By Amit Kumar Yadav
One out of every ten children under the age of five is severe acute malnourished (very low weight for their height/length), as per estimations, two in every three females of reproductive age suffer from anemia in Jharkhand. Over ten years, Jharkhand has shown only a negligible improvement in key nutrition parameters, like underweight, stunting and wasting, compared to the national average as per the analysis of NFHS-3 and NFHS-4 data. For a state like Jharkhand that is burdened with the issue of malnutrition, the second COVID wave is nothing short of a tsunami that threatens not only to reverse the recent advancements but push back the state into years of deprivation and incalculable losses.
Noting the virulence of the fresh outbreak, some states, including Jharkhand, have decided to impose a lockdown of short duration as an immediate response to cope with the spiraling number of COVID cases. As a consequence, essential nutrition delivery platforms like school and Anganwadi centers have, once again, been closed and several community health services stand suspended. The supply chain disruptions caused by current containment measures are at loggerheads with the promises of continuity, coverage, intensity and quality (C2IQ) of delivery of essential nutrition services. However, adopting alternative mechanism, these challenges need to be controlled and strategic interventions need to be devised that can tackle the devastating aftermath of this global public health emergency.
Challenges and need of the hour
A recent Lancet 2020[1] study figures suggest that there will be a 14.3% increase in severe acute malnutrition (very low weight for height) cases for children below the age of five due to the COVID-19 pandemic. Jharkhand has the highest rates of underweight and wasting in the country, with about 43%of children under five being underweight and 29% wasted[2]. In another 2020 Lancet study[3], the findings estimate that the current wasting prevalence, indirectly caused by the pandemic, will account for an additional 18 to 23 percent of child deaths in the world. Challenges in accessing healthcare services healthy diets, clean water and sanitation, this risk gets amplified for a resource-poor state like Jharkhand, where 13 million out of its 33 million[4] population still lie below the poverty line.
Understanding the need for a multisectoral approach to malnutrition, in 2018, the government launched POSHAN Abhiyaan which strengthened the service delivery systems by training frontline workers on high impact nutrition interventions.
The convergence between multiple departments and ministries, besides health and women and child welfare, has improved the coverage and quality of nutrition interventions. But the breakdown of service delivery systems due to COVID 19 pandemic will put children and mothers at risk of becoming malnourished.
Poor nutrition in the first thousand days – from conception to two years – has a pernicious impact on a child’s development. Malnourishment at this phase can lead to poor brain development, weak learning ability, poor metabolism, low immunity, greater susceptibility to infections and diseases, and in worst cases, even death. The damages are often irreversible, with millions of children becoming stunted, underweight or obese. Chronic health complications affect the life chances of individuals, which then sets off a cycle of generational deprivation, as seen especially in marginalized and vulnerable communities.
For every rupee spent on nutrition the return of investment is as high as 16 times.
Strategies
Frontline workers like Anganwadi workers, Sahiyas/ASHA, ANMs must communicate the importance of the first 1000 days through home visits and all contact points. Families bot mothers and fathers need to be counselled to continue breastfeeding to their under 2 year children regardless of their COVID status. Consequently, doorstep delivery of services must continue through caregivers and community frontline workers using appropriate COVID-19 protection measures so that growth monitoring, medical assessment, counselling, tracking and delivery of nutrient-dense food can continue uninterrupted. Frontline workers already have the necessary knowledge and training to counsel and guide parents to follow good nutrition and hygiene practices. However, these frontline functionaries require additional resources and support to adjust and sustain supply and surveillance activities amidst the restrictions of the COVID safety protocols. Existing food security schemes, under ICDS, take-home rations can include micronutrient supplementation, like iron folate, calcium and Vitamin A, supplementary nutrition packages and fortified rations for households that can tackle the issue of accessibility. Community engagement is key to ensure the continuity of interventions since its success is highly dependent on the social and behavioral response of the targeted communities.So, the government can utilize multiple media platforms to provide counselling and advice on feeding, meal preparation and diet for mothers and children through call – based support, radio messages and social media. Anganwadi workers and Sahiyas or ASHA who have smartphones can leverage common social media platforms to stay connected to parents and other caregivers even when home visits are curtailed or suspended because of lockdowns or curfews.
Call to Action
As elected representatives, our leadership and guidance are vital in coordinating efforts to improve the health and nutrition status of the women and children in our state. We have to devise innovative strategies and ensure proper implementation of the high-impact nutrition programmes through effective planning and consultation with grassroot-level stakeholders. Representatives can play important leadership role in ensuring quality review of delivery of Essential nutrition services and ensure local supply chain distribution should not be allowed to disrupt. To ensure this, we have to equip all frontline workers with smartphone devices and appropriate safety gear.
We can demand the availability of disaggregated nutrition data to help better track progress and target actions to ensure that all women and children benefit from nutrition and health services.
As an elected representative, we have a critical role in influencing budgetary decisions for nutrition. Thus, it would be prudent that we in our own capacities ensure that nutrition becomes a political priority, which is percolated at all levels.
Concerned Ministries and government departments have already issued COVID safety guidelines to conduct routine health and nutrition services. It is thus our responsibility to our people to access their local health centers and register for essential services whenever the occasion arises.
As public leaders, we have to urge our people to keep up their trust and faith in healthy nutrition practices. It is the only way to resist this silent pandemic of malnutrition and prevent the future disease burden of our state.
(The author is an independent MLA representing the Barkatha Vidhan Sabha Constituency in the Hazaribagh district of Jharkhand. The Views expressed are personal opinion of the author.)
