Wanted: A Poshan Plus Strategy To Deal With Malnutrition

The Niti Aayog’s monitoring and evaluation unit has highlighted several gaps and challenges in the implementation of the Poshan Abhiyan in various States, stressing on the need to “quickly graduate” to “a Poshan-plus strategy” to address the problem of malnutrition more effectively.

The Poshan-Plus strategy should not only focus on strengthening the core pillars of the national nutrition programme but also have “renewed focus” on other social determinants such as sanitation, education, poverty alleviation and food security, it has recommended.

“While Poshan Abhiyaan continues to play an important role in India’s endeavour against malnutrition, we need to now accelerate actions on multiple fronts,” it has suggested in a 140-page report on the progress of the Union government’s Poshan Abhiyan during October 2019 to April 2020.

The report has also stressed on the need to address the governance challenges that the National Health Mission (NHM) and the Integrated Child Development Scheme (ICDS) delivery mechanisms face.

Results of the phase-1 of the fifth round of national family health survey (NHFS-5), released by the Union Health Ministry last month, red red-flagged the issue of malnutrition and prevalence of anaemia in most of the 22 states and union territories covered. In the NHFS survey conducted for the period 2019-20, as many as 13 States including some of the populous ones like Maharashtra, West Bengal, Gujarat, and Kerala showed a rise in stunting. NHFS data also showed that percentage of wasting in many of the states covered.  As many as 16 states and union territories have shown a rise in underweight children below five years.

Integrated Child Development Services (ICDS) is the core platform for intervention delivery under the Poshan Abhiyan. It provides food, pre-school education, and primary healthcare to children under six and pregnant and lactating women.

In its report, the Niti Aayog’s evaluation and monitoring unit has noted that though a range of evidence indicates that the program platforms have expanded reach but they are still not reaching as many women and children as they should in high burden States.

“Even in the aspirational districts, overall reach is moving slower than needed,” the report underlines.

The report underlines that new research affirms that key governance challenges must be addressed as they pertain to financing, supervision vacancies, infrastructure and more. Core interventions delivered by the ICDS program such as Take Home ration (THR) and growth monitoring need “significant quality improvements."

“These are important to help strengthen community-based prevention, detection and treatment of uncomplicated severe under-nutrition and strengthen referrals with the health system for those requiring in-patient care,” it adds.

It also calls for ensuring strong linkages between the counselling and take-home rations in the ICDS, stressing that it must be ensured that both behaviour change counselling and take-home ration reach all the households with a child below two years.

“It is very significant because together, these two interventions provide a package of known evidence-based interventions for vulnerable and food-insecure households. Address the challenges of the system that are currently preventing adequate reach and quality of counselling services, in particular,” the report suggests.

According to the report, one of the main challenges to service delivery through the ICDS platform is that Anganwadi workers (AWWs), being the village-level point-of-contact for all government schemes, are left with little time to carry out tasks related to the ICDS.

“In urban areas, the AWWs sometimes also have to take on the work of ANMs/ASHAs if their post is vacant,” the report observes.

The report has emphasised on the need to upgrade the physical infrastructure of the Anganwadi centres (AWCs), observing that there are “huge gaps” in provisioning of drinking water, toilet facilities and electricity supply across the States and the union territories. “Since different line-departments deal with each of the items, convergent action at the highest level is necessary for universal provision of these basic facilities,” the report suggests.

The Niti Aayog report has also noted that the developmental funds available with the gram panchayats (GPs) that can facilitate the functioning of AWCs are not used “appropriately”. “For the AWC construction-related problems, it is important that the ICDS budgeting for AWC construction should be sensitive to regional variations.”

The report underlines that the efforts are underway to improve the integration of nutrition interventions into the existing health platforms, saying campaigns such as ‘Anaemia Mukt Bharat’ is bringing visibility to issues within the health sector.

 “One key challenge in the health sector is the use of private care platforms, especially for curative care, and this will need attention for key interventions such as diarrhoea control and use of zinc,” the report suggests.

The report says that Anaemia continues to remain a lingering challenge in India for decades because various programmes launched to address the problem have only been “partially successful.”

The recently launched Anaemia Mukt Bharat (AMB) offers “a new impetus” to strengthen, focus and amplify work to address anaemia. “However, much more is needed to scale-up and strengthen some of the existing interventions in the health system, like micronutrient supplements, de-worming, prevention and treatment of malaria,” the report points out.

The report says that the AMB mission’s focus action require acceleration. “New analysis highlight that a range of micronutrient deficiencies are a challenge too. Some of these also affect outcomes such as anaemia,” it underlines, “single micronutrient deficiencies do not require single micronutrient solutions. Deeply investing in improving dietary quality in rural and urban India and for all age groups – through a primary focus on dietary diversity via food systems– will help achieve multiple nutrition goals.”

The report calls for strengthening nutrition interventions into the existing health platforms such as Antenatal Care (ANC), Home Based Newborn Care (HBNC) and Home-Based Young Child Care (HBYC).