More in news: Government Allocating Rs 35,600 Crore For Nutrition-Related Programmes in Budget 2020.

Malnutrition:

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition addresses 3 broad groups of conditions:

• Under-nutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
• Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
• Overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and some cancers).

Status of the problem of Nutrition in India:

• The latest Global Hunger Index (GHI) 2019 has ranked India a lowly 102 among the 117 countries it has mapped.
• On the whole, the 2019 GHI report has found that the number of hungry people has risen from 785 million in 2015 to 822 million. 
• In India, only 9.6% of all children between 6 to 23 months of age are given a minimum acceptable diet.
• As per the report, the child wasting rate is the highest (20.8%) in the world while the child stunting rate is 37.9% in India. Child wasting refers to the share of children under the age of five who are wasted, i.e, they have low weight with respect to their height, reflecting acute undernutrition.
• As per the National Family Health Survey (NFHS)-4 (2015-16), 35.7 per cent children below five years are underweight, 38.4 per cent are stunted and 21 per cent are wasted in the country.
• Among adults, 23% of women and 20% of men are considered undernourished in India.  On the other hand, 21% of women and 19% of men are overweight or obese.  The simultaneous occurrence of over nutrition and under-nutrition indicates that adults in India are suffering from a dual burden of malnutrition (abnormal thinness and obesity).
• Though anaemia has declined, it still remains widespread. More than half of children and women are anaemic. Anaemia is prevalent in 53% women and 23% men in the 15-49 age groups.

Measures taken by Indian Government:

• The Integrated Child Development Services (ICDS) scheme was launched in 1975. ICDS is one of the world’s largest and most unique outreach programme for early childhood care and development and covers all the districts and blocks in the country. The Integrated Child Development Services (ICDS) scheme provides a package of services including supplementary nutrition, nutrition and health education, health check-ups and referral services addressing children, pregnant and lactating mothers and adolescent girls, key groups to address community malnutrition, and also tackle calorific deficiency.
• Universal Salt Iodisation: National Iodine Deficiency Control Programme (NIDDCP) was initiated in 1992 with the goal that all salt for human consumption will be iodised to ensure universal household access to iodised salt. 
• Mid- Day Meal Scheme was universalized in 1995. It aims to enhance nutrition of schoolchildren.
• The Government is now working on close Monitoring of the Nutrition programmes by digitisation of the Anganwadis. This is expected to turnaround the entire system since it will help in real time monitoring of nutrition status of each child and take up immediate interventions wherever required.
• Government enacted that National Food Security Act, 2013 (NFSA) in July 2013 with an intended coverage of upto 75% of rural population and upto 50% of urban population for receiving highly subsidized foodgrains under Targeted Public Distribution System. One of the guiding principles of the Act is its life cycle approach wherein special provisions for supplementary nutrition have been made for pregnant women and lactating mothers and children in the age group of 6 months to 14 years.
• National Nutrition Mission (NNM):
  • NNM has introduced a central nodal agency with extensive financial resources to coordinate various central and state government schemes and imbue them with additional financial resources.
  • The programme will cover all states and districts in a phased manner.
  • The core strategy of the mission is to create decentralised governance systems with flexibility given to states, districts and local level with robust monitoring, accountability and incentive frameworks that will encourage local solutions. 
  • More than 10 crore people are likely to be benefitted by this programme. 
• Poshan Abhiyan:
  • The Prime Minister’s Overarching Scheme for Holistic Nutrition, is Government of India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers.
  • POSHAN Abhiyaan intends to significantly reduce malnutrition in the next three years. For implementation of POSHAN Abhiyaan the four point strategy/pillars of the mission are:
    • Inter-sectoral convergence for better service delivery
    • Use of technology (ICT) for real time growth monitoring and tracking of women and children
    • Intensified health and nutrition services for the first 1000 days
    • Jan Andolan
• POSHAN Atlas: To map the crops and food grains grown in different regions of the country so that nutritious protein rich food in local areas can be promoted.
• Indian Government has taken important steps, such as the release of fortification standards for five staples by the Food Safety and Standards Authority of India (FSSAI) to fight micronutrient malnutrition, release of food composition tables by the National Institute of Nutrition to increase focus on dietary diversity, and now, the release of nutrition data to address the issue of malnutrition more holistically.
• Giving importance to Millets: In 2018-19, the Government of India launched a national millet mission which included renaming millets as “nutri-cereals” also launching a Year of Millets in 2018-19 to promote nutritious cereals in a campaign mode across the country. This could have been further emphasised in National Food Security Mission (NFSM) which includes millets.
• Bharatiya Poshan Krishi Kosh: It was launched by Ministry of Women and Child Developemnt in collaboration with Microsoft founder Bill Gates in 2019 in an attempt to bridge the gap between agriculture and nutrition.
• Eat Right Movement: Food Safety and Standards Authority of India (FSSAI) unveiled ‘The Eat Right Movement’. The programme aims to engage and enable citizens to improve their health and well-being by making the right food choices. ‘The Eat Right Movement’ is built on two broad pillars of ‘Eat Healthy’ and ‘Eat Safe’.
• Poshan Maah: To take the messages of POSHAN to the grass root level, government celebrated the month of September in 2019 as Poshan Maah. The programme was an initiative of Ministry of women and child development and NITI Aayog. It seeks to synergise all efforts by leveraging technology and intends to take nutrition awareness to the level of Jan Andolan or People’s Movement. The programme focused on 8 themes – Antenatal Care, Optimal Breastfeeding (Early & Exclusive), Complementary Feeding, Anemia, Growth Monitoring, Girls-education, diet, right age of Marriage, Hygiene & Sanitation, Food Fortification.

