Improving quality of antenatal care services in a high case load tertiary care teaching hospital (Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College) in Kanpur, Uttar Pradesh, India.

In India, half of all pregnant women between the ages of 15 and 49 years are anaemic. In Uttar Pradesh (UP), this figure is slightly higher at 51%. Unfortunately, only 5.4% pregnant women received full antenatal care (ANC) (National Family Health Survey 4, 2015-2016). A formative research conducted in UP in 2016 found that only 9% of pregnant women in UP consume the five recommended food groups, as per global recommendations.Ganesh Shankar Vidyarthi Memorial Medical College Hospital is one of the four high case load tertiary care facilities in Kanpur, UP, with an obstetrics and gynaecology (OBGY) outpatient department (OPD) of 2500-3000 consultations with delivery load of 250-300 deliveries per month and paediatric OPD of approximately 5400-6000 consultations per month. It was identified that pregnant women visiting the OPD for ANC were not receiving maternal nutrition-related services, and anthropometric measurements to assess nutritional status and gestational weight gain were also not done.The department of OBGY decided to apply the four-step Point of Care Quality Improvement (POCQI) approach using Plan-Do-Study-Act cycle for implementation of the maternal nutrition protocol during ANC.In April 2019, with the support of A&T, the hospital team applied the POCQI methodology to improve ANC service provision. By the end of 2019, the measurement and recording of anthropometric parameters increased to 84% and 74% for height and weight, respectively, from the baseline of zero. Hb testing increased from 58% to 84% and blood pressure (BP) monitoring from zero to 84%. Maternal nutrition counselling was delivered to 76% of the pregnant women visiting the OPD, which was a significant achievement for a new practice introduced into the system.The improved practices identified and implemented by the department are being sustained through active engagement of the staff and supportive leadership of the department of OBGY.

India's Policy and Program Landscape for Early Childhood Development.

Despite continuous improvement in health and nutrition-related child outcomes in India in the last decade, sub-optimal developmental outcomes still prevail due to multiple risk factors. Overcoming these risks depends on a supportive policy environment and implementation across relevant sectors to achieve universal coverage for all children and their families, especially those at-risk and those already affected by developmental disorders/disability. Several national policies articulate the multi-dimensional and multisectoral vision for achieving early childhood development (ECD), focusing on the first 1000 days and reaching the most vulnerable children. The enactment of various 'Acts' entitles children to their right to nutrition, safety, and security. Flagship programs of various Ministries translate this vision into action through various schemes that provide services in each of the five domains of nurturing care. Public spending is the largest source of funding for ECD programs while Corporate Social Responsibility is emerging as a promising funding opportunity. Ensuring effective implementation of ECD by developing a shared framework for implementation across sectors, establishing a robust governance mechanism, and sustainable financing strategies for universal access is the recommended way forward.

Intersectoral Action for Early Childhood Development in India: Opportunities, Challenges and the Way Forward.

Nurturing care framework for early childhood development (ECD) focuses on five essential aspects of the holistic development of a child, which are interrelated and inseparable. This multidimensional approach to child development is dependent on contributions from multiple sectors, requiring the 'whole of government' approach. In India, the lack of a single multisectoral framework for ECD, narrow accountability to sector-specific outcomes, overlapping responsibilities of frontline workers, lack of leadership for coordination, and limited supervisory mechanisms result in fragmented service delivery. In recent years, there is high-level political commitment to intersectoral action, which promote holistic health. Better results and developmental outcomes are possible with different sectors working closely by converging their resources under the Sustainable Development Goals strategic action plans, POSHAN Abhiyaan, and the Aspirational districts program. Leveraging opportunities for intersectoral action requires a deliberate and consistent effort towards alignment of goals, favorable conditions of partnerships, leadership and governance, and capacity at every level.