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Opinion: India’s Malnutrition Burden Still High, Is Poshan 2.0 The Answer?

Despite its vast scope, ICDS has struggled to reach the most vulnerable communities within our country

Opinion: India's Malnutrition Burden Still High, Is Poshan 2.0 The Answer?

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.

Also Read: Opinion: Making India’s Azadi From Multiple Forms Of Malnutrition A Reality 

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.

Also Read: Opinion: Nourishing The Undernourished In Quarantine During COVID-19 Times

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.

Also Read: Opinion: Public Health Nutrition Priorities- Disrupted But Not Defeated By COVID-19

(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.

NDTV – Dettol have been working towards a clean and healthy India since 2014 via Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ populationindigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity,  that is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that 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 the country can become a Swasth or healthy India.

World

24,24,98,327Cases
20,40,54,102Active
3,35,14,449Recovered
49,29,776Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 24,24,98,327 and 49,29,776 have died; 20,40,54,102 are active cases and 3,35,14,449 have recovered as on October 22, 2021 at 5:24 am.

India

3,41,43,236 15,786Cases
1,75,7453,086Active
3,35,14,449 18,641Recovered
4,53,042 231Deaths
In India, there are 3,41,43,236 confirmed cases including 4,53,042 deaths. The number of active cases is 1,75,745 and 3,35,14,449 have recovered as on October 22, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,98,218 1,573

27,899 1,434

64,30,394 2,968

1,39,925 39

Kerala

48,88,523 8,733

82,093 1,240

47,79,228 9,855

27,202 118

Karnataka

29,84,849 365

9,017 86

29,37,848 443

37,984 8

Tamil Nadu

26,91,797 1,164

13,790 268

26,42,039 1,412

35,968 20

Andhra Pradesh

20,62,303 493

5,500 66

20,42,476 552

14,327 7

Uttar Pradesh

17,10,068 10

107 5

16,87,062 14

22,899 1

West Bengal

15,83,646 833

7,535 44

15,57,090 775

19,021 14

Delhi

14,39,488 22

311 1

14,14,087 21

25,090

Odisha

10,37,056 524

4,336 51

10,24,422 573

8,298 2

Chhattisgarh

10,05,773 38

206 21

9,91,995 16

13,572 1

Rajasthan

9,54,395 2

36 2

9,45,405 4

8,954

Gujarat

8,26,353 13

156 20

8,16,110 33

10,087

Madhya Pradesh

7,92,721 12

88 6

7,82,110 6

10,523

Haryana

7,71,125 9

131 2

7,60,945 11

10,049

Bihar

7,26,042 6

30 0

7,16,351 6

9,661

Telangana

6,69,739 183

3,967 1

6,61,829 183

3,943 1

Assam

6,07,811 384

3,762 152

5,98,087 228

5,962 4

Punjab

6,02,135 22

226 6

5,85,358 27

16,551 1

Jharkhand

3,48,526 40

166 24

3,43,225 16

5,135

Uttarakhand

3,43,787 14

176 0

3,36,213 14

7,398

Jammu And Kashmir

3,31,386 87

814 14

3,26,143 73

4,429

Himachal Pradesh

2,22,138 202

1,452 58

2,16,955 140

3,731 4

Goa

1,77,765 59

618 21

1,73,790 35

3,357 3

Puducherry

1,27,564 43

454 7

1,25,258 50

1,852

Manipur

1,23,051 81

1,346 14

1,19,800 94

1,905 1

Mizoram

1,15,944 737

10,034 229

1,05,510 962

400 4

Tripura

84,369 18

105 10

83,448 8

816

Meghalaya

83,210 52

735 26

81,034 76

1,441 2

Chandigarh

65,315 3

26 2

64,469 1

820

Arunachal Pradesh

55,065 22

140 2

54,645 20

280

Sikkim

31,819 19

185 10

31,241 9

393

Nagaland

31,670 11

250 5

30,743 15

677 1

Ladakh

20,896 10

43 9

20,645 1

208

Dadra And Nagar Haveli

10,678 2

4 2

10,670

4

Lakshadweep

10,365

0 0

10,314

51

Andaman And Nicobar Islands

7,646

7 0

7,510

129

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