decided to mobilise
multisectoral action to address the multiple causes of undernutrition effectively.
Nutrition is being accorded utmost priority at the highest levels with the Ministries
of Women and Child Development (WCD) and Health and Family Welfare (HFW)
jointly formulating a Strategy Note, in consultation with the Planning Commission
and Prime Minister’s Office. Based on the same and deliberations of the Retreat,
recommendations have been drawn up and these were placed before the PM’s
National Council at its first meeting on 24 November 2010.
Against the above backdrop, the Planning Commission was mandated to anchor As the title of the
a Multistakeholder Retreat to address the country’s nutrition challenges, using consultation suggests,
a synthesis of the joint strategy note to facilitate dialogue. As the title of the the purpose of the
consultation suggests, the purpose of the retreat was to first hear and then factor retreat was to first
in the concerns of all stakeholders. The unique aspect of the consultation was hear and then factor
the inclusion of voices of different players, significantly, grassroots functionaries, in the concerns of all
by engaging them in discussion and dialogue using different tools such as group stakeholders.
work, presentations, multi/open voting, system, futuring and visualisation of
participatory programming (VIPP).
A special exhibition was mounted with details of state best practices, innovations,
local materials and poster presentations as part of a walk-through display. State
teams facilitated inter-state sharing and learning during the retreat and in the
evening, local folk media and street theatre were mobilised to broaden the scope
of discussion on nutrition.
Objectives of the Retreat
Develop a framework for a multisectoral National Plan of Action to prevent

and reduce undernutrition in a time-bound manner.
Have clearly articulated commitments from different stakeholders.
Outline how institutional reform will take place at village level.
Prioritise key multisectoral interventions for accelerating action.
Preparatory Work Undertaken Prior to the Retreat
Design and Leadership teams were constituted in June 2010, to facilitate the
retreat by providing vision and leadership. A joint strategy note was prepared
after consultations between MoWCD and different groups such as Members
of Parliament, Conference of State Ministers/State Secretaries in charge of
WCD and Consultative Committee of Parliament on Malnutrition in Women and
Executive Summary 1
Children. Recommendations of the draft Mid Term Appraisal of the Eleventh
Plan, presented to National Development Council with findings of the interim
report of NCAER ICDS Evaluation study, also provided insights for developing an
agenda for institutional reform.
The retreat was held in New Delhi on 7-8 August 2010 with over 200 participants
from 16 states. The strength of the initiative and seriousness with which
malnutrition was taken up could be seen by the wide representation of all key
players at policy and field levels. Uniqueness of the initiative lay in its including
voices from the field, giving them space to express themselves freely as they
shared their struggles and triumphs. Apart from members of various Commissions
such as NCPCR, NCW and national institutions like NIHFW, NIN, NHSRC and PHFI,
the meeting was attended by experts, development partners, civil society groups,
Panchayati Raj Institutions (PRIs) and Women’s Self-Help Groups (SHGs).
Government representation was seen through the presence of Union Ministers,

Deputy Chairman and Members of the Planning Commission, senior officials
from the Prime Minister’s Office and the Planning Commission, Secretaries of
concerned Ministries at national and state levels (WCD, HFW, rural development,
agriculture, food and civil supplies, elementary education, PRI, Information and
Broadcasting) and field functionaries.
Design Methodology to Optimise Interaction and Outcomes
The retreat was designed not so much as an instructional workshop but as a

participatory process wherein everyone, directly and indirectly connected with
nutrition, was either presenting, sharing, brainstorming or outlining strategy.
Team work was a strong component of the two-day deliberations, with different
groups being assigned themes to enable them to discuss and present their thoughts
and recommendations to a larger group.
Careful thought went into planning the retreat, with professional facilitation to
ensure vibrant interaction and sharing of ideas. To ensure active participation,
discussions were broken into two categories: what needed to be done and how
it could be done.
Defining Feature of the Retreat: Giving Priority to Voices from

the Field
Voices from the field included ANMs, ASHAs, AWWs, members of PRIs, women
SHGs and community members from different states. Parallel to voices from the
field were commitments made by policy leaders. For instance, suggestions for
addressing maternal and child malnutrition included linking social and voluntary
organisations and government programmes in tribal dominated and hilly areas;
training frontline workers; involving PRI members and helping women panchayat
members to turn into change leaders; involving women and mothers committees in
ICDS; designing multisectoral interventions by spreading awareness and mobilising
collective action on “how to” fight undernutrition; strengthening convergence,
especially with health sector to improve access to primary healthcare, preventing
infections and managing common neonatal and childhood illnesses that impacted
nutrition; maintaining hygiene; improving agricultural productivity, dietary
diversification and environment security; and improving access to household food
security and environmental sanitation.
2 Addressing India’s Nutrition Challenges

Group Work I: Sharing Ideas and Developing a Collaborative Approach
Participants were asked to brainstorm and draw a list of issues that made their
work on nutrition positive (glads), negative (sads) and angry (mads). The purpose
was to spell out successes, challenges, bottlenecks and gaps at the ground and
policy level.
Under “Glads” they talked of introducing new schemes with greater focus
on women and children with greater direct and visible impact; enhancing
involvement and honorarium of AWWs and ASHAs; adopting a life cycle approach
to child nutrition; involving multiple stakeholders; strengthening convergence of
communities; universalising ICDS and NRHM; and increasing political will.
Under “Sads”, the group highlighted issues such as lack of convergence at higher
levels of policy; delay in paying AWWs; insufficient unit cost of nutrition; inability
to reach untapped population; low nutritional indicators; less trust in government
run programmes; lack of parental participation; insufficient monitoring of ICDS;
outcomes not being commensurate with inputs; weak infrastructure; poor
involvement of community in planning and executing nutrition programmes; and
limited resource allocation.
Under “Mads”, the group talked of corruption; poor governance and lack of
accountability; inefficient implementation of schemes; poor convergence among
departments; lack of motivation; skewed priorities and allocation of resources;
high anaemia and children being denied their right to food, nutrition and care;
low follow-up on pregnant women; and many strikes/hartals.
Group Work II: Identifying specifically, what needs to be done
Seven groups were formed and each given a theme for discussion, outlining gaps
and drawing up recommendations on “what” needed to be done. The themes
were:
Household Food Security and Livelihoods
Women and Child Care Services
Healthcare and Services
Water, Environmental Sanitation and Hygiene

Infant and Young Child Caring and Feeding Practices
Capacity Development and Community Processes

Nutrition Policy, Planning and Surveillance
Once gaps were identified, how to address them: After consensus was achieved
on “what” needed to be done, different strategies and institutional mechanisms
were identified for effective implementation through a collaborative and
consultative process. Groups voted on “how” India’s nutrition challenges would
be addressed.
1. Household Food Security and Livelihoods: Promoting agricultural policies

and research to protect land and water resources; improving storage facilities
in food deficient regions; addressing hidden hunger; improving efficiency
and effectiveness in National Rural Employment Guarantee Scheme; promoting
non-farm businesses and micro-enterprises; providing free food for destitute
and needy; encouraging women’s participation in intra-household food
Executive Summary 3
security; and engaging PRIs and SHGs to address women’s participations in food
and nutrition.
2. Maternal and Child Care Services: Having additional childcare centres for
working mothers; increasing household visits by AWWs, ASHAs and nutrition
workers; focusing on early breastfeeding and complementary feeding practices;
focusing on under-2s; conducting informative meetings with fathers and mothers;
having regular village meetings on health and nutrition; providing adolescent
girls with information on nutrition, IFA supplements and sanitation; making AWCs
mother and child development centres, rewarding panchayats and districts
that reduced malnutrition; making District Collector responsible for creating a
convergent action plan for the district; using ICT for effective communication
and reporting; implementing community level third party monitoring of services;
providing greater focus to high-burden districts; making District Actions Plans for
nutrition mandatory; and getting the state to select high-priority districts.
3. Healthcare and Services: Using weighing scales at grassroots level to

ensure regular growth monitoring; identifying cases of severe malnourishment;
introducing malnutrition treatment centres in states where they do not
exist; synchronising Malnutrition Treatment Centre/Nutrition Rehabilitation
Centre parameters; maintaining growth monitoring records; stepping up IEC
and disseminating information on VHSC and VHND; hiring nutrition experts at
block level in states where the intergenerational cycle of malnutrition needs to
be addressed; reviewing and following-up condition of severely malnourished
children; coordinating efforts of health workers; minimising differences in agendas
of departments; having regional planning at district level; identifying problems
based on five-year plans; and specifying roles of workers at grassroots level.
4. Water, Environmental Sanitation and Hygiene: Addressing problem of safe

drinking water; building proper toilets; providing water access to AWCs for
cleaning; allocating funds for maintaining centres; constructing dry toilets in
areas with low water tables; making water testing kits available; chlorinating
water; encouraging use of low cost filters; discouraging keeping cattle in toilets;
coordinating efforts of solid and liquid waste management; and creating platform
for convergence of all flagship programmes.
5. Maternal, Infant and Young Child Caring and Feeding Practices: Encouraging
early initiation and exclusive breastfeeding for the first six months; making
maternity benefit schemes available to all women; providing childcare services
under MGNREGS; imparting intensive skilled counselling to husband and mother-
in-law to address cultural practices that may prevent the mother from ensuring
optimal nutrition and care; providing additional resources to AWCs and appointing
dedicated village nutrition worker at every AWC; informing people of laws and
regulations; and launching block level campaign on exclusive breastfeeding of
infants for the first six months of life.
6. Capacity Development and Community Processes: Recognising ASHAs for their

work, and providing them with information and training; involving community;
empowering SHGs and getting them to work as social auditors; getting PRIs to
dedicate themselves to planning, and providing supportive supervision on nutrition
and child health; holding monthly public meetings on health and nutrition at
various levels; increasing involvement of home science colleges, NGOs and

community medicine departments to undertake action research; launching
toll-free helpline on nutrition.
7. Nutrition Policy, Planning and Surveillance: Revising Nutrition Policy; setting

up independent department of nutrition at the state and centre; empowering
communities on priority; adopting a life cycle approach; developing coordinated,
multisectoral strategy to integrate all nutrition related programmes and
having them in mission mode; installing independent monitoring mechanism;
decentralising nutrition programmes; assigning responsibility for implementing
and monitoring community groups; involving technical, professional and academic
research institutions in planning process; and having an effective nationwide
surveillance mechanism.
Moving from “What” Needs to be Done to “How”
Group work of 7 August was synthesised and followed-up with a multi-voting

prioritisation exercise, to develop consensus on strategy options for subsequent
discussion by groups on ‘how” to move forward.
Group Work on Day 2 was more advanced, with participants thinking of nutrition
more comprehensively. Divided into seven groups based on group composition of
Day 1, they brainstormed and presented their recommendations on the following
themes:
National Child Malnutrition Prevention and Reduction Programme
Panchayat-led Models
Conditional Cash Transfers
ICDS Restructuring
Nutrition Counselling Service Model
Institutional Arrangements at National/State/District/Local Levels
Nutrition Data Collection, Mapping and Surveillance
1. National Child Malnutrition Prevention and Reduction Programme: Launch

a multisectoral programme in mission mode, focusing on children under
two years, pregnant and lactating mothers, with a national interministerial
empowered executive body; prioritise nutrition at all levels; ensure convergent
action among participating departments; build ownership of the programme;
and use a rights-based approach.
2. Panchayat-led Models: Empower panchayats with regard to nutrition
programmes; involve them in communication strategies for bringing about
behaviour change; set up an institution at the block level for capacity
building, data collection and monitoring; promote village health and nutrition
committees; and have an independent institution to collect data and have a
proper MIS to ensure monitoring.
3. Conditional Cash Transfers: Progressively universalise schemes for adolescent
girls and conditional maternity benefits, pilot and develop a model to implement
CCTs in order to improve nutrition status of adolescent girls, pregnant women
and lactating mothers.
4. ICDS Strengthening and Restructuring: ICDS in mission mode with flexibility
in implementation; convergence at all levels; more resources for ICDS; provide
additional worker at AWC to focus on reaching under threes in community, a
separate department for WCD in states; redefine the role of AWW; and push
for better service delivery.
Executive Summary 5
5. Nutrition Counselling Service Model: Provide one village level nutrition
counsellor/additional AWW for every 1,000 persons or as per ICDS norms;
appoint a supervisor for every 20 village counsellors; form a multisectoral
team under DM; involve medical colleges and institutes; and make additional
financial resources available.
6. Institutional Arrangements at National/State/District/Local Levels: Create an
empowered department of nutrition within MoHFW or MoWCD; set up a similar
structure at the state level; make arrangements for advocacy, awareness and
counselling; avoid duplication of duties; and place interventions such as SNP
in the hands of trained and empowered local women.
7. Nutrition Data Collection, Mapping and Surveillance: Prioritise monitoring
and surveillance; strengthen existing data collection systems; link ICDS to
MGNREGA and upcoming National Food Security Act; expand annual health
and nutrition surveys to cover all districts and age groups; and link proposed
UID system to ICDS nutritional surveillance programmes.
Group work was synthesised and followed-up with a multi-voting prioritisation

exercise, to develop consensus on strategy options for implementation.
Summing Up and Way Forward
The Chief Guest Dr. Montek Singh Ahluwalia, Deputy Chairman of the Planning
Commission along with dignitaries Dr. Syeda Hameed, Member, Planning
Commission, Professor Abhijit Sen, Member, Planning Commission, Ms. Sujatha
Rao, Secretary, Ministry of Health and Family Welfare and Mr. D. K. Sikri, Secretary,
Ministry of Women and Child Development shared their views and made note of
the recommendations shared by the participants. These included: establishing
a National Institutional Arrangement for Prevention and Reduction of Child
Malnutrition; restructuring ICDS; developing panchayat and urban local body-led
models; strengthening nutrition counselling; introducing and popularising cash
transfers; conducting nutrition monitoring and surveillance. Feedback was shared
by field functionaries and community members from different states, highlighting
learnings and positive experiences from the Retreat. The meeting concluded with
the closing observation from Dr. Syeda Hameed, Member Planning Commission
that the recommendations for action emerging from this consultative process
would be placed for the consideration of the PM’s National Council on India’s
Nutrition Challenges.
The retreat, apart from bringing all stakeholders on a common platform to

discuss challenges and deterrents in pursing nutrition goals and outlining next
steps to combat these, helped create a sense of ownership towards a common
goal, and generated a consensus for moving forward. Importance of dialogue
was emphasised with there being a need for following a democratic process that
factored in all voices in a fair and equitable manner. Efforts such as organising
the Retreat would play a significant role in helping devise and streamline a viable
strategy that can help achieve nutrition targets aligned with national goals,
priorities and timelines.

II. Background
India faces a development paradox - of being in the front ranks of fast growing
global economies, with vibrant economic growth rates and in stark contrast – around
one third of the world’s undernourished children are found in India.
The above development paradox persists in spite of strong Constitutional,

legislative policy, plan and programme commitments that address the multi-
dimensional nature of the nutrition challenge. Various national programmes
that contribute to improved nutrition outcomes include the Integrated Child
Development Services, National Rural Health Mission including Janani Suraksha
Yojana, Total Sanitation Campaign, National Rural Drinking Water Programme,
Mid Day Meals Scheme, Targeted Public Distribution System, National Horticulture
Mission, Mahatma Gandhi National Rural Employment Guarantee Scheme, National
Food Security Mission and National Rural Livelihoods Mission among others.
Vicious cycle of undernutrition, disease/infections and mortality: Maternal

and Child Undernutrition is the attributable cause of more than one third of
the mortality of children under five years (LANCET 2008), many of which are
preventable through effective nutrition interventions operating at scale.
Stunting, severe wasting and intrauterine growth restriction represent the largest
attributable risk factors for deaths in children under 5 years old. Around two
thirds of undernutrition related deaths are related to inappropriate caring and
Infant and Young Child Feeding practices, and occur in the first year of life.
Preventive early action is critical: In India, annually, it is estimated that about

1.83 million children die before completing their fifth birthday. Currently the
mortality rate in children under 5 years is 69, 50 out of 1000 infants die in the
first year of life and 39 out of 1000 in the first month of life (Sample Registration
System (SRS) Bulletin 2011). Current trends highlight the need to accelerate
reductions in neonatal mortality as this constitutes nearly two thirds of infant
mortality and around half of under-5 child mortality.
In India, undernutrition levels remain persistently and Persistently high undernutrition

Using WHO Growth Standards
unacceptably high – especially in utero and in the first % Children Under-3 Years
two years of life, in adolescent girls and in women across
the life cycle, in disadvantaged/excluded community 100
51
groups and those living in areas or conditions of 43 45
80
40
nutritional vulnerability. 60
20 23
40
Maternal and Child Undernutrition: Every third woman
20
in India is undernourished (35.6 % with low Body Mass
Index) and every second woman is anaemic (55.3%). 0
Underweight Stunted Wasted
This intergenerational cycle of undernutrition is
NFHS-2 NFHS-3
perpetuated, with high incidence of babies born with 1998-99 2005-2006
low birth weight (22 %), more susceptible to infections,
Note: Using WHO 2006 International Reference Population
Background 7
more likely to experience growth
Early Preventive Action is Critical
failure, reflected in high levels of child
Percent of children age 0-59 months
70 undernutrition and anaemia. Nearly
Stunted
60 every second young child in India today
is undernourished– underweight (42.5 %
50 Underweight
of children under five years) or stunted
40 (48 % of children under five years) and
30 19.8 % are wasted.
20 Wasted
Infant and Young Child Feeding
10
practices remain sub optimal- early
0 initiation of breastfeeding within 1 hour
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 is 25 % (NFHS 3), 40.6 % as per DLHS 3.
Age in months NFHS-3, India 2005-06 Only 46 percent of infants younger than
Note: NFHS 3 - Using WHO 2006 International Reference population
six months are exclusively breastfed,
and at the completion of 6 months, only
28% are exclusively breastfed (NFHS 3 -2005-06). There has been an increase in
introduction of complementary feeding in children 6-9 months from 33 % to 55
% between NFHS 2 and 3, which can be used to build further improvements in
young child feeding.
Anaemia in young children, adolescent girls and women across the life cycle,
is also reflected in that three out of four young children are anaemic (79%) and
anaemia prevalence in young children, under 3 years has increased from 74 % to
79% between NFHS 2-1998-99 & NFHS 3-2005-06.
The girl child goes on to become an undernourished and anaemic adolescent

girl, often deprived of adequate health care and nutritional support, educational
opportunities, denied her right to be a child- married too early, with early child
bearing, inadequate inter pregnancy recoupment. This perpetuates a vicious cycle
of undernutrition and morbidity that erodes human capital through irreversible
and intergenerational effects on cognitive and physical development.
This intergenerational cycle of undernutrition is accentuated by multiple

deprivations related to gender discrimination, poverty and exclusion.
High levels of undernutrition persist: Improvements over successive plan periods

have been inadequate, with a decrease of less than 0.5 percentage points per
year in underweight prevalence in children under 3 years between 1998-99 and
2005-06. The reduction of nearly 1 percentage point per year in stunting rates in
the same period (NFHS 2,3) is indicative of the possibilities of ensuring long term
improvements in nutrition status. Another finding from NFHS 2,3 is that there
has been deterioration in child nutrition status in states such as Madhya Pradesh,
Jharkhand, Bihar, Gujarat and Meghalaya.
Micronutrient Deficiencies, i.e. deficiencies of key vitamins and minerals such as

Vitamin A, Iron, Iodine and also zinc continue to coexist with protein and energy deficits
and need to be addressed synergistically, through a multi-pronged approach.
The prevention and management of common neonatal and childhood illnesses

and adequate care and referral of severely undernourished and sick children also
remains a challenge.

Wide disparities in nutrition status
Undernourished Children in India
exist across and within states, districts (% underweight children under 5 years-Using WHO CGS-NFHS 3)
and different community groups. For
instance, underweight prevalence in 70
children under 5 years from Scheduled 60
tribe communities was as high as 50
54.5%, compared to the national
40
average of 42.5%, and 33.7 % in other
communities (NFHS 3-2005-06). NFHS 30
data also suggests that India is in the 20

process of nutrition transition, where 10
the dual burden of malnutrition – i.e.
0
INDIA
MP
UP
HP
J&K
Jharkhand
Bihar
Gujarat
Orissa
Tripura
Assam
Meghalaya
Chhattisgarh
Rajasthan
Haryana
West Bengal
Karnataka
Andhra Pradesh
Tamil Nadu
Delhi
Goa
Nagaland
Punjab
Kerala
Mizoram
Manipur
Sikkim
Uttarakhand
Maharashtra
Arunachal Pradesh
overnutrition and undernutrition is
beginning to be seen in some groups.
Therefore, preventive early action –

prenatally, in the neonatal period, early
Note: NFHS 3 - Using WHO 2006 International Reference population
infancy- in the first hour, day, week,
month, and in the first two years of life
is critical for addressing a vicious cycle of undernutrition, disease/infections,
related mortality and risks to maternal and child survival and development.
Determinants of Undernutrition: Undernutrition is the outcome of insufficient

dietary intake, absorption and inadequate prevention and management of
disease/infections.
Underlying causes include the lack of access to health and child care services and
hygienic environments, lack of access to household food security and livelihoods,
and inadequate caring and feeding practices for children and women. Basic
determinants include poverty, agriculture, public distribution systems, water
and environmental sanitation, education and communication, control and use of
resources (human, economic, natural), shaped by the macro socio-economic and
political environment.
Undernutrition – A Conceptual Framework
Multisectoral Interventions needed:
To address the multi- dimensional Manifestations
Child Undernutrition
nutrition challenges being faced in
Immediate
India – especially by the most critical, Inadequate Dietary Intake Disease/Infections determinants
vulnerable and excluded community
groups – comprehensive multisectoral Lack of Inadequate Care Inadequate access
Household for Women and to Health Childcare
interventions and redesigned Food Security Children Services & Hygienic Underlying
institutional arrangements are needed. Environment determinants
Lack of Information
The Eleventh Plan Monitorable Education Communication
Targets Lack of Resources & Control Human,
Economic & Organisational
The Eleventh Five Year Plan positions
the development of children at its Political and Ideological Superstructure
Basic
centre and recognises nutrition as determinants
critical for ensuring the health, survival Economic Structure
and development of children and

Potential resource base
women, towards more inclusive growth.
Background 9
It accords high priority to addressing maternal and child undernutrition through
multisectoral interventions by different sectors.
The Eleventh Five Year Plan and its Mid Term Appraisal, presented to the
National Development Council on 24 July 2010, provide the vision, objectives
and monitorable targets for the strategy to address India’s Nutrition Challenges.
The objectives of the Strategy to address India’s Nutrition Challenges, as defined

in the Eleventh Plan Monitorable Targets, are as follows:
Reduce malnutrition among children (underweight prevalence) in the age
group 0–3 years to half its present level, by the end of the Eleventh Plan.
Reduce anaemia among women and girls by 50% by the end of the Eleventh
Plan.
The Mid Term Appraisal of the Eleventh Plan, presented to the National Development
Council on 24 July 2010, clearly highlights the need to accelerate action to prevent
and reduce maternal and child undernutrition, as early as possible, across the
life cycle. It also calls for policy reform and ICDS restructuring.

