February 21, 2011
Can India halve its malnutrition rate by 2015 – which is a stated Millennium Development Goal (MDG)?
Highly unlikely, would be the answer in the current scenario.
Unless:
The recognition of malnutrition as a critical area jumps out of policy documents, research notes and thunderous speeches.
The public distribution system (PDS) is turned on its infamous, bulky and ill-fated head.
Benefits of employment schemes, food-subsidy schemes, poverty-reduction schemes and child-and-woman-development schemes reach the intended beneficiaries.
Delivery of nutrition service to communities with the highest concentration of poor is made corruption-proof.
The delivery system becomes self-sustaining and works with clockwork precision—more or less.
‘Inclusive growth’ is paid more than lip service.
‘Inclusive growth’ becomes more than ‘the term of the moment’.
The application of science and technology to achieving workable innovation in nutrition becomes a vital part of the national nutritional strategy.
There is a national nutritional strategy.
To put it blandly, India’s progress in reducing child malnutrition has been cumbersome. India has one of the highest rates of underweight children in the world – nearly 40 per cent of the country’s small children are malnourished. This is a higher percentage than most countries in sub-Saharan Africa.
In annual terms, an estimated 2.5 million children die in India. More than half of these deaths can be prevented if children are well nourished. One reinforces the other: inadequate nutrition weakens the immune system, increasing the risk of infectious disease; illness, for its part, compromises a child’s nutritional count.
Over and above its linkage to half of all child deaths and nearly a quarter of cases of disease, malnutrition has other equally critical implications. For one, malnourished children tend not to reach their potential, physically or mentally. This has a straight impact on productivity. According to the World Bank, in low-income Asian countries physical impairments caused by malnutrition make a difference of at least three per cent to GDP, in minus terms.
In a fundamental way, the Integrated Childhood Development Service (ICDS) has not worked. To quote a World Bank (WB) report, ‘More attention has been given to increasing coverage than to improving the quality of service delivery and to distributing food rather than changing family-based feeding and caring behavior. This has resulted in limited impact.’
Launched in 1975, the ICDS is the world’s biggest programme for maternal and child health and nutrition. According to the programme, an anganwadi centre with one teacher and an assistant are made available for every 1,000 people. Each centre has to provide nutritional care to pregnant women and all children aged up to six years. Anganwadi centres also provide daily pre-school childcare and education.
Stating that there is a mismatch between the programme’s intentions and its actual implementation, the WB report defines the key mismatches thus:
The dominant focus on food supplementation is to the detriment of other tasks envisaged in the program which are crucial for improving child nutritional outcomes. For example, not enough attention is given to improving childcare behaviors, and on educating parents how to improve nutrition using the family food budget.
Older children (between 3 years and 6 years) participate much more than younger ones and children from wealthier households participate much more than poorer ones. The program fails to preferentially target girls, lower castes or poorest villages (all of whom are at higher risk of undernutrition).
Although program growth was greater in underserved than well-served areas during the 1990s, the poorest states and those with the highest levels of undernutrition still have the lowest levels of program funding and coverage by ICDS activities.
In addition to these mismatches, the programme faces substantial operational challenges – among these, inadequate worker skills, shortage of equipment and poor. While the daily meals—meant to provide each child with an extra 500 calories a day—are beneficial, they do not replace the nutritional guidance the parents of young children need. Also, community workers are overburdened, because they are expected to provide preschool education to four-to-six-year-olds as well as nutrition services to all children under six, with the consequence that most children under three—the group that suffers most from malnutrition and who the government should be targeting most seriously—do not get micronutrient supplements. Moreover, most of their parents are not reached with counselling on better feeding and childcare practices. It does not help matters that most growth retardation is determined by the age of two and this process is irreversible.
The ICDS is emblematic of the malaise that defines public services in India. There is nothing exceptional here. Nothing of the deviant. None whatsoever of the worm in the apple. At the moment, the worms dominate.
There is a way out, though. There always is. Sometimes, there is more than one way. The fact that there are examples—however stray—of successful interventions (Bellary district in Karnataka) and innovations/variations in ICDS from several states (the Integrated Nutrition and Health Project [INHP] in nine states, the Dular scheme in Bihar, and the Tamil Nadu Integrated Nutrition Project [TINP] in Tamil Nadu) suggest that the promise for better implementation and for real impact holds.
http://causebecause.com/news-detail.php?NewsID=296
Can India halve its malnutrition rate by 2015 – which is a stated Millennium Development Goal (MDG)?
