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Strategy for New India at 75:Inclusion- Nutrition

  • The purpose of this, ‘Strategy for New India @ 75’, is to define clear objectives for 2022-23 in a  diverse range of 41 areas that recognize the progress already made; and challenges that remain; identify binding constraints in specific sectors; and suggest the way forward for achieving the stated objectives. 
  • The Strategy document has disaggregated the 41 sectors under four sections: drivers, infrastructure,  inclusion, and governance. 
  • The first section on drivers focuses on the engines of economic performance – in macroeconomic terms with chapters on growth and employment.
  • The section also discusses strategies for the doubling of farmers’ incomes; boosting Make in India; upgrading the science, technology and innovation ecosystem; and promoting sunrise sectors like fintech and tourism.
  • An annual rate of growth of 9 percent by 2022-23 is essential for generating sufficient jobs and achieving prosperity for all. Four key steps, among others, have been spelled out for achieving this GDP growth rate. These are:

a. Increase the investment rate as measured by gross fixed capital formation (GFCF) from present 29 percent to 36 percent of GDP by 2022. About half of this increase must come from public investment which is slated to increase from 4 percent to 7 percent of GDP. Government savings have to move into positive territory. This sharp increase in the investment-to-GDP ratio will require significantly higher resource mobilization efforts as elaborated in the chapter on Growth.

b. In agriculture, emphasis must shift to converting farmers to ‘agripreneurs’ by further expanding e-National Agriculture Markets (e-NAMs) and replacing the Agricultural Produce Marketing Committee  (APMC) Act with the Agricultural Produce and Livestock Marketing (APLM) Act. The creation of a unified national market, a freer export regime and the abolition of the Essential Commodities Act are essential for boosting agricultural growth.

c. A strong push would be given to `Zero Budget Natural Farming (ZBNF) techniques that reduce costs,  improve land quality and increase farmers’ incomes. This is a tested method for putting environmental carbon back into the land. Therefore, ZBNF allows India to significantly contribute to reducing the global carbon footprint.

d. To ensure maximum employment creation, codification of labour laws must be completed and a massive effort must be made to upscale apprenticeships.

  • The second section on infrastructure deals with the physical foundations of growth. A lot of progress has been made across all infrastructure sectors. This is crucial to enhancing the competitiveness of Indian business as also ensuring the citizens’ ease of living. Three key steps, among others, are:

a. Expediting the establishment of the Rail Development Authority (RDA), which is already approved. RDA  will advise or make informed decisions on an integrated, transparent and dynamic pricing mechanism for the railways. Investment in railways will be ramped up, including by monetising existing railway assets.

b. The share of freight transported by coastal shipping and inland waterways will be doubled. Initially,  viability gap funding will be provided until the infrastructure is fully developed. An IT-enabled platform would be developed for integrating different modes of transport and promoting multi-modal and digitised mobility.

c. With the completion of the Bharat Net programme in 2019, all 2.5 lakh gram panchayats will be digitally connected. In the next phase, the last mile connectivity to the individual villages will be completed. The aim will be to deliver all government services at the state, district, and gram panchayat level digitally by  2022-23, thereby eliminating the digital divide.

  • The section on inclusion deals with the urgent task of investing in the capabilities of all of India’s citizens. The three themes in this section revolve around the various dimensions of health, education, and mainstreaming of traditionally marginalized sections of the population. While there are multiple dimensions and pathways  contained in the chapters in this section, four key steps, among others, are:

a. Successfully implementing the Ayushman Bharat programme including the establishment of 150,000  health and wellness centres across the country, and rolling out the Pradhan Mantri Jan Arogya  Abhiyaan.

b. Upgrading the quality of the school education system and skills, including the creation of a new innovation ecosystem at the ground level by establishing at least 10,000 Atal Tinkering Labs by 2020.

c. As already done in rural areas, affordable housing in urban areas will be given a huge push to improve workers’ living conditions and ensure equity while providing a strong impetus to economic growth.

d. Implementing strategies to achieve regional equity by focusing on the North-East region and successfully rolling out the Aspirational Districts Programme.

  • The final section on governance delves deep into how the tasks/business of government can be streamlined and reformed to achieve better outcomes. It involves a sharp focus on ensuring accountability and a shift to performance-based evaluation.
  • The government will revamp its data systems and analysis so that all policy interventions and decision-making are based on evidence and real-time data. This will yield efficient and

targeted delivery of services and justice to those who need them the most.

