Puri Seema, Fernandez Sylvia, Puranik Amrita, Anand Deepika, Gaidhane Abhay, Quazi Syed Zahiruddin, Patel Archana, Uddin Shahadat, Thow Anne Marie
Department of Nutrition, Institute of Home Economics, University of Delhi, New Delhi, India.
National Institute of Nutrition, Hyderabad, India.
BMC Public Health. 2017 Jun 13;17(Suppl 2):461. doi: 10.1186/s12889-017-4339-z.
Over the last decade, infant and young child feeding (IYCF) indicators in India have improved. However, poor IYCF practices are still apparent, associated with pervasive high rates of child under-nutrition. Interventions to improve IYCF need augmentation by appropriate policy support to consolidate gains. The aim of this study was to identify opportunities to strengthen and support IYCF policies through a policy content and stakeholder network analysis.
IYCF policies and guidelines were systematically mapped and coded using predetermined themes. Six 'net-map' group interviews were conducted for stakeholder analysis with data analyzed using ORA (organizational risk analyzer, copyright Carley, Carnegie Mellon University) software. The study was carried out at a national level and in the states of Maharashtra and unified Andhra Pradesh.
Thirty relevant policy documents were identified. Support for IYCF was clearly apparent and was actioned within sectoral policies and strategic plans. We identified support for provision of information to mothers and caregivers in both sectoral and high-level/strategic policy documents. At a sectoral level, there was support for training health care workers and for enabling mothers to access IYCF. Opportunities to strengthen policy included expanding coverage and translating policy goals into implementation level documents. At the national level, Ministry of Women and Child Development [MoWCD], Ministry of Health and Family Welfare [MoHFW] and the Prime Minister's Nutrition Council [PMNC] were the most influential actors in providing technical support while MoHFW, MoWCD, and Bill Melinda Gates Foundation were the most influential actors in providing funding and were therefore influential stakeholders in shaping IYCF policies and programs.
We identified a wide range of strengths in the IYCF policy environment in India and also opportunities for improvement. One key strength is the integration of IYCF policies into a range of agendas and guidelines related to health and child development service delivery at the national and state level. However, the lack of a specific national policy on IYCF means that there is no formal mechanism for review and monitoring implementation across sectors and jurisdictions. Another opportunity identified is the development of IYCF policy guidelines in emergencies and for tribal populations.
在过去十年中，印度婴幼儿喂养（IYCF）指标有所改善。然而，不良的婴幼儿喂养做法仍然明显，与普遍存在的儿童营养不良高发生率相关。改善婴幼儿喂养的干预措施需要通过适当的政策支持来加强，以巩固成果。本研究的目的是通过政策内容和利益相关者网络分析，确定加强和支持婴幼儿喂养政策的机会。
使用预先确定的主题对婴幼儿喂养政策和指南进行系统映射和编码。进行了六次“网络映射”小组访谈以进行利益相关者分析，使用ORA（组织风险分析器，版权归卡内基梅隆大学的卡利所有）软件对数据进行分析。该研究在国家层面以及马哈拉施特拉邦和统一的安得拉邦进行。
确定了30份相关政策文件。对婴幼儿喂养的支持显而易见，并在部门政策和战略计划中得到落实。我们在部门和高层/战略政策文件中都发现了对向母亲和照顾者提供信息的支持。在部门层面，支持对医护人员进行培训，并使母亲能够获得婴幼儿喂养服务。加强政策的机会包括扩大覆盖范围以及将政策目标转化为实施层面的文件。在国家层面，妇女和儿童发展部[MoWCD]、卫生和家庭福利部[MoHFW]以及总理营养委员会[PMNC]是提供技术支持方面最具影响力的行为体，而MoHFW、MoWCD和比尔及梅琳达·盖茨基金会是提供资金方面最具影响力的行为体，因此是塑造婴幼儿喂养政策和项目的有影响力的利益相关者。
我们确定了印度婴幼儿喂养政策环境中的一系列优势以及改进机会。一个关键优势是将婴幼儿喂养政策纳入国家和州层面与卫生和儿童发展服务提供相关的一系列议程和指南中。然而，缺乏关于婴幼儿喂养的具体国家政策意味着没有正式机制来跨部门和跨辖区审查和监测实施情况。确定的另一个机会是制定紧急情况下和针对部落人口的婴幼儿喂养政策指南。
