WHO WE ARE

Save the Children, India’s portfolio of Health and Nutrition is committed to ensure that children grow up healthy and enjoy a happy childhood. Our primary focus is on supporting the existing healthcare system and facilities in India for accelerating the progress towards reduction in child and maternal mortality and morbidity rates.

In order to achieve this, we focus on the following themes:

1. Maternal, Newborn and Child Health2. Infant, Young Child and Maternal Nutrition 3. Water, Sanitation and Hygiene (WASH)4. Adolescent Sexual and Reproductive Health (ASRH)

Our work is centred around:

• Providing robust health and nutrition benefits to disadvantaged children to save lives. Increasing equitable access and use of quality centred and gender sensitive maternal, child and newborn services within a continuum of care that links families, communities and facilities.• Developing innovative solutions to the problems which the system encounters in delivering quality maternal, newborn child health and nutrition services including access to safe drinking water and basic sanitation.• Healthcare systems strengthening and community based service provision and achieving universal coverage through focused initiatives on capacity building, accountability and good governance.• Almost 50% of our work for children is done in the area of Health & Nutrition.

By 2030, Save the Children, India will be the world’s leading child rights movement for and with children; and be the catalyst for India to be amongst the top 5 countries achieving the greatest improvement in child indicators related to survival, protection, development and participation

KEY DONORSUSAID, Bill and Melinda GatesFoundation (BMGF), Swedish International Development Agency (SIDA), Dalai Lama Trust Foundation, Reckitt Benckiser, Mondelez Interna-tional

NUMBER OF ACTIVE AWARDS15 Active Grants (Financial Year 2016-17)

VALUE OF AWARDS8 million Euros

REACH0.5 million Children in 2015

SCALE THAT WORKS So that no mother or child dies of preventable causes

The Health and Nutrition team at Save the Children, India is a multidisciplinary team comprising super-specialist doctors, medical doctors, doctors of philosophy, public health professionals, health administrators, health managers, statisticians and social scientists.

The programmes are spread across 10 States of India to ensure that the most deprived women and children (including adoles-cents) - particularly those living in poor, urban settings and those made vulnerable by conflict and disaster - can survive and lead healthy lives. Using our expertise and geographic reach, we facilitate efficient, evidence-based health services and care for those who need it the most. At Save the Children, India, we strive to increase equitable access and use of quality-centered and gender sensitive maternal, child and newborn services within a continuum of care that links families, communities, and facilities.

We apply our Theory of Change to address key gaps and barriers to improve maternal, adolescent, newborn and child health. In addition to this, we measure and monitor performance to achieve the highest possible coverage and quality.

KEY PROGRAMMES IN HEALTH

1. Saving Newborn Lives aims at improving the health and survival of newborns by

generating and supporting the applications of knowledge to improve, expand and sustain

effective coverage of newborn care services and practices at scale. The project is operational

in three states in India.

2. Strengthening Maternal Newborn Child health and Nutrition Services in

India through healthcare systems strengthening and community empowerment for ensuring

safe motherhood and improved infant health in addressing the maternal and infant mortality

rates in the country. The project is operational in five states in India

3. Stop Diarrhoea Initiative aims at reducing the prevalence of diarrhoea through

enhancing the capacities of public, private and community level health workers. The project

also ensures the system strengthening for immunization, ORS supply chain management and

access to safe and sustainable water supply. The project is operational in four states in India

4. Shubh Aarambh focuses on creating healthy lifestyles amongst children in the age

group of 0-14 years. The 0-6 years age group focus is on mothers and caregivers to educate

them on nutrition education; whereas the focus for childnre in the age group of 7-14 years is

on nutrition education, active play and growing fresh foods in their backyards through kitchen

gardens. This project is operational in four states in India

5. Project Ananya focuses on adolescents for improving their sexual and reproductive

health through the provision of adolescent friendly health services, awareness generation and

capacity building of frontline workers for improving the institutional response. One of the

major aims of the project is to prevent early marriages which is a major cause of poor

reproductive and sexual health of adolescents. This project is operational in two states in India

KEY HIGHLIGHTS & ACHIEVEMENTS

Noorzahan Begum resides at Tiljala Shibtala lane, under ward no 65 in an urban slum in Kolkata. Her husband is a

tanner and they have two children: a girl and a boy aged 5 and 7 years respectively.

She is an active and regular participant in meetings organized by Save the Children on the various aspects of ‘Diarrhoea 7 point plan’ in the area. Due to lack of proper knowledge regarding immunization, she missed out on the routine immunization schedule for both her children. Her son was became sick and under-weight which impacted his performances in play as well as school.

The situation changed gradually when she started attending the meetings organized by Save the Children. We mobilized the mother and her son to the local private medical practitioner, who prescribed some medicines and suggested her to continue the immuniza-tion for both her children as per schedule.

WIth time, Noorzahan’s son got well and our Community Volunteer now keeps a tab on the boy’s health and well-being.

Helping children grow up healthy is what the bulk of our work revolves around. In the year 2015 alone, we reached more than 450,000 children through our projects on health and nutrition across various parts of India.

