India faces a huge burden of malnutrition rooted in its social, economic, and cultural asymmetries and challenges. According to the National Family Health Survey (NFHS)-4 conducted in 2014-15, for children under five years of age, 38.4 per cent were stunted (height-for-age), 21 per cent were wasted (weight-for-height), 7.5 per cent were severely wasted (weight-for-height), 35.8 per cent were underweight (weight-for-age) and 58.6 per cent were anaemic.
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These alarming statistics have further worsened, despite several targeted service delivery schemes and outreach programmes by the government. As per the NFHS-5 conducted in 2019, stunting has gone up in 13 states and wasting has gone up in 12 out of 22 states and UTs surveyed, respectively. This abysmal situation is further exacerbated by the emergence of COVID-19 which is expected to push many more children into malnutrition.
The worsening situation of malnutrition in India demands urgent attention and resources to prevent any further backsliding on nutrition indicators. With the revival of Mission Poshan and an allocation of Rs 20,105 crore earmarked for the new national nutrition programme, the government has shown intent to tackle malnutrition.
However, to fight the chronic burden of malnutrition and the simultaneous increase in severe acute malnutrition (SAM) in a holistic manner, more concerted efforts are needed. To achieve India’s “Sustainable Goal” target of reducing under-five mortality by 25 per cent by 2030, the country needs to revamp its strategy and adopt new methods of combating SAM.
Apart from the most popular method of treating children with acute malnutrition at the Bal Sewa Kendra (BSK) or Child Malnutrition Treatment Centers (MTCs), Community Management of Acute Malnutrition (CMAM) is a proven approach to manage SAM in children under five. CMAM involves timely detection and treatment of SAM children without medical complications with ready-to-use-nutrient-dense-foods at the community level itself.
At a time when the pandemic has disastrously upended access to basic healthcare for far-flung communities, leveraging this opportunity will go a long way in ensuring the last-mile delivery of health care services, should there be any other disruptions in the future.
Case Study-Odisha
In 2015, the Odisha government piloted CMAM in tribal-dominated Kandhamal district which had the highest levels of under 5-year child mortality in the state in 2012–13. A standard CMAM approach consisted of setting-up of treatment sites closer to the community, weekly monitoring of uncomplicated SAM children, an in-patient facility to admit children with SAM and associated medical complications along with provision of Modified Energy Dense Nutritional Food (EDNRF), Modified Hot Cook Meal (HCM) and Modified Take Home Ration (THR).
The targeted programme resulted in children achieving the desired weight after treatment, thereby significantly improving the nutritional status in the district. In fact, Odisha’s success in community-led and community-managed experiments in several fields including disaster management, forest management and waste management have become legendary now with only Kerala giving it some competition.
But while Kerala has been a forbearer of such praxis since long, Odisha has been able to reach this level in just the last 20 years with the advent of the Mission Shakti Programme — a scheme to organise women into self-help groups first as a livelihood initiative. In a similar vein, Rajasthan, Gujarat, and Uttar Pradesh are some of the other states that have also shown effectiveness towards this approach.
According to the CMAM Association of India, ready-to-use-nutrient-dense-food can ensure the recovery of a SAM child in two to three months at the community level in most of the cases and reduce the need for treatment at MTCs, ultimately reducing the chances of infections and the overall cost of treatment.
Currently, India does not have a framework or a set of guidelines to address the treatment and the prevention of SAM in children. But, as we gear towards the release of national guidelines for POSHAN 2.0, it is essential to streamline and integrate CMAM as a routine part of the government system.
Since, CMAM has the potential to tackle severe acute malnutrition by strengthening community health systems, a collaborative effort at the community level will ensure the efficient delivery of sustainable healthcare in times to come. Additionally, while prioritising SAM, learnings from best practices of other states, will hold the key to tackle the growing burden of malnutrition.
According to a study by Lancet 2019, multiple forms of malnutrition (MOM) reduce nearly 8 per cent of a nation’s economic growth. As the wealth of the nation depends not only on the skills and knowledge but health and nutrition of its people, it is high time that India caters to its eight million SAM children, if it aspires to be a $5-trillion economy by 2024-25.
Recent Posts
- In the Large States category (overall), Chhattisgarh ranks 1st, followed by Odisha and Telangana, whereas, towards the bottom are Maharashtra at 16th, Assam at 17th and Gujarat at 18th. Gujarat is one State that has seen startling performance ranking 5th in the PAI 2021 Index outperforming traditionally good performing States like Andhra Pradesh and Karnataka, but ranks last in terms of Delta
- In the Small States category (overall), Nagaland tops, followed by Mizoram and Tripura. Towards the tail end of the overall Delta ranking is Uttarakhand (9th), Arunachal Pradesh (10th) and Meghalaya (11th). Nagaland despite being a poor performer in the PAI 2021 Index has come out to be the top performer in Delta, similarly, Mizoram’s performance in Delta is also reflected in it’s ranking in the PAI 2021 Index
- In terms of Equity, in the Large States category, Chhattisgarh has the best Delta rate on Equity indicators, this is also reflected in the performance of Chhattisgarh in the Equity Pillar where it ranks 4th. Following Chhattisgarh is Odisha ranking 2nd in Delta-Equity ranking, but ranks 17th in the Equity Pillar of PAI 2021. Telangana ranks 3rd in Delta-Equity ranking even though it is not a top performer in this Pillar in the overall PAI 2021 Index. Jharkhand (16th), Uttar Pradesh (17th) and Assam (18th) rank at the bottom with Uttar Pradesh’s performance in line with the PAI 2021 Index
- Odisha and Nagaland have shown the best year-on-year improvement under 12 Key Development indicators.
- In the 60:40 division States, the top three performers are Kerala, Goa and Tamil Nadu and, the bottom three performers are Uttar Pradesh, Jharkhand and Bihar.
- In the 90:10 division States, the top three performers were Himachal Pradesh, Sikkim and Mizoram; and, the bottom three performers are Manipur, Assam and Meghalaya.
- Among the 60:40 division States, Orissa, Chhattisgarh and Madhya Pradesh are the top three performers and Tamil Nadu, Telangana and Delhi appear as the bottom three performers.
- Among the 90:10 division States, the top three performers are Manipur, Arunachal Pradesh and Nagaland; and, the bottom three performers are Jammu and Kashmir, Uttarakhand and Himachal Pradesh
- Among the 60:40 division States, Goa, West Bengal and Delhi appear as the top three performers and Andhra Pradesh, Telangana and Bihar appear as the bottom three performers.
- Among the 90:10 division States, Mizoram, Himachal Pradesh and Tripura were the top three performers and Jammu & Kashmir, Nagaland and Arunachal Pradesh were the bottom three performers
- West Bengal, Bihar and Tamil Nadu were the top three States amongst the 60:40 division States; while Haryana, Punjab and Rajasthan appeared as the bottom three performers
- In the case of 90:10 division States, Mizoram, Assam and Tripura were the top three performers and Nagaland, Jammu & Kashmir and Uttarakhand featured as the bottom three
- Among the 60:40 division States, the top three performers are Kerala, Andhra Pradesh and Orissa and the bottom three performers are Madhya Pradesh, Jharkhand and Goa
- In the 90:10 division States, the top three performers are Mizoram, Sikkim and Nagaland and the bottom three performers are Manipur and Assam
In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance
The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.
Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.
The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.
The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)