About
PATH

PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world, most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions, including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. PATH has been working in India since the late 1990s, bringing governments, communities, private-sector companies, and experienced public health practitioners together to address some of the country, most crucial health problems. Today, PATH, projects in India focus on Tuberculosis, HIV, Neglected Tropical Diseases, Vaccines, and Maternal, New born Child health and Nutrition.
PATH provides technical support to the central government and multiple state governments on various health and nutrition issues. We also engage at the district level through our local partners. We are recognised as a key agency with vast technical expertise in health technology, health systems, and nutrition in India.

Focus Area

Infant and Young Child Feeding practices (for e.g. Appropriate care-giving and feeding behavior e.g. exclusive breastfeeding and complementary feeding/ minimum dietary diversity/ responsive feeding, feeding behaviors and stimulation)

Target State

Seattle, USA

Objectives

PATH focuses on strengthening newborn nutrition and essential health care services and practices. As a technical partner, we strengthen facilities in multiple states by promoting proven interventions like breastfeeding , donor human milk banking, kangaroo mother care (KMC); family centric care which empowers the family to take care of their newborns, especially those born vulnerable; optimal infection prevention and control, patient centric care practices and innovation. In India, PATH was part of the technical committee which supported the government in the development of the , National Guidelines on Lactation Management Centers in Public Health Facilities. The guidelines emphasize on setting up lactation management systems at all levels of public health facilities. Comprehensive Lactation Mangement Centres (CLMCs) are established at tertiary care facilities which promote and support breastfeeding and milk expression for vulnerable babies, encourages kangaroo mother care (KMC) and provides donor human milk for vulnerable babies for whom mothers, own milk is unavailable. WHO and other health leaders recommend donor human milk made available through human milk banks (HMB) as the next-best feeding option, when mothers, own milk is unavailable. KMC is another evidence based intervention to improve exclusive breastfeeding for vulnerable babies. KMC is a natural form of human care that stabilizes body temperature, improves breastfeeding, and prevents infection and other morbidities in newborns. Lactation Management Units (LMUs) are established at all sub-district hospitals to facilitate expression and collection of mother, own milk for consumption by own baby. Lactation Support Units (LSUs) will be constituted in all delivery points to provide round the clock breastfeeding support, lactation counselling and Kangaroo Mother Care (KMC) support to
Mothers. PATH is now working with the central Government and multiple state governments to support the scale up of lactation management systems.

PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world, most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions, including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. PATH has been working in India since the late 1990s, bringing governments, communities, private-sector companies, and experienced public health practitioners together to address some of the country, most crucial health problems. Today, PATH, projects in India focus on Tuberculosis, HIV, Neglected Tropical Diseases, Vaccines, and Maternal, New born Child health and Nutrition.
PATH provides technical support to the central government and multiple state governments on various health and nutrition issues. We also engage at the district level through our local partners. We are recognised as a key agency with vast technical expertise in health technology, health systems, and nutrition in India.

Seattle, USA

Infant and Young Child Feeding practices (for e.g. Appropriate care-giving and feeding behavior e.g. exclusive breastfeeding and complementary feeding/ minimum dietary diversity/ responsive feeding, feeding behaviors and stimulation)

iv. Bihar;vi. Delhi NCR;viii. Gujarat;xiii. Karnataka;xv. Madhya Pradesh;xvi. Maharashtra;xxi. Odisha;xxiii. Rajasthan;xxv. Tamil Nadu;xxvi. Telangana;xxviii. Uttar Pradesh

Patna, Delhi, Lucknow, Cuttack, Bhubaneswar, Bhopal, Indore, Gandhinagar, Vadodara, Surat, Jaipur. Churu, Beawar, Alwar, Bharatpur, Dholpur, Karauli, Sawai Madhopur, Tonk, Baran, Boondi, Udaipur, Baanswara, Rajsamand, Chittorgarh, Bhilwara, Sirohi, Jalore, Barmer, Jodhpur, Bangalore, Hyderabad, Chennai,

