India is home to one of the largest populations of malnourished children in the world. The POSHAN (PM’s Overarching Scheme for Holistic Nourishment) Abhiyaan was launched in2018. The scheme aims to ensure holistic development and adequate nutrition for pregnant women, mothers and children. It is to ensure that malnutrition doesn’t affect children’s cognitive development or physical growth.

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Salient features of POSHAN:

• The Abhiyaan targets to reduce stunting, undernutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.
• The target of the mission is to bring down stunting among children in the age group 0-6 years from 38.4% to 25% by 2022.
• POSHAN Abhiyaan aims to ensure service delivery and interventions by use of technology, behavioural change through convergence and lays-down specific targets to be achieved across different monitoring parameters.
• Under the Abhiyaan, Swasth Bharat Preraks will be deployed one in each district for coordinating with district officials and enabling fast and efficient execution of the Abhiyaan across the country. Swasth Bharat Preraks would function as catalyst for fast tracking the implementation of the Abhiyaan.

Pros of POSHAN Abhiyan:

• Complete approach towards malnutrition: The programme through use of technology, a targeted approach and convergence strives to reduce the level of stunting, under-nutrition, anaemia and low birth weight in children, also focus on adolescent girls, pregnant women and lactating mothers, thus holistically addressing malnutrition.
• It targets to reduce level of under-nutrition and other related problems by ensuring convergence of various nutrition related schemes and provide performance based incentives to states and community nutrition and health workers, facilitating a focus on results.
• It will monitor and review implementation of all such schemes and utilize existing structural arrangements of line ministries wherever available.
• Its large component involves gradual scaling-up of the interventions supported by ongoing World Bank assisted Integrated Child Development Services (ICDS) Systems Strengthening and Nutrition Improvement Project (ISSNIP) to all districts in the country by 2022.
• Union Government has signed $200 million loan agreement with World Bank for National Nutrition Mission (POSHAN Abhiyaan) for 315 districts across all states and union territories.
• The World Bank loan will be used for improving coverage and quality of ICDS nutrition services to pregnant and lactating women and children under 3 years of age.
• It will be also used for project in improving skills and capacities of ICDS staff and community nutrition workers, instituting mechanisms of community mobilization and behaviour change communication, strengthening systems of citizen engagement and grievance redress.
• It will be also used for establishing mobile technology based tools for improved monitoring and management of services for better outreach to beneficiaries during critical 1,000 day window for nutrition impact.
• POSHAN Convergence Matrix looks at deploying a multi-pronged approach to mobilise the masses towards creating a nutritionally aware society.
• Community based events at anganwadi centres to engage the beneficiaries and their families towards nutritional awareness; sustained mass media, multimedia, outdoor campaigns; mobilisation of all frontline functionaries; SHGs and volunteers towards nutrition are the methods to be adopted. The aim is to generate a Jan Andolan towards Nutrition.
• Thus the POSHAN Abhiyan is to bring all of us together, put accountability and responsibilities on all stakeholders to help the country accomplish its desired potential in terms of its demographic dividend.

Challenges towards POSHAN Abhiyan:

• Challenges with data:
  • Lack of credible data on a year-year basis. For example, there has been a 10-year gap between NFHS 3 and NFHS 4.
  • Further, there is confusion and inability to cope with measurement procedures among poorly trained Anganwadi workers and thus data on malnutrition may not be accurate.
  • Lack of adequate access to food: Due to ineffective functioning (corruption and leakages) of the public distribution system (PDS), access to food is a major problem. Loss of food grains in warehouses (due to rotting and theft) further aggravates the problem.
• Issues with ICDS:
  • Major issues with ICDS are the supply of quality food and its uniform distribution.
  • Also, Anganwadi workers are unable to play an effective role in attending to the problem of malnutrition because of low wages and inadequate training.
• Cereal-based Diet:
  • A major reason for micronutrient deficiency in India is because of a cereal-based diet. However, even the National Food Security Act does not address the issue of nutritional deficiency adequately.
  • Further, food fortification has also been inadequate.
• Social-economic and Cultural challenges:
  • Major challenges in implementing nutritional programmes are socio-cultural factors such as caste. For example, Hausla Poshan Yojana, a plan to provide nutritious food to pregnant women and malnourished children in Uttar Pradesh failed to even start because some women beneficiaries allegedly refused to consume the food prepared by Anganwadi workers belonging to the SC community.
  • Illiteracy among women and gender biases is also a challenge
• Lack of nutritional and health awareness:
  • Lack of awareness, ignorance of healthy diets, unhealthy feeding and caring practices, poor breastfeeding practice are major challenges in reducing malnutrition
• Sanitation and hygiene:
  • Lack of sanitation is also an important challenge in reducing malnutrition. Poor sanitary conditions caused by open-defecation and other issues lead to the incidence of diarrhoeal diseases which make children susceptible to stunting
• Financial Constraints:
  • Budgetary allocations of many schemes have decreased over time. Further, the money allocated has remained unspent in many states.

Way forward:

• To address the problem of child under-nutrition, and disease there should be early life-cycle interventions targeting the first 1,000 days of a child’s life.
• ICDS, Mid day Meal and PDS should be re-worked upon for greater effectiveness. Public-Private partnership in this domain should be encouraged. This would ensure that leakages, space and other constraints of lack of hygiene, delay in supply of food etc do not hinder delivering nutritious food.
• It is important to extend the food fortification of staples. Public-private partnerships can help leverage the appropriate technology for scaling up food fortification interventions. Further, the focus should be on incorporating nutritious food and diversify the diet.
• It is important to target multiple contributing factors, for example, water, sanitation and hygiene (WASH). The focus should not only be on building toilets but bringing about a behavioural change among people
• Agricultural policy should be aligned with nutrition policy with incentives provided for encouraging the production of nutrient-rich and local crops for self-consumption.
• It is important to have sufficient information and reliable, updated data for effective interventions. It is thus necessary to collect and maintain real-time data on various nutrition indicators.

Conclusion:

Boosting nutrition levels across the country is one of the biggest low hanging fruit in the Indian public policy sphere. If we can conquer space, we can conquer malnutrition.