With the aim of mainstreaming and scaling effective strategies, ICCHN commits considerable effort and resources in building a range of innovative approaches, institutions and partnerships for child health and nutrition. These initiatives derive from the understanding that success and sustainability of systems essentially hinges on the quality of the human resources engaged in running programmes at all levels and in creating enabling processes for performance and accountability, and institutional arrangements to align the perspectives and competencies of different actors. In doing so, we must try to avoid the common tendency to create vast but critically under-resourced systems where the technical capacity and implementation machinery are de-linked, as are the planners and providers. This is even more important when strategies are required to facilitate changes in behaviours and practice and attend to individual needs and local contexts rather than mechanically deliver standardised products. Indeed, the challenge is precisely in facilitating community health workers, community facilitators, Anganwadi Workers, Multipurpose Workers, medical officers, trainers, programme managers, and others to have access to relevant technical and social knowledge and skills as part of an overall programmatic environment that is responsive to the health and social needs of the poor. This is all the more complex when one has to work with established and entrenched systems, where “entrepreneurs” need to be supported within resistant institutional settings to catalyse change. In such a context, ICCHN therefore strongly believes that “capacity building” is not only a question of “training” but essentially about creating and strengthening a mix of new and existing institutions and individuals with well-structured working arrangements at multiple levels in states, districts, blocks and villages. It also means building deep capacity in action-research and evaluation to continuously innovate and improve existing interventions and systems.
India is fortunate to have a range of individuals and institutions – both within government and civil society – with the expertise and experience to bring about significant changes in the performance of public systems and large-scale programmes. All too often, however, these social and institutional innovators work in isolation, in scattered efforts and diffuse initiatives that either remain small or dissolve over time. In other cases, innovative technical materials such as training manuals or BCC materials are adopted as finished products by government programmes without integrating the critical processes that went into their production and dissemination. Unsurprisingly, the impact of such adoption tends to be short-lived. ‘Mainstreaming’ innovation, then, clearly requires more innovation in itself, but the kind of innovation directed at facilitating and structuring diverse working partnerships and new institutional arrangements. Complete absorption within large-scale bureaucratic machineries is unlikely to be effective, but equally the usual models of contracting out technical expertise or creating technical consultancies do not seem to generate the necessary ownership within the system or accountability outside it. What is required is a careful mix of internality and externality to build and strengthen public systems.
With this understanding and on the basis of continuous engagement, ICCHN supports a number of resource institutions and partnerships at state, district and city-levels to engage in systemic innovation and reform within public systems and programmes to strengthen the quality of services and improve early child health and nutrition outcomes.
