Hyderabad: At a time when the latest nutrition surveys (NFHS-4, CNNS etc) still show India’s persistent high burden of under nutrition (17% wasting, 35% stunting, 33% underweight) and rising overweight-obesity burden, a welcome move was to invite Brazilian President Mr. Jair Bolsonaro as India’s special guest for her 71st Republic Day.
The nutrition community was excited about this as Brazil has been a champion in reducing its stunting rates from about 55% to 6% in less than 4 decades. Additionally, there is a continued momentum in the speed with which the number of stunted children has declined. How did Brazil do it? Brazil firstly analyzed the underlying causes of child stunting.
The main factors identified were inadequate access to food, inadequate care for children and women, insufficient health services and an unhealthy environment. Do these ring a bell? Of course- India shares these concerns to a large extent. Now, taking solutions from other countries or settings and applying them in our landscape may not be straightforward. A simple ‘Cut copy paste’ approach may be a dampener but mindful contextualisation of interventions may be helpful.
What do I want from this piece? Nothing new- just more power and outreach to Government’s vision of 'Kuposhan mukt bharat 2022' i.e throw out all forms of malnutrition forever. What I propose are some areas that need strengthened strategies to amplify/accelerate the real E-F-F-E-C-T in our ongoing efforts to tackle multiple forms of malnutrition.
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- EVIDENCE– Focus on high quality, rigorous data generation tools, techniques and technology for improving real time action. Effective monitoring and evaluation processes will also need to complement this space and help accelerate action in right direction.
- FOOD SYSTEMS – This is one of the most important link to healthier populations. Current food system may actually be fueling increased consumption of unhealthy high fat, sugar and salt foods and undermining home cooked meals prepared with diverse, fresh, seasonal and locally available grains, vegetables and fruits. Our national nutrition programs have emphasized use of fortified grains and staples to curb the micronutrient deficiencies but popularizing use of indigenous traditional foods especially by our younger ones will go a long way in bringing back the diverse Indian menu in our homes, on our plates daily.
- FINANCES – Nothing works without money! Not only sustained prioritized funding to public health and nutrition is critical, using fiscal measures to nudge people to make healthier choices will be beneficial. Paying attention to alleviate poverty, gender- and income-inequalities using well-designed pro-poor public policies is warranted. Efforts are underway by the government but ensuring better income distribution and increased access to health and nutrition services will really light up the lamps in marginalized sections. Beneficiary leakages owing to corruption and poor accountability should urgently be identified and plugged.
- EXCLUSIVE BREASTFEEDING AND IYCF PRACTICES – While a lot of expectations from the government can be enumerated, individual responsibility in optimal newborn, young child feeding must also be factored in. Of course there are external environmental factors (family dynamics, socio-economic status, accessibility and convenience, supportive work policies etc) which shape practice, there is no excuse for less than 7% of our under two’s to be inadequately fed and nourished. Malnutrition is not visible in early days and thus many caregivers don’t ‘realize that they may not be feeding the correct nutrient density, diversity, frequency, amounts etc. In our society, exclusive breastfeeding ends early and proper complementary feeding begins quite late. Hygienic meal preparation, clean surroundings and timely immunization are also important to prevent repeat infections. We all know that the damage done (especially to overall growth and brain development) in first 1000 days can’t be undone to a large extent. Another issue in this feeding space is our trying to apply short-sighted quick fixes for alleviating hunger and undernutrition. Subsiding cereals alone (via National Food Security Act) and giving carbohydrate rich meals (Take home rations, mid-day meals, anganwadi meals etc), we may be achieving a reduction in SAM children but we sure are pushing them to become early non communicable disease (NCD) targets. Utmost caution should be exercised so as to not lift people from one form of malnutrition to the other. Improvements by introducing fruits, green leafy vegetables, eggs and pulses are being seen in some states but this surely needs to step up.
- CONVERGENCE AND CAPACITY BUILDING- Solid holistic action on convergence with other sectors which impact nutrition strongly like water, sanitation, employment, education, advertising, immunization, agriculture, environment etc is a key piece in this malnutrition solving puzzle. Nutrition actually fits the bill to act as a hook to integrate/leverage action from multiple stakeholders in several domains and sectors. Joint ownership and accountability, sound, time-bound logistics planning for smooth action and generous acknowledgement, incentives etc may help a great deal. For tackling capacity shortfalls, filling up vacancies, avoiding recruitment delays, timely promotions, short term trainings to enhance performance etc may be useful start points. Convergent capacitated staff can also overcome system inefficiencies- generate local solutions for local problems by brainstorming, keeping motivation of staff high, avoid repetitive work and answerability of front line workers to multiple people. Studies document that AWW’s time to counsel and conduct preschool education is reduced to a quarter of what is envisaged due to documentation work (repetitive entries, report making, etc).
- TECHNOLOGY TO TRANSFORM EVIDENCE TO ACTION FOR IMPROVED NUTRITION – Technology can really help fast-pace growth and development in a sector like nutrition at both government and individual levels. On one hand, technology enables people to make better and informed choices; on the other it bestows the power of social media for social advocacy to policy makers to pump the Jan andolan, participatory ownership. It is imperative that we invest in high quality technology-enabled interventions which positively impact behavior change. Modern appliances should priorities transitioning knowledge to action to sustained practice or way of living among masses.
Real effect will definitely be visible sooner or later if the efforts are in the right direction. India is one of the few countries which can boast of an elaborate and diverse set of public nutrition programs and policies for almost all age groups. However improved rigorous processes, renewed energy/motivation amongst all stakeholders to amplify action against all forms of malnutrition, innovative ideas and collective strengths may just help hit the nail on its head.
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