‘Stunting and malnutrition big challenges facing govt’
Despite several government health programmes, 39% of children under five in India are short for their age, (stunted) according to findings by Public Health Foundation of India (PHFI) and the International Food Policy Research Institute (IFPRI). Vandana Krishna (IAS), Director General of Maharashtra State Health and Nutrition Mission spoke
on why the government should take the problem of malnutrition seriously. Vandana has headed the Woman and Child department of the State twice, and has been the Secretary, Health and Family Welfare department and she has also been the Mission Director of National Rural Health Mission.
Q How can we identify problems related to severe malnutrition like stunting and wasting?
First, we must recognize that stunting is a huge problem for India. Stunting means low height for age and wasting means low weight for height. Early childhood stunting causes irreversible damage to overall health of children. Their IQ and lifelong productivity is affected. The government needs to recognise that the whole world is looking at stunting and wasting while India is not. We must first start to track height gain of infants so that we can identify stunting and wasting caused due to under nutrition. We should measure height of each child right from birth till at least till 3 years of age to see if they are growing well.
Q How can this process of taking measurements of children be carried out effectively?
Under the ICDS Anganwadi workers have already been measuring weight of children. They can very well be trained to measure height as well. Health department also has Asha’s in villages; they can also be used for this work. In fact, it might be a good idea if the two Ministries of Health and ICDS can mutually decide that MWCD can address stunting and be responsible for preventing malnutrition, while the Ministry of Health can address wasting and work at the curative aspects of malnutrition. This division of roles might help in achieving greater clarity and coherence, given that the departments tend to work in silos.
Q Do we have guidelines for making food recipes for malnourished children?
There are no clear guidelines or prescribed nutrient dense recipes on how to treat severely underweight children (very low weight for age) which is the only indicator that MWCD recognises (it does not recognise the global standard of Severe Acute Malnutrition based on weight for height). At present, ICDS centres do provide extra food to severely underweight children, but emphasis is only on quantity, not on quality or density of the food.
Q What do you think about our agriculture policy, does it help in improving nutrition?
The agriculture policy is often at variance with nutrition policy. There is no policy to discourage cultivation of sugarcane, cotton or other cash crops with no nutritive value but which are risky and leads to farmers’ indebtedness, and to encourage cultivation of pulses or vegetables. Indians don’t need so much sugar in their diet anyways, given the spread of diabetes even among the poor. Agriculture policy today is mostly about mono-cropping, cash crops and increasing production and yields for the market, with no space for multi-cropping and cultivation of local crops for self-consumption. Agriculture extension officers should be widely used for training farmers in low cost or organic farming, cultivation of local crops, vegetables and fruits on their farm. A part of their land can be kept aside for such crops and the rest can be allotted for the cash crops. But we must realise that today agriculture has become a risky business and we must aim to reduce the risk factors by reducing costs, especially in areas which face high farmer suicide and drought prone areas.
Q In what way can the National Employment Guarantee Scheme help in elevating malnutrition?
Efforts should be made so National Employment Guarantee Scheme (MNREGS) can fund vegetable cultivation/ kitchen gardens by paying for the wages of the caretaker. Since funds are always scarce in the nutrition sector, why not tap MNREGS?
Q Malnutrition has its roots in adolescence, how to we address this problem?
The training of adolescent boys and girls in health, nutrition and life skills must be given higher priority and allotted more budgets. There is no point in launching adolescent training schemes if there are no budgets for training state and district level master trainers.
Q How can the Public Distribution Scheme (PDS) be brought in more effectively specially for migrant workers?
PDS for subsidised food focuses exclusively on carbohydrates, while protein and micronutrient deficiencies are unaddressed. The PDS needs to include pulses and fortification of wheat flour. In addition the ration cards of migrant workers (construction workers, brick kiln labourers, sugarcane cutters) need to be made ‘mobile’ so that they can access PDS rations at the place of work. Labourers are away from their native place for almost 6 months every year, and buying wheat or rice at market prices is a huge drain on their resources. Today with the use of technology it should be possible to provide them with ration cards which can be accessed anywhere within the country, not only within a state. Children of migrant workers come back home every year more malnourished than before and migrant women and children have no access to health and ICDS services. Government departments that give licenses to brick kiln owners or builders could easily insist that employers must provide basic creche services, toilets and drinking water facilities.
Q What do you feel of the central government’s stand on joining the global Scaling Up Nutrition (SUN) movement?
Government of India seems not to be in favour of joining the global Scaling Up Nutrition (SUN) movement. This is a missed opportunity. The Government seems to think SUN membership is mere posturing. Maharashtra’s experience is that attending SUN events provides an opportunity for state level and middle level nutrition stakeholders (from within and outside the government) to get sensitised about, and to take ownership of, nutrition issues. Equally importantly, it provides a way of rewarding and encouraging good performers by giving them learning opportunities abroad. Government systems are not designed for providing out of turn rewards or performance-based increments. Where else do middle level health and ICDS workers get an opportunity to attend world-class events and to interact with nutrition experts? They come back renewed with energy and determination to work for nutrition.
Q What are the corrective measures to be taken to arrest the problem of stunting and wasting?
