Recrafting India’s nutrition initiative

Why in news? 

• The article while highlighting the recently released fifth National Family Health Survey (NFHS-V) 2019-21 brings out the unfinished agenda and the slow rate of decline in undernutrition in India.

 

What is malnutrition?

• Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
• The term malnutrition covers 2 broad groups of conditions - undernutrition and overweight.
• Undernutrition includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
• Overweight, obesity and diet-related noncommunicable diseases such as heart disease, stroke, diabetes and cancer.

 

What is the status of malnutrition in India?

• Malnutrition in India has multiple dimensions like calorific deficiency, protein hunger and micronutrient deficiency.
• According to the NHFS-V data, child malnutrition (35.5% stunted, 67.1% anemic) attributing to 68.2% of under-five child mortality is a major health issue being faced by India.
• The Global Hunger Index (GHI) 2022 also ranked India 107 out of 123 countries, dropping from the rank of 101 in 2021.
• GHI also reported that prevalence of undernourishment has also risen in India from 14.6% in 2018-2020 to 16.3% in 2019-2021.

 

What are the major causes of malnutrition in India?

• Malnutrition is an ecological problem that does not occur alone. It accompanies poverty, disturbed family structure, ignorance and despair.

Image Caption: Causes of malnutrition in India

 

What are the government schemes to tackle malnutrition?

• Integrated Child Development Services (ICDS) Scheme: It was launched in 1975, aiming to provide food, preschool education, primary healthcare, immunization, health checkups and referral services to children under 6 years old and their mothers.
• Mid-Day Meal Scheme: It aims to improve nutrition levels among school children in addition to increasing enrolment, retention and attendance.
• National Food Security Act (NFSA), 2013: It assured food and nutrition security for the most vulnerable by making access to food a legal entitlement.
• Anemia Mukt Bharat Abhiyaan: It was launched in 2018 with the aim of accelerating anemia decline by one to three percentage points annually.
• Poshan Abhiyaan/National Nutrition Mission: It aims to reduce stunting, undernutrition and Anemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
  • It also targets to bring down stunting among children in the age group 0-6 years from 38.4% to 25% by 2022.
  • It also put emphasis on high impact essential nutrition-sensitive interventions, improving coverage of maternal-child health services, access to water, sanitation, diversified diet and hygiene that indirectly impacts mother, infant and young child.
• Bharatiya Poshan Krishi Kosh: It was launched to address the most undernourished hubs and develop mechanisms to check the nutritional security of villages.

 

What are the limitations of nutrition initiatives?

• Inadequate financial commitment: For example, POSHAN 2.0 programme have seen only a marginal increase in budgetary allocation this year.
• Underutilization of funds: For example, 32% of funds released under POSHAN Abhiyaan to States and Union Territories have not been utilized.
• Initiatives have remained fragmented: For instance, the ICDS is lagging in the institutional role of local panchayats and communities with untied financial resources.

 

What are the measures to address nutritional challenge in India?

• Revamped ICDS: The ICDS needs to be converged with health, education, water, sanitation, and food security at all levels, under the local governments’ supervision.
• Collective approach: The gram panchayat, gram sabha, women’s collectives and other community organizations need to be made responsible for education, health, nutrition, skills and diversified livelihoods.
• Nutritional Awareness: Addressing undernutrition also requires a behaviour change in favour of exclusive breastfeeding, natural foods instead of junk food, and clean water and sanitation.
• Advancing grassroot interventions: Panchayat-led committees need to be set up at the block and district Zila Parishad levels as well for simultaneous interventions on all determinants of nutrition.
• Decentralized planning and fund allocation: Decentralized district plans based on village plans should be framed to ensure anganwadis face no deficits like no buildings or no untied resources.
  • Also, village-specific planning process needs to be operated with decentralized financial resources.
• Capacity building: The capacity development of care givers needs to be assessed to ensure household visits are monitored for outcomes to intensify behavior change communication.
• Diet and drug accessibility: A diversity of local food including millets need to be encouraged and availability of basic drugs and equipment for healthcare need to be ensured accompanied with growth monitoring in each village.
  • The monthly health days at every Anganwadi centre need to be institutionalized with community connect and parental involvement.
• Direct engagement with nutritionally vulnerable groups: Platform for adolescent girls and leaving no one behind, rights-based approach is needed to be created in every village for diversified livelihoods through skills.

 

Lessons from NRHM success

• The National Rural Health Mission (NRHM) was launched in 2005 to provide accessible and affordable healthcare through primary, secondary and tertiary healthcare services alongside the private capacity to ensure good quality services at effective rates.
• It resulted in the improvement of health facilities with increased access to doctors, drugs and diagnostics by -
  • The community involvement, involvement of Panchayats, Rogi Kalyan Samitis or hospital management committees and flexible financial resources were available at all levels.
  • The civil society led community monitoring, decentralized planning and involvement of frontline workers was a major thrust in NRHM success.
  • Tapered funding, where over 60% of funds were spent at the district level and untied grants were being made available to every level of the health institution.
• As a result,
  • Institutional deliveries also shot up as vacancies of ANMs (Auxiliary Nurse Midwife) and nurses started getting filled up.
  • The community’s ASHA workers were incentivized to put pressure on public systems to perform by getting patients there.
• The Registrar General of India revealed that India’s infant mortality rate (IMR) has declined to 27 in 2021 from 58 in 2005 and maternal mortality rate (MMR) was 97 during 2018-2020, while it was 301 during 2001-03.

 

Conclusion

• The whole-of-government and whole-of-society, outcome-oriented approach along with women empowerment is the key to make nutrition challenge successful.
• Also, periodic review of nutritional status across States along with a process to monitor and evaluate programmes could address systemic challenges on the ground.

 

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Q1) What is the objective of NRHM?

NRHM seeks to provide quality healthcare to the rural population, especially the vulnerable groups. Under the NRHM, the Empowered Action Group (EAG) States as well as North Eastern States, Jammu & Kashmir and Himachal Pradesh have been given special focus.

 

Q2) What is stunting and wasting?

Stunting results from chronic undernutrition, which retards linear growth, whereas wasting results from inadequate nutrition over a shorter period, and underweight encompasses both stunting and wasting.

 

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Source: Recrafting India’s nutrition initiative