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| Srinath Reddy, Purnima Menon, me, Min. Gandhi, Min. Nadda, Ramanan Laxminarayan and Soumya Swaminathan |
I just returned from a few days in Delhi. The first part of the week was teaching on a short course convened by the Public Health Foundation of India for Indian policy and programme professionals: Transforming Nutrition Outcomes, Policy and Action. My fellow course convenors were Purnima Menon (IFPRI), Aryeh Stein (Emory University), Reynaldo Martorell (Emory University), Ramanan Laxminarayan and Shweta Kandelwal (Public Health Foundation of India). We had 50 participants, all asking very good questions and sharing their pricesless field experiences. All in all a great few days.
The last day of my visit was to launch the Global Nutrition Report (GNR) in conjunction with the launch of the TransformNutrition/PHFI/IFPRI India Health Report: Nutrition (IHR). Both reports are supported by DFID and other development partners.
Things got off to a good start that day -- we saw an op ed in the Times of India from Bill Gates and Ratan Tata about nutrition and its vital role in driving sustainable development and the need for sustained leadership.
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| The Times of India front page, Dec 10, 2015 |
The GNR and IHR both use the latest RSOC data
from the Government, 2013-14. The GNR
compares India’s performance against other South Asian countries and the IHR
focuses on State level variations.
Between IFPRI, PHFI and the GNR we managed to get a
great line up of speakers: Minister Maneka Gandhi of Women and Child
Development and Minister PJ Nadda of Health and Family Welfare as well as Dr. Soumya
Swaminathan the DG of the Indian Medical Research Council.
Key messages from the 2 reports include:
* At the national
level India's rate of stunting decline has increased dramatically: from 1.7%
Average Annual Rate of Reduction pre NFHS 2005-6, now to 2.6% post RSOC (a 50%
increase). But this is still short of the 3.7% needed to get to the World
Health Assembly and SDG target on stunting. GNR
* The benefit cost ratio of investing in the scaling
up of essential nutrition programmes in India is 34 to 1. GNR
* Wasting rates have come down by a quarter (from 20
to 15%) but this is still very high. Women's anaemia rates are very high at 48%
and are the second highest in the SAARC countries. GNR
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| 2 lead authors of the IHR: Neha Reykar and Moutushi Majumdar |
* Adult overweight and obesity is relatively low at
26% but is increasing. India needs to resolve issues like stunting, wasting and
anemia while slowing down and reversing overweight and obesity rates. GNR
* The 2 big states that had the worst stunting rates
in 2005-6 were the ones that made least progress over the 2005-2014 period —
Bihar and UP. Efforts need to be redoubled in these two states if the national
numbers are to decline faster. GNR and IHR 2015
* Governance and delivery of health and nutrition
schemes is highly variable, as seen in the state comparisons of delivery of
ANC, ICDS, immunization; need to understand if this is because of capacity,
financing, implementation bottlenecks, human resources or community
demand-generation. IHR 2015
* Women’s health and status are known drivers of poor
nutrition, especially education, health, nutrition and age at marriage; these
are issues even in better-off Southern states and need urgent attention. IHR
2015
* Adolescent girls’ nutrition is a particular
challenge across the country and has serious implications for transmission of
poor nutritional status from young mothers to their children. IHR 2015
* Although exclusive breastfeeding rates have
considerably improved, complementary feeding of young children is still a big
area of challenge, across the board, almost regardless of which state one looks
at. IHR 2015
* Sanitation, another major driver of poor nutrition,
remains a major challenge in several states, even in those that perform well on
implementation of health and nutrition programs. IHR 2015
* Strengthening full accountability for delivery of
certain identifiable set of high impact nutrition interventions is critical to
ensuring accelerated improvements in nutrition. IHR 2015
* The need for a
comprehensive consistent data collection effort around nutrition is vital. NFHS
4 needs to be published in a timely way and subsequent NFHS surveys should be
collected every 3 years. GNR and IHR 2015 Global Nutrition
So, how did the Ministers react?
