Maharashtra, was ranked the state with the best infrastruc ture in 2016, in the ‘State of States Reports’ and . However, the state struggles to cope with high rates of child malnutrition. The situation aggravates during lean seasons by a sharp increase in child deaths, attributable to malnutrition. Many develop -ment partners including Tata Trusts is collaborating to make the government’s vision of malnutrition-free Maharashtra a reality, writes Dr Rajan Sankar, Senior Adviser, Nutrition, Tata Trusts
The National Family Health Survey 4, (NFHS-4) shows that 34.4 per cent of children under the age of five are stunted, i.e. they are too short for their age. But acute malnutrition as evidenced by wasting (low weight for height) has increased from 16.5 per cent (NFHS 3) to 26.1 per cent (NFHS 4). Wasting, which represents recent failure to receive adequate nutrition and increased vulnerability to acute illnesses, is severe in the state. Anaemia levels remain high, with nearly 48 per cent of women in reproductive age and 54 per cent of children below five years suffering from anaemia. The survey also found that a fourth of women were chronically energy deficient, ie. having low Body Mass Index (BMI), an established risk for the mother as well as her offspring.
In order to streamline efforts towards improved nutrition, health and well-being of the community, the state has been running numerous welfare programmes. Integrated Child Development Services (ICDS) is one of the critical programmes for improving maternal and child nutrition. The programme offers health, nutrition and hygiene education to mothers, non-formal pre-school education to children, supplementary feeding for children, pregnant and nursing mothers, growth monitoring and promotion, and links to primary healthcare services such as immunisation. These services are delivered in an integrated manner at the anganwadi centres and the number of anganwadi centres have increased in recent times. Over one lakh Anganwadi centres in Maharashtra cater to around 60 lakh children. Immunisation coverage can be used as a surrogate indicator of how well the anganwadi centres are functioning. It indicates how efficiently the services are delivered as well as the seeking behaviour of the population. Immunisation coverage in Maharashtra has remained unacceptably low at 56.3 per cent and it has been the same over the past decade.
ICDS and National Health Mission (NHM) have unmatched reach and are intended to serve the most vulnerable populations. Together they are structured to deliver the essential nutrition and health inputs required to improve health and nutrition status of the population. However, they are not delivering. Some of the key problems identified are poor targeting and poor implementation. Lack of community ownership is another major gap. There is a need to focus on the consumers too. The creation of demand is necessary. If people do not want, do not demand them, then even limited supplies and services can prove superfluous. Our programme, the ICDS in particular is ‘hardware’ oriented, concentrating on the supply factor – on the assumption that demand is automatically appeased by supply. Focus on mass mobilisation is to increase demand and community ownership of the ICDS.
Science has now shown that this ‘window of opportunity’ has a major effect on the future of a child, his community. Maharashtra need to aggressively focus on this period where millions of children are facing the most critical development period of their lives. Nutritional status results from a complex interaction between food intake, access to safe water and sanitation, nutritional knowledge of caregivers and access to care and appropriate medical services. NFHS-4 reveal that in Maharashtra only half of the infants are exclusively breastfed in the first six months of their lives, only 6.5 per cent of children aged six to 24 months receive an adequate diet. Children during this phase of development require continued breastfeeding and age appropriate complementary foods. Individual families and communities have to take the responsibility to adopt and practice appropriate infant feeding practices, hand washing and take responsibility to utilise services provided by ICDS and NHM. Community pressure is sure to improve the efficiency of delivery of services in these otherwise poorly functioning services.
A multi-sectoral approach to nutrition is necessary to eliminate malnutrition. A number of interventions need to converge and should be targeted to the most vulnerable geographies and vulnerable people within it. Such convergence approach has become the central tenet of successful nutrition programmes. Maharashtra achieved rapid decline in stunting rates, nearly a 15 per cent decline in six years (2006-2012), by adopting a mission approach. The state has renewed its commitment to address malnutrition. Tata Trusts have adopted a multi-pronged approach to be able to address the issue of malnutrition and has effectively started to work in Palghar district that has one of the worst indicators. The plan is to demonstrate scalable model that works with and within the government and communities to increase coverage of both nutrition specific and nutrition sensitive interventions to the most vulnerable populations, with speed and with quality.
The state has the necessary infrastructure, human capacity and financial resources needed to sustain this and scale it up across the state. It is time to act and rid Maharashtra from the scourge of malnutrition.