In 2017, the government of India launched POSHAN Abhiyaan or its flagship National Nutrition Mission that aims to improve nutrition amongst children, pregnant women, and lactating mothers and to provide a convergence mechanism for the country’s response to malnutrition.
Aim of POSHAN Abhiyaan:
With the objective of enhancing inclusion and increasing the quality and quantity of services, the Ministry of Women and Child Development launched the National Nutrition Mission (POSHAN Abhiyaan) in 2017. The principal goal of POSHAN Abhiyaan is improving the nutritional status of children from 0-6 years, adolescent girls, pregnant women, and lactating mothers.
POSHAN Abhiyaan is a three-year programme established to ensure a holistic approach, covering all 36 States and Union Territories. The strategy presents a unique opportunity to the eradication of undernutrition in the grassroots. It is an overarching multi-ministerial convergence mission that is working towards a malnutrition-free India by 2022.
The mission is a conjunction of various schemes/programmes, including the PMMVY, Anganwadi Services, Scheme for Adolescent Girls of Ministry of Women and Child Development (MWCD), National Health Mission (NHM) of the Ministry of Health & Family Welfare, Swachh Bharat Mission of Ministry of Drinking Water & Sanitation (DW&S), Public Distribution System (PDS) of Ministry of Consumer Affairs, Drinking Water & Toilets with Ministry of Panchayati Raj, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) of Ministry of Rural Development (MoRD), Food & Public Distribution (CAF&PD), and other Urban local bodies through relevant Ministries. The Abhiyaan aims to target the unique 1,000-day window of child-birth, pre- and post-delivery support to mothers to reduce malnutrition.
The implementation of the POSHAN Abhiyaan is hinged on the key pillars of supporting the development of services for the vulnerable populations: Technology (ICDS- Computer application software), Convergence Action Planning, Behavioral Change Communication, and Capacity Building. The POSHAN Abhiyaan programme aims to provide a platform for the convergence of the three pillars discussed above.
With the slogan ‘Jan Andolan’ (people’s movement), the Abhiyaan intends to make the fight against malnutrition a national goal for each citizen. Currently, the programme has seen the participation of 2.51 billion people in the country with more than 36 million activities. A higher proportion of activities have been focused on overall nutrition, anemia, hygiene (water & sanitation), breastfeeding, growth monitoring and immunisation. These activities aim to fill the knowledge gap and reduce infections by providing information, supplements & vaccines, thereby helping break the intergenerational cycle of undernutrition.
To further reach out to the people, there have been numerous initiatives such as the Food Fortification Resource Centre, the Eat Right India Movement, the Anemia Mukt Bharat programme, and the School Health Programme under Ayushman Bharat. The Food Fortification Resource Centre (FFRC) was set up to provide information to the various Ministries of the government to fortify the five staples—rice, wheat, oil, milk and salt—and provide assistance to the states on how these can be disseminated through Public Distribution System, Mid-Day Meals or the ICDS. One of the greatest benefits of having fortified staples is that without tablet distribution or monitoring, staples containing essential micronutrients can be provided to the people.
Similarly, the Eat Right India movement by the FSSAI focuses on eating right, safe and sustainable. It focuses on promoting awareness about a balanced and healthy diet. The initiative, in association with POSHAN Abhiyaan, has penetrated schools, homes and hospitals to educate and promote quality diets, with a strong focus on well-being. Furthermore, the development of Eat Right Toolkits will further enable the goals by providing a method of digital counseling on how to improve their nutrition and diet.
The Anemia Mukt Bharat Initiative (Anemia Control Programme), under the overarching scheme of POSHAN Abhiyaan, targets to reduce anaemia by three percent per year, higher than the historical trend of one percent reduction from 2005 to 2015. Developed by the Ministry of Health and Family Welfare, it is a 6x6x6 strategy implying 6 age groups, 6 interventions and 6 institutional mechanisms.
The strategy focuses on ensuring supply chain, demand generation and strong monitoring to address the nutritional and non-nutritional causes of anaemia.The School Health Programme under Ayushman Bharat, initiated by the Ministry of Health and Family Welfare, aims to educate school children about health and nutrition. It inculcates habits of healthy living, wellness, menstrual hygiene, and the importance of safe drinking water. The interactive initiative promotes teachers as ‘Health and Wellness Ambassadors’ to enhance age-appropriate health discussions amongst their students. The programme also promotes national-level and state-level coordination amongst ministries and organisations to ensure horizontal and vertical reach.
Broad Solution to Malnutrition:
A key inference after investing in a range of initiatives and programmes to fight malnutrition has been the importance of a micro-level approach with needs-based additions in order to reach and influence each individual. High levels of variation have long existed amongst the states and Union Territories while evaluating the prevalence of malnutrition. These variations have suggested a need to develop and guide interventions in harmony with the unique circumstances of each region, rather than continuing with a single national approach.
There is a need of initiation of Information, Education and Communication (IEC) activity, wherein crowded public areas such as railway stations, we should install a wall art with messages of nutrition, early care for the mother and the child, the first 1000 days, WASH, and sanitation which can help to increase awareness and can generate a sense of ownership amongst the people towards resolving their health issues.
Participatory Learning and Action (PLA)-based interventions aligning with the Jan Andolan Strategy can create a consensus around nutrition at the community level and raise awareness about malnutrition as a problem that the community must collectively act on.
Adoption of a Severe Acute Malnutrition (SAM) Child. This Adoption will signify taking care of the child in the early phase of their life by aiding the child’s family or organisation in providing for their health and education. This will encourage a sense of responsibility in the political representatives, industrialists, private organisations and the community towards reaching the goal of a malnutrition-free India.
Community-level monitoring with the objective of strengthening the involvement of the people as well as monitoring the services provided by the ICDS programme to ensure proper quality of home-cooked meals distributed at AWCs and to ensure the feeding programmes uphold quality and quantity accreditation.
Developing an interactive and integrated socio-cultural intervention focusing on Health, Education, Engineering and Environment to strengthen nutrition in children. Since connectivity has been a major challenge for the POSHAN Abhiyaan, schemes aimed at boosting reach are desirable like developing a POSHAN Helpline which can provide remote access to the Anganwadi worker and also to give the opportunity to book a home visit of the Anganwadi worker/Auxiliary Nurse MidwifeExtended version of the PMMVY programme should be started to provide benefits to mothers and lactating women of the second child as well. Additionally, the Particularly Vulnerable Tribal Women should be provided a cash incentive for all children, in order to incentivise them to pursue a healthy lifestyle.
There is a strong need of educating girls to prevent early marriage, pregnancy and childbearing; building a social network to ensure comprehensive sexual and reproductive education and using technology to equip adolescent boys and girls with correct knowledge; changing social norms to ensure that girls remain in school, delay marriage to at least 21 and first birth at 24, and promote contraceptive use; and, lastly, to support married adolescents to delay first birth, space subsequent births and thereby prevent low-birth weight.
Another important component of fighting malnutrition is the quality of nutrients, their availability, and combatting ill-informed or regressive social beliefs or norms. Encourage use of iron utensils and kitchenware in households and at Anganwadis. This can enhance the nutrition value of the food being consumed, reducing the prevalence of anemia. Organize competitive programs like Healthy Mother-Healthy Baby, Mera Gaav, Healthy Gaav, Chalo Anaemia Mukt Bane etc.