One of the major developmental challenges that India faces is malnutrition, which contributes significantly to India’s overall disease burden. Malnutrition has a significant effect on the proper infant and maternal growth and development as well as the socio-economic development.

As per the latest NFHS 5 data for Phase I released recently by the Hon’ble Health Minister, Government of India, that covered 17 states and 5 Union Territories, the Under 5 and infant mortality rate (IMR) has come down in 18 states and union territories but in parallel 16 states recorded an increase in underweight and severely wasted under 5 children among 22 states that were surveyed. Wasting percentage increased in under 5 children in 12 states and UTs in comparison to NFHS-4. The malnutrition indicators have worsened from the last survey, with the proportion of children with stunting rising, wasting going and anaemia. NFHS-5 also showed that 20 states and UTs saw rise in the percentage of overweight children under 5 years of age.

Prevalence of stunted children is higher in rural areas in comparison to urban areas, and it seems to peak at the age 18 to 23 months. Alarmingly, the prevalence of wasting has not declined, and remained at the level, it was three decades ago.

There are various factors which play a pivotal role in chronic malnutrition in children. One of the most important factors is the mother’s nutritional status. Around 36% of the population of women are underweight, and 53% of women and 56% of adolescent girls between 15 and 19 years old suffer from iron deficiency anaemia due to undernourishment in India. The decline in the prevalence of anaemic children and pregnant women has been awfully slow, a decline of 11.5% and 8.5% over a decade, respectively. The problem of malnutrition is inter-generational. Pregnant women and lactating women suffer from malnutrition the most, which will most likely result in a premature or low birth weight baby. This pattern perpetuates through the generations. The first 1000 days (conception to 2 years post-partum) are considered a ‘window of opportunity’ for addressing malnutrition. Another important factor which contributes to the level of malnutrition in India is poor hygiene and sanitation which leads to infections by pathogens and diseases like diarrhoea. According to WHO, 50% of the malnutrition cases are due to diarrhoea.

Government Efforts on Combating Malnutrition

There have been a host of policies in India which have been in practice since 1990 to tackle malnutrition, the key ones being Integrated Child Development Scheme launched in 1975, the National Nutrition Policy 1993, the Mid Day Meal Scheme for school children 1995, and the National Food Security Act 2013, as the prevalence of stunting, wasting and underweight remains high. In 2010, India launched another program, Pradhan Mantri Matritva Vandana Yojana (PMMVY), a maternity benefit program that is a cash transfer scheme for pregnant and lactating women of 19 years of age or above for the first live birth.

The Government of India set up the “POSHAN Abhiyaan” on December 18, 2017 for a period of three years with an overall budget of Rs. 9046 crores. The goal of ‘POSHAN Abhiyaan’ is to achieve improvement in nutritional status of children from 0-6 years, adolescent girls, pregnant women, and lactating mothers in a time-bound manner During the three years, the program aims at achieving fixed targets in terms of improving nutritional outcomes, reduce the levels of stunting, underweight and low birth weight by 2% per annum and anaemia by 3% per annum. As per NFSH5, one of the significant improvements from

India Co-Win Action Network (ICAN) Contributing to Government’s POSHAN Abhiyaan Through POSHAN Jan Abhiyaan
ICAN has planned to contribute to Government of India’s POSHAN Abhiyaan through its initiative “POSHAN Jan Abhiyaan” in more than 15 districts in the state of Uttar Pradesh. The project will cover about 15 blocks in these districts. The envisaged project is being driven by NITI Aayog’s endeavour to achieve the goal of the POSHAN Abhiyaan. The initial six months of the project activities are being supported by Tata Trusts and Marico India.

Based on the experience of selected interventions to combat malnutrition in these districts, there is a plan to review the interventions midway during the project and plan a three-year long-term intervention covering more districts.  The project is expected to commence in early January 2021.

Strengthening Poshan Abhiyaan through active engagement of Civil Society in 15 districts of Uttar Pradesh’

S. NO District Name of Organisation
1 Ayodhya Human Upliftment Mission (HUM)
2 Bahraich Trust Community Livelihoods
3 Basti Surya Foundation
4 Etwa Unit of Science and Educational Development (UNISED)
5 Farrukhabad Shanti Samaj Sevi Samiti
6 Fatehpur Aawahan- The New Voice
7 Hardoi Poorvanchal Gramin Vikas Sansthan (PGVS )
8 Jaunpur Ram Gramin Sewa Sansthan
9 Kannauj Shashwat Sahbhagi Sansthan
10 Kheri JPS Foundation
11 Mahrajganj Lok Pyas Society
12 Mirzapur Mahila Prabodhini Foundation
13 Pilibhit Shalini Memorial Sewa Sansthan
14 Shahjahanpur National Inst for Env and Agri.
15 Shrawasti Uttar Pradesh Gandhi Samrk Nidhi Sewa Puri

In 2018 Hon’ble Prime Minister Shri Narendra Modi launched The POSHAN Abhiyaan with an aim to make India malnutrition-free by 2022. The Abhiyaan is based on 4 pillars of:

  1. Ensuring access to quality services
  2. Ensuring inter-sectoral convergence
  3. Leveraging technology (ICDS-CAS)
  4. Jan Andolan.

