Malnutrition is a public health emergency in the country. With less than four years remaining for the POSHAN Abhiyaan to end, it continues to remain a major burden for poor States
It is no surprise that one of the poorest States in the country is also battling malnutrition, especially in rural areas. As per the National Family Health Survey, four (NFHS-4), the total number of children under five in Odisha suffering from severe wasting, better known as Severe Acute Malnutrition (SAM), has increased from 5.2 per cent to 6.4 per cent in the last 10 years. The children belonging to the Scheduled Tribes (23 per cent) and Scheduled Castes (17 per cent) are the worst victims of perpetual poverty and marginalisation.
As a result, the State is largely poverty-stricken and backward, leading to high rates of malnutrition, poor health and hunger among the people.
Malnutrition is majorly a socio-cultural problem and has the potential to create major setbacks for India. According to a 2019 study by Dr Mayadhar Panda, “Malnutrition can result in adverse physical, cognitive and/or emotional results in the short-term as well as in the long-term health and well-being of an individual. Its deleterious effects on the socio-economic development and health of the society are well recognised, and undernutrition is taken to be an indication of a society’s wellbeing.”
In parallel, Odisha’s diluted public accountability, poor access and control over food and livelihood entitlement programmes like Targeted Public Distribution Programme (TPDS), ICDS Supplementary Nutrition Programme and Mid-Day Meal (MDM) programme and National Rural Employment Guarantee Programme have not generated the desired impact on curtailing hunger and malnutrition either.
So what is Odisha doing about it?
As a response to the growing malnutrition situation in the last decade the Central Government released the National Nutrition Strategy in 2017. The following year, in 2018, the Prime Minister launched the National Nutrition Mission (NNM), also known as POSHAN Abhiyaan, with an overarching goal of reducing child and maternal malnutrition. Similar to most States in India, Odisha follows the facility-based management approach to treat children with SAM, better known as the Nutrition Rehabilitation Centre (NRC).
Recently, during the POSHAN Month celebrations in Odisha, the School and Mass Education Minister, Samir Ranjan Das said, “We are doing well on nutrition but the challenge is still very tough. Under the leadership of Chief Minister Naveen Patnaik, we will surely achieve the goal of a malnutrition-free Odisha”, indicating the willingness and commitment of the State to improve its malnutrition situation.
How can Odisha further its efforts? In Odisha, the community workers, like the Accredited Social Health Activists (ASHA), Anganwadi Workers (AWW), and Auxiliary Nurse Midwives (ANM) play a central role in screening and identification of children with SAM, mostly while conducting the Village Health and Nutrition Days (VHND) sessions. These community workers play a key role in helping reach that last SAM child in the rural areas of Odisha.
While the NRCs have been effective in treating children with complicated SAM, their cumulative efficiency may be in question. Scientific evidence shows that almost 90 per cent of SAM cases are uncomplicated and can be treated at the community level. States like Rajasthan, Maharashtra and Jharkhand, to name a few, are some examples where community-based management for acute malnutrition (CMAM) has been successful.
A 2019 evaluation done on the performance of the NRCs in Odisha says, “Frontline workers, health workers in the community and public health centres should be trained and given hands-on training to measure the weight, Mid-Upper Arm Circumference (MUAC), weight-for-height Z-scores (WHZ), and check for oedema in children aged 1-59 months”, echoing the importance of using the frontline workers for early detection of SAM at the community level.
The recommendation from the 2019 evaluation further adds, “The process of identification and referral of SAM children from the community to NRC needs to be further strengthened for early referral. During the Village Health and Nutrition Day session, mothers/ caregivers are also to be provided counselling and support to address the reasons for poor nutrition and health to their child. Awareness generation among community members should actively be taken up regarding infant and young child feeding (IYCF) practices.”
In totality, there is still a window of opportunity for Odisha to fight malnutrition. Nevertheless, Odisha alone cannot do it. Perhaps a national guideline on community-based management of severe acute malnutrition can show the way to Odisha to reverse the harm of undernutrition and promote longevity among malnourished children. We need to act now, before the sun sets on the horizon for these children with SAM. Only then will we be able to achieve the major milestone of the 2030 Agenda for Sustainable Development.
(The writer is a Member, National Council for India Nutritional Challenges, POSHAN ABHIYAN and president, ICCIDD, India. He is former Head, CCM, AIIMS, New Delhi.)