Unfortunately, the malnutrition figures in India are worse than in many poorer countries in sub-Saharan Africa. Wasting, which is low weight for height, is 19.3% in children under five years of age according to the latest National Health Survey. For stunting – short height for age, this number is 35.5% nationally. India cannot be a superpower if so many children are malnourished. The nutrition situation has not improved much between the last two national surveys. Why is this?
There are many explanations for persistent malnutrition in India: low income, illiteracy, traditional culture and associated feeding practices, etc., which may be partially true. The government has three main programs for nutrition. First, the large public distribution system (PDS) of subsidized grains to ensure that even the poor can afford to buy food grains. Then there is the Integrated Child Development Services (ICDS), which provides take-home rations (6 months to 3 years) and morning snacks and hot cooked meals (3 to 6 years) for children in the center. of Anganwadi. This program is run by the government’s Women and Child Development (WCD) department. We also have on-site management of severely malnourished children in the form of NRCs or CMTCs run by the health department. Finally, we have the midday meal plan to provide school meals for children. In addition to this, both the health department and the WCD carry out nutrition health education so that people’s habits change for the better and child nutrition improves. The government launched POSHAN Abhiyan in 2018, a special initiative to improve nutrition nationwide with the vision of ensuring the achievement of a malnutrition-free India by 2022. Despite all these efforts, Indian children remain malnourished. Why?
Here we present a public health management perspective on this topic. We believe that nutrition is not getting the necessary political support in the first place like industry, defense, space science, or infrastructure. The budget allocation for nutrition programs is not adequate. ICDS provides around eight rupees per day per child. This low allocation is a reflection of low political priority. Second, the nutrition programs are divided into several departments: WCD, health, and education. Therefore, interdepartmental coordination becomes a major problem. Another key issue is the absence of nutrition experts in the management of these programs. The WCD department has very few nutrition technical experts in the entire government system. At the national level, the lead technical institution is the National Institute for Public Cooperation and Child Development (NIPCCID) and not the National Institute of Nutrition (NIN), which is an institute of the Indian Council of Medical Research (ICMR).
Nutrition is also a neglected area in health departments, since its main focus is in medical schools and hospitals. In the public health directorate, there are no nutrition technicians ─ unfortunately, most of them are doctors, often without training in nutrition. Even in medical schools there is no nutrition department and no links to universities where there are nutrition departments. Therefore, there is a lack of nutrition expertise for large nutrition programs in the country. The education department that administers the midday meal plan also has very little nutrition expertise. Furthermore, the main objective of this scheme is to attract poor children to school and not to improve nutrition. The budget for the midday meal is also much lower. The Akshaya Patra Foundation, an NGO that provides midday meal services to the government, has to collect donations to run the program.
Monitoring of nutritional status in India is also not robust. ICDS has its own service statistics that show very low levels of malnutrition, while independent national surveys always show much higher levels of the same indicators. National surveys are only conducted every 5-10 years and therefore do not provide regular data on children’s nutritional status for data-driven policy and action. Some states have conducted their own nutrition surveys, but those too are few. The National Nutrition Surveillance Office (NNMB), under which 10 state-level units were established, supporting the continuous collection of data on the diet and nutritional status of the population, has now been discontinued. Some small-scale independent studies are conducted through some universities or funded research projects, but they are not representative of data at the district, state, or national level, and are therefore of limited use to policymakers. policies.
To remedy this situation, we propose the following solutions. First, create central services related to nutrition at the national level in line with IAS, IPS, etc. These officers are to staff all nutrition related programs such as ICDS, midday meal and management of severely malnourished children etc. starting from block or taluk. level. All of these programs will be under the responsibility of a Ministry of Nutrition headed by a Cabinet-level Minister and a Principal Secretary. There must be adequately staffed nutrition departments at each state and central level with administrative and technical officers in the nutrition directorate. NIN should have a much larger technical role in the ICDS, the midday meal and other nutrition programmes.
The NNMB needs to be revived and expanded to conduct independent annual nutrition surveys. An adequate budget should be allocated to nutrition programs. States must provide funds and technical personnel to plan, implement and monitor nutrition programs in the districts. Each of the nutrition programs should be regularly monitored by the chief secretary and the CM. The ministry of nutrition should have a large and well-developed communication division, since about 60-70% of the nutrition work has to be done by families at home: how to cook and how to feed the children, how to maintain hygiene food and prevent diarrhea This requires massive communication efforts.
Unless, as a nation, we take nutrition seriously and provide an adequate budget, as well as administrative and technical support, Indian children will continue to suffer from malnutrition, which will have a serious negative impact on the knowledge economy of tomorrow. Malnutrition hampers brain development and physical growth of the individual. With our children malnourished, we will suffer setbacks in the future.
The article has been written by Dileep Mavalankar, Director and Ritu Rana, Indian Institute of Public Health Gandhinagar (IIPHG).
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