Nutrition In The Context Of The COVID-19 Pandemic In India

The rapid increase in the number of COVID-19 cases, as well as the measures adopted to contain its spread have put many families at risk by impacting their food supply, livelihoods and household incomes and their ability to access critical services for health and nutrition, early childhood care, education and social protection globally and in India. This is especially true for the migrants and poor urban populations as well as many rural poor and other disadvantaged populations in India.

COVID-19 is a complex crisis that affects all aspects of life, both immediate and long-term. The United Nations (UN) in India is concerned about the impact of the crisis on vulnerable
populations, especially women and children. The prevalence of malnutrition in India has notably declined over the last decade, and the Comprehensive National Nutrition Survey 2016-18 revealed that major challenges remain. There are still around 20 million children under five years of age who are suffering from wasting, over 40 million children are chronically malnourished , and more than half of Indian women aged 15-49 years are anaemic. The secondary impacts of the COVID-19 crisis are aggravating the challenges faced by many families, especially in terms of access to affordable and nutritious food. This could reverse some of the recent gains in reducing malnutrition.

The Government of India already has robust and effective schemes and programmes in place to address food insecurity and malnutrition such as the Targeted Public Distribution System (TPDS), the Mid-Day meals (MDM) and the Integrated Child Development Services (ICDS), all covered under the National Food Security (NFS) Act, 2013. Furthermore, in March 2018, the Prime Minister launchedPOSHAN Abhiyaan, an ambitious, multi-sectoral programme with the vision to attain a malnutrition-free India by 2022.

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During its first 2 years, POSHAN Abhiyaan has made notable progress: service delivery systems have been strengthened with a significant number of frontline workers trained on nutrition interventions; many ministries, beyond the traditional health and nutrition departments of the Ministry of Health and Family Welfare (MoHFW) and the Ministry of Women and Child Development (MoWCD) have been brought on board to support a comprehensive nutrition response; and information sharing, monitoring and reporting have improved through mobile phone application ICDS-CAS. An example of the success of POSHAN Abhiyaan is the increase in the coverage of iron folate supplementation for adolescent girls under the Anaemia Mukt Bharat Campaign, which reduced the prevalence
of anaemia from 20 percent to 39 percent in two years.

Over the past few weeks, the Government of India has also taken several steps to protect the investment and achievements made under POSHAN Abhiyaan. Recognizing that reproductive, maternal, newborn, child and adolescent health and nutrition services are amongst the most crucial health interventions, the MoHFW issued detailed guidance to ensure continued delivery of these services during the crisis. In addition, several state governments have also issued operational guidance for delivery of lifesaving nutrition interventions including distribution of food, micronutrient supplementation, continued breastfeeding and treatment of malnourished children in the context of COVID-19. These interventions, both at the national and state level, provide a strong basis to strengthen access to food, health and nutrition services during these times. Likewise, changes have been brought about in the TPDS scheme which include provision of 5 kg of rice or wheat, per
person, per month for 3 months, 1 kg of pulses per household, per month and at home delivery of food rations to vulnerable populations – all free of cost.

We understand that in India, COVID-19 and its containment measures are likely to be a part of everyday life for the near future. To mitigate the impact of the crisis on families and society and to protect the nutrition of the most vulnerable families and individuals, further action is urgently needed from national and state governments, donors, and partners. Presented here are a set ofsix crucial domains against which concerted actions are required by concerned stakeholders, including the UN, to support in order to maintain nutrition and food security during this crisis:

1.Maximise maternal, infant and young child nutrition actions: During this crisis it is critical to ensure that the guidelines issued by the government on the continuation of essential nutrition and health services for mothers and children are followed with full coverage, continuity, intensity and quality (C2IQ) to ensure maximum impact. It is paramount to provide appropriate support for mothers to breastfeed, including those with COVID-19. Accurate information on maternal, infant and young child nutrition and continued protection against the marketing and donations of breastmilk substitutes and availability of age appropriate, nutritious take home rations should also remain a priority for governments. Intensified communication initiatives also need to be put in place on the importance of consuming well-balanced, diversified, nutritious foods, including whole grains, nutri-cereals, legumes, fruits, vegetables, where appropriate animal source foods and safe diet to build immunity while limiting the consumption of low-cost junk foods that contribute to overweight and obesity.

