September is being observed as ‘Poshan Maah’ (nutrition month) across the country to ensure mobilisation at the grassroots level to achieve the targets laid down under the ‘Poshan Abhiyaan’ or the National Nutrition Mission (NNM). Launched by Prime Minister Narendra Modi in 2018, the programme aims to reduce levels of underweight, stunting, low-birth weight as well as anaemia by 2022. Member (Health & Nutrition), NITI Aayog, Vinod K. Paul talks about the journey so far.
It has been nearly 18 months since the launch of Poshan Abhiyaan. How much ground has been covered so far?
The Poshan Abhiyaan has surpassed our expectations in terms of awareness at the grassroots level. The Jan Andolan [people’s movement] is very vibrant, which is important because it is ultimately about behaviour change. Chief Ministers and Ministers have participated in 15-16 events resulting in a high level of political visibility, which augurs well for the programme. Secondly, our clearest focus on the holistic interventions to ensure optimum care in the first 1,000 days has also percolated down well. Then, there is convergence among different Ministries, which is starting to happen. There is also the role of technology through mobile phones and tablets given to anganwadi workers, which is a multipurpose tool effective for behaviour change, education, managing care and collecting data. The Integrated Child Development Scheme-Common Application Software (ICDS-CAS) is the biggest-ever IT-driven public health programme in the world.
In the remaining phase, our aim is to accelerate these efforts as well as focus on care of small babies, or undernourished babies. These children account for 25%-30% of children in poor households.
What are the main pillars of Poshan Abhiyaan?
There is an interplay of three broad themes of which nutrition intake is only 50% of the story. There is low birth weight among newborns due to poor maternal health, which accounts for 25% of the problem; illnesses among children such as diarrhoea are responsible for 25%-30% of undernutrition.
When we look at undernutrition like this, we look at what needs to be done holistically: maternal health, childhood illnesses and optimum amount of feeding — breastfeeding, complimentary feeding and food adequacy. Only 10% of children get adequate nutrition in our country.
There are also socio-cultural determinants which form an outer circle, including maternal literacy, women empowerment, and prevention of child marriage, etc.
Will there be a review from time to time?
The National Family Health Survey-5 is currently picking up data. We expect the first set of State-level reports early next year, which will give us early phase trends so that we can learn from them and decide where our action should be focussed and recalibrate our efforts. And next year, which is a year after NFHS-5 data collection, there will be another survey which will tell us where we were in the middle years of NNM.
What is happening with the data being collected through ICDS-CAS?
There is data analyses going on. Apart from its reporting within the Ministry of Women and Child Development, it is also presented to the National Nutrition Council. We are also using Artificial Intelligence to map how various cohorts of small children are doing over a period of time, what is the coverage, and why are some districts lagging behind and then making required interventions.
The Maternity Benefit Programme, or the Pradhan Mantri Matru Vandana Yojana, is also linked to nutritional outcomes of children. How is that performing? Don’t you think it is exclusionary in so far as it’s only for the first-born?
I would say it is doing reasonably well, knowing that it took a little bit of time last year to take-off. In December 2017, only two lakh beneficiaries had been reached, in March 2018 about 22 lakh, and now we are at 98.5 lakh.
Benefiting the mother of the first-born is in the design of the scheme. Every scheme has its finite scope and focus. But we can have discussions [on how to reach those not covered under the scheme].