  • Three key steps, among others, are:

a. Implementing the recommendations of the Second Administrative Reforms Commission as a prelude to appointing a successor for designing reforms in the changing context of emerging technologies and the growing complexity of the economy.

b. A new autonomous body, viz., the Arbitration Council of India, may be set up to grade arbitral institutions and accredit arbitrators to make the arbitration process cost-effective and speedy, and to pre-empt the need for court intervention.

c. The scope of the Swachh Bharat Mission may be expanded to cover initiatives for landfills, plastic waste and municipal waste and generating wealth from waste.

  • To achieve the goals of New India in 2022-23, it is important for the private sector, civil society and even individuals to draw up their own strategies to complement and supplement the steps the government intends to take. With the available tools of 21st-century technology, it should be possible to truly create a mass movement for development. With the Sankalp of all Indians, India will have Siddhi.

Check out our previous blogs on the Strategy for New India at 75:

Objectives

Under POSHAN Abhiyaan, achieve the following outcomes by 2022-23, compared to the baseline of 2015-16 (National Family Health Survey-4):

  • Reduce the prevalence of stunting among children to 25 percent or less.
  • Reduce the prevalence of underweight in children (0-6 years) to 25 per cent or less.
  • Reduce the prevalence of anaemia among young children (6-59 months) to 43 percent or less.
  • Reduce the prevalence of anaemia among adolescent girls and women (15-49 years) to 38 percent or less.

Current Situation

  • Undernutrition is the prime risk factor in over 40 per cent of under-five child deaths. Children with under-nutrition, anemia, and iodine deficiency will have low IQ scores and productivity as adults.
  • A World Bank estimate indicates that reducing stunting can raise India’s GDP by 4-11 percent. The prevalence of stunting declined by an estimated 3.2 percent for every 10 percent increase in income per capita. Similarly, a 10 percent rise in income per capita translates into a 7.4 percent fall in wasting.
  • Thus, increasing per capita incomes through rapid and equitable economic growth is a necessary condition for improving nutrition outcomes Although progress has been made, according to the National Family Health Survey-4 (NFHS-4), 2015-16, over one-third of all under-five children are stunted (low height-for-age), every fifth child is wasted (low weight-for-height), and more than 50 percent of the children are anaemic.
  • Other emerging economies such as Brazil (stunting – 6.1 percent, wasting – 1.6 percent), China (stunting – 6.8 percent, wasting – 2.1 percent), and Mexico (stunting – 13.6 percent, wasting – 1.6 percent) fare far better on nutrition indicators compared to India.
  • Ironically, at the same time, India is also grappling with the rising menace of ‘over-nutrition. Nearly one fifth of India’s adults are either obese or overweight as per NFHS-4 data, leading to an increased risk of diabetes and cardiovascular disorders.
  • India can leverage its demographic dividend only if its citizens attain optimum levels of health, nutrition, and cognition.
  • Recognising this, the government launched the POSHAN Abhiyaan in March 2018 to provide police and programmatic guidance to high burden states and districts, facilitate multisectoral planning, catalyse resource mobilisation, and develop a surveillance system for nutrition
Nutritional Status

Constraints

  1. Multidimensional determinants of under-nutrition are inadequately reflected in policymaking
  • Inadequate and poor-quality food is an important, but not the only, cause of under-nutrition.
  • The underlying causes of malnutrition are multifaceted and rooted in economic and social factors like low levels of female literacy, lack of access to clean drinking water and sanitation.
  • At a more proximate level, nearly half of childhood under-nutrition is attributable to illnesses (in particular, diarrhea, pneumonia, and measles) and foetal growth restriction that results in low birth weight due to maternal nutrition, maternal health, pregnancy complications, and epigenetic factors.
  1. Design limitations of the Integrated Child Development Services (ICDS)
  • The design of the ICDS programme has an important limitation – its focus on the first 1000 days of the child’s life is inadequate. Over 80 percent of brain growth occurs during the first 1000 days of a child’s life. This has a significant bearing on work capacity, productivity and IQ in adulthood. Hence, nutrition programmes in the country must accord the highest priority to this critical period of life. However, the ICDS programme’s most prominent activities are focused on the delivery of pre-school education and hot cooked meals as well as growth monitoring at Anganwadi centres for children between 3 and 6 years. Only 10% of children between 6 and 13 months received an adequate diet in 2015-16 (NFHS-4).
  1. ICDS programme implementation
  • The ICDS programme is beset with persistent challenges such as shortage of staff and field workers, poor monitoring, instances of food pilferage and poor quality of services.
  • Given the complex nature of the challenge, a multi-dimensional approach is a must. NITI Aayog has already detailed a possible action agenda in its National Nutrition Strategy, which needs to be urgently implemented.
ICDS scheme Shaan IAS Academy

Way Forward

  1. Address policy and governance issues
  • Provide greater flexibility to states under the POSHAN Abhiyaan to adapt programmes for context-specific implementation and to experiment with innovative approaches to attain high coverage, quality, equity and better outcomes.
  • Establish an institutional mechanism, outside the government, to conduct independent annual audits of the programme to achieve implementation improvements.
  1. Ensure convergent action at all levels
  • Develop and implement Annual Integrated Health, Nutrition and Swachh Bharat Mission (SBM) action plans for all districts under the POSHAN Abhiyaan.

