We need to make sure nutrition is not easily neglected. And that means putting pressure on leaders throughout society to focus on nutrition.
I have just finished a trip to India to help contribute to the efforts on ending malnutrition. The politicians and media were talking about the sparkling new economic growth and development figures. There was no such attention given to the “other” growth and development figures — those related to child nutrition. These figures are less than sparkling. If current rates of progress in reducing undernutrition are not improved upon, India will reach the U.N. Millennium Development Goal of halving undernutrition by 2043. The target date is 2015. China has already exceeded the target.
There are some glimmers of hope. The State of Karnataka has just adopted a Nutrition Mission which promises to give focus, coherence and urgency to efforts to combat undernutrition. There are some initial indications that the decline in undernutrition rates may be accelerating in one of the worst affected States, Madhya Pradesh. More and more international agencies such as the U.K.'s Department for International Development have ramped up their focus on nutrition. But there are worrying signs at both the national and State levels. It is at least 18 months since the creation of the Prime Minister's Council on Nutrition. It has not met once. The scandal of rotting food grains in the midst of hunger and undernutrition has rightly been getting a lot of media coverage. And we still don't know who in Delhi is responsible for leading efforts to reduce undernutrition.
During my stay I went to Bihar to visit some ICDS Anganwadi centres. The Anganwadi workers in charge of the centres were inspirational in their attempts to make the best out of the resources at their disposal. But the conditions in which they have to teach and feed about fifty 3-6 year olds, do home visits, and monitor child growth are testing and undermining. The centres are understaffed. Many are without toilets, washing facilities, clean drinking water, decent floors or food storage facilities. It is a miracle that the centres have any positive impact on nutrition status. I visited several AWCs in the mid 1990s. Nothing much seems to have changed. More pressure for change needs to be generated.
So how do we make more noise about undernutrition? During my visit I gave a presentation at a conference on “Nutrition: Reaching the Hard Core” organised by the Britannia Nutrition Foundation. For me, there are three key puzzles on how to overcome undernutrition: (a) how to raise the quality and expand the coverage of interventions such as ICDS; (b) how to make investments in various related sectors (such as agriculture) more pro-nutrition; and (c) how to create an environment where it is hard for anyone to neglect malnutrition.
My presentation was on the third area and was entitled “The 7 Habits of Highly Effective Environments for Nutrition”. The 7 habits are: (1) developing new surveillance techniques using mobile technologies to allow the government and civil society to react in real time to the changing nutrition situation, (2) the importance of creative campaigns to reset norms around what are acceptable rates of undernutrition reduction, (3) the need to support and expand the cadre of nutrition champions, (4) the need to learn from success within India (taking advantage of the federal set-up) and internationally, (5) the potential of a new class of “commitment indices” which monitor the nutrition commitments of governments, civil society and businesses, (6) the insights to be gained from adopting the new generation of economic growth diagnostics for nutrition to help prioritise and sequence the laundry list of potential nutrition actions in a given context, and (7) the value added of feedback — asking intended beneficiaries to score existing services and suggest what to do differently. Too little attention has been given to these issues.
Undernutrition is insidious — it sucks the life out of kids before clinical signs show. Undernutrition requires action on many fronts and hence it requires coordination and leveraging. Undernutrition requires scaling up of quality. All of these features — invisibility, scaling, coordination, leveraging — demand leadership. Sometimes leadership just emerges as in Mexico or Brazil or Ghana or Karnataka. But with so many lives being ended or wrecked by undernutrition, we can't afford to wait. We need to make sure nutrition is not easily neglected. And that means putting pressure on leaders throughout society to focus on nutrition. These seven habits will play a big role in doing that.
What should the private sector do?
Despite the aforementioned conference being organised by the Britannia Nutrition Foundation there was little discussion of the roles of the private sector in accelerating undernutrition reduction. Is there a role at all? The provision of nutrition is a prime public good — undernutrition generates negative spillovers for the current and next generation, is often generated through information deficits and affects the poorest — all classic features of a public good provided by the state. But that should not preclude dialogue on the question “are there any overlaps between commercial interests and sustainable and equitable improvements in nutrition?” This is a discussion that many are afraid to have — and not just in India. It seems to me that four things are being mixed up when we talk of the private sector. First, what can business do to make its core activities more supportive of nutrition? This means going beyond corporate social responsibility and making sure for example that advertising is responsible, that legal resources are directed in ways that do not only protect shareholders, that labelling is clear and gives consumers real choice, and that transparency is high on the business agenda so that civil society can hold businesses accountable.
