For several years now, India has been sharply criticized for being one of the most undernourished nations on earth despite consistently high rates of economic growth. So the First Global Nutrition Report released recently by the International Food Policy and Research Institute (IFPRI) provides a welcome update on the nation’s progress on key nutrition indicators. Using the Indian government’s rapid survey on children (2013-14), the authors of the Global Nutrition Report estimate that under-five stunting in India has reduced on average from 47.9% in 2005-06 to 38.8% in 2013-14. This nine percentage point reduction translates into almost 14.5 million fewer stunted children. Perhaps the World Health Assembly target of reducing under-five stunting worldwide from 162 million children in 2012 to ~100 million in 2025 is feasible after all.
However, the fourth round of the District Level Household Survey (DLHS 4; 2012-13) tells a different story. The numbers are not encouraging. Looking at only the southern states, we find that not a single state can claim victory. Almost a third of children under-five are underweight in Kerala, by far the best performer in this group; and more than 43% in neighboring Tamil Nadu. Severe anaemia continues to be rampant among children in Andhra Pradesh and Karnataka at 21% and 14% respectively. The situation is far worse in Maharashtra, with almost 54% of the children underweight and more than 17% severely anaemic.
The government has implemented a number of programmes over the years: (i) nutrition specific programmes, providing supplementary nutrition to pregnant and lactating mothers and children from 0-6 years of age, hot meals for school going children, micronutrient supplementation, and deworming; (ii) nutrition sensitive programmes, through programmes which address the underlying determinants of improved nutrition, such as food security, clean water, and sanitation, increased school enrollment (particularly for girls), and raising the age at marriage; and (iii) enabling environment investments such as programmes to support household income.
Which of these programmes had the greatest impact and provided the greatest value for money? The truth is, in the absence of any systematic evaluation, there is no way to tell.
When alarm bells rang with regard to the HIV/AIDS epidemic in India in the late 1990s, one of the first things that the National AIDS Control Organization (NACO) did with the help of donor funding was to establish a network of sentinel surveillance sites which generated real time information on HIV incidence. As a result, NACO can produce reliable annual estimates of HIV/AIDS incidence and prevalence. Surely the epidemic of malnutrition that India now faces demands the same level of rigorous monitoring?
If the country is serious about addressing chronic malnutrition, the government needs to establish a robust system of on-going data collection; and this data must be rigorously analyzed by implementing agencies, policy think tanks, academic institutions, and others to extract useful lessons that inform policy and programmes.
Competing interests: None declared.
Shreelata Rao Seshadri, professor of health and nutrition at the Azim Premji University, Bangalore, India. Her research focuses on the social determinants of malnutrition among primary school children; and exploring innovative approaches to addressing this problem.