I
have just finished a trip to India to help contribute to the efforts on ending
malnutrition. The politicians and media were talking about the sparkling new
economic growth and development figures. There was no such attention given to
the “other” growth and development figures — those related to child nutrition.
These figures are less than sparkling. If current rates of progress in reducing
undernutrition are not improved upon, India will reach the U.N. Millennium
Development Goal of halving undernutrition by 2043. The target date is 2015.
China has already exceeded the target.
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| Celebrating 9% Growth of GDP |
There
are some glimmers of hope. The State of Karnataka has just adopted a Nutrition
Mission which promises to give focus, coherence and urgency to efforts to
combat undernutrition. There are some initial indications that the decline in
undernutrition rates may be accelerating in one of the worst affected States,
Madhya Pradesh. More and more international agencies such as the U.K.'s
Department for International Development have ramped up their focus on
nutrition. But there are worrying signs at both the national and State levels.
It is at least 18 months since the creation of the Prime Minister's Council on
Nutrition. It has not met once. The scandal of rotting food grains in the midst
of hunger and undernutrition has rightly been getting a lot of media coverage.
And we still don't know who in Delhi is responsible for leading efforts to
reduce undernutrition.
During
my stay I went to Bihar to visit some ICDS Anganwadi centres. The Anganwadi
workers in charge of the centres were inspirational in their attempts to make
the best out of the resources at their disposal. But the conditions in which
they have to teach and feed about fifty 3-6 year olds, do home visits, and
monitor child growth are testing and undermining. The centres are understaffed.
Many are without toilets, washing facilities, clean drinking water, decent
floors or food storage facilities. It is a miracle that the centres have any
positive impact on nutrition status. I visited several AWCs in the mid 1990s.
Nothing much seems to have changed. More pressure for change needs to be
generated.
So
how do we make more noise about undernutrition? During my visit I gave a
presentation at a conference on “Nutrition: Reaching the Hard Core” organised
by the Britannia Nutrition Foundation. For me, there are three key puzzles on
how to overcome undernutrition: (a) how to raise the quality and expand the
coverage of interventions such as ICDS; (b) how to make investments in various
related sectors (such as agriculture) more pro-nutrition; and (c) how to create
an environment where it is hard for anyone to neglect malnutrition.
My
presentation was on the third area and was entitled “The 7 Habits of Highly
Effective Environments for Nutrition”. The 7 habits are: (1) developing new
surveillance techniques using mobile technologies to allow the government and
civil society to react in real time to the changing nutrition situation, (2)
the importance of creative campaigns to reset norms around what are acceptable
rates of undernutrition reduction, (3) the need to support and expand the cadre
of nutrition champions, (4) the need to learn from success within India (taking
advantage of the federal set-up) and internationally, (5) the potential of a new
class of “commitment indices” which monitor the nutrition commitments of
governments, civil society and businesses, (6) the insights to be gained from
adopting the new generation of economic growth diagnostics for nutrition to
help prioritise and sequence the laundry list of potential nutrition actions in
a given context, and (7) the value added of feedback — asking intended
beneficiaries to score existing services and suggest what to do differently.
Too little attention has been given to these issues.
Undernutrition
is insidious — it sucks the life out of kids before clinical signs show.
Undernutrition requires action on many fronts and hence it requires
coordination and leveraging. Undernutrition requires scaling up of quality. All
of these features — invisibility, scaling, coordination, leveraging — demand
leadership. Sometimes leadership just emerges as in Mexico or Brazil or Ghana
or Karnataka. But with so many lives being ended or wrecked by undernutrition,
we can't afford to wait. We need to make sure nutrition is not easily
neglected. And that means putting pressure on leaders throughout society to
focus on nutrition. These seven habits will play a big role in doing that.
What should the private
sector do?
Despite
the aforementioned conference being organised by the Britannia Nutrition
Foundation there was little discussion of the roles of the private sector in
accelerating undernutrition reduction. Is there a role at all? The provision of
nutrition is a prime public good — undernutrition generates negative spillovers
for the current and next generation, is often generated through information
deficits and affects the poorest — all classic features of a public good
provided by the state. But that should not preclude dialogue on the question
“are there any overlaps between commercial interests and sustainable and
equitable improvements in nutrition?” This is a discussion that many are afraid
to have — and not just in India. It seems to me that four things are being
mixed up when we talk of the private sector. First, what can business do to
make its core activities more supportive of nutrition? This means going beyond
corporate social responsibility and making sure for example that advertising is
responsible, that legal resources are directed in ways that do not only protect
shareholders, that labelling is clear and gives consumers real choice, and that
transparency is high on the business agenda so that civil society can hold
businesses accountable.
Second,
when can business act as a substitute for the state? I am not too optimistic
here about the role of business — in the end, nutrition is a public good. But
there might be things that the private sector can do better than the state.
Would the private sector have handled the supply chain management of food grains
as badly as the state seems to have done? Third, when can business be a
complement to the state? For example, while fortification of salt and other
widely used low cost foods is only a small part of an effective nutrition
strategy, international experience has shown that the private sector is usually
the best way of implementing it. The fourth and perhaps the most promising area
is to work with businesses outside the traditional food and health areas to
make the environment more enabling for nutrition. For example, when renewing a
contract for mobile telephone operation, could the state build in requirements
to set up sms services to remind health workers about childhood vaccinations?
And could computing companies be engaged to help improve nutrition surveillance?
I don't know the answers to these questions. They can only come through a
dialogue that is sorely missing in India and elsewhere.
To
be fair to the Government of India, it needs help to combat undernutrition. It
is such a huge burden (43 per cent of children are malnourished) that the
government cannot do it alone. Civil society, business, and the academic
community have to help. International donors have an important catalytic role
to play. But nutrition is a public good. Leadership has to come from the
government. I still do not see it.
(Author
: Professor Lawrence Haddad is director of the U.K.-based Institute of
Development Studies and president of the U.K. and Ireland's Development Studies
Association.)
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