Second, when can business act as a substitute for the state? I am not too optimistic here about the role of business — in the end, nutrition is a public good. But there might be things that the private sector can do better than the state. Would the private sector have handled the supply chain management of food grains as badly as the state seems to have done? Third, when can business be a complement to the state? For example, while fortification of salt and other widely used low cost foods is only a small part of an effective nutrition strategy, international experience has shown that the private sector is usually the best way of implementing it. The fourth and perhaps the most promising area is to work with businesses outside the traditional food and health areas to make the environment more enabling for nutrition. For example, when renewing a contract for mobile telephone operation, could the state build in requirements to set up sms services to remind health workers about childhood vaccinations? And could computing companies be engaged to help improve nutrition surveillance? I don't know the answers to these questions. They can only come through a dialogue that is sorely missing in India and elsewhere.
To be fair to the Government of India, it needs help to combat undernutrition. It is such a huge burden (43 per cent of children are malnourished) that the government cannot do it alone. Civil society, business, and the academic community have to help. International donors have an important catalytic role to play. But nutrition is a public good. Leadership has to come from the government. I still do not see it.
(Professor Lawrence Haddad is director of the U.K.-based Institute of Development Studies and president of the U.K. and Ireland's Development Studies Association.)
Those who wish to perform there duty honestly , will end up mal-nourished in India. Prices of foods are high enough. Corruption breeds corruption and perpetuates corruption. Beginning from the top (our supreme, parliament) to down.
It is unfortunate that no comparison has been made between the performing states and others. While India as a whole may be suffering becauseof the high average of mal-nutrition, there are exceptions in States like Kerala which should have been highlighted to give a balanced picture.
AWW & supervisors needs to be given extencive training functionally & more importatly on sensationalising. They needs to be made more demanding. They needs to be more empowred & trusted. I do not see any other solution.
It is good to read the article which is of a great concern to every citizen of the country. Although India is making steady progress in a few sectors including agriculture, malnutrition still appears to be nobody's baby. Unless the civil society organizations take active role in making the communities understand the grave problem, the government alone cannot do justice. There needs a strong political commitment rather than a lip serivice in the form of some legisltaitons and guidelines. Every elected member be made responsbile for reducing malnutrition in their constituencies and discuss the progress in each session constitution by constitution either in the state assemblies or parliament. There has to be close watch with accountability.
The biggest gap that remains wide open is with respect to the implementation of the bill, as that largely remains in the hands of the state government. It is no secret that the existing Public Distribution System has been a complete disaster! Bald-faced corruption has been perpetually robbing food from the mouths of the poor. A relook to the Right to Food Act from the standpoint that it is being promulgated for giving food security to all the poorest of Indians, who ironically are engaged in the very production of agricultural commodities – as a majority of the poorest of Indians, are engaged in subsistence farming. This is shocking because it shows the sheer anomaly in the market – where the ones who actually produce the food grains cannot themselves avail of the same from the market.
The article clearly elucidates the fact that India is suffering from a serious leadership crisis. We have to learn from china. When such a big country can act quickly lift people out poverty, India can very well do it. Politicians who are as ministers should not have any other responsibilities other than taking care of his/her ministry. In our case the agriculture minister is very busy solving problems of BCCI and tackling Lalith Modi he hardly finds time to solve peoples problem. Prime Minister wakeup......
Why is no one talking about educating these people the importance of family planning. When will they stop re-producing babies they can't feed. Did they ask Government before they produced their babies?
How many people can government feed with this logic? Some one will have to work to get these godowns to fill in the first place.
Along with feeding them, most important thing is to make the fellow citizens aware of the responsibilities of the parents and educate them to plan for only the numbers of kids whom they can easily feed, instead of having 4-5 + kids, one crying out in every corner of the house.
"More hands, more work, more money" mentality has to stop.
India wants to host the CWG here, in a country where people are suffering from malnutrition, starving and dying of hunger. The government must priorities its goals first, whether country’s pride is in hosting such games or in the welfare of its people. With such governance, India's pride is at double stake. Neither the problems of the poor are addresses, nor are the resources utilized in the right way for the right cause. With all its resources; monetary, intellectual, manpower etc India can march towards a better country every day. But the monster, Corruption alone, not only, stops India from progress but is causing it to regress. If India will not wake up now, then there is little hope that it will ever do.
The Anganawadi Centers need to be empowered urgently. They are an effective gross-root institutions to combat malnutrition. There is a severe shortage of staff at AWCs and the current staff are working at very low wages. An effective monitoring of ICDS on the lines of School Committees should be put in place. At present there is no role of local people to monitor AWCs. There is a huge corruption and political interference in the current set-up of implementation of ICDS.
I like the solutions you have mentioned. Your work is really an 'eye opener', not only for the government but also for the citizens of the country.
