MP: THE HIDDEN PANDEMIC
Madhya Pradesh, which has long had the dubious distinction of being a ‘bimaru’ state (a reference to its sick economy and poor development indicators) is making a push to salvage its reputation. Improving nutritional outcomes has been identified as a priority, and, to that end, the state recently announced a new nutrition policy.
Malnutrition manifests in many ways, and there are health indicators (see Madhya Pradesh’s Health Card) that identify and measure the extent of the problem. For example, a state’s infant mortality rate (IMR) or maternal mortality rate (MMR) offer insights. On both these counts, Madhya Pradesh has among the worst records in India. As per the Sample Registration Survey 2018, the state has an IMR of 56 per 100,000 births, which is the highest in the country; the national average is 36 per 100,000 births. In terms of the MMR, the state is placed fourth from the bottom, with 173 deaths per 100,000 births (national average: 113).
Madhya Pradesh’s new policy, titled the ‘State Nutrition Policy 2020-2030’, aims to reduce malnutrition across the board, with targets set across population groups, from children and adolescents to women and adults. For instance, the policy calls for the IMR to be reduced from 56 to 25, the MMR from 173 to less than 70, and the prevalence of anaemia in adolescents from 53.2 per cent to 26.6 per cent, by 2030.
The policy has its genesis in interventions carried out following the first wave of Covid-19. In 2020, Vikas
Samwad, a voluntary agency working in the nutrition sector, carried out a survey across 122 villages in MP to assess how much the pandemic had exacerbated the malnourishment problem. “We found that the nutritional intake in vulnerable groups such as women and children was down to 45-50 per cent [of pre-pandemic levels],” says Sachin Jain of Vikas Samvad. The report was widely discussed in the government, which then invited suggestions to formulate a new policy to remedy the situation.
A key feature of the new policy is the notion of ‘nutritional governance’, which calls for an inter-departmental approach, rather than putting the entire burden on the state’s department of women and child development. A total of 16 departments have been assigned roles under this policy—for example, the department of agriculture has been tasked with promoting the cultivation of crops that tackle malnutrition more effectively in affected areas. The state’s public health engineering department has been tasked with ensuring the supply of clean water in such areas, while the state’s health and rural development departments have been assigned roles to improve medical services and create livelihoods, respectively. The policy also provides for a social audit of nutrition programmes that are underway, and also encourages evidence-based planning at the aanganwadi (rural child care centre) level instead of a statecentric response. Madhya Pradesh has around 97,000 aanganwadis, which are the smallest unit at which health indices are monitored and nutritional supplements distributed. “The programmatic approach to tackling malnutrition is giving way to a policy-based approach,” says Swati Meena, commissioner of the Madhya Pradesh woman and child development department.
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he new policy has already been rolled out, and all the departments concerned have been set measurable targets. Progress will be evaluated every two years to assess if targets are being met. Well-intentioned it may be, but the policy can easily falter in its implementation. Nutritional programmes are hotbeds of corruption, with resource leakages being rampant. Aside from the newly mandated social audit, the policy does not have a robust mechanism to prevent this. Secondly, there is an overwhelming reliance on technology for reporting. The architects of the policy say technology is the need of the hour, dismissing the data-related problems faced by the Union government’s flagship nutrition programme—the Poshan Abhiyaan. Successful implementation of the policy will also critically require a high level of commitment from the political and permanent executive, given its structural dependence on the efficient working of a large number of departments to produce the desired results. “The policy is comprehensive. However, it requires money. Unless an additional allocation of funds is made, it may be difficult to attain targets,” says Dr Dipa Sinha, assistant professor at the School of Liberal Studies, Dr BR Ambedkar University, Delhi.
The policy also calls for the involvement of civil society groups, which could partially offset problems like resource leakages and inefficient government interventions. “There are roles that have been defined in the policy for civil society groups,” says Meena. “There is greater scope for public involvement and opportunities for intervention by civil society groups in case there is deviation from stated goals.” One way or another, this will be a long haul, with many hoping that the new policy does not derail. For now, the jury is out on whether or when Madhya Pradesh will emerge healthier.