India's Endeavour towards Achieving Nutrition Security

Uttara Singh

Awell-nourished, healthy and educated population is the foundational prerequisite for growth and economic development. Healthy and productive people have more income, pay more taxes and build a country's capacity to contribute its own resources towards essential services, such as quality education and improved healthcare. The Government of India, through its various ministries, has been running a number of schemes and programs aimed at making healthcare affordable and accessible to all. The government has also adopted a focused approach on ensuring a well nourished and productive population by facilitating and inculcating healthy eating habits among the citizens. For the needy and vulnerable population, the government has devised and implemented targeted schemes to ensure no one is left out of the nutrition agenda. For effective implementation of those schemes, concerted efforts have been made in the recent past to address gaps in actions by the States and to promote inter-ministerial and inter-sectoral convergence to create legislation, policies and programs that aim towards making India healthy, nourished and progressive.

The major schemes are:

AYUSHMAN BHARAT YOJANA: Launched in September 2018, the Ayushman Bharat Yojana aims to provide healthcare (through Health and Wellness Centres) and health insurance facility (through Pradhan Mantri Jan Arogya Yojana) to the poor, at all healthcare levelsprimary, secondary and tertiary. The ABY has two sub-missions - (i) Establishment of Health and Wellness Centres (HWCs) - these centres are aimed at improving access to affordable and quality healthcare services at the primary level. These centres provide Comprehensive Primary Health Care (CPHC), covering both maternal and child health services and non-communicable diseases, including free essential drugs and diagnostic services and (ii) Pradhan Mantri Jan Arogya Yojana (PM-JAY) - it provides financial protection to the poor for availing healthcare services at the secondary and tertiary levels. Citizens with Ayushman Bharat card are entitled for cashless treatment of up to Rs 5 lakh in all government and those private hospitals that are empanelled under the scheme. These hospitals cannot deny treatment to Ayushman Bharat card holders and all pre-existing diseases are covered under it. The scheme covers 3 days of prehospitalisation and 15 days of post-hospitalization, including diagnostic care and expenses on medicines. The eligibility criteria are based on the Socio-Economic Caste Census (SECC), 2011. This means that if the family is listed in the SECC database, it is eligible under this scheme. But, since the SECC happened in 2011, there are many families that might be eligible now but could not be included in that census. In rural areas, such left out families can avail benefit if they fall into at least one of the six deprivation criteria:

(i)                 Households with only one room with kuchcha walls and kuchcha roof

(ii)               Households with no adult member between ages 16 to 59

(iii)             Households with no adult male member between ages 16 to 59

(iv)              Household with disabled member and no able-bodied adult member

(v)                SC/ST households

(vi)              Landless households deriving a major part of their income from manual casual labour

In Urban areas, 11 occupational categories of workers are eligible for the scheme:

(i)                 Ragpicker

(ii)               Beggar

(iii)             Domestic worker

(iv)               Street vendor/cobbler/hawker/other service provider working on streets

(v)                Construction worker/plumber/mason/labour/painter/welder/security-guard/ coolie and other head-load worker

(vi)              Sweeper/sanitation worker/mali,

(vii)            Home-based worker/artisan/handicrafts worker/ tailor,

(viii)          Transport worker/ driver/ conductor/ helper to drivers and conductors/ cart puller/ rickshaw puller, shop worker

(ix)              Assistant/ peon in small establishment/ helper/delivery assistant / attendant/

(x)                Waiter, electrician/mechanic/assembler/repair worker,

(xi)              Washer-man/chowkidar

POSHAN ABHIYAAN:   POSHAN Abhiyaan was launched in March 2018, to comprehensively address the problem of malnutrition in the country. The progress made and achievements under POSHAN Abhiyaan are as follows:

(i)                 POSHAN Abhiyaan covers all the districts of 36 States/UTs.

(ii)               State, District and Block level convergence meetings are held regularly

(iii)             Procurement of smart phones and growth monitoring devices has been coordinated through Government e-Marketplace (GeM) Portal.

(iv)              A robust Information and Communication Technology (ICT) application "Poshan Tracker" has been conceptualized which is an overarching system, providing facilities, services and inter-linkages, and thereby also promote real time data with analytics.

(v)                Approximately 40+ crore Jan Andolan based activities have been conducted since the launch of the Abhiyaan.

(vi)              Poshan Pakhwadas and Poshan Maahs have been conducted every year since the launch of the Abhiyaan.

(vii)            26 States/UTs have started implementing more than 50 innovative projects, whereas 30 States/UTs have initiated implementation of Flexi Fund based activities.

(viii)          More than 10 lakh frontline Functionaries have been trained on thematic modules following the cascade mode of training at State, District and Block level.

(ix)              Community Based Events (CBEs) are organized in a converged manner in Anganwadi Centres with the field functionaries. Around 3.70 crore CBEs have been organized since the launch of the Abhiyaan.

POSHAN Abhiyaan aims to reduce malnutrition in the country in a phased manner, through a lifecycle approach, by adopting a synergized and result oriented approach.

The targets laid down under the Abhiyaan are as under:

The estimated number of underweight, malnourished and severely malnourished children under 5 years of age is obtained under National Family Health Survey (NFHS) conducted by the Ministry of Health & Family Welfare. As per the recent report of NFHS-5 (2019-21), the nutrition indicators for children under 5 years have improved as compared with NFHS-4 (2015-16). Stunting has reduced from 38.4% to 35.5%, wasting has reduced from 21.0% to 19.3% and underweight prevalence has reduced from 35.8% to 32.1%.