III. Introduction
In this perspective, the highest priority is being accorded to combating

malnutrition, through concerted multisectoral action to address the immediate,
underlying and basic determinants of undernutrition. Meetings were held by
the Prime Minister’s Office and the Planning Commission with the ministries of
Women and Child Development (MoWCD) as well as Health and Family Welfare The joint strategy
(MoHFW), to formulate a joint Strategy Note and evolve action recommendations note was shared with
to be placed for consideration of the PM’s National Council on India’s Nutrition different sectors in
Challenges. June 2010 and their
suggestions and inputs
It was also decided that a Multistakeholder Retreat on Addressing India’s were incorporated by
Nutrition Challenges would be organised by the Planning Commission, to evolve a core group, to enrich
a Framework for a multisectoral National Plan of Action to prevent and reduce the same.
undernutrition- especially maternal and child undernutrition in India, in a time
bound manner, with clearly articulated commitments of different stakeholders.
It was agreed that the joint Strategy Note evolved by both ministries would
be used to facilitate group work at the Retreat, with further ideas for action
emerging from this consultative process. The joint strategy note was shared with
different sectors in June 2010 and their suggestions and inputs were incorporated
by a core group, to enrich the same. The suggested emphasis was on defining
how institutional reform would take place at the village level, recognising that
there were major implementation gaps in the national programmes, delivering
nutrition related interventions.
Developing a Joint Strategy Note

The MoWCD in consultation with the MoHFW drafted a joint strategy paper on tackling India’s nutrition
challenges prior to the retreat which was further refined through inputs from other sectors, experts and
consultations, especially through interaction at the retreat. While outlining the conceptual framework
designed for better child nutrition outcomes, which took into account basic, underlying and immediate
determinants of malnutrition, there were reasons like the prevalence of common diseases and infections,
lack of access to healthcare, unhygienic environments and sub-optimal maternal and child caring practices
which contributed to child under nutrition.
It was emphasised that the continuum of care could be strengthened through a childcare and development-
based approach. Also, household food security and livelihoods could be enhanced by increasing food
supplementation programmes and linking them to the proposed National Food Security Act. More importantly,
ICDS strengthening and restructuring had to be a priority. There was need for additional AWW as nutrition
counsellor. Convergence at all levels (joint Mother and Child Protection Card as an entitlement tool), joint
training and capacity building of workers and resource centres, constructing nutrition centres, using ICT
and instituting strong regulatory mechanisms were also suggested. A Policy Coordination and Support Unit
within the Planning Commission was recommended to support policy alignment across sectors and states,
helping position nutrition centrally in development plans and programmes while coordinating third party
evaluations.
Introduction 11
Design and Leadership teams were constituted in June 2010, to facilitate
the Multistakeholder Retreat – from inception and design to culmination in
recommendations for action, to be synthesised and placed before the PM’s
National Council on India’s Nutrition Challenges. The Design team constituted
a representative sample of the multiple stakeholders who participated in the
retreat, to help ensure that the design and organisation of the retreat responded
to different stakeholder perspectives. The Leadership team provided the vision
and leadership that guided this initiative and is critical for its conceptualisation,
multisectoral implementation and effective impact.
Several consultations were also organised by the Ministry of Women and Child
Development, including the Conference of State Ministers/State Secretaries in
Charge of WCD (16-17 June 2010), Consultative Committee of Parliament on
Malnutrition in Women and Children (25 June 2010), and a Consultation with
young Members of Parliament (28 July 2010). The recommendations from these
consultations further enriched the joint strategy note, which facilitated the
deliberations of the Multistakeholder Retreat.
The recommendations of the draft Mid Term Appraisal of the Eleventh Plan,
presented to the National Development Council on 24 July 2010, and the findings of
the interim report of the NCAER ICDS Evaluation study provided valuable insights,
enriching and reinforcing strategic options for institutional reform.
The Multistakeholder Retreat
The Multistakeholder Retreat on Addressing India’s Nutrition Challenges was

subsequently organised by the Planning Commission in New Delhi on 7-8 August
2010. Over 200 participants from 16 states took part in the two-day consultation,
which brought together representatives from different stakeholder groups.
The states that were represented include Andhra Pradesh, Assam, Bihar,
Chhattisgarh, Delhi, Himachal Pradesh, Jharkhand, Kerala, Madhya Pradesh,
Maharashtra, Meghalaya, Orissa, Rajasthan, Tamil Nadu, Uttar Pradesh and West
Bengal.
Objectives of the Retreat
These were as follows:

To prioritise key multisectoral interventions for accelerating action to urgently
address India’s nutrition challenges.
To identify different strategy options and institutional mechanisms for effective
implementation, building on the experiences of different stakeholders.
To evolve a National Plan of Action for Nutrition Framework for combating
undernutrition.
To reaffirm commitment to action for addressing India’s nutrition challenges.
Participants’ Profile
These included a wide spectrum of stakeholders – the Deputy Chairman, Planning

Commission, Union Minister of Tribal Affairs, Minister of State (Independent
Charge) for Women and Child Development, Members of the Planning Commission,
Secretaries of concerned Ministries from the Central and State governments, senior

officers of the Prime Minister’s Office and the Planning Commission, members of
the PM’s National Council on India’s Nutrition Challenges and other Commissions,
civil society groups, experts, national institutions, field functionaries such as
supervisors, ANMs, anganwadi workers, ASHAs, representatives of Panchayati Raj
Institutions and Women’s Self Help Groups, other community groups, converging
diverse stakeholder perspectives.
Specifically, the stakeholder groups included:

Union Ministers of key sectors, Deputy Chairman and Members of the Planning
Commission
Senior Officials from the Planning Commission
Senior Officials from the Prime Minister’s Office
Secretaries and Senior Officials of concerned Ministries at national level:
Women and Child Development

Health and Family Welfare
Rural Development
Agriculture Food and Civil Supplies
Elementary Education
Panchayati Raj
Information and Broadcasting
State Secretaries from major Ministries
Women and Child Development
Health and Family Welfare
Panchayati Raj
National Commissions and Councils such as NCPCR, NCW

National Institutions such as NIHFW, NIN, NHSRC, PHFI
Peoples’ Representatives
Civil society groups, voluntary agencies, Alliances and Networks
Experts and professional bodies
Development partners
Representatives of field functionaries.
Representatives of Panchayati Raj Institutions
Representatives of community groups, women’s groups, mother support groups
Design team and facilitators
Methodology
The Retreat used Real Time Strategic Change methodologies, listening to the
voices of stakeholders, small group dialogue, large group interaction, multi or open
voting, preferred futuring and Visualisation of Participatory Programming (VIPP).
The exhibition of state best practices, innovation, local materials and poster
presentations by state teams facilitated interstate sharing and learning, while the
use of local folk media, street theatre after Retreat sessions enabled a shared
appreciation of different issues and local solutions in different state contexts.
“What”: On the first day of the Retreat, seven groups were formed. They
discussed and identified gaps before making recommendations on “what” needed
to be done on the following themes:
Health Care and Services
Water, Environmental Sanitation & Hygiene
Introduction 13
Infant and Young Child Caring and Feeding Practices
“How”: On the second day, based on consensus achieved over “what” needed
to be done, different strategy options and institutional mechanisms for effective
implementation were identified. They built on the experiences of different
stakeholders. Groups voted on “how” India’s nutrition challenges would be
addressed, with emphasis on changes envisaged for communities at the village
level.
Principles of action were synthesised and major recommendations were

prioritised and discussed by the different groups.
Outcomes
The Retreat evolved a Framework for a multisectoral National Plan of Action to

prevent and reduce under-nutrition, especially maternal and child undernutrition,
in India.
Spread over two days, key outcomes of the discussions were:

Common understanding of multiple stakeholders on strategies for addressing
India’s nutrition challenges.
Key Recommendations for Action to address India’s Nutrition Challenges,
especially maternal and child undernutrition.
Renewed commitment of stakeholders to key actions within specified time
frames.
Consensus on the process for moving forward.
These have been detailed in Chapter V – Synthesis of Major Recommendations

For Action.
Detailed proceedings of the Consultation have been documented to record the

process through which consensus was created, the recommendations for action
that emerged from this process and to facilitate sharing of information amongst
all stakeholders.

Day-1
7th August 2010
15
Glimpses of the
Multistakeholder
Retreat

IV. Proceedings of the Multistakeholder Retreat
The Retreat was initiated through informal interactions between state teams and The use of local folk
other participants on 6th August, 2010, as teams worked together to put up an media by some state
exhibition of training and communication materials from their states, showcasing teams also provided
innovative approaches, best practices and state initiatives. Poster presentations insights into how
facilitated inter state sharing and learning, as well as dialogue around the key culturally appropriate
issues highlighted in the joint strategy note, shared earlier with participants and responsive
of the Retreat. The use of local folk media by some state teams also provided approaches contributed
insights into how culturally appropriate and responsive approaches contributed to improvements in
to improvements in caring and feeding practices for children, girls and women. caring and feeding
State teams also identified members who wished to share their experience in the practices for children,
opening session the next day. girls and women.
7 August 2010
Session I: Inaugural Session
The Retreat started with participants greeting the key speakers of the inaugural
session. The dignitaries present on the dais were welcomed by the state
representatives with bouquets.
Mr. Kantilal Bhuria, Union Minister of Tribal Affairs was

welcomed by Ms. Amravati Sharma, AWW, Solan district,
Himachal Pradesh; Ms. Krishna Tirath, Minister of State
(Independent Charge) for Women and Child Development
by Ms. Aruna Sharma, ASHA, Amer district, Rajasthan; Mr.
Arun Maira, Member Planning Commission by Ms. Baphira
Kharbuli, SHG Member, Shillong, Meghalaya; Mr. D. K. Sikri,
Secretary, MoWCD by Ms. Mumthas, Block Panchayat member,
Malappuram, Kerala; Ms. Sudha Pillai, Member Secretary,
Planning Commission by Ms. Ashima Gope, ANM, Uttar
Dinajpur district, West Bengal; Dr. Syeda Hameed, Member
Planning Commission by Ms. Shobha Rani Karan, AWW, Patna district, Bihar;
and Ms. Vandana K. Jena, Senior Adviser, Women and Child Development and
Voluntary Action Cell in the Planning Commission by Ms. Mumthas. Following this,
the inaugural lamp was lit by Mr. Kantilal Bhuria and Ms. Krishna Tirath along with
other dignitaries and the state representatives who had presented the bouquets,
signifying a joint commitment to action.
The inaugural session then began with a welcome address by Ms. Vandana K.
Jena, Senior Adviser, Women and Child Development and Voluntary Action Cell, in
the Planning Commission. After welcoming the participants, Ms. Jena elaborated
on the purpose of the retreat, stating the following four key objectives:
Prioritise key multisectoral interventions for accelerating action to urgently
Proceedings of the Multistakeholder Retreat 19

Identify different strategy options and institutional mechanisms for effective
implementation, building on the experiences of different stakeholders.
Evolve a National Plan of Action for Nutrition Framework for combating under-
nutrition.
Reaffirm commitment to action for addressing India’s nutrition challenges.
Ms. Jena especially welcomed the ANMs, ASHAs, Anganwadi Workers (AWWs),
members of Panchayati Raj institutions, women’s SHG groups and community
members from different states who were participating in the retreat. She
emphasised that their voices and rich field experience would bring valuable
insights for addressing India’s nutrition challenges. She said successful models
and best practices had been documented and poster presentations had also been
exhibited and shared. She then invited some of the community representatives
and field functionaries to share their perspectives.
1.1 Voices from the Field
Ms. Archana Jangid, member of a Self Help Group (SHG) in Chembur block
of Jaipur in Rajasthan spoke of ‘Kaleva Yojana,’ a programme initiated by a
SHG, which provides milk, biscuits and porridge as breakfast to women. She
highlighted how earlier, women returned home few hours post delivery without
partaking of any food in the hospital, leading to their weakness, low resistance
and vulnerability to illness. However, now they are given nutritious food and
medical care for 48 hours after delivery, as well as counselling
on early initiation (within one hour of birth) and exclusive
breastfeeding for the first six months of life and optimal
childcare practices. Also, the mother and the child are both
given thorough health check-ups before being released.
Staying in the hospital ensures early initiation and colostrum
feeding, which is ideal nutrition for the baby, and is like the
child’s first immunisation, protecting her/him from illness.
It is also a rich source of Vitamin A. It fosters mother child
bonding and healthy child development. She suggested that
this approach should be extended in other states also.
“Nowadays, mothers are given food and proper medical care for 48 hours
after delivery, and are also given guidance on promoting and supporting
optimal breastfeeding and childcare practices.”
Archana Jangid, SHG member, Chembur block, Rajasthan
Ms. Dinesh Sharma, an AWW also from Rajasthan, highlighted a programme

under which they provided nutritious food like soyabean and wheat to prevent
undernourishment in mothers and children. Every child was also weighed and
the weight was regularly monitored on a growth card given to the mother, with
counselling for improving key care behaviours. This regular monitoring and
promotion of young child growth and development helped prevent undernutrition
in infancy itself, contributing to reducing Infant Mortality Rate (IMR). She
expressed the view that early prevention must be emphasised to tackle this
problem effectively– so that children do not suffer.
Ms. Ranju Devi, ASHA from Sariahat Block, Dumka District, Jharkhand informed
that, under NRHM, her main role was to bring health facilities to the family/

community, provide DOTS services, organise meetings, carry
out NSV and help reduce overall IMR and MMR. Her duties
included advising women and adolescent girls on nutrition,
and motivating young girls to become healthy by providing
information about IFA tablets, green leafy vegetables and
nutritious food. She highlighted the need for an integrated
strategy for health and nutrition, in a life cycle approach that
includes adolescent girls.
Ms. Chhaya Jadhav, ASHA from Thane District, Maharashtra,

talked about how before she became an ASHA, women used
to deliver their babies at home, but now thanks to NRHM
and her interventions, they are opting for institutional deliveries, whereby both
the mother and child receive proper care. The mothers also receive honoraria
through the Janani Suraksha Yojana (JSY) scheme, which is a boon in the tribal-
dominated village where the average income of a household is Rs. 40-50 a day.
She highlighted the need for maternity benefits to ensure better post natal care
and optimal breastfeeding and care of the infant.
“Before I became an ASHA, women used to deliver their babies at home,

but now I ensure that they undergo only institutional deliveries, whereby
both the mother and the child can receive proper care. Moreover, the
mothers also receive honorarium under the Janani Suraksha Yojana.”
Chhaya Jadhav, ASHA, Nadora village, Palgarh, Thane District, Maharashtra
Mr. Sachin Baghel, member of a Zilla Parishad in Chhattisgarh, spoke about how
India has made tremendous progress in various sectors, but continues to lag in
the field of nutrition, where change is needed to address implementation gaps.
He said that since independence, numerous schemes had
been launched, but few were sustained. Since 2002, various
steps had been taken such as the ‘Nutrition Health Day’
celebrated every Monday, which had yielded positive results.
The attempts to eradicate undernutrition continue despite
development challenges in areas affected by extremism, and
the absence of basic infrastructure like AWCs and schools.
He called upon panchayati raj members to show greater
concern and involvement in the area of women and child
development –including nutrition. He was glad that the
subject of undernutrition was being taken up now and he
urged panchayats to respond with enthusiasm to this clarion
call for malnutrition free panchayats.
1.2 Concerns and Commitments by Policy Leaders
Mr. Kantilal Bhuria, Union Minister of Tribal Affairs, then addressed the gathering,
emphasising the need for nutrition to be seen as a critical development imperative,
especially for the most excluded and vulnerable tribal community groups. He
appreciated this initiative of the Planning Commission in bringing together such a
diverse group of voices from the field. He stated that the multistakeholder retreat
demonstrated the government’s commitment to listen to the experiences of the
grassroots workers and the communities for whom the programmes were designed.
He reiterated that undernutrition is a major problem in India, and that IMR and

MMR levels have failed to go down sufficiently, despite the
widespread presence of NRHM, ICDS, and other programmes.
He highlighted the need for improving the quality of delivery of
public services, with greater transparency and accountability,
emphasising grass roots level monitoring. ICDS does not focus
adequately on children under three years of age, he stated,
whereas this is the most crucial and vulnerable period for their
survival and development. Also, NFHS-3 data revealed that
the majority of children afflicted with undernutrition reside
in states with significant concentration of tribal population-
Madhya Pradesh, Jharkhand, Bihar, Chhattisgarh, Orissa, West
Bengal and Maharashtra. He made a few key suggestions on
tackling maternal and child undernutrition:
Link social and voluntary organisations and government programmes in tribal
dominated and hilly areas, for effective capacity development.
Impart training to frontline workers to enhance awareness among people and
to bring about motivation for change.
Link panchayati raj members to the entire gamut of processes and empower
them for action, especially women panchayat members, who can become
change leaders.
Involve women and mothers’ committees in the ICDS programme, especially
since they are key stakeholders, committed to the best interests of children.
They can be empowered not only to demand quality services, but also to
improve the quality of services, and support community based monitoring of
services and the use of funds for such programmes.
He concluded by saying that children are the future of the country, and that the
achievement of major development goals begins with children. Faith and trust
must be maintained in programmes that touch their lives- with empowered local
governance mechanisms which listen to the voices of the most excluded. New
schemes being brought in a life cycle approach such as those for adolescent
girls and maternity support must be designed to complement and enrich existing
schemes. Emphasis is needed on village level implementation, to ensure that
change takes place and child related survival, growth, development and early
learning outcomes are visible.
Ms. Krishna Tirath, Minister of State (Independent Charge)

for Woman and Child Development (MoWCD) spoke about
preventing the intergenerational cycle of maternal and child
undernutrition, stating that this is the foundation for India’s
human development and inclusive growth. Women and
children constitute 70% of India’s population –and they shape
both the present and the future of India’s development. She
stressed the need to involve everyone, especially grassroots
level workers, in combating undernutrition, appreciating that
in this retreat, their participation was significant. She then
shared the outcome of a series of consultations held by the
Ministry of WCD with State WCD Ministers and, Secretaries,
the Consultative Committee of Parliament and young MPs on nutrition, which
highlighted the need for multisectoral State/District Nutrition Action plans,
especially in states/districts with very high levels of maternal and child
undernutrition. She emphasised that multisectoral interventions are needed for
addressing undernutrition, highlighting the following recommendations:

Spread awareness and mobilise collective action on “how to” fight
undernutrition, with all ministries joining hands in this regard.
Strengthen convergence, especially with the health sector to improve access
to primary health care, including the prevention of infections, and the
management of common neonatal and childhood illnesses, impacting upon
nutrition.
Maintain clean, hygienic and healthy environments and reduce hazardous
processes.
Improve agricultural productivity, dietary diversification and environment
security, thereby improving access to adequate household food security and
environmental sanitation.
She reiterated that the ICDS programme was designed as a unique community
based outreach programme, addressing the interrelated needs of children under
six years, pregnant and breastfeeding mothers through integrated services for
health, nutritional support and early learning. ICDS is not just a feeding or nutrition
programme – it is a comprehensive programme for the holistic development of
children. Several services are specifically designed for pregnant and lactating
mothers and children under three years, such as supplementary nutrition, Take
Home Rations (THRs), growth monitoring and promotion, immunisation, health
check ups and referrals, IFA supplementation, nutrition and health education,
including on optimal infant and young child caring and feeding practices. However
implementation strategies need to be strengthened to reach the most vulnerable
and the most unreached.
She then highlighted the details of the new scheme that is being launched, the
Rajiv Gandhi Scheme for the Empowerment of Adolescent Girls - SABLA in 200
districts, addressing undernutrition and anaemia in out of school adolescent
girls, and promoting their self development and empowerment. In addition
to supplementary nutritional support, IFA supplementation, health check ups,
awareness creation, services include life skills and vocational skills; mainstreaming
out of school AGs into formal/non formal education; and providing information/
guidance about existing public services.
She indicated that another scheme providing maternity benefits and support for
early and exclusive breastfeeding of infants for the first six months of life is on
the anvil. With the addition of both schemes, the lifecycle approach to addressing
India’s nutrition challenges will be strengthened, as interventions will specifically
focus on pregnancy, lactation, early infancy, under threes and adolescent girls.
The involvement of ASHAs and ANMs in this regard and joint action with AWWs at
field level would be essential.
She concluded by calling for strong multisectoral linkages, for instance with
the health and rural development ministries by promoting tree plantation
and promoting hygiene and cleanliness through continuous counselling and
demonstrations, which would contribute in improving the health and nutrition of
women, children and their communities.
Ms. Sudha Pillai, Member Secretary of the Planning Commission then highlighted
a framework for a National Plan of Action for Nutrition. She said that if the
problem of undernutrition continued, it would signify the denial of basic
human rights, as undernutrition compromises brain development, depriving

children of the right to achieve full development potential.
This is reflected in an intergenerational cycle of multiple
deprivations – of poverty, exclusion, gender discrimination
and undernutrition. She drew attention to the large
proportion of the population working in the unorganised
sector, who are not paid even minimum wages. Added to
this is the neglect of their health, owing to illiteracy, social
customs and unhygienic environments. This deprivation
is also manifest in problems such as child labour, lack of
education and undernutrition.
Certain segments of society require special care and services because of their
vulnerabilities and deprived conditions. These include tribal villages and
construction workers, whose life conditions cannot support optimal health,
nutrition practices and realisation of development potential.
Ms. Pillai concluded therefore by stating that it is a right as well as a responsibility

of all stakeholders to eradicate the problem of undernutrition, to ensure more
inclusive growth and sustainable human development.
Dr. Syeda Hameed, Member of the Planning Commission

summed up the session, saying that the Retreat had brought
together a diverse pool of people from various fields and
parts of the country, who were aware of the problem and
also the possible solutions. She expressed the hope that with
the help of the varied experiences of those present, major
recommendations would emerge to help map concrete steps
for the road ahead. She highlighted that the Prime Minister has
accorded high priority to addressing this challenge and that
the recommendations of the Retreat will be placed for the
consideration of the PM’s National Council on Addressing India’s
Nutrition Challenges, for evolving a road map for action.
She emphasised that the Retreat had been designed to encourage inclusion of
a diverse spectrum of stakeholder groups such as policy leaders, programme
managers, institutions, experts, grassroots functionaries, panchayati raj
institutions and community members. The participatory process would help
people learn from each other and to collectively formulate an actionable
strategy to combat undernutrition. This consultation is also unique in that it
brings together both the science and the practice, and focuses not just on
what needs to be done –but on how this will be done. She then concluded
the inaugural session, with a brief introduction to the participatory process
envisaged for the Retreat.
Session II: Voices of Stakeholders
Session II was designed as an opportunity to listen to different stakeholders and

structured to build cohesion across different stakeholder groups represented
at each table. Each table represented a microcosm of the larger spectrum of
stakeholders engaged in this process. This was designed to ensure that each
stakeholder group could voice their concerns, listen to diverse groups and through
dialogue come to a common understanding. This affinity process helped build a

common understanding of India’s nutrition challenges and strategy elements for
addressing them.
During this session, various stakeholders from different settings and levels of
functioning spoke regarding the nutrition challenges from their perspective,
within the different states, districts and villages they were representing. They
highlighted the status of the nutrition programme within their own community,
highlighting the successes and achievements as well as indicating the areas in
need of improvement.
Mr. Anil Sachdeva, Founder and CEO of the School of

