India is not just fighting undernutrition but is also battling COVID 19 outbreak in the country.
Zero hunger and good nutrition have the power to transform and empower the present and future generations. Malnutrition (deficiency or excess of nutrients in a diet) remains a major threat to the survival, growth and development of children. Undernutrition (deficiency of nutrients i.e. calories, proteins, carbohydrates, vitamins or minerals in a diet) is most prevalent in India.
Question: NFHS-4 figures in Jharkhand shows that 45.3 percent of children under 5 years of age are stunted, 29 percent are wasted and 47.8 percent are underweight. It indicates high prevalence of malnutrition in the State of Jharkhand that needs to be addressed by employing appropriate and robust interventions. If you could reflect on the effects of malnutrition on the life of the child, their family, and also what does it mean for a state / country?
Response: Our Jharkhand’s greatest state treasure is our people. Although Jharkhand has made tremendous advances in many other fields, malnutrition remains unacceptably high. Poor nutrition is a major cause of other health problems in the state, including severe wasting and prevalence of anaemiaduring pregnancy.
Malnutrition remains a major threat to the survival, growth and development of children. Cost benefit analysis of nutrition interventions report a return of Rs 18 on investment of Rs 1 per child. Adults undernourished as children earn at least 20% less than those that were not. With adult height, a 1 cm increase in stature is associated with 4% increase in wages for men and 6% increase in wages for women (Comprehensive National Nutrition Survey: 2016-18).
Child malnutrition happens very early in life. Their nutritional status deteriorates rapidly over the first two years of life, and once this damage is done, catch up and recovery are almost impossible.
Therefore, improving the quality of foods, feeding practices, and the nutrition situation of children in the first two years of life (first 1000 Days), represent a critical window of opportunity to break the intergenerational cycle of malnutrition. If this critical opportunity is missed, childmalnutrition will continue to self-perpetuate - : malnourished girls will become malnourished women, who give birth to low birth weight infants, who suffer from poor nutrition in the first two years of life. The best opportunity to break this vicious inter-generational cycle is to concentrate efforts on improving the nutrition of infants and young children from conception through the first two years of life.
Question: We know that malnutrition is a wicked problem which is a multifaceted and multi-dimensional issue, affected by poverty, insufficient food consumption, inequitable food supply, inappropriate infant and child feeding and care practices, equity, and gender disparities, poor hygienic and environmental settings and inadequate access to quality health, social services and education. What are the possible solutions to deal with this wicked problem?
Response: In Jharkhand, the problem of malnutrition is not just limited to the lack of calorie intake. Social and cultural factors are affected malnutrition badly. Adolescents are tomorrow’s adult population and their health and well-being are crucial. The best opportunity to break the cycle is to concentrate efforts on improving the nutrition of adolescent. It is important to understand Nutritional Requirements among women throughout their Life Cycle. Treat Women as a Woman. Usually we consider them as a special category when they become pregnant
For a long time, development partners have been working in silos. There are lot of repetitions of work, somewhere synergies are required as the agenda that we are all working is the same. Information technology can be leveraged for ensuring many services related to maternal and child health such as machine learning and artificial intelligence (AI). Nutri garden should be largely promoted so that mothers can participate in income generation activities and hence cater to the nutrition of their child and themselves. GIS tracking to identify hotspots at the block and sector level can also be done to take required actions. Nutrition needs to be integrated into universal health coverage as an indispensable prerequisite for improving diets, saving lives and reducing healthcare spending, also highlighted in the Global Nutrition Report.
Question: What are the policy initiatives that the government has undertaken, and what were the significant bottlenecks in those policy plans?
Response: Though Government of India has taken some initiatives like Poshan Abhiyaan, Aspirational Districts Programme, Anameia Mukt Bharat for taking the agenda of nutrition in a mission mode, and while we hope that these initiatives will bring good results in the coming days, it may still take some time to achieve the desired outcomes. Government of India is committed to improving the nutritional status of children and women through POSHAN Abhiyaan. The mission mode approach provides the impetus to strengthen implementation and its monitoring. There are core programmatic inputs including funding, human resources, supplies, and infrastructure that are critical to functioning of these POSHAN Abhiyaan pillars. Overall across the States, there are gaps that require immediate attention to strengthen the inputs and the pillars of POSHAN Abhiyaan as highlighted in the progress report of Transforming nutrition in India : PoshanAbhiyaan, September 2019 by NITI Aayog. The binding constraints in the implementation of the Abhiyaan are gaps in human resources, particularly at the supervisory level, procurement of growth monitoring devices and smartphones and likelihood of attrition in the quality of data collected through ICDS-CAS, fund utilisation, convergence at grassroot level, capacity building etc
Question: This pandemic has further entrenched and magnified the structural problems present in society, one of which is malnutrition. What would be the socio-economic burden of malnutrition looks like in the post COVID era? How far low has this pandemic setback our battle with malnutrition?
India has to not only deal with the present health crisis but also with the already existing problems of unemployment, low incomes, rural distress, malnutrition, and widespread inequality which is in a state of aggravating further. The situation has added to the miseries of the poor, with massive job losses and rising food insecurity. Our food systems are already stressed by increasing climate extremes. Containing the virus has caused food and nutrition shortages and driven governments to reduce social services, such as school nutrition programmes, that the most marginalised rely upon. Levels of hunger and malnutrition could double within the space of just a few weeks as highlighted in the Global Nutrition Report 2020 that is likely to increase load of hospitalisation for severe acute malnourished children in the NRCs/MTCs. Undernutrition and micronutrient deficiencies cost up to $2.1 trillion per year (CNNS 2016-18). This is likely to increase further due to COVID.
Question: How do you see the Role of Civil Society Organisations / NGOs in COVID 19 phase?
Role of Civil Societies Organizations today and in coming days will be very important. Even with so much of negativity, there is a silver lining for sector which will make the country stronger and make its own place much relevant in coming years. The crisis brought us together again, with more focused deliverables and objectives. To make India a stronger country and how we should learn managing its human resource. COVID-19 is a unique opportunity to reform our public health sector. A strong public health system will benefit everyone, and there is no better time than now to make it a reality. To Boost public-private partnership (PPP), To Build a data culture, To Engage communities, To Engage private healthcare services. If we reform our public health system now, it creates an opportunity for ripple effects in other areas too: for instance, nutrition and water&sanitation etc.
Dr Sujeet Ranjan, has been associated with public health sector for more than two decades. His experience includes large scale program management, policy advocacy and partnership management. Dr. Ranjan is leading the Coalition for Food and Nutrition Security (CFNS) as Executive Director. The Coalition for Food and Nutrition Security is the largest platform to raise awareness, foster collaboration and advocate for improved programmes to achieve sustainable food and nutrition security in India.