MISSION POSHAN 2.0

In a strategic shift in the approach to tackling malnutrition, the Poshan Abhiyan, Anganwadi Services and Scheme for Adolescent Girls have been realigned under Poshan 2.0 for the period of FY 2021-22 to FY 2025-26. Mission Poshan 2.0 an integrated nutrition support program. It seeks to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers through a strategic shift in nutrition content and delivery and by creation of a convergent eco-system to develop and promote practices that nurture health, wellness and immunity. Key highlights are:

·         Poshan 2.0 will bring 3 important program/schemes under its ambit, viz., Anganwadi Services, Scheme for Adolescent Girls and Poshan Abhiyaan. Poshan 2.0 shall focus on maternal nutrition, infant and young child feeding norms, treatment of MAM (Moderate Acute Malnutrition) and SAM (Severe Acute Malnutrition) and wellness through AYUSH.

·         It will rest on the pillars of convergence, governance, and capacity-building.

·         The mission seeks to optimize the quality and delivery of food under the Supplementary Nutrition Program.

·         It aims to contribute to human capital development of the country by addressing malnutrition challenges; promoting nutrition awareness and good eating habits for sustainable health & well-being and by addressing nutrition related deficiencies through key strategies.

·         Under the program, nutritional norms and standards and quality and testing of THR (Total Health Record), will be improved and greater stakeholder and beneficiary participation will be promoted besides traditional community food habits.

·         Poshan Abhiyan will be the key pillar for outreach and will cover innovations related to nutritional support, ICT interventions, media advocacy and research, community outreach and Jan Andolan.

·         Mission Poshan 2.0 will integrate several key strategies to fulfill its objectives, viz., corrective strategies, nutrition awareness strategies, communication strategies and creation of green eco-systems.

Anganwadi Services

Anganwadi Services which was earlier under the ambit of the Integrated Child Development Services (ICDS) Scheme will continue in mission mode under Mission Poshan 2.0. It aims to ensure holistic development of children below 6 years of age and pregnant women & lactating mothers, by providing a package of six services:

(i)                  Supplementary nutrition

(ii)                Pre-school non-formal education

(iii)               Nutrition and Health Education

(iv)              Immunization

(v)                Health check-up

(vi)              Referral services through Anganwadi Centres at grassroots level.

Pradhan Mantri Matru Vandana Yojana

Pradhan Mantri Matru Vandana Yojana (PMMVY) is a Centrally Sponsored Conditional Cash Transfer Scheme, implemented across the country with effect from 01.01.2017. The maternity benefit under PMMVY is available to all Pregnant Women & Lactating Mothers (PW&LM), excluding PW&LM who are in regular employment with the Central Government or the State Governments or Public Sector Undertakings (PSUs) or those who are in receipt of similar benefits under any law for the time being in force, for first living child of family. Under the scheme Rs 5,000/- are provided to the eligible beneficiary in three installments during pregnancy and lactation in response to individual fulfilling certain nutrition and health seeking conditions. The eligible beneficiary also receives the remaining cash incentive as per approved norms towards maternity benefit under Janani Suraksha Yojana (JSY) after institutional delivery so that on an average, a woman gets Rs 6,000/. Cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss. Objectives of PMMVY include the following:

·         Providing cash compensation against wage loss so that the mother can take adequate rest before and after the birth of the first living child.

·         Promoting good nutrition and feeding practices to reduce infant mortality and malnutrition. It would also promote healthier behaviour among pregnant/lactating mothers.

·         Promoting the use of health services and institutional care to reduce the risk of disease.

National Creche Scheme

National Crèche Scheme, a centrally sponsored scheme, is implemented through the State Governments/UT Administrations with effect from 01.01.2017 to provide day care facilities to children (age group of 6 months - 6 years) of working mothers, improve nutrition and health status of children, promote physical, cognitive, social and emotional development (holistic development) of children and educate and empower parents / caregivers for better childcare. The scheme provides an integrated package of the following services:

(i)                  Daycare facilities including sleeping facilities

(ii)                Early stimulation for children below 3 years and pre-school education for 3 to 6 years old children.

(iii)               Supplementary nutrition (to be locally sourced)

(iv)              Growth monitoring.

(v)                Health check-up and immunization.

EAT RIGHT INDIA MOVEMENT

The Eat Right India movement is an initiative of the Government of India and the Food Safety and Standards Authority of India (FSSAI) launched in 2018 to transform the country's food system in order to ensure safe, healthy and sustainable food for all Indians. Eat Right India is aligned to the National Health Policy 2017 with its focus on preventive and promotive healthcare for all citizens of the country with tagline 'Sahi Bhojan. Behtar Jeevan'. Key highlights include:

·         It is a pan-India movement aimed to create consumer awareness about eating safe and nutritious food.

·         The movement is built on three broad pillars of 'Eat Healthy', 'Eat Safe' and 'Eat Sustainably.'

·         As food-borne illnesses and various diet-related diseases cut across all age groups and all sections of the society, the movement adopts a 'whole of society' approach, bringing all stakeholders together on a common platform.

·         The vision for 2050 is about creating a culture of safe, healthy and sustainable food for all by making Indian food trans fat-free by 2022 and cut down salt/sugar and oil consumption by 30% in three years.

(The author is Assistant Professor, Department of Food & Nutrition, Government Home Science College, Chandigarh. She can be reached at usuttarasingh@gmail.com).

Views expressed are personal.