Inspired Leadership (SOIL), introduced the session and in
his capacity as a resource facilitator of the Retreat, urged
everyone to “listen” and “absorb” different experiences,
as a prelude to working collaboratively to come up with a
set of recommendations and an action plan. This was also
termed as the “breathing in” process, to enrich perspectives
of individual stakeholder groups, by hearing from others. The
cross section of stakeholder groups asked to present their
views included programme functionaries from both health
and ICDS, a district collector, handling multiple development
sectors and a development partner, working intensively at
field level.
Ms. B. Kamalangi, ICDS Supervisor, Gajapati district, Orissa said that malnutrition
is a major challenge at the national as well as the state level. In Orissa, the Chief
Minister’s Relief Fund is being taken up extensively, and supplementary nutrition is
made available through locally available foods and cereals. Importance is given to
promoting early and exclusive breastfeeding for the first 6 months, with appropriate
complementary feeding upon the completion of 6 months (along with continued
breastfeeding for 2 years or beyond), with the Orissa Government providing
technical assistance in this regard. Nutritional experts were consulted to design
local and culture specific supplementary feeding options. However problems that
they faced in the district included:
Lack of awareness and involvement of women and PRIs
Inadequate attention paid to malnutrition at panchayat level

Inability of women to exercise reproductive rights and poor knowledge
regarding birth spacing, which implies that early marriage and child bearing
take a toll on maternal nutrition and birth outcomes
Absence of clean drinking water; sanitation issues and poverty
Disturbance due to presence of extremism in pockets
Inadequate convergence between departments of health, PRI and WCD/ICDS
Ms. Kamalangi concluded by saying, “Nutrition has to be on everybody’s agenda,

for there to be a visible reduction in undernutrition”.
Ms. Aruna Sharma, ASHA from Amer District, Rajasthan shared her thoughts around
problems related to the implementation of health and nutrition services, including
the lack of sufficient vaccines, proper delivery facilities (even in her Primary
Health Centre), and infrastructural issues such as transport and communication.
She suggested that setting up private hospitals in closer proximity to the villages
might be a solution.

Ms. Ashima Gope, an ANM from the Uttar Dinajpur District, West Bengal cited the
need to have a healthy mother with a healthy baby for the overall health of the
community. Highlighting several positive aspects of the nutrition movement such
as convergence between health workers and services, with monthly meetings
conducted on every third Saturday, she was of the opinion that greater involvement
of PRIs is needed at the grassroots level, with a special focus on remote areas.
Special funds are being reserved for and provided to malnourished children.
Also, mothers’ meetings are held regularly, in which all frontline workers
participate. Counselling is provided for adolescent girls, mothers, mothers-in-
law, and husbands, with a focus on providing IFA supplements and spacing births.
The number of institutional deliveries has increased under the JSY scheme and,
although some women have dropped out of the programme, the numbers are
being monitored. She concluded her talk by emphasising the need for community
awareness and mobilisation regarding nutrition.
“The convergence between services and health workers is a positive

aspect of the nutrition movement. There is also greater involvement of
the PRIs at the grassroots level, with a special focus on remote areas.”
Ashima Gope, ANM, Raiganj, Uttar Dinajpur District, West Bengal
Mr. Mukesh Kumar, Executive Director, CARE India pointed

out the three main problems which ICDS and NRHM had
consistently faced in the past 15 years:
There were many gaps in understanding malnutrition

and undernutrition, which still remain unrecognised.
Understanding the issue of nutrition turned into a debate
and while a lot had been said about ‘Poshan’ (nutrition),
‘Palan’ (care) was conveniently forgotten. This too had to
be everybody’s responsibility.
There must be consensus on the age that should be the
centre of focus, which is -9 to +2 (through pregnancy until the child is 2

years old).
Many people have been excluded from nutrition programmes on account of
social and cultural barriers. New ways of linking them (including those who
drop out of the programme) must be found.
Positive outcomes of nutrition programmes include the increase in commitment

towards providing supplementary nutritional support to different segments of the
population, through government programmes and community participation. More
state and region specific initiatives are needed. A constituency around nutrition
involving AWWs, ANMs, ASHAs, mothers’ groups, civil societies and NGOs could be
developed, as also close monitoring of activities undertaken.
Ms. P. Amudha, District Collector of Dharmapuri District in Tamil Nadu, focused

on the progress made in the state and district, with IMR dropping from 42 in 2006
to 24 in 2010 and MMR also coming down. In spite of low literacy and education
levels, health problems and child marriage, malnutrition had been reduced due
to the following interventions:
Convergence at district level: Work was allocated to various departments on

the basis of fund allocations; 750 AWCs now have drinking
water supply and proper sanitation.
Maternity Benefit Scheme: The mother receives Rs. 6000
in case of an institutional delivery. The money is given on
the day of delivery, and enables improved nutrition and
care of the mother, while supporting her in practising early
and exclusive breastfeeding of the infant for the first six
months- ideal nutrition for the baby. This scheme has led to
a significant increase in institutional deliveries and exclusive
breastfeeding rates.
Appointment of AWWs and Helpers: The selection process is
based on merit and is completely transparent, making all workers responsible
and accountable. Paying AWWs (Rs. 5000) and helpers (Rs. 3000) along with
a bonus or pension at retirement were motivators for reducing the IMR and
MMR.
Ms. Amudha spoke about how child marriage was rampant in Dharmapuri district,
where the average age difference between married couples was quite large. It
was common to find girls of 16 married to men who were 35 years old. This led to
health complications pertaining to early pregnancy, childbirth and delivery.
She suggested that there still remains a need for greater convergence and
monitoring mechanisms, and improvements in nutrition outcomes could be
accelerated if two AWWs were provided in each AW centre, as had also been
done under TINP earlier. Work can be divided, with one AWW looking after centre
based activities, focusing more on early learning for 3-6 year olds, and the other
for family contact/counselling and prioritised home visiting, focusing on mothers
and children under 3 years.
In sharing their experiences with one another, participants realised that they
were not alone in facing problems and frustrations within the programme. Others
too had encountered similar bottlenecks, while others had been successful, and
by coming together, they could find ways of addressing some of these challenges.
The resource facilitators’ team then helped organise participants into groups to
enable them to undertake a joint exercise and to present their findings to the
larger group in the plenary session that followed.
Session III: Group Work - “Glads, Sads and Mads”
Participants were asked to brainstorm within their groups

and draw up a list of issues that made their work on Nutrition
positive (“glads”), negative (“sads”), and angry (“mads”).
A comprehensive list based on their team work is presented
below:
3.1 “Glads”
Introducing new schemes with greater focus on women and

children
Schemes having direct and visible impact on health of
children
Enhancing involvement of AWWs and ASHAs to strengthen nutrition objectives

Increasing honorarium of AWWs
Getting AWW and helpers to work alongside women in select states
Adopting Life Cycle Approach for child nutrition
Getting multiple stakeholders to join hands to discuss nutrition
Strengthening convergence of communities and stakeholders
Universalising ICDS and NRHM
Increasing political will to deal with malnutrition; increasing food ration
programmes and institutional mechanisms
AWW reaching over 14,00,000 households and providing delivery and childcare
services in close proximity to villages
Providing 100% immunisation at AWCs
Seeing good results through Sarva Shiksha Abhiyan
3.2 “Sads”
Lack of convergence at higher levels; in policy, delivery; in multiple sectors

Delay in payments to AWWs
Insufficient unit cost of nutrition
Inability to reach untapped population
Consistently low nutritional indicators over the last 50
years
Low levels of trust in government run programmes
Lack of parental participation
Insufficient monitoring of ICDS
Target beneficiaries not getting required benefits
Outcomes not commensurate with inputs (efforts &
funds)
Poor honorarium of AWWs & helpers
Weak Infrastructure
Disorganised involvement of community in planning & executing nutrition
programmes
Limited resource allocation
3.3 “Mads”
Corruption, seen as funds allocated by government not reaching beneficiaries;

food for children being used to make money; malpractice abounds in the food
supply system
Poor governance and lack of accountability
Poor implementation of schemes
Poor convergence among departments
Lack of motivation
Skewed priorities and allocation of resources
High prevalence of malnutrition, high anaemia and children being denied their
right to food, nutrition and care
Low incentives to ASHA/AWW
Low follow-up of pregnant women
Many strikes/hartals
This exercise was conducted with the intention of getting all participants on the
same wavelength. The brainstorming and discussion that preceded the listing

of clear pointers indicated what they encountered in the field. To that extent,
it spelt out successes, challenges, bottlenecks and gaps at the ground level as
also at the policy level. This discussion also subsequently enabled participants to
take this perspective into their group work. But before they did that, they were
apprised of the major themes and issues that were taken up while formulating the
Joint Strategy Note prepared by the Ministries of Women and Child Development
and Health and Family Welfare on Addressing India’s Nutrition Challenges.
Session IV: Presentation of the Joint Strategy Note
The Ministry of Woman and Child Development, in consultation with the Ministry
of Health and Family Welfare, had drafted a joint strategy paper on how to tackle
India’s nutrition challenges prior to the retreat, as a culmination of meetings held
by the Prime Minister’s Office and the Planning Commission with the Ministries
of Women and Child Development, Health and Family Welfare, to accelerate
action. It was agreed that the joint strategy note would be refined through inputs
from other sectors, experts and other consultations. It was also decided that
the updated synthesis/summary of this strategy note would be used to facilitate
group work at the Retreat, with ideas for action emerging from listening to voices
from the field – validating, refining or modifying the joint strategy note.
Dr. Shreeranjan, Joint Secretary, MoWCD, shared details of

the strategy note, stating that nutrition is critical for overall
health, development, productivity, and economic growth.
The cost for treating malnutrition is 27 times the cost of
preventing it and prevention, as early as possible is critical
for achieving significant reductions in undernutrition levels.
Currently, food security is not ensured in every household,
and there is insufficient improvement in the situation of
women and children. In spite of the inadequate outreach
and provision of maternal and child care and health services,
however, positive changes have taken place in areas where
initiatives have been taken.
While outlining the conceptual framework designed for better child nutrition
outcomes, which took into account the basic, underlying and immediate
determinants of malnutrition, he cited factors such as the prevalence of common
diseases and infections, lack of access to healthcare, unhygienic environments
lack of access to household food security, sub optimal maternal and child caring
practices, all of which contribute to child undernutrition. He emphasised three
main challenges in accelerating nutrition action as follows:
Reconciling scientific knowledge with the practice and implementation
Understanding the complexity of the National Nutrition Policy
Merging the diverse agendas, perspectives and interests of different
stakeholders, while ensuring that this be free from the conflict of interest.
Evidence from the Lancet 2008 shows that, worldwide, maternal and child under-
nutrition is the underlying cause of more than a third of all deaths in children
under five years. Since more than half of these deaths occur within the first two
years of life, most nutrition programmes focus on the critical period from the
commencement of pregnancy till the child is 24 months old. It would be most
beneficial to focus on the prevention of malnutrition rather than its treatment,

concentrating on the critical early window of opportunity. Also, promoting
early and exclusive breastfeeding in the first six months of life, and introducing
appropriate complementary feeding after six months of age, along with continued
breastfeeding for two years or beyond, is imperative.
The ICDS programme was begun in 1975, and by 2005 had reached about 75%
of the country. After the Supreme Court directive in 2008-09, the programme
has now been nearly universalised. The National Nutrition Policy was formulated
in 1993, while the National Action Plan was created in 1995. All states were
asked to make action plans and a plethora of governmental schemes have been
introduced. All major schemes like ICDS, Reproductive Child Health (RCH), and
NRHM have been expanded. Malnutrition can be eradicated within the next 5-10
years, but only if integrated multisectoral district-level plans are developed and
implemented.
Strengthening the continuum of care through a childcare and development-based

approach is integral to nutrition improvement. Other important focus areas
would be improving household food security and livelihood and increasing food
supplementation programmes, linked to the proposed National Food Security Act
(NFSA). This should be enabled to promote a wider concept of household food
and nutrition security, especially for children and women. Strengthening and
restructuring ICDS is critical, to ensure implementation with quality in flexible
mode through decentralised state/district plans of action. Unlike social sector
flagship programmes such as NRHM, SSA, ICDS is the only programme that is
currently not in mission mode. There is also an emerging need for an additional
AWW in the centre as a nutrition counsellor, focusing on improving young child
growth and development outcomes in children under three years of age. Other
important interventions are providing universal access to health care, clean water
and sanitation as a basic human right.
Convergence at all levels through steps such as having a joint Mother Child Protection
card as an entitlement tool, joint training and capacity building of workers and
resource centres, constructing AW centres, introducing use of ICT and instituting
a strong regulatory mechanism were also suggested. A Policy Coordination and
Support Unit within the Planning Commission was recommended to support policy
alignment across sectors and states, help position nutrition centrally in development
plans and programmes and coordinate third party evaluations.
Dr. Shreeranjan concluded by inviting his colleagues in the health ministry to

supplement and share insights on the joint strategy note and recommendations
for action.
Mr. Amarjeet Sinha, Joint Secretary, MoHFW, while

commenting on the strategy note, said that several other
countries had been more successful than India in fighting
malnutrition. He urged participants to view the subject as a
simple concept, and trust the frontline workers and support
the devolution of powers and resources to local panchayats
and village health committees. He suggested that groups of
4-5 local resource persons from the community be formed to
promote changes from within the community. Currently, the
Panchayat was the sole representative of the community and

it might be beneficial to create smaller, village/habitation-level organisations
under the Panchayat leadership.
Other countries have fought malnutrition by a preventive and promotive

public health approach -ensuring universal access to primary health care,
safe drinking water and sanitation, and not necessarily by only focusing on
treating the problem after it occurs and takes its toll. He emphasised that it is
now time for the country to match its economic growth with equitable social
development. Allocating more funds towards crafting effective public systems
is one way of doing it, since currently investment in health, women and child
development is not adequate for ensuring that normative standards are met.
He outlined the main points that could contribute to an effective framework
for public systems:
Have a policy coordination unit for coordinating and ensuring convergence
and accountability of all programmes.
Encourage convergence at all levels in services related to health, nutrition,
child care, water and sanitation: from village and block levels to district and
national levels.
Step up monitoring of nutrition interventions by linking various project
implementation plans (ICDS, NRHM, TSC, MDM, ICT, broadcasting etc.).
Have strong regulatory mechanisms in place and ensure institutional
safeguards.
Build capacities by adding resource centres and developing professionals,
nutrition counsellors and members of the Voluntary Action Group (VAG).
Increase flexibility and decentralisation of programmes and make them more
results-focused.
Restructure ICDS and prioritise care for newborns and infants in high-burden
districts.
Session V: Group Work
The resource facilitators’ team Mr. Anil Sachdeva, Founder

and CEO of the School of Inspired Leadership (SOIL), and
Ms. Deepika Shrivastava, Consultant Women and Child
Development and Nutrition, Planning Commission then briefed
participants about the next group work session. On the first day,
7 August 2010, group work was structured around “what” needs
to be done in respect of the following major strategy themes-
Health Care and Services

Water, Environmental Sanitation & Hygiene
Infant and Young Child Caring and Feeding practices
Ms. Shrivastava explained the suggested terms of reference for the seven groups,
as provided to all participants, highlighting that these had incorporated ideas
coming out of preceding sessions, and were indicative and not prescriptive
in nature. Groups could also add/modify the same as needed, during the
course of group work. Participants were divided into these seven groups,

while ensuring that each group had a mix of different stakeholders and some
members who have expertise and experience in that theme, to facilitate
the dialogue.
Seven groups worked intensively on the identified themes, using the indicative
terms of reference provided, to facilitate discussion. The detailed Terms of
Reference of each of the seven working groups on 7 August 2010 on “What needs
to be done” are provided in Annexure 3.
Groups were asked to recommend what needs to be done to address nutrition

challenges in India, and focus on five key ideas that can make a major difference.
The brainstorming session lasted for one and a half hours, following which the
groups summarised and presented their key recommendations. These were
discussed in the plenary, with suggestions to modify/add comments coming from
the others.
Group I: Household Food Security and Livelihoods
Rapporteur: Mr. Basanta Kar
The group began by stating that there were major

problems with accessibility and availability of food. There
were intra-household and regional disparities arising from
economic, social, political and geographical factors,
often with lack of proper storage facilities and proper
distribution of food. The main focus of food security
efforts therefore ought to be to provide free food to
women and children who are at risk.
Main Recommendations
Promote agricultural policies and research to protect land and water resources
to increase agricultural productivity, especially of pulses and oil seeds, as well
as millet in dry and low productivity areas.
Improve storage facilities, particularly in food deficient regions.
Address issues related to hidden hunger by ensuring food availability,
dietary diversification, and promoting foods that include vitamins and
micronutrients.
Improve efficiency and effectiveness in MGNREGS (Mahatma Gandhi National
Rural Employment Guarantee Scheme) implementation and sustainability.
Promote non-farm businesses and micro-enterprises and address seasonal
nature of employment by providing nutritious food all the year round.
Improve effectiveness of TPDS (Targeted Public Distribution System) and MDM,
and expand food baskets to provide nutritious cereals and edible oils.
Provide free food for destitute and needy (women and children at risk, HIV
positive persons, migrants, elderly and those affected by natural disasters)
Encourage women’s participation in intra-household food security.
Engage PRIs and SHGs to address women’s participation in food and nutrition, and
promote nutrition awareness, transparency and community accountability.

Group II: Maternal and Child Care Services
Rapporteur: Mr. Srinivas Vardan
The lack of adequate childcare centres is a major problem for working mothers in
both rural as well as urban areas, in the organised and unorganised sectors.
Have additional childcare centres for working mothers.

Increase household visits by AWWs, ASHAs and other nutrition workers
to provide more effective nutrition counselling and to increase general
awareness on available health and nutrition services; have special focus on
early breastfeeding and complementary feeding practices, with focus on
under-twos.
Conduct informative meetings with both parents since husband’s involvement
is important and promote the concept of joint parenting.
Have regular village-level meetings on health and nutrition, and promote
leadership roles for women.
Provide adolescent girls with comprehensive information on nutrition, IFA
supplements to prevent anaemia, proper health and sanitation practices,
education, right age of marriage, vocational training and life-skills
coaching.
Make AWCs mother and child development centres, with adequate staff
additions to enable them to function effectively as health and childcare
centres; have SHGs run these centres and allow them to function as an income-
generating mechanism (for example, Kudumbashri programme in Kerala);
alternately, hire skilled workers through MGNREGS, with two workers focusing
on nutrition issues, one worker on house visits, and a fourth being responsible
for the day care centre.
Place two additional workers from NRHM at the centres.
Create adequate infrastructure for AWCs. Pilots can be funded by the private
sector, as demonstrated by successful models in Tamil Nadu and Kerala.
Make it mandatory for local governments to allocate adequate space for AWCs
and childcare centres.
Community kitchens, run by SHGs, can provide nutritious food for AWCs and the
MDM scheme, which in turn can help them become financially independent.
Make available mobile AWCs for migrant population (construction workers and
their families).
Reward panchayats and districts that effectively reduce malnutrition.
Make the District Collector responsible for creating a convergent action plan
for the district and ensure accountability at all levels.
Use ICT for effective communication and reporting and link it with GIS to
track the presence of workers.
Have greater involvement of PRIs in managing and monitoring to ensure
improved delivery of services (differential involvement depending on the
particular state in question).
Implement community level third party monitoring of services.
Have greater focus on high-burden districts; make District Actions Plans for
nutrition mandatory; selection of high-priority districts should be done by the
centre but finalised by the state.

Group III: Healthcare and Services
Rapporteur: Dr. Shilpi
Use weighing scales at the grassroots level to ensure regular

growth monitoring, and prevent children from becoming
severely malnourished.
Identify cases of severe malnourishment.
Introduce malnutrition treatment centres in states like Kerala

and Himachal Pradesh, where they do not currently exist.
Synchronise Malnutrition Treatment Centre (MTC)/Nutrition Rehabilitation
Centre (NRC) parameters for identifying malnutrition with the new parameters
delineated by WHO. This, in addition to proper growth monitoring records,
will provide a systematic record of nutritional status of children across the
nation.
Step up IEC and disseminate information to villagers on Village Health and
Sanitation Committees and Village Health and Nutrition Days.
Hire more nutrition experts at the block level in states such as Himachal Pradesh,
where the intergenerational cycle of malnutrition needs to be addressed.
Consistently review and follow-up condition of severely malnourished
children.
Malnutrition must be recognised at all health facilities as an illness requiring
treatment.
Coordinate efforts of AWWs, ASHAs, (Sahiyyas in Jharkhand) and ANMs to
increase their efficacy.
Minimise existing differences in agendas of various departments to achieve
projected goals.
Have regional planning at district level through regular meetings of all
stakeholders.
Introduce intermediary between the district and grassroots levels to implement
locally feasible solutions at community level.
Increase monitoring/surveillance/accountability at all levels.
Clearly identify problems based on the five-year plan and state the roles of
the workers at the grassroots level.
Set realistic goals that can be achieved within the projected time period.
Group IV: Water, Environmental Sanitation and Hygiene
Rapporteur: Ms. P. Amudha
Poor water and sanitation directly contributes to poor nutrition and ill health, and
increases chances of contracting water-borne diseases. AWCs should be clean and
hygienic and provide basic facilities such as clean drinking water; however, they
are often situated in rented buildings, which do not have proper toilets, water or
power supplies. Furthermore, there is a lack of knowledge about proper hygiene,
as well as no previous experience of optimal practices regarding hygiene such as
using and cleaning toilets, and using soap to wash hands afterwards and before
feeding children. Both communication and infrastructure need to be improved in
order to improve overall health and sanitation.

