Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 11;38(4):454-463.
doi: 10.1093/heapol/czad011.

Integrating an algorithmic and health systems thinking approach to improve the uptake of government antenatal nutrition services in Vidisha, Madhya Pradesh (India), 2018 to 2021

Vani Sethi  1 , Archana Mishra  2 , K S Ahirwar  3 , A P Singh  3 , Sameer Pawar  4 , Pushpa Awasthy  5 , Ankita Tiwari  5 , Avi Saini  6 , Narendra Patel  6 , Abhishek Kumar  6 , Tashi Choedan  6 , Mansi Shekhar  7 , William Joe  6
Affiliations

Integrating an algorithmic and health systems thinking approach to improve the uptake of government antenatal nutrition services in Vidisha, Madhya Pradesh (India), 2018 to 2021

Vani Sethi et al. Health Policy Plan. .

Abstract

In 2018, the Government of Madhya Pradesh initiated the feasibility testing of integrating an algorithmic approach (assess, give, counsel, treat) to strengthen antenatal nutrition services in routine government-funded programmes coupled with a health system thinking approach to strengthen the health service delivery platform. Implementation phases included (1) an evidence review and stakeholder consultations (April 2018) and (2) a health systems strengthening preparedness phase (May-December 2018), including pilot testing in Vidisha district (January-December 2019) covering ∼54 100 pregnant women with 237 antenatal contact points through 241 government auxiliary nurse midwives/staff nurses. During 2020-21, feasibility testing was expanded to an additional 7 districts. We used programme registers of the Auxiliary Nurse Midwives Registers (2019-21) and National Family Health Survey data for 2016 and 2021 to show changes in the Vidisha district and 7 expansion districts. We compare the performance of Vidisha district with Ashok Nagar district, where no such intervention occurred. Comparing 2016 and 2021 data, the Vidisha district showed improvements in receipt of antenatal care in the first trimester (29 to 85%) and in four antenatal visits (17 to 54%). Using the difference-in-difference approach, a 42% net increase in first-trimester antenatal check-ups in Vidisha as compared to Ashok Nagar is observed. There was also an improvement in the maternal nutrition budget of the state from USD 8.5 million to USD 17.8 million during this period. The Vidisha initiative offers several lessons in time-effective workflow to deliver all constituents of nutrition services at various antenatal contact points through and via routine government health systems. Continued execution of the algorithm for screening, with longitudinal data on the management of all nutrition risks, will be critical to show its long-term impact on maternal morbidities and birth outcomes.

Keywords: India; Maternal nutrition; Vidisha; antenatal care; health systems.

PubMed Disclaimer

Conflict of interest statement

All authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Map of the study area, Madhya Pradesh
See this image and copyright information in PMC

References

    1. Aayog NITI. 2018. Transformation of Aspirational Districts: A New India. New Delhi, India: NITI Aayog. https://www.niti.gov.in/aspirational-districts-programme, accessed 5 November 2022.
    1. Adhikari SK, Bredenkamp C. 2009. Monitoring for nutrition results in ICDS: translating vision into action. IDS Bulletin 40: 70–7.
    1. Avula R, Nguyen PH, Ashok S. et al. 2022. Disruptions, restorations and adaptations to health and nutrition service delivery in multiple states across India over the course of the COVID-19 pandemic in 2020: an observational study. PLoS One 17: e0269674. - PMC - PubMed
    1. Choedon T, Dinachandra K, Sethi V, Kumar P. 2021. Screening and management of maternal malnutrition in nutritional rehabilitation centers as a routine service: a feasibility study in kalawati saran children hospital, New Delhi. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine 46: 241. - PMC - PubMed
    1. DiMaria‐Ghalili RA, Edwards M, Friedman G. et al. 2013. Capacity building in nutrition science: revisiting the curricula for medical professionals. Annals of the New York Academy of Sciences 1306: 21–40. - PubMed

Grants and funding