Problems faced in achieving the nutrition targets:

• Under-utilisation of allocated funds: The 2019-20 Budget allocation for Mid-day meal scheme was ?11,000 crore and revised estimates are only ?9,912 crore. Similarly there is under-utilisation of funds in ICDS, NFSM and horticulture mission that can be efficient in addressing micronutrient deficiency effectively.
• Utilising funds on ICT rather than focusing on nutrition:
  • According to Accountability Initiative, 72% of total expenditure of Poshan Abhiyaan is going into “Information and Communication Technology enabled Real Time Monitoring for development and setting up Common Application Software and expenditure on components under behavioural change”.
  • It is also found on average that only 34% of funds released by the Government of India were spent from FY 2017-18 to FY 2019-20 till November 30, 2019.
• Flaws in human resource: Anganwadis are key to the distribution of services to mothers and children. But many States, including Bihar and Odisha, which have large vulnerable populations, are struggling to set up functioning anganwadis, and recruit staff.

Way forward:

• Anganwadis system is the backbone of India’s nutrition target effort and there is urgent need to improve it.
• Fortification, diversification and supplementation may be used as simultaneous strategies to address micro and macronutrient deficiencies.
• Giving explicit emphasis and fund allocation to agriculture-nutrition linked schemes. Also, encouraging and intensifying farmers for agricultural diversification.
• Directing the announcement to form Farmer Producer Organisations (FPOs) with an allocation of ?500 crore to nutrition-based activities.
• Focus on nutrition-related interventions, beyond digitization and intensifying the convergence component of POSHAN Abhiyaan, using the platform to bring all departments in one place to address nutrition.
• Ensuring early disbursement of funds and an optimum utilisation of schemes linked to nutrition.
• A report by IFPRI shows that Senegal, Ghana, Rwanda, Angola, Cameroon, Togo, and Ethiopia have all reduced malnutrition levels significantly over the last 15 years, some by as much as 50 percent. In each case, the government has developed ways of spotting nutrition problems early on and is implementing cutting edge programs, at scale, to prevent people reaching crisis point.
• Promote broad partnerships to pursue shared goals as followed in Ethopia: The National Nutrition Coordination Body (NNCB) in Ethiopia includes government sec­tors, development partners, civil society organizations, academia, and the private sector.
• Make it easier for people to access more nutritious food: Malnutrition can be caused by eating poor quality food, which is low in nutrients. Policies that encourage people to grow and eat more nutritious foods can help. For example, a mandatory food fortification program in Cameroon resulted in a lower prevalence of micronutrient deficiencies in women and children.

Conclusion:

Nutrition budget allocation of Rs. 35,600 crore as proposed in budget 2020-21 is a welcome move. The budget provides the scope and opportunities for nutrition sensitive interventions in a substantial way. If implemented well, it can drive addressing protein hunger and micronutrient malnutrition popularly known as hidden hunger through improving/diversifying both production and farming system which includes nutrition rich horticulture and agricultural crops, poultry, fishery production etc. The budget highlights climate smart nutrition sensitive agriculture and farming system. The intent needs to realised into action in the ground.