Address the problem of safe drinking water; currently

there are problems with access to and availability of clean
drinking water, with water often having high salinity levels
or being contaminated with sewage water, rendering it
unsafe for consumption. Clean drinking water should be
available within 1 km of the village, and the village should
not have to depend solely on seasonal sources.
Build proper toilets to ensure cleanliness.
Provide water access to AWCs, especially for the purpose of
cleaning, and allocate funds for maintaining these centres.
Make sure that AWCs have proper toilets which are cleaned and maintained
regularly.
Construct dry toilets in areas with low water tables.
Make water testing kits available under the Jalmani scheme through AWCs
Chlorinate the water to prevent contamination.
Explore and encourage use of low cost filters in states like Orissa and make
them available in local markets.
Encourage the practice of boiling water, as it is simple, cheap and effective.
Discourage keeping cattle in toilets.
Award Kuposhan Mukt Puraskar and Poshan Yukt Puraskar to AWCs who meet
key indicators.
Solid and liquid waste management should be better coordinated, with a focus
on changing existing behaviours regarding waste disposal.
Educate the community about health, hygiene and nutrition with the intent to
alter existing attitudes regarding these.
Focus on monitoring key indicators through regular review at the district,
block and panchayat levels.
Create a platform for convergence of all flagship programmes (NRHM, SSA
etc.) at all levels.
Group V: Maternal, Infant and Young Child Caring and Feeding Practices
Rapporteur: Dr. Arun Gupta
Encourage early initiation and exclusive breastfeeding for the first six
months.
Make maternity benefit schemes available to all women, using the successful
scheme in Tamil Nadu as a model.
Provide childcare services under MGNREGS.
Impart intensive skilled counselling to the husband and mother-in-law to
address cultural practices that may prevent the mother from ensuring optimal
nutrition and care.
Make more human and financial resources available to AWCs.
Appoint a dedicated village nutrition worker at every AWC, and nutrition
counsellors at the block level to act as counsellor cum trainer, mentor and
supervisor for village level workers.
Inform people about the Infant Milk Substitutes Feeding Bottles and Infant Food
(Regulation of Production, Supply & Distribution) Act 1992 and its Amendment

Act 2003 that promotes, protects and supports breastfeeding and ensure that
it is implemented properly.
Launch a campaign at the block level for encouraging changes in behaviours
and practices regarding nutrition, focussing on exclusive breastfeeding of
infants for the first six months and complementary feeding thereafter, along
with continued breastfeeding for two years or beyond.
Group VI: Capacity Development and Community Processes
Rapporteur: Mr. Samir Choudhary
Recognise ASHAs for their work, and provide them with

information and training.
Involve the community, since malnutrition happens at
home; educate and empower mothers on nutrition; work
towards building community ownership of the programme
to minimise corruption.
Empower SHGs to enable them provide more information
to women; allow them to organise and be involved in TPDS
as an important link to nutrition security.
Let SHGs work as social auditors of the programmes and provide periodic
review along with recommendations.
PRIs to dedicate themselves to planning, allocating programmes, and providing
supportive supervision on nutrition and child health.
Expand capacities of VHSCs, SHGs and ANMs.
Strengthen links between health, PRIs, CBOs, and AWWs, and encourage
convergence of activities.
Strengthen infrastructure (AWCs, Mahila Vikas Kendras), hire additional
workers and increase technical and financial support.
Hold monthly public meetings on health and nutrition at the village, district/
block and sector levels.
Increase involvement of home science colleges, NGOs and community medicine
departments to undertake action research.
Launch a toll-free helpline (Palan Poshan Line) to answer callers’ queries on
nutrition.
Group VII: Nutrition Policy, Planning and Surveillance
Rapporteur: Dr. Sangeeta Saxena
Revise the Nutrition Policy, which is old and dated; currently, it does not
adequately address all issues. Recent developments, such as the nation-wide
increase in obesity, need to be considered in the revised policy.
Set up an independent Department of Nutrition at the state and centre
levels.

Empower the community on a priority basis.
Take up a life-cycle approach for nutrition to effectively
eliminate the problem.
Work towards having a coordinated, multisectoral approach
which integrates all nutrition related programmes (ICDS,
NRHM, MDM and SABLA).
Put an independent monitoring mechanism in place.
Decentralise nutrition programmes and make them
flexible.
Ensure that all nutrition programmes are in mission mode
and are ready for delivery, planning and implementation at
all levels.
Assign responsibility for implementation and monitoring to community groups
such as SHGs, NGOs and PRIs.
Involve technical, professional and academic research institutions in the
planning process.
Work towards achieving a 50% reduction in IMR and MMR.
Optimise existing infrastructure.
Make AWCs child-friendly, and provide a sanitary environment with safe
drinking water.
Have an effective nation-wide surveillance mechanism in place to provide
insight into the causes and remedies of malnutrition; also devise a method for
timely intervention.
After the group presentations, comments and clarifications, the session concluded
with the agreement that the resource facilitators would collate and synthesise
group work outputs on “what” needs to be done, outputs from glads/sads/mads
and identify seven key themes for group work on “how” things need to be done.
This would then also be put through a multi-voting prioritisation exercise, to
evolve consensus on the strategy options for implementation.
The seven key themes for discussion on “How” that emerged from the late
evening meeting of resource facilitators are as follows:
National Child Malnutrition Prevention and Reduction Programme
Panchayat-Led Models
Conditional Cash Transfers
ICDS Restructuring
Nutrition Counselling Service Model
Institutional Arrangements at National/State/District/Local Levels
Nutrition Data, Mapping and Surveillance

Day-2
8th August 2010
39
Glimpses of the
Multistakeholder
Retreat

41
Proceedings of the Multistakeholder Retreat
8 August 2010
Session VI: Multi-Voting Session
On the second day, 8 August 2010, based on “what” needs to be done, different
strategy options and institutional mechanisms for effective implementation were
identified. Groups then voted on which were the priority strategy options for
“how” India’s Nutrition Challenges would be addressed, with emphasis on what
would change for communities at village level. The strategy options as emerging
from the previous day discussions and the multi-voting exercise, informed by the
experiences of different stakeholders formed the basis for a second round of group
work on 8 August 2010 on “how to make this happen”.
Mr. Anil Sachdeva explained the process envisaged for the second day and
outlined the methodology for group work discussions. The focus on the first
day had been on what
Ms. Deepika Shrivastava, Consultant, Women and Child Development and Nutrition, needs to be done to
Planning Commission recapitulated the discussions that were held on Day 1 of the tackle the nutrition
Retreat. She highlighted that the focus on the first day had been on what needs to challenge and now it was
be done to tackle the nutrition challenge and now it was time to concentrate on time to concentrate on
how necessary changes could be made to tackle undernutrition- focusing on critical how necessary changes
strategy options that can make a significant difference. She shared the process could be made to tackle
followed by the resource facilitators in factoring in the group recommendations undernutrition.
of the previous day to formulate seven main strategy options for multi-voting and
subsequent deliberation.
She then introduced the multi-voting system, wherein each person was given three
bindis and asked to vote for the three topics that they considered being of the
highest importance, because of their high and large scale impact on addressing
India’s nutrition challenges. The seven discussion topics were put up on flip charts.
It was emphasised that blank flip charts were also put up next to these, so that if
any individual participant felt that there was a major strategy option which has not
been envisaged or left out – that can also be listed for the exercise.
Participants were then invited to briefly discuss the multi-

voting exercise at their tables and also identify any alternate
topics that they felt were of high importance, but not listed.
Mr. Anil Sachdeva coordinated the voting process, inviting all

participants to come in table groups and vote. The results of the
multi-voting exercise were:
1. National Child Malnutrition Prevention and Reduction
Programme (including women’s empowerment for improved
family-based care) – High Priority

2. Panchayat-Led Models – Medium Priority
3. Conditional Cash Transfers – Low Priority
4. ICDS Restructuring – Very High Priority
5. Nutrition Counselling Service Model – Medium Priority
6. Institutional Arrangements at National/State/District/Local Levels – High
Priority
7. Nutrition Data, Mapping and Surveillance – Medium Priority
Two topics were added by individual participants: Legal Framework for Nutrition;
NGOs and SHGs with structural, administrative, financial and training structures,
and Mission mode for ICDS with district specific planning linked with other
flagship programmes. The former was merged with Topic 6 as an additional point
of discussion, while the latter was already included and further highlighted under
Topic 4.
Ms. Deepika Shrivastava then outlined the indicative terms

of reference provided in respect of these seven strategy
options (with additional points above incorporated), which
were indicative rather than prescriptive, and were shared to
facilitate discussion. She also highlighted interlinkages across
the different working groups. Resource facilitators were also
assigned to each group, whose role was to guide the discussion
and ensure that every member of the group was heard. Each
group was requested to identify a rapporteur who could
record ideas on the available flip chart, and present them.
Illustrative examples were used to explain the proposed
terms of reference for different groups and how these were
designed to open up innovative ideas and not to be prescriptive. The detailed
Terms of Reference of each of the seven working groups on 8 August 2010 on
“How to make things happen” is provided in Annexure 4.
The participants were divided into groups based on the group composition of the
previous day, and on specific interest areas expressed by them. The participants
were then asked to join their groups and discuss their topics until lunchtime,
after which the groups were scheduled to present their main recommendations.
Session VII: Group Work and Presentations
Each group was asked to list the five most important recommendations determined
during their discussion, and display them on a flip chart. They were asked to look
at the recommendations of the different groups prior to the presentations, and
to write down their comments and suggestions on the blank sheets provided for
the purpose.
Post lunch, there was a cultural performance by musicians from Rajasthan,

who combined traditional folk songs with messages on health, nutrition and
development of women and children.
Following this, each group was asked to present their main recommendations
which were followed by discussion. The recommendations as presented by the
different groups are as enunciated below, incorporating modifications/suggestions
accepted by the group.

Group I: National Child Malnutrition Prevention and Reduction Programme
Rapporteur: Ms. Indu Capoor
The group drafted a Mission Preamble highlighting the need for

combating malnutrition:
“It is shameful to have accepted the high levels of malnutrition

in a democratic country like ours, with such vibrant economic
growth. Existing programmes have been unable to significantly
address the problem, as huge gaps exist within the system.”
1. Establish/revive/strengthen the Nutrition Mission, such that it is well

resourced (both human and financial resources), empowered, and provides a
national framework that is flexible and can be moulded according to the local
context. It should have representation from multiple sectors (convergent),
and have a supra ministerial top agency that coordinates the work of different
departments as well as holds them accountable for their work. This mission
should focus on adolescent girls, pregnant and lactating mothers, and children
under five years of age.
2. Make Nutrition visible and prioritise it at all levels. A communication strategy
should be developed, with the commitment of politicians as well as the media.
There should be greater capacity building within existing programmes, and
people need to be empowered to act independently for improved nutrition.
3. Ensure convergent action amongst participating departments, with suitable
restructuring of line departments to include nutrition analysis. Also, policy-
making in all sectors should take nutrition issues into consideration.
4. Build ownership of the programme amongst households, communities, civil
societies and local bodies of governance. There should be an inclusive
community surveillance mechanism in place. It would be beneficial to engage
and assist CBOs, NGOs, institutions etc.
5. Use a rights-based approach, wherein the citizens are claim holders and
owners, not merely beneficiaries. Focus on providing sufficient support to
women and have a mechanism for holding duty bearers accountable for their
work, as well as a system for legal recourse.
Suggestions
There should be a focus on children under 5 years, and within that, special
attention should be given to infants under 2 years, since most irreversible
growth and developmental damage takes place in the first two years of life.
The programme should take a woman and girl-centred, life cycle based
approach.
Clearly define duties of each department (health, water, sanitation, and food
provision).
Provide day-care centres for working mothers.
Have operational guideline for national convergence, to clarify and define the
roles of different departments, making them accountable for specified tasks.

Group II: Panchayat-Led Models
Rapporteur: Mr. Basanta Kar
The group discussed the concept of Panchayat led model/s and what this implies
in terms of devolution of powers – Functions, Funds, Functionaries - with regard
to different flagship programmes. The roles of Panchayat members, especially
women, as change leaders were discussed. Strategic recommendations were
evolved, recognising that different states have different contexts, capacity of
PRIs, and levels of devolution of powers.
1. Empower panchayats with the necessary human and financial resources, in

addition to adequate administrative authority, with regard to all programmes
concerning or related to nutrition. Since the panchayat is transparent in its
functioning, it can be made more accountable.
2. Institutionalise convergence mechanisms under the
panchayats, and involve them in communication
strategies for initiating behaviour change amongst the
people. Power relations of different stakeholders across
levels should be discussed, since the village panchayat
cannot have power without a proper distribution at the
district and block levels. The stronger the Gram Sabha,
the more effective the work of the village panchayats,
a fact that is especially true in tribal communities,
which also demand special care.
3. Install/Identify a catalytic institution at the black level
for capacity building, monitoring, data collection, and
programme management. This could be an agency such
as an NGO, or another organisation that can enhance and work alongside the
panchayat.
4. Build and promote a village health and nutrition committee. Redefine roles of
the elective and executive structures at the block and district levels to enable
them to focus on providing supervision and supportive guidance.
5. Have an independent institution that can develop a system to collect
creative, IT-based data and MIS to ensure ongoing assessment, monitoring and
accountability.
Suggestions
Monitoring mechanisms for panchayat-led models should focus on set indicators

and be conducted using the social audit model.
Funds for village health plans from NRHM and ICDS should be transferred to
panchayats.
Nutrition should be the focus of decentralised planning.
Build PRI commitment for nutrition.
Spread awareness on differences between nutrition, malnutrition and under-
nutrition.

Group III: Conditional Cash Transfers (CCTs)
Rapporteur: Ms. Mukta Arora
The group designed a possible model for implementing CCTs with the objective
of improving nutrition status of pregnant women and infants under 2 (-9 months
to +2 years). There was consensus around the fact that there was need to impose
conditions, but that these should be few in number and easy to fulfil, involving the
larger community as well. The programme which would be implemented through
ICDS would make use of Unique Identification (UID) system for registration,
identification, and monitoring. An amount of Rs.1000 would be awarded at each
instalment, with a total of six instalments, divided as follows:
Instalment Timing and Condition

First Given when the mother registers her pregnancy at the local AWC.
This also provides an opportunity for the AWWs to educate the
mother about proper health and nutrition practices.
Second Given on the condition that the mother attends the Godhbharai,
Walaigapu or equivalent ceremony in the 7th month of pregnancy. It
is a pre-existent custom in most parts of the country, and involves the
entire community as well as the AWWs. It occurs after the mother has
been given the TT immunisation, and involves information sessions
about health, nutrition and childcare.
Third This instalment comprises the regular aid given under the existent
JSY scheme, with an additional stipend only given as an incentive in
case the child is female.
Fourth Given when the child is 7 months, on the condition that the mother has
been visiting the AWC for regular growth monitoring and promotion
(can be seen from mother child protection card). The mother also
attests that she has been breastfeeding exclusively for six months,
and that she has begun complementary feeding.
Fifth Given when the child is one year old, on the condition that the
mother has been visiting the AWC regularly (at least three times)
and maintaining a growth chart, in the form of Mother and Child
Protection Card.
Sixth Given when the child is two years old, on the condition of regular
growth monitoring and consistent growth. A certificate can be given
to “Star Mothers” along with this instalment, as a reward and further
incentive to the mother as well as the community at large.
They suggested that the panchayats that demonstrated

the greatest improvement in nutrition levels be awarded a
stipend of Rs. 5000, 20% of which could be given to the AWW
and helper. It was also stressed that all payments should be
made via cheque, in order to effectively avoid corruption
and mishandling of funds.
Suggestions
Include more nutrition-related indicators for CCTs, such

as administering Vitamin A supplements, IFA supplements
and vaccinations.

Award AWW or ANM who identify maximum “Star Mothers.”
Ensure that there is no misappropriation of funds and that cash transactions
are carefully monitored and accounted for.
Create more visibility regarding governance, supply of nutritious food/meals
and rural monitoring mechanisms to help prevent leakage of funds, utilising
the Supplementary Nutrition Programme (SNP).
For CCT, register pregnancy at the beginning of the 2nd and 3rd trimesters,
at birth, when the child is 3 months old and finally when the child is 4 months
old.
Conduct a pilot experiment with this model, where it is applied in few smaller
localities, and thereby determine its efficacy.
Group IV: ICDS Restructuring
Rapporteur: Ms. Ira Tanwar
The group discussed the concept of ICDS Restructuring,

recognising that both nutrition and early development and
learning outcomes are critical for inclusive growth. ICDS
Restructuring objectives and principles were also deliberated
upon, identifying core interventions and services envisaged
under this programme, especially in districts with high
nutritional vulnerability. Discussion focused on what and
how would this be different from what already exists, with
different implementation experience across and within
different states/districts. Best practices/models that can
be adapted and scaled up were also shared.
1. ICDS needs to be in mission mode, with separate and adequate resources and
authority. There is a great need for convergence at all levels. Funds should
be given at the district level, and monitoring and accountability should come
into play at the same level, as well as at other levels.
2. Resources need to be provided for smooth functioning of ICDS, including
infrastructure, equipment and mobility. Currently, there is lack of space,
equipment and other resources at several AWCs. Similarly, mobility is often
an issue, and AWWs are unable to reach the entire community. Providing cars,
motorcycles/scooters and bicycles would increase the number of people
benefiting from ICDS.
3. Hire an additional worker at AWCs as well as at the sector/cluster level with
clearly defined responsibilities. AWWs are currently overburdened, as they are
responsible for a large number of people and are given extra work.
4. There should be a separate department for WCD/ICDS in states, as they are
often overburdened with work from other departments. Additionally, the role
of an AWW needs to be redefined. There should be at least two workers at
every centre, with a clear definition of responsibilities. This will help with
better monitoring and accountability at the field level. There also needs
to be greater incentives in place for all departments and levels of ICDS,

particularly at field level. Currently, there is little or no scope for promotion
or advancements in the workplace.
5. Enable better delivery of services through community participation,
monitoring and convergence. The health and nutrition programme needs to
be incorporated in community life as a whole. This should come about through
convergence.
Suggestions
Restructure ICDS by age groups.

Strengthen provision of supplementary nutrition and mid-day meals through
ICDS.
Strengthen preschool education in ICDS, linking with Sarva Shiksha Abhiyan
(SSA).
Focus more intensely on maternity entitlements and care and enable AWWs to
work alongside ASHAs in this regard.
Make changes in planning and infrastructure development, taking into account
the changing economic and technological realities.
Group V: Nutritional Counselling Service Model
Rapporteur: Mr. Subramaniam
The group highlighted the fact that counselling had not been
accorded much importance and that it should be treated as
an important tool for educating and empowering mothers
especially and the community as a whole. This should be
done at the household and community level by making use of
existing community platforms.
1. Appoint one village level counsellor for every thousand persons, or as per
ICDS norms. While this may be a good ratio for populated locations, it can
be relaxed where there is lower population density. The counsellor’s duties
should involve monitoring growth rates of children in addition to educating
and assisting women on good health and nutrition practices.
2. There should be one sector-level counsellor/supervisor for every 20 village
counsellors. The supervisors should have supervising, monitoring and training
skills in addition to all the skills possessed by the counsellors.
3. Form a core multi-disciplinary, multisectoral district level team for nutrition,
with leadership of the District Magistrate (DM).
4. Involve medical colleges and technical institutes, such as nursing colleges and
home science centres, in the training of counsellors.
5. Additional financial resources need to be made available though flexible
decentralised funding managed at the district level. Similarly, such a team
can be formed at the block level.

Group VI: Institutional Arrangements at National/State/District/Local levels
Rapporteur: Mr. Lov Verma
The group discussed the objectives and strategic guiding

principles in designing and implementing the proposed
institutional arrangements, especially recognising that
different state/districts have different contexts. The kind
of decentralisation and flexibility provided by different
implementation frameworks was also deliberated upon.
How would a new arrangement be different from existing
institutional arrangements was highlighted and also how
this would link to existing arrangements in different sectors.
The emphasis was on the implementation framework and
institutional mechanism envisaged at village level, and how
this would be empowered for community action.
1. Create an empowered department of Nutrition within the Ministry of Health

and Family Welfare or Women and Child Development. Have a supra-ministerial
set-up to help allocate nutrition to a single ministry. Allow for accountability to
be implemented at all levels and to facilitate this draw up sound operational
guidelines.
2. Establish a similar structure at the state level as well. There is need for trained
personnel at every level, with an overall increase in manpower.
3. There is need for advocacy, awareness building and counselling regarding
nutrition at various levels, which can be implemented through trained staff
members.
4. At the operational level, there should be no duplication or redundancy of
responsibilities; duties should be clearly defined and focused.
5. At the community level, nutritional interventions such as SNP should be
placed in the hands of trained and empowered women. Women should be
active participants, and be assigned responsibilities wherever possible and
communities should be made self-sufficient.
Suggestions
Have a well resourced department/body (human as well as financial

resources).
Bring about strong leadership.
Introduce an annual “report card” for this body to ensure accountability and
transparency.
The Food and Nutrition Board under MoWCD can be strengthened as the
technical wing/Department of Nutrition suggested above.
Village governments to be given more freedom to manage these issues without
interference from the top.
Have a multisectoral, district level team to combat malnutrition.

