New Delhi: COVID-19 has caused more than one crisis across the world and in India. Not only has it created a direct health crisis, but it is also an economic and socio-economic crisis. Compounded further with the prevalence of food insecurity and lack of access to nutritious food. As India celebrates the month of September as Poshan Maah (Nutrition Month) NDTV reached out to UNICEF India’s Chief of Nutrition, Arjan De Wagt to talk about India’s malnutrition crisis, POSHAN Abhiyan, and what can be done to bring the Abhiyan back on track.
NDTV: The coronavirus pandemic has had a major impact on the nutritional status of India’s children. How huge are the effects of the pandemic on the ground?
Arjan De Wagt: There are two things happening, of course, people are getting infected and we are dealing with those problems. But there’s also the secondary effects of COVID, that I call COVID induced nutrition crisis, which is what we saw during the lockdown. Last week we saw new data that came out on the economic situation of the declining GDP. This is the economic cost of the lockdown. Many people lost their jobs, their fixed incomes, many farmers have seen losses. What we are really worried about is that poverty is increasing which results in food insecurity. Which means that not only people don’t have the money to buy food, they can’t afford nutritious food. So we’re really worried about that. Another thing that we are worried about is the impact of COVID-19 on the services that were stopped during the lockdown. After the lockdown was lifted also, we saw that the immunisation rates are not back to what they were pre-COVID. We see that the access to services, the way it used to be before, are not back at that level yet. And then, of course, the frontline workers and everyone in the healthcare sector is so busy trying to deal with COVID, to identify people with COVID and helping them; this competes with the importance of nutrition interventions.
If we look at the global data, for instance in South Asia, we expect that there will be close to 4 million more children suffering from acute malnutrition, this is due to the expected rise in poverty. Another factor is the additional child deaths, which happens, if the child has a background of malnutrition.
If we look at the data from two years ago, at the Comprehensive National Nutrition Survey, that shows that almost 50 percent of the children have one or the other form of undernutrition. Which means, they didn’t grow well, their immune system didn’t grow well. If their brain doesn’t grow well, when children go to school, they can’t perform well. With their backgrounds and the impact of COVID-19, we are just worried that the numbers relation to malnutrition crisis, will further increase.
A Lancet study which was published a year ago, in September 2019, showed that in all children under the age of 5, that are dying in India, about two-thirds of those have malnutrition as an underlying cause. So again two-third of all under-five mortality is linked to malnutrition.
But because of COVID-19, the only worry is that these figures and the condition will only worsen.
NDTV: If we split the problem of hunger and nutrition, what do you think has been the effect of COVID-19 pandemic and the subsequent lockdown on the POSHAN Abhiyan and its target of malnutrition-free India by 2022?
Arjan De Wagt: If we talk about POSHAN Abhiyan, in my opinion, it’s an amazing programme. I have been working in the field of nutrition for the last 25 years in many countries. I’ve never seen a situation where a Prime Minister launches and delivers, and it’s not only me, the Human Resource Development Ministry, the Chief Ministers, media, private sector, people; everybody is talking about nutrition suddenly.
POSHAN Abhiyan is trying to deliver the right thing, it’s a good set of high potential interventions for the women and children and the target is for 2022 which is feasible. Now, of course, because of the COVID-19 pandemic, we’re really worried that some of the progress made in the last 2 and a half years may be lost. But the good thing is that it’s back. After silence for months, the POSHAN Abhiyan is completely back. For me first of all, the way the Prime Minister Narendra Modi talked about nutrition and POSHAN Maah in his monthly radio show, I was relieved that at least nutrition is part of the conversation again. His leadership is to fight the malnutrition crisis is impeccable because what we know is that the only way you can stop malnutrition is by having leadership. Having funding but not leadership doesn’t work, it’s not enough. So the PM highlighting the importance of nutrition and the launch of POSHAN Maah, is a very good set of interventions.
The minister of Women and Child Ministry, at the launch of POSHAN Maah said that it’s not only about September, but it should also and will continue further. I am a big fan of the POSHAN Maah initiative, but even I always say that I need 12 Poshan Maah, every year, one is not enough. So, hearing the same thing from the Minister was very encouraging.
Yes, we lost something because of COVID, but implementing POSHAN Abhiyan the way it was designed, with the intensity that was intended, is the right answer to the problem of COVID and nutrition. We don’t need anything else, we just need POSHAN Abhiyan to be implemented the way it was before the pandemic.
I hope the level of support, intensity, leadership will continue.
NDTV: In your opinion, what steps can the government take to bring Poshan Abhiyan back on track?
Arjan De Wagt: As a Nutrition Scientist, I think India has an amazingly designed programme. There are very few countries in the world that have got an Integrated Child Development Services (ICDS) system, that has ASHA workers, Anganwadi workers, the community programmes, the self-help groups; very few countries have such systems. These are good and technically sound programmes. We maybe need a little bit of tweaking here and there.
The three things we need to ensure to bring back Poshan Abhiyan on track are coverage, continuity and intensity.
If the mentioned programmes don’t reach every child or offer full coverage, it doesn’t have enough impact. So in order to bring Poshan Abhiyan back on track, India needs to ensure full coverage, which will have a much bigger impact. The second thing we need to focus on is the continuity of the programme, which was interrupted by COVID-19.
