Malnutrition among children in the age group of 0-19 years continues to be a problem in India. As per the Comprehensive National Nutrition Survey (2016-18), 22% of school-age children (5-9 years) were stunted and 24% of adolescents (10-19 years) were thin for their age. While that’s one side of the coin, the survey also showed that conditions of overweight and obesity are on the rise.
Bengaluru-based nonprofit organization Nourishing Schools Foundation (NSF) aims to address this problem by bridging awareness gaps in nutrition among school children and nudging them to become problem-solvers.
Archana Sinha, co-founder and CEO at NSF | Photo Credit: Special arrangement
The organisation which has been taking a ‘toolkit-based approach’ has so far implemented its programmes in more than 230 government schools across the country, impacting over 60,000 children, says Archana Sinha, co-founder and CEO at NSF. The nonprofit is now getting ready to roll out its toolkit for private schools, with Bengaluru as one of its focus cities.
In an interview with The Hindu, Sinha talks about the new programme, where Karnataka stands in terms of battling nutritional challenges and what to keep in mind while designing such programmes in a country where food is a complex topic.
Can you tell us about your work?
The core of our work has been helping children learn to take charge of tackling malnutrition and working with various stakeholders to enable that. So far, we’ve reached more than 230 schools all over the country, impacting over 60,000 children.
In Karnataka, our engagement has been more at an institutional level. Around the year 2015, we collaborated with the government of Karnataka to implement the central government guidelines on food safety, hygiene and nutrition of midday meals. GoK published a booklet in collaboration with us for the training of midday meal cook-cum-helpers.
Our toolkit is how we engage with government schools across the country. We give a box of games and activities that we have developed with different partners. The toolkit enables children to learn about nutrition in a fun way. And they go on to problem-solve by taking on various projects.
Tell us about the relevance of the toolkit and how it is rolled out in schools?
A lot of nutrition programmes target pregnant women or young mothers. And then the focus tends to drop off. Hence, we thought of reaching out to schools and talking to children - boys and girls - from 4th to 9th grades. The toolkit was a result of this.
We map out the different topics related to health and nutrition such as diet and food, water, hygiene and sanitation, agriculture, midday meals and so on. For each of these, we partner with experts or organizations to develop games and activities. But awareness alone is not enough.
So, we use the knowledge as a base to nudge them to do a small solution-driven project.
This could be something like starting a school garden to supplement the midday meal and broaden the access to diet. We have a school garden manual to support that.
Or it could be setting up a DIY hand washing station inside the school from readily available materials.
We do a baseline survey before we roll it out in the schools so that we understand the specific challenges and we go back to the schools with a customized report.
The programme is rolled out over eight weeks, ending with a midline survey. All this happens in one academic year.
In the second year, we roll out an upgraded version of the toolkit and also carry out an endline survey to see the overall impact. We’ve seen that there’s been a reduction in undernourishment. In some cases, there’s also been an improvement in education outcomes and a change in behaviours.
We are also currently developing a model for engaging students in private schools, and we are looking at expanding our presence in Karnataka schools.
For example, we are collaborating with the Children of India Foundation to roll out our programme in seven schools in the outskirts of Bengaluru this year.
Would the toolkit for private schools be different from that for government schools?
It would be similar but with certain adaptations.
In a government school you’re dealing with challenges such as absence of proper sanitation facilities or water amenities. That may not be as much of a challenge in a private school.
However, there will be other things that they will still relate to, let’s say, diet-related concepts, balanced diet. So, we adapt accordingly.
When you’re working with a private school lack of information is not so much a challenge. If anything they are overwhelmed by information. So with them you have to really try to simplify it and make it easy to understand.
Whereas with a government school you would be working a little bit more from the ground up and make concepts familiar to them.
The second difference is that you can leverage technology a lot more in private schools because they are familiar with it.
The third is more of a hunch because we don’t have exact data. What we have seen is that in government schools, undernourishment percentage being high is a larger challenge. On an average 15-30% of children will be undernourished and the obese and overweight tend to be in the range of 1 to 4%.
In a private school my hunch is that children being obese or overweight can also be a challenge because there you’re not exactly dealing with scarcity issue most of the time. Micronutrient deficiencies and hidden hunger could be an issue. Studies have shown that as income level goes the percentage of fat intake goes up and protein intake comes down. So, we will need to talk a lot about the importance of dietary diversity and balanced diet. We’re not going to be dealing with affordability issues as much.
Engaging the parents may also work a bit differently.
What are the timelines and targets for the new programme?
Our online modules should be available by next month. Around July would be a good time to kick off levels 2 and 3.
In the first year we would like to reach between 30 to 50 schools, and we are exploring different cities to see where the most uptake will be.
Personally, since we are based in Bengaluru, I would love to see at least 10 schools from our city sign up for this
How much does the toolkit cost?
In a government school we implement it with the help of CSR partners and the cost would come to about Rs 2.5 lakhs per school per year and that comes to about 1,250 per child per year.
That being said, to do it in a private school would be costlier. We are aiming to provide most of the elements of this programme but at a very subsidized cost. Let’s say you have 10 private school students coming together as a team and implementing it in their school for about 5 months, you could charge them something in the range of Rs 3,000-5,000 per month.
In terms of nutrition in children how does Karnataka fare?
There seems to be scope for improvement.
If you look at national data, previously the percentage of children under five years who were chronically undernourished was at about 38% and it’s down to about 36% between the 2015 National Family Health Survey and the more recent survey that came out in 2021. That’s about a 2% reduction.
In Karnataka it was about 36% and it has come down to 35.4% - barely a 1% reduction.
For the age group of 15 to 49 years we seem to be making better strides nationally. The percentages of undernourished men and women have come down by about 4 to 5 percentage points. Whereas, for the state of Karnataka that reduction has been slightly less, more in the range of 2 to 3 percentage points.
Where we see quite a difference is in the percentage of people who are overweight or obese. For men and women in India that figure is between 23 to 24% but in Karnataka it’s at about 30%. This number was 22-23% previously for Karnataka. At a national level too, this statistic has gone up, but only by 2-4%.
In India food and food choices are often a topic of contention. Does that impact your operations?
We have adopted a very ground-up approach and put children in charge. The reason for that is while some solutions can be applied in all settings, others need to be tailored to that geography, climate and so on.
Something as simple as a school garden would look very different in Rajasthan or Assam. Availability of water, the things you can grow, even the local dietary patterns are all very different.
So keeping it broad enough to be relevant for an audience in a country as large as ours while also allowing for adaptation to local needs is critical and we’ve always thought to do that.
It’s not about taking a stance of this diet versus that diet. It’s important to meet people where they are in all kinds of practices, because the only way you can bring change is by giving them the flexibility to incorporate their own beliefs, habits and customs into it.
