Best food forward

Helping India improve its nourishment quotient is the objective of the three-dimensional India Nutrition Initiative

Indians of all faiths are familiar with Ramleela, the dramatic retelling of the epic Ramayan where virtuous brothers Ram and Laxman vanquish the villainous Ravan in a climactic battle. In Shahjahanpur in Uttar Pradesh, this story has been adapted into a ‘healthier’ version called Suposhan ki leela (the story of nutrition).

Characters such as Suposhit Ram and Iron Laxman take the stage to fight Kuposhan (malnutrition) Ravan and his sister Anaemia Surpanakha. It is a fun way to make villagers aware of the need for good and healthy food, and a vignette from the Tata Trusts’ ambitious and widely distributed nutrition programme.

Malnutrition is one of India’s biggest health challenges and countless surveys have revealed the startling extent of its consequences, among them stunting, anaemia and babies with low birthweight. The Indian government’s National Nutrition Mission has been a catalyst, and a rallying call, in battling these multiple deficits.

The India Nutrition Initiative (TINI) of the Trusts is one of many supporting and contributing to what is a national cause. The Trusts’ partnerships forged with governments at the centre and the states have paved the way for TINI to participate in the Nutrition Mission in full measure, in project implementation, consultations, advocacy and more.

There are three principal parts to TINI’s efforts, which unfold in 26 states: refurbishing anganwadis (government childcare centres), backing food fortification initiatives, and placing 322 trained young men and women — called Swasth Bharat Preraks (SBPs) or nutrition fellows — at the service of district administrations to help with the Nutrition Mission.

The work that TINI has done with anganwadis — 593 of these centres have been upgraded in Rajasthan, Andhra Pradesh and Maharashtra — is the most impactful. Under a programme called ‘making it happen’, TINI works directly with village communities to bring together anganwadi staff, community health workers (known as Ashas) and auxiliary nurses and midwives.

The anganwadi takes pride of place in nutrition and related activities for children and their mothers. The centres are brightly painted, have equipment and learning material and, importantly, trained frontline workers.

Double impact

The growth metrics of children, from newborn babies to those aged six, are measured and entered into an all-India dashboard. New mothers and infants get a weekly ‘take-home ration’, a dry powder that makes for a nutritious porridge. Older children get a nutritious meal daily at the centres.

Sarita Khushwah, an anganwadi worker in Rajasthan’s Dholpur district, says the transformation of her centre has been a draw for children: “Earlier, it was difficult to get the kids to come here,” she says. “Today my anganwadi is better than a school. Children start queuing up at 9 in the morning, even though the centre normally opens at 10. We have 34 children at the centre and they don’t want to leave.”

Getting the frontline workers to operate in concert (they come under different ministries) is the programme’s biggest achievement. The impact of this coordination was demonstrated in May 2019 with a small project in Malpura in Rajasthan’s Tonk district. About 50 children and their mothers from eight anganwadis were the subjects of much attention, and their progress on nutrition metrics the measure of impact. In three months, the number of malnourished children dropped from 33 to one.

Building awareness in the community is a crucial element in the programme. TINI has organised more than 25,000 community awareness events, while also educating some 1,700 panchayats (village councils) on how to make the centres of best nutritional use for their people. 

Hari Om Singh Parmar, head of the Paraua panchayat in Bharatpur in Rajasthan, hits the nail on the head when he says, “From vaccination to nutrition, the anganwadi is the centre of the village. The villagers have realised that without such anganwadis our next generation is at risk.”

The SBP project is cut from a different kind of cloth. Here the attention is on enabling district administrators to be as effective as possible in driving the government’s nutrition initiatives. The preraks play several vital roles: they support the government machinery in administering community nutrition programmes, ensure data on undernourished children is captured, and they think up innovative ideas to raise awareness about nutrition.

Prerak punch

“The preraks bring diverse perspectives and they work successfully with stakeholders in the field,” says Vinita Vaid Singal, former principal secretary with the Department of Women and Child Development, Maharashtra.

The food fortification component in TINI’s basket is all about raising nutritional levels across all ages and regions. Addressing micronutrient deficiency — as much as 75% of Indians may be falling short on this count — is the goal. That means delivering iron, folic acid, vitamins, iodine, etc, through staple foods, a solution with the potential to reach hundreds of millions of people.

Collaboration with the government is, yet again, the preferred way and five staple foods — salt, milk, edible oil, wheat flour and rice — get the fortification treatment. Oil and milk are targeted to deal with Vitamin A and D deficiencies; wheat flour, rice and salt address the problem of anaemia through fortification with iron, folic acid and B12.

Fortified salt, oil, wheat and rice reach beneficiaries through the country’s public distribution system, and fortified milk is sold through the public-sector National Dairy Development Board (NDDB). Food fortification has now been adopted by 22 states and five union territories, making micronutrients accessible to 600 million Indians.

TINI is active at multiple levels in this exercise. It supports the Food Fortification Resource Centre and it drives advocacy and implementation at the state level. In Andhra Pradesh and Maharashtra, TINI works with rice millers to fortify rice for the public distribution system. The programme also works with NDDB Nutrition Foundation for milk fortification.