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.
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Steve Ovett, the famous British middle-distance athlete, won the 800-metres gold medal at the Moscow Olympics of 1980. Just a few days later, he was about to win a 5,000-metres race at London’s Crystal Palace. Known for his burst of acceleration on the home stretch, he had supreme confidence in his ability to out-sprint rivals. With the final 100 metres remaining,
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]Ovett waved to the crowd and raised a hand in triumph. But he had celebrated a bit too early. At the finishing line, Ireland’s John Treacy edged past Ovett. For those few moments, Ovett had lost his sense of reality and ignored the possibility of a negative event.
This analogy works well for the India story and our policy failures , including during the ongoing covid pandemic. While we have never been as well prepared or had significant successes in terms of growth stability as Ovett did in his illustrious running career, we tend to celebrate too early. Indeed, we have done so many times before.
It is as if we’re convinced that India is destined for greater heights, come what may, and so we never run through the finish line. Do we and our policymakers suffer from a collective optimism bias, which, as the Nobel Prize winner Daniel Kahneman once wrote, “may well be the most significant of the cognitive biases”? The optimism bias arises from mistaken beliefs which form expectations that are better than the reality. It makes us underestimate chances of a negative outcome and ignore warnings repeatedly.
The Indian economy had a dream run for five years from 2003-04 to 2007-08, with an average annual growth rate of around 9%. Many believed that India was on its way to clocking consistent double-digit growth and comparisons with China were rife. It was conveniently overlooked that this output expansion had come mainly came from a few sectors: automobiles, telecom and business services.
Indians were made to believe that we could sprint without high-quality education, healthcare, infrastructure or banking sectors, which form the backbone of any stable economy. The plan was to build them as we went along, but then in the euphoria of short-term success, it got lost.
India’s exports of goods grew from $20 billion in 1990-91 to over $310 billion in 2019-20. Looking at these absolute figures it would seem as if India has arrived on the world stage. However, India’s share of global trade has moved up only marginally. Even now, the country accounts for less than 2% of the world’s goods exports.
More importantly, hidden behind this performance was the role played by one sector that should have never made it to India’s list of exports—refined petroleum. The share of refined petroleum exports in India’s goods exports increased from 1.4% in 1996-97 to over 18% in 2011-12.
An import-intensive sector with low labour intensity, exports of refined petroleum zoomed because of the then policy regime of a retail price ceiling on petroleum products in the domestic market. While we have done well in the export of services, our share is still less than 4% of world exports.
India seemed to emerge from the 2008 global financial crisis relatively unscathed. But, a temporary demand push had played a role in the revival—the incomes of many households, both rural and urban, had shot up. Fiscal stimulus to the rural economy and implementation of the Sixth Pay Commission scales had led to the salaries of around 20% of organized-sector employees jumping up. We celebrated, but once again, neither did we resolve the crisis brewing elsewhere in India’s banking sector, nor did we improve our capacity for healthcare or quality education.
Employment saw little economy-wide growth in our boom years. Manufacturing jobs, if anything, shrank. But we continued to celebrate. Youth flocked to low-productivity service-sector jobs, such as those in hotels and restaurants, security and other services. The dependence on such jobs on one hand and high-skilled services on the other was bound to make Indian society more unequal.
And then, there is agriculture, an elephant in the room. If and when farm-sector reforms get implemented, celebrations would once again be premature. The vast majority of India’s farmers have small plots of land, and though these farms are at least as productive as larger ones, net absolute incomes from small plots can only be meagre.
A further rise in farm productivity and consequent increase in supply, if not matched by a demand rise, especially with access to export markets, would result in downward pressure on market prices for farm produce and a further decline in the net incomes of small farmers.
We should learn from what John Treacy did right. He didn’t give up, and pushed for the finish line like it was his only chance at winning. Treacy had years of long-distance practice. The same goes for our economy. A long grind is required to build up its base before we can win and celebrate. And Ovett did not blame anyone for his loss. We play the blame game. Everyone else, right from China and the US to ‘greedy corporates’, seems to be responsible for our failures.
We have lowered absolute poverty levels and had technology-based successes like Aadhaar and digital access to public services. But there are no short cuts to good quality and adequate healthcare and education services. We must remain optimistic but stay firmly away from the optimism bias.
In the end, it is not about how we start, but how we finish. The disastrous second wave of covid and our inability to manage it is a ghastly reminder of this fact.