‘Convergence’ is one of the most used terminologies in the field of development. Everybody recognizes its importance and understands its relevance for strengthening most social development indicators. Many states including Odisha, have a separate Planning-cum-Convergence Department for coordinating the efforts of different departments. However, little effort has been seen for ensuring convergent action in the area of nutrition. Public Health Nutrition is a multi-facet sector which needs joint effort of various stakeholders and Government departments.
There has been some reduction in under-nutrition over the last few decades and the results have generated a lot of learning. The results have been encouraging in most states, but it was way behind the targets set under MDG. In this age of globalization, rapid urbanization, wide and exhaustive reach of information and the national GDP staying above 6% on an annual basis, the reduction in under-nutrition has been just 1-2% annually. In fact, the number of wasted children has increased in the last decade. Hence, to conclude that such issues can be taken care of by ‘demographic dividend’ is mostly farce.
For reduction of under-nutrition, the need for convergence was felt long back. ICDS, the flagship Government programme for eradicating under-nutrition, was started way back in 1975 on a project mode and half of the six services envisaged under it are related specifically to Health Department. Several calls have been made by leading development organizations like UNICEF and CARE for convergence at various levels for smooth implementation of various programmes related to nutrition. It is one of the crucial approach that has been practiced, demonstrated and its outcomes have been widely recommended by most development players.
Some of the best practices on convergence like Village Health and Nutrition Days (VHND), the position of ASHA and village level ‘village health nutrition and sanitation committee’ (VCHNC) have been institutionalization and have proved to be successful too. All these are actions and institutions are at the community level or at the level of frontline workers. The convergent action needed to deal with issues like regular programme planning and review, streamlining the supplies, address the gaps and share the progress made by each player at all levels – Sector, Block, District and State level have been conveniently missed out.
Departments work in silos and want to limit their action to only those things in which they are good at or the things they are mainly expected to do. In the districts, the already over burdened Collectors who are supposed to ensure convergence for nutrition interventions. Convergence meeting at the state level is mostly need-based, takes a lot of efforts, has limited follow up and has to deal with a lot of resistance. Most States have not yet initiated ‘Nutrition Mission’ and its future appears to be bleak now. There seems little possibility of merging the efforts of ICDS (under Human Resources Department) with Health and Family Welfare Department. Other sporadic efforts like setting up of a ‘nutrition secretariat’ at the State level are still being experimented with the support of leading Development partners.
Amidst this scenario, National Food Security Act, 2013 provides a lot of opportunity in fulfilling this gap and some of the States have set up an empowered ‘State Food Security Commission’. The recent Supreme Court direction to the States to notify appropriate rules for grievance redressal under the Act and designating appropriate and independent officials as District Grievance Redressal Officers (DGRO) has offered tremendous opportunity to address the issue of lack of Convergence for food and nutrition interventions. The Act has also mandated ‘Vigilance committee’ at all levels and ‘social audit’ as a tool to address gaps and lack of transparency.
The experience of Odisha State Food Commission can be widely shared as an example for facilitating convergence at the State and District level, where it routinely conducts review meeting on all nutrition specific and nutrition sensitive programmes and schemes. Though, taking up this role has not been a pre-conceived well thought out plan, things got in place after subsequent joint review cum convergence meetings were held and lots of issues and gaps related to food and nutrition interventions were identified. Among all the nutrition issues reviewed in such meetings, five are already a part of NFSA like Targeted Public Distribution System (TPDS), Antodaya Anna Yojana (AAY), supplementary nutrition under ICDS, Mid Day Meals (MDM) and Maternity benefit scheme. Other schemes are also reviewed in these meetings like ‘National Iron Plus initiative (NIPI), Calcium supplementation to pregnant and lactating mothers, Deworming programme, Vitamin A supplementation, facility based management of Severe Acute Malnutrition (SAM), SABLA (Rajiv Gandhi scheme for empowerment of adolescent girls), Swachha Bharat Mission (SBM) and livelihood related programmes like MGNREGA, land lease and land demarcation under Forest Rights Act (FRA) and National Rural Livelihood Mission (OLM). The outcomes of such review meetings and advisories issued by the Commission have already started creating ripples.
With the institutionalizing of an independent DGRO, such convergent reviews and actions can be taken at the District and Block level on a regular basis and issues which arises due to lack of sharing or coordination can easily be addressed. The vigilance committee at all levels can monitor implementation and highlight the gaps. It is high time all the State Government framed rules for formation of a State Food Commission and a grievance redressal mechanism is set up as per the provision under NFSA. This empowered body, equipped with sound technical knowledge on food and nutrition issues, can play a significant role in addressing the gap of a coordinating cum regulating body, much needed for most nutrition interventions where ever convergent action is required.
Nutrition Consultant – Odisha State Food Commission