Recommendations of the Consultation Meets on
Nutrition
-
Consultation Meet For the North
Eastern State at Shillong
-
Consultation Meet For the
-
Consultation Meet For the Eastern
State at Bhubneshwar
The programme was inaugurated by the Hon’ble
Minister of Social Welfare, Government of Meghalaya, Shri Martle
N. Mukhim. Mr.
S.K. Tiwari, Additional Chief Secretary, Government
of Meghalaya and Mr. Eimar
Barr, Deputy Director, UNICEF addressed the participants in the Inaugural
Session. A power point presentation on Nutrition Scenario in North East: Call for Urgent Action
was made by Smt. Shashi P.
Gupta, Technical Adviser (FNB) in the Department. The Secretary (WCD), Smt.
Reva Nayyar delivered the
Presidential Address in the Inaugural Session and presided over all the
sessions of the first day.
The Inaugural
Session was followed by State Presentations by senior representatives of all
the 8 states of the North East. There
was a session on Visualisation in Participatory
Planning and Programming involving all the participants of the Meet. Through this interesting practical session,
the participants brought out factors contributing to malnutrition and the
strategies for eradicating the same.
There were
two technical presentations namely ‘Establishing
Nutrition Monitoring, Mapping and Surveillance through ICDS’ by Dr.
K.V.R. Sarma, Deputy Director, National Institute of
Nutrition, Hyderabad and ‘Addressing
the Widespread Problem of Nutritional anaemia
particularly in adolescent girls’ by Dr. Werner Shultink,
Chief (Child Development and Nutrition), UNICEF.
The Second
day sessions were chaired by Mr. Cecilio Adorna, Country Representative, UNICEF. There was an open discussion on Intersectoral Coordination for Nutrition Promotion
facilitated by Smt. Shashi
P. Gupta, TA (FNB). The Infant and
Young Child Feeding was addressed by Dr. Tarsem Jindal, Prof. of Paediatrics, Breastfeeding Promotion Network of India,
There was a
Working Group Session to enable active involvement of the participants in
providing a framework for developing State Plan of Action on Nutrition.
In the
Valedictory Session, the draft ‘Recommendations
of the North East Consultation Meet on Nutrition and the Strategy for Moving
Forward’ were presented by Smt. Shashi P. Gupta, TA (FNB).
Mr. Cecilio Adorna,
Country Representative, UNICEF delivered the Valedictory Address and Ms. L. Diengdoh, Director, Deptt. Of
Social Welfare, Meghalaya extended a Vote of Thanks.
The two-day North East Consultation
Meet was a grand success from all accounts.
All the participants attended all the sessions from
The
Secretaries of Ministry of Health and Family Welfare and Department of North
East Region, and North Eastern Council have been apprised of nutrition and
health situation in the North East. The
State Secretaries of Social Welfare of 8 States were provided with the copies
of Presentations on Nutrition Scenario in the Nor East and Strategies for
Improving Nutrition in the State Secretaries’ meet held at
Recommendations
1. The picture that emerged from several expert presentations both by the
Department as well as by eminent experts from other institutions and UNICEF is
not very optimistic. The nutrition and
health status of children and women in North East is far from
satisfactory. For instance, the anaemia levels in women are quite high. The infant mortality rate and under-5
mortality rates in many of the North Eastern States are rather high and most
surprisingly the percentage of children vaccinated against all diseases (all
the six vaccine preventable diseases in children), is low inspite
of high female literacy and matriarchal society of the North East. The North East, therefore, deserves more
focus through various nutrition and health interventions of the
Government.
2. The nutritional status of the vulnerable groups is the outcome of complex
and interrelated set of factors. Many of
these factors relate to health care, hygiene, sanitation, safe drinking water,
public health measures etc. Needless to
say, if the non-food factors are not taken care of, the supplementary food
given to children through ICDS will have no impact. It would be just like a ‘leaky pot’ where
food provided through mouth finds the way out through various infections.
3. The hilly terrain of some of the regions probably makes it difficult for
the population to access health and welfare services. Innovative interventions of reaching health
care, immunisation, health
and nutrition education to the people need to be evolved on priority. Deworming of
children and women in areas with high anaemia levels
need to be implemented.
4. Capacity building of field personnel, training institutions and
professional organisations in the region also deserve
due attention.