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2.Protect functioning food supply chains & strengthen food security: To ensure food availability and its access by the most vulnerable populations, actions are needed at several points within the food supply chain. Supply chain logistics for food should also include critical hygiene and safety measures while being strengthened and functioning. Incomes and livelihoods of farmers and farm workers must be protected through the use of decentralized or direct procurement from farmers which will also minimize food price divergence between farm gate, wholesale and retail. To ensure smooth transportation of food supply, transportation costs should be reduced, and transporters incentivized while public buildings can be used as temporary storage facilities for increasing storage capacity. Focus needs to be on those who are most at risk of facing food shortages such as daily wage earners and returning migrant workers.

3.Manage cases of acute malnutrition: The crisis has reduced availability and access to nutritious food for many vulnerable households which will likely result in an increase in acute malnutrition in young children. A Lancet article on the indirect effects of the COVID-19 pandemic in low-income and middle-income countries estimates that an increase in wasting prevalence would account for 18–23 per cent of additional child deaths. Given that addressing acute malnutrition is a key priority under POSHAN Abhiyaan, it is imperative to strengthen the existing mechanisms in place to detect and treat acute malnutrition. Early identification supported by a package of services including medical assessment, counselling, weekly tracking and nutrient dense foods should continue to be prioritized and delivered using appropriate COVID-19 protection measures. The continuation of facility-based screening and treatment services, along with Community Management of Acute Malnutrition, to identify and treat acutely malnourished children and undernourished mothers, should remain a primary focus of the government’s interventions.

4.Accelerate micronutrient supplementation and fortification activities: Programmes to prevent and treat micronutrient deficiencies must continue through routine service delivery for pregnant women, adolescents and young children. The standard delivery approaches for distributing key micronutrient supplements such as iron/folate, calcium, and vitamin A should be adjusted to keep social distancing in mind and to prevent transmission of COVID-19. Adequate stocks should be available at primary health facilities and with frontline workers. However, planned mass micronutrient campaigns (e.g. Vitamin A supplementation and deworming) should be temporarily suspended/postponed until it is safe to resume. These campaigns can be tailored to be included in routine service delivery programmes such as immunization or home visits. Another area of focus should be ensuring fortified staple foods such as rice or wheat flour are included in the food-based safety nets and
that the take home ration (THR) under the ICDS is fortified.

5.Strengthen school feeding and nutrition: As schools are closed due to COVID-19, comprehensive guidance should be provided to school staff, parents and children on the importance of social distancing, consumption of safe and healthy diets, hygiene and physical activity for school-aged children. The central and state governments have already taken action to ensure the availability of school meal entitlements to children through various modalities both during the lockdown and the summer vacations. States and schools need to be directed on how to make the MDM functional following school re-opening.

6.Establish nutrition surveillance: Regular collection and analysis of maternal and child nutrition data at state and district levels will assist in identifying areas where malnutrition is
increasing. This will allow for targeted intensification of prevention and treatment programmes such as provision of additional foods and identification and management of severe acute malnutrition. Existing systems, including growth monitoring and reporting by Anganwadi workers reporting through the MWCD mobile phone system (ICDS-CAS), can be used as well as targeted low-cost nutrition assessments. Especial monitoring of the situation on the most vulnerable segments of the population, especially those at highest risk of being affected by economic hardship, is crucial as is linking them to the afore-mentioned services.

India has taken important steps and a few more concerted actions can get us closer to ensuring nutrition and food needs of the people are adequately met during these unprecedented times. By joining efforts, the Government, civil society, development partners, private sector, academia, the United Nations and other stakeholders can support the continued, safe and appropriate delivery of nutrition programmes to meet the needs of all vulnerable populations and those directly and indirectly affected by the COVID-19 crisis, and to ensure that the people of India are able to manage the impact of the shock today, and into the future.

(Dr Yasmin Ali Haque is the Representative of UNICEF India
Mr. Bishow Parajuli is World Food Programme Representative in India
Ms. Payden is the Acting WHO Representative, WHO Country Office for India
Mr. Tomio Shichiri is the Representative, Food and Agriculture Organization, India)