Over the last 15 months, the attention of the country and the world has, justifiably, been focused on managing Covid-19 and mitigating its impacts. Covid has many visible impacts — both proximal and distal. But one of the silent and invisible crises it is amplifying is that of malnutrition, as incomes, food consumption and essential services all come under pressure. As India intensifies efforts to rebound from the impact of the pandemic, there is added urgency for an evidence-based, integrated, outcome-focused approach to address India’s nutrition challenge. This is clearly on the government’s agenda, but we need to move fast, so this generation of Indian children can achieve their full potential.
In recent years, the government has prioritised addressing malnutrition through the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan and with updated POSHAN 2.0 guidelines announced in January 2021. The focus is on the 1,000 days between a mother’s pregnancy and her child’s second birthday, prioritising women and girls, and addressing their nutritional deficiencies through fortification and provision of take-home rations. The introduction of community-based programmes for severe acute malnutrition, Jan Andolans, and community-based events, as well as the strengthening collaboration across departments has led to the implementation of a holistic approach to addressing malnutrition. The guidelines place accountability for the first time at the district level with nutrition indicators included in the KPIs (key performance indicators) of district magistrates/district collectors. The Government of India has now clearly indicated that the DM/DC is expected to set up district nutrition committees, review progress and take appropriate actions to improve nutrition indicators.
Poshan Abhiyaan also emphasised the importance of a data-driven approach to plan and manage delivery of nutrition services, particularly through anganwadi workers (AWWs). So far, a key challenge in addressing malnutrition in India has been the inability to track and identify the coverage and quality of nutrition interventions in real time. Technology and data systems can play a crucial role in designing programmes and tools to support the reach of key interventions to intended target groups in time. It is this need to monitor and improve interventions to address malnutrition that led to the development and deployment of the “Poshan Tracker” by the Ministry of Women and Child Development.
The tracker replaces the CAS system as the digital backbone of Poshan 2.0. It aims to provide a holistic view of distribution and access of nutrition services by anganwadi centres and AWWs to eligible groups — pregnant women, lactating mothers, children and adolescents. The tracker is designed to ensure real-time updates and enhance transparency, enabling the system to identify last-mile beneficiaries who may be left out. Its centralised data architecture enables interfaces with digital technology systems of other ministries, to help ensure that households which fall in the critical 1,000-day period receive benefits and services across different social protection programmes. Further, in response to the tragedy of children orphaned by Covid-19, the tracker now carries a module to enable AWWs to identify and provide support to these children.
Since its launch in March, the tracker is today being used by nearly 15 lakh AWWs and over 8.30 crore mothers and children have been registered in this system. The app has enabled the delivery and tracking of over 2.94 crore take-home rations, and over 1.35 crore hot cooked meals — critical components of India’s nutrition programme. These are still early days for the tracker, as added functionality and analytical tools are planned, but the signals are promising. The forthcoming job-aid functionality, in particular, which will allow AWWs to identify at-risk children and take prompt action could be transformative.
Improving nutrition calls for a systems approach, cutting across health, food and care systems with data-backed digital tools providing an enabling backbone to scale evidence-based interventions. There is growing evidence that convergent actions, especially agriculture-nutrition convergence and strengthening of demand-side behaviour can play a pivotal role in preventing undernutrition.
The majority of India’s smallholder plots are tended by women farmers. Investing in their empowerment and in nutrition-sensitive agricultural programmes can help women and their communities live healthier and more prosperous lives.
Recognising this, the government, working closely with development partners and community groups, in Uttar Pradesh, Bihar, Odisha and other states, has supported setting up “Poshan Vatikas” or nutrition gardens, allowing families to access locally-produced nutritive foods while increasing their livelihoods and productivity.
The path ahead is not easy. But, as a country, we have made considerable progress on a range of complex developmental challenges like water, sanitation, and financial inclusion. Each time the pathway to progress needed us to use multiple levers — scientific innovation, traditional knowledge systems, community engagement, digital tools, and data-driven management. Poshan 2.0 is making available all those levers. The government, development partners, and communities coming together at this time to drive an integrated push for improved nutrition can ensure that the crisis is resolved.
This column first appeared in the print edition on June 11, 2021 under the title ‘In COvid, tracking nutrition’. The writer is director, India country office, Bill and Melinda Gates Foundation.