To fight malnutrition in India, engage all stakeholders | Analysis
Zero hunger and good nutrition have the power to transform and empower the present and future generations. India’s greatest national treasure is our people but one-fourth of our children are born with low birth weight, 35.7% of children under five are underweight, 38.4% are stunted and 21% are wasted. Severe acute malnutrition (SAM), estimated, as severe wasting is 7.5%. Although India has shown progress in improving child nutrition, malnutrition remains high.
Poor nutrition in the first 1,000 days of children’s lives can have irreversible consequences. For millions of children, it means they are stunted, which in turn makes them more susceptible to sickness. The consequences of child hunger and undernutrition can be extreme, both for families and cumulatively for the communities and nations.
Community management of acute malnutrition (CMAM) is a proven approach to manage SAM and MAM moderate acute malnutrition (MAM) in children under five. It involves timely detection of SAM children in the community and the provision of treatment for those without medical complications with nutrient-dense foods at home. The Integrated Child Development Services programme provides supplementary nutrition in the form of take-home ration to cater to the malnourished children. Currently, there is a lack of policies and common national guidelines to address both, the treatment and the prevention of SAM children. The guidelines of Poshan Abhiyaan states that the community-based traditional events must be organised once in a month at Anganwadi centres to promote and support social behaviour change to improve maternal and child nutrition through the information, education and communication approach along with interpersonal commination. In the absence of clear guidelines, however, community management faces challenges such as poor follow-up of cases, the lack of convergence among ministries and line departments, poor networking among government functionaries due to a lack of clarity, as highlighted in the position paper on India’s CMAM review.
United Nations Children’s Fund’s (Unicef, 1990) conceptual framework on the determinants of child malnutrition illustrates the multidimensional nature of the problem and requires a multisectoral approach to address it. Multisectoral approach is one of the key steps to tackle malnutrition and micronutrient deficiencies to help control infections, morbidity, disability and mortality.
Poshan Abhiyan recognises that chronic malnutrition is a major nutrition problem in the country. This approach considers the factors that limit the capacity of government institutions to implement it. The Poshan Abhiyaan already ensures convergence with various line departments aimed at initiating convergent action plans at every level of care, to achieve synergy and the desired results. Taking a sector-wide approach by engaging multiple stakeholders can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths to produce better health outcomes.
One of the major advantages of a multisectorial approach is resource optimisation. Also, it aims to ensure a strong focus on management through institutional and programmatic convergence, by integrating it in the planning, implementation and supervision processes. This approach will lead to better policies, institutions and programmes to improve nutrition outcomes.
However, there is still a massive challenge in making a functional multisector action plan. This hurdle can be overcome with national guidelines, and its implementation through leadership at every level — a strong catalyst to initiate and strengthen the convergence and collaboration.
Rajasthan and Gujarat have been successful in implementing a community-based model for treating children. It’s time to make efforts in the rest of the country as well.
There are no medical complications for the majority of children with SAM and they can be managed at their homes with standard protocols. There is an urgent need to streamline CMAM guidelines as a routine part of the government system. Together, this may prove to be the most robust investment we can make to fulfil the promise of the 2030 agenda.
Sujeet Ranjan is executive director, The Coalition for Food and Nutrition Security
The views expressed are personal