12 June 2014

If the 21st century is to be India’s it has to get rid of undernutrition--fast

We just completed a writer’s workshop for an IDRC supported collection of papers for an upcoming NCAER-IDS book on Indian public policy priorities for nutrition. 

The workshop comes at a good time with Prime Minister Modi's government only a few weeks old.  

Many of the participants felt that the new government generated a new opportunity to put undernutrition prevention higher on the political agenda.  

Why the optimism?

A new government and a new opportunity for undernutrition reduction

First, there was a sense that the Congress Government really failed on undernutrition reduction.  There has been no government funded nutrition survey since 2006.  The PM’s Nutrition Council took over 1000 days to meet after its formation.  There is no focal point for nutrition anywhere in the central government.  India has chosen not to become a member of SUN.  The Total Sanitation Programme focuses on subsidies for hardware rather than on the behaviour change needed to end open defecation.  The list goes on.  New governments like to pick up on things that outgoing government failed to do.  The only way is up.

Second, Prime Minister Modi was a Chief Minister of a state, Gujarat.  States have been the source of inspiration for those of us who care about undernutriton reduction in India.  Maharashtra, Karnataka, Chhattisgarh and Odisha have led the way – reforming seemingly unreformable programmes (e.g. PDS and ICDS).  The space for the states to set higher expectations for the centre will probably expand under Modi’s government.

Third, the ruling BJP party manifesto talked a lot about undernutrition reduction and prevention--and in an informed way.  Manifesto pledges often end up as empty promises, but these pledges were not necessary to win votes, and yet they were made.  Someone seems to care, at least at the moment.

Fourth, the government has also pledged to tackle sanitation, putting a toilet in every home by 2020.  While this may not be the best strategy—as Dean Spears noted, often toilets are not used by some household members even if the toilet is working, preferring the traditional practice of open defecation—it is a step in the right direction and something to build on.

Fifth, resources do not seem to be a strictly binding constraint (we were repeatedly told by participants—official and otherwise).  The commitment in the 12th 5 year Plan is to increase spending on social services. 

Finally, the Government-- emboldened by its large majority-- is seeking “out of the box” thinking on nutrition.  Perhaps some programmes will be radically altered. 

Set against this optimism is a real worry that a “grow the economy now, distribute later” mentality will take over and social programmes will be seen as handouts rather than investments in the future.

Seizing the opportunity

The nutrition community has to seize this opportunity and manage the risks along the way.

First, we must emphasize the notion that undernutrition is a marker of development and that undernutrition reduction is a maker of development.  If you want sustained economic growth, invest in child growth.  If you want the demographic dividend to materialize, invest in infant nutrition now.  If you want to help avert a crisis in diabetes, hypertension and obesity in 25-30 years, invest in the nutrition of adolescent girls and newborns and infants now.  If Modi is to make the 21st century India’s century, he has to get rid of undernutrition -- fast.

Second, we need to support the Government to set out an Indian vision for nutrition.  If the various new (non-Government) all-India surveys (i.e. the Indian Human development Report data and the new UNICEF survey) are to be believed (they are unpublished and I have not seen them), then stunting in 2012-13 is about 35-37%.  This is a decline of about 1.5 percentage points a year since the 48% of 2006.  That is very respectable.  Now push that to 2% (still below what Bangladesh has managed) and India can get to below 20% by 2020. 20% stunting by 2020. That’s a target worth fighting for.  Can India beat this target before its 75th anniversary of Independence in 2022?

Third, there needs to be a high level focal point in the central government. The person should be the public face of the government’s public commitment to undernutrition reduction, preferably in national mission mode.  They would be a respected public figure who transcends political parties and for whom this is their main pursuit. Perhaps an ex-President. Their job would be to inspire and lead all stakeholders, convene and facilitate various initiatives, and report to the public, annually, on what the government has achieved.  Such a person has not been in place for at least the past 10 years.  I don’t even know who to direct this blog to!  Who is responsible for undernutrition reduction in India?  No one can tell me.

Fourth, we need to convince the government that data collection on nutrition is in its interest.  How can you diagnose the problem and prioritize action without a series of comparable data points 3-4 years apart?  In addition to the 2014 NFHS-4 there should be a 2017 NFHS-5 and a 2020 NFHS-6.  If we were talking about economic data collection there would be no discussion about periodicity—annual surveys are automatic.  Nutrition data are just as vital to guide investments in the nation’s destiny.  We would not run an economic policy based on data from 2006 (two World Cups ago!) so why would we do the same for nutrition policy?

Fifth, we need to urge the new Government to invest in Indian researchers working on this topic.  Externally funded research is helpful but it is no substitute for Indian Government funded research.  For the latter, the government has to work out for itself what information it needs and the evidence thus generated will be less easily dismissed if the government supported it.

Finally, there are just some areas which we know need urgent attention, no matter what: efforts to reduce open defecation, ICDS reform to focus it more on 0-3 year olds, efforts to improve the nutrition of adolescent girls, and attention to the price increases of non-staple foods which tend to be higher in micronutrients. 

Undernutrition reduction is everyone’s responsibility

The new Government has a once in a decade opportunity to make its mark on undernutrition and leave an enduring legacy to the nation.  

The rest of us have an opportunity to urge and support it to do so.  Let’s seize the moment: write your MP, write those op-eds, blog like never before, tweet the relevant killer facts and articles, work with filmmakers to make videos about undernutriton, inspire your students to work on it, talk to your doctors about it and convince your influential friends from all walks of life about its existence and importance.  

Undernutrition reduction is everyone’s business and everyone’s responsibility, not just the government’s.

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