Stepping up on nutrition

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Context: Improving capacities of anganwadis is one of the ways to improve the country’s woeful record in addressing malnutrition.

A skilled and healthy workforce, working at optimum capacity, is a source of strength for any country.
The pandemic has exposed to us the multiple reasons for putting health at the top of our priorities — it has exacerbated existing risks among vulnerable populations.
It is in this light that India’s malnutrition crisis acquires significance.
The Global Hunger Index 2020, which measures levels of undernourishment, stunting, wasting, and mortality rates among our children, is a stark reminder of how deep this crisis runs in the country — India ranks at 94th position out of 107 countries.
The Comprehensive National Nutrition Survey (CNNS) launched in 2019, which explores the nationwide prevalence of malnutrition points out that 35 per cent of children under five are stunted, 17 per cent are “wasted”, and 33 per cent are underweight — this adversely affects their cognitive development and learning capacities, resulting in decreased productivity.
The CNNS also brings out data on micronutrient deficiencies such as those of iron, Vitamin A and D among pre-school, school-age and adolescent youths, the lack of which leads to problems like anaemia, reduced bone density, and compromised immunity.
This not only undermines the quality of life of our population but also costs us significantly in economic terms — a Save the Children report places the economic cost of micronutrient malnutrition at $15-46 billion in India.
The CNNS data shows that anaemia remains a moderate public health problem in the Northeast states among children between the age of one to four, while Vitamin A deficiency is a moderate to severe public health problem.
Among the Scheduled Tribes of Meghalaya, 40.4 per cent of children under five years were reported to be stunted – this is significantly higher than the national average of 34.7 per cent.
The POSHAN Abhiyan programme along with Integrated Child Development Services (ICDS) aims to tackle these nutritional challenges using technology (ICT) for real-time monitoring, data management along with ensuring convergence of schemes.
The thrust areas under is on the Severely Acute Malnourished (SAM) children and improving their health outcomes through Nutrition Rehabilitation Centres (NRCs) where children with medical complications are admitted.
In Meghalaya, these interventions have shown success on multiple fronts, such as bringing down “child wasting” and recovery of about 1,000 SAM children in the state.
However, they also face unique challenges such as poor connectivity which poses an impediment to the efficient rollout of the ICDS-CAS, which was launched to help anganwadi workers monitor the growth of children in crucial years.
Improved infrastructural capacity at the anganwadi level and capacity building for frontline workers along with an increase in their wages can also help them solve some of these challenges.
The NITI Aayog points out how undernutrition is both the cause and consequence of poverty, thus also drawing emphasis to the intergenerational effects of undernutrition made worse by persisting inequalities along lines of gender and socio-economic status.
The progress report of Poshan Abhiyaan shows that the coverage of most targeted interventions such as food supplementation, breastfeeding counselling is only about 50 per cent.
Hence, to ensure that we meet our targets, this coverage needs to be stepped up and requires the involvement of the community.
Focusing on the health of mothers can help break this cycle across generations, due to which interventions like ante-natal care, institutional delivery, birth spacing are of utmost importance.
The WHO recommended Community-based Management of Acute Malnutrition (CMAM) to treat children with SAM has been adopted by several countries.
The CMAM approach involves the timely detection of SAM in the community and provision of treatment for those without medical complications with nutrient-dense foods at home.
When the services at NRCs are integrated with the community-based therapeutic care, there is a continuum of care from facility to doorstep and vice-versa.
In India, different models of CMAM have been adopted in several states for treating SAM children and its success in states like Rajasthan can be emulated across the country.
This requires the formation of guidelines and treatment protocol at the national level which can be adapted to state requirements.
Similarly, for addressing micronutrient deficiencies, food fortification is considered an effective and scalable solution.
India’s success at addressing iodine deficiency shows that this can be achieved at a large scale for other micronutrients as well.
This can be carried out through the Public Distribution System (PDS) which provides one of the crucial ways to reach citizens across the country as witnessed during the pandemic.
The government should extend it to all citizens and not just ration cardholders as there is a need to expand its coverage, especially since the Food Corporation reported excess food grain stocks in June.
The food basket under National Food Security Act should also move away from its current overemphasis on cereals to more diversified foods that are nutrient-rich to tackle malnourishment as this will ensure equitable access to a more balanced diet and promote nutritional security.
We need to step up our efforts to bring down the current malnutrition levels to ensure that we reach our Sustainable Development Goals along with our vision of inclusive growth for all.