Veena Rao on addressing undernutrition in India

My previous blog was about the Indian finance minister’s 2012 budget speech, which marked a significant moment for the much awaited, much required, paradigm shift in the government’s approach to reduce undernutrition and micronutrient deficiency.

An inter-sectoral strategy to address undernutrition in India, however complex it initially appears, is not that difficult to implement. Professor MS Swaminathan, chairman of the coalition for sustainable nutrition security in India was able to build a consensus regarding key interventions, both immediate and indirect, to address the multi-causal undernutrition/micronutrient deficiency in India. (May 2010) The Karnataka Nutrition Mission is structured on these interventions, and has been able to integrate them into a comprehensive programme, exclusively targeting the 40% of the population at the base of the pyramid.

The direct interventions constitute a complete life-cycle protocol addressing the health and nutritional requirements of children, adolescent girls, and pregnant and nursing women. For children, they cover colostrum feeding, exclusive breastfeeding for six months, introduction of complementary foods at six months, appropriate dietary supplementation for children between 6 – 72 months to bridge the protein/calorie/micronutrient gap, hygienic feeding practices, complete immunisation and vitamin A supplementation, de-worming, diarrhoea management, and special therapeutic feeding for severely malnourished children.

For adolescent girls and women, they cover dietary supplements of iron–rich, energy-dense fortified supplementation, especially during growth periods and pregnancy. The interventions also include ensuring optimal weight-gain during pregnancy, anaemia screening, weight monitoring, and iron folic acid supplementation, information, and awareness.

Indirect interventions include access to safe drinking water and sanitation, female education, delayed age of marriage and pregnancy, gender equity, better health services for women, and public private partnerships for making low-cost, energy-dense food available in the market for the poor.

These interventions sound so basic and ordinary that most policy makers find no new solution in them, even though our national data regarding them is worrisome. But what most policy makers don’t realise is that the interventions can significantly impact chronic undernutrition only if they operate simultaneously, so that the benefit of one intervention is not lost on account of absence of another. For example, undernutrition may persist in a properly fed, immunised child who keeps getting diarrhoea because drinking water is contaminated, and sanitation lacking.

Karnataka has sewed together these diverse interventions that range from governance/service delivery for food supplementation, maternal and child healthcare, water and sanitation, to awareness and information, changing negative family and social attitudes, and acts simultaneously through an innovative programme structure. Precise targets and responsibilities have been specified, and an effective management information system to monitor each performance indicator has been set up, supervised by the mission.

Who will provide oversight and direction to a national programme that requires cross-sectoral coordination of ministries of women and child development, health and family welfare, food, agriculture, rural development, drinking water and sanitation, education, and state governments? Obviously, only an overarching authority, e.g. the prime minister’s Office or the planning commission can do this, and exert political will to demand results and accountability.

I hope the finance minister’s budget statement is followed up with the creation of an oversight council who will formulate a cross-sectoral roadmap for reducing undernutrition and micronutrient deficiency in India in a time bound manner, and who will monitor it.

Veena S Rao, advisor, Karnataka Nutrition Mission.