Health and nutrition for children and mothers have been at the forefront of policy concern in the Indian state of Odisha over the past 25 years. Improvements have been made at multiple levels including increased policy and financial support as well as issues related to nutrition outcomes such as feeding, caregiving and hygiene. A recent paper in Global Food Security looks at the factors that have helped drive progress in nutrition in Odisha.
The authors note that Odisha has high levels of poverty, especially among marginalized tribal communities. Despite these challenges, a number of nutrition initiatives have been successful. In fact, the rate of stunting in Odisha is 3 times lower as compared to other Indian states with similar poverty levels (Raykar et al., 2015); and although the infant mortality rate is still higher than the national average in all India, average, it has been reduced significantly in the past 25 years. Due to these positive changes, the authors looked to shed light on the successes and build upon them.
The researchers used multiple forms of data and outcomes of health improvements such as; like stunting and infant mortality rates to understand what drives positive change and how that progress can be accelerated in other states in India or even outside of India. Specifically, data from 1990- 2015 was used and various nutritional policies and programs were linked to overall improvement in the state’s nutritional outcomes. Interviews with community members and policy stakeholders in various social service offices were also taken into account to allow further insight.
There are two national programs in India that facilitate nutrition and health interventions. They are the Integrated Child Development Services (ICDS) and the health/National Health Rural Health Mission (NRHM). ICDS has village-level centers where their programs are administered.
The results were very positive overall; early adoption and exclusive breastfeeding rates increased over the 25-year period, as well as antenatal care, assisted births, immunizations and food supplementation. Continued challenges are malaria (Odisha represents 20% of India’s malaria cases in 2010, even though the rate has decreased in the last decade), low body mass index among women, clean water and sanitation, complementary feeding and folic acid supplementation (despite the supplementation of vitamin A being on the rise).
The main catalyst to nutrition initiatives was the media and intense human rights monitoring of starvation deaths in the state of Odisha during the 1990s. In response to this, one of the actions taken by policy makers was to give bureaucrats tenure in their positions to allow services to remain uninterrupted. It also allowed them the time needed to gain knowledge of the situation and then to experiment with various innovations based on that knowledge. These administrators were then given the ability to take the credit for implementation of new programs.
Political stability over the last decade in Odisha has also allowed the state to innovate around the policy and programs offered to support the social sector. Another important initiative was financial support at the national, state and international levels (including UNICEF, the World Bank, CARE and the United Nations), insuring diverse sources of funding and increasing technical support to health and nutrition programs in Odisha.
Transparency in recruitment and hiring and including women-led leadership, especially at the village administrative centers also helped motivation and participation in the programs.
One of the biggest positive changes in overall policy in the past 25 years has been the shift in focus from just reducing maternal and child mortality to a more holistic approach. Initiatives to that end include access to nutritional supplements and supplementary food, long-lasting insecticidal nets for pregnant women, monthly screening for malnourishment, better road connectivity, access to free medical care, rice subsidies, increased access to water and fertilizers for better crop yields, as well as financial incentives and women-led self-help programs.
However more work needs to be done to improve drinking water quality, overall sanitation and access to indigenous varieties of food due to loss of land and forest access. Inquiries into these issues show that sanitation programs have usually taken a back seat to road construction (both are under the department of rural development) mainly to service the timber and mining industries. There is a program under the National Rural Health Mission, and its own Village Health and Sanitation Committee structure, called the Gaon Kalyan Samiti, that focuses on promoting good hygiene among adolescent girls and mothers that looks promising, but without an evidence of impact.
Taking a holistic approach means that social sector administrators are also looking at the role women’s education, age at marriage and decision making power have on overall health and nutrition. These are all areas that continue to be a struggle in Odisha as nearly one third of women are married by age 18 and less than 50 percent participate in household decision making; these issues have yet to be addressed by the state.
In conclusion, even in the midst of extreme challenges, in the past 25 years Odisha has seen increased progress with regard to overall health, nutritional and food security initiatives compared to other Indian states with similar levels of poverty. These changes occurred due to the state’s commitment to reduce starvation deaths as well as high infant and maternal mortality rates. Through the desire to change these outcomes, the state has used international, national and local financial resources; administrative competence and tenure; technical improvements; and political policy makers to create a more stable infrastructure from which to work these programs from a more holistic outlook. In addition to these, future work needs to focus on engaging other governmental departments in order to bring critical factors like sanitation, the empowerment of women, land rights and sustainable livelihoods to the forefront for improvements in the coming decades.
Written by: Jenn Campus