Sorting Supply Chain and Bundling Multi Sectoral Interventions Andhra Pradesh, the Sunrise State of India Sorting Supply Chain and Bundling Multi Sectoral Interventions to improve Maternal Nutrition NURTURING WOMEN│ NOURISHING WOMBS Conclave 5th December, 2017 Hyderabad

Pregnant and Lactating women Anna Amrutha Hastham (One Full Meal Scheme) The state based flagship initiative under Supplementary Nutrition Program for Pregnant and Lactating women

factors for initiation of ‘One Full Meal’ program Prior to initiation of the spot feeding program (One Full Meal at Anganwadi) Take Home Ration was under implementation The state has witnessed inadequate gestational weight gain (<8 kg) Very high percentage of children with birth weight < 2500 gr Source: RSoC 2014

Noon Meal: Rice, Dal, Vegetables Expansion of the program Noon Meal: Rice, Dal, Vegetables Oil, Eggs &Milk 1053 Calories 33 gms Protein 500 mg Calcium 40% of the RDA In compliance with National Food Security Act 55,607 Anganwadis covered 5.87 lakh PW & LM registered Budget: 8 Billion INR

Gestational weight gain (>8kg) in pregnant women (in%) the impact witnessed between Spot feeding and THR projects Data Source: ICDS, MIS, NHTS 45% in all projects for the period July to Sept 2017 after expansion of the program across the state

Striving to improve Maternal Nutrition The State Nutrition Mission Striving to improve Maternal Nutrition through ‘Multi-sectoral convergence’

Combating Anaemia among pregnant women pilot study initiated in the state under convergence with Health, ITDA and PanchayathRaj departments The challenge : 1 in 3 women in the state are Anaemic The highest prevalence of anemia among women is in Vizianagaram (75.5 %) The innovative & state based solution: Ensuring 5 hundred to pregnant women The Five hundreds are: 100 eggs 100 glass of milk 100 groundnut chikki (50 gr per day) 100 IFA tablets 100 Calcium tablets

Working with multiple stakeholders with in and outside Government Health & Family Welfare PanchayathRaj Rural Development Tribal Welfare Civil Supplies Development Urban Agriculture dept Horticulture dept Fisheries dept Poultry Dairy Development corp Planning dept Agriculture University Mahila University Krishi Viagnana Kendras Home Science Colleges

Improving convergence to deliver nutritional services at scale with PanchayathRaj Department Improving Anganwadi infrastructure facilities: Providing @ Rs.5000/- per AWC Panchayaths providing running water supply, electricity and sanitation facilities Improving governance: PW, LM list is being shared every month to GP Office Gram Panchayath Sarpanch, designated as Chairman of AAH committee Anganwadi Workers and Helpers submit Aadhar enabled biometric attendance supported by Panchayath Office Nutrition sensitive initiative with Gram Panchayaths: Developing Nutri-Gardens in Panchayaths Mahila Sisu Darshini Anganwadi Worker will submit monthly report to Gram Panchayath on the profile of the AWC Aiming to achieve 100% anganwadi centeres provided electricity, drinking water and saniation facilities by March 2018

Working jointly for implementation of PMMVY Improving convergence to deliver nutritional services at scale with Health & Family Welfare Department Key nutrition services to PW&LM disseminated through 102 Call centre run by the department of HFW To improve supply chain of IFA and Calcium through District deport to PHC to AWC connecting with OFM and Home Visits Working jointly for implementation of PMMVY Organizing joint review meetings at PHC level Validating common health and nutrition indicators at Gram Panchayath level to improve service delivery as well accountability Implementation of Weekly Iron Folic Acid Supplementation (WIFS)

Improving convergence to deliver nutritional services at scale with Sarva Siksha Abhiyan, School Education and Collegiate Education Departments and NGOs Joint procurement of Egg under ICDS and MDM & Bio-metric monitoring of weekly delivery of eggs to Anganwadi Centers across the state Organizing Adolescent empowerment program ‘Kisori Vikasam’ a Peer Group interaction based program across the state

Improving convergence to deliver nutritional services at scale with Tribal Welfare Department ‘Nutri-basket’ to support in ensuring nutritional security to the wage seeking families under 24 ICDS projects in ITDAs in the state. Annual estimated cost for this initiative is Rs.347 Cr

Improving convergence to deliver nutritional services at scale with Real Time Governance through Chief Minister’s Office ‘1100’ mobile numbers of >85% pregnant and lactating women are registered and updated Recorded voice messages are being sent to women to aware on the entitlements under nutrition program Registered pregnant /lactating women are contacted by ‘1100’ (People First initiative by Government of Andhra Pradesh) to get feedback on the service quality 87% of the pregnant and lactating women are availing nutrition services under One Full Meal program 85% of the women felt they are comfortable attending spot feeding at AWC 92% of the Anganwadi centers are mapped with Geo-tagging

Improving convergence to deliver nutritional services at scale with Home Science Colleges and Universities Proposed menu for pregnant women (of those identified under severe anaemia (hb % <7 g/dl) and MUAC <21 cm Ragi powder (20 gr) : 24 kcal energy; 5 g carbs; calcium; iron; dietary fiber Jaggery (20 gr): 76.6 kcal energy; 19.79 g carbs; 0.018 g protein; 0.6 mg iron; minerals and vitamins The intervention will be jointly implemented with tribal welfare, PanchayathRaj departments

Thank you one and all! Any questions? You can find us at Dept. of Women Development & Child Welfare, Government of Andhra Pradesh 2nd Floor, Jampani Towers, Lodge Center, Amaravathi Road, Guntur-522006. Ph: 0863 2332587 Websites:  http://wcdsc.ap.nic.in/,  http://wdcw.ap.gov.in/ E-mail: apwdcw@gmail.com