It must have been a while since I visited a small town called Tonk in Rajasthan, which is around 100 kms from Jaipur. There is particularly nothing memorable about Tonk, except a group of adolescent girls, I met as part of understanding issues related to their health and education. We were accompanied by an organization that works with these young girls to help access their rights. I didn’t know what to expect as I had read and heard about child marriages being very high in this town. But I was surprised when I came across empowered, loud and bold young girls who were not afraid to talk about issues women faced in their town. We touched upon many challenges faced by these young girls but one that really caught my attention is the sheer disgust on their faces when we spoke about the consumption of iron folic acid tablets. Most of them spoke out and mentioned that the tablets they received if at all, once consumed caused nausea and discomfort, so it was best that it was dumped. To be honest I could relate to this but I knew that in the absence of any ready alternative, consumption of these tablets was critical in tackling anemia caused due to iron deficiency. The prevalence of anemia is a serious one in our country where the current rates are 53% amongst women aged between 15-49 years according to National Family Health Survey (NFHS) 4 data. What is really worrying is that the reduction in the prevalence of anemia between NFHS 3 and NFHS4 has not been very significant.
When I read the National Nutrition Strategy (NNS) launched by Niti Aayog a couple of days ago, it was satisfying to see reduction of anemia stand out. The strategy spells out that one of the main vision is “To reduce the prevalence of anemia among young children, adolescent girls and women in the reproductive age group (15- 49 years) by one third of NFHS 4 levels by 2022.” As a strategy document the NNS accurately identifies the problem and also states the right guiding principle to achieve the outcomes. The principles are rooted in building good governance for nutrition and keeping the community central to implementing nutrition related programmes. The “how” of achieving the strategy is also practical with the focus on governance reforms starting at the highest level by activating the Prime Minister’s Nutrition Council and building mechanisms for ministries to work together especially the Ministry of Women and Child, Ministry of Health and Ministry of Rural Development. Further the strategy focuses on decentralized nutrition planning with a convergence of the flagship programmes like ICDS, NHM and Swachh Bharat Mission. There has been an attempt to keep the focus, to districts that are most vulnerable and it was a relief to see that monitoring the programme has been given weightage by creating a Nutrition Information System to track the strategy. An interesting tool suggested in the document is the Social audit units to evaluate the progress of various programmes and also build accountability on nutrition at all levels in the bureaucracy and service providers. Overall the NNS is a holistic document, but to achieve the desired results the nutrition community and investors must tease out the right pathways in their context.
Having said this, I still worry as we have a crisis at hand with the high prevalence of anemia and without a focused basket of interventions aimed at children under 3 and the life cycle of a woman, the needle on this problem will not move. There are well designed schemes like SABLA, ICDS, National Iron + Initiative, but the movement is slow and a possible reason could be the lack of strategic focus which I was hoping the NNS would capture considering the outcomes to be achieved by 2022. Given the history in improving anemia amongst children and women, a recommendation to all stakeholders is to target vulnerable districts with a layered approach. Traditionally most nutrition investments are targeted at immediate determinants of nutrition, followed by underlying and very minimal at basic determinants. It is time to turn this on its head and focus on women empowerment to build strong foundations, then ensure that children and women have access to rights and health services and finally design programmes to improve diet diversity amongst the community. The hope is that the governance mechanism created by the NNS will allow for such programmes to be developed keeping the beneficiary at the center of problem solving.
IPE Global Limited
Views expressed are personal.