5. Six critical areas were identified for action by the State Governments:
i.
Bringing nutrition issues centre
stage.
***
RECOMMENDATIONS
OF THE REGIONAL CONSULTATION MEET ON NUTRITION AT PUNE, 19-20 MAY, 2005
The
important Recommendations that emerged from the two-day
Regional Consultation Meet on Nutrition for Western Region, covering the
States/UTs of
1. Giving high priority to malnutrition
control
Nutrition
is an input into development. Nutrition
was considered critical for human and economic development and its neglect
would adversely impact on health, cognitive development of children, productivity of the people, economic growth and slow pace of
national development. Nutrition agenda,
therefore, needs to be given high priority with greater investment for
accelerating human, economic and national development.
A
proactive approach for prevention and control of malnutrition was needed.
A
revolution in nutrition programming to reach all infants and young children, to
address every stage of the life cycle including adolescent girls, to strengthen
micronutrient malnutrition control programmes and to monitor behavioural change was required.
2. State Nutrition
Every
State should have a State Nutrition Mission to reduce malnutrition and
mortality rates among children and women on the pattern of Maharashtra
Nutrition Mission. The
3. Convergence for synergistic impact
Achieving
convergence between Departments implementing developmental programmes was
crucial for achieving the synergistic impact.
The village level community based micro planning was essential to
involve all the available functionaries, numbering about 17-20, in nutrition
related services. A resource team was
needed to build alliance between Government functionaries and the community so
that Assessment, Analysis and Action could become a regular activity. Training institutions like NIPCCD, YASHADA
etc could be utilised in micro planning exercise.
The
Department of WCD being the nodal Department for implementing the National
Nutrition Policy in the country needs to establish stronger linkages with
Ministries of Agriculture, Food and Public Distribution, Elementary Education and
Literacy, Health & Family Welfare, Information & Broadcasting, Rural
and Urban Development, Tribal Affairs to ensure improved food and nutrition
security and access to health care.
“Community Grain banks” in hunger hot spots to be managed by Gram Sabhas, Women Self Health Groups utilising
grain surpluses should also be set up.
4. Utilising
Civil Registration System
Civil
Registration System need to be gainfully utilised to
provide valuable information on sex ratio, low birth weight of the new borns as was being done in
5. Urban Malnutrition
The
problem of malnutrition was invariably much worse in urban slums than in rural
areas. Urban malnutrition, therefore,
needs to be addressed more effectively.
6. Tribal Areas
Special
attention was required to address the problem of malnutrition in tribal
pockets.
7. Infant and Young Child Nutrition
National Guidelines on Infant and Young Child Feeding needs to be
integrated in the curricula of various training institutions particularly for
health and ICDS functionaries. A
diploma in Lactation management needs to be instituted. Certification of crèches was necessary to
prevent bottle feeding and other harmful practices concerning breastfeeding and
complementary feeding.
The
ICDS needs to focus on children under three years with due emphasis on the care
of the pregnant women, new born care, breastfeeding issues, complementary
feeding, hygienic practices for feeding infants and psychosocial stimulation
through active feeding. Skill
development training of ICDS personnel was an important prerequisite to focus
on IYCF issues.
8. Nutrition and Health Education
A
paradigm shift was required from Nutrition and Health Education (NHE) to
Nutrition & Health Education and Communication (NHEC) in ICDS. Empowerment of women is an important
objective of ICDS but NHEC from an empowerment and behaviour
change perspective was one of the weakest links in ICDS.
NHEC
has great potential to improve infant and young child feeding practices,
improve utilization of services and reduce malnutrition in women and children
under-three years. Reorientation of ICDS was needed to make time and resources
available for NHEC on a regular and sustained basis, strengthening supervision
and monitoring of NHEC. Adequate budget
allocation for development, production and dissemination of quality NHEC
materials was required. Training in communication
and counselling and ensuring outreach of services
through home visits also needed strengthening.
NHE
should focus on communication for behaviour change,
should address family as a whole and not just the women, and should have gender
sensitivity built into it.
NHEC
has not been given a chance so far. It
needs to be taken up as a service and successful experiences giving cost
benefit analysis and operations for best practices need to be documented.
