Strengthening private sector engagement may improve infant and young child feeding outcomes

In India, stunting among under-five children has reduced by only one-third between 1992 and 2016 and as per a recent study, 35% of our under-five children are stunted

By Ruchika Chugh Sachdeva and Lakshmi Sethuraman

Optimal infant and young child feeding (IYCF) practices are extremely important for child survival, healthy growth and development, and can together prevent almost one-fifth of deaths in under-five children. These feeding practices comprise early and exclusive breastfeeding for the first six months and timely introduction of complementary foods at six months with continued breastfeeding for two years.

Status in India

In India, stunting among under five years of age children has reduced by only one-third between 1992 and 2016 and as per a recent study, 35 per cent of our under-five children are stunted. Only 57 per cent mothers put their babies to breast within the first hour of birth 1, despite the fact that about 78.7 per cent deliver in health facilities. Further, half of our babies are initiated with complementary feeding at six months while merely 6 per cent received a minimum acceptable diet.

India has set ambitious targets under National Nutrition Mission, launched in 2018, to reduce stunting (2 per cent), underweight (2 per cent), anaemia (3 per cent) among young children per annum through multi-sectoral coordination. However, given the current trajectory, and with the disruptions caused due to Covid-19, India does not look poised to reach this target. In these unprecedented times, given the critical role that nutrition plays in building immunity, it is even more important that the health and nutrition of infants and young children are not only safeguarded but also strengthened.

Solving India’s malnutrition challenge calls for a comprehensive and concerted response in which the private sector must actively participate along with its government counterparts
India has a wide network of private healthcare providers having 66 per cent share in outpatient and 55 per cent share in inpatient care. A substantial number of deliveries take place in private hospitals and the sector accounts for nearly 21 per cent deliveries in rural areas and 48 per cent deliveries in urban areas. While the private sector’s significant role in delivering maternal and new-born health services is evident, quality of care is often an issue given the fragmented nature of the sector. This point to the significance of delivering skilled and high-quality counselling services to pregnant and lactating mothers and their families seeking care in private hospitals that can lead to higher rates of breastfeeding and appropriate complementary feeding practices during the first 1,000 days of a child’s life.

The government is now actively exploring partnerships with the private sector to expand the coverage of care. Larger opportunities for entering into public-private partnerships [owing to
Pradhan Mantri Jan Arogya Yojana, Pradhan Mantri Surakshit Matritva Abhiyan wherein the government is engaging with private specialists for identification of high-risk pregnancies,
incentivising private sector obstetricians for childbirth services and participation in the Ayushman Bharat scheme for inpatient services. The recently launched Poshan Abhiyan has opened avenues for the private sector to innovate and actively participate in the endeavour to end India’s malnutrition. Programs such as the Arogya Rakshak in Chittoor, IMPAct4Nutrition and Access to Nutrition Index are some successful examples.

Given this context, there is a strong opportunity for sustainable and high-quality nutrition intervention models to be scaled up across private healthcare institutions to help achieve desired nutrition outcomes in targeted populations. Here are some suggestions on how this can be realised:

Ensuring high quality of services

Involving professional bodies like Indian Dietetic Association (IDA), National Neonatology Forum (NNF), Indian Academy of Paediatrics (IAP) and Federation of Obstetric and Gynaecological Societies of India (FOGSI)-strong advocacy efforts coupled with modifying IYCF packages for private hospitals and building capacity to deliver IYCF counselling services will be critical to deliver high-quality nutrition care in the first 1,000 days. It will also be pertinent to create a cadre of IYCF counsellors who can provide dedicated and skilled support to mothers and families.

Defining quality standards and providing accreditation to private facilities in partnership with professional associations and government can incline them towards wider service provision and acceptance of standardised protocols.

While India has instituted the IMS (Infant Milk Substitute) Act to curb sales of infant milk substitutes, many private hospitals continue to violate the same. Strategies need to be worked out to strengthen enforcement of the IMS Act through bringing in stronger penalties

Businesses can be brilliant shapers of demand, often for unhealthy foods, and we must find ways to engage them in bending demand towards healthy and nutritious diets. The private sector can play a key role in driving campaigns around the importance of nutrition outcomes and its link to healthy food and thereby increase demand for higher quality services.

Ensuring wider deployment and scale

Stronger engagement with the private sector can happen through a hub and spoke model where the hub is a centre with specialised paediatric services, while spokes are a larger network of private providers. Service provision can be increased by enlisting private service providers and linking them with front line workers who can identify early signs of malnutrition and refer patients to the hub (specialist). Government schemes like PMJAY can be leveraged to provide quality nutrition rehabilitation services and treatment for childhood illnesses through private hospitals. This will also help reduce out of pocket expenditure.

Increasing efficiency

Maintaining essential health and nutrition-related data including those on IYCF indicators at public and private healthcare facilities will aid in streamlining and amplifying national response to tackling malnutrition through informed policy guidance. The recently launched National Digital Health Mission strategy has set the stage for technology that can enable richer data to drive efficiency and better decision making.

Ensuring economic viability at facility level

Financial viability is a key determinant for the uptake of demand for these interventions to work at facility level. Therefore, executing focused pilots to showcase the financial viability of the intervention (such as focus on upskilling existing staff rather than investing in new resources and increased consumer demand for services) for the facility is important for this to gain widespread acceptance.

Given this context, we believe that there is a strong opportunity for sustainable and high-quality nutrition intervention models to be scaled up across private healthcare institutions to help achieve desired nutrition outcomes in targeted populations.

(Ruchika Chugh Sachdeva is the Deputy Director-MNCHN, PATH, and Lakshmi Sethuraman, Principal, Sattva Consulting)