India’s northeast region presents challenge in terms of healthcare delivery: Study

The occasional paper by Vitamin Angels India (VAI) and Observer Research Foundation (ORF) makes several critical recommendations given the large inter-state and inter-district variations in the status of malnutrition among children and women in the region

India’s northeast region, home to over 220 ethnic groups and large tribal populations spread sparsely across remote areas, presents a challenge in terms of healthcare delivery, finds the study titled, ‘The Uphill Climb to Maternal and Child Nutrition in Northeast India’. The occasional paper by Vitamin Angels India (VAI) and Observer Research Foundation (ORF) makes several critical recommendations given the large inter-state and inter-district variations in the status of malnutrition among children and women in the region, as well as the region’s performance compared to the national average. The paper calls for a holistic approach to malnutrition in the Northeast to fill gaps in healthcare and nutrition, while leveraging the region’s agro biodiversity and traditional knowledge of its tribal populations.

The paper, authored by Shoba Suri (Senior Fellow, ORF), Priya Rampal (Consultant, Oxford Policy Management), and Shruti Menon (National Program Manager, VA), builds on data from National Family Health Surveys; the Comprehensive National Nutrition Survey; India SRS Special Bulletin on Maternal Mortality; and reports from organisations such as FAO, UNICEF, WHO, World Bank, and more. The paper also explores the dietary practices of women and children, with a special focus on the region’s tribal populations.

Speaking on the relevance of the study, Menon stated, “The in-depth analysis of the statistics on the key nutrition indicators in the northeast region show high degrees of inter-state and inter-district variations. To effectively combat malnutrition in the region, we need a holistic approach that focuses on strengthening existing health projects under POSHAN Abhiyan and optimising delivery mechanisms of nutrition interventions, especially among hard-to-reach, vulnerable populations. A greater emphasis should be placed on tribal communities, including disaggregated data on their health and nutrition performance, as well as documenting and leveraging traditional food systems. Civil society groups across the Northeast have historically played a crucial role in peace building and development — this active and thriving society must be leveraged to maximise the impact of health and nutrition interventions, particularly in strengthening last mile delivery of services.”

“There is an urgent need to address malnutrition in the north-eastern States by scaling up direct nutrition interventions and coupling them with nutrition-sensitive approaches to bridge the nutrition gap. Creating synergies to strengthen inter-sectoral coordination and multi-stakeholder collaborations and convergence can be key to improving maternal and child nutrition in the northeast region of India. To quote from Lancet, ‘It is the juxtaposition of coverage and efficacy that explains progress in reducing malnutrition or its absence”, added Suri

As per the study, among the 13 states and Union Territories across India that witnessed a rise in the percentage of stunted under-five children from 2015-16 to 2019-20, four states (Meghalaya, Mizoram, Nagaland, and Tripura) were from the Northeast. Out of the eight States in the region, four States (Mizoram, Nagaland, Manipur, and Assam) also witnessed a rise in wasting among children. In terms of micronutrient deficiency, the study raises concerns about the increasing prevalence of anaemia among children and women. For instance, Assam (68.4 per cent) and Tripura (64.3 per cent) have a high prevalence of the disease among children aged 6-59 months. Factors such as poor maternal health, lack of antenatal care facilities, poor feeding, insufficient infrastructure and healthcare facilities, lower uptake of nutritional programmes, and remoteness of the region were some of the reasons cited.

However, it’s not all bad news. The prevalence of underweight children in the region was found to be lower than the all-India average of 35.8 per cent. The study found a satisfactory nutritional status for under-five children, with stunting at 22 per cent, underweight at 14 per cent, and wasting at 7 per cent. Four Northeast states (Assam, Sikkim, Arunachal Pradesh, and Nagaland) witnessed a notable reduction in neonatal mortality, infant mortality, and under-5 mortality from NFHS-4 to NFHS-5. Sikkim recorded the lowest infant and child mortality rates, performing better than the all-India figures. During the COVID-19 pandemic, the North-eastern states saw a mixed record in the implementation of the take-home rations (THR) scheme. During the lockdown, while beneficiaries found it difficult to collect their THRs, Nagaland was the only state that delivered the rations daily, while Assam provided it weekly and fortnightly. Sikkim, Tripura, Manipur, and Mizoram delivered THR in bulk only once a month or once in two months. In Meghalaya, the beneficiaries had to continue to collect THR directly from Anganwadi centres.

Harnessing the rich biodiversity of the Northeast to improve access to, and utilise locally available, sustainable, low-cost, nutritionally dense wild and cultivated foods can go a long way in nutrition equity, according to the study. About 10 per cent–15 per cent of the wild foods from forests are known to reduce malnutrition and improve food security. For instance, the Chakhesang Naga tribe in Nagaland showed wide food diversity with high consumption of cereals and millets, green leafy vegetables, and fruits, contributing to a healthier diet. Therefore, the study called for efforts towards documenting locally available food and mobilising their use among larger communities, potentially leading to self-sustainability.