O Ensure accountability of the local administration.

O Actively engage panchayati raj institutions, the public distribution system (PDS) and public health engineering departments for delivery of the action plans.

  • Integrate health, SBM and nutrition services at the village level through the Village Health, Sanitation and Nutrition Committees and by ensuring regular observance of Village Health Sanitation and Nutrition Days (VHSNDs).
  • Develop an implementation guide for integrated action for nutrition (‘a cook book’) for district administrators.
  • Establish a state-level convergence mechanism for nutrition under the chief secretary/ equivalent officer and corresponding structures at the district and block levels.
  1. Implement mission mode action in districts with a high burden of malnutrition under POSHAN Abhiyaan
  • Set up convergence mechanisms at the state, district and block levels; develop action plans specifying timelines; ensure sufficient budgetary allocation; strengthen monitoring systems; galvanize coordination; demonstrate change guided by annual surveys and intensively monitor implementation by NITI Aayog.
POSHAN Abhiyan Shaan IAS Academy
  1. Refine programme interventions 

Focus on the first 1000 days

  • As envisaged under the POSHAN Abhiyaan, devise a strategy for additional home-based contacts under the home-based young child care initiative with:

O Mothers having children in the age group of 3 months to 2 years to ensure compliance with infant and young child feeding practices as well as healthy behaviours.

O Mothers having a child with moderate or severe malnutrition for regular follow-up.

O These home visits should be conducted by accredited social health activists, a second auxiliary nurse midwife or community infant, and young child feeding counsellors.

  • Replace the food-centric approach with more broad-based action that includes healthcare measures (special care of low birth weight infants and immunization), birth spacing, delaying the age of marriage, exclusive breastfeeding for 6 months, and timely and adequate access to complimentary food interventions.
  • Focus on immunization including Rota Virus and Pneumococcal Vaccines; target the vaccines preferentially to high focus district.

Fortification

  • Consider mandatory fortification of staples produced in the organized sector and provide incentives to the industry to do so.
  • Incorporate fortified food grains and double fortified salt within government programmes such as ICDS, mid-day meal scheme, and PDS.
  • Explore approaches to bio-fortification of grains for micronutrient deficiencies.

Research

  • Create a national nutrition surveillance system to track food quality and consumption patterns and nutritional deficiency profiles for all age groups in different regions.
  • Conduct implementation research studies to inform improvements in the programme.

O Key research areas include assessing the effectiveness of conditional cash transfers/ vouchers in improving child nutrition and the optimum formulation of supplementary nutrition for young children.

O Evaluate the ICDS programme in depth and suggest reforms for greater effectiveness.

  • Track changes in birth weight and prematurity rates at the population level; conduct long-term cohort studies on changes in body composition and early biomarkers of metabolic disorders.
  • Review and redesign nutrition programmes targeted at adolescent girls; link these with pre-pregnancy interventions.
  • Test approaches to prevent childhood and adult obesity at the population level.
  1. Scale-up nutrition MIS and strengthen monitoring mechanisms
  • Establish an IT-based real time monitoring mechanism by rolling out the Common Application Software (CAS) developed by the Ministry of Women and Child Development on a countrywide basis.
  • Undertake joint health and nutrition reviews in the field as a standard practice.
  • Establish accountability with defined responsibilities at all levels – state, district and field.
  1. Make ‘ POSHAN Abhiyaan’ a Jan Andolan
  • Make POSHAN Abhiyaan a community-led movement with adequate political backing.
  • Develop behavioural change communication modules and ensure its use by all frontline workers, especially during VHSNDs; emphasise individual as well as group counselling.
  1. Galvanize the National Anaemia Control Programme
  • Implement the revised strategy for the anaemia control programme based on evidence; incorporate home, community, school and facility-level action; embed the strategy in the activities of the emerging health and wellness centres.
  • Consider ‘screen and treat’ as a part of the anaemia control intervention package