Group VII: Nutrition Data Collection, Mapping and Surveillance
Rapporteur: Dr. Rajul Gupta
The group provided clear definitions of the terms used: data

collection entails long-term data collection of a particular
group, while nutritional mapping is done when this operation
is taken to the district, state or national level. Surveillance
is the continuous collection and monitoring of data, based
on the assessment of the effective strategies which can be
devised and implemented. Collecting this data on nutrition
is essential, as the assessment of this baseline data will
determine necessary actions to be taken in order to improve
the situation.
1. Prioritise monitoring and surveillance in order to better assess problems as

well as monitor the areas of improvement regarding nutrition. There is a need
for national criteria on what information should be collected and how this
should be done to ensure consistency in the data across the nation.
2. Strengthen existing data collection systems on nutrition by increasing logistics
and capacity building. Include nutritionists and CDPOs for village heath and
nutrition action auditing. Surveys that already exist can be made more
effective by collecting information about specific nutritional aspects about
certain groups.
3. Link village level ICDS MIS to MGNREGS and the proposed National Food
Security Act.
4. Expand annual health and nutrition surveys to cover all districts and age
groups, with special focus on risk factors and determinants of malnutrition.
5. Link proposed UID system to ICDS nutritional surveillance programmes, making
it possible to track individual nutritional status as well as link it to GIS system
for effective nutritional mapping. (Mother Child Protection cards with UID
numbers will help make this link.)
Suggestions
Have sentinels/monitors who can ensure quality of data collection and

monitoring.
Ensure convergence between departments, preferably a single MIS for health
and nutrition.
Make the data accessible to and for use by all levels in order to determine
appropriate action plans.
Provide feedback based on data monitoring to workers at field level, ensuring
positive action and accountability.
Link data mapping and surveillance to Health Management Information System
(HMIS) under NRHM.
Strengthen National Nutrition Monitoring Bureau (NNMB) as a national level
institution for surveillance.
Set up an independent body that directs the process of surveillance.
Make this data publicly available on a periodic basis.

All recommendations were collated for further presentation to the concluding
session. Resource facilitators, one each from all the groups formed a core team,
to synthesise major action recommendations emerging from the work of all the
groups. The presentation on behalf of the core resource team was made by Dr.
Arun Gupta and Dr. N. K. Arora at the Concluding Session. While the core resource
team worked on the synthesis, participants revisited the stalls put up by state
teams from different states, to see how some of these captured the strategy
options debated and innovative approaches for the same.
Session VIII: Concluding Session
The Chief Guest and Guests of Honour: The Chief Guest

Dr. Montek Singh Ahluwalia (Deputy Chairman of the Planning
Commission), Guests of Honour Dr. Syeda Hameed (Member,
Planning Commission), Professor Abhijit Sen (Member,
Planning Commission), Ms. Sujatha Rao (Secretary, Ministry
of Health & Family Welfare), Mr. D. K. Sikri (Secretary,
Ministry of Women & Child Development) and senior officers
from Prime Minister’s Office (PMO) and other ministries were
warmly welcomed and they also went around the exhibition,
interacting with state teams and going through the flip
charts/group work output displayed.
Mr. Anil Sachdeva, who had provided managerial support for conducting the
retreat with help from students from SOIL said that the discussions had been very
fruitful. He shared a summary of the Glads/Sads/Mads exercise to demonstrate
that problems such as corruption were well recognised –and solutions also
emerged from other experiences, such as in Tamil Nadu, which holds the potential
to educate and inspire others to work in a results driven manner. Such cases
reiterate the point that people should work together, since when they do so, the
results speak for themselves. He was particularly happy about the diversity of
voices and the different points of view that had been heard and brought together
through a carefully designed affinity process. The “Whats” and the “Hows” of
India’s nutrition challenges had been discussed at length, which would culminate
in a clear strategy for the way forward.
Key stakeholders from the field were first invited to share their thoughts on the
two days of deliberations. Ms. B. Kamalangi, an ICDS Supervisor from Gajapati
District, Orissa, said that it was the first time she had attended such a large
conference and heard senior government functionaries state their views and make
affirmative commitments towards the cause of reducing malnutrition, something
that was rampant in their villages and districts. She gained knowledge through the
experiences of other grassroots workers, and was particularly pleased that the
issue of social inclusion had been taken up.
Ms. Kunti Bora, an ICDS Supervisor from Golaghat district, Assam, felt it was a
great learning experience to meet so many people on a common shared platform.
She gained valuable insights from hearing what the CDPOs and other high-level
officials from different states had to say, as well as what field workers from Tamil
Nadu and West Bengal shared. This made her realise the extent of work that still
needed to be done in her home state of Assam. She felt she would be returning
home with a better understanding of the different roles of ASHAs, ANMs and

AWWs. However, she did express her disappointment at not
finding any senior government representative from Assam.
She suggested that a similar meeting be organised at the
state or district level in Assam too. She quoted Rabindranath
Tagore saying:
“Do not give me a fish. Teach me how to fish.”
Ms. Usha Rani, an AWW from Sriperumbudur District, Chennai,

Tamil Nadu, felt that her biggest learning had come from
interacting with other AWWs and hearing from them about
their successes as well as the challenges which they faced in
tackling malnutrition in their respective districts and states.
She placed on record the need for a second AWW at AWCs.

V. Presentation of Key Recommendations
Dr. Arun Gupta and Dr. Narendra Arora presented the synthesis of key
recommendations derived from the resource facilitators’ discussion. The group
decided on a preamble:
Preamble
“It is shameful and unacceptable to have such a high prevalence of malnutrition

alongside vibrant economic growth in a democratic country like India. Malnutrition
has to be made visible, and be considered a developmental priority for all. Gaps
in existing programmes need to be bridged to effectively combat nutritional
problems.”
Guiding Principles of Action
Focus on children under 2 years, pregnant women and adolescent girls.

Extend from the centre to family and community.
Strengthen convergence using appropriate institutional arrangements.
Make the programme rights-based.
Focus on empowerment of women.
Make the programme universal.
Ensure it is free from conflicts of interest.
Ensure good governance and accountability.
Key Recommendations
1. Establish a National Institutional Arrangement for Prevention and Reduction

of Child Malnutrition by taking the following steps:
Coordinate and converge all programmes already in existence.
Conduct a technical overview of the situation.
Establish an inter-ministerial, well-empowered and well-resourced entity
whose structure and function is drafted on the basis of existing experience.
Introduce a policy support unit under the Planning Commission.
Make sure the initiative is community-driven.
2. Restructure ICDS
ICDS to be in mission mode, with proper resources, authority and convergence
at all levels.
Strengthen infrastructure, provide proper equipment, and facilitate mobility
at all AWCs.
Recruit one additional worker at every AWC and at the sector/cluster level to
fulfil clearly defined responsibilities.
Improve quality of services provided by training and monitoring workers,
ensuring convergence between different programmes, and encouraging
community participation. There should also be constant monitoring conducted
through mothers’ groups, NGOs and other social audit groups.

3. Develop Panchayat/Urban Local Body-Led Models
Encourage state governments to progressively entrust more responsibility of
nutrition programmes to PRIs, encouraging community ownership.
Involve mothers with village health and nutrition committees by working
through PRIs.
Increase aid, assistance and technical support from NGOs, institutions etc.
Provide additional resources to PRIs with flexibility, authority and
accountability.
4. Strengthen Nutrition Counselling

Ensure presence of Nutrition counsellors in rural and urban areas (ratio of one
counsellor for every thousand people).
Appoint a nutrition supervisor for every 20 counsellors.
Set up support teams at the state as well as district level.
Train counsellors with the help of existing institutions, including home science
and medical schools.
5. Introduce and Popularise Cash Transfers

There was lack of consensus about CCTs, but it was decided that they should
be optional. It was suggested that there should be pilot schemes (for example,
CMB and SABLA) limited to specific areas, perhaps leveraged on existing CCT
schemes such as JSY.
Have simple conditions which are minimal and easy to fulfil. There should also
be built in incentives for workers and the community.
6. Conduct Nutrition Monitoring and Surveillance

Organise a sound monitoring and surveillance system.
Strengthen existing ICDS reporting system for effective surveillance by
improving the quality of data and using it to determine future action.
Build logistics and widen the capacity of functionaries.
Strengthen VHNDs for ensuring data quality and verification and leverage data
for MGNREGS and the proposed NFSA beneficiaries.
Expand monitoring to cover all districts in the form of an annual District Level
Household and Facility Survey (DLHS). Also, converge the nutrition and health
sectors.
Use ICT and GIS for collection, collation, analysis and interpretation of data,
as well for planning future activity.
Additional Recommendations
Increase food production including pulses and oils.

Provide Universal access to affordable food at all times, safe drinking water,
sanitation and primary healthcare, as already enunciated government
commitments.
Presentation of Key Recommendations 55

VI. Summing Up and Way Forward
The presentation of the synthesis of major action recommendations of the

plenary was followed by responses and comments from the Deputy Chairman
and Members of the Planning Commission, and Secretaries of the Ministry of
Health and Family Welfare and the Ministry of Women and Child Development.
They shared their perspectives on how to move forward, while responding to the
synthesis presented and suggestions for accelerating action to address India’s
Nutrition Challenges.
Prof. Abhijit Sen, Member, Planning Commission, said that

although the key messages that emanated from the Retreat
were important, they were not all new. To that extent this
reinforces some major strategic thrusts of the Mid Term
Appraisal of the Eleventh Plan. There was clear need for
more human resources and better infrastructure, and a
methodology had to be developed to determine how to
achieve this. He pointed out that convergence was needed
at the top, but that it was also needed at the bottom of
the pyramid, amongst field workers, where it would be most
effective. He felt that it would be fruitful to encourage more
discussion about this amongst field level workers, at district
and state levels also. Experiences shared about why certain programmes worked
in some states and not in others, were useful. A major challenge ahead will be
how to change the existing institutional structure.
Ms. Sujatha Rao, Secretary, Ministry of Health and Family Welfare, said she
had positive reflections regarding the Retreat. She appreciated that a unique
consultation such as this was organised, bringing Members of the Planning
Commission and other government departments on the same platform as
Anganwadi and other field workers, women’s SHGs, community members and
panchayati raj institutions. She stated that the recommendations that emerged
out of the group discussions were valuable, especially concerning convergence
and the development of an institutional mechanism for policy-making. She
emphasised that these would be taken up by the concerned ministries for further
action and strategy development.
She suggested that greater priority be accorded to empowering

women at the district level and below. She was of the strong
opinion that women had to be at the centre and in control
of the nutrition movement, and that depending solely on
governmental interventions would not be as successful. This
is because women’s issues are often not even addressed in
government planning. This is an unfortunate situation where,
often more energy is devoted to building roads rather than
building schools and hospitals. Women have been fighting
social issues across caste, religious and regional barriers and

they needed to be provided with social security, proper health, and education
facilities. For this to happen, it is necessary to institute and mandate women’s
development groups at the community level. Women also needed to be trained
and organised, and above all, trusted. An institutional mechanism, therefore,
needs to be drafted to achieve this.
She concluded by saying that change cannot happen from the top down, and
that a bottom-up approach will have to be taken. Her advice was to gauge which
measures have been effective and which have not, and accordingly plan for the
future. She felt that it is unacceptable that malnutrition continues to be a major
problem even in 2010, and that there is no reason why it should not be resolved
if everyone works together to counter it.
Mr. D. K. Sikri, Secretary, Ministry of Women and Child

Development, endorsed Prof. Sen’s observation that the
Retreat had reinforced some of the recommendations of
the joint strategy note, while also providing some fresh
insights and ideas for action. He felt that though the ICDS
infrastructure has been in place for years, not much has
changed so far as the country’s nutrition status is concerned.
There needs to be more discussion regarding the shortcomings
in infrastructure and the structural weaknesses of ICDS. One
reason that many participants gave for the failure of ICDS
pertained to AWCs not being given ample infrastructure to
perform their duties. According to him, accountability and
convergence are essential, especially at field levels. These programs should be
women-centric and also driven by women, as they will be more successful than
governmental agencies, be they local panchayats or the central government.
Women needed to be in leadership positions, though they may need support and
supervision in the initial stage (for example, in the SABLA Scheme, where women
will be responsible for monitoring).
Mr. Sikri confirmed that many of the recommendations that had been presented
during the Retreat would be taken into account and implemented, especially as
related to ICDS restructuring, Empowerment of Adolescent Girls and piloting of
the CCT approach in the upcoming Maternity Benefits scheme.
Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning

Commission, said that the diversity of experiences shared
during the two days had revealed some positive issues as
well as some issues requiring attention. He observed from
the “Mads” that corruption stood out as an issue that most
people were very angry about. Speaking of the unacceptable
situation of malnutrition in India, Dr. Ahluwalia said that
while it was an issue of major importance to all stakeholders,
it cannot be expected to change overnight. Furthermore,
instead of inventing analytical solutions to the problem of
nutrition, it might be more pertinent to learn from situations
where conditions have shown improvement. States such as
Tamil Nadu have managed to reduce malnutrition rates, while Madhya Pradesh
still has high malnutrition levels. He advised that states that have shown marked
improvement should act as a yardstick, while others should attempt to replicate
Summing Up and Way Forward 57

their success. This might be a more effective strategy than constantly pointing
out flaws in the system.
He concluded by asking the field workers if they had been sensitised to the
situation in other states, and if they were considering ways in which they could
adapt and take up the positive aspects of what they had learned at the Retreat.
Dr. Syeda Hameed, Member, Planning Commission, stated

that the main reason for organising the Retreat was to
provide the Planning Commission with new ideas on dealing
with the nutrition problem. According to her, the main
strength of the conference was the coming together of so
many different colleagues from village, block, district, state
and national levels. She reiterated that whatever had been
recommended during the course of the Retreat was done
so after deep consideration and weighing of all options and
that they would be accorded serious consideration.
She stressed that issues had been dealt with in an in-depth manner. Additionally,
this was the first time that the bottom-up approach had been used, denoting
a positive change in itself. She called for urgent action, stating that India’s
children cannot wait and that it was important to address the vicious cycle of
poverty and malnutrition. She concluded by highlighting the imperative to act
immediately- to fulfil the rights of India’s children and women to nutrition, health
and development, towards more inclusive growth.
Ms. Sudha Rao, Adviser, Women and Child Development and Voluntary Action
Cell, Planning Commission concluded by thanking all those who had participated
in and contributed to the design, organisation, deliberations, group exercises
and recommendations of the Multistakeholder Retreat, anchored by the Planning
Commission, especially the technical team which had designed this to be different
and also done differently.

Conclusion
The Retreat concluded on a positive note, with participants feeling that they
had been exposed to many different ideas, which they could bring back to their
own communities. The most positive responses came from field workers, many of
whom had not previously interacted with other workers from different parts of the
country. They felt fortunate to have met so many different people working in the
same field, and learnt about different problems, solutions and new approaches
from each other. Most were eager to implement all that they had learnt in the
course of the retreat.
Members from governmental agencies also benefited greatly, as they were able
to assess the conditions in the field more accurately through discussions with
the field workers, and understand the perspective of the implementers of the
programmes. Future planning, therefore, will be based on a more realistic
assessment of the requirements in the field.
A major benefit of the retreat was that it created a sense of community within
those working in the field of nutrition, and showed the importance of having open
dialogue between all levels. By creating a common platform for all stakeholders,
it demonstrated the true meaning of the democratic process and allowed all
voices to be heard equally.
The Nutrition Retreat signifies the beginning of a process of dialogue and

consensus building for collective action, empowered by voices from the field.
And the process will move forward with the placement of recommendations for
action for the consideration of the PM’s National Council on India’s Nutrition
Challenges.
Summing Up and Way Forward 59

VII. Synthesis of Major Recommendations for
Action placed before the PM’s National
Council on India’s Nutrition Challenges
Various consultations, including the Multistakeholder Retreat recognise that it is

unacceptable to have high prevalence of malnutrition in a democratic country
like India, with a vibrant economy, that gaps in the existing programs need to be
bridged and that malnutrition has to be made visible and a development priority
for all.
Principles of Action: It is reaffirmed that the highest priority should be accorded

to preventing and reducing undernutrition, towards progressively achieving the
11th plan monitorable targets, with the following guiding principles of action:
Focus on reaching pregnant and lactating mothers, children under two years
and adolescent girls.
Prevent undernutrition, as early as possible, across the life cycle, and fulfil
realisation of full development potential.
Promote rights based approaches, with women’s empowerment as the mover
of social change.
Extend from the anganwadi centre to family and community based approaches.
Strengthen convergence through appropriate institutional arrangements.
Ensure progressive universalisation of services and multisectoral
interventions.
Promote flexibility to support local initiatives for service quality improvement.
Free from conflict of interest, with requisite safeguards.
Ensure good governance and accountability.
Major Recommendations for Action are given below.
A. National Mother and Child Malnutrition Prevention &

Reduction Programme
1. Initiate a National Mother and Child Malnutrition Prevention and Reduction

Programme in high burden and most vulnerable districts, in mission mode,
with multisectoral State/District level Action Plans. This would synergise
multisectoral interventions from ICDS, NRHM, Rajiv Gandhi Scheme for the
Empowerment of Adolescent Girls, Indira Gandhi Matritva Sahyog Yojana,
Mid Day Meal Scheme, the proposed National Food Security Act, Public
Distribution System, Total Sanitation Campaign, NRDWP, MGNREGS, and
others. This could be rolled out in proposed NFSA districts and coverage
progressively scaled up.
The proposed programme would seek to ensure universal access to food

security and livelihoods, primary health care, women and child care

services, safe drinking water and sanitation, nutrition counselling as a
service, change caring and feeding practices in families and communities
and address the different multisectoral determinants of undernutrition in
an integrated way, with new institutional arrangements.
This would also focus strategically on the most critical and vulnerable age
groups so that undernutrition is prevented as early as possible (pregnancy,
lactation, children under 2 years, adolescent girls), which will yield accelerated
and significant reduction in undernutrition levels on a large scale.
2. Creation/Strengthening of a National body in mission mode, for coordination

and convergence of the above, which is an empowered, interministerial,
well resourced (human and financial) entity that is results focused, and
equipped to provide technical guidance and mentoring support. This would
imply similar institutional arrangements at State/District levels, with a
national policy framework that is responsive to the needs and problems of
states/districts, especially for high prevalence states/districts. The Structure
and function of the national body is to be drafted on the basis of existing
experience, with leadership of District Collectors at district level and Project
Implementation Plans of related flagship programmes reflecting convergence
and accountability of different sectors for nutrition outcomes. This would
involve the following-
Creation of a National Nutrition Mission body, under the PM’s National
Council on India’s Nutrition Challenges, the apex body constituted in
October 2008, linked to similar institutional arrangements at State and
District levels.
This may also involve revamping the existing National Nutrition Mission
(Gazette Notification of 30 July 2003) accordingly, reconstituting the
National Executive Committee, State and District Nutrition Councils and
their Executive Committees, ensuring multisectoral and wider stakeholder
representation.
Creation of a new Department of Nutrition, within the Ministry of
Women and Child Development, which is the nodal ministry for nutrition
and currently has one department for Women and Child Development.
(The department was designated as a ministry in January 2006).
3. Progressively establish State/District Resource Centres for Nutrition,

building on existing institutions such as SIHFWs/SHSRCs, Medical College
Hospitals, Home Science Colleges, AWTCs, the Nutrition Resource
Platform initiative- responding to the requirements of different sectors
and stakeholders. This would be linked to State/District Nutrition Mission
Councils, and will be set up in a phased manner, initially in high burden
states/districts. This will also require additional financial and human
resources for mentoring support by voluntary agencies, resource teams
at district/block/local levels, especially for strengthening community
processes, decentralised planning and monitoring.
4. Universalise access and enhance the quality of primary health care and
services at village level, and strengthen the Nutrition component of NRHM
for better synergistic impact-especially in high burden states/districts. This
would require that Fixed Day monthly Village Health and Nutrition Days
are held in all AWCs, using joint microplanning, ICDS revised population
Synthesis of Major Recommendations for Action placed before the PM’s National Council on India’s Nutrition Challenges 61
norms and mini AWCs to reach hard to reach vulnerable habitations/groups,
with the involvement of Village Women’s Health and Nutrition Groups and
common village committees. This will help ensure universal delivery of
mother and child health and nutrition related services at AWCs, as village
health and nutrition centres.
5. Enhance resources for constructing child friendly toilets and for

providing safe drinking water in all AWCs and schools, Sub-centres
and PHCs, on priority basis, to reach the most vulnerable. These will
also constitute demonstration models for changing hygiene practices in
families and communities, with the AWC being the first village level health,
nutrition and early learning centre. The provisions would also include safe
and clean drinking water source access, chlorination, water testing kits,
low cost filters, solid/liquid waste management and behaviour change
communication interventions. This will contribute to ensuring that the 11th
plan monitorable targets for universal access to safe drinking water and
environmental sanitation are achieved, for improved health and nutrition
outcomes – in the identified districts of the proposed National Mother and
Child Malnutrition Prevention and Reduction Programme and progressively
in all states/districts, as indicated in the 11th Plan.
6. Support finalisation of the draft National Food Security Act, with expanded
social safety nets and an expanded food basket (more nutritious coarse
grains, pulses, edible oils), with provisions supporting Child Nutrition and
Maternity Entitlements and free food for people with special needs. Food
and Nutrition entitlements of 0-6 months infants will be respected and
translated into earmarked resources for promoting exclusive breastfeeding
for this age group. Progressive universalisation of the draft Act is needed,
covering the poorest/most vulnerable districts in the first phase, with
greater accountability at different levels.
B. Panchayat Led Models with Women’s/Community Empowerment
7. Promote Panchayat led models, with progressive devolution of powers

(Funds, functions, functionaries) to PRIs, with women panchayat members
being designated as change agents for malnutrition free panchayats. This
will be based on the state context, with State governments being encouraged to
progressively entrust responsibility of nutrition related programmes, including
ICDS, to PRIs with community ownership. Additional resources should be
given to PRIs with flexibility, authority and accountability. Women panchayat
members will be empowered through training and mentoring support, to lead
a societal campaign against malnutrition, with additional resources for WCD
and nutrition being mobilised through panchayat committees.
Mothers must be involved through village health and nutrition committees,

working through PRIs, with mentoring/capacity building through technical
support from voluntary agencies and institutions. At block levels, a catalytic
institution and voluntary action teams will be fostered for capacity building,
monitoring, data collection and program management.
Awards like Nirmal Gram Puruskar should be given to panchayats, frontline

workers, for reducing malnutrition.

