Early this year, the government announced the merger of supplementary nutrition programme and the Poshan Abhiyan to launch Mission Poshan 2.0 to strengthen nutritional content, delivery, outreach, and outcome across 112 aspirational districts in the initial phase. This announcement was significant because it came at the back of the National Family Health Survey 2019-20 (NFHS-5) data, which showed India’s limited progress on malnutrition, particularly among children and adolescents.
As per the NFHS report released in December last year, stunting among children under five years did not improve at all while wasting worsened in the last five years, in a majority of the 22 states and Union territories (UT) that were surveyed. Acute malnutrition among children under five increased significantly in Nagaland, Manipur, Mizoram, Assam, Telangana and Bihar. Every fourth child in Bihar, Gujarat and Maharashtra, and every fifth child in Assam, Telangana and Nagaland were reported thin for their age. More than half of the surveyed states reported every third child below five suffering from chronic malnourishment. The prevalence was greater in rural areas than urban across all surveyed territories. The majority districts of Bihar and Meghalaya and a few districts of Gujarat, Karnataka and Assam were the worst performers.
The data for the NFHS-5 was gathered before the Covid-19 pandemic. It is very likely that the already grim figures would have worsened due to the pandemic’s severe adverse impact on food security, employment and access to essential health services.
Thus, the launch of Mission 2.0 is encouraging as it displays political intent to address malnutrition in mission mode. By acknowledging that a problem exists and showing the urgency to act, India has taken a step in the right direction.
India has been grappling with the menace of malnutrition since independence. Over the years, various Five Year Plans were launched aimed at improving nutrition, eradicating malnutrition and minimizing micronutrient deficiencies. The earlier plans were focused on ensuring food security and addressing food production. Programs such as Public Distribution System, Fortification, Mid-Day Meals for school-going children, Micronutrient supplements to address nutritional deficiencies and prevent anaemia and blindness due to Vitamin A, took shape and effect. These schemes were relevant and had a positive impact in addressing malnutrition, but these schemes functioned on an individual level. Thus, India’s early approach to address malnutrition was rather disjointed and fragmentary.
Later, however, an integrated approach was deemed essential in tackling undernutrition in women and children. Integrated Child Development Services (ICDS) program launched in 1975, became one of the earlier programs to adopt a holistic approach to address malnutrition. Under the ICDS scheme, children between the age of 6 months to 6 years and pregnant and lactating women would be provided with supplementary nutrition, immunization, health check-up, referral services, pre-school non-formal education and nutrition and health education.
This scheme is not just aimed at providing nutrition and supplements to beneficiaries but also aimed to affect behavioural change and create nutritional awareness among them. This was very essential because illiteracy, poverty, regressive socio-cultural practices were all major determinants of malnutrition. ICDS adopted a multi-sectoral approach focusing on converging health with other services like water, sanitation, agriculture, horticulture, fisheries etc. Most importantly, the scheme leveraged local community members (Anganwadi Workers (AWW) and Anganwadi Helpers (AWH) to deliver services to improve nutrition. The use of local community members, mostly women, not only increased reach and access but it worked to generate trust amongst the community which made it easier for them to adopt and accept public health interventions. Today, ICDS is one of the largest community-based programs in the world.
But despite the fact that India has mature policies and vast nutrition supplementation programs in place, even today 68 per cent of under-five deaths in India are because of maternal and child undernutrition. The majority of India’s total disease burden (15 per cent) is attributed to child and maternal malnutrition. Pinpointing a singular reason for this would not only be unfair but also be rather reductionist. But, broadly, the reason our interventions have failed to have the desired impact is that there is significant gaps in service coverage, lack of data-driven and evidence-based approach and poor community engagement.
For example, despite its vast scope, ICDS has struggled to reach the most vulnerable communities within our country, including the tribal populations in hilly, remote regions and hard-to-reach regions. Similarly, various intervention programs, such as the Vitamin A supplementation program (VAS) have been unable to reach remote areas. Logistical problems, financial constraints and other factors have caused this gap in coverage. It has often been seen that gaps in service coverage remain largest in low and middle-income countries and the most vulnerable populations. Even though reliance on community-based intervention (AWW/AWH) has improved and solved, to some extent, the problem of access, but more intensive efforts are required. Better coordination and collaboration between nutrition and health-related sectors, departments, private stakeholders, development partners will be crucial as we chart our way towards addressing malnutrition.
Our intervention programs also need to focus on real-time monitoring and data gathering processes. Data is the most effective way to help governments implement, track, measure, and ultimately improve the performance of their programs. Establishing effective monitoring mechanisms and accountability through intensive and real-time monitoring of nutritional indicators is essential. Poshan Tracker under the Poshan Abhiyan is one important innovation that will help track nutrition coverage and quality of nutrition interventions in real-time. This will enable the providers to better plan and manage the delivery of nutrition services so that those who deserve the most are catered to on priority. Going forward, Poshan Tracker will become an essential tool for streamlining the service delivery system and ensuring transparency so that no deserving beneficiary gets left behind.
India has made a global promise of ending all forms of malnutrition by 2030. Will Mission Poshan 2.0 be the pathway to that goal? This is yet to be seen. What is important, however, is that the policymakers have taken into account the learnings of the past 75 years and have addressed the gaps of the previous schemes. The health and future of children and mothers of India is at stake, we should not leave any stone unturned to secure that.
(Sunish Jauhari is the President of Vitamin Angels India, an international NGO that works on eradicating malnutrition and tackle deficiencies like Vitamin A and anaemia)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
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