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The article analysis the Nutrition level of Indian society and problems associated with government programmes along with suggestion.
- The Global Nutrition Report 2016 once again demonstrates India slow overall progress in addressing chronic malnutrition, manifest in stunting (low weight for age), wasting (low weight for height), micronutrient deficiencies and over-weight.
- In a ranking of countries from lowest to highest on stunting, India ranks 114 out of 132 countries. Even Bangladesh and Nepal rank marginally higher than India.
- On wasting, India ranks 120 out of 130 countries and on the prevalence of anaemia in women of reproductive age, India ranks 170 out of 185 countries.
Breaking the cycle
- Aggregate levels of undernutrition in India remain shockingly high, despite the impressive reduction in stunting in the last decade.
- The segments most at risk continue to be adolescent girls, women and children, and among them Scheduled Castes and Tribes are the worst off, reflecting the insidious economic and sociocultural deprivation so prevalent in India.
- According to the most recent United Nations Population Fund (UNFPA) report, nearly 50 per cent of women in India are married before they turn 18, in violation of the law.
- The poor nutritional status of adolescent girls, combined with child marriage and multiple pregnancies even before becoming an adult, lead to another dismal fact, that 30 per cent of all children are born with low birth weight.
- For India to be healthy and break the inter-generational cycle of malnutrition, we have to focus on the health, nutrition and social status of children, adolescent girls and women as a priority.
- The past decade has seen a steady build-up of momentum around nutrition with the setting up of the SUN (Scaling Up Nutrition) secretariat in the UN.
- The World Health Assembly adoption (in 2012) of the 2025 global targets for maternal, infant and young children nutrition, and the 2015 Sustainable Development Goals which centre-stage the ending of all forms of malnutrition for all people by 2030, to name a few.
- Indias progress clearly lags behind what is needed to eliminate malnutrition by 2030.
- Maharashtra was the first State in India to launch a nutrition mission, in 2005, followed by five other States, Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat and Karnataka, covering a total population of 300 million.
- In all six States the focus of the nutrition mission is inter-sectoral coordination to improve child nutrition in the first 1000 days.
- The problem and solution framework are correctly identified, but there are hardly any targets or financial commitments or concrete and specific programmes and processes to accomplish this goal.
- Systemic development is a long process that requires continuity, consistency, excellence in execution and a measurement of process, output and outcome/impact metrics, and so far at least, much of this seems to be missing for converting intent to action.
- One of the reasons for persistent undernutrition in India, despite the creation of Integrated Child Development Services (ICDS) in 1975 and national coverage of the mid-day meal scheme in 1995, is that there is no structure for multi-sectoral coordination which is essential to address the inter-generational and multifaceted nature of malnutrition.
Poor nutrition is poor economics
- The World Bank estimates that India loses 2-3 per cent of its annual GDP by way of lower productivity, the underlying cause of which is malnutrition.
- Poor nutrition will fracture the dreams and aspirations of India to become a global player in manufacturing and other industries.
- The human dividend on which we are banking is actually a huge liability given that one out of every three children is born underweight and unable to realise the full potential for physical growth and cognitive development, leading to lower levels of productivity.
- Poor nutrition is poor humanity. Article 47 of the Constitution mentions the duty of the state to raise the level of nutrition and the standard of living and to improve public health. The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties.”
Harnessing positive factors
- Several programmes already announced by the government like Swachh Bharat, Beti Bachao, Beti Padao, etc. are critical nutrition-sensitive factors that address hygiene, sanitation and education.
- For the nutrition-specific areas, India already has the infrastructure and mechanism for reaching people most at risk. These have to be urgently revamped and made more effective.
- The three structures that must be prioritised are:
- The ICDS, which caters to the needs of pregnant and nursing mothers and children under the age of six;
- The mid-day meal scheme, which directly feeds approximately 120 million schoolchildren every day;
- The public distribution system, which makes available subsistence rations to above and below poverty line families.
- All three are also excellent platforms for public-private partnerships to improve the level and quality of service and could be considered as specific areas for collaboration in CSR programmes.
- Borrowing from best practice in countries that have made quick and significant progress in combating malnutrition, it is recommended that a Nutrition Mission be created to orchestrate and sequence the work both in nutrition-specific and nutrition-sensitive areas so that the impact from each of these is embedded in positive and productive outcomes.
- There is enough evidence from other countries, especially those which have adopted a multi-sectoral framework, that the results are tangible and specific.
- There are other proven interventions like large-scale food fortification (flour, oil, milk, etc. in addition to salt) that are inexpensive and effective and must be mandated into food standards.
Steps to change outcomes
- The immediate actions to step change nutrition outcomes could be summarised as follows:
- Create a Nutrition Secretariat as part of the Prime Minister Office with responsibility for ensuring multi-sectoral alignment on priorities, sequencing and timelines. This would include both nutrition-specific and nutrition-sensitive initiatives. Agree on a dashboard of nutrition metrics to be tracked, just as we track economic metrics.
- Make the nodal Ministries accountable for revamping the ICDS, MDM, PDS with clear goals, timelines and resources. Open these up for public-private partnerships and make these CSR-eligible.
- Extend large-scale food fortification beyond salt to other staples like flour, oil, dairy, etc. and establish mandatory standards by category.
- Invest in information and education about good nutrition practices, extending from a diverse diet to deworming, breastfeeding, hygiene and sanitation, etc. Nutrition is complex and therefore needs to be simplified in behavioural terms.
The Global Nutrition Report 2016 once again demonstrates India slow overall progress in addressing chronic malnutrition, manifest in stunting (low weight for age), wasting (low weight for height), micronutrient deficiencies and over-weight. India must convert its young population to a competitive advantage, and nutrition and health are foundational to that outcome. Discuss.
- The present level of nutrition level problems in India.
- Why it is important to improve nutrition and health.