These major additional and catalytic activities can be summarized as below.  

3. General Guidelines for Block Operationalization

One of the key recommendations of the Leadership Agenda for Action is to place more focus on nutrition in existing programs and to improve coordination and accountability mechanisms so these programs produce nutrition results.   This requires building stronger collaborative mechanisms at the block level, championed by leaders such as the Block Development Officer (BDO) and panchayti raj institution leaders, at block, sub-block and village levels.  These leaders should involve other local champions as appropriate and work to prioritize nutrition – and hold all related public sector programs accountable for achieving agreed upon nutrition outcomes.  The missions and departments that should be involved include: NRHM, Water and Sanitation Mission, Horticulture Mission, Literacy Mission, MHFW, MWCD, MFA, MPRI, MRD, MHRD, PDS, MDM, NREGS, MFP, MHPP, Ministry of Statistics and Program Implementation, MIT, and others.  These leaders should involve local civil society groups as possible, and this may be particularly important in insurgent areas.

Another key recommendation from the Leadership Agenda for Action is to add more community level workers, dedicated to nutrition.  Evidence from other countries that have made significant progress in achieving nutrition security show that this is critical.  This operational plan proposes block and community level staffing; four to six Nutrition Advisors at gram samiti level (with one of these serving also as a Coordinator at block level) and Nutrition Counselors serving at village level.   See attached summary job descriptions. These workers will also need supportive supervision.

There is a need for a focused and comprehensive nutrition education and awareness generation programme to inform the community regarding proper nutritional and health practices, including the use safe drinking water and hygienic sanitation.  This will require prioritizing and then harmonizing key nutrition messages and ensuring all departments promote and reinforce these messages. This effort will also include community mobilization, especially entertainment education.  The new Nutrition Counselors, along with other frontline workers (AWW, ANM, ASHA) will be the key actors in the nutrition education program, offering information and counseling at the community and household level.

This plan proposes support for women's empowerment through promotion of education, delayed age of marriage and self help groups (SHGs), with significant linkages and support from the PRI. One or two selected SHGs should be supported to develop food processing units for each block, which will  1) increase access to affordable, locally acceptable nutritious and convenient foods, especially for pregnant and lactating women and young children (i.e., complementary foods and 2) generate income for the SHGs.  This is consistent with ICDS and other government guidelines which promote local food production and government programs may purchase the locally produced foods from the women’s SHGs.  The ingredients and composition these foods should be developed in accordance with the preference of the communities, available local farm produce, and the PFA quality standards and guidelines in force.

A final critical recommendation to achieve nutrition security is to strengthen the nutrition monitoring system.  This is needed to ensure strategies are working and to hold government programs accountable for achieving results (and improve governance).  Block leaders should develop a Nutrition Action Plan with a set of key nutrition indicators.  The BDO and other leaders should then use the monitoring data at the regular coordination meetings, to ensure accountability and progress toward nutrition security.

Note that the government leaders are often able to request technical assistance from local training and academic institutions, NGOs, the private sector (through corporate social responsibility programs) or development partners, often at limited or no cost to the Government (e.g., to develop a nutrition education campaign, to improve monitoring systems).

4. Possible Outcome Indicators

• Percentage of children under 2 yrs who were put to the breast within one hour of birth
• Percentage  of infants 0-6 months of age who are fed exclusively with breast milk
• Percentage of infants 6-9 months of age who receive solid, semi-solid or soft foods
• Percentage of breastfed and non-breastfed children 6 months-2 yrs of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-reastfed children) the minimum number of  times or more
• Percentage of children 6 months to 2 yrs of age who receive an iron-rich food or iron-fortified foods specially designed for infants and young children, or fortified in the home
• Percentage  of children 6 months to 5 yrs old having received two doses of vitamin A in the previous 12 months
• Percentage  of children 1-5 yrs old having received deworming tablets in the previous 12 months
• Percentage of children under 5 yrs reported to have had an episode of diarrhoea in the previous two weeks who took zinc supplements
• Percentage  of adolescent girls 10-19 years old who have taken an iron and folic acid supplement in the previous week
• Percentage  of adolescent girls 10-19 years old who have taken a deworming tablet in the last 6 months
• Percentage of adolescent girls  with increased level of haemoglobin
• Percentage  of pregnant women who consumed at least 100 iron and folic acid supplements
• Percentage of women who have consumed foods rich in bio-available iron in the last 24 hours
• Percentage of women  with increased level of haemoglobin
• Percentage of households with access to safe drinking water
• Percentage of households with access to improved sanitation
• Percentage increase in girls enrolment and retention in schools
• Percentage increase of girls completing school
• Horticulture/kitchen gardens

5. Estimated Costs Per Block Per Year :

• To undertake Awareness Generation  through community mobilisation and interpersonal communication in support of the nutrition education campaign
• Support priority nutrition messages and interventions (as per the Leadership Agenda for Action) including:
  - Growth monitoring
  - Importance of feeding of colostrum within 1 hour of birth
  - Importance of exclusive breastfeeding for the first six months
  - Timely introduction of complementary foods at 6 months
• Promote  other nutrition interventions, along with the Village Panchayat, , including:
  - Educating the community regarding safe disposal of excreta
  - Creating demand with respect to provision of sanitation and other facilities through National programmes
  - Promoting options that enhance safe food management by households
  - Educating the mother how to prepare food from locally available raw materials
  - Importance of schooling for the girl child
  - Equity with respect to female nutrition, workload and economic conditions
  - Delaying age of marriage and of first pregnancy
• Coordinate with ANM and AWW in priority nutrition areas, including support to VHND and VHSC
  
• Expand village awareness of government benefits and entitlements
  
• Promote collaboration between government programs and departments
  

Annexure 2: Job Description - Nutrition Advisors   

• Assist the BDO in developing the Nutrition Security Action Plan for the block
• Assist with key activities in the Nutrition Action Plan, such as review of data, preparation for the review meetings
• Support the Nutrition Counselors, especially with nutrition education efforts
• Support the PRI in fostering active VHSC (needs assessment, development of health plan, implementation of health plan)
• Support women’s self help groups and food processing schemes
• Support improved monitoring efforts, including community accountability efforts
• Other work with the BDO and PRI system to ensure nutrition is a priority focus area
  

Annexure 3: Job Description –Nutrition Coordinator
The Nutrition Coordinator is based in the block HQ, serves as a Nutrition Adviser in the gram samiti of that area, and also assists the BDO as follows:

• Assist BDO to organize and prepare for regular nutrition review meetings (lead in preparing meeting agenda, meeting logistics)
• Assist BDO to ensure inter-department communication and collaboration
• Other work with the BDO or PRI system to ensure nutrition is a priority focus area

• Identify and invite relevant stakeholders for nutrition security
• Commit to lead toward the common goal of achieving nutrition security in the block
• Review needs and develop a Block Nutrition Security Action Plan, with a list of priority results (measurable indicators)
• Hold a regular review and coordination meeting at block and lower levels, with set agenda items as well as variable agenda items (can build on existing platforms)
• Review monitoring data and engage in problem solving at each meeting