No child left behind (Nutrition for Indian children)

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No child left behind (Nutrition for Indian children)

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1. A compelling need: Poor nutrition among Indian adolescent children, girls and women needs to be tackled fast.
2. Three major surveys: The latest NFHS-4 (2015-16), the Global Nutrition Report 2016, and the Global Hunger Index (GHI) 2017 have all pointed out to these facts. The GHI ranks India at 100 out of 119 nations, and gives a score of 31.4.
3. Wasting, stunting, and child-mortality: While wasting (low weight for height) hasn't gone down, stunting (low height for age) has reduced and mortality too is down. But 25% of Indian kids below 5 years are malnourished.
4. Hunger and anaemia: Nearly 19 crore sleep hungry each night. More than 50% of girls and women are anaemic.
5. Various forms of poor nutrition: There is a new emphasis to resolve core issues 
1. Stunted, wasted, anaemic, underweight children, and 
2. Anaemic girls and women (15-49 years).
6. Government's 2018 approach: 
1. The Ministry of Women and Child Development has launched the "Poshan Abhiyaan" (NNM - National Nutrition Mission). It will help converge all existing  programmes. The budget is heavy - Rs.9046 cr.
2. NITI Aayog's National Nutrition Strategy (NNS) has isolated 100 most backward districts for stunting reduction.
7. Earlier failures: The PM "National Council on India's Nutrition Challenges" was made in 2008, and a report by Planning Commission submitted in 2010. But things didn't converge as thought. But there are lessons learnt.
8. Existing three programmes for "most-at-risk" populations:
1. ICDS - The Integrated Child Development Services : It has 14 lakh Anganwadi Centres, and reaches 10 crore children upto 6 years, and pregnant women and nursing mothers; 
2. MDM - Mid Day Meal scheme - 12 crore children in school; and 
3. PDS - Public Distribution System - 80 crore people under NFSA. 
4. We need to overhaul capability in these three.
9. NNS and NNM: They both have ambitious 2022 targets. 
1. Reduce stunting, under-nutrition and low birth weight by 2% each year, and 
2. Reduce anaemia by 3% per year. 
3. It surely is important to have common goals. But more important is to break them up by year, state, and districts. We need a dashboard and real-time tracking. (an earlier mechanism was dissolved in 2015)  
10. What about the private sector? While both NNS and NNM understand the necessity of collaboration across Ministries, both are silent on private sector's role. What all is needed to fight this nutrition-battle : 
1. increased availability of nutritious food & potable water 
2. hygiene and sanitation 
3. primary health care, etc. India has to address poor diets + poor sanitation + poor disease management.
11. Three urgent priorities: 
1. Re-engineer ICDS, MDM and PDS for higher effectiveness – Involve nutritionists to work with local communities to design nutritious foods that are within budget, and made by SHGs, and taken up as CSR by private firms.
2. Mandatory food fortifications with micro-nutrients : This is needed to ensure people get vitamins and minerals from the staple foods they consume. Other than salt, fortifications like edible oil, wheat, rice, dairy products need to be scaled up. "Hidden hunger" or micro-nutrient deficiencies can be tackled thus (Example of iodised salt in reducing iodine deficiency is proven). PDS will have to supply these, and PPP is the way out.
3. Education and advertising campaigns : These are needed for breast feeding, diet diversity, hand-washing, de-worming, safe drinking water, hygiene and sanitation. PPP can be used here too.
12. A complex exercise: Nutrition is not an easy thing, and only through a simplified delivery that works across domains, uses technology and capable people, can it happen.
13. Nutrition = Economic growth: Without it, the population will remain under-nourished and malnourished.
14. Summary : The complex task of ensuring nutrition for all Indians can be accomplished only if all concerned Ministries and domains work
    collaboratively, private sector is involved and a proper design is put in place.

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