NITI Aayog India’s Malnutrition – A Call to Action

1. NITI Aayog India’s Malnutrition – A Call to Action Veena S Rao, IAS, (Retd), Advisor, Karnataka Nutrition Mission 27th June 2016

2. Why are our nutritional indicators not improving fast enough? Because its Direct Causes have not been addressed: Cause 1 - At least 50 % of our population suffers from chronic protein calorie micronutrient deficiency, even after decades of ICDS, MDM, and PDS, (NNMB 3rd Repeat Survey 2012). No debate or response on this fact continuously brought out by NNMB Surveys. Cause 2 - India’s malnutrition is inter-generational. However, current nutrition programmes do not address it inter-generationally Cause 3 – Vast awareness and information deficit across the population about proper food intake and nutritional practices regarding children, adolescents, mothers, adults. There is no sustained nutrition education programme at community/family level Cause 4 - Crucial prescriptions of the National Nutrition Policy, 1993, eg. ‘Fortification of Essential Foods’ and ‘Popularisation of low cost nutritious foods’, ‘Behavioural Change’, were not translated into national schemes Cause 5 - No overarching authority to coordinate sectoral programmes impacting nutrition, setting time-bound targets and monitoring them, and fixing accountability

3. NNP, 1993 – the need to review it • New data and evidencethat needs to be analyzed • Gaps and challenges persist-New innovative strategies needed to address them with a long term vision • New policies and inter-sectoral programmes since 1993 need to be included • Several important prescriptions of the NNP, 1993need to be re-emphasised in the NNP and conceptualized and converted into programmes with budgetary support, especially fortification, low cost energy foods, and behavioural change • Protein-calorie-micronutrient dietary deficit among more than 50% of our population of both sexes and all age groupsneeds to be addressed (diet adequacy of infants 6-23 months is 5.9% to 31.1% , NFHS-4)

4. NNP, 1993 - the need to review it (contd.) • Target chronic pockets of malnutrition through flexible customized programmes • Involve State political leadership to lead the nutrition agenda • Facilitate creation of an authentic real time data base • Create a template for NGOs, Private Sector, philanthropies to partner with government in nutrition interventions • Provide an effective, functional inter-sectoral mechanisms that works - to oversee inter-sectoral planning, deployment of resources, coordination in implementation, set time-bound monitorable targets, and fix accountability for achieving them

5. Why a National Nutrition Mission ? Ideally, the essential interventions of the NNP should have been woven into a National Programme to combat Under-nutrition, with • a definite template of workable interventions on the ground • a strong overarching coordination mechanism • a system in place on the ground to ensure that these critical inter-sectoral interventions operate simultaneously with full coverage of target groups. However, this did not happen.

6. Why a National Nutrition Mission ? • India’s growth story requires strong and healthy human resources, just as it does physical infrastructure • Addressing under-nutrition is the last milestone in our development agenda that has defied a satisfactory solution so far • The National Nutrition Policy, a sound policy document to address undernutrition and micronutrient deficiency never got fully operationalized • The National Nutrition Mission announced in the Budget Speech of 2014 has also not yet happened

7. Why a National Nutrition Mission ? (contd.) The National Nutrition Mission should be built upon the prescriptions of the National Nutrition Policy, that address the direct causes of undernutrition and micronutrient deficiency, most importantly • bridging the protein calorie micronutrient deficit • breaking the inter-generational cycle • improving coverage of existing nutrition programmes • establishing inter-sectoral convergence and filling gaps at community level • disseminating information and messages for behavioral change at community/family level • setting up real time monitoring systems and accountability, and • providing a template for participation of the private sector, NGOs and philanthropic agencies.

8. Why a National Nutrition Mission ? (contd.) A national programme by itself would be the strongest advocacy tool for • spreading information and awareness about malnutrition in the community and families, which presently lack information about their own affliction. • addressing the information vacuum among community organizations, Panchayati Raj Institutions (PRIs) and field staff of Non Government Organisations (NGOs) and Government, regarding • critical issues like preventing child under-nutrition, proper maternal nutritional care to ensure adequate pregnancy weight gain and prevent low birth-weight babies, (first casualties to neo-natal mortality), and nutritional care of adolescent girls, (the most under-nourished in the world), who are future mothers.

9. Why a National Nutrition Mission ? (contd.) • A national "mission” will define clear objectives, methodology, implementation timelines, measurable outcomes and service levels. • It will also provide for a strong over-arching coordination mechanism, and a system in place on the ground to ensure that critical inter-sectoral interventions operate simultaneously with full coverage of target groups

10. Why a National Nutrition Mission ? (contd.) • It would provide the private sector, NGOs, philanthropies, a platform and options to complement Government efforts in its campaign against malnutrition based on their strengths, expertise and comparative advantage • It would particularly seek the private sector’s participation for making available appropriate low cost energy foods for the poor, under nourished anaemic children, women, adolescent girls and boys, the sick, aged and infirm, in rural and urban markets • It would facilitate inter-sectoral coordination between major Ministries whose programmes impact nutrition

11. Recommendation The Niti Aayog, as the highest inter-sectoral policy making body in the country, must take charge of this long-orphaned subject, and Constitute a High Power Committee headed by an eminent Social Scientist, serviced by the Ministry of Women and Child Development to Revise the National Nutrition Policy, 1993 and Prepare the blueprint for the National Nutrition Mission within a given time frame.

12. Points for discussion • How do we address the protein-calorie-micronutrient deficit that persists among children, adolescent girls and boys, (despite the operation of the ICDS and MDM for decades), and Chronic Energy Deficiency among adults? • How do we engineer the convergence of critical indirect interventions, most importantly, Immunization, Vitamin A and IFA supplementation, use of iodized or double fortified salt, safe drinking water, sanitation, and socio-cultural factors, like female literacy, late marriage, feeding children of both sexes equally, at the community level, that are critical to eradicate malnutrition on a long term, sustainable basis? • How can we overcome the information deficit at the family/community level, and provide basic information and messages regarding proper food intake in the family, even within family budgets; about proper complementary feeding of infants after 6 months, about proper weight gain of pregnant women, so as to prevent low birth weight babies, about adolescent nutritional requirements?

13. Points for discussion (contd.) • How can we establish effective real time monitoring mechanisms to track improvement of nutritional indicators, and fix accountability at the village/community levels? • What is the most effective over-arching inter-sectoral mechanism that can ensure effective coordination between major Ministries, most importantly, Ministries of Women & Child Development, Health & Family Welfare, Food, Agriculture, Rural Development, Drinking Water & Sanitation, and Human Resource Development, and with State Governments? And how would it work? • What role do we see for the private sector, for NGOs, community organizations, and philanthropies, in our mission against malnutrition? • How can we get a strong political statement that combating malnutrition and micronutrient deficiency stands in high priority in the development agenda, both at the Centre and in the States, that will improve the physical and cognitive potential of our human resources for building the nation?

14. Thank You