Accountability for Nutrition Outcomes qaryrovement in Lownowit, Pebrbical fSoria/ bat NubrKon a looked, Chinmaya Goyal n the 70_years since nutrition status in India an immediate independence, India has _ priority made great progress in Baxkgiaualt poe all fields, be it economic, ™ gatly years of independence, social or politcal. And yet the principal challen ye was fo be self ‘suicient in food production. Due to there is mich more to be achieved. The Prime Minister has given aclarion {he greea:tevolution, this particular call towards creating a transformative challenge was largely met. Now, while adequate intake of calories in )movement towards ayNew India” by the 75th year of the country’s SPecific segments of the society does ° nation iti independenoe. ve.sin 2022, remain a challenge, there are several The natic al en erence _ also other determinants for nutrition jsission is an ambitious One of the most important areas outcomes. These include, for example, that should be targeted is nutrition. the status of water suppl, sanitation, 7 GE yl is the most basic facets of human and hygiene. [ris estimated that the is Jone wighy Hitgs Foundations oflong-term —ifnesses such as chronic diarrhea, momentum along with —Soonomic development are based on often caused due to the lack of proper a well-nourished society)Batiling } sanitation facilities, is responsible of ‘ef the about half of cases of malnutrition. Wiost effective tools to empower The status of girl child and mothers empt to create la innovations in the rernance mechanisins . people left behind to participate in js also important as their nutritional for programme tie growth process. THe economic status influences the status of the iinplementatic benefits oFinvestingin proper nutrition child. The Swachb, Bharat Mission tinplementation to are several: improving nutritional (§BM) and ine Be Bacao Bet credibly tackle the outcomes would help indontroTling Padhag missions by the government : aiseasesf¥educe infant and materal faye been launched to tackle these problem of malnutrition — qoralityapmpower imap sk ig arrnany j : the viciois intergenerational cycle inthe country. Now FFimainutritiongyimprove worker —_In addition, a number of existing i programs target nutrition outcomes, is the time roductivity, and eyen improve isthe tine for all eT Temes fr students. Ang iret or indirectly. These include the pletaied Child D t stakeholders to combine 3 (igrermananar study]has ascribed the y tukeholders t0 Combine 3 (ase psi rifiobe 161 Sendoes ICDS), National Health their energies to make ~ Fopiowand middle income countries. Mission-, Janani Suraksha Yojana, ¥ ac etfare the government, which the National Rural Drinking Water fie Mission A SUCCESS 54..c%45 one principle oF "sabka saath, Rrogramme, Matritva Sahyog Yojana, has made improving SABLA fe cent girs, Mid- distr outcomes at a faster rat been performing the worst, ‘parallel "Giglzaon st be paul dan yee ED districts. 13an Andolan: Success in the nutrition missionffequires participa This i more so because several aspects of changes are behavioural, and the government {nferventions are to ‘nudge’ the dual/families/cognmunities Social awareness on nutrition, and nutrition resource centres would be D Participation ‘SF people in the programme would be important to develop the required commitment to bring about lasting change at the ground level. EE ——— tontlunion t The national nutrition mission is ne an ambitious attempt to create large ‘momentum along with innovations in the governance mechanisms for programme implementation to credibly tackle the problem of malnutrition in the country. Now is the time Tot all stakeholders to combine their energies to make the mission a success. = (E-mail: chinmaya goyal@gov.in) 23Nutritional Status in India(+* +) Shamika Ravi (0) Ithough India has made 9 Policy-makers must account for sizeable economic and two key facts: (1) Gireet nutrition) social gains over the, interventions can redube stunting o last_ two decades, the Sby20 per cent] a) Challeng of maternal (for example, access to_W and child undernutrition remains ans tation) must tackle the remaining national public health concer “ avail supplementary nutrition. A complimentary public