Why have I dedicated 30 years of my life to public health nutrition? The quick answer is that 45 percent of child deaths are attributable to malnutrition, and many children who do survive malnutrition are deprived of optimal physical and cognitive growth.
It has been a great year with the world waking up to the urgent need to address malnutrition. When I look back over the last 12 months and consider the most important moments in nutrition, I think of the Global Nutrition Summit held in Milan — which brought together actors across the globe, including the Tata Trusts, to commit $3.6 billion into nutrition — and the launch of India’s Poshan Abhiyaan, the National Nutrition Mission. Both are major steps with the potential to change the trajectory not just for India, but for the world.
India represents at least one third of the world’s burden of malnutrition; therefore, as a global community, we will not be able to keep our Sustainable Development Goal promise of eliminating all forms of malnutrition by 2030 unless we accelerate progress in India. A program of the stature and scope of Poshan Abhiyaan is a huge step towards this.
India has had many of the Poshan Abhiyaan building blocks in place for some time, from robust policies in line with global best practices to a committed battalion of 2.5 million front line workers, including Anganwadi workers (AWWs), Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). There are strong self-help groups working towards empowering women, and new energy to ensure programmes in sectors like agriculture and food processing to ensure programs are helping to improve nutrition.
So, what has been missing, and why am I so excited about the potential of Poshan Abhiyaan?
First is the level of political attention and support for the National Nutrition Mission. This alone represents a huge opportunity to make real change in nutrition outcomes for women and children.
Second is convergence. The framework facilitates ministries, departments, donors, non-profits and ground workers to come together. This streamlining will reduce the amount of time and resources spent.
The focus on convergence will also mean utilising existing opportunities. Starting when a woman goes to a clinic to confirm her pregnancy up until her child’s second birthday, her family will have multiple touch points with the health system. Antenatal care, institutional delivery, immunisation sessions, home visits, Annaprashan diwas and Godbharai are all opportunities to counsel families on good nutrition and provide services.
Yet in the past, these programmes have not been well-coordinated and nutrition has been neglected. In Bihar, for instance, 90 percent of women get a tetanus shot through the antenatal clinic platform but less than 10 percent of mothers consume the recommended dose of Iron Folic Acid (IFA) that is critical for the health of the mother and the child she is carrying. Prioritising nutrition would mean mothers receive IFA tablets and counselling on good nutrition when they visit a clinic to get their tetanus vaccination.
Breastfeeding, which is one of the most vital ways to save children’s lives and ensure their future development, is another example. 65 percent of women give birth in clinical facilities in Bihar, but only about 35 percent of women initiate breastfeeding within the first hour. If all women who delivered in a health facility were supported to initiate breastfeeding immediately, this opportunity gap would be closed.
Third is better use of data for decision-making. The strength of the programme’s success will lay in its ability to develop a strong evidence base through data gathering and sharing, and reacting to that data by designing targeted messages and campaigns and communicating effectively across multiple platforms and partners to reach the audience targets with the right messages and create the desired behavioural changes on a large scale.
Lastly, is its people-centered approach. The mission’s focus is to transform into a people’s movement, a Jan Andolan, to bring about change in the people themselves, in their behaviour. The mission is bringing the power of Janbhagidari, people’s participation, into making India’s children well-nourished and healthy. Behaviour change, especially when it comes with practices that are part of the social norm, require an all-of-society response – and the scale in this context is enormous.
The success of the National Nutrition Mission, like any policy, will lie in implementation. Ultimately, the deciding factor on how effectively Jan Andolan can be implemented across the country is up to the people the programme is looking to reach – adolescent girls, their mothers, pregnant and lactating women. But this change will not happen in a vacuum. Families, frontline health workers, community members, panchayat members, religious leaders, and teachers are all critical. Only with their support can the fight against malnutrition be won.
The author is Director of Nutrition, Bill and Melinda Gates Foundation.
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Updated Date: Oct 18, 2018 17:15 PM