Dr Ashutosh Mishra, Senior Regional Technical Director, Asia, Vitamin Angels in India highlights that access to healthy diets along with inculcating the importance of appropriate nutritional practices can help break the intergenerational cycle of poverty and poor health
Globally, malnutrition continues to be a major public health challenge. It is estimated that over two billion people worldwide suffer from ‘hidden hunger’ (micronutrient deficiency), including over 80 per cent of the Indian population. In particular, malnutrition affects the physical and cognitive development of children and young adults, and has adverse consequences on the overall development of the country. Access to healthy diets along with inculcating the importance of appropriate nutritional practices can help break the intergenerational cycle of poverty and poor health.
The nutritional status of a child is directly influenced by the mother. UNICEF reports that malnutrition can permanently harm children’s growth and development. In fact, hidden hunger can even cause childhood blindness due to vitamin A deficiency, impair learning ability due to iodine deficiency, and increase the risk of death during birth due to iron deficiency. In India, malnutrition-induced anaemia is common due to a variety of factors, including the lack of diet diversity largely impacted by food insecurity, occurrence of infectious diseases like TB, Malaria, worm infestation, lack of awareness, and educational backwardness, resulting in high maternal mortality. To address these challenges effectively and in a more holistic and targeted manner, the government has established various programs such as the Integrated Child Development Services (ICDS), which provide comprehensive health and nutrition services to infants, pregnant women and lactating mothers, and midday meals for school children. The government has also launched the Swachh Bharat Mission, aimed at eliminating open defecation and other unhealthy practices among people.
There is, however, still a challenge in reaching socio-economically disadvantaged women and children with poor nutritional status. To address this, private partnerships with government are helping reach the unreached sections of the country where access to health facilities is limited. It is essential to work with a range of organisations across thematic areas to reach vulnerable populations. However, geographic access to health centres alone does not result in an improved nutritional status. A public health challenge as crucial and urgent as this, requires a framework of interventions where stakeholders from government, private sector, community-based organisations, and the general public can effectively contribute and leverage the combined resources to optimize impact of the interventions.
Every year, the Government of India celebrates Rashtriya Poshan Maah-a flagship program that aims to improve nutritional outcomes of children under six years old, pregnant women, and nursing mothers. A facility-based management system for children with severe malnutrition is also available through the government in the form of Nutrition Rehabilitation Centers (NRCs) or Child Malnutrition Treatment Centres (CMTCs) managed by the health department. Moreover, both the Women and Child Development (WCD) and Health departments promote health education about nutrition to help people change their eating habits and improve child nutrition. Similarly, different initiatives are being implemented by the government to tackle malnutrition and make sure nutrition reaches the most vulnerable sections of the society. Across states like Maharashtra and Nagaland, requests for Albendazole are decreasing from external donors, which means the government’s National Deworming Day program is reaching more children directly. Efforts to reach the last mile population are complemented by collaborations between state government bodies and civil society organisations in Nagaland. Since Nagaland is home to a number of ethnic tribes, language barriers prevent evidence-based nutrition interventions from being implemented – hence, support from frontline workers is crucial. It is important to focus more on tribal communities by deploying disaggregated data on their health and nutrition performance, as well as utilising traditional food systems. Malnutrition in such regions needs a holistic approach that focuses on strengthening existing health projects under POSHAN Abhiyaan and optimising nutrition delivery mechanisms, especially, among hard-to-reach, vulnerable populations.
Besides launching a number of nutritional programs, the Government of India also organises intensive activities to raise awareness about nutrition at the ground level through awareness drives, outreach programs, and various camps and fairs aimed at women and children under the age of six and adolescent girls to realize the vision of ‘Swasth Bharat’. The Government of India currently distributes high-dose vitamin A syrup and deworming tablets free of charge through its National Prophylaxis Programme Against Nutritional Blindness and National Deworming Day. However, a continued effective implementation of government programs requires social mobilisation which cannot be achieved without the participation of organisations working at grassroot level that understand the local context and can leverage the peculiarities to drive impactful interventions.
It is important to develop NGOs, Civil Society Organisations (CSOs), and other volunteer organisations that serve hard-to-reach populations to support government frontline workers in their nutritional activities. These trained service providers can complement government efforts in reaching nutritionally vulnerable by coordinating with local authorities, particularly during pandemics when resources are stretched to their limits.
As India strives to become malnutrition-free by 2030, it must simultaneously tackle its ‘double burden of malnutrition’- under-nutrition and obesity- as part of its development agenda. It is imperative that the Poshan Abhiyaan becomes a people’s movement (Jan Andolan) by bringing nutrition awareness to the people and encouraging them to make the appropriate diet choices. Our responsibility as citizens is to collaborate with all stakeholders in creating a healthy India.