Stories of Change in Nutrition: Odisha
Source: Flickr, DFID
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Odisha has high levels of poverty and has faced several development challenges over the years, including insurgent movements, large pockets of extreme deprivation, social disparities, and natural disasters. Despite these challenges, Odisha has demonstrated significant commitment to reducing undernutrition and has seen some achievements.

In September, a study by the Stories of Change research project was released that examines the changes in nutrition in Odisha as well as the policies and factors which have driven these changes. The study also highlights continuing challenges and areas where progress has been slow, and provides a number of recommendations for sustaining and achieving future reductions in undernutrition. The study covers the period from 1991 to 2015 and its findings are based on a variety of sources, including: stakeholder interviews at the state level (government staff, civil society members) and with community members (mothers and frontline workers) and data from official documents.

Overall, the study emphasises that Odisha has performed better in reducing undernutrition compared to richer states, and has seen improvements in most determinants of nutrition such as early initiation of breastfeeding, exclusive breastfeeding and children with diarrhea. For instance, the proportion of stunting and wasting among children younger than 5 years in Odisha fell from 51 percent to 38 percent and 28 percent to 18 percent respectively between 1992 and 2014 with faster reductions noted in later years.

The study finds that these improvements have mainly been driven by increased coverage of nutrition-specific interventions and improved interventions for food security and infrastructure. The increased coverage of nutrition-specific interventions, such as vitamin A supplementation, immunization, etc., have been achieved by significant and clear policy support for these interventions, as well as significant amounts of financing at both the national and state level. Furthermore, development partners and civil society have also contributed significantly to expanding nutrition interventions.

The improved interventions for food security were achieved through state level reform of the public distribution system (PDS) that improved access to the PDS, strengthened delivery systems and reduced leakages. Simultaneously, significant investments were made that improved roads, drinking water sources and rural electrification. These improvements helped improve food security interventions as they enabled interventions to be conducted in remote areas.

Despite these achievements, the study notes that progress in the areas of sanitation, women’s education, and poverty reduction has been slow and that these factors have implications for and are significant challenges to achieving future improvements in nutrition. Over the past few decades, relatively little emphasis has been placed on improving sanitation and Odisha currently has extremely low access to improved sanitation. Similarly, despite improvements in female literacy, significant gaps remain in female secondary education rates and completion. Moreover, Odisha has achieved slower reductions in poverty rates as compared to other states and income inequality has remained high.

Based on these challenges, the study suggests that scaling up poverty reduction efforts and tackling income inequality could lead to more rapid reductions in undernutrition.  The study argues that despite the successes in reforming the PDS coverage, it still needs to be further scaled up.  The study also argues that political and bureaucratic leadership, which was instrumental in achieving reductions in undernutrition, needs to expand to include the sanitation and education sectors and this needs to be complemented by supportive and inclusive policies. Furthermore, the study recommends that a significant portion of Odisha’s budget be allocated to the health and nutrition sectors.

By: Bas Paris

Photo credit:Flickr, DFID