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Food policy: The national fight against malnutritionFood policy: The national fight against malnutrition
Mar 10, 2014, Economic Times
By Veena S Rao
The periodic public outcry over India's malnutrition and hunger has curiously stopped despite repeated reports confirming the alarming situation. However, a welcome development is that political parties have raised the issue in the run up to the polls, recognising nutrition as a determinant of development.
The perception among nutrition experts and NGOs has changed. The ICDS is no longer seen as a vehicle to tackle malnutrition. Rightly, the focus has shifted to an inter-sectoral approach, but the discourse gets stuck at this point. Without a national programme with an inter-sectoral template, no one including the government seems to know how exactly to intervene inter-sectorally. Many institutions are unable to address the problem on the ground, without a design or format to guide them.
National programmes with a well defined structure such as the Sarva Shiksha Abhiyan, Midday Meal Programme or the National Rural Health Mission provide a fulcrum for NGOs to offer support without complication. The absence of a national programme to fight malnutrition denies such a platform, and results in an information void on what interventions are essential, and how best to undertake them. Hence, apart from organising occasional conferences and "advocacy", mostly on isolated themes, there is no concerted strategy on the ground to effectively address malnutrition afflicting people across age groups.
Public awareness and information on social and development issues is generated through strong national programmes. They become the strongest advocacy tools, taking the message to the grassroots, notably health, education and women empowerment programmes.
Information and awareness on malnutrition has no such medium, leading to the vacuum in information at the grassroots within families, communities, PRIs and field staff of NGOs and government on critical issues: preventing child under-nutrition, proper maternal nutritional care to ensure adequate weight gain during pregnancy and prevent low birth-weight babies (first casualties to neonatal mortality) and nutritional care of adolescent girls (the most undernourished in the world), who are future mothers.
Lack of information and awareness cascades further into the absence of capacity creation at all levels and stages of the participation/implementation process and, more importantly, in the absence of demand for nutritional services from the afflicted population. This is why there are hardly any think tanks, research or capacity-building institutions at state or district levels. Also, there are no journals or information in local languages on the subject to educate people, and not even vernacular equivalents for terms like "body mass index" or "chronic energy deficiency".
Neither is there an enabling environment for a united and vocal nutrition lobby with strong leadership to influence government. There is negligible presence of public health/nutrition in research institutions in state capitals and none at all in district/block institutions, where the action really lies. Besides, the nutrition lobby is disunited, often deflecting attention from the urgency of addressing malnutrition holistically. A strong, united nutrition lobby, providing innovation and working models, could have influenced the government to announce a national programme to address malnutrition.
There is despondency about the governance environment to address malnutrition: lack of information and capacity among stakeholders, particularly the community, lack of demand and ostracism of the private sector that has a mandate to address malnutrition under new CSR norms. Old schemes and the army of Anganwadi workers are also a baggage for government. Instead of innovation, the creaking Anganwadi is being saddled with more activities, but sinking under the malaise of contractors, commissions and corruption.
Acomprehensive strategy to address malnutrition is perfectly doable. The Karnataka Nutrition Mission has piloted this, based on inter-generational, inter-sectoral interventions, bridging the dietary calorie-proteinmicronutrient gap, initiating grassroots awareness programmes and rigorous real-time monitoring, with encouraging results.