Expert Speak Health Express
Published on Aug 20, 2016
India needs to considerably accelerate its effort to combat malnutrition and improve nutritional indicators.
Shaking up India's policy approach to nutrition

Niti Aayog is currently drafting a Nutrition Strategy for implementation across India, including converging schemes addressing malnutrition in various ways as well as improved ways of tracking data and performance.

This is urgent. India needs to considerably accelerate its effort to combat malnutrition and improve nutritional indicators. Under-5 stunting at almost 39% and anaemia among women at 48% according to the Global Nutrition Report 2016 launched in June, makes India one of the worst performers in Asia with respect to malnutrition, in spite of recent improvements.

Read more on the nutritional status in India: Achieving SDG-2: India needs comprehensive approach

While earlier efforts towards a national nutrition policy and the State Nutrition Missions have had limited success, the Nutrition Strategy currently being developed is a timely opportunity to make a lasting and positive impact.

What are the key policy areas that a nutrition strategy should consider?

First, focus broadly on nutrition rather than more narrowly on treating malnutrition, or nutritional deficiencies (although these remain a crucial part). This means recognising the many overlapping factors affecting nutrition and the nutritional status of a person or family. These include, access and availability of nutritious food; health (and the body’s ability to efficiently metabolise nutritious food) and adequate water, sanitation and hygiene practices; and care in the home (such as feeding practices, and support for pregnant and lactating mothers).

Women’s empowerment plays a major role for improved nutrition since women are the primary care givers in the home (cooking, cleaning and bringing up children). Empowerment and increased agency (such as ability to take household decisions, and freedom of movement) affects the nutritional choices of households.

Thus, while malnutrition is often seen as a health issue and today sits primarily within the remit of the Ministry of Health and Family Welfare and the Ministry of Women and Child Development, a nutrition strategy requires a broader approach.

Second, moving to a multi-factor nutrition approach requires collaboration across policy spheres and ministries. At the very least, policies should be aligned. For example, agriculture and nutrition are to a large extent treated as separate issues within India’s policy framework. Agriculture has an important part to play to ensure availability of nutritious foods, but agriculture policies to date are not nutrition conscious. Likewise, in spite of the importance of women in ensuring good care within the home (including nutritious food), there is no gender empowerment policy linked to nutrition. So, while policies exist in silos, at the household level, food access and availability, health, care, empowerment and nutrition are interlinked.

Could, for instance, the agriculture department incentivise growth of local nutritious crops (such as pulses for which production needs to increase substantially to meet demand)? Could MGNREGS be used to produce vegetables for midday meals locally? A more effective policy framework would see programmes and schemes relevant to all factors affecting nutrition work in unison and towards the same goal.

Third, work with unusual suspects. While the government machine at central, state and district level are at the core of any effort to improve nutritional outcomes, a wide network of stakeholders can be tapped- social enterprises, civil society, the private sector and education institutions. We should consider how such local non-state stakeholders as well as the community, can be brought on board in a collaborative manner. Can social enterprises or CSR funded private sector initiatives, for example, work with district level government officials to provide basic services, such as creating kitchen gardens or raising awareness of nutrition and nutritious foods.

Fourth, prioritise enabling implementation at the district and village levels. Since it is at the local government level that implementation takes place, the design and shape of local institutions matter for delivery. This in turn, results in the varied nutritional status across districts in the country. At the same time, while policy and bureaucracy may be slow to shift at the central level, the district level can be more nimble, for example, through initiatives and platforms cutting across nutrition-related sectors. What does it take to enable collaboration across multiple policy silos that require implementation? Can we learn from the experience of state nutrition missions and consider forming district level platforms that involve local social enterprises, civil society and the private sector as well as the community? Perhaps toolkits such as this nutrition and gender sensitive agriculture toolkit by KIT can guide local officials in rural districts towards the most appropriate holistic and systematic approach to improve the nutritional status of the community.

Fifth, strengthen and enable a two-way flow in information. Not only does nutrition-related data need to be more efficiently collected. It also needs to be collected in a manner that helps district officials and others to implement programmes more effectively. Likewise, as it is at the district and village levels that local officials understand the nuances in nutrition related challenges particular to their area, mechanisms that accommodate two-way knowledge flow can feed information about what works back up to state and central levels which in turn can consolidate and further strengthen existing programmes and their implementation. Niti Aayog already plans to launch a multi-stakeholder platform for information collection and sharing, and has proposed to link tracking and data collection to Aadhaar cards.

Sixth, education and empowerment are key. At the core of nutrition are the choices that households are able to make with respect to food preparation and intake, care and health. Education about nutritious food, appropriate food preparation and improved water, sanitation and hygiene practices are needed to affect behavioural change. Likewise better information can enable families to make more informed choices about their habits and practices with respect to nutrition. An exciting step in this direction is the recently launched IAP HealthPhone — a mobile phone based programme sponsored by the Government of India and UNICEF, providing women and girls with nutrition related advice. In most households, the primary care givers are women. However, women are generally not the primary decision-makers within the family. At the same time, a disproportionate number of women suffer from nutrition-related deficiencies, such as anaemia. Therefore increasing the agency of women and empowering them to make good choices with respect to nutrition needs to be an integral part of an enabling policy framework. Again, behavioural change is at the core, as shifts in cultural values and norms are required to allow women more agency, something that a gender sensitive nutrition policy needs to take into account.

In sum, the underlying factors that affect nutrition are multiple — including access to, and availability of, food at its core, but also appropriate care, and health, water, hygiene and sanitation practices. With a new nutrition strategy that takes a broader view on nutrition, emphasises the role that women play, enables both access and behavioural change, works with a wider range of stakeholders while enabling better local implementation and distribution, and ensuring that data and information are better collected and more easily shared, India can be on track for global nutrition targets and importantly a healthier population.

The author is a researcher on innovation, entrepreneurship and development in South Asia, and is based out of Mumbai.

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