January 2016 | Nithin Rao
Food way forward
Tackling malnutrition in India is a pressing need, and one of the focus areas for the Tata Trusts
Malnutrition is the biggest killer of children under five, accounting for nearly 45 percent of all deaths — one of India’s most shameful statistics. Just as alarming as the following: nearly 40 percent of Indian children are stunted in growth, leading to a life-long impact on cognition and productivity; about 70 percent of all children below the age of five are anaemic, even those from the highest income groups in India.
|Centralised kitchens, the result of a partnership between the Maharashtra government, Tata Trusts and Bengaluru-based NGO Akshaya Patra, provide nutritious food to students in ashram schools in the state|
Malnutrition is such a critical issue that its multi-dimensional repercussions extend beyond child mortality rates to impact a nation’s overall economic health. Evidence shows that the right nutrition in the first thousand days of a child’s life — from conception to the age of two years — can save more than 1 million lives each year, reduce the risk of developing diseases such as diabetes, and increase a country’s GDP by as much as 11 percent year over year. It was the pervasive and alarming consequences of India’s malnutrition burden that led Tata Trusts Chairman Ratan Tata to make malnutrition a priority area.
The nutrition initiative started a couple of years ago as a small task force that reported directly to Mr Tata and executive trustee R Venkataramanan. The challenge, according to Mr Tata, was the scale and complexity of the problem, along with the fact that for years, the state had focused on solutions that were not working.
In response, the task force looked at other solutions. Says Mr Venkataramanan: “The nutrition issue involves more than just food supplements. It has linkages to the overall healthcare system, availability of clean water, awareness of dietary needs, hygiene requirements, and even livelihood opportunities.”
After a series of discussions with various stakeholders, the Trusts decided to tackle the malnutrition issue from two very different approaches.
One, was to address the issue of stunting and wasting through an integrated approach that looks at maternal care, water and sanitation, access to food with adequate diversity, and encouraging right care-giving practices.
The other was to focus on a micronutrient-based intervention — such as the use of iron-fortified salt in cooking midday meals in schools — and scale it up to a level where it would deliver wider impact and measurable results in tackling anaemia.
Tata Trusts has started testing out several solutions that meet the multi-dimensional nature of the problem. Most of the projects are in partnership with central or state governments because that ensures both scale and long-term sustainability.
One of the nutrition projects relates to treatment of severe acute malnutrition (SAM), which affects eight million children every year. The typical treatment, which is hospitalisation, is not an affordable solution for the underprivileged. Global evidence suggests that 80 percent of SAM cases can be managed at the community level. In India, however, there is no standardised protocol for this, and the Tata Trusts set out to find a solution.
It started a three-armed trial project in Nandurbar district of Maharashtra, which involves testing the use of different energy-dense foods in SAM cases. The programme has screened over 100,000 children and treated close to 10,000 acutely malnourished children so far.
Another essential aspect of tackling malnutrition is controlling vitamin and mineral deficiencies through staple food fortification. Salt and edible oil are excellent vehicles to deliver iron, iodine, vitamin A and D because of their high household penetration and near universal consumption.
For the Tata Trusts, promoting fortified staple foods is a key intervention as this method can lead to rapid improvements in the micronutrient status of a population at a very reasonable cost.
Currently, there are no robust context-specific tools for analysing all the factors that affect a nutrition outcome. Tata Trusts has partnered with St Johns Research Institute in Bengaluru for development of this tool. The project will be piloted at Sirohi in Rajasthan and Nandurbar in Maharashtra.
In short, what the Trusts are looking to achieve is scale, measurable impact and sustainability. Driven by Mr Tata’s vision and personal commitment, the nutrition initiative aims to make a real and perceptible difference in the millions of children who are being born today and will power the future of India.
Analytics and advocacy
An interesting sidebar is the increasing use of analytics to measure impact. The Trusts have found that one of the chief stumbling blocks is lack of updated and reliable data. “We want to create a public domain data portal which will extract data from government sources, institutions, non-profits, etc, and put it up in a readable and visual format, such that anyone who works in nutrition can read it,” says Mr Venkataramanan.
|This article is part of the cover story about the Tata Trusts featured in the January 2016 issue of Tata Review:|
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