It is high time that the process of monitoring nutrition got importance over survey outcomes
The National Family Health Survey (NFHS)-5 shows negligible gains in nutritional outcomes among under-five children. There has been tardy progress in reducing undernutrition, wasting and stunting. It is a national shame that even now, 35.5% of under-five children are stunted and 19.3% are wasted. Childhood anaemia has worsened from NFHS-4. Anaemia among adolescent girls and women aged 15-49 has also worsened. Though institutional delivery has gone up, early initiation of breastfeeding is static. If we are serious about a healthy new generation, we must ensure proper nutrition and growth.
While we need to monitor data for programmatic evaluation and correction, the question is, what type of data do we need to help starving children? Is it data on how much food is supplied, served and consumed or data on what went wrong and the prevalence of weight loss and growth stagnation? Do we need output or impact data or input and process data with their quality parameters?
We need to monitor the input and process indicators. That is how we can rectify past mistakes. Data generated quickly can lead to mid-course corrections. Data-driven planning and strategies lead to good governance with accountability.
The way forward
So, what can we do? After monitoring the successful initiation of breastfeeding in the hospital, anganwadi workers, ASHA workers and Auxiliary Nurse Midwives must continue to monitor exclusive breastfeeding till the infant is six months old. Then they must record the timely initiation of complementary feeding with soft gruel. If this step is missed, growth faltering starts. And this is the critical period of growth that we cannot afford to compromise on. We must also ensure that there is take-home ration for under-three children through the regular supply of supplementary nutrition from the Integrated Child Development Services. We also need to know whether anganwadis are intermittently closed without any valid reason; whether the supervisors are erratic in field monitoring; how we can capture the regularity and quantity of dry rations supplied to anganwadi centres and schools for mid-day meals; whether there is live web-based centrally monitorable data on the movement of dry rations to anganwadis and schools; whether parents and teachers can monitor the serving of hot, cooked meals; whether self-help groups of women are involved in preparing the menu and procuring locally available vegetables, grains and millets to ensure dietary diversification and whether eggs are being denied or stopped for sociopolitical reasons.
What goes into the family pot is also important. This depends on what parents can earn, and their purchasing capacity. So, it is important to monitor the Mahatma Gandhi National Rural Employment Guarantee Scheme workdays as well as the wages earned in areas where droughts frequently recur; where there is mass migration; and where there is prevalence of high malnutrition. The National Nutrition Monitoring Bureau was shut down some years ago. So, we don’t know what families can afford to cook and what they are cooking.
Real-time monitoring of the Public Distribution System (PDS) will go a long way in ensuring food at the family level. Except in a few States where web-based portals are functioning, there is no monitoring of when PDS shops are open as well as the quantity and quality of dry rations supplied. Unfortunately, PDS is a hunger-mitigation mechanism; it does not enable nutrition security. The aim of the National Food Security Act of 2013 is to ensure that nobody goes to bed hungry and there is no starvation. The PDS is focused on procuring wheat and rice through the Food Corporation of India to distribute to families. Cereals fill the stomach and hunger is averted, but not malnutrition.
There seems to be an aversion to facts and to reality that demands immediate action. Many established surveys seem to have methodological errors. The Consumer Expenditure Survey results of 2017-18, for instance, were withheld.
Both Poshan Abhiyan and the Pradhan Mantri Garib Kalyan Anna Yojana need to be monitored with the help of the community to ensure sustainable nutrition security.
Little of what is happening in the field right now reaches programme managers and policymakers for timely action. So, what is the point of crying over spilt milk? Malnourished children do not need repeated surveys that confirm our apathy and heartless inaction.
K.R. Antony is a pediatrician, former health and nutrition specialist for UNICEF and Independent Monitor, National Health Mission, based in Kochi. Views are personal