Nutrition Mission: A way forward towards tackling malnutrition through a multi-sectoral approach at the National & State Levels

The key findings from the 2013 Lancet series on maternal and child nutrition show that nutrition sensitive programmes in agriculture, social welfare, early child development and schooling can be successful at addressing several underlying determinants of nutrition. Once there is consensus for a multi-sectoral approach, then only there is a way to tackle all the causes of malnutrition in a coordinated and synergistic way.

In Rajasthan wasting and severely wasting rate is 23 % and 8.6 % respectively which is comparatively higher than the National level (21% and 7.5%-NFHS-4) figures. Similarly, in case of stunting also 39.1 % of the children are affected that makes it higher than India’s (38.4%) data. The Global Nutrition Report 2016 pegged malnutrition related economic losses to be around 11 per cent of the GDP per year in Asia. It has been estimated that because of under nutrition, India will suffer an economic loss of about $40 billion by 2030, which might perhaps be the highest loss of human potential ever (Save the Children).

Nutrition is the cornerstone that defines and affects health and well-being of all individuals. Despite several policies and programmes both at the national and the state levels, raising the health and nutritional status of the child population still remain a mammoth challenge. The sustainable development goal-2 aims at “Zero Hunger” which is indeed a priority area for India. To ensure food and nutrition security, there is a growing need for a multi- sectoral convergence approach. The policies and programmes of various ministries should see some sort of convergence and alignment for better results within health and nutrition in India. This will not only transform India’s nutritional practices, but also spread awareness about nutritional best practices among key vulnerable groups, including the tribal, women and children. Multi-sectoral actions improve nutritional outcomes in several ways. The causal framework for nutrition by UNICEF highlights the immediate and underlying determinants of nutrition, calling for both nutrition specific and nutrition sensitive interventions, as envisaged in the National Nutrition Policy 1993. These involve several sectors such as the Women & Child Development, Health, the Ministry of Consumer Affairs, Food and Public Distribution, Sanitation & Drinking Water, Rural Development, Livelihoods, Education and Agriculture, among others. Indirect multi-sectoral nutrition interventions are also designed to have a longer term impact – even inter generationally such as girls’ education.

Under nutrition can be prevented through a range of programmes across different sectors i.e. Health, Water Sanitation and Hygiene (WASH), Agriculture, Education and others. On one hand, the different factors which lead to under nutrition are diverse, complex and interconnected, while on the other hand, the programmes of the government of India under different Ministries are mildly interconnected. The immediate determinants are related to food and nutrient intake and health. The underlying determinants include household food insecurity, inappropriate child care practices and unsafe environments including low access to safe drinking water, sanitation and hygiene, inadequate access or availability to health service and education, which are themselves often linked. The immediate causes of under nutrition can be addressed through a well-planned strategically designed multi sectoral approach by improving dietary intake which also helps to address the underlying causes of under nutrition like improved sanitation, hygiene and women’s education.

Nutrition specific interventions address the immediate determinants of fetal and child nutrition and development, such as-adequate food and nutrient intake, feeding, caregiving and parenting practices, and low burden of infectious diseases. Nutrition sensitive interventions address the underlying determinants of fetal and child nutrition and development, like- food security, adequate caregiving resources at the individual, household and community level; and access to health services and a safe and hygienic environment and incorporate specific nutrition goals and actions. Thus achieving nutrition’s full impact on health and development outcomes requires a multi-sectoral approach which will achieve optimal nutrition outcomes through greater coverage, while also helping other programmes achieve improved results and demonstrate their own potential for impact.

On the occasion of International Women’s Day, the Prime Minister, Shri Narendra Modi, launched the National Nutrition Mission, and expansion of the coverage of Beti Bachao Beti Padhao programme, at Jhunjhunu in Rajasthan on 8th March 2018. The National Nutrition Mission (NNM) has been set up with a three year budget of Rs.9046.17 crore commencing from 2017-18. It is as an apex body under the Ministry of Women and Child Development will monitor, supervise, fix targets and guide nutrition related interventions across the Ministries. It will comprise mapping of various Schemes contributing towards addressing malnutrition, including a very robust convergence mechanism, ICT based Real Time monitoring system, incentivizing States/UTs for meeting the targets, incentivizing Anganwadi Workers (AWWs) for using IT based tools, eliminating registers used by AWWs, introducing measurement of height of children at the Anganwadi Centres (AWCs), Social Audits, setting-up Nutrition Resource Centres, involving masses through Jan Andolan for their participation on nutrition through various activities, among others. There are a number of schemes directly and indirectly affecting nutritional status of children (0-6 years age) and both pregnant women and lactating mothers. The underlying concern is that these schemes lack a sense of synergy and linkages which could achieve improved common goals. It’s implementation strategy will and should be based on intense monitoring and convergence action plan right up to the grassroots.
The targets of the NNM are:

• To reduce stunting, under-nutrition, anemia among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
• Although the target to reduce Stunting is at least 2% p.a., Mission would strive to achieve reduction in Stunting from 38.4% (NFHS-4) to 25% by 2022 (Mission 25 by 2022).
• More than 10 crore people will be benefitted by this programme. All the States and districts will be covered in a phased manner i.e. 315 districts in 2017-18, 235 districts in 2018-19 and remaining districts in 2019-20.

The State Nutrition Missions established in different states such as in Gujrat, Maharashtra, Uttar Pradesh, Chhattisgarh, Haryana etc. for tackling malnutrition is an integrated and multi-sectoral strategy based on inter-sectoral approach as per the state nutrition indicators and plan of action. Similarly, responding to malnutrition crises, Rajasthan needs to be focused, to establish this mission for quality service delivery with focus, coordination and convergence. Rajasthan State Nutrition Mission could be helpful for the convergence of all the concerned departments and sectors actively involved in addressing the multiplicity of causes and the multiple determinants of nutrition. This Mission would serve as an example for achieving health and nutritional goals through a mission mode, based on specific strategies and local initiatives. By engaging multiple sectors, partners can leverage knowledge, expertise, reach and resources benefitting from their combined and varied strengths as they work toward the shared goal of producing better health outcomes. The roles and responsibilities of different sectors/ministries need to be defined in this perspective, with accountability for monitorable outcomes. Strategies to resolve the issue of malnutrition needs to be designed tactfully keeping in mind that food security and access to healthcare needs should be a basic human right.