06 November 2014

Undernutrition in India: Is the “Curse” Finally Lifting?

Five years ago Sushila Zeitlyn and I co-edited a collection of papers by Indian authors on why undernutrition was so persistent in India and why the government seemed so disinterested in making tackling it a priority.  At that time the Prime Minister called undernutrition a “curse”.  It must have seemed like that—rapid economic growth and high and stubborn levels of stunting, wasting and micronutrient deficiencies.

I just returned from a trip to Delhi and Lucknow and I have never been more encouraged.  Is the curse finally lifting?

First there was the Together for Nutrition Conference organized by two consortia, both convened by IFPRI: POSHAN and Transform Nutrition.   The conference explored different forms of collaboration in nutrition: from alignment to coordination to cooperation to integration.   What was so encouraging here was the participation from 14 different states.  The nutrition champions were everywhere.  We had great research papers and inspiring stories from a range of Indian and international practitioners and researchers.  Once again, there was the prevalent feeling that dynamism, innovation and commitment are coming from the States, not the central Government.   
Second, there was the Coalition for Food and Nutrition Security, chaired by M.S. Swaminathan, still driving the agenda with a razor sharp intellect and turn of phrase.  The Coalition is a group of civil society, government and research organisations and individuals who are fighting for nutrition.  I attended the launch of their Action Agenda. The Coalition outlines 5 urgent areas of action; coverage of evidence informed nutrition interventions, equitable access to services provided by sectors related to nutrition, adequate financing, nutrition as a development indicator with regular data collected every 3-5 years and institutional leadership within the offices of the Prime Minister and state Chief Ministers.  I like this set of 5, especially the last two as I think they set the tone.  

Speaking of Chief Ministers who take the lead, I next went to Lucknow in Uttar Pradesh (UP), to speak at the launch of the new State Nutrition Mission.  UP is the biggest state in India at 200 million people (the 6th largest country in the world, if it were one) and has the highest rate of stunting at about 56%.  That is about 13 million stunted children or about 8% of the world’s total.  8%.  The Chief Minister and his wife, an MP, spoke passionately about the need to reduce malnutrition.  The Citizen Alliance, a group of MPs and civil society featured strongly at the podium and are clearly powerful.  UP was strongly influenced by the Maharashtra experience (hence my invitation to present this report) and there were many officials from that state also present.  If things can get moving in UP it could be a real global game changer.
Finally, I returned to Delhi to co-teach in the Transforming Nutrition short course co-hosted by PHFI and IFPRI.  The quality of the participants was really excellent and it was inspiring to be around so many experienced and knowledgeable experts on nutrition.  Aryeh Stein from Emory University was a great addition to the PHFI/IFPRI faculty, especially with his knowledge of the double burden and developmental origins of health and disease.

There’s a real energy and excitement about the Indian nutrition scene: a sense that progress is being made.  Causes for optimism include:
* New headline figures from the yet to be released Rapid Survey on Children (Government of India and UNICEF)—under 5 stunting declines from 48% to 38%
* UP’s Nutrition Mission
* The new Government’s preparation of a National Nutrition Mission
* The new Government focus on sanitation
* The active role civil society is playing: the Citizen’s Alliance, the Coalition and Naandi’s Hungama 2
* Maharashtra, Odisha and Kanartaka’s leadership on nutrition at the state level
* A PDS system that seems to be lurching into life in terms of promoting food security
* UNICEF’s strong partnership of the States

Challenges remain: the promise needs to be delivered on and there are some very difficult hurdles to overcome (open defecation, caste barriers, sluggish agricultural development). But the sense I took away—perhaps for the first time in 20 years—is one of optimism.  People kept saying that they were “waking up to malnutrition”. 
Maybe the curse really is lifting.  Maybe India will join SUN.  Maybe India will hit the WHA targets by 2025 or even exceed them.  We shall see. 

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