India’s Malnutrition Challenge

Context:

The challenge of malnutrition is a major public health concern in India

The extent of the Problem:

• The Global Hunger Index (2017) ranks India 100^th out of 119 countries with a low overall score of 31.4.
• According to the State of Food Security and Nutrition in the World 2017 report, India is home to 190.7 million undernourished people- a 14.5% prevalence of hunger vis-à-vis the country’s total population.
• According to NHFS4, 38% of children below 5 years are stunted, 21% are wasted and 36% are underweight.
• Anaemia is prevalent in 53% women and 23% men in the 15-49 age groups
• 21% of women and 19% of men in the same age group are either overweight or obese. The dramatic increase in the prevalence of obesity has a consequent impact on the burden of non-communicable diseases such as diabetes and cardiovascular disease.

Note: Stunting– low height for age, Wasting– low weight compared to height, Underweight- low weight for age. Malnutrition includes both under and over nutrition.

Major Policy and Programme Interventions:

Constitutional Provision: Article 47 of the Constitution of India states that it is the duty of the State to raise the level of nutrition and the standard of living and to improve public health

On March 8th, 2018, The National Nutrition Mission or the POSHAN Abhiyan was launched from Jhunjunu, Rajasthan.National Nutrition Mission (NNM)

• The Mission has been set up with a three year budget of Rs.9000 crore commencing from 2017-18.

Goal:

Improvement in nutritional status of Children from 0-6 years, Adolescent Girls, Pregnant Women and Lactating Mothers in a phased manner

Objectives and Targets:

Major Components:

1. Convergence: Convergence between different Ministries for successful implementation of the programme.

2  ICDS-CAS:

• It comprises a mobile application which is made available to the field functionaries preloaded on mobile phones and a six-tier monitoring dashboard for desktops.
• It is aimed to improve service delivery and also enable the Mission to effectively plan and make fact-based decisions.

3 Training and Capacity Building: The NNM envisages ‘incremental learning approach (ILA)’. According to this approach, the programme functionaries will be trained by breaking down the total learning agenda into small portions of doable actions.

4  Behavioural Change: The Mission seeks to bring behavioural change among people through community-based events, use of mass media and Jan Andolan

5 Innovation: activities to be implemented at a project scale for improving the service delivery system, capacity building of functionaries and community engagement.

6 Incentives:

• To annually incentivize the States/UTs, NITI Aayog has decided to rank states/UTs on nutrition parameters.
• Cash incentives to be given to field functionaries for achieving targets

7 Grievance redressal through call centres.

Issues and Challenges in reducing malnutrition in India:

1. Challenges with data:

• Lack of credible data on a year-year basis. For example, there has been a 10-year gap between NFHS 3 and NFHS 4.
• Further, there is confusion and inability to cope with measurement procedures among poorly trained Anganwadi workers and thus data on malnutrition may not be accurate.

2. Lack of adequate access to food: Due to ineffective functioning (corruption and leakages) of the public distribution system (PDS), access to food is a major problem. Loss of food grains in warehouses (due to rotting and theft) further aggravates the problem.
3. Issues with ICDS:

• Major issues with ICDS are the supply of quality food and its uniform distribution.
• Also, Anganwadi workers are unable to play an effective role in attending to the problem of malnutrition because of low wages and inadequate training.

4. Cereal-based Diet:

• A major reason for micronutrient deficiency in India is because of a cereal-based diet. However, even the National Food Security Act does not address the issue of nutritional deficiency adequately.
• Further, food fortification has also been inadequate.

5. Social-economic and Cultural challenges:

• Major challenges in implementing nutritional programmes are socio-cultural factors such as caste. For example, Hausla Poshan Yojana, a plan to provide nutritious food to pregnant women and malnourished children in Uttar Pradesh failed to even start because some women beneficiaries allegedly refused to consume the food prepared by Anganwadi workers belonging to the SC community.
• Illiteracy among women and gender biases is also a challenge

6. Lack of nutritional and health awareness: Lack of awareness, ignorance of healthy diets, unhealthy feeding and caring practices, poor breastfeeding practice are major challenges in reducing malnutrition
7. Sanitation and hygiene: Lack of sanitation is also an important challenge in reducing malnutrition. Poor sanitary conditions caused by open-defecation and other issues lead to the incidence of diarrhoeal diseases which make children susceptible to stunting
8. Financial Constraints: Budgetary allocations of many schemes have decreased over time. Further, the money allocated has remained unspent in many states.

Way Ahead

1. To address the problem of child under-nutrition, and disease there should be early life-cycle interventions targeting the first 1,000 days of a child’s life.
2. ICDS, Mid day Meal and PDS should be re-worked upon for greater effectiveness. Public-Private partnership in this domain should be encouraged. This would ensure that leakages, space and other constraints of lack of hygiene, delay in supply of food etc do not hinder delivering nutritious food.
3. It is important to extend the food fortification of staples. public-private partnerships can help leverage the appropriate technology for scaling up food fortification interventions. Further, the focus should be on incorporating nutritious food and diversify the diet.
4. It is important to target multiple contributing factors, for example, water, sanitation and hygiene (WASH). The focus should not only be on building toilets but bringing about a behavioural change among people
5. Agricultural policy should be aligned with nutrition policy with incentives provided for encouraging the production of nutrient-rich and local crops for self-consumption.
6. It is important to have sufficient information and reliable, updated data for effective interventions. It is thus necessary to collect and maintain real-time data on various nutrition indicators.