8. Strengthen community processes and women’s empowerment for nutrition
interventions – linking Panchayati Raj institutions, Village Women’s Health
and Nutrition Groups, Women’s SHGs, women link community volunteers/
peer counsellors for a cluster of 15-20 households ( Local resource persons/
Positive role models) Mothers’ Support Groups, extending the outreach of
AWWs and ASHAs at village level. Training modules and packages will be
developed on these issues, and additionally, their integration mandated in
the training provided through the Rural Development training institutions
and district/block/cluster training teams. Integrated Mother Child Protection
Cards, as a counselling and tracking tool should be used by every mother
and volunteer/peer counsellor.
Women’s SHGs will also be involved in piloting community kitchens,

assuming a greater role in the supplementary nutrition component of ICDS
(cooking, using a variety of nutritious local recipes, adding/contributing
locally produced vegetables, fruits), Mid-Day Meals and in community based
monitoring and social audits, for greater transparency and accountability.
9. Extend NRHM Village Health and Sanitation Committees to include

Nutrition - with a Common Village committee for NRHM, ICDS, TSC and
possibly RGSEAG, IGMSY in selected districts, empowered for village level
planning, local response, and community based monitoring. At habitation
and village levels, this will effectively link the frontline worker team, village
women’s health and nutrition groups/SHGs/mothers’ support groups and
panchayati raj institutions, linked to the aggregated Gram Sabha (larger
population). Similar committees are also recommended for urban local
bodies, contextualised to the urban setting, and linked to the proposed
National Urban Health Mission.
C. ICDS Restructuring and Systems Strengthening
10. Restructure ICDS in mission mode with flexibility in implementation (like

SSA, NRHM) and with a menu of innovative pilots/models provided for state
specific adaptation, backed by adequate resources.
The Mission mode would include resources, authority & convergence at

all levels, strengthened infrastructure - construction of child friendly AWCs
with adequate space and facilities (See 12), equipment & mobility, improved
service quality through training, convergence and community participation
& improved monitoring with oversight and social audits by mothers’
groups, NGOs. Additional resources will also be required for indexation
of SNP financial norms to inflation, consistent with the practice followed
for MDM.
A new generation ICDS is envisaged, focusing on enhanced child survival,

nutrition, development and early learning outcomes- through decentralised,
locally responsive state, district and village/slum habitation based plans
of action, that include unreached groups. These would focus on reaching
pregnant and lactating mothers and the younger child under three years of
age, through family and community based empowerment approaches and
also on improving the quality of early learning, with improved parenting
support and AWCs being seen as joyful early learning centres.
The innovative models will represent the scaling up of community based early
child care models, with evidence of impact on child nutrition, development
and early learning outcomes. The models include management of child care
centres by SHGs in Kerala, Keno Parbo Na (Positive Deviance approach) in
West Bengal, Ami Bhi Paribu (Positive Deviance approach) Orissa, greater
involvement of PRIs/Urban Local Bodies in management and monitoring
to ensure improved delivery of services and more effective training of
PRIs/ULBs. Mandatory child care provisions are also recommended in town
development plans, through JNNURM.
Accountability mechanisms: The restructuring will also seek to ensure that

separate Departments for WCD with a dedicated cadre, are established
in states, where these are not already in place. Service guarantees and
accountability mechanisms for outcomes should be put in place.
11. Launch and progressively universalise the Rajiv Gandhi Scheme for
the Empowerment of Adolescent Girls (RGSEAG) and the Indira Gandhi
Matritva Sahyog Yojana (IGMSY-Conditional Maternity Benefit Scheme),
to address adolescent and maternal undernutrition and anemia. IGMSY will
also promote early and exclusive breastfeeding for the first six months
of life. Pilot the strategy options of Conditional Cash Transfers (CCTs), as
optional, (as the consensus here was not as clear as it was for other options),
leveraging on the learning from existing CCT schemes (e.g. JSY). In addition,
it is suggested that there be minimal conditions and incentives are in-built
for the community & beneficiaries, including rewards for panchayats, AWWs
and STAR mothers in IGMSY.
12. Strengthen AWCs as village WCD centres: the first village/habitation post
for health, nutrition and early learning, with provision of additional financial
resources for infrastructure and facilities, anchoring ASHAs and converging
multisectoral interventions for young children, adolescent girls and women.
The AWC should be viewed as a comprehensive village maternal, child &
adolescent girl care centre, having its own building, with adequate space for
children with a joyful early learning environment, a separate room for Ante
Natal Care checkups for pregnant women and centre for adolescent girls
(RGSEAG), hygienic SNP arrangements with a kitchen, store, safe drinking
water and child friendly toilets, gas stove, utensils and early play/learning
material etc. Women’s SHGs should be involved in the production of items
such as durries, local play/learning material.
Linkages with MGNREGS: It is suggested that guidelines for MGNREGS

be modified to include AWC construction as a permissible work, thereby
enhancing resources available for AWC construction. (Other resources could
also include MSDP, BRGF, SSA, NRHM and Additional Central Assistance).
D. Introduce Nutrition Counselling as A Service
13. Introduce a nutrition counsellor/additional AWW in ICDS for improved

family contact, nutrition counselling and care for pregnant and breastfeeding
mothers and children under two years of age. This should be done initially in
the most vulnerable and high burden districts, where the proposed National
Programme is to be implemented and then progressively scaled up.

The additional AWW would ensure services for nutrition counselling,
monitoring and promotion of young child growth and development, using
the new joint Mother Child Protection Card, reaching food supplements and
linking these age groups with the child care and health referral systems. She
would support community based child care/crèche arrangements, if piloted,
and linkages with MGNREGS child care provisions. Nutrition counselling will
seek to ensure the promotion, protection and support of optimal infant and
young child feeding practices, especially early and exclusive breastfeeding
for the first six months of life. This will contribute to the operationalisation of
the National Guidelines on Infant and Young Child Feeding (MoWCD 2006) and
effective implementation of the Infant Milk Substitutes Feeding Bottles and
Infant Food (Regulation of Production, Supply & Distribution) Act 1992 and its
Amendment Act 2003.
This additional AWW/nutrition counsellor would also link mothers with

IGMSY and adolescent girls with RGSEAG, the new schemes addressing the
inter-generational cycle of undernutrition and anaemia. Resources from
MGNREGS for the additional AWW could also be explored.
This would enable the other Anganwadi worker to improve the quality of centre
based early learning and supplementary feeding activities, related to children
3-6 years of age and in strengthening linkages with Sarva Shiksha Abhiyan.
This will require closer supportive supervision provisions in ICDS, from the
current supervisory ratio of 1:17-25 AWCs, and a redefinition of the role
of the supervisor to a mentor, providing supportive supervision and on the
job enrichment/problem solving. Additional resources should be provided
to strengthen the ICDS supervisory unit as a cluster resource unit with the
supervisor mentoring both AWWs and ASHAs in that cluster of villages/AWC,
promoting convergent action for health and nutrition at local levels cost
effectively and addressing the supervision/mentoring needs of ASHAs also.
14. Introduce nutrition counselling as a service with a support chain and

additional human resources, from village level i.e. the AWC to sub-centre,
PHC, CHC, sub-division, district and state levels, linking ICDS and NRHM.
At the village level, the nutrition counsellor/AWW (rural/urban) will be for

1:1000 population, or as per the revised ICDS population norms. At the sub
centre level, this could be within the role of the second ANM in EAG states,
with appropriate training and mentoring support. At PHC level, MOs could
be designated and trained as nutrition mentors, with additional nutrition
officers/mentors in the ratio of 1:20 (mentor:counsellors) at block/CHC
levels. There would be additional human resources needed, with a nutrition
resource team and coordinators at district/state levels, linked to the
proposed new department of nutrition. The support team will extend to
cover state/district/block/sector/sub-centre levels. The training network
will include existing institutions, such as home science and medical colleges,
professional networks, and also draw upon voluntary action teams.
15. Harmonise, prioritise and refine the roles and responsibilities of the
frontline worker team – ASHAs, AWWs and ANMs – with greater emphasis
on nutrition in NRHM and prioritised early home visiting for improved
antenatal, postnatal and early neonatal care. This requires a change in the
existing guidelines of 2005, especially in the light of revised ICDS population
and nutrition norms and the introduction of the new joint card with tracking
of prioritised home visits. Similarly Village Health and Nutrition Days need
to be used not only for routine immunisation, but also for an expanded
outreach service package that includes nutrition related interventions.
E. National Nutrition Education and Communication Campaign
16. Launch a national nutrition communication campaign, linking across sectors

for promoting optimal Infant and Young Child Caring and Feeding practices
and Care of Girls and Women, also using opportunities provided by the Bharat
Nirman Campaign and Sakshar Bharat. This will include different aspects
related to care behaviours, i.e. health, hygiene, psychosocial care and early
learning, supporting improved parenting, with shared responsibilities of both
parents and family support for care.
17. Nutrition Education to be integrated appropriately/strengthened in the

school education curriculum framework at national levels and linked to
Mid-Day Meals, so that children also promote nutrition relevant practices
in the community and through the Child to Child approach. This will also
be incorporated in Sakshar Bharat.Similarly the nutrition component in
the medical and nursing education curriculum will also be strengthened,
networking medical colleges, nursing colleges and councils.
18. Education of girls and women’s literacy to be promoted, responding to their

nutrition, development and protection needs. Retention of girls in elementary
and secondary schools, availing of MDM, health care, IFA supplementation
and deworming interventions, increased duration of schooling, improved
life skills and subsequent linkages to the Skill Development Mission, will be
long term approaches for addressing gender discrimination, early marriage
and early child bearing.
F. Nutrition Policy and Surveillance
19. Operationalise a National Nutrition Surveillance System and Mapping,

working closely with Integrated Disease Surveillance, extending the current
coverage of the National Nutrition Monitoring Bureau, especially to states/
districts with high vulnerability. This should be rooted in community based
assessment, analysis and action, with monthly growth monitoring of all
under threes in ICDS, using new WHO child growth standards and the joint
Mother Child Protection card. Use of ICT, GIS should be promoted for data
collection, collation, analysis and interpretation, planning. It should also
be linked to proposed UID systems, so that individual nutritional status,
especially of pregnant mothers, young children can be tracked, and linked
to GIS system nutritional mapping in these states/districts.
Annual DLHS surveys should be extended to converge the nutrition and

health sectors, and expanded to all districts.
20. Create a Policy Coordination Support Unit in Planning Commission to

provide technical back up support as needed, provide multisectoral policy

coordination support, linking with the PM’s National Council on India’s
Nutrition Challenges, concerned Ministries/Sectors, and institutional
mechanisms established under the National Nutrition Policy and the
National Plan of Action for Nutrition. This would provide a setting that
supports policy alignment across sectors and states, helps position nutrition
centrally in development plans and programmes, linked to the Nutrition
Surveillance System.
The Policy Coordination Support Unit will coordinate third party evaluations
of proposed pilots/innovative models and new programmes, and will also
be needed to facilitate evolution/design of the proposed new multisectoral
programme and its institutional mechanisms.
Members of the Core Group
Dr. Shreeranjan, Joint Secretary

Ministry of Women and Child Development
Government of India
Mr. Amit Mohan Prasad, Joint Secretary

Ministry of Health and Family Welfare
Government of India
Ms. Deepika Shrivastava, Officer on Special Duty

Women and Child Development & Nutrition
Planning Commission
Government of India
Mr. Maha Bir Pershad, Deputy Secretary

Ministry of Panchayati Raj
Government of India
Annexures

Annexure 1: Agenda
Multistakeholder Retreat on Addressing India’s Nutrition Challenges
Organised by the Planning Commission, Government of India
Venue: Indian Council of Agricultural Research (ICAR)

NASC Complex, PUSA, New Delhi
Dates: 7-8 August 2010
Agenda
Time Topic Presenters

Friday, 6 August, 2010
Evening Poster Session- State Specific
displays of innovative approaches
Interaction with state teams and
other stakeholders
Saturday, 7 August, 2010
08:30 – 09:00 Registration
Opening Session Setting the Context
09:00 – 09:10 Presentation of Bouquets Lighting
of the Lamp
09:10 – 09:20 Welcome & Objectives of the Ms. Vandana K. Jena Senior Adviser
Retreat WCD and VAC Planning Commission
09:20 - 09:45 Voices from the Field Ms. Archana Jangid, SHG, Chembur
Block, Jaipur, Rajasthan
Ms. Dinesh Sharma, AWW, Rajasthan
Ms. Ranju Devi, ASHA, Jharkhand
Ms. Chhaya Jadhav, ASHA, Maharashtra
Mr. Sachin Baghel,
Zilla Parishad member, Chhattisgarh
09:45 – 09:55 Address – Reaching Unreached Mr. Kantilal Bhuria
Tribal Communities Minister for Tribal Affairs
09:55 – 10:05 Address – Preventing the Ms. Krishna Tirath
Intergenerational Cycle of Minister of State (IC) for Women and
Under-nutrition Child Development
10:05 - 10:10 Towards A National Plan of Action Ms. Sudha Pillai
Framework for Nutrition Member Secretary, Planning
Commission
10:10 - 10:15 Summing Up Dr. Syeda Hameed
Member, Planning Commission
10:15 – 10:30 Tea/Coffee
Annexures 71
Session II Voices From the Field
Chaired by Dr. Syeda Hameed, Member, Planning Commission
10:30 – 12:30 Listening to the voices of Ms. Aruna Sharma,
stakeholders Amer District, Rajasthan
Ms. Ashima Gope, West Bengal
Mr. Mukesh Kumar, Project Director,

ICDS and CARE India
Ms. P. Amudha, District Collector,

Dharmapuri District, Tamil Nadu
12:30 – 13:30 Group Exercise and Affinity Process: Coordinated by Mr. Anil Sachdeva, CEO
Glads, Sads and Mads and Founder, SOIL, Gurgaon
13:30 – 14:30 Lunch

14:30 – 15:15 Addressing India’s Nutrition Dr Shreeranjan, Joint Secretary,
Challenges – Ministry of WCD
Presentation and Discussion on the Mr. Amarjeet Sinha, Joint Secretary,

Joint Strategy Note Ministry of HFW
Session III Group Work on Strategy Themes
15:15 – 15:30 Formation of Work Groups on Strategy Themes (What needs to be done)
I. Household Food Security and Resource Facilitators’ Team:
Livelihoods Ms. Deepika Shrivastava,
II. Women and Child Care Services Consultant, WCD and Nutrition,
Planning Commission
III. Health Care and Services
Mr. Arunav Banerjee, SOIL
IV. Water, Environmental Sanitation
& Hygiene
V. Infant and Young Child Caring
and Feeding practices
VI. Capacity Development and
Community Processes
VII. Nutrition Policy, Planning and
Surveillance
15:30 – 17:00 Group Work on Strategy Themes (Tea/Coffee break in between)
17:00 – 18:00 Presentation and discussion of Group Rapporteurs: Mr. Basanta Kar, Mr.
Group Work Recommendations on Srinivas Varadan, Dr. Shilpi,
Strategy Themes Ms. Amudha, Dr. Arun Gupta, Mr. Samir
Choudhary and Dr. Sangeeta Saxena
Incorporating Feedback and
Building Consensus
18:00 – 18:15 Tea/Coffee

Late evening street theatre/role play/skits by participants’ teams - Issues and Solutions
Sunday, 8 August, 2010
Session IV Group Work on Strategy Options
09:00 – 09:30 Open vote session on Strategy All participants
Options – Defining “How To”
09:30 – 09:45 Briefing on Group Work for Resource Facilitators’ Team:
8 August Ms. Deepika Shrivastava,
Consultant, WCD and Nutrition
Formation of Work Groups on Planning Commission
Strategy Options (How To) Mr. Arunav Banerjee, SOIL
09:45 - 13:00 Group Work on possible options*-
I. National Child Malnutrition Discussion Facilitators:
Prevention and Reduction Dr. Samir Chaudhari
Programme
II. Panchayat Led Model/s Mr. L.K. Atheeq
Mr. Gyanendra Badgaian
III. Conditional Cash Transfers Ms. Firoza Mehrotra
IV. ICDS Restructuring Dr. Shreeranjan
Dr. Brahmam
V. Nutrition Counselling Service Dr. Arun Gupta
Model
VI. Institutional Arrangements at Dr. Sundararaman
National/State/District/Block/ Dr. Dinesh Paul
Village Levels
VII. Nutrition Data, Mapping and Dr. Prema Ramachandran
Surveillance Systems Dr. N.K. Arora
*Grouping was finalised, based on the outcome of group work on 7 August
2010 and multi-voting
13:00 – 13:30 Finalisation of Group Work Reports
and Poster Presentation
Consolidation of Major Action Resource Facilitators’ Team
Recommendations
13:30 – 14:30 Lunch
Session V Understanding Strategy Options
Chaired by Dr. Syeda Hameed, Member, Planning Commission
14:30 – 16:00 Presentation and discussion of Group Rapporteurs: Ms. Indu Capoor,
Group Work Recommendations on Mr. Basanta Kar, Ms. Mukta Arora,
Strategic Options for “How To” Ms. Ira Tanwar, Mr. Subramaniam,
Mr. Lov Verma and Dr. Rajul Gupta
Concluding Session Recommending Strategic Choices
Chaired by Dr. Montek Singh Ahluwalia, Deputy Chairman,
Planning Commission
16:00 – 16:10 An Overview of the Retreat Mr. Anil Sachdeva, CEO and Founder,
SOIL, Gurgaon
Annexures 73
16:10 – 16:25 Voices from the Field State Teams:
Ms. B. Kamalangi, ICDS Supervisor,
Gajapati District, Orissa
Ms. Kunti Bora, ICDS Supervisor
Kakudona, Golaghat, Assam
Ms. A. Usha Rani, AWW, Tamil Nadu
16:25 – 16:45 A Synthesis of Major Resource Facilitators’ Team:
Recommendations Dr. Arun Gupta
Dr. N. K. Arora
16:45 – 17:05 Comments on Emerging Strategic Prof. Abhijit Sen, Member, Planning
Choices Commission
Ms. Sujatha Rao, Secretary, MoHFW
Mr. D.K. Sikri, Secretary, MoWCD
17:05 – 17:15 Concluding Remarks Dr. Montek Singh Ahluwalia
Deputy Chairman, Planning Commission
17:15 – 17:25 Summing up Dr. Syeda Hameed
Member, Planning Commission
17:25 – 17:30 Wrap Up and Vote of Thanks Ms. Sudha P. Rao
Adviser, WCD & VAC
Planning Commission
17:30 – 18:00 Tea/Coffee

Annexure 2: List of Participants
Ministers
Mr. Kantilal Bhuria, Minister for Tribal Affairs
Ms. Krishna Tirath, Minister of State (IC) for Women and Child Development
Planning Commission
Dr. Montek Singh Ahluwalia, Deputy Chairman
Dr. (Ms.) Syeda Hameed, Member
Ms. Sudha Pillai, Member Secretary
Mr. Arun Maira, Member
Prof. Abhijit Sen, Member
Ms. Vandana Kumari Jena, Senior Adviser, WCD & VAC
Dr. N K Sethi, Senior Adviser (Health & Family Welfare)
Ms. Deepika Shrivastava, Consultant, WCD & Nutrition
Mr. S. P. Chauhan, Advisor RD
Ms. Sudha P. Rao, Adviser WCD &VAC
Ms. Rupa Dutta, Director, WCD & VAC
Prime Minister’s Office

Mr. Sanjay Mitra, Joint Secretary PMO
Mr. L. K. Atheeq, Director, PMO
Secretaries/Additional/Joint Secretaries – Government of India

Ms. K. Sujatha Rao, Secretary, Ministry of Health & Family Welfare
Mr. D.K. Sikri, Secretary, Ministry of Women & Child Development
Mr. H. Panda, Additional Secretary, Ministry of Panchayati Raj
Mr. Sudhir Kumar, Additional Secretary, MoWCD
Dr. Shreeranjan, Joint Secretary, MoWCD
Mr. Sanjiv Khirwar, PS to MOS I/C WCD
Mr. Amarjeet Sinha, Joint Secretary NRHM, Ministry of Health & Family
Welfare
Mr. Amit Mohan Prasad, Joint Secretary, MoHFW
Dr. B. K. Tiwari, Advisor Nutrition, MoHFW
Dr. Sangeeta Saxena, AC Child Health, Ministry of Health and Family Welfare
Mr. T. M. Vijay Bhaskar, Joint Secretary, Dept of Drinking Water Supply, Ministry
of Rural Development
State WCD/HFW/Other Secretaries

Dr. Sarita Singh, Secretary WCD, Government of Rajasthan
Dr. Usha Titus, Secretary WCD, Government of Kerala
Mr. A. Som, Commissioner and Secretary, SW/WCD, Govt. of Meghalaya
Dr. Manohar Agnani, Mission Director NRHM, Govt. of Madhya Pradesh
Ms. N. Vijaya Lakshmi, Director, ICDS, Government of Bihar
Annexures 75
National Councils/Commissions
Dr. Arun Gupta, Member PM’s National Council on Nutrition and National
Coordinator BPNI, Regional Coordinator IBFAN
Dr. Prema Ramachandran, Member PM’s National Council on Nutrition and
Director NFI
Mr. Amod Kanth, Chairperson, Delhi State Commission For Protection of Child
Rights
Mr. Lov Verma, Member Secretary, National Commission For Protection of
Child Rights
Mr. Jawahari Singh, National Commission for Women, New Delhi
National Institutions
Dr. G. N. V. Brahmam, HOD National Institute of Nutrition
Dr. Dinesh Paul, Director, NIPCCD
Dr. Neelam Bhatia, Joint Director, NIPPCD
Dr. Deoki Nandan, Director, NIHFW
Dr. T. Sundararaman, Executive Director, NHSRC
Dr. K. Srinath Reddy, President, Public Health Foundation of India
Dr. C. S. Pandav, Professor and HOD Community Medicine
Dr. Arvind Singh, Rr, AIIMS
Dr. Nikhil S.V Jr, CCM, AIIMS
Experts, Civil Societies, NGOs and Development Partners

Mr. Anil Sachdeva, CEO and Founder, SOIL
Mr. Arunav Bannerjee, SOIL
Dr. Rajiv Tandon, Save The Children
Mr. Ramesh Babu, USAID
Ms. Firoza Mehrotra, Expert and Former Special Consultant, Planning
Commission
Dr. N. K. Arora, INCLEN
Dr. Ajay Gaur, Prof. Paediatrics Gwalior Medical College
Dr. Samir Chaudhri, Director, CINI
Mr. Mukesh Kumar, Executive Director, CARE India
Dr. Mohamed Musa, Country Representative, CARE India
Mr. Satyaswar Nayak, CARE India
Mr. Basanta Kar, Director, CARE India
Ms. Vimala Ramakrishnan, Director, New Concept
Ms. Ashi Kohli Kathuria, World Bank
Ms. Karin Hulshof, Country Representative, UNICEF India
Dr. Nidhi Choudhary, WHO
Mr. Victor Aguayo, UNICEF India
Mr. Chris Chalmers, Country Director, DFID
Ms. Anne Philpott, DFID
Mr. Sangay Thinley, Acting Country Representative, WHO India
Mr. Yunas Tegegn, WHO
Ms. Indu Capoor, Founder Director, CHETNA (India)
Dr. Monisha Behal, North Eastern Network
Ms. Priyanka Singh, In-charge - Health & Education Programme
Ms. Swati Patel, Seva Mandi
Ms. Jasodhara Dasgupta, SAHAYOG
Mr. Ashok Rao, Secretary, Swami Sivananda Memorial Trust
Mr. Gyanendra Badgaian, Poverty Action Lab

