National Workshop on Adoption of New WHO Child Growth Standards 8 and 9 February 2007, New Delhi RECOMMENDATIONS

Basis of Recommendations  Limitations of the existing Child Growth Standards used in the country.  Clear evidence of the accuracy of the New WHO Child Growth Standards and the availability of gender disaggregated data  Guiding Principle that the new standards are the “golden standards” for the child – in the best circumstances and environment – the Right of the Child in India  Implementing the new standards is feasible and an opportunity to revamp the ICDS System for improvement in quality and convergence with NRHM.  This is a powerful entry point for accelerating reduction in under-nutrition and promoting early child development.

Recommendation 1  A national consensus and agreement has emerged for adopting the new WHO Child Growth Standards across the country for use within ICDS, NRHM and by the professional bodies (IMA, IAP,NNF, TNAI, IAPSM, etc) and institutions (ICMR, NIN, NIPCCD, NIHFW) for monitoring and promotion of young child growth and development as well as for research.

Recommendation 1 (sub set)  The weight for age will be used at the AWC across the country.  Stunting and wasting will be used at the PHC, and above levels progressively in a phased manner initially in IMNCI and other districts with high under-nutrition levels.  Z Score classification will be adopted.  Growth tracking to be introduced as appropriate  In the 11 th Plan the focus will be on reducing under- nutrition through ICDS and NRHM; hence - 2,(-2.5) -3 SD will be the priority.  Separate charts for girls and boys.

Recommendation 2  Formation of National and State level Multi- Sectoral Task Forces with clear Terms of Reference including: The formulation of the Roll Out Plan for use of the New Growth Standards through a consultative process led by the Health and Social Welfare Depts of the government, supported by the State Technical institutions and involving the stakeholders viz. IAP, IMA, BPNI, UNICEF, WHO and others at the State Level. The formulation of the Roll Out Plan for use of the New Growth Standards through a consultative process led by the Health and Social Welfare Depts of the government, supported by the State Technical institutions and involving the stakeholders viz. IAP, IMA, BPNI, UNICEF, WHO and others at the State Level. Inclusion of the plan components in the 11 th Five Year Plan document Inclusion of the plan components in the 11 th Five Year Plan document

Recommendation 3  National Roll Out Plan to ensure development of guidelines for State Plans, training modules, prototype growth charts and community charts, mother child protection card.  Mother Child Protection Card package, with state specific adaptation, to be used nationwide in both ICDS and NRHM

Recommendation 4  State Roll out plans to cover all aspects of implementing the new growth standards Capacity Building from State up to village and slum. Capacity Building from State up to village and slum. Supplies – growth registers, charts, standard weighing scales, Mother Child Protection cards, etc. Supplies – growth registers, charts, standard weighing scales, Mother Child Protection cards, etc. SNP requirements in view of the higher number of severely undernourished children expected to be recorded. SNP requirements in view of the higher number of severely undernourished children expected to be recorded. Budget Plan along with Time Line. Budget Plan along with Time Line. Management Information System, operated from CDPO level upwards, using dedicated software with mechanism for monitoring and feedback. Management Information System, operated from CDPO level upwards, using dedicated software with mechanism for monitoring and feedback.

Recommendation 5  Budget allocation under the relevant programmes – ICDS, NRHM, Medical and Nursing Education among others for implementing the roll out plan of the weight for age component of the growth standards for implementing the roll out plan of the weight for age component of the growth standards for action research on the other variables - height for age, height for weight and BMI in collaboration with professional bodies for action research on the other variables - height for age, height for weight and BMI in collaboration with professional bodies

Recommendation 6  The new growth standards be incorporated in all institutional trainings – induction and in-service eg. Medical Colleges, Nursing, ANM and AWW Training schools among others as well as all relevant courses conducted by the public sector, private and semi-private institutions.  The training on the growth charts will be an integral component of ICDS and NRHM Training. Joint training of functionaries of both departments to be reintroduced. A training completion certificate to be issued.

Recommendation 7  Based on the outcome of this workshop, a road map will be finalized by the Ministry of Women and Child along with the Ministry of Health, professional bodies, UNICEF and WHO and shared with all the States, the Planning Commission, the Finance Ministry and the PMO incorporating the adoption of the Growth Standards through the Roll Out Plans as one important component towards Reduction of Under-nutrition in Children of India and ICDS universalization with quality.