Special Focus on Household Level Convergence to Strengthen Nutrition, Uttar Pradesh, India A Household Level Convergence (HHC) study in Uttar Pradesh has moved into the data collection phase. The study proposed a collaborative pilot to improve the convergence of health and nutrition services at the household level. Overall, the objective is to jointly design and conduct a landscaping study in Fatehpur and Shravasti- the two districts of Uttar Pradesh to understand the magnitude of the household convergence issue, its root causes, and opportunities to improve it. In early July, Alive & Thrive facilitated a meeting of convergence departments of Poshan Abhiyan that was called by the District Magistrate to describe the purpose of the study to district officials. The meeting involved the Chief Medical Officer, Project Director-DRDA, District Program Officer-Integrated Child Development Scheme, District Supply Officer, District Panchayati-Raj officer, District Education Officer, and District Information Officer. Following this meeting, CDO Fatehpur and Gorakhpur issued a letter to district heads of all six departments with whom interviews are scheduled.

Later in the month, Alive & Thrive collaborated with the All India Medical Sciences (AIIMS) Gorakhpur to organize a three-day training for data collection personnel. A support letter from the Government (of the state or the federal?) was shared with partners in the study, including AIIMS Gorakhpur, Project Concern International (PCI), and Uttar Pradesh Technical Support Unit (UPTSU). In-depth interviews and focus group discussions are now ongoing with the front-line service providers (AWW, ASHA & SHG members), their supervisors (Mukhay Seveika & ASHA Facilitators and mission manager), and Block level officials of all convergence departments along with beneficiaries (pregnant women, lactating mother, mother of 6-23 months children, mother of SAM & Children, Adolescent girls and head of the household) including fair shop owner, PRI members, school teachers.

QI Approach to Address Anemia among Pregnant Women and Weight Gain among Children, Bihar, India The community level “Quality Improvement (QI) on improving Hemoglobin (Hb) among pregnant women (PW) and weight gain among children under 2” has been initiated in Gaya, Bihar. The approach has been rolled out in Bodhgaya to improve the Hb levels among PW and Wazirganj has been selected for improving the weight gain among children under 2. In Bodhgaya, the QI approach aims to reduce the mild and moderate anemia among PW by 50% to normal and reduce severe anemia to mild by 100% over four months between July-Oct 2022 in Gohti Health Sub-Centre, Bodhgaya block.  In Wazirganj, the approach targets child (under 2) growth and weight gain, including improving moderate from 24% to 4% and severe from 15 % to 5% in four months. A structured form of the implementation has been planned and followed to achieve the desired goals in the stipulated time frame.

Medical Colleges Reviewed under LAQSHYA- Program of Ministry of Health and Family Welfare in Bihar, India

Medical colleges in Bihar are being reviewed under the Ministry of Health and Family Welfare's LaQshya program, including five supported by Alive & Thrive. LaQshya brings together Quality Assurance (QA) and Quality Improvement (QI) approaches to improve the quality of care (QoC) in the Labour Rooms (LRs), Operation theatres (OTs), and other mother and child services areas in public health facilities across the country and strives to provide a better experience of care to the beneficiaries by integrating the concept of respectful maternity and newborn care. The state-level review of the Laqshya program for all government medical colleges and hospitals was organized on 1 July 2022 in the State Health Society Bihar (SHSB), Patna. The meeting was facilitated by the Head of the Department of Obstetrics and Gynecology and a nodal person of Laqshya in the state, under the chairmanship of Additional Executive Director, Shri Keshvendra Kumar, I.A.S. Health Department, Government of Bihar. Out of eleven government medical colleges in the state, five are being supported by Alive &Thrive. Alive & Thrive carried out the external assessment of these five colleges; three of the colleges are technically supported to get the LaQshya Quality Certification for Operation Theatre. The review was organized by the Quality section of SHSB supported by Care and included the national expert, Dr. Harish of Care. To complete the review, the national expert will visit all the colleges to review the training of faculties and nurses. Development partners supporting these colleges will continue and support the review process. SHS will share relevant materials, including case sheets and patient satisfaction forms. The medical colleges will regularly communicate and meet with SHSB as the review process is implemented. During the review meeting, the medical colleges and Government partners acknowledged the support provided by Alive & Thrive.

STORIES OF CHANGE Supportive Supervision improving the quality of nutrition service de in Gujarat, India

Meet the Changemaker- Smt. Leelaben Gamit, Mukya Sevika (MS) from Ghatak-2, Surat corporation, Gujarat. After the training on supportive supervision (SS), she now regularly uses the SS mobile application, developed with support from Alive & Thrive, in her day-to-day work. As a protocol, she has started sharing meeting agendas in advance and pre-plans the meeting in the mobile app. Using the application, she has conducted review meetings, monitored the meetings schedule, ensured full attendance of Anganwadi workers, reviewed the Monthly Progress Report, and shared her observations from home visits and Community-Based Events, including gaps identified during the visit. Additionally, she had done the planning of major events for next month and prepared the meeting minutes, including the actionable points, discussed during the meeting. This is how Alive & Thrive's Supportive Supervision intervention is enhancing the quality of monthly sector review meetings in Gujarat.

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