First of all, it was great to see these 2 Ministers on
the stage together—it does not happen often enough. As one of the Ministers
noted, this side by side arrangement represented one type of convergence of leadership (the coming together of the 2 major
ministries that deliver nutrition specific interventions).
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| Ministers Gandhi and Nadda in the middle of the platform |
Minister Nadda (Health) said all the right things. He
talked about malnutrition in all its forms, the double burden, and the fact
that business as usual would not deliver reductions fast enough.
He quoted the 34:1 benefit-cost ratio for India from the GNR and the fact that that is equivalent to a 12% compound rate of interest over 30 years. In other words, a fantastic investment. He praised the reports for the signposts to accelerating malnutrition reductions that they delivered.
He quoted the 34:1 benefit-cost ratio for India from the GNR and the fact that that is equivalent to a 12% compound rate of interest over 30 years. In other words, a fantastic investment. He praised the reports for the signposts to accelerating malnutrition reductions that they delivered.
Minister Gandhi (Women and Child Development) noted
the importance of raising the ratio of girls to boys in the country’s poorest
100 districts. She noted that after just
one year the ratio was now much closer to 1000 to 1000 than it had been a year ago (around 750 to
1000). This of course is vital for child survival, but also for nutrition. She said that the same rapid change would
happen for nutrition “once we focus on it”.
An area of focus for Minister Gandhi was the highly
variable quality of food provided for under 5’s in ICDS programmes. She thought
that involving businesses more closely to produce food to a specification
determined by the Government (and due for a refresh).
She also mentioned the potential of mobile phones for messaging around nutrition, citing a new initiative with Vodafone that every time the phone is switched on a very short video from the film star Aamir Khan on how to feed your baby plays (and you get 10 rupees if you watch the whole thing).
She talked about how important it was to train frontline workers and to reduce their burdens. MPs were also an important set of allies that the Minister thought represented a missed opportunity to engage on nutrition (she recounted her own relative lack of awareness over the role of frontline nutrition workers in her own constituency before taking on her current role).
She also mentioned the potential of mobile phones for messaging around nutrition, citing a new initiative with Vodafone that every time the phone is switched on a very short video from the film star Aamir Khan on how to feed your baby plays (and you get 10 rupees if you watch the whole thing).
She talked about how important it was to train frontline workers and to reduce their burdens. MPs were also an important set of allies that the Minister thought represented a missed opportunity to engage on nutrition (she recounted her own relative lack of awareness over the role of frontline nutrition workers in her own constituency before taking on her current role).
Earlier that day we had a fantastic meeting with 2 senior
bureaucrats in the Prime Minister’s Office.
The 2 officials we met really “got” nutrition—what it was, why it
mattered and what to do about it. They confirmed the launch of a National
Nutrition Mission in early 2016 and they made us optimistic about its content
and influence. We shall see.
While national level policymakers can enable or hinder
state level governments, the state by state variation in implementation,
spending and monitoring of national policy shows that the states have a lot of
freedom to act for nutrition. The centre
can facilitate or show indifference, but it will not deliver improvements
without committed states.
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| Purnima Menon, speaking to the Ministers |
We called the launch event “Made in India” because
this is a play on Make in India, the government’s strap line on reviving
indigenous manufacturing to make India the workshop to the world and power its
own economic growth (and India is now the fastest growing major economic in the
world).
Based on the data and our gut instinct, we felt India could now be on the verge of driving a very rapid decline in global stunting rates in the SDG period, much as China drove global poverty rates down in the MDG period.
But my colleague Purnima Menon (who along with PHFI's Ramanan Laxminarayan were the other 2 IHR lead authors) put it best “Make in India cannot happen if the children 'made in India' are stunted, wasted and underweight”. Absolutely.
Based on the data and our gut instinct, we felt India could now be on the verge of driving a very rapid decline in global stunting rates in the SDG period, much as China drove global poverty rates down in the MDG period.
But my colleague Purnima Menon (who along with PHFI's Ramanan Laxminarayan were the other 2 IHR lead authors) put it best “Make in India cannot happen if the children 'made in India' are stunted, wasted and underweight”. Absolutely.
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