National Nutrition Mission

The Nutri­tion Data Calls for a Holis­tic Nutri­tion Plan The NITI Aayog India has recent­ly pub­lished Nutri­tion Charts on 17 Jan­u­ary 2018. With India recog­nis­ing nutri­tion as a nation­al issue and gear­ing up for Nation­al Nutri­tion Mission(NNM), such data pub­lish­ing helps wide vari­ety of peo­ple asso­ci­at­ed with health­care and nutri­tion ecosys­tem in our coun­try to get into action and aid in mis­sion mode imple­men­ta­tion. The Glob­al Nutri­tion Report 2015 esti­mates invest­ment in nutri­tion has a cost ben­e­fit ratio of 1:16 for 40 low and mid­dle income coun­tries. More over invest­ment in nutri­tion is recog­nised glob­al­ly as both crit­i­cal devel­op­ment imper­a­tive and as ful­fill­ment of human rights.

The pub­lished data rep­re­sents the cur­rent state of nutri­tion in our coun­try. Data col­lec­tion from across nation­al to dis­trict lev­el paints a real time pic­ture of progress and out­come assess­ment. This trans­paren­cy is huge wel­come step as it will help in var­i­ous spheres such as data dri­ven approach to prob­lem solv­ing, ana­lyt­i­cal­ly & time­ly choos­ing of appro­pri­ate pol­i­cy inter­ven­tion, draw­ing of best prac­tices intro­duced in dif­fer­ent states in achiev­ing tar­gets, involve­ment of relat­ed NGOs for grass root infor­ma­tion dis­sem­i­na­tion, improv­ing coop­er­a­tive and com­pet­i­tive fed­er­al­ism by cor­re­spond­ing incen­tivi­sa­tion of best per­form­ing states. This data calls for an urgent and well thought-out plan of action to improve the nutri­tion­al out­comes of the coun­try.

Indi­ca­tors Used: The key indi­ca­tors that the report includes are stunt­ing, wast­ing and under­weight. ‘Stunt­ing’ (low height for age), which is a direct con­se­quence of mal­nour­ish­ment, is a key indi­ca­tor to under­stand the nutri­tion­al sta­tus of dif­fer­ent states and dis­tricts. The over­all stunt­ing rate of the coun­try is 38.40 % and UNICEF places this at “High” as it is between 30 and 40%. Ker­ala is the best per­form­ing state with 19.70% stunt­ing and Bihar records the high­est rate of stunt­ing with 48.30 %. A look at the stunt­ing map sug­gests that the states in the mid­dle region name­ly Rajasthan, MP and UP have high lev­els of stunt­ing, the plateau have rea­son­ably low lev­els and the north most and south most states seem to be per­form­ing well. Includ­ing Maha­rash­tra and Gujarat the pic­ture is sim­i­lar for the ‘Under­weight’ indi­ca­tor as well.

While stunt­ing is a chron­ic prob­lem, ‘wast­ing’ is rel­a­tive­ly short term and can be rec­ti­fied through a prop­er nutri­tion plan. With­out such a cure, this could lead to ail­ments like tuber­cu­lo­sis and chron­ic diar­rhoea. North­east states have rea­son­ably low rates of wast­ing while the west of India has high wast­ing. Mizo­ram is the best-per­form­ing state under this indi­ca­tor and Jhark­hand records the high­est rate.

At this junc­ture, it would be inter­est­ing to go beyond these num­bers and analyse the con­tribut­ing fac­tors like health­care sup­port and bud­get, pre-natal care etc in each of these states.

