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.
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.