New partnerships for child nutrition

John Heller

The headlines from India can sometimes be misleading. Growth rates are soaring, the economy is overheating, a high-tech giant is in the making. While these headlines ring true in the corporate parks of Bangalore and the high-rise towers of Mumbai, hundreds of millions of people remain in crushing poverty.

Despite the real progress made since independence, a host of seemingly intractable social problems persist. One of the most pressing is child under-nutrition[1] – and this is the challenge that an unusual partnership of government, civil society and business is now addressing.

Insufficient nutrition is cited as an underlying cause of about 1 million under-5 deaths in India each year. For those who survive, the prospects of a healthy and productive life are often greatly reduced as insufficient intake of calories and micronutrients can lead to irreversible physical and mental disabilities. The human cost to families and children is of course extreme, while the economic cost to India in lost productivity is estimated at over $2 billion a year.

The missing link – cooperation

Despite huge efforts by the Indian government and others, child under-nutrition has declined only slightly since independence. India maintains the largest government supplementary feeding programme in the world, the Integrated Child Development Service. India has ample human, financial and organizational capacity to address the issue. The technical requirements for improving child nutrition are well understood. Scores of on-the-ground initiatives are already working well, albeit not yet at a scale to match the need. So what’s missing?

One stumbling block is the inability of those working on child nutrition to combine efforts. The government agencies and non-profits addressing the issue often work in isolation. The great capacity of corporate India has yet to be fully harnessed. Dramatically reducing child under-nutrition will require the combined talents and resources of government, companies, civil society and affected communities.

Bhavishya Alliance

To accelerate progress, an influential group of Indian and international organizations formed the Bhavishya Alliance, India’s first tri-sectoral alliance for child nutrition, in 2005. Bhavishya, meaning future in Sanskrit, is connected to a larger global programme called the Partnership for Child Nutrition, an alliance between the Synergos Institute, Unilever and UNICEF-India, which helped to initiate Bhavishya and support its growth into an independent entity.

Working first in the state of Maharashtra, Bhavihsya brings together a network of organizations with an interest in child nutrition and social development. These include corporations such as Hindustan Unilever, ICICI Bank, Tata and HDFC; government agencies such as the Integrated Child Development Service and the Mother-Child Welfare Agency; civil society groups such as the Society for Nutrition Education and Health Action; and multilateral agencies such as UNICEF-India. ‘The basic idea is that everyone should come together and stop pointing fingers at each other,’ says V Ramani, Director General of the Mother-Child Health and Nutrition Mission of the Maharashtra government.

Theory U and a shifting of paradigms

This is easier said than done. Partners entered the project with a shared passion for new action on child nutrition but with radically different points of view about what action was needed. Most had extensive knowledge about their own approach but little awareness of the larger system of which they were a part.

To address these issues, the programme used an intensive process for participants to learn from one another, build relationships, and seek synergies. Known as the Change Lab, designed and facilitated by Generon Consulting, and modelled on ‘Theory U’,[2] the process helped people working on child nutrition to re-perceive the problem and their role in solutions, and to stimulate new forms of collaborative action.

The process unfolded in three parts. First, Alliance members engaged in a field learning experience, spending time in villages, slums, feeding centres and health clinics, and with families of under-nourished children. These experiences enabled Alliance members to learn from one another, to challenge cherished assumptions, and to develop a set of shared experiences. Second, there was a nature retreat where individuals went off on their own to reflect on their own learning and develop new ideas. Third, the team worked together to integrate the ideas that arose during the learning experiences and retreat and to distil them into prototype project concepts.

Shilpa Deshpandi from ICICI bank says of this experience: ‘There’s a sense of togetherness, there’s a lot of faith in each others’ abilities, and in the fact that we can together do something. There’s a shifting of paradigms.’

The early results

Bhavishya has now become a centre for cross-sectoral action on child under-nutrition. Focusing on children under three years old, mothers, and pregnant/lactating women in the five Maharashtra districts where under-nutrition is highest, members are finding some promising ways of collaborating. Bhavishya initiatives are forming an integrated spectrum of activities from prevention (eg nutrition training for teenage girls) to the strengthening of existing systems (eg enhancements in government service provision) to immediate care (eg emergency feeding).

In one example, Hindustan Unilever is applying its expertise in supply chain management to help improve the state government’s system for distributing children’s micronutrient supplements. As a result, inventory management systems have been installed in several central storehouses and public health clinics; early indications are that this has raised the availability of supplies by over 30 per cent in test areas. Meanwhile, Bhavishya members are teaming up to test village-based Nutrition Rehabilitation Centres, which will provide intensive feeding for the most severely under-nourished children as well as training and other services for parents.

We need one another more than we know

Any one of these initiatives in isolation may not be particularly newsworthy. That they have been generated through a multi-sectoral coalition involving Indian government, business and civil society is at least a cause for hope and at best an important breakthrough.

The Partnership for Child Nutrition is part of a family of inclusive partnerships linked to the Synergos Institute. Others include the Aboriginal Leadership Initiative, which is working to improve quality of life among Canada’s First Nations, and the Orphans and Vulnerable Children Program, which seeks to enhance collaboration among organizations caring for children affected by HIV/AIDS in South Africa.

These and other initiatives are addressing complex social challenges where technical or single-sector approaches are not likely to work. Such challenges often arise from an interplay of social, economic, political and historic forces and are embedded in entrenched systems that are resistant to change. If we are to see significant change, we will somehow need to shift these underlying patterns and systems. One approach is to reach across boundaries and more creatively combine the resources of government, the market know-how of business, the social connectivity of civil society, and, most importantly, the wisdom of affected communities. We need one another more than we know.

1 Here we use under-nutrition instead of ‘malnutrition’ since the latter refers both to under- and over-nutrition.

2 Scharmer, Senge, Jaworski, Flowers.

John Heller is Director, Multi-Stakeholder Partnerships, at the Synergos Institute. Email jheller@synergos.org


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