Mr. K. S. Subrahmaniam, CARE INDIA, Hyderabad, AP
Dr. Alok Mukhopahyay, Chief Executive Voluntary Health Association of India
Dr. Anupa Sidhu, Principal, Lady Irwin College, New Delhi
Dr. Anchita Patil, USAID
Ms. Sarita Anand, Lecturer Nutrition, Lady Irwin College
Ms. S.A. Jain, FNB, Govt. of India
Mr. Shashank Grahacharjya, Consultant MoWCD
Mr. Srinivas Varadan, Consultant, MoWCD
Mr. Surendra Singh, MoWCD
Ms. Anita Makhijani, FNB
Mr. Abhishek Neelakantan, New Concept, Delhi
Ms. Parul Baghel, New Concept, Delhi
Ms. Ajaa Sharma, New Concept, Delhi
Ms. Ayesha Vemuri, New Concept, Delhi
Members of the Press

Mr. S.C. Bhatia, Assistant Director, CPC, New Delhi
Mr. H.R. Naik, PEX, CPC, New Delhi
Mr. Harender Kumar Garg, PEX, New Delhi
Supporting Team
Planning Commission
Ms. Nandita Mishra
Mr. Alok Kumar
Ms. Astha Kapoor
Dr. Rajul Gupta
Dr. Shilpi
Dr. R.V.P. Singh
Mr. D. Meher
Mr. Pandey
SOIL
Ms. Aditi Dalmia
Mr. Adwaita Govind Menon
Mr. Budhaditya Baul
Mr. Harpreet Kapoor
Mr. Jobby Mathew
Ms. Natasha Vermani
Mr. Nikhil Parmar
Ms. Ragini Tyagi
Ms. Shailee Mody
Mr. Sidhant Thakur
Ms. Smitha J S
Mr. Varun Singh
Mr. Vasudevan Chinnathambi
State Teams
Andhra Pradesh
Ms. S.K. Saidani, AWW, Kariterlagudem, Gopalapuram project,
O/o Gopalapuram ICDS, West Godavari District, Andhra Pradesh
Ms. Shyamala, ANM, Golagaon, Dankada, Vizianagaram District, Andhra
Pradesh
Annexures 77
Jharkhand
Dr. Satish Kumar Sinha, Dir. Health Services
Ms. Akay Minz, State Programme Co-ordinator, VSRC
Ms. Mariam Sanga, Community representative, ASHA, V.P.O Jaltanda, Khunti
District, Jharkhand
Ms. Poonam Devi, Community Representative, ASHA, Chatakpur village,
Sidraul, Ranchi District, Jharkhand
Ms. Sarita Devi, AWW, Post-Mahilong, Thana – Tatisivai, Namkum, Ranchi
District, Jharkhand
Ms. Snehalata Srivastava, AWW, Supudera 2 AWC, Golmuri Jugsalai, East
Singhbhum District, Jharkhand
Ms. Ranjana Kumari, ANM, MTC, Sadar Hospital, Gumla District, Jharkhand
Ms. Ranju Devi, ASHA, Sariahat, Dumka Village, Koshiyari, Post-Chutia,
Sariahat Block, Dumka District, Jharkhand
Bihar
Ms. Shobha Rani Karan, AWW, Centre Sadar-3, Nathu Lane, Patna District,
Bihar
Ms. Uma Kumari, ASHA, Bindu Block, Bhairopur, Biddupur, Vaushaili District,
Bihar
Ms. Pratibha Devi, Member, SHG, V.P.O., Poswa District, Bhojpur, Bihar
West Bengal
Ms. Sharmila Sarkar, AWW, Memari – 1, Burdwan District, West Bengal
Ms. Manasi Roy, ASHA, Bamangola Block, Malda District, West Bengal
Ms. Ashima Gope, ANM, Raiganj, Uttar Dinajpur District, West Bengal
Orissa
Ms. Bhagyabati Pattnaik, AWW, Muligumma AWC, Rayagada ICDS Project
Gajapati
Ms. B. Kamalangi, ICDS Supervisor, Narayanpur Section, Rayagada ICDS Project,
Gajapati
Ms. Jhani Sabar, SHG Member, Fanashree SSG, Muligumma, Rayagada Block,
Gajapati
Ms. Ambika Mohapatra, AWW, Bairasa/Budel Sector, Puintala Block, Bolangir
District, Orissa
Ms. Surjykanti Pandhi, ANM Kalahandi, At. Beherapati, Po Sargiguda, Kalahandi
District, Orissa
Ms. Sarpati Tudu, President, Zilla Parishad, Mayurbhanj, Orissa
Tamil Nadu
Ms. P. Amudha, District Collector, Dharmapuri District, Tamil Nadu
Ms. M. Kasturi, AWW, Dharmapuri District, Tamil Nadu
Ms. G. Kalavathi, AWW, Dharmapuri District, Tamil Nadu
Mr. Ravindranath Singh, Deputy Director ICDS - Nodal Officer
Ms. K. Kanmani, Deputy Director Nutrition
Mr. K Anbalagan, Assistant Director (IEC & Monitoring)
Ms. S. Fahitha, Child Development Project Officer, Sriperumbudur district,
Chennai, Tamil Nadu
Mr. S. Ramachandran, Superintendent
Ms. A. Usha Rani, AWW, Chellaperumal Nagar, Sriperumbudur District, Chennai,

Tamil Nadu
Mr. L D George, Panchayat Raj, Institutional Member, Sriperumbudur District,
Chennai, Tamil Nadu
Ms..Uday C.Lal Department of ICDS, Tamil Nadu
P. Adalarash, Department of ICDS, Tamil Nadu
R. Kaliyappan, ICDS, Tamil Nadu
Meghalaya
Mr. C C M Mihsil, IAS Director of Social Welfare, Shillong, Meghalaya
Mr. L N Jyrwa, Addl Director of Social Welfare, Shillong, Meghalaya
Ms. E Basaiawmoit, Assistant Director of Social Welfare (ICDS), Shillong,
Meghalaya
Ms. S. Rynga, Programme Officer (ICDS) Directorate of Social Welfare, Shillong,
Meghalaya
Mr. I Talang, District Programme Officer (ICDS cell), Shillong, Meghalaya
Ms. Arphita B Marak, AWW, Selsella ICDS Project, Shillong, Meghalaya
Ms..Emily, Social Welfare (ICDS), Shillong
Ms.Rishowar, Social Welfare (ICDS), Shillong
Mr. R B Shadap, Community Leader, Umsning ICDS Project, West Garo Hills
District, Shillong, Meghalaya
Ms. Baphira Kharbuli, Member, Mother’s Committee/SHG Mylliem ICDS Project,
Shillong, Meghalaya
Maharashtra
Ms. Rita S Gaikwad, District Programme Manager, NRHM cell
Dr. R C Sagar, NRHM, Maharashtra
Dr. Dilip Datnaik, ICDS Aurangabad
Ms.Surekha Patil, ICDS Aurangabad
Ms.Tara ICDS Aurangabad
Ms. Chhaya R. Jadhav, ASHA, Nadora village, Palgarh, Thane District,
Maharashtra
Ms. Smita G. Patil, Member, Panchayat Samiti, Palgarh, Thane District,
Maharashtra
Himachal Pradesh
Ms. Ira Tanwar, Child Development Project Officer, ICDS
Ms. Amravati Sharma, Supervisor, ICDS project, Solan District, Himachal
Pradesh
Ms. Prema Devi, SHG Member, Solan District, Himachal Pradesh
Rajasthan
Ms. Dinesh Sharma, AWW, Rajasthan
Ms. Aruna Sharma, ASHA, Amer District, Rajasthan
Ms. Archana Jangid, SHG Member, Chembur Block, Jaipur, Rajasthan
Ms.Manju Soni,ICDS Jaipur, Rajasthan
Ms. Ranjeeta, Lady Supervisor
Ms. Mukta Arora, Nutrition Coordinator, DWCD, Jaipur, Rajasthan
Mr. Santosh Jain, Supervisor, Sanganer District, Rajasthan
Ms. Hemlata Vijat, AWW, Jaipur – III District, Rajasthan
Ms. Radha Mani, ANM, Bundalsar-Dungargarh, Bikaner District, Rajasthan
Ms. Raju Devi, ASHA, Katakabadi-Ashapura, Jamalsar District, Rajasthan
Annexures 79
Kerala
Ms. Mumthas T.V., Member, Block Panchayat, Malappuram, Kerala
Ms. K T Deveki, AWW, Kavanoor Panchayat, Kerala
Ms. O P Rema, Supervisor, ICDS Mankada, Malappuram, Kerala
Ms. Thasneem P.S., Department of Social Welfare, Kerala
Assam
Ms. Kunti Bora, Supervisor, ICDS Project Kakudonga, Golaghat District, Assam
Ms. Kalpana Gayan, AWW, Barhampur ICDS AWC, Nagaon District, Assam
Uttar Pradesh
Ms. Jeet Kaur Nirbhay, Mashay Sevika, Block Campus, Bal Vikas Pariyojna,
Jewar, Gautam Budh Nagar District, Uttar Pradesh
Ms. Pushpa Singh, AWW, Banisaradul, Banghrauli Road, Jewar Gautam Budh
Nagar, Uttar Pradesh
Ms. Sunita Nagar, ASHA, Roja Jalalpur village, Visrakh Block, Gautam Budh
Nagar, Uttar Pradesh
Ms. Seema Singh, President, Mother’s Committee, Ward No.8, Bhangrauli
Road, Jewar, Gautam Budh Nagar, Uttar Pradesh
Mr. Santosh, Deputy Director, ICDS, UP
Chhattisgarh
Ms. Nandini Chandrakar, AWW, Village Rasni, Block Aurang, Raipur District,
Chhattisgarh
Ms. Sunita Sahu, ANM, Sub-centre Tumudiband, Block Dongargaon, Rajnandgaon
District, Chhattisgarh
Ms. Gomti Sahu Sarpanch, Elected PRI at Village level, Village Bhansuli K.,
Patan Block, Durg District, Chhattisgarh
Mr. Sachin Singh Baghel, Zilla Parishad member, Chhattisgarh
And many other participants who could not stay all through.

Group Work Participants
Day I: 7 August 2010
Group I: Household Food Security and Livelihoods
S. A. Jain, Ministry of Women & Child Development, Govt. of India

Sharmila Sarkar AWW, Memari – 1, Burdwan District, West Bengal
Smita G. Patil, Member, Panchayat Samiti, Palgarh, Thane District,
Maharashtra
Sarita Singh, Secretary WCD, Government of Rajasthan
Surendra Singh, MoWCD
Yunas Tegegn, WHO
K Kanmani, Deputy Director, Nutrition, Tamil Nadu
I. Talang, District Programme Officer (ICDS cell), Shillong, Meghalaya
L. N. Jyrwa, Addl Director of Social Welfare, Shillong, Meghalaya
Shashank Grahacharjya, Consultant MoWCD
Bhagyabati Pattnaik, AWW, Muligumma AWC, Rayagada ICDS Project Gajapati,
Orissa
B. Kamalangi, ICDS Supervisor, Narayanpur Section, Rayagada ICDS Project,
Gajapati, Orissa
Group II: Women and Child Care Services

R. B. Shadap, Community Leader, Umsning ICDS Project, West Garo Hills
District, Shillong, Meghalaya
D. K. Sikri, Secretary, Ministry of Women & Child Development
Usha Titus, Secretary WCD, Government of Kerala
Mumthas T.V., Member, Block Panchayat, Malappuram, Kerala
Aruna Sharma, ASHA, Amer District, Rajasthan
L. D. George, Panchayat Raj, Institutional Member, Sriperumpudur District,
Chennai, Tamil Nadu
Vimala Ramakrishnan, Director, New Concept
Sarita Anand, Lecturer Nutrition, Lady Irwin College
Group III: Health Care Services

Dr. S. K. Sinha, Dir. Health Services, Jharkhand
Akay Minz, State Programme Co-ordinator, VSRC, Jharkhand
Amod K. Kanth, Chairperson, Delhi State Commission For Protection of Child
Rights
Thasneem P. S, Department of Social Welfare, Kerala
Snehalata Srivastava, AWW, Supudera 2 AWC, Golmuri Jugsalai, East Singhbhum
District, Jharkhand
Jeet Kaur Nirbhay, Mashay Sevika, Block Campus, Bal Vikas Pariyojna, Jewar,
Gautanbudh Nagar District, Uttar Pradesh
Annexures 81
Pushpa Singh, AWW, Banisaradul, Banghrauli Road, Jewar Gautam Budh Nagar,
Uttar Pradesh
P. Amudha, District Collector, Dharmapuri District, Tamil Nadu
K. Ambalagan, Assistant Director (IEC)
Ira Tanwar, Child Development Project Officer, ICDS, HP
Kunti Bora, Supervisor, ICDS Project Kakudonga, Golaghat District, Assam
Group IV: Water, Environmental Sanitation and Hygiene
Dr. Prema Ramachandran, Member PM’s National Council on Nutrition and

Director NFI
Firoza Mehrotra, Expert and Former Special Consultant, Planning Commission
Uma Kumari, ASHA, Bindu Block, Bhairopur, Biddupur, Vaushaili District, Bihar
Pratibha Devi, Member, SHG, V.P.O., Poswa District, Bhojpur, Bihar
Sachin Singh Baghel, Zilla Parishad member, Chhattisgarh
Rita S Gaikwad, District Programme Manager, NRHM cell, Maharashtra
G. Kalavathi, AWW, Dharmapuri District, Tamil Nadu
Archana Jangid, SHG Member, Chembur Block, Jaipur, Rajasthan
Prema Devi, SHG Member, Solan District, Himachal Pradesh
O P Rema, Supervisor, ICDS Mankada, Malappuram, Kerala
M. Kasturi, AWW, Dharmapuri District, Tamil Nadu
Kalpana Gayan, AWW, Barhampur ICDS AWC, Nagaon District, Assam
Ashi Kohli Kathuria, World Bank
Shobha Rani Karan, AWW, Centre Sadar-3, Nathu Lane, Patna District, Bihar
K.T. Deveki, AWW, Kavanoor Panchayat, Kerala
Group V: Infant and Young Child Caring and Feeding Practices
Lov Verma, Member Secretary, National Commission For Protection of Child

Rights
Arindam Som, Commissioner and Secretary, SW/WCD, Govt. of Meghalaya
Arphila B Marak, AWW, Selsella ICDS Project, Shillong, Meghalaya
Basanta Kumarkar, Director, CARE India
Dr. Monisha Behl, North Eastern Network
Aruna Sharma, ASHA, Amer District, Rajasthan
Poonam Devi, Community Representative, ASHA, Chatakpur village, Sidraul,
Ranchi District, Jharkhand
Jawahari Singh, National Commission for Women, New Delhi
Amravati Sharma, Supervisor, ICDS project, Solan District, Himachal Pradesh
S.K. Saidani, AWW, Kariterlagudem, Gopalapuram project, O/o Gopalapuram
ICDS, West Godavari District, Andhra Pradesh
Sudhir Kumar, Additional Secretary MoWCD
Dr. K. Srinath Reddy, President, Public Health Foundation of India
Sharmila Sarkar AWW, Memari – 1, Burdwan District, West Bengal
Indu Capoor, Founder Director, CHETNA (India)
Abhishek Neelakantan, New Concept
Seema Singh, President, Mother’s Committee, Ward No.8, Bhangrauli Road,
Jewar, Gautam Budh Nagar, Uttar Pradesh
Mukesh Kumar, Executive Director, CARE India

Group VI: Capacity Development and Community Processes
L. K. Atheeq, Director, PMO

Mukta Arora
Dr. Anupa Sidhu, Principal, Lady Irwin College, New Delhi
Saurabh Porwal, CARE
Dr. N. Vijaya Lakshmi, Director, ICDS, Government of Bihar
E. Basaiawmoit, Assistant Director of Social Welfare (ICDS), Shillong,
Meghalaya
Subhash Moghe, CARE
Satyaswar Nayak, O.O. CARE India
Dr. Sangeeta Saxena, AC Child Health, Ministry of Health and Family Welfare
Group VII: Nutrition policy planning and surveillance
Dr. Ajay Gaur, Prof. Paediatrics Gwalior Medical College

Dr. G. N. V. Brahmam, HOD National Institute of Nutrition
Dinesh Sharma, AWW, Rajasthan
S. Prabhath, A.T.A, MoWCD
Dr. N. K. Arora, INCLEN
Srinivas Varadan, Consultant, MoWCD
Anita Makhijani, FNB
G. Ravindranath Singh, Deputy Director ICDS - Nodal Officer, Tamil Nadu
Dr. R. C. Sagar, NRHM, Maharashtra
K. S. Subrahmaniam, CARE INDIA, Hyderabad, AP
DAY 2: 8 August 2010
Group I: National Child Malnutrition Prevention & Reduction Programme
Dinesh Sharma, AWW, Rajasthan

Sharmila Sarkar, AWW, West Bengal
Sarita Singh, Secretary WCD, Government of Rajasthan
Smita G. Patil, Member, Panchayat Samiti, Palgarh, Thane District, Maharashtra
Abhishek Neelakantan, New Concept, Delhi
Rita S. Gaikwad, District Programme Manager, NRHM cell, Maharashtra
Satyaswar Nayak, O.O. CARE India
Ashi Kohli Kathuria, World Bank
Indu Capoor, Founder Director, CHETNA (India)
Group II: Panchayat Led Models
Basanta Kumarkar, Director, CARE India

Shashank Grahacharjya, Consultant, MoWCD
Sachin Singh Baghel, Zilla Parishad member, Chhattisgarh
Bhagyabati Pattnaik, AWW, Muligumma AWC, Rayagada ICDS Project Gajapati,
Orissa
Annexures 83
Dr. N. Vijaya Lakshmi, Director, ICDS, Government of Bihar
L. K. Atheeq, Director, PMO
Group III: Conditional Cash Transfers
Thasneem P. S, Department of Social Welfare, Kerala

K. T. Deveki, AWW, Kavanoor Panchayat, Kerala
P. Rema, Supervisor, ICDS Mankada, Malappuram, Kerala
M. Kasturi, AWW, Dharmapuri District, Tamil Nadu
Kalpana Gayan, AWW, Barhampur ICDS AWC, Nagaon District, Assam
Shobha Rani Karan, AWW, Centre Sadar-3, Nathu Lane, Patna District, Bihar
Firoza Mehrotra, Expert and Former Special Consultant, Planning
Commission
Uma Kumari, ASHA, Bindu Block, Bhairopur, Biddupur, Vaishali District, Bihar
G. Kalavathi, AWW, Dharmapuri District, Tamil Nadu
Archana Jangid, SHG Member, Chembur Block, Jaipur, Rajasthan
Prema Devi, SHG Member, Solan District, Himachal Pradesh
Group IV: ICDS Restructuring
Ira Tanwar, Child Development Project Officer, ICDS, HP

Mumthas T.V., Member, Block Panchayat, Malappuram, Kerala
K. Ambalagan, Assistant Director (IEC)
I. Talang, District Programme Officer (ICDS cell), Shillong, Meghalaya
P. Adalarash, Department of ICDS, Tamil Nadu
R. Kaliyappan, ICDS, Tamil Nadu
Mariam Sanga, Community representative, ASHA, V.P.O Jaltanda, Khunti
District, Jharkhand
P. Amudha, District Collector, Dharmapuri District, Tamil Nadu
Dr. Saroj K. Adhikari, MoWCD
S. Fahitha, Child Development Project Officer, Sriperumbudur district,
Chennai, Tamil Nadu
A. Usha Rani, AWW, Chellaperumal Nagar, Sriperumbudur District, Chennai,
Tamil Nadu
B. Kamalangi, ICDS Supervisor, Narayanpur Section, Rayagada ICDS Project,
Gajapati, Orissa
S. K. Saidani, AWW, Kariterlagudem, Gopalapuram project, O/o Gopalapuram
ICDS, West Godavari District, Andhra Pradesh
N. Shyamala, ANM, Golagaon, Dankada, Vizianagaram District, Andhra
Pradesh
Dr. Arvind Singh, Rr, AIIMS
Srinivas Varadan, Consultant, MoWCD
Group V: Nutrition Counselling Service Model
Dr. Neelam Bhatia, Joint Director, NIPPCD

Dr. Nikhil S.V, Jr, CCM, AIIMS
S. Prabhath, A.T.A, MoWCD

Prakash Nayak, Technical Specialist-BCC
Amravati Sharma, Supervisor, ICDS project, Solan District, Himachal Pradesh
Sunita Sahu, ANM, Sub-centre Tumudiband, Block Dongargaon, Rajnandgaon
District, Chhattisgarh
Sunita Nagar, ASHA, Roja Jalalpur village, Visrakh Block, Gautam Budh Nagar,
Uttar Pradesh
K. S. Subrahmaniam, CARE INDIA, Hyderabad, AP
Jawahari Singh, National Commission for Women, New Delhi
Jeet Kaur Nirbhay, Mashay Sevika, Block Campus, Bal Vikas Pariyojna, Jewar,
Gautam Budh Nagar District, Uttar Pradesh Santhosh, Deputy Director, TCDS, UP
Pratibha Devi, Member, SHG, V.P.O., Poswa District, Bhojpur, Bihar
Pushpa Singh, AWW, Banisaradul, Banghrauli Road, Jewar Gautam Budh Nagar,
Uttar Pradesh
Group VI: Institutional Arrangements at National/State/District/Block/Village

Levels
Dr. S. K. Sinha, Dir. Health Services, Jharkhand

Baphira Kharbuli, Member, Mother’s Committee/SHG Mylliem ICDS Project,
Shillong, Meghalaya
Dr. Dinesh Paul, Director, NIPCCD
Surendra Singh, MoWCD
Anita Makhijani, FNB
Dr. Anuradha Jain, Consultant, NHSRC
Akay Minz, State Programme Co-ordinator, VSRC, Jharkhand
Dr. Rajiv Tandon, Save The Children
K. Ashok Rao, Secretary, Swami Sivananda Memorial Trust
Lov Verma, Member Secretary, National Commission for Protection of Child
Rights
Subhash Moghe, CARE
Group VII: Nutrition Data, Mapping and Surveillance Systems
Ranjana Kumari, ANM, MTC, Sadar Hospital, Gumla District, Jharkhand

Ranju Devi, ASHA, Sariahat, Dumka Village, Koshiyari, Post-Chutia, Sariahat
Block, Dumka District, Jharkhand
G. Ravindranath Singh, Deputy Director ICDS - Nodal Officer, Tamil Nadu
Dr. G.N.V Brahmam, HOD, National Institute of Nutrition
Dr. R. C. Sagar, NRHM Maharashtra
Y. S. Kataria. Director (Media), MoWCD Systems
Dr. N.K. Arora, INCLEN
Prema Ramachandran, Member PM’s National Council on Nutrition and Director
NFI
Maitreeji Kollegal, Director, International Institute of Health Management
Research, New Delhi
Roma. N, Social Welfare Government, Meghalaya
Parul Baghel, New Concept
Annexures 85
Annexure 3: Terms of Reference for Group Work – 7 August 2010
Terms of Reference for Group Work- 7 August 2010
1. The time provided for group work is 14:45 hours to 16:15 hours on 7 August
2010. Group reports will be presented at 16:15 hours.
2. The objective of the group work is to recommend what needs to be done under
different strategy themes, to address India’s nutrition challenges. A copy of
the detailed strategy note prepared by the Ministries of Women and Child
Development and Health and Family Welfare is available for ready reference,
as well as a summary note of the same.
3. Discussion on strategy themes would be informed by the evidence of what

works and why, as well as the rich experience of group members, from
different stakeholder groups, state, field level functionaries and community
members.
4. The discussion would be structured around the seven themes presented in the
7 August morning session by both ministries-
Group I — Household Food Security and Livelihoods
Group II — Women and Child Care Services
Group III — Health Care and Services
Group IV — Water, Environmental Sanitation & Hygiene
Group V — Infant and Young Child Caring and Feeding Practices
Group VI — Capacity Development and Community Processes
Group VII — Nutrition Policy, Planning and Surveillance
5. Groups have been brought together, to provide a mix of different stakeholder

perspectives, states and programming contexts.
6. Resource Facilitators’ teams are available to each group. These include

experts and representatives of the concerned ministries of the Government
of India.
7. Please identify a chairperson for your group and identify the group rapporteur
for your group. Please inform the facilitator if language translation is
needed,
8. It is suggested that the presentation summarise major recommendations.
9. The use of flip charts/cards is recommended, to facilitate participation of

all group members. For presentation, use of powerpoints would facilitate
synthesis of reports.

