Challenges and key recommendations

The enormous task of addressing India's complex malnutrition issue necessitates a meticulous and
multifaceted strategy. The Indian government wants to reduce stunting, underweight, and low birth
weight in children by 2 percentage points per year and anemia in children (and young women) by 3
percentage points per year by implementing POSHAN Abhiyaan. In addition, the significance of
micronutrient malnutrition, such as anemia and other micronutrient deficiencies, was once more
brought to light by brand-new findings from the Comprehensive National Nutrition Survey (CNNS
2016–18).
Our primary recommendation is to first acknowledge that the new findings, as documented in this
report, require attention before addressing the emerging challenges like micronutrient deficiencies and
the cross-cutting challenges of urbanization and growing overweight and obesity. Profoundly
contributing
to working on dietary quality - through an essential spotlight on dietary variety and diet quality - will
assist with accomplishing different nourishment objectives. In addition, some micronutrient
deficiencies will be mitigated, at least partially, by following the previously laid out path regarding
the fortification of essential staples. Work on urban nutrition must address overweight and obesity
issues in addition to addressing the difficulties faced by the urban poor and involve all stakeholders.
As a result, it can be deduced that in order to address the issue of malnutrition in India, a nutrition
policy and program must address both old and new challenges at the same time. Following this, we
offer the following suggestions to strengthen POSHAN Abhiyaan for enhancing key nutrition
outcomes:
A. Recommendations for Accelerating Current Trends in Addressing Key Undernutrition
Goals:

 Stunting

 The LiST model places emphasis on reducing stunting by enhancing complementary

feeding through the use of both behavior change interventions and complementary food
supplements in the ICDS. About 60% of cases of stunting could be avoided with
appropriate complementary feeding.
 The success stories in a few states showed how important it is to invest in girls and
women, including early education, cutting down on marriage and pregnancies, improving
care for pregnant women, and other social factors that contribute to stunting reduction.
 Other effective interventions that would prevent about a quarter of stunting cases included
improved water, sanitation, soap-based hand washing, and hygienic disposal of children's
stools.

 Wasting

 According to the LiST model, interventions that address moderate wasting in addition to
treating severe acute malnutrition (SAM) have the potential to achieve more significant
reductions in wasting than SAM treatment alone.
 The MoHFW's facility-based treatment of SAM must expand to include all patients
requiring inpatient care. Interventions for moderate malnutrition are already included in
the ICDS; however, in order for interventions to be effective, improvements in screening
 and referral, as well as the quality and accessibility of ICDS food supplements, are
necessary. Overall, a comprehensive national strategy for wasting prevention and
integrated management is urgent.

 Anemia

 According to the LiST model, a scale-up scenario that only focuses on interventions in
the health sector will only see slight improvements in anemia among women of
reproductive age. Accordingly, more consideration is required on different determinants
and mediations.
B. POSHAN Abhiyaan pillar strengthening recommendations:

 Technology

 A lot of states still need to get phones faster and train providers and managers faster.
 Supportive efforts to scale up technology—servers, issues with the network, building
capacity, and help desks—need attention.
 Based on the findings of this report, a state-by-state assessment should drive state-specific
action to close gaps.

 Convergence

 Stakeholders at the district level must translate the vision of effective household
convergence from the national level. Convergent action planning efforts will remain
tokenistic if there is no clarity of vision.
 Adequate convergence gaps must be diagnosed, planned for, and filled with new models.

 Behavior change

 Because routine platforms like home visits are supported by community-based events and
the media, which have a wider reach, efforts need to focus on expanding their reach.
 Using existing frontline worker platforms and all available platforms, interpersonal
counseling to support good nutrition practices must reach every family with a child in the
first two years of life. All evidence points to the significance of this impact, in addition to
the campaign's overall effort to raise awareness.

 Capacity building

 Investing in the quality of capacity building should be a primary objective, particularly

with regard to growth monitoring and counseling quality.
 The procurement procedure for smartphones must be expedited, and training must be
prioritized in order to accelerate the rollout of e-ILA.
D. Recommendations for transforming nutrition in India by addressing old and new obstacles

 Complementary feeding, anemia, and micronutrient deficiencies

 Complementary feeding o Make use of all existing program platforms to emphasize

complementary feeding at every possible contact with families with children under two
years old.
  In ICDS, make sure that counseling and take-home rations are firmly linked, and make
sure that all households with children under the age of two receive them.
 Work on the piece and quality and afterward do all that could be within reach to build the
reach of the bring back home apportions.
 Address the problems with the systems, both in the ICDS and the health sector, that are
making it difficult for counseling services to reach enough people and be of high quality
at the moment.

 Frailty and micronutrient inadequacies

 Scale up and fortify a portion of the current mediations in the well-being framework to
address iron deficiency, including micronutrient supplements, deworming, counteraction,
and treatment of intestinal sickness.
 Speed up other center activities of the Iron deficiency Mukt Bharat (AMB) mission and
social determinants of iron deficiency.
 Other deficiencies in micronutrients have been identified, but these do not necessitate
isolated micronutrient supplements. Put resources into working on dietary quality –
through an essential spotlight on dietary variety through the food framework - to
accomplish different sustenance objectives.
 Some micronutrient deficiencies will be mitigated, at least partially, if key staples are
continued to be fortified.
E. Identifying and acknowledging the new challenges posed by urban food systems, food
environments, and the delivery of urban health services, as well as mobilizing to address the
emerging and cross-cutting challenges of urbanization and overweight/obesity

 Work on urban nutrition must involve all stakeholders and go far beyond just addressing the
issues facing the urban poor.
 In both food and wellbeing frameworks in metropolitan settings, connecting with private
medical services suppliers and scope of entertainers who can assist with establishing better
food conditions for a scope of purchasers is fundamental.
 Food and the physical environments in homes, workplaces, and institutions must be addressed
in order to address the problem of obesity, overweight, and non-communicable diseases.
 Establish a connection between the POSHAN Abhiyaan's goal of improving diets for all
stakeholders and existing movements like Eat Right and Fit India.
Conclusions
As previously stated, POSHAN Abhiyaan continues to be a significant part of India's fight against
malnutrition; We need to move quickly on several fronts right now. The LiST tool modeling study
demonstrates that we must swiftly transition to a POSHAN-plus strategy, which, in addition to
maintaining the four pillars of the Abhiyaan and addressing the governance difficulties of the
NHM/ICDS delivery mechanisms, also requires a renewed focus on other social determinants.