How India can break the cycle of hunger: insights from Sudarshan Suchi, CEO of Bal Raksha Bharat | Health

Undernutrition among women and children is a persistent public health problem at the global, national and local levels, with the latest joint UNICEF-WHO-World Bank Group malnutrition estimates showing that 149.2 million children under the age of five were stunted in 2020 and 45.4 million were wasted. Global leaders and agencies are responding to these urgent challenges, while governments and non-governmental organizations are implementing programs and facilitating the uptake of nutritious food by vulnerable populations. However, progress in nutritional outcomes has not been in sync with our significant economic growth.

In an interview with HT Lifestyle, Sudarshan Suchi, CEO, Bal Raksha Bharat, shared ways to improve cross-sectoral convergence in nutrition in India and the role civil society organisations can play.

Why do millions of people in India still suffer from malnutrition?

The improvement in nutritional indicators in India has been modest as seen from the five panels of the National Family Health Survey. Of course, there are states where the reduction has been impressive, but it becomes elusive when we look at the national average. There is a strong drive to improve nutritional outcomes and address the challenge of hunger and malnutrition. The Government of India, its development partners and civil society organisations are committed to achieving the targets set under the National Nutrition Strategy. Launched in 2018, the POSHAN Abhiyaan is the flagship programme of the Government of India to improve nutritional outcomes of children, pregnant women and lactating mothers. Since then, the month of September has been observed as ‘Poshan Maah’ to create awareness about nutrition and this is the 5th Poshan Maah in this series.

Q. How is Poshan Abhiyaan from India dealing with the crisis?

The approach of POSHAN Abhiyaan is to anchor multi-sectoral convergence to address nutrition issues through a framework of appropriate interventions, indicators and targets for programmes implemented by different departments. The objective of achieving multi-sectoral convergence is to ensure that interventions from different sectors converge across households within the first 1000 days. It is now very well established that cross-sectoral convergence is essential to address this multi-dimensional nature of malnutrition. India is currently scaling up its nutrition movement by adopting a cross-sectoral convergence strategy and promoting Jan Andolan. While the overarching intention of convergence is clear, the operational guidelines do not explain how stakeholders could ensure that multiple programmes reach the same beneficiary within the stipulated time frame.

Q. How can cross-sector convergence be a game-changer?

The operational guidelines of the Government of India for the Convergent Action Plan (CAP) aim to clarify the process of multi-sectoral engagement. The CAP framework has identified activities and indicators based on existing services that contribute to improving nutrition. The CAP requires programme managers to set targets for key indicators, identify bottlenecks, plan activities and define monitoring mechanisms in key thematic areas. However, studies do not show clear operational guidelines for convergence at the village level. According to the NITI Aayog monitoring report, Poshan Abhiyaan has improved nutritional outcomes among children, pregnant women and lactating mothers. However, the coverage of Poshan Abhiyan remains low in most states. The report emphasises the expansion of coverage and improvement in quality of basic health and nutrition interventions.

Decentralization of financial authority at the grassroots level has been a critical systemic barrier in our policy space, hence convergence of line departments and their active role is essential for timely delivery of services. Lack of accountability and administrative hierarchy is also a challenge in achieving convergence in nutrition. Inadequate data is a significant barrier to effective planning and implementation of interventions. Data on the target population at the village level, their needs, availability of resources and a comprehensive plan for their mobilization are essential for delivering nutrition outcomes.

Q. How could India’s new plan end malnutrition once and for all?

Answer: Thematic areas in the nutrition discourse are mainly limited to nutritious food, food security, women’s empowerment, social safety nets, access to health and nutrition services, and access to WASH (water, sanitation and hygiene). There is a need for a strategic response, including financial, business, scientific and policy commitments, at every level of program implementation.

• The government should lead this movement by enabling civil society organizations, agencies, businesses and the scientific community to play a key role in implementing policy commitments, capacity building and targeted funding. Convergence of all stakeholders in their thinking and action is necessary to provide the necessary support for this Jan Andolan.
• Diverse stakeholder groups can actively support dialogue, evidence gathering, learning and consensus building to implement knowledge into practice for health, nutrition and well-being.
• Gram Panchayat is an ideal platform for strategic convergence at the community level. It will bring together women, social activists, health workers, anganwadi workers, resource persons, village level committee members, institutions and development partners on one page.
• Civil society organizations play a significant role in facilitating convergence efforts at the community level. These organizations can become the first-choice partner in identifying community nutrition needs, sharing ideas and implementing projects in collaboration with the government. This will also help strategically identify tasks and implement them in line with agreed plans at the local level. Convergence can create a multiplier effect to break the vicious cycle of poverty and malnutrition. This network will help in effective implementation, real-time monitoring and evaluation of nutrition interventions.
• Poshan Panchayat and other village meetings provide a better platform to scale up demand-side interventions in nutrition and improve community participation.
• Jan Andolan will be successful when people at the grassroots level truly get involved and act on the policies and programmes.
• Experts suggest that households can be treated as convergence points and the village as the unit of each programme.
• Annual and quarterly plans must ensure a coherent approach that includes nutrition issues and monitoring of results. Poshan Panchayat is a breakthrough in improving convergence at the local level.
• As part of the convergence strategy, linkages between existing nutrition and hygiene programmes and income support efforts at the community level are essential, along with a strong communication strategy on behaviour change. As progress is made, convergence should bring efficiencies to the system through coordinated efforts in nutrition data collection, communication, resource mobilisation, monitoring and evaluation. Convergence at local and national levels will improve service delivery, ensuring that entitlements from all sectors reach the intended beneficiaries.