To achieve the next set of milestones, Garg says the focus will be on delivering services to people in areas that are hard to reach. But stakeholders acknowledge that Covid-19 and the diversion of resources to contain the pandemic will have a significant impact, too.
That arc of the story of India’s battle with malnutrition is a familiar one — even with efforts like one of the world’s largest programmes for childhood development in the form of ICDS (Integrated Child Development Services), swathes of the country still struggle with under-nutrition. This was underlined in the Global Nutrition Report 2020 earlier this year, which said India is likely to miss global nutrition targets such as reducing stunting (low height due to malnutrition) among children under the age of five years.
The Centre launched POSHAN Abhiyaan in 2018 to bridge these gaps and to make India malnutrition-free by 2022, as part of which September began to be observed as national nutrition month. Targets include reducing stunting from 38% now to 25% — the developing country average — by 2022. These are ambitious goals, considering that between 2006 and 2016, the reduction was about a percentage point a year. While states have seen varying degrees of success in improving the health of women and children, experts point to Odisha as a state that’s been able to make considerable progress.
For instance, analysis by the International Food Policy Research Institute (IFPRI) shows Odisha’s rate of decline in childhood stunting between 2005-06 and 20015-16 was three times that of similarly poor states like Bihar. In an analysis of POSHAN Abhiyaan interventions shared this month, IFPRI says Odisha is one of the few states that achieved high coverage in the crucial 1,000 days from the beginning of pregnancy to the child’s second birthday.
“Overall, in terms of the gains made, Odisha’s is a positive story. They have done well on delivering health and nutrition programmes,” says Purnima Menon, senior research fellow at IFPRI. She attributes a lot of this to the state’s focus on improving equity among districts, with targeted interventions in 15 districts. “A lot of the focus was on pulling up districts that were lagging behind. But many of them continue to lag behind, so the story is not over.”
Policymakers, bureaucrats and social activists list a host of factors that have helped — some of which are part of national programmes while others are unique to Odisha — even as they emphasise that more needs to be done. “In Odisha, we are giving a lot of emphasis on ensuring the food is actually reaching everyone. Unlike many other states, we are also giving five eggs every week (to children in anganwadi centres),” says Anu Garg, principal secretary, department of women and child development.
Additionally, parts of the take-home ration are prepared by local women and distributed on fixed days, which helps in transparency and monitoring, she says.
Recent measures include setting up nutrition gardens in anganwadis to improve diversity in diet, setting up mini anganwadis in areas with population of 300-500 and the “Pada Pusti” scheme to deliver nutrition services for tribal hamlets with less than 150 inhabitants through mothers’ groups. In February, the state became the first in the country to announce a separate nutrition budget.
The idea, says Garg, was to bring about better convergence among departments, compile the different efforts and then focus on areas that need more targeted interventions.
“It has been a struggle to improve the health and nutrition indicators particularly in the state’s southern belt, where the tribal population is concentrated. But the government has put a lot of focus in making services available, particularly through the village health nutrition days and the supplementary nutrition programme (take-home ration for pregnant and lactating women and young kids),” says Devjit Mittra, vice-president — programmes, Azim Premji Philanthropic Initiatives, based in Odisha.
In 2015, APPI committed to spending Rs. 300 crore over 10 years to tackle malnutrition in the state. Mittra says one of the most successful programmes to improve maternal and infant health has been the Mamata scheme, Odisha’s conditional cash transfer programme for pregnant and lactating women, launched seven years ahead of the Centre’s Pradhan Mantri Matru Vandana Yojana (PMMVY).
A 2019 survey of six states, helmed by economists Jean Dreze, Reetika Khera and Anmol Somanchi, noted that Odisha’s Mamata scheme covered two children, unlike PMMVY that covers only the first birth. The strong women’s self-help movement — considered a support base of CM Naveen Patnaik — has also helped with the delivery and reach of ICDS and other schemes and entitlements related to maternal and child health. These are at some level channelled through self-help groups in different programmes, says Mittra.
Decentralisation of procurement of provisions under ICDS and a good monitoring system have also helped, says Bidyut Mohanty, secretary of the nonprofit Society for Promoting Rural Education and Development (SPREAD).
“There are jaanch (monitoring) committees at each anganwadi. When the community asks questions, the system works better.” But Mohanty says coverage of programmes in tribal hamlets and isolated villages is still an area of concern, along with identification of children with severe acute malnourishment, and accountability and transparency of welfare programmes. “The government is not ready for a social audit of ICDS,” says Mohanty.
While acknowledging the progress Odisha has made, Bhuputra Panda, additional professor at the Indian Institute of Public Health, Bhubaneswar, says figures from rapid appraisals suggest about 35% of kids under the age of 14 are malnourished. “Ten year ago, it was 45%, so it’s an improvement. But even 35% is dangerous. That’s why most of our attention should be on anganwadis, to reduce malnutrition in the age group of 2-5 years, which is crucial for the development of cognitive functions.”
To achieve the next set of milestones, Garg says the focus will be on delivering services to people in areas that are hard to reach. But stakeholders acknowledge that Covid-19 and the diversion of resources to contain the pandemic will have a significant impact, too. “Odisha has done everything to put nutrition high on the agenda but currently, the ecosystem is operating on a different priority,” says Mittra.
Though the state has taken measures like doorstep delivery of ration to the homes of children who were coming to the 70,000 anganwadi centres which are still closed, SPREAD’s Mohanty points out that the question of who is eating the ration remains. “Is it the pregnant woman and children or the other family members?”
IFPRI’s Menon suggests that an immediate priority for the Odisha government should be to capture the extent to which vulnerable families have been affected by the economic slowdown, so that they will know exactly what kind of social policy instruments are needed in which areas. “This is a new and different world. We still don’t know how far back we have been set by the crisis.”
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