Context: As per the UN Global Nutrition Report 2018, India is home to almost one-third of the world’s stunted children, widespread micronutrient malnutrition or hidden hunger. In the wake of the report’s findings, government of India gave impetus to nutritional reforms, with the launch of Poshan Abhiyaan or National Nutrition Mission (NNM).
What is malnutrition?
According to World Health Organisation (WHO), “Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition covers 2 broad groups of conditions. One is ‘undernutrition’ which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies (a lack of important vitamins and minerals). The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer)”.
Need of Nutrition Policy:
- Nearly every third child in India is undernourished – underweight (35.7%) or stunted (38.4%) and 21% of children under five years are wasted as per NFHS 4 2015-16. Moreover, the NFHS-4 data indicates that every second child is anemic (58.4%). The intergenerational cycle of under-nutrition is accentuated by multiple deprivations related to poverty, social exclusion and gender discrimination. Nutrition vulnerabilities are compounded by differentials in socio economic status and vary by vulnerable community groups such as SC, ST, minorities and others.
- Deficiencies of key vitamins and minerals such as Vitamin A, Iron, Iodine and Zinc continue to coexist and interact with protein and energy deficits.
- In India, annually, it is estimated (as on 2011) that about 1.45 million children die before completing their fifth birthday (MHFW). Currently the mortality rate in children under 5 years is 50, as per NFHS-4. The Infant Mortality Rate is 37 i.e. 37 out of 1000 infants die in the first year of life as reported in SRS Report 2015.
- Infant Mortality Rate (IMR) of India was 34 per 1000 live births in 2016.
- Maternal Mortality Ratio of India maternal mortality continues to be high with MMR at 130 in 2014-2016.
- The study estimates that the economic cost of micro-nutrient malnutrition costs India between 0.8 per cent and 2.5 per cent of its GDP, which is equivalent to $15–46 billion.
- The lack of proper nutrition for pregnant women, breastfeeding mothers and young children, especially before their second birthday can impair the child’s brain development, cognitive abilities and physical development, leading to stunting or reduced growth.
National Nutrition Mission:
- The National Nutrition Mission (NNM) or ‘Rashtriya Poshan Abhiyaan’ has been launched by the government of India with three year budget of 9046.17 crore rupees. The scheme was commenced from 2017-18.
- National Nutrition Mission as an apex body under Ministry of Women and Child Development will supervise, monitor, fix targets and guide nutrition related interventions all over the Ministries. It will also monitor an assortment of schemes contributing towards addressing malnutrition in India.
- 50% of the NNM will be funded by the Government Budgetary Support and 50% will be funded by International Bank for Reconstruction and Development (IBRD, also known as World Bank). The Government budgetary support would be of 60:40 between Centre and States/UTs, 90:10 for Northeast region and Himalayan States and 100% for UTs without legislature.
- National Nutrition Mission will bring in measurement of height of children at the Anganwadi Centres (AWCs). The scheme will assist to conduct Social Audits. It will also set-up Nutrition Resource Centres, which will involve masses through Jan Andolan for their participation on nutrition throughout various activities, among others.
Objective of National Nutrition Mission:
The objective of POSHAN Abhiyaan is to reduce stunting in identified Districts of India with the highest malnutrition burden by improving utilization of key Anganwadi Services and improving the quality of Anganwadi Services delivery. It aims to ensure holistic development and adequate nutrition for pregnant women, mothers and children.
Implementation Strategy and Targets:
- Implementation strategy would be based on intense monitoring and Convergence Action Plan right up to the grass root level. POSHAN Abhiyaan will be rolled out in three phases from 2017-18 to 2019-20.
- POSHAN Abhiyaan targets to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
- Although the target to reduce Stunting is at least 2% p.a., Mission would strive to achieve reduction in Stunting from 38.4% (NFHS-4) to 25% by 2022 (Mission 25 by 2022).
Hurdles in the implementation of National Nutrition Mission:
- Monitoring and delivery system: Real-time data about stunted and wasted children in India is missing. It becomes more difficult to reach out to all the malnourish children. A 2015 evaluation carried out by NITI Aayog had found that over 24% of the AWCs surveyed maintained poor records.
- Technological or digital illiteracy of Anganwadi Workers (AWWs): Government is planning to introduce information and communications technology-enabled real time monitoring (ICT-RTM). However, due to the limited capacities of AWWs to handle smartphones owing to their lack of technological literacy, compounded by technical issues like slow servers and data deletion problems, may result in irregular and improper recording of growth data of children.
- Infrastructure of Anganwadi centres (AWCs): They are the focal point of delivery of health and nutrition services for pregnant women, lactating mothers and children. However, many of the AWCs lack basic amenities and face infrastructure problems. Around 24% of them lacked their own building and operated from small rented premises, and around 14% lacked pucca buildings.
- Under utilization of funds: National Council meeting held in February 2019 found that only 16% of allocated resources for 2018-19 were utilized by the states and union territories.
Measures to improve Nutrition statistics in India:
- Multi-sectoral approach: There have been several nutrition centric schemes in India. However with the failure in implementation and other issues, there is emergent need to establish Nutrition as centre-stage in the National Development Agenda. As a multi-sectoral approach, NNM is offering enough flexibility in operations and at the same time offering a platform for resolving issues relating to policy coordination, incentives and convergent action.
- ICT intervention: There has been poor record maintenance by the AWWs, to overcome the challenges of the tedious and irregular system of manually maintaining daily registers and monitor growth efficiently, information and communications technology-enabled real time monitoring (ICT-RTM). Back-end infrastructure must be strengthen to avoid any flaws.
- National Nutrition Surveillance System: A National Nutrition Surveillance System should be set up, building on previous experience in states such as Andhra Pradesh. This will include an early warning system for increase in nutritional vulnerabilities, through assessment and analysis with trigger points for timely corrective action, through development programmes and safety nets.
- Nutrition Social Audits: Social nutrition audits would be need-specific and based on nutrition surveillance data. Nutrition Social Audit teams should consist of a mixed group representing officials, community members, Panchayati Raj Institutions, experts and technical institutions. It will help in identifying the areas with severe under-nutrition.
- Encouraging Panchayats participation: The active involvement of panchayats is seen to be a key factor in changing societal norms and entrenched behavior patterns in campaigns such as Swachh Bharat, Beti Bachao Beti Padhao. Same must be followed in making Nutrition Mission as a societal movement.
Nutrition is central to the achievement of other National and Global Sustainable Development Goals. It is critical to prevent under-nutrition, as early as possible, across the life cycle, to avert irreversible cumulative growth and development deficits that compromise maternal and child health and survival and undermine the achievement of optimal learning outcomes in elementary education, impairing adult productivity and undermining gender equality. Under- nourished children of today will not be able to build a New India. Good Nutrition will be the foundation of New India. National Nutrition Mission is indeed a timely initiative.