A regional workshop held in Sri Lanka brought stakeholders together Nov. 14-16 to analyse bottlenecks related to implementing and enforcing the International Code of Marketing of Breast-milk Substitutes (BMS Code). The workshop, “Bottleneck Analysis of Legal Measures, Monitoring and Enforcement systems to protect Breastfeeding in the region,” included participants from UNICEF ROSA, country teams from seven South Asian countries, representatives from Ministries of Health, including Nutrition Departments and Legal Affairs, professional medical associations, public health/medicine institutes, and partner organizations including the Breastfeeding Promotion Network of India (BPNI) and Alive & Thrive. After an overview of the BMS Code, and Code implementation at the global, regional, and country levels, including enablers and barriers for effective implementation, participants discussed challenges posed by aggressive marketing, especially digital marketing, and pathways for strengthening measures at all levels for protecting breastfeeding. Country teams undertook a bottleneck analysis related to Code status, including implementation and enforcement mechanisms, and developed action plans for addressing the challenges and improving measures for protecting breastfeeding. Constance Ching from Alive & Thrive's South-East Asia team was one of the course facilitators in the workshop. Dr. Sebanti Ghosh of Alive & Thrive provided inputs for the country-specific bottleneck analysis of the Infant Milk Substitutes Act implementation in India and worked with representatives from the Ministry of Health & Family Welfare, UNICEF India and BPNI to develop the action plan for India.

The National Centre of Excellence and Advanced Research on Anemia Control (NCEAR-A) organized a workshop on Anemia in Childhood (0-19 years) Dec. 21, which included Dr. Vinod Paul, NITI Aayog, Indian Council of Medical Research (ICMR) - Director General Office, and Ministry of Health and Family Welfare (MoHFW), Government of India, along with development partners, professional medical associations, Central Indian Association of Pediatrics (IAP), Pediatric and Adolescent Nutrition Society of IAP, Indian Association of Preventive and Social Medicine (IAPSM) and Indian Public Health Association (IPHA). Alive & Thrive has supported NCEAR-A in developing detailed technical background papers on Pediatric and Adolescent Anemia, and a draft summary background paper was developed and circulated by NCEAR-A during the workshop to all participants.

Improved understanding of the burden of anemia and its determinants have led to consensus on  the key actions that need to be taken for addressing anemia in this age group while addressing anemia burden across the life cycle. Dr. Paul called on stakeholders to provide technical support and improve collaboration between government, development partners, academic institutes, and professional associations for effective implementation of the 6×6×6 STRATEGY of Anemia Mukt Bharat (AMB) program. The strategy should fully reach selected districts for better assessment of implementation processes, design of solutions to address gaps, and expansion of coverage. During the workshop, Dr. Sebanti Ghosh from Alive & Thrive presented a detailed session on global evidence of anemia in children between 6-59 months of age. 

Bihar bringing special focus on strengthening HBYC, increased community participation, and State Action Plan for children, India

The State Health Society Bihar (SHSB) organized the Home-Based Care for New-Born and Young Child (HBYC) state-level review and planning meeting on 9 December 2022for 13 existing aspirational districts and 7 new districts that have been added in the year 2022. The meeting was attended by the State Program Officer-Child health, ASHA resource cell, and key district officials of 20 districts along with representatives of UNICEF, Alive & Thrive, Norway-India Partnership Initiative (NIPI), and CARE. The development partners, including Alive & Thrive, will support the SHSB in improving the quality of HBYC implementation in 20 districts, identifying the gaps in reporting and building the capacity of the ASHAs and ASHA Facilitators on effective reporting and regular visits to ensure the quality of implementation on the ground. 

In an effort to actively engage the Jeevika-Self-help group in the Supplementary Nutrition Programme (SNP) and all community-based outreach activities, the Directorate of Integrated Child Development Scheme (ICDS) Bihar organized a meeting on 13 December2022 with the line departments including Department of Education, Secretary Finance, SHSB, Department of Social welfare, Jeevika, Department of Rural Development, Panchayati Raj Institution, National Nutrition Mission, and Alive & Thrive. The discussion aimed to strengthen the current State Convergence Action Plan (SCAP) for improved nutritional outcomes in the state.



Alive & Thrive along with UNICEF, Aga Khan Foundation, Piramal Foundation, Project Concern International, Pathfinder, Plan International, Save the Children, and Core stone, is playing an active role in providing technical support to the government in the development of State Action Plan for Children (SPAC). The Department of Social Welfare oriented the development partners on objectives, strategies, imperatives, and targets during a meeting on 20 December 2022. 

