State of the world, divided by hunger

India’s rank of 102 out of 117 countries, in the recently published Global Hunger Index (GHI) 2019,  has put the country behind neighbouring countries like China (Rank 25), Sri Lanka (66), Myanmar (69), Nepal (73), (Bangladesh (88), and Pakistan ranked at 94.

The GHI score suggests inadequate food, a poor-quality diet, inadequate child caregiving practices, an unhealthy environment, or all of these factors. India is the world’s second largest food producer and is also home to the second-highest population of undernourished people in the world as per GHI. The GHI is based on four indicators, Undernourishment, Child wasting, Child stunting and Child mortality (see graphic).

A Niti Aayog team lead by its Vice Chairman, Rajiv Kumar were quick to contest the GHI ranking 2019, saying that India’s new rank should have been 91 instead of 102. A vast improvement over this year and the previous one, if one were to take into account the Comprehensive National Nutrition Survey (CNNS, 2016-18) data, which is more recent and uses methodology similar to that mentioned in the report. In 2018, India was 103 out of 132 countries. In 2017, due to a change in methodology, India was ranked 100 out of 119 nations.

For example, the GHI has considered the average value over 2016-18 for undernourishment; 2014-18 for wasting and stunting and 2017 for under-five mortality (World Bank, FAO, WHO and Unicef). CNNS (2016-18) is the most recently conducted third-party survey, conducted across India to assess the nutritional status of children from birth to 19 years.

Data of over 1.1 lakh children were collected at the state level. The results of CNNS show an accelerated decline in stunting at the rate of 1.8 per cent per annum, almost double that of the previous decade. Stunting is down to 34.7 per cent from 38.4 per cent (2015-16), wasting to 17.3 per cent from 21.0 and underweight conditions in children to 33.4 per cent from 35.7 per cent.

Starting 2017-18, the TN Government has set itself an aggressive target to arrest the occurrence of malnutrition, wasting, stunting, and infant mortality by 2019-20.

“There are four ways to find out if the child is malnourished - wasting, stunting, anaemia, and weight deficiency. TN is the first state that started the multi-nutrition project TNINP (Tamil Nadu Integrated Nutrition Project) in the 1990s to cover the 0-5 age group. Later, it got merged with centre’s ICDS (Integrated Child Development Services),” says S Madhumathi, Secretary, Social Welfare and Nutritious Meal Programmes.

“We even provided weaning food, full of nutritious supplements, sometimes in the form of Modak (dumpling) or Laddus that could be taken both by the child as well as the mother. The mothers have to come to the nearest anganwadi and have it there in order to ensure that dietary supplements were adequately taken. Children are not deprived of food as there is enough   available through civil supplies and public distribution systems. We have a holistic 1000-days nutrition programme for the new born babies. We are doing very well as far as providing nutrition goes”, Madhumathi said.

TN has engaged J-PAL (of Abhijit Mukerjee and Esther Duflo, the Noble Prize winners for Economics, 2019) for both research studies and strengthening its data capabilities.

“The relative cost effectiveness of these interventions is being evaluated through a large-scale randomised evaluation across five districts.  For example, a first study looked at constraints faced by anganwadi workers and identified gaps in service delivery related to early childhood nutrition and education. This in turn led to the development of new informed ideas to strengthen the existing ICDS scheme, ranging from motivational measures for anganwadi workers, adding staff capacity and supplementary nutrition,” says Aparna Krishnan, Project Director, J-PAL South Asia.

A provision of Rs 2,236.08 crore has been made for 2019-20 to achieve these goals, 80 per cent of which will come from the Central government. TN’s efforts have been rewarded with the first-ever Poshan Abhiyan prizes — first position in capacity building, convergence, behavioural change and community mobilization and second prize for ICDS application software implementation. More than 54,000 smartphones have been distributed to anganwadis in the state, for daily upload of ICDS information.

There are unique challenges to implementing holistic nutritious meals for children, especially in rural areas. They have moved away from traditional food, that used to include kanji, millets instead of polished rice and green vegetables, to more modern junk food like chips, carbonated drinks, processed food, packed juices, buns, burgers, pizzas, noodles and other packaged food.