Nutri­tion — a State Sub­ject Health and Nutri­tion, a state sub­ject, pro­vides lot of scope and flex­i­bil­i­ty for each state to look into imple­men­ta­tion details. While broad­er poli­cies at the Cen­ter form direc­tives to attain­ing nutri­tion objec­tives, the nit­ty grit­ties of imple­men­ta­tion are open for state play­ers to adapt and adopt. Thus it becomes impor­tant for the states to metic­u­lous­ly draft an imple­men­ta­tion plan which is both effec­tive and time­ly. Dili­gent care has to be tak­en to choose holis­tic solu­tion towards solv­ing nutri­tion prob­lems. When try­ing to tack­le at a large scale, it’s con­ve­nient to adopt a quick-fix solu­tions that can boost nutri­tion lev­els. The Min­istry of Women and Child Devel­op­ment was proac­tive in in noti­fy­ing that the Ready-to-Use Ther­a­peu­tic Food (RUTF), which is mix­ture of peanut, oil and oth­er ingre­di­ents, does not have a sci­en­tif­ic back­ing and hence can­not be accept­ed as a pol­i­cy of the Gov­ern­ment. This hap­pened when some states were try­ing to use it to tack­le nutri­tion prob­lems.

Poten­tial solu­tions

Now that we have data that gives a good pic­ture of the prob­lems, what could be some poten­tial solu­tions?

Local Food: While it would be easy to offer stan­dard­ized meals to all chil­dren who are below the aver­age lev­els of the indi­ca­tors, care has to be tak­en to under­stand the local needs. Each state or region in the coun­try grows crops that is in tune with the cli­mat­ic con­di­tions of the place and the nutri­tion­al needs of the com­mu­ni­ty. Map­ping of whole­some local foods and encour­ag­ing their cul­ti­va­tion will be a cost-effec­tive, scal­able solu­tion and reap inter-gen­er­a­tional ben­e­fits.

Best Prac­tices Shar­ing: Some states score very high on the indi­ca­tors con­sis­tent­ly. It will be impor­tant to delve deep­er into the fac­tors that have helped achieve these results. Shar­ing of these best prac­tices through forums, online por­tals, arti­cles etc can help cre­ate replic­a­ble mod­els.

Holis­tic Health Prac­tices: Indi­an health sys­tems, includ­ing Yoga and Ayurve­da have con­crete frame­works to under­stand the state of health of an indi­vid­ual and a col­lec­tive soci­ety. They also pro­vide instru­ments to under­stand the root caus­es and not just the symp­toms. These sys­tems also have holis­tic prac­tices that are less intru­sive and eas­i­ly scal­able. They also help to cre­ate self-reliant health mech­a­nisms with­in the fam­i­ly through self-admin­is­tered prac­tices, sim­ple herbal gar­dens and easy-to-pre­pare reme­dies. Con­sid­er­ing the ben­e­fits of Yoga and Ayurve­da, it is sug­gest­ed that insights from the AYUSH Min­istry may help design a com­pre­hen­sive nutri­tion plan.

Tech­no­log­i­cal Inter­ven­tions: While tech­nol­o­gy can­not direct­ly enhance the health of chil­dren or moth­ers, it can become a great tool for data cap­ture, mon­i­tor­ing and infor­ma­tion dis­sem­i­na­tion. Mobile apps that edu­cate expec­tant moth­ers, tablet PCs that can help ASHA and Angan­wa­di work­ers cap­ture more data and sim­ple embed­ded devices that mon­i­tor progress can go a long way in ensur­ing that the ben­e­fits of the nutri­tion plan are imbibed in a con­tin­u­ous man­ner.

The data that NITI Aayog has released has great poten­tial for design­ing a com­pre­hen­sive nutri­tion plan. What would be impor­tant at this stage is to involve mul­ti­ple stake­hold­ers, includ­ing suc­cess­ful civ­il soci­eties, holis­tic health sys­tem experts, local com­mu­ni­ty experts etc, to design a plan that helps tack­le the prob­lem organ­i­cal­ly. While quick-fix stan­dard­ized solu­tions can boost the data in a short peri­od of time, for long-term and robust health ben­e­fits of the chil­dren and expec­tant moth­ers, a holis­tic solu­tion is imper­a­tive.