Towards achieving the World Health Assembly (WHA) nutrition targets of 2025 and SDG goals by 2030, there is a need to intensify our efforts for a fast track improvement in Maternal, Infant, and Young Child Nutrition (M IYCN) situation. This implies accelerating the reduction rate of stunting in under five year children from the current rate of 1.3 percent in the last decade to a much higher rate of 3 percent. It is well established that there is a need to redesign the nutrition program by increasing the coverage of evidence based direct essential nutrition interventions (ENIs) in first 1000 days of life to at least 90 percent as well as ensuring inputs are intensified to address nutrition sensitive issues such as improving socio-economic and education situations of women, access to diversified food, improved sanitation and hygienic environment. The ENIs comprise interventions for improving young child feeding practices, maternal nutrition, improving supply and compliance of IFA tablets by adolescent and pregnant women, energy-protein supplements to undernourished pregnant women and prevention and treatment of severe acute malnourished (SAM)children. Both, universal ENIs coverage and simultaneous multi-sector inputs, are imperative and challenging.
The nutrition program systems therefore need to go beyond ICDS and Health sectors. NRLM (now renamed DAY:NRLM) , which focuses on economically empowering poor women for eliminating poverty, needs to be included as a key partner for improving MIYCN situation. There is a need to understand why DAY:NRLM should be an integral part of revised nutrition design. It may be noted that one of the ten focus areas of NRLM, under the concept of “dussutri” , is improving health and nutrition of women. Towards this, NRLM has also launched Mahila Kisan Sashaktikaran Pariyojana (MKSP) where women farmers are being systematically organised in integrated farm and allied activities for attaining food and nutrition security in the poorest of the poor families. The DAY:NRLM aims to build, support and sustain livelihoods of the poor of women by forming self- help groups (SHGs) for microcredit enterprises. The SHGs are federated into Village Organisations (VOs), cluster level and district federations. NRLM, in its mission mode, is expanding fast and is a priority program of Government of India. DAY:NRLM is currently operating in 411 districts with 24.62 lakh SHGs and 1.23 lakh VOs. A total of 2.70 crores (27 million) households are covered. By 2020, universal coverage of rural households in all states and UT’s of the country is targeted.
Recognising the implications of malnutrition on illness, malnutrition and poverty, NRLM measures are being systematically linked to selected health- nutrition – sanitation initiatives. Evidence of on-going state level programs and experimental pilot projects in selected states such as Bihar (Jeevika and Swabhiman), AP , Himachal Pradesh (CORD)), Kerala and Maharashtra demonstrate that VO’s can play an effective central role in creating awareness amongst SHG women members of their entitlements to various existing government schemes and also in creating multisector demands for actions pertaining to improved agriculture/horticulture, water and sanitation, conditional cash transfer schemes for girls education, significance and legal protection from early marriage, addressing domestic violence. Timely response to these demands is also facilitated by VO’s by seeking support from officials of block and district representatives of the various sectors of the state governments. In most states. NRLM, including MKSY initiatives, have also demonstrated how economic improvement can be systematically linked to actions for behavioural change for improved nutrition practices at family level, especially of pregnant women and young children 0-24 months. Additionally, VO’s offer opportunity to mobilise and map families not reached and ensure universal coverage of under twos with ENI’s by ICDS and health sectors.
Taking the above facts and state experiences into consideration, a nutrition program design entitled “Livelihood cum Nutrition, Health and Sanitation (LNHS)” was released in May 2016 by the Ministry of Rural Development. LNHS program presents details of objectives, strategy, operational plan and monitoring indicators and also highlights the lessons emerging lessons from state experiences (CARE (2016), Deendayal Antyodaya Yojana: National Rural Livelihood Mission (DAY:NRLM). A key partner for improving Maternal, Infant and Young Child Nutrition situation in India. A study by Dr Sheila C. Vir, Consultant. Preface by Mr Amarjeet Sinha , Secretary Ministry of Rural Development, Published by CARE India Solutions for Sustainable Development ,May 2016).
Public Health Nutrition Consultant,
Director, Public Health Nutrition and Development Centre