“Humanity is first and foremost a Stomach”

In present day India, many children are experiencing hunger.  The recently compiled IFPRI Global Hunger Index, a composite indicator of proportion of underweight children, under five mortality and prevalence of calorie insufficiency, reports that hunger is widespread and a serious issue in India. Further it states that economic strength, urbanisation and industrialisation have not automatically led to alleviation of hunger.

In a ranking of Indian states, Madhya Pradesh (India’s second largest state) is the only state graded “extremely alarming”.  When placed globally it sits along side Ethiopia and Chad with respect to numbers of malnourished children. 12.6% of children in the state are severely malnourished, and worryingly the proportion of children underweight has in fact increased from 54% to 60% over the last five years.

Some of the underlying causes and challenges
A multiplicity of factors are attributed to this current scenario:

• Food availability: drought, focus on cash crops, and low yield of food grains have all resulted in food insecurity
• Poor nutrition related knowledge and practices including low levels of exclusive breastfeeding and timely introduction of complementary foods
• High proportion of vulnerable populations: schedule caste and schedule tribes represent almost 35% of the total population
• Poor status of women and girls: reflected in early marriage and high levels of anaemia.

The state response so far
To date, the state has not tackled the chronic problem of under nutrition in a cohesive and committed manner. Although there exists a plethora of government interventions and programmes, together they have not been able to make a significant impact.

The central plank of the government response is the Integrated Child Development Scheme (ICDS) programme. It suffers from several serious shortcomings: overall low coverage of eligible children; poor targeting of the most vulnerable age group of children, ie the 0 to 3 years old; and serious governance weaknesses and failures, such as poor attendance of service providers and incorrect reporting.
One of the good practices in the state is the establishment of Nutrition Rehabilitation Centres for addressing the plight of severely malnourished children. Children are admitted in the Centre along with their guardian for rehabilitation and education.

The will for sustained action
The state government has recently re-affirmed its commitment to tackling the alarming and increasing levels of malnutrition in the state. First and foremost, the highest political office of the Chief Minister has indicated health, nutrition, education and women’s empowerment as priority areas. He has constituted several high level permanent working groups tasked with addressing these priorities, among others.

Further, the government is planning to introduce several new initiatives and approaches aimed at reduction of child malnutrition:

1. Formulation of a new Nutrition Policy which will provide the opportunity to re-examine and address wider determinants of malnutrition in a more cohesive manner, and increase ownership and commitment by required departments
2. Better convergence of Health and Nutrition services: as articulated by the Secretary for Women and Child Development, “there is a need to define convergence at different levels and a need for supportive institutional structures and mechanisms”
3. Piloting integrated provision of nutrition and health services at village level: under this initiative, nutrition workers will be trained to take on new born care, infant and young child feeding, and management of common childhood illnesses, as well as work closely with auxiliary health workers
4. Strengthening malnutrition monitoring: innovative approaches adopting e-technology and biometry are being planned to generate real time data for tracking malnourished children and ensuring the required response
5. Conducting a social audit of the ICDS programme:  this will add greater administrative transparency and accountability and create space for public participation.    

Renewed political will and commitment, together with these new activities and approaches provide a real window for impacting on unacceptably high child malnutrition in Madhya Pradesh.