Relevance: GS Paper II
Why has this issue cropped up?
There is an urgency to address poor nutrition in India, especially among children, adolescent girls and women. This has been re-confirmed in virtually every survey — from NFHS to the Global Nutrition Report and the Global Hunger Index (GHI).
Extent of malnutrition/hunger in India
- 25% of India’s children less than 5 years old are still malnourished.
- More than 190 million people in India sleep hungry every night, and over half of adolescent girls and women are anemic.
- Despite a 7% compound annual growth rate over the last decade and the various programs to improve nutrition, levels of under-nutrition are unacceptably high.
Recent govt’s initiatives towards hunger and malnutrition
- The recently announced flagship program of the Ministry of Women and Child Development will be anchored through the National Nutrition Mission (NNM), or Poshan Abhiyaan, with its own specific budget of Rs. 9,046 crore and a proposed World Bank loan of $200 million, to ensure convergence among the various programmes of the government.
- Additionally, NITI Aayog has worked on a National Nutrition Strategy (NNS), isolated the 100 most backward districts for stunting and prioritised those for interventions.
- The National Nutrition Strategy (NNS) has set very ambitious targets for 2022 and the Poshan Abhiyaan has also specified three-year targets to reduce stunting, under-nutrition and low birth weight by 2% each year, and to reduce anaemia by 3% each year.
Way forward
- Exploring new models to address the structural and systemic issues on a priority basis, learning from what has worked or not, and single-minded focus on implementation will be critical to delivering better nutritional outcomes and meeting the Sustainable Development Goals, to which India is a signatory.
- Additionally, initiatives like Swachh Bharat Abhiyan, where implemented, will contribute positively to nutrition outcomes, and well-structured public-private partnerships could be the catalyst.
- The overhaul of capacity and capability in three existing programmes, designed to reach populations most at risk, should be the first priority — namely, the Integrated Child Development Services (ICDS); mid-day meals (MDM); and the Public Distribution System (PDS).
- For purposeful action, it is imperative to have common goals and metrics for improving nutrition, which can then be disaggregated by year, State, district, etc., into a nutrition dashboard, with metrics that are clear and measurable and a real-time tracking mechanism, much like we track economic data.
- The private sector, development agencies and civil society can and must play constructive role in realising these ambitious goals.
- Altering the fundamentals of poor nutrition requires multiple and sustained interventions over a period of time — increased availability and accessibility of nutritious food, potable water, hygiene and sanitation, primary health care, etc.
- The approach, commitment and resources have to be inter-generational, multi-sector, multi-dimensional and multi-year.
- To simplify a complex issue, the challenge for India is to simultaneously address insufficient and poor diets, inadequate hygiene and sanitation and better management of disease and infections.
- Success in this domain will be driven by coordinated action on multiple fronts, but there are at least three urgent priorities. Three priorities
- One, to adequately re-engineer the ICDS, MDM and PDS for greater effectiveness. This is an ideal initiative for public-private partnerships. For example, involving the best nutritionists to work with local communities using easily available local ingredients. The key advantages of this supply model are that it engages local communities, generates employment and ensures minimal leakage. This will also ensure that space and other constraints of lack of hygiene at Anganwadi Centres do not become impediments in the supply of nutritious food.
- Two, to mandate and scale staple food fortification comprising edible oil, wheat, rice and dairy products, in addition to salt. There is persuasive evidence from several countries of the efficacy and cost-effectiveness of large-scale staple food fortification to address “hidden hunger” or micro-nutrient deficiencies.
- Three, multiple campaigns designed to inform, communicate and educate on nutrition-specific and nutrition-sensitive behaviours like breast feeding, diet diversity, hand-washing, de-worming, safe drinking water, hygiene and sanitation. Nutrition has to be “marketed” and made interesting, engaging, simple and personally relevant — this is an expertise where the private sector can meaningfully contribute.
- Nutrition is complex, and therefore its delivery must be simplified through greater awareness and actions. The delivery models must be collaborative across domains, with clear decision rights and hard-wired processes, enabled by technology and a significant investment in strengthening people competencies.
Conclusion
Unless economic growth improves social and human development, it cannot be sustained. Equally, economic growth itself is impeded by low levels of productivity in an under-nourished and malnourished population.
