In 2017, India launched its first project on real-time monitoring of health to proactively track malnutrition in vulnerable population groups. Called the Nutrition Surveillance System (NSS), it is into its third year of implementation in six districts of six selected states through Anganwadi workers, who upload nutrition-related issues online for quick action.
Meenakshisushma speaks to Avula Laxmaiah, project lead, NSS, and scientist with the National Institute of Nutrition, Hyderabad, about how the initiative can help improve india’s nutrition status. Excerpts:
What kind of health information is being collected under the initiative?
It includes the programmes covered under the Integrated Child Development Services (ICDS); the weight and height of the child; morbidity; mortality, including reasons thereof; coverage of food supplementation; distribution of vitamin A/IFA [iron, folic acid] tablets; and health education.
What was the criteria for choosing the six states?
We chose states from all the regions of the country. These are Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Telangana and Odisha. The selection of states was done on the advice of the project expert review committee, which took into account the availability of funds in the states and the presence of National Nutrition Monitoring Bureau infrastructure. At the state level, the selection of the district and the ICDS programme for NSS implementation was done by the ministry of women and child development.
How is the data digitised?
In all the states, anganwadi workers collect the data monthly in a physical form. These are then sent to the district project officer and child development project officer of ICDS, and to the director of women and child development departments of the respective states as monthly monitoring reports. This process takes time. We want anganwadi workers to collect this data on electronic tablets and submit it online every month. To facilitate this, we have distributed about 1,000 tabs to the anganwadi workers/supervisors in the project implementation areas. We have also trained all of them and provided them with SIM cards for internet access.
What is the current status of the initiative?
After the distribution of tabs and internet SIM cards, we have been receiving online and real-time data for each ICDS beneficiary. Now, child development officers, district project officers and other authorised officials can access it to identify any gaps in the services.
What is the duration of the pilot project?
It was initially sanctioned for two years. We have got an extension for one more year. It will now continue till September 14, 2020. The funding is coming totally from the Indian Council of Medical Research.
What kind of steps would be taken at the ground level once the pilot is over?
The data is being reviewed project-wise in all the states once every three months by the six primary stakeholders, which include the health department, agriculture department, horticulture department, women and child development department, water and sanitation department, and the rural development department. We try to achieve convergence among these stakeholders, identify gaps in the services, fix responsibility and plug the loopholes. For example, if a toilet is not available in an anganwadi centre, the responsibility is given to the sanitation department for its construction.
Another important intervention is the use of the system to validate data collected by anganwadi workers. We had found that data collected digitally by anganwadi workers had discrepancies, so we retrained the workers and are trying to correct these measurement errors, which is very important. If the workers can do it properly and if we can expand the scope of the project to all the nutrition and health intervention programmes at the village level, I think, there will be no need of any national health surveys. Health trends, present or past, can be easily tracked. This was not possible earlier.
When will the project be implemented throughout the country?
We share our findings with the government and it is up to the government to take the work forward or scale it up.
Does India have the infrastructure to scale up an initiative like NSS?
Yes. The government has provided the required equipment through various programmes. But if we had a full-time nutrition educator to guide anganwadi workers at the ground level, it would aid the implementation process.