To further strengthen the Jan Andolan component of Poshan Abhiyaan, India Cowin Action Network (I-CAN) had reached out to NITI Aayog to work on demand –side determinants of malnutrition and improve key health and nutrition behaviors and contribute to achieving Honorable PM’s vision of Kuposhan Mukt Bharat. ICAN is a technology-based platform launched by Rambhau Mhalgi Prabodhini in March 2020, in the wake of the COVID-19 Pandemic to connect those in need of assistance with those who can provide the required help. During lockdown, I-CAN could provide help to more than 4 lakh people with the help of its 3800+ registered NGOs and 4000+ volunteers.

NITI Aayog under the leadership of its Vice-Chairman Dr Rajiv Kumar is guiding this consortium of CSOs led by I-CAN in partnership with several major organizations like Tata Trusts and Marico India for providing financial support, and Lucknow University and Alive and Thrive as technical partners. The initiative will create a cadre of volunteers and build their capacities. These volunteers will then engage with the community through Social and Behaviour Change Communication (SBCC) strategy to change behaviors around evidence based key Maternal, Infant and Young children (MIYCN) interventions for improving health and nutrition outcomes

The details about the status of implementation of this initiative is provided as under.

Baseline Study

The baseline survey strategy has been finalized, along with the survey tool and methodology. To undertake the baseline study following steps have been undertaken.

    • Training of Block Coordinators and Poshan Mitras – on the questionnaires (survey tools) and on using the online survey platform has been done
    • Incorporation of suggestions in the survey tool, provided by all stakeholders in the last review meeting at NITI Aayog is done.
    • Field testing of survey tools by Coordinators / Poshan Mitras is complete and minor changes to the tools, as was suggested by them, have been incorporated.
    • Data collection from all sampling units, in the 15 districts, is now in its final stages; it has been completed in ⅓ of all sampling units.

The next steps involve analysis of collected data and generation of the baseline report, which would be done by Dept. of Statistics, Lucknow University.

Coordination with state WCD ministry for Convergence

To ensure coordination with the state, a meeting between CDPOs, DPOs of the select Districts/Blocks and ICAN was held under the chairmanship of Smt. Swati Singh, Hon’ble Minister, Women and Child Development, Government of Uttar Pradesh, on 24.02.2021. Following are major takeaways from this meeting:

    • To make sure that this initiative and efforts/services of the state government work together in synergy.
    • To ensure that the front-line workers of state (especially Anganwadi workers) and the field workers under this Abhiyaan (Poshan Mitra and Poshan Doots) are in close contact and can align the work that they do.
    • The ministry will share the list of schemes, services, and initiatives of the UP Government, in the domain of health and nutrition, so that the interventions of this project can be placed within this larger paradigm.

Review meeting at NITI Aayog with all key stakeholders

To get a grip of the status of implementation of this project, a review meeting was organized for all key stakeholders, under the chairmanship of Vice-Chairman, NITI Aayog on 18.02.2021. Following were the major updates of this meeting.

    • Content of the interventions and training curriculum covering all the themes of this project must be shared with Member, Health, NITI Aayog.
    • Report generation mechanism may cover process indicators as well as outcome indicators.
    • A project note for PMO has been made and shared, stating the rationale, novel approach, and expectation from the project, as was decided in this meeting
    • Focus must be on newborn children, and we should be able to track their improvement till their first year, and a strategy to collaborate with front line workers must be highlighted separately.
    • It was decided that the interventions should be scaled up covering all the blocks of 3 Aspirational Districts of Uttar Pradesh.
    • It was established that the reporting of project status to NITI Aayog would be done quarterly and updates will be sent monthly.

NITI Aayog will also provide support by sending letters to district nodal officers in the 15 districts, the contacts and email address of these officers have been shared with NITI Aayog.

Review of training module and material by NITI Aayog

As was decided in the previous NITI meeting (dated 18.02.2021) Member, Health, NITI Aayog had requested a meeting with I-CAN and Alive & Thrive team, under his chairmanship, to review the training modules and materials which are to be used for the orientation training of Block Coordinators/Mitras. This meeting was held on 25.02.2021. The major takeaways of this meeting were:

    • It was decided that the stage setting of this training will be done by Member Sir, Health and Nutrition. He would talk about the objectives and the goals of the project in introduction of the training.
    • Components like HBNC, HBYC, and Anemia Mukt Bharat were added to the training module, as per the suggestion of Member, Health and Nutrition.

A need to include ‘Health and Nutrition Counsellors’ under the project who are from health and nutrition background and are equipped to provide hand holding support to the frontline workers (e.g., Nurse) was highlighted by the Member, Health and Nutrition. He suggested that the model of implementation may be redesigned to include 1 Health and Nutrition Counselor in every 4-5 Panchayats.

Orientation Training by Alive and Thrive

This was a two-day training held on 27th and 28th February 2021 in Lucknow. First day of the training covered sessions on nutrition and its importance, malnutrition and the types of malnutrition, the status of maternal and child nutrition in India and in UP, the importance of first 1000 days, introduction to Poshan Abhiyaan, ICDS, NHM and maternal nutrition. The day ended with summarization of the learnings. On the second day, following a recap of previous day’s learnings, sessions were conducted on Anemia Mukt Bharat, IYCF practices, Home based Newborn Care with a focus on the care of Low Birth

Weight, Immunization and Vitamin A supplementation, Childhood diarrhea and roles and responsibilities of the block coordinators.

For more details, please contact:
Kamlakant Pathak
Email: kamlakant.pathak@icanonline.in
Mobile: 7208070872