Learn how the Bhavishya Alliance in India successfully tackled child malnutrition through innovative multi-stakeholder initiatives.
Overview
The Bhavishya Alliance, which ran from 2006 to 2012, was a government-business-NGO Social Lab aimed at co-creating solutions to India’s extraordinarily high level of child malnutrition., Bhavishya (“future” in Sanskrit) focused on the state of Maharashtra, where half of the children were classified as being underweight. The Lab broke new ground on several fronts and became one of the most significant and successful multi-stakeholder efforts ever undertaken in India.
Reos Partners started by facilitating a three-month, full-time Social Lab that established areas of work and ways of working. Recognising the intergenerational context of child malnutrition, the 11 pilot interventions spanned girls’ adolescence, marriage, pregnancy and childbirth, and health and nutrition care for mothers and children up to school age.
Impressive pilot results prompted the scaling of several initiatives, and the alliance’s success has only become more exciting with time. A multidisciplinary analysis published in 2014 by the Institute of Development Studies (IDS) and UNICEF found that from 2006 to 2012 (the project period), stunting among children under age 2 in Maharashtra declined by 15 percent—one of the fastest declines in stunting seen anywhere at any time.
This project has global implications, as child undernutrition is thought to underlie nearly half of all child deaths under age 5. As the authors of the IDS/UNICEF report conclude, “When leadership in government and civil society join forces within a reasonably supportive socioeconomic context, as Maharashtra shows us, public action can reduce undernutrition—fast.”
Background
From 2003 to 2006, Reos Partners, with the Synergos Institute, Unilever, and UNICEF, co-convened a group of government, business, and civil society organisations to engage with this issue in a new way. The group grew to more than 30 organisations.
Challenges
Despite enormous social, economic, and technological advances, India’s rates of underweight and stunted children are much higher than those of other developing countries. More than one-third of the world’s undernourished children live in India—47 percent of its 414 million children under age 6 suffer from some form of malnutrition. In response, India runs the largest development programme in the world, with a budget of over $2 billion per year. Yet between 1990 and 2005, malnutrition rates for children under age 3 dropped only 5 percent.
Early to moderate malnutrition has few visible signs. Undernourished children, particularly those under age 6, may appear healthy. This makes the condition difficult to diagnose and to address. Many parents in India do not even know that their children are undernourished. In addition, malnutrition has no single cause. It is the result of a mixture of social, economic, and political factors.
Impact
Bhavishya created a long-term multi-stakeholder partnership among key government agencies, leading business organisations, and civil society organisations working on child malnutrition. And it left a legacy of pioneering initiatives capable of scale-up in their current form and replication in new sites.
Here are four key initiatives that are being scaled up:
Girls Gaining Ground
Adolescent girls were recognized as key stakeholders in the system. Known locally as Gheu Bharari (“Let’s Take Off”), the Girls Gaining Ground project aimed to empower girls with life skills, vocational skills, and more awareness of issues, especially those relating to reproductive health and nutrition.
In three years, more than 10,000 girls were trained, 1,800 were supported in launching enterprises, and 1,250 volunteered to assist nurses, midwives, and childcare providers. The most noticeable impact was the rise in self-esteem among the girls. There was also a marked increase in their awareness of health issues, including those related to HIV/AIDS and anaemia, and in fact anaemia levels fell.
The IDS report noted above cited women’s empowerment as a key driver in the decline in stunting.
Day Care Centres
In urban settings, preventing and managing malnutrition in children under three years old poses a special challenge, with mothers often returning to work to support their families soon after childbirth. So five anganwadi day-care centres, normally open for only a half day, were expanded to provide daylong care to children of working mothers.
More than 1,000 children under age 6 benefited from these centres over a one-year period. At the start of the project, 105 of 111 children monitored were malnourished. A year later, that number was significantly reduced; 32 percent of the children were deemed normal, and the number in the most severe category had been reduced by more than two-thirds.
The IDS report cited day care as another clear driver in the decline in stunting.
Food Diversification at Anganwadis
It was discovered that one reason for children’s low attendance at anganwadi day-care centres was the unappetising and monotonous food the centres served. This project collaborated with the day-care centers to both provide more nutritious, palatable, and diverse foods and expand their services. During the pilot, the number of children benefiting from supplementary nutrition rose from 132,000 to over 149,000 in one month.
Computer-Aided Project for Adult Literacy, Health, and Nutrition Awareness
This project raised the literacy rates of local women and built awareness of good practices relating to health and nutrition. The 40-hour computer-aided trainings were implemented in 30 villages with especially high levels of female illiteracy and child malnutrition. One woman from each community served as facilitator for a group of 25 to 30 illiterate young women.
More than 1,000 women were trained at local centers, and 63 percent achieved functional literacy. A variety of relevant indicators subsequently improved. For example, pregnancy registration at public health centres increased from 1 percent to 45 percent.
The IDS report noted above cited women’s empowerment as a key driver in the decline in stunting.
Testimonials
“Standing on a small hill, looking at sunset, I asked myself: If I was born in pre-independence era, what would I have done? I recall one of the addresses to [our Lab Team]. While doing business, we cannot close our eyes to millions of people who have no food and thousands of babies that are dying every minute owing to malnutrition. This is not a simple problem that can be nailed through a fishbone or pareto analysis.… it is the consequence of a larger systemic failure that includes all … the government, communities, and the business world. And it will take all the players to shift the current reality.”
— Lab team member
“I am clearer than ever that all the challenges we discuss as being ‘in the field’ are in fact present in this room. If we want to know why communities are hostile to health care workers, then the answer is in the room. If we want to know why care programmes in the past have been unsustainable, then the answer is in the room. If we want to know why there is low trust in the malnutrition system between different actors, then the answer is in the room. And if we want to change the system then we must also change what is in the room.”
— Indian facilitator
Download the project report.
Read the Birth of the Bhavishya Alliance.
Download the case study.
