By Shibaji Bose, FHS India Policy Influence and Research Uptake Officer
On 27 April 2015, the Indian Institute of Health Management Research (IIHMR) University (FHS partner) and Welthungerhilfe, with technical inputs from UNICEF, co-hosted a consultation meeting in Kolkata to address the challenges and barriers to the adoption of a sustainable multi-sectoral approach to combat child undernutrition in the Indian state of West Bengal.
Research by IIHMR University indicates that in the Indian Sundarbans region of West Bengal - one of the most severely affected parts of the country - more than one third of children are chronically malnourished; nearly half of children aged 13-36 months are stunted; and children living in the region’s poorest households are more likely (44 percent) to be stunted or underweight compared to those from households with apparently better economic status.
As a multi-dimensional problem, nutrition requires a multi-sectoral response through tackling:
- the immediate causes of poor nutrition outcomes (food, nutrients and health)
- the underlying contextual causes at household and community levels
- the basic causes of undernutrition rooted in institutional, political, and economic issues such as poverty reduction and economic growth, governance and stewardship capacities, environmental safeguards, and trade and patents issues, including the role of the private sector.
This consultation meeting brought together key stakeholders from academia, government, civil society and media to build consensus, and to discuss the challenges faced and the actions necessary to improve nutrition. This included consideration of what government programmes and community-led sustainable innovations could learn from one another and which might be scaled-up.
KEY MESSAGES, OUTCOMES & ACTIONS FROM THE MEETING
It was discussed and agreed that the state of malnutrition in India and West Bengal is very close to Sub Saharan Africa. Some of the main issues identified:
- Efforts to combat malnutrition tend to be more nutrition specific than nutrition sensitive, common both in governments and in the non-governmental sector.
- Nutrition specific programmes are not linked to hygiene and sanitation, resulting in a self-defeating nutrition oriented approach.
- Open defecation causes a host of diseases, including stunting, which in turn contributes to inter-generational malnutrition. As efforts to combat malnutrition do not emphasize water and sanitation, open defecation (practiced by nearly 50 percent of the Indian population) continues to negatively impact people’s nutritional status.
- At the policy level, there is lack of convergence between the line departments dealing with nutrition, hygiene and sanitation. A key example: sanitation, which is under Public Health Engineering (PHE), is absolutely divorced from nutritional realities.
- Threats to livelihood, livelihood insecurity, and non-sustainable livelihoods majorly contribute to malnutrition: there are major gaps in linking nutrition programmes to livelihood generation and sustenance.
- The 1000 days window of opportunity, which is a crucial component of Reproductive & Child Health (RCH), is a sadly neglected pathway to combat malnutrition.
- Drives to bring about behaviour change in hygiene could have been instrumental in enhancing nutrition standards, but this linkage is missing in most implementation programmes.
- Evidence is rare, as the impact of sanitation on nutrition and health is yet to be properly researched and documented. An example: the most recent comprehensive government data on nutrition and stunting is close to 15 years old. District Level Health Survey (DLHS) does not have the figures and National Health & Family Welfare Survey (NHFS) data collection was done about 15 years ago.
- The issues discussed and the key messages from the consultation would be made into a policy document and advocated to the government.
- A platform on nutrition with multi-sectoral links across all levels of policy – community to the national level is needed to share ideas and innovations and also for a sustained policy thrust.
- From a human-induced climate change angle, the key message was: nature is the biggest provider of nutritional support to her children, but now, nature is under threat.
- Intersectoral collaboration should be strongly advocated to policy makers so they can create a comprehensive and holistic plan to combat malnutrition.
- Civil society should push the government to release water and sanitation data.
- There should be more emphasis on collection of research evidence to inform implementation decisions.