Strong
networking between Government, Home Science and
9. Networking with Home Science Faculties
and Colleges of Standing
Home
Scientists with foods and nutrition specialization were a large untapped human
resource that needs to be utilised for improving the
nutritional status of families and communities.
Premier nutrition teaching institutions need to be identified and
regional and zonal centres for nutrition promotion
established. These centres
should help in building the capacities of extension Home
Scientists/Nutritionists in improving the nutrition situation in their state or
region. International organisations working in the area of food and nutrition
could come forward and support the setting up of such centres
by providing necessary infrastructure, expertise and support.
Good
nutrition and dietetic practices need and must be a part of daily life if
people are to be healthy. It was,
therefore, important that those who do not pursue a professional career in food
and nutrition must have “NUTRITION
LITERACY” so
they do not fall a prey to wrong mass media advertisements. A compulsory course on “NUTRITION LITERACY” needs to be included by UGC in all
academic courses for all students.
It
is high time to work towards “NUTRITION
REVOLUTION” in
the country.
10. Improving status of Training Centres.
The
present status of Middle Level Training Centres
(MLTC) deserved strengthening in terms of honorarium, career management,
motivation and recognition to attract properly qualified trainers and
Principals on a sustainable basis (currently the Principal was drawing only Rs.
4900/- and Trainer Rs. 4500/- per month)
11. Involvement of Women’s Technical
Education and Research Institutes
The
area of work of Women’s Technical Education and Research Institutes of Ministry
of HRD has been currently extended to cover BPL population of urban areas
including physically and mentally challenged people although it is basically a
rural based project. There are 450
community polytechnics in the country (
12. Formation of Nutrition/Diet Council of
A
Nutrition or Diet Council like the Medical Council of India is needed to
promote the cause of nutrition and dietetics in the country. Quality management of various courses and
training programmes in this field, employment potential, recruitment details
for this important paramedical course, associated matters like nutrition/health
tourism and hospitality industry, intellectual property rights, nutraceuticals etc factors could be looked into by such a
Council. All these are needed for
improving the quality of teaching in this area and its utilization in the
overall nutrition and health delivery system of the country.
13. Micronutrient Malnutrition Control
A
holistic approach for addressing the widespread problem of micronutrient
malnutrition was required. The
prevalence of vitamin A deficiency (VAD) being still of public health
significance required concerted efforts for its elimination. The prevalence of VAD was high in 3-6 year
age group also besides 1-3 years and hence it was necessary that Vitamin A
Supplementation Programme was extended to children upto the age of six years, as was being done in other South
East Asian Countries also.
Nutritional
Anaemia continued to be a cause of concern as its
prevalence was above 70% in high risk groups namely infants and young children,
adolescent girls, pregnant and lactating women.
Iron and folic acid supplementation for adolescent girls needs to be
undertaken on a national scale on top priority.
Similarly, IFA supplementation for infants who were not covered so far
under the programme deserved top priority.
The
Ministry of Consumer Affairs, Food and Public Distribution need to make
adequately iodized salt available through the Targetted
Public Distribution System.
Supplementary Feeding Programmes under ICDS and Mid Day Meal to use only
adequately iodized salt.
14. Fortification of Common Foods
Fortification
of common foods is one of the important strategies for addressing the problem
of micronutrient deficiencies in a short time in cost effective manner. Fortification of wheat flour with iron and
folic acid and double fortification of salt with both iron and iodine need to
be taken on priority.
The
supply of wheat through various Government schemes, PDS needs to be changed to
fortified wheat flour. States with some
reservations could initiate a pilot project.
Roller
Flour Milling industry needs to be motivated to wheat flour fortification till
mandatory provisions are enacted.
The
Integrated Food Law being enacted may include micronutrient fortification of
foods as per the CODEX guidelines.
The
Information, Education and Communication (IEC) on wheat flour fortification was also required to create awareness among the people. States could examine accessing funds for
Staple Food Fortification Programme from GAIN (Global
Alliance for Improving Nutrition) through their State Nutrition
Mission/Fortification alliance.
