Tackling Indias malnutrition problem
THE COUNTRY NEEDS A DEDICATED & COMPREHENSIVE NATIONAL PROGRAMME TO FEED ITS BILLIONS ……….VEENA S RAO
THE PRESIDENT IN HER ADDRESS TO Parliament said that a National Food Security Act will be enacted, adding that malnutrition has emerged as a major health challenge needing urgent response. This gives confidence that the curse of malnutrition, will now be addressed.
In this context, a think-tank of experts, activists, NGOs and administrators under the leadership of M S Swaminathan brought out two papers: Essential Interventions to Combat Malnutrition in Children and Essential Intervention for Girls and Women that exhaustively enumerate proactive interventions to be taken to address malnutrition in India.
Data established that poverty is a prominent, but not the sole cause of malnutrition. Malnutrition is an extremely complex, inter-generational phenomenon with multiple causes, viz., physical poverty, hunger, calorie/micronutrient deficit, infection and disease; attitudinal/socio-cultural gender-discrimination in society and intrafamily food consumption, early marriage of girls, frequent pregnancies, superstition/ignorance regarding proper maternal & child care and feeding practices; governance related, mainly, inadequate nutrition/health services for women and children, low access to safe drinking water and hygienic sanitation and lack of social inclusion.
Malnutrition causes economic loss to the nation, due to reduced physical/cognitive growth and learning capability, and lower physical work output. Calculations indicate that India loses around $29 billion annually or 4% of GDP due to calorie/energy deficit.
On continuing high malnutrition and failure of on-going programmes to improve it, the expert group concluded that India has no comprehensive national programme with the standalone objective of eradicating malnutrition. Several nutrition related programmes address some but not all aspects and causes of it. The Integrated Child Development Scheme (ICDS) is not a programme for eradication of malnutrition but for child development. Absence of seamless and simultaneous critical interventions causes loss of gains accruing from existing dispersed and isolated interventions. Though Indias malnutrition is deeply rooted in an inter-generational cycle, present interventions do not address the issue inter-generationally. Thirty per cent of Indias population suffers from high protein-calorie deficit. The general population lacks adequate awareness regarding proper nutritional practices. Crucial prescriptions of the National Nutrition Policy, 1993, were not translated into programmes, viz., popularisation of low-cost nutritious foods, reaching adolescent girls, fortification of essential foods and control of micronutrient deficiencies. Most importantly, political will for addressing malnutrition as high priority in the National Development Agenda should be articulated.
No single intervention can eradicate malnutrition. The package of interventions must be widely inter-sectoral and address at least a majority of the causes; they must be simultaneous so that the benefit of one intervention is not lost on account of the absence of another; and they must cover the entire life-cycle of women and children to create immediate impact within one generation on the nutritional status of the three critical links of malnutrition, viz., children, adolescent girls, and women. Only then can the benefits be sustainable enough to break the inter-generational cycle, and pass on to the next generation.
The think-tank has listed a number of essential interventions to address each of malnutritions causes and methods for operationalising them at the village level on certain evidence based principles, such as supplementing through energy/protein/micronutrient dense foods prepared by SHGs from low-cost, locally available farm produce for the three inter-generational groups towards bridging the gap, enabling grass-roots convergence of all nutrition impacting programmes, and initiating a sustained public awareness campaign regarding proper nutritional practices within existing family budgets, to create demand and social inclusion.
It is hoped that this Budget states serious intent to initiate a National Programme with the focused objective of eradicating malnutrition. Since the subject is so inter-sectoral, effective coordination and monitoring of key nutrition related ministries, which have their own substantive mandates would necessarily require oversight and direction at the level of the prime minister. A high powered inter-sectoral panel, headed by an eminent person specialising in this field, should be constituted to finalise a national programme for eradicating malnutrition and draw up a road map with quantified targets and time lines, within a stipulated period.
(The author is a former secretary to the government)