Thu May 17, 2012 2:32 am (PDT)
Fighting Malnutrition ....VEENA S RAO Interventions to fight malnutrition must be simultaneous with outcomes being monitored by an overarching body The finance minister's Budget 2012 speech contains the much-awaited, much-needed paradigm shift in government's approach to reduce undernutrition and micronutrient deficiency, the indicators of which are fast qualifying India as the malnutrition capital of the world. It is now clear that high growth rates are not automatically translating into better nutritional indicators, though there is marginal improvement in infant and mortality indicators, as per SRS 2009. Finance minister has included "decisive intervention to address the problem of malnutrition, especially in the 200 highburden districts", as a priority objective in the preamble to the Budget speech, something unprecedented. It adds that "following the decision taken in the PM's National Council on India's Nutritional Challenges, a multi-sectoral programme to address maternal and child malnutrition in selected 200 high-burden districts, is being rolled out during 2012-13. It will harness synergies across nutrition, sanitation, drinking water, primary healthcare, women's education, food security and consumer protection schemes." Finally, the government has shed its Integrated Child Development Services (ICDS)-centric approach on which it unrealistically relied for too long to reduce malnutrition, even though ICDS was an integrated development programme, and not one to eradicate malnutrition. A multi-sectoral strategy to reduce undernutrition must first remedy the causeintervention disconnect. What distinguishes undernutrition in India from that in other underprivileged societies is its inter-generational character; the calorieprotein-micronutrient deficit afflicting at least 40% of our population covering all age groups and both genders, brought out in NIN Technical Reports 20, 21, 22, about which we are still in a state of denial, and lack of awareness regarding proper nutritional practices, child and maternal care, care of the girl child throughout her lifecycle, gender discrimination, etc. These three immediate determinants that make undernutrition chronic must be articulated and addressed through a composite programme. Thereafter, remaining multi-sectoral interventions, such as safe drinking water and sanitation, female literacy, that are already ongoing national programmers, should be accelerated and targeted to bring value added to interventions addressing immediate determinants. For example, safe drinking water and sanitation cannot bridge the protein calorie gap, but can bring a huge nutritional valueadded to dietary supplementation, by immediately reducing diarrhoea and infection, and preventing nutrition wastage. Similarly, female literacy, per se, cannot improve nutritional status, but it will delay age of marriage and child birth, provide better awareness and improve maternal and new-born health. An inter-sectoral strategy is not really a difficult exercise. Prof M S Swaminathan has done great service enumerating multi-sectoral essential interventions required to address undernutrition and micronutrient deficiency through the Coalition for Sustainable Nutrition Security in India chaired by him (May 2010). The challenge before the nodal ministry is to knit the interventions together into a composite, practical and implementable scheme that addresses at least a majority of the causes of undernutrition, and ensure that it captures and targets the 40% base of the pyramid. The interventions must be simultaneous so that the benefit of one intervention is not lost on account of the absence of another; and they must cover the entire lifecycle of women and children to create an immediate nutritional impact within one generation on the three critical inter-generational links of malnutrition, namely, children, adolescent girls and women. Only then can the benefits be sustainable enough to break the undernutrition cycle and pass on to the next generation. Integrating multi-sectoral programmes seamlessly requires coordinated and dynamic participation of the ministry of women and child development (MWCD), health and family welfare, food, agriculture, rural development, drinking water and sanitation, human resources development, panchayati raj and the state governments. Operationally, this requires not merely coordination, but mega coordination, between formidable ministries with substantive primary mandates of their own, to which nutritional outcomes have to be glued. Does the MWCD have the necessary clout to ensure this mega coordination and command adherence to nutritional outcomes from ministries whose prime objective is understandably to achieve their Plan scheme targets? Only an authority overarching the concerned ministries, such as the Prime Minister's Office or the Planning Commission, can achieve this, and demonstrate the political will, provide policy direction and oversight, and demand results and accountability. This alone can galvanise administrative priority, innovation, efficient execution and the dexterity to overcome daunting bureaucratic procedures and operationalise inter-sectoral interventions at the grassroots, through community participation and inclusion. A high-level committee should be appointed by the Prime Minister's Council with the specific objective of drawing up an inter-sectoral roadmap to combat undernutrition and micronutrient deficiency in a time-bound manner with quantified, monitorable targets, robust monitoring mechanisms and accountability. The Karnataka Comprehensive Nutrition Mission has been designed on the above pattern, now being piloted in five blocks. To address protein deficiency in women and children, the finance minister has reduced basic customs duty on soya protein concentrate and isolated soya protein considerably. An important reason why undernutrition persists among the poor is because they have no access to low-cost protein-energy foods to supplement their inadequate diets, especially for healthy child growth, convalescence after sickness or diarrhoea, or providing extra calories required during adolescence and pregnancy. In this sector, the Indian market has a complete void. Field evidence confirms that farm labour families spend a week's wages to buy Horlicks for a sick or malnourished child. It is hoped that this incentive will motivate private sector participation in combating malnutrition by producing low-cost, protein-rich food for the poor, who need it the most. (The author, a retired secretary to the government of India, is adviser to the Karnataka Nutrition Mission) URL: http://epaper.timesofindia.com/Default/Scripting/ArticleWin.asp?From=Archive&Source=Page&Skin=ETNEW&BaseHref=ETM/2012/05/17&PageLabel=17&EntityId=Ar01700&ViewMode=HTML Back to to
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