While the pandemic has receded, a review of the delivery of essential nutrition services during the 2 pandemic years can offer few insights into future course and action. In this exercise, the Poshan-Covid 19 site is a useful tool. The site updates the continuity of key maternal and child health services section of 14 states on a monthly basis. This tracker hence presents patterns of service delivery in the select states during the period between April 2020 to March 2022.1
The pandemic disrupted facility-based services with reduced access to government services.2 In most states of India, the Anganwadi centres under the flagship ICDS Scheme were closed initially and several services were disrupted.3 Data shows that in most of these states, less than two-thirds of the key services were functional during the months of April and May 2020. However, in the case of 3 states specifically, less than half of the services were functional. In most states, Anganwadi Centres, Community-based Management of Acute Malnutrition (CMAM) services, Home Base Young Child Care, and growth monitoring services were not functional during the 2 months that had coincided with the national lockdown. The situation stabilized in the following months. While Anganwadi centres were still closed in 9 of the 14 states, data shows that in 12 states, more services were functional in December 2020 compared to April 2020. The next slump was only observed during the months of April and May 2021 which was also the period of the second wave of Covid-19 in India. January 2022 was the month which witnessed the peak of the third wave of Covid-19. The data shows that in half of the 14 states, a lesser number of services were functional in January 2022 compared to December 2021. In the next month, the status significantly improved. The latest available data of 8 states shows that overall, either the same or more services were functional in March 2022 compared to March 2021.1
Currently, almost all of the 11 services are functional in states that have reported their status. The implementation of regular nutrition development partners coordination meetings has been inconsistent since the end of 2020. Services such as take-home rations for children and mothers, NRCs, MAA services and PMMVY maternity benefits have remained consistently functional during both lockdown and post-lockdown periods. Additionally, since the end of 2020, services such as the Village Health Sanitation and Nutrition Days have largely been functional in these states.1 The continuity of several key services even during lockdown can be attributed to policy and program adaptations. Various guidelines were issued by the Government at the national and state levels to ensure continuity of health and nutrition services.4,5 Door‑to‑door delivery of take-home rations was one of the important measures taken.6 Counselling and nutrition advocacy have been important components of both government and civil society efforts during the pandemic.7-10 To improve service delivery, change in the primary mode of communication, enhanced use of technology, flexibility and decentralised decision-making were critical.7, 11
- UNICEF. (2022). Poshan Covid-19 Continuity of Services. Poshan Covid-19 Monitoring.
- CPR. (2021). Experiences of Frontline Workers in Rajasthan and Himachal Pradesh during Covid-19 Pandemic. Accountability Initiative, Centre for Policy Research, New Delhi
- Menon, P., De Wagt, A., Reddy, V., Reddy, K., Pandav, C. S., Avula, R., … & Sankar, R. (2021). Supporting efforts to address malnutrition in the context of the COVID-19 pandemic in India: An emergency need. Medical Journal of Dr. DY Patil Vidyapeeth, 14(4), 369.
- MOHFW. (2020). Guidance Note on Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post COVID-19 Pandemic
- National Health Mission-Assam. (2020). Functionalization of NRCs. Government of Assam.
- UNICEF. (2021). Report on assessment of essential nutrition services in Chhattisgarh during second wave of covid 19 pandemic
- Nguyen, P. H., Kachwaha, S., Pant, A., Tran, L. M., Walia, M., Ghosh, S., … & Avula, R. (2021). COVID-19 Disrupted Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights from Service Providers, Household Phone Surveys, and Administrative Data. The Journal of nutrition, 151(8), 2305-2316.
- NHM. (n.d.). Poshan Abhiyaan, Govt of Uttar Pradesh: Video on breastfeeding techniques
- NHM. (n.d.). Breastfeeding guidelines, through illustrations
- ICMR. (n.d.). Nutrition, Lifestyle & Immunity. ICMR-NIN
- UNICEF. (n.d.) Innovations and Adaptations- Nutrition response in India during COVID-19 pandemic