Scaling up Supportive Supervision application in Uttar Pradesh, India 

As a part of concerted efforts to improve the quality of nutrition services, the Government of Uttar Pradesh rolled out a supportive supervision training package for ICDS functionaries in partnership with Alive & Thrive, Uttar Pradesh-Technical Support Unit (UP-TSU), the Bill & Melinda Gates Foundation, UNICEF India, World Vision India, and Piramal Swasthya. The training of trainers (ToT) for the ICDS functionaries was launched on Sept. 6. One Child Development Project Officer (CDPO) per district and divisional/district level representatives of development partners, including UNICEF, Piramal Foundation, HCL Foundation, and World Vision India, were selected as the master trainers. Alive & Thrive has been mandated to support the government in rolling out the state-level ToT of Master Trainers and UPTSU to support the district-level training. Alive & Thrive supported the Government in developing the training manual for Master Trainers and a reference book for CDPO and Mukhya Sevika.

In December 2022, Uttar Pradesh initiated the scale up of the Supportive Supervision Application-SAHYOG across 75 districts. The ICDS-UP, supported by Alive and Thrive, UP-TSU, UNICEF, Piramal Swasthya, and World Vision, has initiated the training of all functionaries in 117 training batches in 75 districts. The first batch of training was inaugurated on 28 November 2022; the last batch concluded on 28 December 2022. Of a total of 2,810 expected participants, 2,618 attended. With the scale-up of this supportive supervision solution, Uttar Pradesh has made a concrete move towards improving the nutritional outcome for women and children in the state.

Technology for effective Supportive Supervision, Gujarat, India

The mobile-based supportive supervision (SS) App designed by Alive & Thrive (A&T) India to support National Health Mission (NHM), Gujarat, is aiding the NHM functionaries in conducting joint field visits along with their supervisees. Followed by comprehensive training for various supervisory cadres in all three program districts in Gujarat, NHM supervisory cadres have started using the App for conducting field visits and debrief sessions.

The App enables supervisors to make real-time observations on services while conducting joint home visits, and the trained NHM functionaries are putting it to effective use. In a recent instance, the ASHA Facilitator (ASHA F) of Mangrola block in the Surat district accompanied the ASHA during a home-based newborn care (HBNC) visit. During the HBNC visit, she realized that ASHA did not have a functional thermometer; so, they could not note the temperature of the mother and newborn with accuracy. The ASHA Facilitator coordinated with ANM to procure a functional thermometer for the concerned ASHA so that beneficiaries could receive complete services. On the surface, such issues may seem small, but they are critical for ensuring service quality. Their speedy resolution aggregates to achieve overall desired outcomes.

During a discussion on App usage, the ASHA Facilitator said that the App allows her to make observations and fill out checklists. At the end of the visit, she can use it to identify issues that need addressing and conduct debrief sessions with ASHAs focusing on these points. Bhumikaben at Kothi village in Bharuch is another ASHA Facilitator who is making use of the App during HBNC and HBYC visits to support the ASHAs falling under her purview. One of her focal points is to ensure complete and correct counseling is provided to the beneficiaries on newborn care and the well-being of mothers post-delivery. She is using the checklists in the App to assess the quality of counseling by ASHAs and is supporting them to make course corrections wherever required.



A combination of joint problem-solving and technology-supported visits is fulfilling the twin goals of improving the quality of HBNC visits and resolving performance issues of frontline workers. 

Alive & Thrive in BMJ Author’s Speak session organized by NQOCN, India

The Nationwide Quality of Care Network (NQOCN) organized a British Medical Journal (BMJ) Speak Session on improving the quality of antenatal care services in a high caseload tertiary care teaching hospital – Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College in Kanpur, Uttar Pradesh. Praveen Sharma from Alive & Thrive India presented the learnings and the challenges faced. More than 40 participants from across the globe participated in the session including National Health Service-United Kingdom (UK), BMJ-UK, Medical colleges, development partners and government officials.



NQOCN is a voluntary network formed by teams working on quality improvement initiatives across North, Central, North-East, and South India. It is present in 15 states across India including Delhi, Uttar Pradesh, Haryana, Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Kerala, Rajasthan, Telangana Meghalaya, Assam, Punjab, and Uttarakhand. It has facilitated quality improvement initiatives in 131 facilities and caters to a combined delivery load of about 5,50,000 [JL1] deliveries/per year. It is a flat hierarchy not-for-profit organization with the goal of inculcating a culture of quality improvement in the healthcare system.

7th National Workshop and CME on Health Systems Strengthening, Chandigarh, India

The Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh and Association for Health Systems Analysis and Strengthening (AHSAS) organized a four-day “7th National Workshop and CME on Health Systems Strengthening,” December 12-16, 2022, at the Department of Community Medicine and School of Public health, PGIMER, Chandigarh.

Praveen Sharma and Priyanka Bajaj from Alive & Thrive contributed to the workshop as key speakers and shared perspectives on quality improvement initiatives in health system strengthening undertaken by Alive & Thrive at community and facility level.