PATH focuses on strengthening newborn nutrition and essential health care services and practices. As a technical partner, we strengthen facilities in multiple states by promoting proven interventions like breastfeeding , donor human milk banking, kangaroo mother care (KMC); family centric care which empowers the family to take care of their newborns, especially those born vulnerable; optimal infection prevention and control, patient centric care practices and innovation. In India, PATH was part of the technical committee which supported the government in the development of the é─˙National Guidelines on Lactation Management Centers in Public Health Facilities. The guidelines emphasize on setting up lactation management systems at all levels of public health facilities. Comprehensive Lactation Mangement Centres (CLMCs) are established at tertiary care facilities which promote and support breastfeeding and milk expression for vulnerable babies, encourages kangaroo mother care (KMC) and provides donor human milk for vulnerable babies for whom mothersé─˘ own milk is unavailable. WHO and other health leaders recommend donor human milk made available through human milk banks (HMB) as the next-best feeding option, when mothersé─˘ own milk is unavailable. KMC is another evidence based intervention to improve exclusive breastfeeding for vulnerable babies. KMC is a natural form of human care that stabilizes body temperature, improves breastfeeding, and prevents infection and other morbidities in newborns. Lactation Management Units (LMUs) are established at all sub-district hospitals to facilitate expression and collection of motheré─˘s own milk for consumption by own baby. Lactation Support Units (LSUs) will be constituted in all delivery points to provide round the clock breastfeeding support, lactation counselling and Kangaroo Mother Care (KMC) support to
Mothers. PATH is now working with the central Government and multiple state governments to support the scale up of lactation management systems.

Other

We are a not for profit development organization

In India, PATH was part of the technical committee which supported the government in the development of the é─˙National Guidelines on Lactation Management Centers in Public Health Facilities. The national guidelines propose the CLMC model which is an adaptation of PATHé─˘s Mother Baby Friendly Initiative Plus (MBFI +) model. PATH is now working with the government and partners to support the effective implementation of these guidelines across newborn care facilities in multiple states by system strengthening, supporting regulation formulation and also supporting setting up of select CLMCs including few Zonal reference centres (to mentor existing and new CLMCs) in tertiary care facilities. Our work is being implemented in multiple states like Uttar Pradesh, Maharashtra, Odisha, Delhi and Madhya Pradesh and Rajasthan, Bihar and KarnatakA. We are supporting the government of Rajasthan in the evaluation of 19 existing CLMCs in medical colleges and district hospitals on baby friendly hospital initiative (BFHI) , KMC, CLMC processes and infection control parameters.

Mothers, newborns, family members and health care facility staff

No

NA

NA

Yes

Paper attached

The study was conducted at a level III hospital to evaluate the impact of a strengthened MBFI+ model on an existing HMB program, and at a level II Hospital, without an HMB, was completed in 2018. The research hypothesis was that the MBFI+ model is superior to routine lactation support and HMB services in improving utilization of human milk for feeding neonates born at secondary- and tertiary-level health facilities. Data showed statistically significant improvement in breastfeeding indicators in healthy newborns and human milk feeding, and in KMC and survival without late onset sepsis indicators in very low birth weight neonates. Among healthy neonates, significant improvement in breastfeeding indicators was also observed. Importantly, end-line data showed that the majority of infants were on exclusive human milk feeding during the hospital stay. Safety, process, and quality improvement indicators also improved.

Yes

Joint advocacy on newborn nutrition, joint material development and cobranding , planning joint events, joint awareness raising on breastfeeding and KMC, financial support to effectively implement newborn nutrition and care model across all neonatal care facilities in India.

Establishment of the MBFI+/CLMC model has been successful. As a direct result of this project, scale-up programming is in place and infants in the country have improved access to human milké─ţthrough strengthened systems for lactation and breastfeeding support, as well as for provision of quality donor human milk when needed. Exclusive human milk diet for newborns has increased in facilities. The government led the development of national guidelines, with PATH providing critical technical assistance. PATH is now supporting the state governments to scale up CLMCs and LMUs in multiple states.

Yes. As the national guidelines roll out, PATH is working with a vision that by 2023 all health facilities (50 tertiary care hospitals, 793 district SNCUs and delivery points) have access to lifesaving human milk as part of integrated newborn care. CLMCs will be established at tertiary hospitals and well performing district hospitals , LMUs will be established at district hospitals and LSUs at all delivery points. If facilities are strengthened, the chances of continued breastfeeding and effective infant feeding practices are higher.

Case study 1
Rashmi, a mother of a low birth weight baby, mentioned the importance of breastfeeding and mother , own milk for her child: é─˙I feel that breastfeeding is like God, gift. Expression using a pump was new to everyone (neighbors, relatives, etc.) due to lack of awareness. I was only able to feed Rewa because I was expressing milk. There is a need to increase awareness among mothers and the community on milk expression.

On breastfeeding, Rashmi mentioned that she received no information despite the fact that she was admitted in the private hospital for nearly five months while she was pregnant.

In India, doctors don, talk about breastfeeding during pregnancy. In fact, we receive most information from our mothers and grandmothers. But a lot of times they, also not able to understand the problems we go through. For the previous generation, getting pregnant and feeding came much easier than it did to us. Hence, right advice from the right doctor is very important, she said.