If you see the messaging around nutrition, creating awareness, a healthy diet, we need the intensity to continue. The intent of messaging, educating people about the importance of health and nutrition. It’s not easy to understand how one can make food for their child rich in nutrients. So we need to improve the intensity of the messaging.
I always say India has the right programmes but they need to deliver them with the utmost intensity and for me, that’s the main challenge with POSHAN Abhiyan. This has now also seen an increased setback with COVID-19. We need to focus that these programmes are reaching the children, the women, the families and communities that require them. Ten years from now, we will be writing history books on malnutrition in India and we will look back and talk about March 8, 2018, when the Prime Minister Narendra Modi launched POSHAN Abhiyan which helped turn around things. But then again, it requires more continued efforts and rebuilding some of the lost ground of the last six months.
NDTV: What specifically can be done under the Poshan Abhiyan to focus on the nutrition needs of pregnant women and new mothers?
Arjan De Wagt: You have raised an extremely important question. We often talk about malnutrition in children. if we look at the data in India, we see that a large amount of malnutrition is already caused during the pregnancy. A large proportion of the children in India are born with a low birth weight. I also see that many children develop Severe Acute Malnutrition (SAM) or Moderate Acute Malnutrition (MAM), in the first year, this is because of the nutritional status of the mother.
So helping pregnant women with nutrition status can strongly help control malnutrition in India.
If you look at the nutritional status of the women in India, new mothers, first-time mothers or even adolescent girls, the prevalence of anaemia is also very high among them. We need to focus on that.
There are three things we can do to help with this, first recognise how important it is. We don’t do that enough. If you can prevent maternal malnutrition, you will prevent a huge part of child malnutrition. I don’t think it is well recognised right now.
Let’s address anaemia, provision of iron-rich foods, but also iron follis tablets. We need to talk about a healthy diet. In the end, nutrition is the food you put in your mouth and the government doesn’t put food in your mouth. It is parents, family and the community puts food in the plate and from the plate in the mouth. And we need to create awareness that nutrition is more than foods, nutrition is more than hunger. A child’s stomach is very small. If you feed the child dal and rice, his stomach will be full and he may stop crying. But, it doesn’t provide the nutrients that the child needs. I often say why do we give the adult food to children when we don’t give baby’s food to adults? Babies need special food, rich in nutrition. But also, pregnant women shouldn’t be relying upon a big bowl of rice, they need more of the protein, they need more vegetables they need more nutritious food.
What the PM really brought under the POSHAN Abhiyan is the Jan Andolan (people’s movement). So much work is needed to educate people in what is food, what is nutrition and how do I translate food to nutrition.
NDTV: How can national and international non-profit and humanitarian organisations be integrated with Poshan Abhiyan to facilitate the programme’s execution and achieve the target of a malnutrition free India?
Arjan De Wagt: I have strong feelings about this. My opinion is let’s put our weight behind one programme, in this case, POSHAN Abhiyan. Technically, it is a strong programme. I feel sometimes, all the sectors – civil society, government, private sectors, etc, are trying to be creative and are looking for a new solution. Which I must admit when it comes to nutrition, we have an existing solution but we have never seriously tried those solutions.
When it comes to nutrition programmes, many of them are not reaching all the children, and especially the most vulnerable children are the ones often left out.
I went on a road trip from New Delhi to Madhya Pradesh, we drove 6,200 kms and we saw many advertisements of fast food and cold drinks, there were several billboards of instant noodles, pasta, sugared drinks and I saw one advertisement on breastfeeding. There was a village which had a breastfeeding shelter and it had a message about the importance of breastfeeding. 2,600 kms – unhealthy food was marketed left and right while there was just one message on good nutrition. Therefore, this is where the intensity comes in. When it comes to nutrition, we have to do a hard job, we have to implement the old programmes. The ICDS, promotion, prevention, raising awareness about nutrition. We have started these but now we need to deliver the results. It’s not about coming up with innovations and creativity, we have all of them existing.
NDTV: Anganwadi workers and Asha workers are the backbones of Poshan Abhiyan. How can this network be strengthened and how can it be used to ensure optimum effectiveness of the Abhiyan?
Arjan De Wagt: For me ASHA workers and Anganwadi workers are heroes. They are the nutrition champions! Everything that is dreamt up in offices in Delhi and state capitals, they are the ones who deliver.
We know their workloads are high, expectations are high, from policymaker, households, communities. They’re hardworking and very committed.
I do like that in POSHAN Abhiyan, there is a component in strengthening this network. For example, providing anganwadi workers with mobile phones, before they used to fill in 10-11 forms, maintain files, and manually record and maintain the data. That has actually now been put into the mobile phones and this digitalisation has helped them work more efficiently. They are also sent videos on training on these phones, having orientation on malnutrition and other important topics.
There are some states who have invested in helpers and digital workers at anganwadi centres. They are there for counselling which is an extremely important thing. Counselling is not to tell mother what to do and not about telling them what to feed their children. It’s about asking them what food do they have and how can we make that food in the most nutritious way for their child. Not all anganwadi workers have to time to conduct frequent counselling, and under the POSHAN Abhiyan, the government has invested in helpers to help with such activities.
In this way, when more resources become available, there’s more impact that you can create.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.
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