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A Nepalese woman in Sirsiya village of Parsa District

As the global health and nutrition community renews its commitment to eradicating hunger and malnutrition among vulnerable people through the newly launched Sustainable Development Goals (SDGs), we have the opportunity to reflect on focussed actions that have successfully helped communities lead healthier and more productive lives.

Three focused actions – strong start, strong surveillance and program monitoring, and strong service led by governments and communities – will help our efforts to improve the nutritional status of women and children.

In my opinion, these actions are the ones that have the potential for maximum impact on the people they are targeting. There is evidence of this in the nutrition programs supported by MI across countries and that make a difference in the lives of millions.


Strong Start
How is maximum impact achieved? It must start from the very beginning.

Once  funding and other inputs are secured, what matters the most in the initial stages of program development is the efficient planning of how a service will be delivered to people, and the filling of any gaps in skills and understanding of the health functionaries/staff involved in the delivery of the service. A key focus area across a majority of programs supported by MI is building the capacity of program planners as well as service providers.

Increased capacity to understand and deliver services is an essential element of success.

It is indeed a powerful process to join hands with those who are within and outside the health system to help them understand “why” change is required, “how” it could be done and “in what way” it contributes to meeting their own objectives. One individual who internalizes the theory of change is able to then communicate it to others and have a multiplier effect.


Strong Surveillance and Program Monitoring
The next action of critical importance is to measure progress and make decisions based on the information that emerges. Knowing where the gaps lie and how to fill them sustainably is key to bringing about a difference in public health programs.

Assessing and reporting on program indicators – such as the number of people reached by a particular service/intervention – in the routine monitoring of health systems can significantly help to inform at the village, district and state/provincial levels.

They can help to answer questions such as why were people not reached. More importantly, they can contribute to finding solutions as the program moves forward.

I have seen excitement mount among district and sub-district health functionaries when they see data showing substantial improvements in infant and young child feeding practices; women consuming recommended number of iron and folic acid tablets to prevent and treat anaemia in pregnant women; and children consuming recommended zinc supplements and oral rehydration salts (ORS) to treat diarrhoea.


Strong Service
Having a strong start and building in strong surveillance and monitoring mechanisms, precede strong service. With effective services, lives change. We have seen firsthand the power of strong services in many countries.

Findings from the Samangan and Sarepul provinces of Afghanistan― where MI had supported the Ministry of Public Health to help treat children with diarrhoea ― revealed more than half the children in those provinces who were treated for diarrhoea in the government-run clinics received both zinc supplements and oral rehydration salts (ORS).

Among those who were treated with zinc and ORS, more than two-thirds of the children consumed the complete course of zinc supplements. This was a big success since zinc and ORS therapy not only saves lives of children sick with diarrhoea but also reduces the frequency of future diarrhoea episodes.

Similarly, the Nepal the health system was strengthened with increased skills of health workers and a strong program plan to improve antenatal care services.  More women consumed the recommended dose of iron and folic acid supplements when health workers supported them with encouragement and reminders.


The 3S to Success
My quest remains to support the goal of reaching even more vulnerable populations, particularly women and children, with packages of nutrition and health services.

Good nutrition is a basic right of all individuals.  On this journey, I know I am joined by many others.

The Millennium Development Goals (MDGs) gave us significant successes towards a more just world. With the SDGs, we can see not only that there is more to be done but we have stronger pathways to reaching those still unreached.

When we employ the 3S strategy, we find success in strengthening health systems, educating communities to demand these packages, and adding to the global evidence base so others can learn from our work.