On December 10th, the Global Nutrition Report was launched in India, alongside the release of the first India Health Report (IHR) by the Public Health Foundation of India (PHFI). It was a high profile event attended by two union ministers – Minister JP Nadda of Health and Family Welfare and Minister Maneka Gandhi of Women and Child Development; Dr. Soumya Swaminthan, Director General for the Indian Council for Medical Research; several government officials, academics, and representatives from development organisations and civil society. There were keynote speeches followed by a panel discussion.
For me, three main points stood out as the speeches and a panel discussion concluded: 1) improve implementation of the existing programs; 2) work mutli-sectorally; and 3) invest in girls and women. As a public health researcher conducting research on maternal and child nutrition programs for the past three years, under the umbrella of the POSHAN project in India, this was music to my ears.
Improving implementation of the current programs is a low-hanging fruit, if one is willing to revisit their existing design, assess, and make changes as required. Minister Gandhi questioned the highly variable quality of locally-prepared food for children under three years and thought that a centralised business model could be a better approach. A similar concern about the quality of food but for the mid-day meals was raised by Dr. Swaminathan. It is indeed timely to examine these issues. A 2007 Supreme Court Order called for decentralisation of the supplementary nutrition program (SNP). It is unclear if any programmatic research was conducted to examine if a decentralised model improved the quality and supply of food compared to its predecessor, a centralised model, or to check how many of the states did in fact fully implement the order, and what it took to do so. In addition, it is timely to revisit the government of India’s SNP guidelines for children under three years. It is time to ask, “Do the SNP formulation and quantity meet global complementary feeding recommendations for macro- and micro- nutrients?” It is likely that costs for implementing the SNP component could even be reduced if the SNP is tailored according to the global recommendations.
Minister Gandhi also talked about how important it is to train frontline workers and to reduce their burdens. Again, I cannot agree with her more. Dr. Rajesh Kumar, Joint Secretary for Women and Child Development, announced a revamping of the nutrition monitoring system using smartphone technology and merging with the health monitoring information system. The efforts are to gather real time data and to reduce frontline worker drudgery from maintaining multiple registers. However, technology alone might not do the trick for quality data. Without adequate training, support, and trust in the system, it is unlikely that the monitoring reports will reflect reality because of new technology. Therefore, it is paramount to test these strategies on a small scale, identify gaps, and address them before scaling up.
“Work multisectorally” was the mantra of the day! A great progress in our thinking, indeed! It is time to ensure that all the sectoral programs that cater to women and children converge on the same household and deliver for the same mother and child dyad. I vote for Naandi Foundation's Manoj Kumar’s HAMMER: H- Create hungama (commotion) on the issue of undernutrition; A – Create awareness among mothers; M – Keep the mother at the centre of the solution; M – Invest in the mother-to-be; E – Create an enabling environment; R – Invest in rehabilitation of children who need it. A very simple mnemonic that captures the essence of elements needed for reducing undernutrition. I would like to add ME to it: M – monitoring and E – evaluation, the remaining two elements that are critical to keeping the targets in check and investing limited resources wisely.
India has the potential to achieve the Sustainable Development Goals, as demonstrated by high rates of reduction in stunting in some of its states, but it is important that the political commitment translates into ground realities for the women and children of this country. India should continue to generate timely data to know the status of its children and that of its programs so that it can make smart investments of its limited resources. It is the responsibility of the research community to continue to generate timely evidence that is relevant for policy makers to make informed decisions.