“Health and nutrition are important social infrastructure for human development. We should not shy away from using purpose driven public-private partnerships in nutrition.”
In the 2020 Global Hunger Index, India ranks 94th out of 107 countries. According to UNICEF’s data on India, nearly half of all deaths in children under 5 are attributable to undernutrition. Undernutrition puts children at greater risk of dying from common infections, and becomes especially dire during the pandemic. We need to improve the nutrition status of the country on an urgent footing. However, the government alone cannot win this battle and we need collective commitment to achieve our nutrition goals. Good nutrition is good for business, as healthy employees perform at optimal productivity. In 2019, IMPAct4Nutrition was launched with the idea of accelerating private sector action for nutrition. Today, it has 200 pledged partners from the private sector who have started, or increased, activities and programmes on employee and community nutrition. Financial Express Online caught up with Dr Rajan Sankar, Ambassador – IMPAct4Nutrition, to understand how India can achieve its ambitious nutrition targets.
Why is September celebrated as POSHAN Maah and what is its significance?
One of the distinct and defining features of POSHAN Abhiyan is Jan Andolan – creating a social movement. Since 2018, every September, the country has been celebrating POSHAN Maah, a month-long effort on social behaviour change communication and mass mobilisation to improve and increase the coverage of essential nutrition interventions. This has been a huge success and hopefully as in the previous years all stakeholders – the civil society, the private sector and academia will come together to help create the necessary awareness and demand for nutrition.
How important is it to get different sectors involved in tackling India’s significant nutrition crisis?
Malnutrition is a complex problem: Causes are many and many of them are interrelated. Therefore, any solution that we offer to solve malnutrition should ideally involve all relevant sectors. It is necessary to create neutral platforms composed of all key sectors of society. The private sector plays a key role in our society, and increasingly so.
Analysis of causality of malnutrition reveals that food and status of health are the two immediate determinants. And we know that the private sector is involved in all segments of the food system, which encompasses agricultural production, harvesting, processing and packaging, food transformation, marketing and consumer access. It also plays a major role in influencing both the food environment and consumer preferences.
Creating a neutral platform that offers an opportunity for all sectors including the private sector to be a part of solving the challenge of malnutrition should help accelerate progress on reducing malnutrition across the country, and even the world.
How has COVID-19 affected the situation?
Covid-19 has disrupted almost everything. As always, in any emergency, the hardest hit are the poor. In poor households, women and children are the worst affected.
In poor households, a high proportion of income is spent on food – it could be as high as 75% of total income. When the income comes down, as it happened to millions due to the pandemic and the containment strategies adopted by various governments, it seriously affects both the quantity and quality of food consumed by the poor.
India as such was facing serious issues with lack of food diversity amongst the vast majority of its population. Even before the pandemic, the dietary intake in low income households was far below the Recommended Dietary Allowance (RDA) prescribed by the Indian Council for Medical Research (ICMR). The dietary gaps both in terms of quantity and quality have widened due to financial difficulties the pandemic has imposed on large sections of our population.
Government, many civil society organizations, and philanthropies have done well to do the best under the constrained conditions. Many states restarted Take-Home Ration (THR) distribution after the complete lockdown, and food grain distribution too started through the Public Distribution System. But the dietary gap is sure to widen and we can expect a surge in malnutrition among women and children.
We have a fairly large budget for delivering rations to the last mile and yet there is a significant chunk of people missing out – do you feel there is a need for more investment in nutrition?
More investment is always welcome. But the important issue is to improve implementation and targeting. People who need the services are the ones who should be targeted by the program on priority.
India’s Integrated Child Development Services (ICDS) is well conceived and has been universalized with close to 1.4 million Anganwadi centres across the country. The infrastructure needs a lot more improvement though. In our context improving service delivery in ICDS is largely a function of program management and not so much on resources.
POSHAN Abhiyaan has the right framework and has also brought in additional resources. Key is to implement it in earnest and involve the community through Jan Andolan.
What would you say are the most urgent action points we need to take to address the malnutrition burden?
Focus on community participation. Make POSHAN Abhiyaan and Mission Poshan 2.0 a community owned, community driven mission. Increase community demand for services. That is likely to improve the service delivery in ICDS. We have to break the vicious cycle of poor demand leading to poor services leading to further poorer demand. This has to be broken to increase demand leading to better service delivery, further improving the demand for services, a virtuous cycle.
Secondly, mothers, families and communities should be educated to adopt appropriate nutrition practices. The community norm on many nutrition-related behaviours have to change. Most nutrition happens at home and we need families to adopt the right nutrition practices.
Thirdly, nutrition sensitive interventions such as women’s empowerment and water and sanitation are highly important and should be prioritized.
What role do you feel can IMPAct4Nutition play in this?
IMPAct4Nutition (I4N) aims to play the role of an honest broker. I4N is a platform for multi-stakeholder dialogue and collective commitment to action, and is working with different sectors. We need to bring down the mistrust between sectors. I4N can work to synergize the strength of each sector to benefit the malnourished and reduce malnutrition in the country more rapidly. In course of time I4N aims to become the preferred partner for the private sector and governments for tri sector partnerships involving government, civil society and private sector.
I4N’s work and resources supports POSHAN Abhiyaan in general and Jan Andolan in particular and is the knowledge hub on whom the private sector can rely on to understand the intersect available for their investment in nutrition in general and POSHAN Abhiyaan in particular.
Do you think making the government and private sector work together is an achievable target?
As mentioned earlier, causes of malnutrition are multifactorial. The range of interventions required are beyond the capacity of any sector working alone. Private sector plays an important role in almost every walk of life. Private sector can use their markets, their efficiency and innovation to reach those outside of the regular markets. Rapid gains have been made in many fields in India through public-private partnerships. Most of the infrastructure creation has happened through this route and is in fact the preferred route for the government. Health and nutrition are important social infrastructure for human development. We should not shy away from using purpose driven public private-partnerships in nutrition where the government looks for enhancement of public health.