Case Study 2
Another mother named Neha, a working mother, talks about the importance and availability of lactation experts, as a result of whose support she could feed her baby after 20 days of birth: thought it was a miracle (donating milk). Anyone can donate blood, but not everyone can donate milk.

She also mentioned, when I donated milk, I felt on the top of the world. I thought that Ié─˘m a mother of so many babies. We even had a party to celebrate the donation.

Neha continued, think awareness should really increase about milk donating and milk banks. Every woman should donate. Why can we promote breastfeeding the way we promote top-up feeds (formula). We need to counsel mothers on breastfeeding because top-up feeds arené─˘t good. I wanted to contribute towards building.

Hiring appropriate project staff was a major challenge. Candidates for the lactation counselor position tended to be highly paid, and they were understandably reluctant to take a salary cut to join the project.
Tendering process is highly bureaucratic delaying the procurement of equipment

Project activities complement and support the government, work to scale up CLMCs and to improve breastfeeding practices in the country. Indiaé─˘s Ministry of Health aims to expand lactation management systems nationally; this project has directly strengthened the technical capacity and available resources to enable expansion of health facilities. The initiative has helped strengthen systems through evidence generation, tool development, training , development of monitoring and evaluation formats communication materials development , supportive supervision and mentoring contributing to robust facility based newborn nutrition and care services

Weakness/learning
Stabilization of CLMC operations takes time and intensive mentorship and resources to achieve a high standard of safety and qualityé─ţboth mandatory for direct delivery of a biological substance to a vulnerable neonate. This requires nurturing and ongoing and concentrated engagement from PATH to mitigate potential risks, build local technical competency, and secure a fully operational system.

There needs to be a focus on an integrated approach that includes support for breastfeeding , milk expression and KMC , provision of donor human milk for sick babies without access to mothersé─˘own milk, family centric care and infection prevention and control. Patient centric care should form the cornerstone of this approach. At the same time country specific policy guidance based on this integrated approach needs to be in place to universalize access to optimal newborn nutrition for all babies. Ensuring local ownership and raising awareness on the guidelines among stakeholders is important to engage them in effectively rolling out the guidelines. To ensure that our neonates get the best start in life, mothers need to get support from all stakeholders such as family and health facilities to support her in breastfeeding. The staff at the health facilities should be adequately motivated and supported to ensure quality delivery of services for mothers and babies.


About
PATH

PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world, most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions, including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. PATH has been working in India since the late 1990s, bringing governments, communities, private-sector companies, and experienced public health practitioners together to address some of the country, most crucial health problems. Today, PATH, projects in India focus on Tuberculosis, HIV, Neglected Tropical Diseases, Vaccines, and Maternal, New born Child health and Nutrition.
PATH provides technical support to the central government and multiple state governments on various health and nutrition issues. We also engage at the district level through our local partners. We are recognised as a key agency with vast technical expertise in health technology, health systems, and nutrition in India.

Focus Area

Maternal health and Child care (for e.g. Maternal and child micro-nutrient/ dietary supplementation/ Food fortification for children, women and general population/ Iron Folic Acid supplementation/ Vitamin A supplementation)

Target State

Seattle, USA

Objectives

the objectives include, Feeding of fortified rice (Iron, folic acid, Vitamin B12, Thiamin , Niacin, Viatmin b6 and Vitamin A), under MDM and ICDS schemes to address/ prevent micronutrient malnutrition/ Anemia amongst school going children and beneficiaries reached through these schemes. And piloting batch blending operations at warehouse / centralized kitchen level for rice fortification scale up.

PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the worldé─˘s most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutionsé─ţincluding vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide. PATH has been working in India since the late 1990sé─ţbringing governments, communities, private-sector companies, and experienced public health practitioners together to address some of the countryé─˘s most crucial health problems. Today, PATHé─˘s projects in India focus on Tuberculosis, HIV, Neglected Tropical Diseases, Vaccines, and Maternal, New born Child health and Nutrition.
PATH provides technical support to the central government and multiple state governments on various health and nutrition issues. We also engage at the district level through our local partners. We are recognised as a key agency with vast technical expertise in health technology, health systems, and nutrition in India.