Highly unlikely, would be the answer in the current scenario.
Unless:
The recognition of malnutrition as a critical area jumps out of policy documents, research notes and thunderous speeches.
The public distribution system (PDS) is turned on its infamous, bulky and ill-fated head.
Benefits of employment schemes, food-subsidy schemes, poverty-reduction schemes and child-and-woman-development schemes reach the intended beneficiaries.
Delivery of nutrition service to communities with the highest concentration of poor is made corruption-proof.
The delivery system becomes self-sustaining and works with clockwork precision—more or less.
‘Inclusive growth’ is paid more than lip service.
‘Inclusive growth’ becomes more than ‘the term of the moment’.
The application of science and technology to achieving workable innovation in nutrition becomes a vital part of the national nutritional strategy.
There is a national nutritional strategy.
To put it blandly, India’s progress in reducing child malnutrition has been cumbersome. India has one of the highest rates of underweight children in the world – nearly 40 per cent of the country’s small children are malnourished. This is a higher percentage than most countries in sub-Saharan Africa.
In annual terms, an estimated 2.5 million children die in India. More than half of these deaths can be prevented if children are well nourished. One reinforces the other: inadequate nutrition weakens the immune system, increasing the risk of infectious disease; illness, for its part, compromises a child’s nutritional count.
Over and above its linkage to half of all child deaths and nearly a quarter of cases of disease, malnutrition has other equally critical implications. For one, malnourished children tend not to reach their potential, physically or mentally. This has a straight impact on productivity. According to the World Bank, in low-income Asian countries physical impairments caused by malnutrition make a difference of at least three per cent to GDP, in minus terms.
In a fundamental way, the Integrated Childhood Development Service (ICDS) has not worked. To quote a World Bank (WB) report, ‘More attention has been given to increasing coverage than to improving the quality of service delivery and to distributing food rather than changing family-based feeding and caring behavior. This has resulted in limited impact.’
Launched in 1975, the ICDS is the world’s biggest programme for maternal and child health and nutrition. According to the programme, an anganwadi centre with one teacher and an assistant are made available for every 1,000 people. Each centre has to provide nutritional care to pregnant women and all children aged up to six years. Anganwadi centres also provide daily pre-school childcare and education.
Stating that there is a mismatch between the programme’s intentions and its actual implementation, the WB report defines the key mismatches thus:
The dominant focus on food supplementation is to the detriment of other tasks envisaged in the program which are crucial for improving child nutritional outcomes. For example, not enough attention is given to improving childcare behaviors, and on educating parents how to improve nutrition using the family food budget.
Older children (between 3 years and 6 years) participate much more than younger ones and children from wealthier households participate much more than poorer ones. The program fails to preferentially target girls, lower castes or poorest villages (all of whom are at higher risk of undernutrition).
Although program growth was greater in underserved than well-served areas during the 1990s, the poorest states and those with the highest levels of undernutrition still have the lowest levels of program funding and coverage by ICDS activities.
In addition to these mismatches, the programme faces substantial operational challenges – among these, inadequate worker skills, shortage of equipment and poor. While the daily meals—meant to provide each child with an extra 500 calories a day—are beneficial, they do not replace the nutritional guidance the parents of young children need. Also, community workers are overburdened, because they are expected to provide preschool education to four-to-six-year-olds as well as nutrition services to all children under six, with the consequence that most children under three—the group that suffers most from malnutrition and who the government should be targeting most seriously—do not get micronutrient supplements. Moreover, most of their parents are not reached with counselling on better feeding and childcare practices. It does not help matters that most growth retardation is determined by the age of two and this process is irreversible.
The ICDS is emblematic of the malaise that defines public services in India. There is nothing exceptional here. Nothing of the deviant. None whatsoever of the worm in the apple. At the moment, the worms dominate.
There is a way out, though. There always is. Sometimes, there is more than one way. The fact that there are examples—however stray—of successful interventions (Bellary district in Karnataka) and innovations/variations in ICDS from several states (the Integrated Nutrition and Health Project [INHP] in nine states, the Dular scheme in Bihar, and the Tamil Nadu Integrated Nutrition Project [TINP] in Tamil Nadu) suggest that the promise for better implementation and for real impact holds.
http://causebecause.com/news-detail.php?NewsID=296
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