If 43% of children are malnourished, then one must also consider that after 15-16 years this population only will contribute towards the 'youth population' of the country. No country has been or will be able to achieve competence in terms of international standards if half of its youth is physically incompetent.
If India thinks the other way around then providing nourishment to these kids will help to raise its 'highest youth population' stature to 'highest and competent youth population', which will be fruitful to the country itself in the future. If India wants a development beyond GDP then the country must take seriously the aforementioned admonition.
Under nutrition in India is really a matter of concern.I think everybody,every class in our society should join hands and combat this menace.Cooperation not conflict is the need of the hour if we have to tackle this curse.
The basic problem is that the majority do not know what is nutritious food. Proper and correct education is the need of the hour.You can have umpteen conferences and seminars - they do not help.Educate all mothers on what is good nutrition and then malnutrition will slowly fade away.
Nutitional status of a community is outcome of development of many sectors like health, agriculture,water supply and sanitation, status of women in the community , availabilty of water and fuel for the family, education of women and girl child.It is easy and simple to be a para-trooper and visit few places and make negative comments. Yes we are a poor nation BUT we are progressing speedily. We are self sufficient in food and aiming for food security from our internal resources. We are providing best IT sector services, we have developed best missiles in the world , we are in club of countries with atomic power. My request is not to be a part of " India bashing syndrome ". Please do mention our achievements. If undernutrition rates are high then our over-nutrition rates at national level are inncreasing rapidly .
Having to go through lot of activities,the politicians aren't paying any attention to the under-nutritioned class.It is high time they start taking appropriate measures for these people.Or else , the future is definitely going to be grim-looking.
Agree with Prof. Haddad. For the last fifty years Indian leaders and scientists have been talking about eradicating malnutrition without any action. Illiteracy, ignorance, and apathy on the part of all concerned are the root causes of the problem. In fact, most policy makers, and bureaucrats simply do not care as it is not important to them. There are some technological solutions like the genetically engineered golden rice locked up in greenhouses without a chance of being released in the near future. Thanks to the anti-GM activism by certain members of the civil society who should be in the forefront of tackling the problem. As long as there is no firm leadership, there will be no solutions. Millions will die as human life is very cheap in India.
The article shows us that where we are. we proudly discussed about Indian economy's strength, global acceptance of Indian products, and everything what makes our heads high. Last month, there was a report that our poverty status is equal to poorest African countries. If our kids are not fed adequately, that is the main worry of a human being. The same way the authorities should consider that what makes us proud is not the economy status, but wiping out the poverty and handling malnutrition properly in the country.
The central Congress govt needs to stop being nice to countries like Afghanistan and Pakistan by giving them aid and needs to concentrate on its own people and infrastructure. The Govt has just donated $25 million for the flood aid in Pakistan, the same people who hate us the Indians. The anti-India militancy is continuing through the ISI and military. The poor people of India need help now and the govt should make them the priority. Invest in our own infrastructure and food aid. There is even a debate about whether rotting food grains should be distributed for free. This is appaling behaviour from this government.
India has achieved second ranked population, but it did not get good place in Human Development Index. Slum areas are increasing in India and it is becoming HUNGRY REPUBLIC. Food security bill needs to be implemented so that children get a proper nourishment.
I like the solutions given by you. But government needs to concentrate on implemention of all policies. We have everything except its good implemetation.
See that our best PM constituted a council for malnutrition . And the council has not met for 18 months. No priority for them. We must judge our govt with these yardstick as well. And the intended beneficiaries have no say at all , though they have the maximum stake.
So civil society is the only hope. I can join the movement at Hoshiarpur. Anyone listening.
Pictures speak louder than words! Can someone forward this to our honorable minister Pawar, before he leaves foodgrains to rot.
A holistic article to achieve nutritional security.Also we must have inbuilt nutrinal security in Food security structures.Diversification of agriculture(beyond wheat and rice) and PDS system(inclusion of coarse cereals) will ensure nutritional security and sustainable agriculture.
Articles such as these help to spotlight the need for urgent attention by both political leaders, civil servants and the general public including the media. For quite sometime articles candidly depicting the poor performance of this county has appeared both in the country and outside. While we are making faster progress, the picture of the other India is disturbingly bad. Sometime back, the Obsever of London carried an article on our progress.
By "storing" large amount of grain in politicians owned godowns...there are three things that are happening.
1. Artificial scarcity and therefore high prices.
2. Increasing wastage where some percent of it gets rotten or eaten away.
3. When Govt announces procurement of large (more than needed) amount of grain, the farmers cut the crop and bring it in to markets, but only a small percent of it brought, which means many farmers have to sell their produce to middle men when demand is less than supply. That is at much lower prices.
In one shot three or more ills. I think therefore Govt should go on "Just in time, Just on demand" way.
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