Terms of Reference for Group Work
Group I - Household Food Security and Livelihoods
1. Please discuss major issues in ensuring universal availability and access to

household food security, especially for unreached and excluded groups and
groups with high nutritional vulnerability.
2. Discuss the recommendations emerging for the draft National Food Security
Act and suggest further interventions needed to move towards the concept of
nutrition security.
(This may also include issues related to intra household food distribution and
absorption).
3. Please identify major issues in improving the Targeted Public Distribution

System and suggest interventions for increasing the access of the poorest and
most vulnerable groups.
4. Similarly, please suggest key interventions for strengthening food

supplementation programmes, such as the Mid Day Meal Scheme, AAY etc.
(ICDS covered by group 2), with greater ownership of panchayats and local
communities.
5. Please identify major issues in improving access to livelihood security through

programmes such as MGNREGA. Suggest interventions for engendering the
same.
6. What is the change we would like to see in the above in the next 5 years?
7. What are the 5 key recommendations for increasing access to household food
security and livelihoods?
The terms of reference provided to the group are indicative and not prescriptive,
and may be modified, as needed, by the group.
Annexures 87
Group II - Women and Child Care Services
1. Please identify major issues in improving nutrition and development outcomes

through women and child care services, such as ICDS, crèches, and other
upcoming schemes (such as Indira Gandhi Matritva Sahyog Yojana, and Rajiv
Gandhi Scheme for the Empowerment of Adolescent Girls).
2. What interventions and services are needed for addressing the intergenerational
cycle of under-nutrition, focusing on reaching the crucial and most vulnerable
prenatal- under two years age group?
3. What is needed for increasing the effectiveness of ICDS in preventing

and reducing under-nutrition and promoting young child survival and
development?
4. Discuss the roles of ICDS & Health functionaries - ANMs, AWWs, ASHAs, AWHs and
how team work can be strengthened, with greater community involvement,
especially at critical contact points.
5. Suggest how convergence of major flagship programmes and others can enhance
the effectiveness of different services for women, children and adolescent
girls, with greater decentralisation and ownership of women, communities
and Panchayati Raj Institutions.
6. What is the change we would like to see in the next 5 years?
7. What are the 5 key recommendations for progressively universalising access,

enhancing the quality and impact of women and child care services?

Group III - Health Care and Services
1. Please discuss major issues in improving the nutrition component and impact
of NRHM and other health related interventions.
2. What interventions and health services are needed for addressing the
intergenerational cycle of under-nutrition, focusing on reaching the crucial
and most vulnerable prenatal- under two years age group?
3. What is needed for increasing the effectiveness of NRHM in preventing and

reducing maternal, infant and child under-nutrition and related mortality?
4. Discuss the roles of ICDS & Health functionaries- ANMs, AWWs, ASHAs, and
AWHs and how team work can be strengthened, with greater community
involvement, especially at critical contact points.
5. Suggest how NRHM decentralised planning processes and institutional

mechanisms can be used to accelerate community action for nutrition–
especially in the states/districts with high nutritional vulnerability?

enhancing the quality and impact of health care and services?
Annexures 89
Group IV - Water, Environmental Sanitation & Hygiene
1. Please discuss major issues for progressively universalising access and enhancing
the nutritional impact of services for safe drinking water, environmental
sanitation and hygiene.
2. What further interventions are needed for enhancing the quality and nutritional
impact of these –especially as relates to the most crucial and vulnerable
groups?
3. Suggest how decentralised planning processes and institutional mechanisms in

the Total Sanitation Campaign, NRDWP can be used to strengthen convergence
with other schemes for nutrition.
4. Building on the Nirmal Gram Puruskar experience – what interventions are

suggested for encouraging malnutrition free panchayats/districts ?Especially
in the states/districts with high nutritional vulnerability?

enhancing the quality and impact of services for safe drinking water,
environmental sanitation and hygiene for improved nutrition and development
outcomes?

Group V – Infant and Young Child Caring and Feeding Practices
1. Please discuss major issues for ensuring optimal Infant and Young Child Caring
and Feeding Practices and care for girls and women?
2. What further interventions are needed for progressively scaling up optimal

caring and feeding practices?
3. What is needed to universalise early and exclusive breastfeeding (0-6months)

and promote appropriate complementary feeding, (along with continued
breastfeeding for 2 years or beyond)?
4. What are the resources needed for supporting mothers, caregivers and families
and the support required for maternity protection?
5. Please suggest how skilled counselling support can be provided, linking across
home, community and facility levels, anchored in a support network at village
level.
6. What is the change we would like to see in the next 5 years, including making
the 0-6 months infant visible?
7. What are the 5 key recommendations for protecting, promoting and supporting
optimal Infant and Young Child Caring and Feeding Practices and care for girls
and women?
Annexures 91
Group VI - Capacity Development and Community Processes
1. Please discuss major issues in strengthening the capacity of different

stakeholders for enhancing nutrition and development outcomes, through
sustainable and empowering processes.
2. What further interventions are needed for enhancing institutional capacity,

across different sectors, and at different levels, for effectively responding
to training needs, including experiential learning and field based mentoring
support?
3. Please suggest what is needed to strengthen decentralised training capability

and mentoring support at field levels, linking capacity development with
service quality improvement and programme monitoring.
4. Please suggest what is needed to strengthen community processes and

mechanisms, for assessment, analysis and action to improve nutrition
outcomes, especially for the most vulnerable groups.
6. What are the 5 key recommendations for strengthening capacity and community
processes for improved nutrition outcomes?

Group VII - Nutrition Policy, Planning and Surveillance
1. Please identify major issues in the current policy framework that need to be
addressed for improved nutrition and development outcomes.
2. Suggest what is needed to strengthen the institutional framework for nutrition

for effective multisectoral action, by multiple stakeholders, with requisite
safeguards.
3. What interventions are needed to strengthen decentralised planning processes

i.e. processes by which locally responsive village/cluster/block/district/state
plans of action would be developed?
4. What are the major issues in the current Nutrition Surveillance System and
what is needed for effective nutrition surveillance and timely corrective
action at different levels?
5. Suggest how the introduction of the new ICDS NRHM Mother Child Protection
Card and the strengthening of community level monitoring and promotion of
young child growth and development can be used for effective mother child
cohort tracking.
6. Please discuss what intensification of efforts is required in districts/community

groups with high nutritional vulnerability.
8. What are the 5 key recommendations for improved nutrition outcomes?
Annexures 93
Annexure 4: Terms of Reference for Group Work – 8 August 2010
Terms of Reference for Group Work - 8 August 2010
1. The time provided for group work is 09:15 hours to 12:30 hours on 8 August
2010. Group reports will be presented through posters/flip charts walk around
at 12:30 and in the plenary session at 14:00 hours.
2. The objective of the group work is to recommend how to implement the

interventions suggested under different strategy themes on 7 August 2010, to
3. Discussion on strategy options would be informed by the evidence of what

works and why, as well as the rich experience of group members, from different
stakeholder groups, states, field functionaries and community members.
4. The discussion would be structured around the seven strategy options emerging
from the thematic presentations, multi-voting and affinity process of sessions
held on 7 August. These could include strategy options such as -
• Group I — National Child Malnutrition Prevention and Reduction

Programme
• Group II — Panchayat Led Model/s
• Group III — Conditional Cash Transfers
• Group IV — ICDS Restructuring
• Group V — Nutrition Counselling Service Model
• Group VI — Institutional Arrangements at National/state/district local
Levels
• Group VII — Nutrition Data, Mapping and Surveillance
5. Groups have been brought together, to provide a mix of different stakeholder

perspectives, states and programming contexts.
6. Resource Facilitators’ teams are available to each group. These include

experts and representatives of the concerned ministries of the Government
of India.
7. Please elect a chairperson for your group and identify the Group Rapporteur for
your group. Please inform the facilitator if language translation is needed.
8. It is suggested that the presentation summarise major recommendations.
9. The use of flip charts/cards is recommended, to facilitate participation of

all group members. For presentation, use of powerpoints would facilitate
synthesis of reports.

Group I - National Child Malnutrition Prevention and Reduction

Programme
1. Please discuss what the concept of a National Child Malnutrition Prevention

and Reduction Programme means to the group.
2. What would be the objectives of such a programme and its strategic

principles?
3. What would be the core interventions and services envisaged under this
programme, especially in districts with high nutritional vulnerability?
4. What and how would this be different from what already exists, through
multisectoral interventions of different government programmes and
partnerships with voluntary action groups?
5. What is the implementation framework envisaged at village level? How does

this link with/get rooted in Panchayati Raj Institutions?
6. What kind of institutional arrangements are envisaged at different levels and

how will this link with those of existing schemes?
7. What are the 5 key recommendations for developing and initiating such
a programme, for improved and sustainable nutrition and development
outcomes?
Annexures 95
Group II- Panchayat Led Model/s
1. Please discuss what the concept of a Panchayat led model/s means to the
group.
For instance what does this imply in terms of devolution of powers – Functions,
Funds, Functionaries- with regard to different flagships, and the roles of
Panchayat members, especially women, as change leaders.
2. What would be the objectives of such a model/s and its strategic principles,
especially recognising that different states have different contexts, capacity
of PRIs, and levels of devolution of powers?
3. What would be the core interventions and services envisaged for “malnutrition
free Panchayat/districts” under this model/s?
4. What and how would this be different from what already exists, through a
multitude of government programmes?
5. What is the implementation framework envisaged at village level and the

community based monitoring mechanism?
6. How will this ensure convergence of multisectoral interventions and sustained

community action?

how will these link with those of existing schemes?
8. What are the 5 key recommendations for ensuring the progressive devolution
of powers to Panchayat Raj Institutions for improved and sustainable nutrition
and development outcomes?

Group III - Conditional Cash Transfers
1. Please discuss what the concept of Conditional Cash Transfers, for nutrition
related programmes, means to the group.
Specific examples include the upcoming Rajiv Gandhi Adolescent Girls’ Scheme,
(RGSEAG) and the Indira Gandhi Matritva Sahyog Yojana (IGMSY- Conditional
Maternity Benefit Scheme).
2. What would be the objectives of such a strategy option, its assumptions

regarding service delivery mechanisms and its guiding principles?
strategy option, especially in districts with high nutritional vulnerability?
4. What and how would this be different from what already exists, through other
schemes like the Janani Suraksha Yojana?
5. How can such an option use the power of Information and Communication
Technology and use, for instance, SMART cards linked to UID numbers, mother
child cards etc.

this link with/get rooted in Panchayati Raj Institutions?

8. What are the 5 key recommendations for developing and initiating such a
strategy option, for improved and sustainable nutrition and development
outcomes?
Annexures 97
Group IV – ICDS Restructuring
1. Please discuss what the concept of ICDS Restructuring means to the group,
recognising that both nutrition and early development and learning outcomes
are critical for inclusive growth.
2. What would be the ICDS Restructuring objectives and principles?
programme, especially in districts with high nutritional vulnerability?
4. What and how would this be different from what already exists, with different
implementation experience across and within different states/districts?
5. Which best practices/models can be adapted and scaled up, based on

implementation experience and the local context and what additional
resources are needed?

this link with/get rooted in Panchayat Raj Institutions?

8. What are the 5 key recommendations for ICDS Restructuring for enhanced and
sustainable nutrition and development outcomes?

Group V – Nutrition Counselling Service Model
1. Please discuss what the concept of a Nutrition Counselling Service Model means
to the group, and how this supports Behaviour Change Communication.
2. What would be the objectives of such a model and its strategic principles,
acknowledging that skilled nutrition counselling support is not yet recognised
as a service?
3. What are the core interventions envisaged for ensuring behaviour change
communication and skilled nutrition counselling support at different levels?
4. How can this support chain be created - extending from home/family,

community/AWC to Health Sub centre PHC/CHC facilities and the referral
system?
5. How would this strengthen the continuum of care during pregnancy, lactation,
infancy and early childhood and be different from what already exists?
6. What does this imply for the communication strategy, management of human
resources, roles of frontline workers, capacity development, reward and
recognition, at different levels, across sectors?
7. What is the implementation framework envisaged at the village level and

the community based monitoring mechanism, linked to Panchayati Raj
Institutions/other community based mechanisms?
8. What are the 5 key recommendations for ensuring that a skilled nutrition
counselling support system is created for improved nutrition and care
behaviours and outcomes?
Annexures 99
Group VI - Institutional Arrangements at National/state/district/

local levels
1. Please discuss what institutional arrangement options are emerging from

Group Work on Day 1. Please identify the preferred option for your group and
discuss what this institutional arrangement means to the group.
For instance – mission mode/society, normative framework, etc.
2. What would be the objectives and strategic guiding principles in designing and
implementing the proposed institutional arrangements, especially recognising
that different state/districts have different contexts?
3. What would be the kind of decentralisation and flexibility provided by this

implementation framework?
4. How would this be different from existing institutional arrangements and how
would this link to/be harmonised with those existing in different sectors?
5. What is the implementation framework and institutional mechanism envisaged

at village level, and how would that be empowered for community action?
9. What are the 5 key recommendations for ensuring that effective institutional
arrangements are in place, for improved nutrition and development
outcomes?

Group VII - Nutrition Data, Mapping and Surveillance
1. Please discuss current systems for collection; analysis and synthesis of nutrition
data. What are the emerging issues that need to be addressed, building on the
group discussion on 7 August?
2. What does the concept of an effective nutrition surveillance system mean to

the group, especially in districts with high nutritional vulnerability and during
natural disasters?
3. What would be the objectives of such a system and its strategic principles?
4. How can nutrition data management be linked intrinsically with other health
data management initiatives e.g. HMIS, NIIDSP, linked to GIS mapping to make
under-nutrition visible?
5. How can such an option use the power of Information and Communication
Technology for real time data monitoring, possibly linked to UID numbers and
family based records such as mother- child growth cards etc.
6. What is recommended in terms of the design, periodicity, scope, methodology

of ongoing surveys related to nutrition parameters e.g. District Annual Health
Surveys?
7. What are the institutional mechanisms needed to strengthen the Nutrition Data
Management function, including assessment, analysis and action processes at
different levels?
8. What are the 5 key recommendations for improved and sustainable nutrition
and development outcomes?
Annexures 101
State
Exhibitions
on
Display
Annexures 103
State
Perspectives

IX. The Exhibition
States Display Innovations in Addressing the Malnutrition

Challenge
Using an innovative format of display cum demonstration, more than 15 states

and Union Territories took up stall space at the Multistakeholder Retreat on
Addressing India’s Nutrition Challenges on 7-8 August, 2010 in New Delhi. They
displayed nutritional food items, charts, posters, models, audio-visual films,
tool kits and other IEC material which they had developed in recent years.
Representatives from each of the participating states explained the rationale
for most of the interventions and shared their experience of implementing
them within the community. Results, outcomes and impact were discussed –
both in cases where they had shown excellent results and where they were still
addressing major challenges.
The purpose of the exhibition was to allow for greater interaction around the
nutrition debate as also to see (first hand) some of the activities that had been
undertaken by the respective states and the NGOs which had been supporting
some of them.
The Food and Nutrition Board for instance, under the Ministry of Women and
Child Development, highlighted through their literature some of the recent
initiatives they had taken for nutrition education to generate awareness in
hard to reach areas. Breastfeeding Promotion Network of India highlighted its
comprehensive IYCF counselling package and its demonstration model in Lalitpur
in Uttar Pradesh, where nutrition counselling has been introduced as a service
with nutrition mentors. The progress made in all these spheres through a strong
NGO, CBO and health worker route served as inspirational stories for other similar
districts across the country.
The strides made by states like Orissa, West Bengal, Chhattisgarh and Rajasthan
which have traditionally been riddled with anaemia, high rates of malnutrition
and stunting were pictorially represented through posters, tracking the slow
but gradual progress in different blocks. Touch screen monitors were placed
strategically, allowing visitors to acquaint themselves with health programmes.
Non-governmental agencies like Chetna, Voluntary Health Association of India
had displayed innovative nutrition and health education material with case
studies of innovation. Most of the charts and information was put across in a
simple, creative and effective manner, drawing attention to how nutrition could
be made a part of daily lives and how inexpensive options could be popularised.
To add colour to the exhibition, the puppet shows and music performances were
also included.
The Exhibition 107

Most of the information clearly brought out the role played by states,
institutions, NGOs, professional bodies and other development agencies in the
interventions that were designed and implemented specifically for adolescent
girls, newborn infants and young children, expectant and lactating mothers and
older people. It highlighted the role that men can play as also other influencers
in the community, including panchayats.

Addressing
India’s Nutrition Challenges
New Delhi 7-8 August 2010
Planning Commission
Government of India

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Addressing

India’s Nutrition Challenges

Report of the Multistakeholder Retreat

7-8 August 2010

I extend my appreciation to Member Planning Commission, Dr. Syeda Hameed

(Montek Singh Ahluwalia)

The Multistakeholder Retreat was a signiﬁcant milestone as it evolved a consensus on how to

We all derive wisdom from the words of Jalauddin Rumi:

Constant, slow movement teaches us to keep working

IV Proceedings of the Multistakeholder Retreat 19

VI. Summing Up and Way Forward 56

VII. Synthesis of Major Recommendations for Action 60

IX. The Exhibition 107

ANM Auxiliary Nurse Midwife

India has accorded the highest priority to combating malnutrition, since it

Objectives of the Retreat

Develop a framework for a multisectoral National Plan of Action to prevent

Preparatory Work Undertaken Prior to the Retreat

Government representation was seen through the presence of Union Ministers,

Design Methodology to Optimise Interaction and Outcomes

The retreat was designed not so much as an instructional workshop but as a

Deﬁning Feature of the Retreat: Giving Priority to Voices from

2 Addressing India’s Nutrition Challenges

Group Work II: Identifying speciﬁcally, what needs to be done

Water, Environmental Sanitation and Hygiene

Capacity Development and Community Processes

1. Household Food Security and Livelihoods: Promoting agricultural policies

3. Healthcare and Services: Using weighing scales at grassroots level to

4. Water, Environmental Sanitation and Hygiene: Addressing problem of safe

6. Capacity Development and Community Processes: Recognising ASHAs for their

4 Addressing India’s Nutrition Challenges

7. Nutrition Policy, Planning and Surveillance: Revising Nutrition Policy; setting

Moving from “What” Needs to be Done to “How”

Group work of 7 August was synthesised and followed-up with a multi-voting

1. National Child Malnutrition Prevention and Reduction Programme: Launch

Group work was synthesised and followed-up with a multi-voting prioritisation

Summing Up and Way Forward

The retreat, apart from bringing all stakeholders on a common platform to

6 Addressing India’s Nutrition Challenges

The above development paradox persists in spite of strong Constitutional,

Vicious cycle of undernutrition, disease/infections and mortality: Maternal

Preventive early action is critical: In India, annually, it is estimated that about

In India, undernutrition levels remain persistently and Persistently high undernutrition

The girl child goes on to become an undernourished and anaemic adolescent

This intergenerational cycle of undernutrition is accentuated by multiple

High levels of undernutrition persist: Improvements over successive plan periods

Micronutrient Deﬁciencies, i.e. deﬁciencies of key vitamins and minerals such as

The prevention and management of common neonatal and childhood illnesses

8 Addressing India’s Nutrition Challenges

data also suggests that India is in the 20

Therefore, preventive early action –

Determinants of Undernutrition: Undernutrition is the outcome of insufﬁcient

and development of children and

The objectives of the Strategy to address India’s Nutrition Challenges, as deﬁned

10 Addressing India’s Nutrition Challenges

In this perspective, the highest priority is being accorded to combating

Developing a Joint Strategy Note

The Multistakeholder Retreat

The Multistakeholder Retreat on Addressing India’s Nutrition Challenges was