India’s public health and nutrition efforts are differentiated by an enterprising early start going as far back as 1975 with the beginning of Anganwadi centres and Integrated Child Development Services (ICDS). Lauding this strong, continued focus on maternal and child nutrition, experts specialising in India's nutrition space prescribe integration of three key factors like quality of services, convergence of healthcare services at the household level, and strategic use of data at various levels for improving program implementation, that could further advance public nutrition service delivery in India.
Committed to a malnutrition-free India, the country’s robust public health and nutrition infrastructure has positioned dedicated frontline workers as its pillars, making it one of the few countries to achieve this scale and intensity of human resource support. For every 1000 population, there is one Accredited Social Health Activist (ASHA), one Anganwadi Worker (AWW) and one Anganwadi helper, and one Auxiliary Nurse Midwife (ANM) for approximately every 5000 population. Under the Poshan Abhiyaan, key public programs and outreach schemes make nutrition-based interventions to lift nutritional well-being for all.
“India has a well-funded program for various nutrition-specific and sensitive interventions covering the entire country. During the POSHAN Maah (Nutrition Month) there was reiteration to continue focusing on the basics of prevention of maternal and child undernutrition and focus was also brought on new areas, such as children with Severe Acute Malnutrition (SAM) and promotion of locally-sourced nutrient-rich foods grown in kitchen gardens. Food fortification, too, has gained good momentum in India over the last few years. I feel a larger number has been added to the people consuming fortified products in the world from India, than any other country in the last few years. India has almost everything (policies, human resource, funding and political will) in place in terms of what needs to be driven and the focus now more than ever before has to be on strengthening the implementation,” shares Dr Alok Ranjan, Country Lead (Nutrition), Bill and Melinda Gates Foundation.
Setting foundations of health and cognitive development in a child, the first 1000 days (pregnancy to first two years of life) are often neglected, visible in the abysmally low levels (6.4%) of minimum adequate diet received by children between 6-23 months of age, as shown by the 2016-18 Comprehensive National Nutrition Survey (CNNS). Failure to nourish the mother-child dyad in accordance with the five components of Poshan -- the child’s first 1000 days, anaemia prevention, diarrhoea management, nutritional foods and WASH (water, sanitisation and hygiene) -- can set back the healthy physical and cognitive development of a child. At the macro level, undernutrition impairs public health levels and the future of a nation.
Highlighting the multi-sectoral aspect of nutrition, Dr Ranjan builds on his experience like the Polio, Routine Immunization and Vitamin A supplementation work in states like Bihar and Uttar Pradesh, and points out that the nutrition program implementation can borrow few key factors from successful public health programs like polio, routine immunization and vitamin-A that could aid transforming India’s nutrition landscape – such as improving the quality of services and using data for improving program implementation, along with ensuring the convergence of service delivery for the core target of mother and child.
According to Mr. Thomas Forissier, Director Programs, South Asia, Alive & Thrive (FHI 360), increasing the coverage of nutrition-related services and benefits is often the first step, but increasing the coverage of high quality services and benefits is the necessary second step.
Under the ‘POSHAN Ke 5 Sutra’, the focus has been on the absolute critical components for prevention of undernutrition. And one cannot overemphasize the need to prevent mother and child from getting undernourished, because once they become undernourished we will always be busy treating them rather than fixing the problems that led them to become undernourished in the first place. Unless we fix those underlying factors mother and child will continue becoming undernourished.