The Indian finance minister’s 2012 budget speech marks a significant moment for the much awaited, much required, paradigm shift in the government’s approach to reduce undernutrition and micronutrient deficiency, the indicators of which are fast qualifying India as the malnutrition capital of the world (despite 8% economic growth). It is now clear that high growth rates are not automatically translating into better nutritional indicators, though there is marginal improvement in infant, child, and maternal mortality indicators.
The finance minister has included a “decisive intervention to address the problem of malnutrition especially in 200 high-burden districts,” as a priority objective in the preamble to the budget speech, something unprecedented, which provides a great deal of hope for future programming. The speech adds that “following the decision taken by the prime minister’s National Council for India’s Nutritional Challenges, a multi-sectoral programme to address maternal and child malnutrition in a 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 had unrealistically relied on to reduce undernutrition for too long, even though ICDS was meant to be a child development programme, and not a programme to eradicate malnutrition. It has taken almost two decades for the government to articulate the correct inter-sectoral solution that was blueprinted very convincingly in its own national nutrition policy in 1993.
A multi-sectoral strategy to reduce undernutrition must first remedy the cause-intervention disconnect. What distinguishes India’s undernutrition from that in other underprivileged societies is its chronic inter-generational character linking undernourished mothers, low birth weight babies, and undernourished, anemic adolescent girls who become undernourished mothers and perpetuate the intergenerational cycle of undernutrition. The calorie-protein-micronutrient deficit afflicts at least 40% of our population, covering all age groups and both genders, and we are still in a state of denial about it. And there is a lack of awareness regarding proper nutritional practices, child and maternal care, care of the girl child throughout her life-cycle, and gender discrimination. These three immediate determinants that make undernutrition chronic have to be articulated and addressed through a composite programme. Thereafter, remaining multi-sectoral interventions, for example—safe drinking water and sanitation, and female literacy, that are already ongoing national programmes, should be accelerated and targeted to bring added value to interventions addressing immediate determinants. For example, safe drinking water and sanitation cannot by itself bridge the protein calorie gap, but can bring a huge nutritional value-added 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/child birth, provide better awareness, and improve maternal and new-born health, most optimally, if the calorie-protein-micronutrient deficit has been bridged through dietary supplementation.
An inter-sectoral strategy is not really a difficult exercise. The Karnataka Comprehensive Nutrition Mission, designed on the above pattern, is presently being piloted in five blocks. More about that in my next blog.
Veena S Rao, advisor, Karnataka Nutrition Mission