Save the Children India has demonstrated experience and expertise in:

• Policy and guideline development (India Newborn Action Plan, National guidelines on newborn sepsis, Kangaroo Mother Care and Facility-based New Born Care)

• Advocacy and Thought Leadership for children’s right to health and survival (Every Last Child Campaign, State of India’s Newborns 2014 report, Ending Newborn Deaths 2014 report)

• Evidence generation for improving coverage, quality of interventions and translating policy into action (birth asphyxia management, sepsis management at community and facility level, improving quality/coverage of postnatal care, implementing seven point agenda of WHO/UNICEF for diarrhoea prevention and control, improved coverage of IYCF practices and Community Management of Acute Malnutrition)

• Partnership with national and state governments and professional organizations such as Secretariat for RMNCH+A Coalition, Nutrition Coalition, membership of various national/state Technical Advisory Groups and Expert Groups)

INDIA HEALTH CHALLENGES

An estimated 47,000 mothers and 0.73 million neonates continue to die every year due to causes related to pregnancy, childbirth and the post-partum period.

About 70% of infant deaths and 56% of under-five child deaths occur in the neonatal period, the first 4 weeks of life. Major proportion of these newborn deaths are still due to preventable causes.

Over 50% of the child deaths are associated with malnutrition. According to recent data from the Rapid Survey on Children (RSOC 2014), 38.7 % of Indian children under five years old are stunted, 15.1 % are wasted and 29.4 % are underweight. India has highest burden of undernutrition in the world.

The 2015 Global Hunger Index (GHI) Report ranks India 20th amongst leading countries with a serious hunger situation

OUR APPROACH

MATERNAL, NEWBORN AND CHILD HEALTH• Community based service provision of full Ante Natal Care and ensuring Post Natal Care• Promoting safe delivery practices • Continuum of new born care (home & facility based) programming • Increasing coverage and improving the quality of preventive, promotive and curative services for children under 5 (diarrhoea & pneumonia)

INFANT, YOUNG CHILD, AND MATERNAL NUTRITION• Early initiation of colostrum and exclusive breastfeeding• Timely weaning - appropriate complementary foods• Community based identification, management & treatment of Severly Acute Malnourished (SAM) children• Prevention-control of adolescent and maternal anaemia • Improvement of dietary intake during adolescence and pregnancy

ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH• Altering norms: delayed marriage & child bearing, gender-based violence, sexual and reproductive health (SRH) rights. • Improving access to SRH services for married/unmarried girls and boys.• Identify, test, and evaluate innovative approaches for improving girls school attendance and retention.

WATER, SANITATION AND HYGIENE (WASH)• Improving access to safe, adequate and sustainable water facilities • Behaviour change and capacity building to ensure sustainable access to WASH facilities at household, community and institutional level • Aligning our WASH agenda with Government’s Swatch Bharat Mission (Clean India Campaign)• Promotion of WASH during humanitarian response (focusing children)

We work in supporting the health system strengthening through a catalytic approach across various life stages in the following manner:

FUTURE ROADMAP

1. Continuum-of-care Approach for Newborn HealthWe propose to deliver a continuum-of-care package of newborn health interventions using the existing health delivery platforms and a health system strengthening approach to combat the three “big killers” of newborns – low birth weight, sepsis and birth asphyxia. The package will have the following objectives:• Improving birth asphyxia management through Essential Newborn Care and Resuscitation (ENCR) at delivery points

• Improving sepsis management through early identification of sepsis at community level and appropriate treatment at both community and facility level

• Improving identification and care of small/LBW babies at community and facility level through effective postnatal care

2. Significantly Improving Urban Health Outcomes through Technical Assistance for Healthcare System Strengthening In the absence of defined, standardized and uniform urban health service delivery mechanisms in most cities/towns/states of India, we propose the following three broad strategies for streamlining health systems in urban India: • Planning and Governance: Rapid assessment/ situation analysis of health systems, infrastructure, existing service delivery mechanisms, bottlenecks & challenges in the implementation of health services from equity perspective.

• Technical assistance in implementation of the healthcare plans: Developing and operationalizing the healthcare plans

• Policy advocacy at city and state levels: Influencing existing policies for effective implementation of different urban health strategies related to strengthening of healthcare systems, which can be further scaled-up in other parts of India.

3. Combating Early Childhood Malnutrition through Multi-sectoral Convergent Approach In India, 48% of under-five children are stunted, 70% anemic and 15% obese. Childhood malnutrition is more evident in rural India due to reasons beyond dietary intake and health status (e.g., intergenerational poverty, gender inequity, educational and societal disadvantages, inadequate access to basic services and poor environmental conditions, etc.).

Due to disconnection of such inter-sectoral mechanisms, the situation of childhood nutrition in rural India remains a challenge. There is a need to synchronize the community and the government mechanisms to improve the situa-tion of childhood nutrition.

We propose to undertake the following for improving health and nutrition status in the community with focus on improving Infant and Young Child Feeding (IYCF) practices:• Improving leadership and coordination for childhood nutrition through creation of a platform for multi-stakeholder interaction and synergy at the block level and below,

• Developing and implementing a combative plan against malnutrition through participatory approach ensuring ownership and accountability of the key stakeholders, and reaching the most vulnerable

• Developing and implementing a contextualized nutrition education and communication program

• Facilitate performance of frontline workers working for childhood nutrition

• Integrating Information Communication Technology (ICT) in programming to add momentum and facilitate better impacts.