At “Made in India: Good Nutrition for All,” an event held in New Delhi on December 10 by the Public Health Foundation of India (PHFI) and the International Food Policy Research Institute (IFPRI), experts discussed the implications of the Global Nutrition Report and the India Health Report for nutrition security in India.
The welcome address was delivered by K. Srinath Reddy, president of the Public Health Foundation of India (PHFI). He proclaimed that 2015 was the year to transform health all over the world, including India.
“Health is fundamental for sustainable and equitable welfare of any developing country,” he said. While India has seen transformation in health indicators in recent years, the country still faces challenges such as the incidence of child stunting, undernutrition, and susceptibility to chronic diseases. “The momentum needs to be changed for achieving a sustainable pace,” he said.
IFPRI Senior Research Fellow Lawrence Haddad highlighted key points from the Global Nutrition Report. He pointed out that malnutrition affects every country in the world, and 45 percent of all mortality has some kind of linkage with undernutrition. The cost and benefit ratio of investing in nutrition is 1:34, which shows a great potential for government investment. Meanwhile, all countries are still off target to meet women’s anaemia and human obesity goals. India is making progress in breastfeeding but still ranks behind Bangladesh and Sri Lanka in terms of stunting.
Each stakeholder needs to contribute in order to achieve nutrition goals, said Haddad. The objectives of better nutrition and health can be met by making commitments, scaling up the interventions that work, and striving for policy coherence across the sectors. Each country needs access to a dashboard with quick facts—in the case of India, for instance, it would read that the country ranks 127th in Gender Inequality and 54th in Sanitation in the world—and to invest more resources in nutrition targets and data for tracking them.
According to the India Health Report, presented by Ramanam Laxminarayan of the Public Health Foundation of India (PHFI), stunting, wasting, and underweight rates of India’s children have declined over the past decade but are still higher than in other countries of similar income level. India cannot rely solely on economic prosperity to meet its nutritional goals, which is obvious from state level data: states do not have to be rich to provide better nutrition to their children, and agricultural productivity is poorly correlated to stunting of children under age five. Crop variation can be a key, and diversion from sugar to pulses and other nutritious options was recommended. The variability in India’s rates of stunting was associated with a variety of factors, including but not limited to: marriageable age of women and their education, infant and supplemental foods, minimum dietary diversity, public health, immunization, the Swatch Baharat Scheme (Clean India), antenatal visits, and open defecation.
Soumya Swaminathan from the Indian Council of Medical Research (ICMR) pointed out the major consequences of the current health status of the Indian children for the country. Cognitive abilities are being impacted, irreversibly; a whole generation is being deprived of health. Undernutrition and overnutrition leads to predisposition to diseases: 50 percent of tuberculosis is attributable to undernutrition on the one hand, and there is an increase cardiovascular diseases and diabetes on the other.
The top health-risk factors in India are still high pollution, poor sanitation, and lack of access to nutritious food, said Swaminathan. The rising prices of pulses, for instance, is depriving the population from a basic source of protein. To see progress within the next three to four years, Swaminathan recommended adjusting the frequency of national data collection, increasing attention to the composition of Indian diets and locally available food use, and more nutrition education. Additionally, midday meal plans should be transformed from whole carbs to more balanced compositions, and sanitation, handwashing and toilet accessibility should be increased.
Two ministers participating in the panel discussion-- Jagat Prakash Nadda of the Ministry of Health and Family Welfare and Maneka Gandhi of the Ministry of Women and Child Development—also discussed the health costs of malnutrition for the country and urged multi-stakeholder action. One example of a new policy is that children are now to be weighed every month for first three months and then at quarterly intervals until reaching adolescence. More needs to be done to determine which programs to accelerate at the state level, to increase accountability, and to provide a continued care approach that is more holistic and integrated (for example, the government is providing newborns with 11 kinds of vaccines and also caring for women for the 48 hours after delivery).
Minister Gandhi also touched on a change of strategy that has worked wonders for her ministry: a focused approach on the worst districts of country. For example, the government has digitized the Integrated Child Development Services (ICDS) system with GPS tracking and provided tablets to its workers, along with a creating incentive system to avoid leakage. This has proved efficient in terms of regulation and monitoring, and also results in high quality data collection for analysis on the performance of this system. The next big change that the Indian government is trying is the centralization of food—in terms of both prepacking and fortification-- before they go into midday meals under the ICDS.
In the summary panel, participating stakeholders highlighted the following main points highlighted for the way ahead:
1) There is need for rewriting and scaling up of good interventions, and prioritization is necessary.
2) 50 percent of stunting occurs in the womb while the other 50 percent occurs in the first two years of child growth, so interventions need to be prioritized accordingly.
3) There is a need for political commitment both from ministers and ministries.
4) There is a need for robust and timely data.
5) There should be a disbursement of the funds to be spent on this issue (60 percent by the central government and 40 percent by states) with proper monitoring systems in place.
6) Micronutrient fortification for mid-day meals is needed.
7) There should be more investment in young mothers (there is a large population of young mothers between the ages of 13 to 16 years old).
8) Education of women should be a priority as 30 percent of Indian women have 10 years of education or less.
9) Multi-sectorial partnerships are needed for the success of these programs.
Food availability does not automatically lead to nutrition, and revolutionizing the current nutrition profile of India as a country will require large-scale commitments.
BY: Jaspreet Aulakh, IFPRI NDO