|Achieving the goal of nutrition security for all Indians will need a fusion of political will and action, professional skill, and peoples’ participation.|
“To a people famishing and idle, the only acceptable form in which God can dare appear is work and promise of food as wages.” These were the words of Mahatma Gandhi when he was healing the wounds arising from the Hindu-Muslim divide at Naokhali in 1946. He thus stressed the symbiotic bonds among work, income and food security. Eradication of hunger and poverty is also the first among the U.N. Millennium Development Goals (MDG), which in my view represent a global common minimum programme for human security and well-being.
On September 25, a high-level meeting was held in New York under the leadership of the United Nations Secretary-General to consider the fate of the first MDG in the light of escalating food prices and vanishing global food reserves. The Director General of the Food and Agriculture Organisation pointed out at this meeting that far from achieving the goal of reducing hunger by half by 2015, some 75 million more were added to the hunger trap during 2007, principally due to the rise in food prices.
Nearly 30 million of the 75 million additions are from India. Recent data from the National Family Health Surveys indicate an unacceptable extent of malnutrition among children and pregnant women in particular, leading to Prime Minister Manmohan Singh’s plea during his address on August 15, 2008 that we should overcome the curse of malnutrition as soon as possible.
In 1981, Indira Gandhi suggested after meeting Vinoba Bhave at the Paunar Ashram in Wardha district that the district should be converted into a “Gandhi district,” since Gandhiji spent an important part of his life there. She asked me to chair a small group to prepare a blueprint to develop Wardha into “Gandhi district.”
Our first task was to develop a definition for a Gandhi district. We defined it as one where no one is below the poverty line and no one goes to bed hungry, not because of doles but because of opportunities for sustainable livelihoods. In other words, bread with human dignity was to be the hallmark of the proposed district.
At that time, over 80,000 families were below the poverty line and hence specific suggestions were given to raise all these families above the poverty level by creating opportunities for productive and remunerative work. Unfortunately, this plan to dedicate Wardha to Gandhiji is yet to be implemented. Even now, it will be worthwhile to update the report and transform Wardha into a hunger-free and poverty-free district dedicated to Gandhiji.
On the occasion of the 60th anniversary of India’s Independence in 2007, a broad-based Coalition for Sustainable Nutrition Security in India was formed at a meeting held at the M.S. Swaminathan Research Foundation, Chennai. The coalition, comprising national and U.N. organisations as well as USAID prepared a report titled “Overcoming the Curse of Malnutrition: A Leadership Agenda for Action.” During a recent discussion on this report, the following five-point action plan emerged:
a) Institutional structures for public policy and coordinated action in nutrition
Overcoming malnutrition requires concurrent attention to food (macronutrients and micronutrients, clean drinking water) and non-food factors (such as sanitation, environmental hygiene, primary health care, nutrition, literacy and work and income security). Achieving the goal of nutrition security for all will need a fusion of political will and action, professional skill and peoples’ participation. Such a coalition of policy makers, professionals and citizens will have to start from the village and go up to the national level. The following consultative, policy oversight and monitoring structures are suggested.
• At the panchayat/ nagarpalika/ local body level
The council for freedom from hunger, established by gram sabhas/ local bodies, with one man and one woman from each village being trained as hunger fighters;
• State/ Union Territory level
• The State-level Committee on Nutrition Security, chaired by the Chief Minister, with all concerned Ministers and representatives of civil society organisations, the corporate sector and the mass media;
• National level
The Cabinet Committee for Nutrition Security, chaired by the Prime Minister.
A system for horizontal linkages among these three levels of action will have to be developed.
b) Learning for success: converting the unique into the universal
Nothing succeeds like success. Therefore it is important to learn from successful examples of the elimination of malnutrition, as for example, Kerala and Tamil Nadu. Kerala has adopted a universal Public Distribution System (PDS). A unique combination of the ICDS (Integrated Child Development Services) and the TINP (Tamil Nadu Integrated Nutrition Project) was launched in Tamil Nadu where TINP identified a community worker to concentrate on families with children in the 0-3 age group. From 1982, Tamil Nadu has been operating a universal noon-meal programme for school children, which now covers old age pensioners, destitutes, widows and pregnant women. Support is being extended to nursing mothers. Further, Tamil Nadu is providing rice to the poor at Re. 1 a kg from September 15, 2008. This will help reduce under-nutrition substantially. Various indicators of malnutrition show a downward trend in Tamil Nadu. For example, the incidence of severe malnutrition (Grades III and IV) among children aged 0-36 months declined from 12.3 per cent in 1983 to 0.3 per cent in 2000. It will be useful to replicate such effective measures to combat malnutrition in all States and adopt a universal PDS.