Recommendations of the Regional
Consultation Meet on Nutrition held at
The important Recommendations that emerged from the two-day Regional
Consultation Meet on Nutrition for Eastern Region, covering the States of
Bihar, Jharkhand, Orissa and
1. Malnutrition
is a drain on Economy and a silent emergency requiring urgent multipronged action
·
Malnutrition
is a drain on economy and adversely affects national development. Thus, malnutrition was a Silent Emergency and
required innovative measures for its prevention and control. A multipronged
action involving all developmental sectors was required urgently to address the
problem of malnutrition in a time bound manner.
·
The
action and progress to be monitored in months and not years.
·
Urban
malnutrition was as bad as rural picture if not worse, and deserved due
emphasis.
2. Panchayati Raj Institutions for convergence
and effective delivery of services at periphery
Out of the six services provided
through ICDS, three and a half services concerned health sector. Convergence of services was important and the
Panchayati Raj Institutions could be utilized to
achieve convergence. Interface between
Government and PRI system needs to crystallize.
3. Food and Nutrition
State Level Coordination Mechanism
is essential for policy initiatives and greater synergy between various
programmes. A centrally sponsored Food
and Nutrition Mission at State level could be the best option to address the
problem of malnutrition in a mission mode.
4. Better Linkages between ICDS and
Department of Elementary Education and Literacy
·
“Balwarg”
comprising of 3 – 6 year old children need preschool education as well as
supplementary feeding and micronutrient supplements. Such children covered under ‘Sarva Shiksha Abhiyan’ should be provided quality preschool education
and nutrition through convergence between MID Day Meal and ICDS as Education
has a separate teacher for ‘Balwarg’.
·
The
existing training institutions under Education like Block Resource Centres (BRCs), Cluster Resource Centres (CRCs) (for a group of
villages in good middle school) and DIETs should be
utilized for training ICDS personnel too.
One training centre could take care of two ICDS projects.
·
Joint
Committee of Education and ICDS should look after both programmes for better
convergence.
·
Nutrition
Education should become an important service under ICDS.
·
Syllabi
of all formal and non-formal educational systems should have basic nutrition
information. The syllabi should be
reviewed and nutrition content incorporated utilizing the expertise of FNB and
NIN.
·
School
children can prove to be the best change agents. NIN has converted FAO “Feeding Minds Fighting
Hunger” publication to suit Indian system.
The Indian module on Feeding Minds Fighting Hunger should be
incorporated in primary, secondary and senior secondary school curricula.
5. Effective positioning of Infant and
young child Feeding in ICDS, RCH, NRHM etc.
·
Optimal
breastfeeding i.e., early initiation, exclusive breastfeeding for the first six
months and continued breastfeeding upto two years and
beyond alongwith complementary feeding introduced at
six months of age, was considered critical for child survival, development and
health. Exclusive breastfeeding for
first six months and continued breastfeeding for another six months along with
adequate complementary feeding has shown to reduce infant mortality rate by 16%
(Lancet 2003).
·
Priority
to infant and young child feeding has to be reflected in national/state/local
plan resources and goals.
·
Effective
positioning of infant and young child feeding in ICDS, Reproductive and Child
Health, National Rural Health Mission and others – focusing on best possible
start to life, survival, growth and development, maternity protection and
family support is required.
·
Adopting
/ translating National Guidelines on Infant and Young Child Feeding,
integrating these in the training curricula under ICDS, Reproductive and Child
Health, Panchayati Raj Institution and Rural
Development needs to be undertaken on priority.
·
ICDS
monitoring to include indicators on early initiation of breastfeeding,
exclusive breastfeeding for first six months, complementary feeding with home
based foods from six months along with continued breastfeeding up to two years
or beyond.
·
Facts like breastfeeding prevents obesity, it has economic value,
exclusive breastfeeding prevents HIV in infants, etc. need to be utilized in Behavioural Change Communication.
·
Reposition
ICDS with a focus on under twos. Deliver
IYCF counseling as a service in ICDS.
·
BPNI’s network in States and Districts to be utilized for skill
development training, capacity building and awareness generation on IYCF.
6. Promoting production of low cost processed
and fortified complementary foods for infants and young children at District,
Block and Village levels
·
Self
Help Women Groups to be the owners of such production units (2
MT capacity/day) with one time financial assistance as has been done in Orissa.
·
Public
– Private partnership for reaching ‘Sattu’ like
instant infant mixes at village shops should also be explored.
