How India can sort out its formidable vitamin problem

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For the past 15 months, the country and world’s attention has rightly been focused on managing Covid-19 and mitigating its impact. Covid has many visible effects – both proximally and distally. But one of the silent and invisible crises that aggravates it is that of malnutrition as income, food consumption and vital services come under pressure. As India steps up its efforts to recover from the effects of the pandemic, an evidence-based, integrated and results-oriented approach to addressing the food challenge in India becomes even more urgent. This is clearly on the government’s agenda, but we must act quickly so that this generation of Indian children can reach their full potential.

In recent years, the government has given priority to tackling malnutrition through the Prime Minister’s Overarching Holistic Nutrition Program (POSHAN) Abhiyaan and the updated POSHAN 2.0 guidelines announced in January 2021. The focus is on the 1,000 days between a mother’s pregnancy and her child’s second birthday, prioritizing women and girls and remedying their nutritional deficiencies by fortifying them and providing them with take-away rations. The introduction of community-based programs for severe acute malnutrition, Jan Andolans, and community events, as well as strengthening cross-departmental collaboration, have resulted in the implementation of a holistic approach to tackling malnutrition. For the first time, the guidelines establish accountability at the district level by including nutritional indicators in the district judges ‘/ district collectors’ KPIs (Key Performance Indicators). The Government of India has now made it clear that the DM / DC is expected to establish district nutrition committees, review progress and take appropriate action to improve nutrition indicators.

Poshan Abhiyaan also emphasized the importance of a data-driven approach to planning and managing the delivery of nutritional services, particularly by Anganwadi Workers (AWWs). One of the biggest challenges in tackling malnutrition in India so far has been the inability to track and identify the coverage and quality of nutritional interventions in real time. Technology and data systems can play a critical role in the design of programs and tools to support the timely reach of important interventions with the intended target groups. It is this need to monitor and improve interventions to combat malnutrition that led to the development and implementation of the “Poshan Tracker” by the Department of Women and Children Development.

The tracker replaces the CAS system as the digital backbone of Poshan 2.0. It aims to provide a holistic overview of the distribution and access of nutritional services through Anganwadi Centers and AWWs to eligible groups – pregnant women, nursing mothers, children and adolescents. The tracker is designed to ensure real-time updates and increase transparency so that the system can identify beneficiaries on the last mile who may be left out. Its centralized data architecture enables interfaces to digital technology systems of other ministries to ensure that households that fall within the critical period of 1,000 days receive benefits and services from various social protection programs. In response to the tragedy of children orphaned by Covid-19, the tracker now includes a module that AWWs can use to identify and support these children.

Since its introduction in March, the tracker has been used by nearly 15 lakh AWWs today and over 8.30 crore mothers and children have been registered in the system. The app has enabled the delivery and tracking of over 2.94 crore take-home rations and over 1.35 crore hot cooked meals – key components of the Indian nutritional program. These are still the early days for the tracker as additional features and analysis tools are planned, but the signals are promising. In particular, the upcoming job support feature, which will enable AWWs to identify children at risk and take prompt action, could make a difference.

Improving nutrition requires a systemic approach that includes health, nutrition and care systems with data-driven digital tools that provide a supportive backbone for scaling evidence-based interventions. There is growing evidence that convergent policies, particularly the convergence between agriculture and food and strengthening demand-side behavior, can play a critical role in preventing malnutrition.

Most of the smallholders in India are farmed by women farmers. Investing in their empowerment and nutrition-sensitive farming programs can help women and their communities live healthier, more prosperous lives.

In recognition of this fact, the government, in close cooperation with development partners and community groups in Uttar Pradesh, Bihar, Odisha and other states, has supported the establishment of “Poshan Vatikas” or food gardens, which enable families to access locally produced nutritious food and at the same time support their livelihood and productivity.

The road ahead is not easy. But as a country, we have made significant progress on a number of complex development challenges such as water, sanitation and financial inclusion. Every time we had to use multiple levers on the path to progress – scientific innovation, traditional knowledge systems, collaborative engagement, digital tools, and data-driven management. Poshan 2.0 provides all of these levers. The government, development partners and communities that come together at this point to drive an integrated push for improved nutrition can ensure that the crisis is resolved.

This column first appeared in the print edition on June 11, 2021 under the title “In COvid, Follow Nutrition”. The author is the Director, India Country Office, Bill and Melinda Gates Foundation.