Community-level institutions can ensure that the burden of malnutrition is not aggravated during the pandemic
Besides wreaking havoc in the healthcare space, the COVID-19 outbreak has also caused a setback in other developmental areas, including those related to the removal of poverty and improving nutrition. Even as responses are mounted to keep the pandemic in check, other serious problems loom large. Since the launch of the POSHAN Abhiyaan by the Centre in coordination with the states, there has been an increasing momentum to implement comprehensive plans for the identification and treatment of children with Severe Acute Malnutrition (SAM), and exploring innovative solutions for dealing with this nutrition disorder within the ambit of government programmes.
As per, “The State of the World’s Children 2019, UNICEF”, before the COVID-19 outbreak, malnutrition was the cause of 69 per cent of the total deaths of children under five years. India was home to nearly half of the world’s “wasted” (low weight for height ratio) children. The report also highlighted that only 42 per cent of infants in the age group of six to 23 months were fed at adequate intervals, and only 21 per cent received an adequately diverse diet.
Given the significantly high number of malnourished children already present in the country, screening, and treatment of all at-risk cases in hospitals is not feasible. With government support schemes coming to a standstill during the pandemic, and an economic crisis that has led to over 120 million people losing their jobs, UNICEF warns that an additional 3 lakh children will die in India unless health services and nutritional support is quickly reinstated.
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Eliminating malnutrition has been a difficult target for India. However, measures taken over the last few years have given development sector experts hope. In Odisha, for instance, over the last few years, the local authorities have taken steps to improve nutritional outcomes. The most recent nutrition strategy adopted by the Odisha government is “SOPAN”- Strategy for Odisha’s Pathway to Accelerated Nutrition. Implemented by the Women and Child Development and Mission Shakti Department, SOPAN has shown promise in achieving the state’s nutrition targets across 22 districts.
Community-based crèches have been established for improved health management of children under three years. These crèches provide community-based management of SAM (CMAM), supervised feeding and counselling for mothers and children with moderate acute malnutrition. The community-based approach involves the timely detection of SAM in the community and provides treatment for uncomplicated SAM cases through ready-to-use therapeutic foods or other nutrient-dense foods. If combined with a health facility-based approach for those malnourished children with medical complications or below six months and implemented at scale, community-based management of severe acute malnutrition could prevent the deaths of thousands of children.
Half-yearly screenings and diligent tracking of malnourished children helped in timely management of malnutrition. As part of the initiative, supplementary hot cooked meals were also provided to pregnant women and lactating mothers, in addition to the existing nutrient fortified ‘Take Home Ration’ (THR) provided under the ICDS supplementary nutrition programme.
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SOPAN also makes an effort to improve accessibility for nutrition services by mobilising mothers’ groups via the “Pada Pusti Karyakram” and by deploying Pusti Sakhis, or nutrition helps from the community, in hard-to-reach areas. Training centres for anganwadi workers are being upgraded to Centres of Excellence (CoE) to give the initiative the direction and support it needs. Moreover, dialogues of interdepartmental convergence and partnerships within the state are underway to ensure positive nutrition outcomes for the future.
However, there is much scope for improvement in such state-level interventions. For instance, SAM management is driven by the Health department in some states and the department of Women and Child Development in others. This indicates a lack of ownership in addressing malnutrition at the governance level. Uniformity in the implementation framework at all levels needs to be adopted stringently to build an administrative will to address the burden of malnutrition. This should be taken up by the Department of Women and Child Health and adequately supported by the Health Department for effective implementation strategies. The Union Ministry of Women and Child Development has drafted guidelines for Community-Based Management of Severe Acute Malnutrition (CMAM) which will be finalised after consultations with all States.
Given the dire situation of our nutrition indicators and the resource-crunch brought on by the pandemic, the best way forward would be to minimise the burden of malnutrition cases on hospitals by resolving less severe cases at the community level by engaging the frontline workforce such as anganwadi workers and institutions like the Nutrition Rehabilitation Centres (NRCs) at the community level efficiently. National guidelines would be imperative in highlighting successful models across the country and for establishing a proper continuum of care – that is from the home and community to the health centre and back again in cases with medical complications.
Mothers, new-borns, and children are inseparably linked in life and health care needs. In the past, maternal and child health programmes addressed the mother and child health issues separately, resulting in gaps, which especially affected the health of new-born babies. Continuum of care can be achieved through a combination of well-defined policies and strategies to improve home care practices and health care services throughout the lifecycle, building on existing programmes and packages.
An effective continuum of care strengthens the links between the home and the first level facility and the hospital, assuring appropriate care for beneficiaries. Strategies involve improving the skills of health workers, strengthening health system supports, and improving household and community practices and community actions for health. This approach also brings care closer to the home through outreach services and promotes referral by strengthening access to and improving the quality of health services. Combining effective care in health facilities, healthy behaviour at home and early care-seeking for illness will have a significant impact on mother, new-born and child health.
If all stakeholders at the Centre and state-level work together at an accelerated pace, only then can India hope to steadily improve its nutrition indicators and eventually eradicate malnutrition.
The writer is a Rajya Sabha MP of the Biju Janata Dal from Odisha
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