7. Addressing
critical stages of life cycle adopting life cycle approach
·
Focus
on prenatal care and counseling, under threes, pregnant and lactating mothers
and adolescent girls.
·
Emphasis
on early action and preventive approach is required.
8.
Joint
Training and Supervision of ICDS and Health personnel for synergetic impact
·
Joint
training of ICDS and health personnel is essential.
·
Using
a common mother-child growth and development card by RCH and ICDS and an
entitlement card for unreached population would be
desirable.
9.
Monitoring
of performance under ICDS to be based on “Outcome indicators” and not “Process
indicators” alone
Monitoring of ICDS through Monthly/Quaterly Progress Reports to be based on “Outcome”
indicators like improvement in nutritional status of the children rather than
“process” indicators like receiving supplementary food, preschool education
etc.
10.
Ensuring
100 % weighing efficiency in ICDS
·
Weighing
efficiency was reported to be directly proportional to reduction in
malnutrition levels.
·
Universalisation of ICDS should also mean 100 % registration of all children
under three years, all under threes to be weighed and
all under three families to be provided with mother child card.
11.
Addressing
micronutrient malnutrition in a holistic manner
·
Micronutrient
malnutrition control requires concerted action on all the five major strategies
viz. Dietary Diversification, Supplementation, Food Fortification,
Horticultural Interventions and Public Health Measures.
·
Ensuring
universal coverage under Iron and folic Acid supplementation programme and extending the anaemia
control programme to cover infants and adolescent
girls needs to be taken up on priority.
·
ICDS
workers could identify moderate and severe anaemia
through pallor of mucosal membranes and take remedial measures.
·
Importance
of iodine in brain development to be emphasized in communication efforts.
·
Vitamin
A supplementation coverage should be universalised
for children under 3 years and all efforts made to
cover children up to 6 years. Household
and community production and consumption of red, yellow and green coloured fruits and vegetables besides milk and eggs needs
to be promoted.
12.
Fortification
of Foods
·
Multipronged strategies with due focus on fortification is required for
addressing micronutrient malnutrition.
·
Micronutrient
malnutrition has been effectively addressed through fortification in West and
also in some South American and African countries. Fortified wheat flour in
·
Supplementary
foods for ICDS beneficiaries and Mid Day Meals for primary school children
should be fortified with essential micronutrients.
·
Iodised salt and fortified supplementary foods should be made
available to people through fair price shops.
·
Fortification
of cereals with iron and folic acid, salt with iron and iodine needs to be
adopted on priority.
13.
Vigorous
Awareness Campaign on Nutrition
·
The
link between nutrition education and health needs to be emphasized. Awareness on consequences of malnutrition on
physical and mental growth, school performance, productivity and economic
growth needs to be generated.
·
Nutrition
education should address family as a whole and not just the women. Nutrition education should focus on
communication for behavioural change.
·
Advocacy
and sensitisation of policy makers and
Parliamentarians should be undertaken to create “Administrative” and
“Political” will.
·
Networking
with professional institutions like Food and Nutrition departments of
·
Electronic
media to be involved in Advocacy and Behavioural
Change Communication.
·
All
commercial advertisements need to be censored and celebrities need to
dissociate themselves from the same.
14.
Achieving
Convergence between ICDS and RCH
·
Observe
Nutrition and Health days in AWCs to increase
outreach coverage with focus on ANC, weighment, immunisation and micronutrient supplementation.
·
Regular
subcentre level meetings for better coordination
between AWWs, ANMs and PRI
functionaries.
·
Continuous
capacity building of AWWs and ANMs.
15.
Nutrition
Monitoring, Mapping and Surveillance
·
The
successful experiences of
·
Community
based monitoring to be adopted and Social audit at the village level using
social maps/para-maps done on a regular basis.
·
Resources
available with the ICDS could be utilized effectively for monitoring and data
analysis.
·
The
Monitoring Procedure could be as
under:
o
Data
compilation at the Project level by CDPO.
o
District
level compilation by the DPO
o
Electronic
transmission and state level compilation at the Directorate.
o
Data
analysis with various indicators
o
Nutritional
and growth monitoring on the basis of these indicators and available resource
maps.
·
Coordination
Committees at State and District levels, monitoring Committees at Subdivision
and Project levels and Village Level Committee at the AWC should be the Monitoring Infrastructure.
******