Science is certain that persistence of under-nutrition creates irreversible changes in the learning abilities of many infants, besides susceptibility to disease as they grow. The first thousand days are the key to reversing changes and ensuring proper nutritional development of every infant and mother. The Fifth National Family Health Survey 2019-21 (NFHS-5) reports 35.5 per cent children under five are stunted, 19.3 per cent wasted, and 32.1 per cent under-weight. These are unacceptable levels and compromise India’s coming generation’s learning and health.
The challenge of tackling under-nutrition is no rocket science. It can be tackled effectively over a short period if the thrust is correct. The recently released NFHS-5 brings out the unfinished agenda and the slow rate of decline in under-nutrition. Nutrition as a subject does not lend itself to narrow departmentalism.
Technology can at best be a means and monitoring too has to become local and community led. Panchayats and community organisations are the best way forward. The nutrition challenge is also a women’s empowerment challenge. It is an important behaviour change challenge in favour of exclusive breast feeding, natural foods instead of junk food, clean water, sanitation, and food diversity.
The National Rural Health Mission pushed the community activity of Village Health, Sanitation, Nutrition and Health Days (VHSND). This thrust translated into an improvement in nutrition indicators. Decentralisation through PRIs (Panchayati Raj Institutions) and urban local bodies with funds, functions and functionaries becomes imperative to be able to make need-based choices and meet resource needs.
Communities need attractive and periodic activities with a role in the monitoring of their children’s progress. If more people in a village including panchayat leaders and women SHG (self-help group) and cooperative institution representatives can weigh and measure infants, timely interventions to tackle under-nutrition is possible.
Timely availability of basic medicines often reduce the incidence of wasting caused by seasonal illnesses drastically. It is time every infant and pregnant mother is monitored by a frontline worker or a community volunteer, and local governments have the responsibility and resources to seek redress of deficits.
There is a strong case for wider determinants of health priority, considering the impact of clean water on water-borne diseases, sanitation on vector-borne diseases, and improved housing and safe cooking on the physical and environmental health of the poor households. With a thrust on these sectors as part of the pro-poor public welfare and improving ease of living, it is a good time to make quantum gains in nutrition.
Balanced diet vital
While foodgrains contribute to food security, it does not alone address the challenge of chronic hunger and under-nutrition. Infants in their growing age and pregnant women need a range of vitamins, minerals and proteins that are not there in foodgrains alone. They need a balanced and diverse meal where fruits and green vegetables, milk, eggs, pulses, oil andpaneer are all an integral part of the food. Diversity of food in adequate quantity and of appropriate quality is the way forward.
If we want to improve our position on the Global Hunger Index, we will have to address under-nutrition as a societal mission where women SHGs, panchayat leaders, frontline workers and households have well-defined responsibilities. Flexibility and mid-course changes at the cutting edge to respond to felt need is a must in any system of public management. Same size fits all is a recipe for disaster and flexibility calls for enormous public accountability.
We need to develop institutions of accountability through community monitoring and action, social audit and community led planning and implementation. The Gram Panchayat Development planning process has to give primacy to nutrition as most of the 29 transferred sectors with Panchayats have a direct role in improving nutrition.
Some very poor villages or hamlets may well need Day Care Centres and other support and the programme has to be flexible enough to provide for need-based interventions at the local level.
Complementary and supplementary feeding at six months and immediate and timely support in case of diarrhoea, dysentery, fever, skin infections, etc., to prevent repeated loss of appetite and dehydration, are critical as often infants get undernourished on account of a few of these episodes going unattended. It makes the infant weak and susceptible to further infections.
Measurement holds the key as it will facilitate a focus on those who need immediate attention. There may even be a need for care and support at a facility if infants have already fallen into severe under-nutrition.
The efforts at local nutrition kitchen gardens and fruits and vegetables grown in school premises and on other public lands will create a societal impact on under-nutrition. Food diversity and in appropriate quantities are critical for child survival. The Gadhchiroli experiment bears this out.
Under-nutrition also calls for an appreciation of the need for mature age at marriage and at first delivery. Social movements for women’s rights and care during adolescence and during pregnancy need a strong thrust. With more women in Panchayats and a large presence of women SHGs under the Livelihood Mission in rural areas, it is an opportunity to make a difference in gender relations.
The National Education Policy 2020 has emphasised the continuum of learning and views pre-school learning as integral to primary learning. It is hoped that the partnership with schools will improve access to food for children in the 3-6 age group. The duplication will lead to savings that should be used more effectively for 6-36 month infants.
The use of technology for monitoring is needed. And immediate rectification ought to be the focus. Support for immunisation and health services and periodic health assessments by trained local community frontline workers will be helpful. Guidance to parents is needed and greater the interaction of the frontline worker with households, the greater the likelihood of timely interventions.
Let us address the curse of under-nutrition with complete involvement of State, local governments, civil society, community organisations, industry, business and all of society and government.
The writer is a retired civil servant. Views are personal