Going To The Ground On Nutrition

Five years have passed since the World Health Assembly endorsed a set of six global nutrition targets to be achieved by 2025 in order to improve maternal, infant and young child nutrition across the world. The six targets are: 40 per cent reduction in prevalence of childhood stunting, 50 per cent reduction in anemia in women, 30 per cent reduction in low birth weight, no increase in childhood overweight, increase in exclusive breastfeeding to at least 50 percent and reduction in childhood wasting to less than 5 percent. The Sustainable Development Goals for 2030 fully endorsed and included these nutrition targets as part of the SDGs.

Although India has committed to contributing to the achievement of the global nutrition targets and nutrition has certainly improved in the last decade, the road ahead on addressing India's nutrition challenge is still long. The deaths of children in the tribal belts of Nagada and Malkangiri in Odisha and Palghar in Maharashtra due to malnutrition are stark reminders of how things can go terribly wrong for the most vulnerable members of society. The data from Rapid Survey of Children (2014) captures the gravity of the situation at the national-level - showing that more than 1 in 3 children are stunted, that 1 in 5 infants are born too small and that wasting remains a challenge.

The repercussions of malnutrition on the wellbeing of individuals are long-lasting and multidimensional, making it imperative that India up the investment in nutrition. Good nutrition improves economic productivity in the long run, thus making it not just a social investment, but a profitable economic one as well. Various estimates show the high benefit-cost ratio of investing in nutrition, dispelling notions of it being an expenditure with no economic returns to offer. Investing in nutrition is not "money down the drain"! To achieve the global nutrition targets by 2025, it is important that adequate investments are made at least now to put effective monitoring and accountability mechanisms in place. Our work shows that an investment of close to 40,000 crores is needed to ensure a basic set of health and nutrition interventions that cover the entire population. These are not new interventions - just those that are already included in India's multiple policy directives for nutrition and well-captured in both the Integrated Child Development Services and the National Health Mission. Ensuring that investments are adequate, that funds that are allocated to nutrition are used well, and that delivery on the ground is well-coordinated and of high quality, should be a high priority.

Knowing where to invest, and in what, requires regular and reliable data on the coverage and reach of critical nutrition interventions at frequent intervals - at levels where decisions are taken. In a large country, with multiple states and social groups, the gaps in reach of programs and interventions also varies - by state, by type of intervention, and across districts within states. The India Health Report 2015 on all states in India and on District Nutrition Profiles for over a 100 districts demonstrates this very clearly. It's also important to recognize that although poor nutrition indicators among some scheduled tribe communities has received attention due to the malnutrition deaths, the problem of reach, coverage and quality of nutrition interventions is not restricted to these pockets. Given the need to identify the geographic areas and nutrition outcomes that need prioritized action, therefore, data and analytic work to help to prioritize and track whether interventions that are invested in and budgeted for are reaching those who need them can help tremendously. Our reviews, and those of others, of data gaps continues to highlight that much more work is needed to streamline, harmonize and manage the data that is coming in through various systems.

As an example of the dangers of not paying attention to data, the decade-long gap between rounds three and four of the National Family Health Survey (NFHS), kept everyone in the dark about performance of crucial nutrition indicators. Now that NFHS-4 factsheets for some states are available, it appears that anemia in women of reproductive age has increased in states like Tamil Nadu, Haryana and Meghalaya, and that the reach of interventions to address anemia (iron tablets during pregnancy, for instance) has either dropped or barely moved. This certainly will not help achieve the SDG target of 50 percent reduction in anemia by 2025.

Looking forward from the budget speech of 2017 to what needs to happen on the ground to move towards the nutrition SDGs, it is quite important that states are supported, with data, on how and where to prioritize interventions based on their specific needs. States like Odisha are taking the lead with the announcement of state-level nutrition action plans. More states must make nutrition a priority, identify how and where to invest by examining their own situation in a data-driven manner and make the right investments.

Investing actively in strengthening implementation for nutrition - i.e., what happens in the middle between policy announcements and the people on the ground, using the right data and metrics -- is an essential step in India's journey to achieve global nutrition targets. The devil will be in the details. And if we don't get the details right, the spectre of malnutrition will continue to haunt India for decades.