Mothers and caregivers of young children must be trained in proper child caring and child feeding practices, specially proper breastfeeding and complementary feeding (weaning). Proper hygiene, washing hands, prevention of open defecation are equally important as they lead to stunted growth. Wasting is an emergency situation which has to be treated either in the community or hospital. The Health Ministry must allocate a budget even for community level treatment of wasting.
Q How can we identify problems related to severe malnutrition like stunting and wasting?
First, we must recognize that stunting is a huge problem for India. Stunting means low height for age and wasting means low weight for height. Early childhood stunting causes irreversible damage to overall health of children. Their IQ and lifelong productivity is affected. The government needs to recognise that the whole world is looking at stunting and wasting while India is not. We must first start to track height gain of infants so that we can identify stunting and wasting caused due to under nutrition. We should measure height of each child right from birth till at least till 3 years of age to see if they are growing well.
Q How can this process of taking measurements of children be carried out effectively?
Under the ICDS Anganwadi workers have already been measuring weight of children. They can very well be trained to measure height as well. Health department also has Asha’s in villages; they can also be used for this work. In fact, it might be a good idea if the two Ministries of Health and ICDS can mutually decide that MWCD can address stunting and be responsible for preventing malnutrition, while the Ministry of Health can address wasting and work at the curative aspects of malnutrition. This division of roles might help in achieving greater clarity and coherence, given that the departments tend to work in silos.
Q Do we have guidelines for making food recipes for malnourished children?
There are no clear guidelines or prescribed nutrient dense recipes on how to treat severely underweight children (very low weight for age) which is the only indicator that MWCD recognises (it does not recognise the global standard of Severe Acute Malnutrition based on weight for height). At present, ICDS centres do provide extra food to severely underweight children, but emphasis is only on quantity, not on quality or density of the food.
Q What do you think about our agriculture policy, does it help in improving nutrition?
The agriculture policy is often at variance with nutrition policy. There is no policy to discourage cultivation of sugarcane, cotton or other cash crops with no nutritive value but which are risky and leads to farmers’ indebtedness, and to encourage cultivation of pulses or vegetables. Indians don’t need so much sugar in their diet anyways, given the spread of diabetes even among the poor. Agriculture policy today is mostly about mono-cropping, cash crops and increasing production and yields for the market, with no space for multi-cropping and cultivation of local crops for self-consumption. Agriculture extension officers should be widely used for training farmers in low cost or organic farming, cultivation of local crops, vegetables and fruits on their farm. A part of their land can be kept aside for such crops and the rest can be allotted for the cash crops. But we must realise that today agriculture has become a risky business and we must aim to reduce the risk factors by reducing costs, especially in areas which face high farmer suicide and drought prone areas.
Q In what way can the National Employment Guarantee Scheme help in elevating malnutrition?
Efforts should be made so National Employment Guarantee Scheme (MNREGS) can fund vegetable cultivation/ kitchen gardens by paying for the wages of the caretaker. Since funds are always scarce in the nutrition sector, why not tap MNREGS?
Q Malnutrition has its roots in adolescence, how to we address this problem?
The training of adolescent boys and girls in health, nutrition and life skills must be given higher priority and allotted more budgets. There is no point in launching adolescent training schemes if there are no budgets for training state and district level master trainers.
Q How can the Public Distribution Scheme (PDS) be brought in more effectively specially for migrant workers?
PDS for subsidised food focuses exclusively on carbohydrates, while protein and micronutrient deficiencies are unaddressed. The PDS needs to include pulses and fortification of wheat flour. In addition the ration cards of migrant workers (construction workers, brick kiln labourers, sugarcane cutters) need to be made ‘mobile’ so that they can access PDS rations at the place of work. Labourers are away from their native place for almost 6 months every year, and buying wheat or rice at market prices is a huge drain on their resources. Today with the use of technology it should be possible to provide them with ration cards which can be accessed anywhere within the country, not only within a state. Children of migrant workers come back home every year more malnourished than before and migrant women and children have no access to health and ICDS services. Government departments that give licenses to brick kiln owners or builders could easily insist that employers must provide basic creche services, toilets and drinking water facilities.
Q What do you feel of the central government’s stand on joining the global Scaling Up Nutrition (SUN) movement?
Government of India seems not to be in favour of joining the global Scaling Up Nutrition (SUN) movement. This is a missed opportunity. The Government seems to think SUN membership is mere posturing. Maharashtra’s experience is that attending SUN events provides an opportunity for state level and middle level nutrition stakeholders (from within and outside the government) to get sensitised about, and to take ownership of, nutrition issues. Equally importantly, it provides a way of rewarding and encouraging good performers by giving them learning opportunities abroad. Government systems are not designed for providing out of turn rewards or performance-based increments. Where else do middle level health and ICDS workers get an opportunity to attend world-class events and to interact with nutrition experts? They come back renewed with energy and determination to work for nutrition.
Q What are the corrective measures to be taken to arrest the problem of stunting and wasting?
Mothers and caregivers of young children must be trained in proper child caring and child feeding practices, specially proper breastfeeding and complementary feeding (weaning). Proper hygiene, washing hands, prevention of open defecation are equally important as they lead to stunted growth. Wasting is an emergency situation which has to be treated either in the community or hospital. The Health Ministry must allocate a budget even for community level treatment of wasting.
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