Context:

• The urgency to address poor nutrition in India, especially among children, adolescent girls and women is compelling, and re-confirmed in virtually every survey — from NFHS-4 in 2015-16 (the latest available information), to the Global Nutrition Report 2016 and the Global Hunger Index (GHI) 2017, which ranks India at 100 out of 119 countries, with a low overall score of 31.4.

Poor nutrition among children in India

• 25% of India’s children less than 5 years old are still malnourished
• Among children less than 5 years, wasting (low weight for height), continues to be 21% in the 2017 index — it was 20% in 1992
• 190.7 million people in India sleep hungry every night, and over half of adolescent girls and women are anaemic

Proposed measures of the Govt:

1. The recently announced flagship program of the Ministry of Women and Child Development will be anchored through the National Nutrition Mission (NNM), or Poshan Abhiyaan
2. NITI Aayog has worked on a National Nutrition Strategy (NNS), isolated the 100 most backward districts for stunting and prioritised those for interventions
3. The National Nutrition Strategy (NNS) has set very ambitious targets for 2022 and the Poshan Abhiyaan has also specified three-year targets to reduce stunting, under-nutrition and low birth weight by 2% each year, and to reduce anaemia by 3% each year

What is required to curb malnutrition?

1. Altering the fundamentals of poor nutrition requires multiple and sustained interventions over a period of time — increased availability and accessibility of nutritious food, potable water, hygiene and sanitation, primary health care, etc
2. The challenge for India is to simultaneously address insufficient and poor diets, inadequate hygiene and sanitation and better management of disease and infections

Re-engineer the existing approaches:

• Adequately re-engineer the Integrated Child Development Services (ICDS), mid-day meals (MDM) and Public Distribution System (PDS) for greater effectiveness

1. This is an ideal initiative for public-private partnerships as the strength of good private sector companies is in creating and designing frameworks, structures, processes and metrics for action, implementation and tracking
2. Involving the best nutritionists to work with local communities on calorie and nutrition dense supplementary foods, using easily available local ingredients that are within the ICDS and MDM budget guidelines
3. Products produced by self-help groups could easily be anchored by the relevant private sector and development agencies, working with State governments, and considered a corporate social responsibility initiative
4. The key advantages of this disaggregated supply model are that it engages local communities, generates employment and ensures minimal leakage as it works with and inside the community
5. This will also ensure that space and other constraints of lack of hygiene at Anganwadi Centres do not become impediments in the supply of nutritious food

• To mandate and scale staple food fortification comprising edible oil, wheat, rice and dairy products, in addition to salt

1. There is persuasive evidence from several countries of the efficacy and cost-effectiveness of large-scale staple food fortification to address “hidden hunger” or micro-nutrient deficiencies
2. The success of micro-nutrient fortified food is that it does not entail a change in behaviour
3. A case in point is the mandate of July and August 2017 to use fortified oil, salt and wheat flour in the ICDS and MDM by the Ministries of Women and Child Development and Human Resource Development, respectively

• Multiple campaigns designed to inform, communicate and educate on nutrition-specific and nutrition-sensitive behaviours

1. These behaviours include breastfeeding, diet diversity, hand-washing, de-worming, safe drinking water, hygiene and sanitation
2. Nutrition has to be “marketed” and made interesting, engaging, simple and personally relevant
3. Nutrition is complex, and therefore its delivery must be simplified through greater awareness and actions

Way Forward:

• Unless economic growth improves social and human development, it cannot be sustained
• Equally, economic growth itself is impeded by low levels of productivity in an under-nourished and malnourished population
• Exploring new models to address the structural and systemic issues on a priority basis, learning from what has worked or not, and single-minded focus on implementation will be critical to delivering better nutritional outcomes and meeting the Sustainable Development Goals, to which India is a signatory

Source:TH