intervention is the prpvision ‘of school meals as part of the Mid D mings Field studies highlight the link between fhe pgovision of school meals and i wed cognition. Furthermore, the pro Sol meals has been fgund 10 Guicomed ‘ead to improved learning for childrep- @ Existing Policy Framework ‘The most prominent government Fable 2: Nutritional Status of Women and Adoleseent Girls 7 - a Pa ee ___qutgition interventions include ee [% | thecDS programme led by the (15-49 years) with anaemia Ministry of Women and Child oman ofrepreductive age) who are undemourished? Evelapment (MWCD), and the proaactne seem = NagMv led by the ealth and Family Welfa ). Both 2 ronan ay Save SFIS, 2 UNICEF 3075 RapidSuney tae 4 Ses pci intereatons (ICDS and NRUIM) Indicator coors sem women voxel aplemenay odanderiCDS | a7 1 cenunkrnnny) who weaved anomalies | 614 rae cx (12-2 nwo) who are fully mmunised ‘jeer onc Conires (AWC) without functional adult weight scales Rapid Survey on Children (RSOC), 2014 evant population Pex mune ol CSSs prioritise the role of community- level organisations: gu Csand ALS under the ICDS and Accredited So jealth Activists (ASHAS) under the ol) NHRM - for the deliv. NHRM of nutrition Tnterventiohs to the tgrget groups of pregnant and {a ers, and fants. ANIM Ss are These programmes ‘Supplemented by the PDS, which is ued to provide subsidised food grains to large sections of the country’s poor. In addition, more than six states. including Maharashtra, Madhya Ryadesh, Uttar Pradesh, Odisha, Gujarat, Karnataka, and mostrecently YOJANA May 2018jparkhand have also established state ~~ (amor Thissions. An overview of the interventions directly relevant to the first 1.000 days of a child’s life is provided in Table 5. Ff) The National Nutrition Mission NNM) bas been set up with a a3 o)ihree year budget of Rs.9046.17 8 crore commencing from 2077-18. pwiED3- 4 The NNM will comprise mapping iia of various Schemes contributing ! towards addressing malnutrition, i . including a very robust convergence nr’ mechanismB{CT based Real Time ipeentivizing Anganwadi Works L (AQ Ws) for using IT-based tools, 4) — Tegisters used by AWWs, , ae Giooducindypeasirement OT height "Ke lessons for nutrition specif policy Q) Extend coverage of ford seilen athe Angamwadi Cempes imterventions areas fllows: ‘eiicaton oD Enbenng TAWCSHHSocial Audits, setting-up $4) Sirengrhenand reseucure ICDS, Currently fortification of apes ate ‘Nutrition Resource Centres, involving and leverage PDS : limited to the Mandatory iodisation off" asses througHJar Arcola for ther MAPEEMREETE tor witptor, sl Howeverghe Fund Sate and <4) participation on nutrition through CCDS needs to be in mission” Grandards Auth ity af nde FSSAD as various activites, among oters, ir modelfvith-a sanction of Adequale isi te proces of Tomuatng dat ein will be a central nadal agency thar manclal resources,(Trom the Cental” standards for the fortification of food “ helps cgordinate central and state governmgnt) an decision-meking jins which will add to the nutrient bi MLast-mile delivery of ICDS value, Ad I proposals under ernment programmes and infuse whoriyyLast value. nal prope eg them with additional finds resources ofstandardise th consideration include making the PE See Eee eee C)double fortification of salt (with iodine) d Jprioritise educational outreach (and iron), and the fortification of 7 fhe pregint and lactating mothers, etc ote mandaen The sands In response to ihe persistence iniprove programme targeting, and Te ocak el shad egy of the underovtrition challenge in cteanlicopeatmcTAWCSIyugh —chanost viene oul fied ps India, and taking note of the evidence better infrastructure provision and (This would help in providing sufficient evaluating current policy approaches, cu ATS aon ITO AWW. Cffadive Useof Healores and micronutrients 0 3 large ‘AGSC'g. ? number of children under-five)) ifcant state-level disparities in outritional status and Soe progress on reducing stuntin Table 4: State-level disparities in nutritional status Monitoring systeengfSceaTiVizn ; Siates/UTs Tor meeting the targets, { Se seentiaiag-Rnganadi Waskers i Policy Recommendations Target multiple contributing ‘factors, for example, WASH , = [Beat Performers [Worst Performers |, The underlying drivers for India's tediewtor__ tndin Ave’ mer a ‘hidden hunger challenges are complex Children (undersfive) 38.7% — Kerala: 19.4% | Uttar Pradesh: and go beyond direct nutritional inputs. Goa: 21.3% 50.4% ‘The significant push by the present who are stunted oe ay atrcanay | THe aeiion! pe by Be Pre a Bharat abhian es 8) 8 under the Swachh Bharat Abhi 7 under "ikki: 5.1 cess to Joiletshroughout five ‘a Sikkim: 5. ipcreasedGccess to joileis) Chin andesve) 15.1% Sim 3. [ane Bostesauo s at es Jamama & Kashmic: 7.1% Tamil Nadu: 190% | construction must, oe | Gujarat: 18.7% strategy for pehavioural change. 4. Align agricultural policy with ‘Childeen (under-five) | 29.4% | Manipur: 14 4 [equ ceria ‘Mizoram, a nek ea national nutritional objectives ‘ Jammu & Kashi: 15.6% | Madhya | i [36.1% €>) Agriculture policy must be brought pees — a Cangrieullare feouud in tune with nutrition policy, with Sexe: Rap Survey on eee 2014 CPT en webbie peentives provided Tor encouraging Noe: "Percentage of relevant popu 7 ; YOIMNA May 28 ae nubion spall polly intnvontong t the Battng pully fone ‘ajo (61) Sager some reforms fer Nation bond Gort. inten, ws.the production ofnutricmtsich and in, ‘Table $: Nutrition-specific interventions crops for self-consumption. Fore (relevant to the first 1,000 days of a child's life) ‘should also be made 7 ile curren stare Cass es x ‘ons in aggicultural incentjy, | Target Group | Schemes | Key Interventions a ge Leelee | Pregnant and | ICDS ICDS. Supplementary | are sourcesrich cash crops with y, 4 fo is mt te a EN RN | = Fotton, Agriculture should be focus, education | onsecuring dict quality for infants gn Indi Gandhi | Conditional Maternty Benefit | Beehlden €) ! MarivaSshyop | | Yojana (IGMSY) | 5 Boost private vector engasemen ~~ Reproductive | | ered vii interventions Child Health | eee vats seetor collaboration in th «Rctet, sprain fer stir sane (ore private parinership TEE Mision | SRT casrang far ensading | (PPPs) has the potential leverage th ONRHM),Janani and spacing of children et Af appropriate technology for sealing Suraksha Yojana | {food fortification inferventionsjind 1. sy) | YSdevelop and distribute nutrihtrit ae monitoring counselling health education Paustian he government should i Urmotheron child car, promotion of | facilitate PPPs in the sector that can 4) | infant and young child feeding, home- | level : technological solutions ford’) | | based counselling for early childhood scaling up food fortification initiatives stimulation, referral and follow-up of and complement the government's | undernourished and sick children outreach ¢fforts through mass i RCuAI, NRIIM: Home-based newbom care, im- | #™areness NRHM ‘munisation, micronutrient supplemen a tation, deworming, health check-up, } Gapetision ‘management of childhood illness and ‘Ahealthy populationisa precondition | severe undernutrition, referral and cashless for sustainable development, and i | reament for the fst month of ie, eae of | jndig faces significant challenges in | Sick newboms,fciiy-based management | famessing long-term dividends from phnionnbaree } _._ | of severe seni malnutrition and follow-up its young population. The success of the | Rajiv Gandhi Rajiv Gandhi National Creche Scheme: government's numerous programmes | leper ‘on the availability of | National Creche | Support for the care of children of working | | mothers ppt pee se ja_trained workforce. India has the ‘World's highest number of children aL tisk of poor development: as of 2010, $2 per cont of the country’s 121 ‘million children (under-five) were at risk. Given the ever-increasing weight of the country’s economic ambitions, 5 (Gan ing nutrition in an integrated health agenda and realigning nutrition ¢ fu ee 10 09) ofa child's Tife are crucial first steps ) towards ensuring India’s development rests on steady shoulders, India has ‘made a promising commitment in the 4, form of the National Nutrition Mission which will help us tackle the problem of malnutrition i chfaren and mothers of the county (We need to county (We need to_ensute effective implementation of its strategy ‘achieve our nutrition goals.) Flusien (E-mail: sravie@brookingsiia.ore) (pot gi) YOJANA May 2018