Successful programming experience and health and nutrition evidence show that breaking the curse of malnutrition will require focussing on two important target groups: children under two years of age and women, especially adolescent girls and pregnant and nursing women. The first two years of life represent the critical window of opportunity to break the inter-generational cycle of malnutrition. If this critical window of opportunity is missed, child malnutrition will continue to self-perpetuate and malnourished girl children will continue to grow to become malnourished women who give birth to low-birth-weight infants who are poorly fed in the first two years of life. Based on successful models, State governments can develop a ‘Hunger Free State’ strategy, with a life cycle approach to the delivery of nutrition support.
c) Action at the local level: community food and water security system
Community food and water security systems including grain, seed, fodder and water banks can be promoted by local bodies. The food basket should be widened so as to include a wide range of millets such as ragi, besides legumes, vegetables and tubers. The panchayat council for freedom from hunger should be assisted with the needed technological and credit support to establish grain, seed, fodder and water banks. Wherever hidden hunger from the deficiency of iron, folic acid, iodine, zinc and Vitamin A in the diet is endemic, food-cum-micronutrient supplementation and appropriate and effective fortification approaches (as for example, the use of iodine and iron fortified salt) can be adopted. Every panchayat or local council for freedom from hunger could invite a home science graduate in the area to serve as nutrition adviser.
d) Action at the State level: coordinating nutrition security initiatives
The State Level Committee on Nutrition Security chaired by the Chief Minister should facilitate the implementation of ongoing nutrition safety net programmes (national, bilateral and international) in a coordinated and mutually reinforcing manner, in order to generate synergy and maximise the benefits from the available resources. The National Horticulture Mission provides a unique opportunity to apply local level horticultural remedies to major nutritional maladies. Overcoming micronutrient malnutrition and intestinal infection load are urgent tasks. The State governments should launch a nutrition literacy movement and set up “media coalitions for nutrition security” to improve nutrition awareness. Such a media coalition should include representatives of the print media, audio and video channels, new media including the Internet, and traditional media such as folk dance, music, and street plays.
e) Action at the national level: mainstream nutrition in national missions
At the national level, the most urgent task relates to including nutrition outcome indicators and targets in all major missions in the field of agriculture and rural development. Programmes such as the Rashtriya Krishi Vikas Yojana (Rs. 25,000 crore), the National Horticulture Mission (Rs. 20,000 crore) and the National Food Security Mission (Rs. 5,000 crore) should have a nutrition advisory board, so that cropping and farming systems are anchored on the principle of food-based nutrition security. The National Rural Employment Guarantee Act (NREGA) sites, where mostly illiterate women and men work on unskilled jobs, should have a nutrition clinic operated by a knowledgeable person and a PDS facility. If food is not available at affordable prices at NREGA sites, most of the money earned will go towards purchasing staple foods at high cost and under-nutrition will persist.
As a concrete manifestation of the country’s commitment to achieving Gandhiji’s goal of food for all, I suggest that the following two steps may be considered, in addition to action at the government level:
• All MLAs and MPs who are provided with Rs. 1 crore to Rs. 2 crore a year respectively for local area development (under MPLADS) should set apart the funds to eliminate malnutrition from their constituencies based on the Gandhi district plan of assisting every family to earn their daily bread. This should be done until malnutrition is totally eradicated from the constituencies concerned.
• Corporate houses should allot funds available for corporate social responsibility to projects designed to eliminate hunger. Such projects could relate to enhancing the productivity and profitability of small scale farming and women’s self help groups, as well as to strengthening nutrition safety nets and eliminating leakages in the delivery system.
If the above steps are taken, we will be walking the talk. We cannot postpone any further the task of erasing the stigma and the shame associated with our country being home to the largest number of malnourished people in the world.
(Dr. M.S. Swaminathan is Chairman, M.S. Swaminathan Research Foundation, Chennai, and a Member of Parliament, Rajya Sabha.)