More WB projects needed

CHRONIC MALNuTRITION : While a National Nutrition Mission was announced in 2014, no scheme has yet emerged, and the Budget makes no mention of it.

The Global Nutrition Report 2016 places India ‘off course’ for all nutrition indicators with some progress in stunting and underweight and none at all in anaemia among women of reproductive age and wasting of children.

India’s jinx in tackling this last unaddressed outpost in its growth and development story continues. Though a National Nutrition Mission was announced in 2014, no national programme has yet emerged, and this year’s Union Budget makes no mention of it. Clearly, the subject appears to have been put on the backburner for the moment, and another opportunity seems to have been wasted.    

However, I have great satisfaction that all interventions of the World Bank-supported Karnataka Multi-Sectoral Nutrition Project being piloted by the Karna­taka Comprehensive Nutrition Mission in Devadurga block, Raichur district and Chincholi block in Kalaburagi district have taken off and are working well. 

The strategy has many unique aspects:

i) Its interventions are multi-sectoral and intergenerational, and directly address the root causes — the inter-generational cycle of malnutrition; the calorie-protein-micronutrient deficit among children, adolescent girls and pregnant/ lactating women; and the information/ awareness deficit among families regarding proper nutritional practices within existing family budgets, regarding proper child, adolescent and maternal care.

ii) This is not another food programme. It begins with awareness generation and behaviour change through reasonably spaced nutrition messaging at household and community level. The food supplementation component commences only after the process of behaviour change has been triggered.

iii) The most unique feature of this project is that it is being implemented through the Department of Rural Development and Panchayat Raj, and Zilla Parishads, for whom multi-sectorality is an integral mandate. 

iv) Sequenced interventions gradually bring about a spontaneous convergence and demand creation for other government programmes impacting nutritional status — immunisation, sanitation, drinking water etc.

Operational logistics are simple. A Village Nutrition Volunteer (VNV) is appointed for each village and given basic training. There is a Project Supervisor for every 10 villages under a Block Project Manager. The VNV’s first task is to identify infants below three years of age, adolescent girls between 11-18 years, and pregnant/lactating women, belonging to BPL families. There are 17,005 beneficiaries in Chincholi block, and 18,001 in Devadurga block.  

A Nutrition Card, customised for each target group, is given to each beneficiary. The card records the socio-economic details, anthropometric measurements, household details, sources of drinking water and sanitation of the target groups. There is a monthly recording and monitoring of height and weight for children and adolescent girls, and periodic monitoring of other parameters specific to target groups.

For infants, details about immunisation, exclusive breast feeding, initiating complementary feeding, diarrhoea episodes are included. For adolescent girls and pregnant/lactating women, there is monthly weight monitoring. This data is computerised and monitored at field and mission level to assess impact and take corrective action.

The VNV uses home visits to disseminate nutrition messages to the target groups and their families, and to counsel the beneficiaries, especially regarding prevention of child underweight, pregnancy weight gain, managing diarrhoeal episodes among children, improving condition of severely malnourished or wasted children, or managing any illness.  

A multi-layered communication strategy has been created for triggering behaviour change. Messages are disseminated in phases to families, community, women’s self help groups (SHGs) thro­ugh different streams of media —posters and flipcharts for household counseling; radio, television and wall paintings for families and the community at large, and focus group discussions for SHGs.

The messages are simple but critical, focusing on the inter-generational cycle of malnutrition; improving family diets within existing budgets; the importance of complementary feeding for infants after six months; improving health and growth of adolescent girls; proper weight gain during pregnancy and prevention of low birth weight babies etc.

Early results show definite improvement in nutritional indicators of the three inter-generational groups — infants under three years of age, adolescent girls, and pregnant and lactating women. What is significant is that this improvement in nutritional status has happened solely on account of behavioural change brought about by the communication strategy and not because of dietary supplementation from the project.

Target groups

The next major intervention is bridging the calorie-protein-micronutrient deficit among the target groups. A medium scale energy food production unit with 2-tonne production capacity per day has been set up with assistance from the Global Alliance for Improved Nutrition in both the blocks. Women from SHGs have been trained and are employed for production.

Fortified energy food, branded as Shakti Vita and appropriate for the three target groups, is being produced from local farm produce such as wheat, green gram, defatted soya, and distributed to the beneficiaries. Energy food distribution started in October 2016 in Chincholi and in December, 2016 in Devadurga. December data for Chincholi is being analysed, and as expected, the results appear very positive.  

Convergence of the existing programmes too is done in phases. To begin with, VNVs motivated and assisted families to apply to the ZPs for construction of toilets in their homes. After project interventions started, 2,734 toilets have been constructed in both blocks by the end of March, and are being used.

This will be followed by the more diffi­cult areas of convergence such as comp­lete immunisation and Vitamin A administration for children. Real time monitoring of the beneficiaries’ nutrition indicators, particularly underweight, stunting and wasting of children, BMI of adolescent girls, pregnancy weight gain, incidence of low birth weight babies, is stringently done at field level where corrective action is also taken, and at mission level.

The pilot projects and their early results have been appreciated by the state administration, with a general consensus that they should be replicated in the chronic malnutrition pockets of Karnataka. So the people concerned are working on that, and on getting Karnataka’s malnutrition ‘on course’.

(The writer is retired Secretary to the Government of India)