Take-Home-Rations: India’s last-mile nutrition programme

* A compendium published last month, by the Tata Trusts’ The India Nutrition Initiative (TINI) and Sight and Life (SAL), an international think tank, draws attention to the role THR can play in meeting nutrition targets

* THR provides food kits to children aged 6 months to 36 months, and pregnant or lactating women

* Low-cost, energy-dense, fortified, blended foods (THR) is a perfect supplement to the diet of many poor households, particularly during and after lockdown

A budget of ₹13,500 crore and a task that makes the word ‘mammoth’ seem tiny. The Government of India’s Take-Home-Rations (THR) programme, first launched in a nascent form in 1975, has many numbers to deal with in a country that has 4.6 crore stunted children and about 2.6 crore wasted (with low weight-for-height or small mid-upper arm circumference) children. THR provides food kits to children aged 6 months to 36 months, and pregnant or lactating women (PLW). A compendium published last month, by the Tata Trusts’ The India Nutrition Initiative (TINI) and Sight and Life (SAL), an international think tank, draws attention to the role THR can play in meeting nutrition targets. As the National Nutrition Month draws to a close, BL ink speaks to the compendium’s two lead editors, Rajan Sankar, director, TINI, and Kalpana Beesabathuni, Global Lead - Technology and Entrepreneurship, SAL.

Edited excerpts:

The THR scheme has been in force for 45 years. Why did you choose to bring out this report now?

Rajan Sankar: THR is a part of the supplementary nutrition programme (SNP) of Integrated Child Development Services (ICDS) that specifically caters to the needs of children aged 6 months to 36 months and PLW. It helps fulfil the missing amount of nutrition from their diets, but not by replacing the staple foods. It’s true that it has been in operation for decades but to achieve its true potential, a few important changes are required. That is the reason for our compiling this compendium. This is to set the stage for a dialogue to improve THR as a product and its appropriate use by the beneficiaries.

Kalpana Beesabathuni: In the last 10 years, a range of field experiments and models have shown some exciting cost-effective ways to improve THR delivery and its impact on the nutrition status of those most in need. This knowledge resides in various organisations from government institutions to not-for-profits and research institutes. With this compendium, for the first time, we all have come together to document our collective experience and key learnings in a digestible format.

Data shows that THR has indeed improved malnutrition and stunting numbers. Is enough being done?

RS: It is heartening to see that between 2005-06 and 2016-18, prevalence of stunting among children under 5 years of age declined from 48 per cent to 34.7 per cent, underweight from 42.5 per cent to 33.4 per cent and wasting from 19.8 per cent to 17 per cent. This is probably the effect of THR in combination with other ICDS programmes. The coverage of SNP and in particular THR is increasing. The last round of NFHS-4 [National Family Health Survey] showed that coverage has increased in most states. However, there is a lot of room for improvement in coverage.

Such schemes depend on people who carry out the functions on the ground. Did you come across any inspiring stories of people going the extra mile?

RS: Success of such schemes depends on those involved at the last-mile delivery. Women are playing a key and inspiring role. All women self-help groups (SHG) and other women’s groups have been involved more and more in production and supply of THR. Kerala’s Kudumbashree is a successful model. Odisha has done a cluster model where several SHGs come together to produce THR. In Rajasthan’s Banswara [district], SHG women set up a decentralised industrial model. It is small (with 8-10 SHGs) but effective.

KB: One story that deeply moved me was from Telangana. During the lockdown, when many children were not able to get their daily guaranteed meals from anganwadi centres (AWC), the anganwadi teachers went door to door delivering THR such as fortified rice, lentils, oils, blended food and eggs.

There are several short- and long-term suggestions in the report to improve the efficacy and reach of THR. Which one(s) do you feel are most urgent?

RS: There are multiple models for THR production — decentralised and centralised. Under decentralised, there are very small operations that cater to 1-5 AWCs and bigger cluster models that cater to 50-100 AWCs. There are also decentralised models that are mechanised as well as fully industrial models run by SHGs.

The continuing debate on what is the best model to make THR should take a back seat. All models can work and deliver. A programme monitoring system that provides real-time information, which can help course correct quickly, will add enormous value.

How has Covid-19 affected THR? What is the role of THR during the pandemic?

RS: The devastation caused by the measures that countries have adopted to contain the virus has wreaked havoc in every sphere of life. Millions of families on the edge have been pushed back into poverty.

The first casualty when cash income decreases is food, and more so nutritious foods. Children and pregnant women are the most vulnerable to this acute shortage. We are sure to see a sharp increase in stunting and wasting in children below 5 years, and a significant increase in low birth weight (LBW).

Low-cost, energy-dense, fortified, blended foods (THR) is a perfect supplement to the diet of many poor households, particularly during and after lockdown. It should be promoted both through the safety net programmes as well as through regular commercial channels.

KB: Covid-19 has disrupted India’s food distribution for the poor and the vulnerable since the first lockdown. Hot cooked meals and supplementary nutrition have been provided under ICDS schemes through 13,77,995 AWCs across India. Children under 3 years of age and PLW have been benefiting from these schemes.

This March, for the first time in 45 years since AWCs opened, they were shut down because of the pandemic. Six months later, except Chhattisgarh, all the AWCs remain shut. Besides, schools are also closed, so many vulnerable children missed their guaranteed school meal as well. THR can be distributed safely and hygienically during Covid-19. Further, they have a long shelf-life. These rations are fortified with essential vitamins and minerals and are crucial for the first 1,000 days of a child’s life and the health of a PLW, especially when they need a stronger immune response to fight infections.

( The full compendium can be accessed at https://www.wcdsbp.org/publications/THR-Compendium_220720.pdf )

Kalyani Prasher is a Delhi-based freelance writer

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