Seattle, USA

Maternal health and Child care (for e.g. Maternal and child micro-nutrient/ dietary supplementation/ Food fortification for children, women and general population/ Iron Folic Acid supplementation/ Vitamin A supplementation)

viii. Gujarat;xiii. Karnataka;xxii. Punjab;xxviii. Uttar Pradesh

Chandigarh Chandigarh KarnatakaBangalore, Mysore, Mangalore, Dharwad and Bellary, Chamrajnagar, Kolar, Belgaum and Koppal, Chamrajnagar, Kolar, Belgaum and Koppal Gujarat Ahmedabad and Gandhinagar Uttar Pradesh Lucknow

The objectives include, Feeding of fortified rice (Iron, folic acid, Vitamin B12, Thiamin , Niacin, Viatmin b6 and Vitamin A), under MDM and ICDS schemes to address/ prevent micronutrient malnutrition/ Anemia amongst school going children and beneficiaries reached through these schemes. And piloting batch blending operations at warehouse / centralized kitchen level for rice fortification scale up.

Other

Chandigarh Chandigarh Administration & PATH, Karnataka Government of Karnataka, The Akshaya Patra Foundation, Karuna Trust and PATH o Gujarat Government of Gujarat, The Akshaya Patra Foundation & PATH Uttar Pradesh Government of Uttar Pradesh, The Akshaya Patra Foundation & PATH, Karnataka Government of Karnataka, The Akshaya Patra Foundation, Karuna Trust and PATH, Gujarat Government of Gujarat, The Akshaya Patra Foundation & PATH, Uttar Pradesh Government of Uttar Pradesh, The Akshaya Patra Foundation & PATH

PATH in India is working with Akshaya Patra, a not-for-profit organization implementing the Mid-Day Meal Scheme in the government schools and government-aided schools, in Karnataka, Gujarat and Uttar Pradesh currently to improve the nutrition and health status and benefitting around 650,000 children every day by integrating fortified rice into the local school feeding program. PATH helped in building infrastructure for rice fortification in Akshaya Patraé─˘s centralized kitchens in Karnataka, Gujarat and Uttar Pradesh. PATH also provided technical support in establishing a robust quality control and quality assurance system at these centralized kitchens. Trainings were arranged for the staff for ensuring smooth operations. In terms of the reach of safety net programs, this is the largest rice fortification initiative to date. The effort is coupled with other complementary activities, such as imparting nutrition and hygiene education among students to encourage healthy behaviors.

School going children

Yes

NGO/Development organisations

Chandigarh Administration & PATH, Government of Karnataka, The Akshaya Patra Foundation, Karuna Trust, Government of Gujarat, Government of Uttar Pradesh

No

NA

In Karnataka, a total of 450,000 children were fed fortified rice through the school meal program from 2,500 schools across 5 districts (Mysore, Mangalore, Bangalore, Bellary and Hubli). Standardized school meals with fortified rice were supplied. Along with nutritional intervention, the project emphasized on comprehensive education of children with regards to nutrition, hygiene and sanitation at the schools. Selected students were followedé─ýup for two years. Quantitative data pertaining to nutritional status, morbidity, absenteeism and cognitive performance was collected from the enrolled children by using standard tools. The findings concluded that providing fortified rice as part of a comprehensive program through the mid-day meal has a positive impact on nutritional status, attendance rate and cognitive abilities of children. Further, rice fortification also has the potential of reducing morbidity rates. Similarly, prevalence of stunting and wasting also reduced. Absenteeism rate has decreased significantly by 2% as compared to the baseline figure of 12%. For cognitive ability, it was observed that nearly half (42.8%) of students showed improvements in both Mathematics and English scores from baseline to end line.

In Gujarat, to assess the effect that eight months of regular fortified rice consumption would have on childé─˘s health. Data was collected from 484 and 489 children from program and control districts respectively, indicating that there was a significant increase in haemoglobin in the program district and a decrease in prevalence of mild and moderate anaemia compared to control district. The study also indicates a positive trend to reducing underweight and stunting and a positive impact of rice fortification on cognitive function and school absenteeism.

No

NA

In Karnataka it was observed that providing fortified rice has a positive impact on nutritional status, attendance rate and cognitive abilities of children. It also helps in reducing morbidity rates. In Gujarat, consuming fortified rice for 8 months lead to significant increase in haemoglobin and a decrease in prevalence of mild and moderate anaemia compared to control district. The study also indicated a positive trend to reducing underweight and stunting and a positive impact on cognitive function and school absenteeism.

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In Karnataka it was observed that providing fortified rice has a positive impact on nutritional status, attendance rate and cognitive abilities of children. It also helps in reducing morbidity rates. In Gujarat, consuming fortified rice for 8 months lead to significant increase in haemoglobin and a decrease in prevalence of mild and moderate anaemia compared to control district. The study also indicated a positive trend to reducing underweight and stunting and a positive impact on cognitive function and school absenteeism.

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