Monday, December 05, 2022
Recrafting India’s nutrition initiative
Amarjeet Sinha writes: Nutrition as a subject does not lend itself to narrow departmentalism. It calls for a whole-of-government and whole-of-society approach. Technology can at best be a means. Monitoring, too, has to become local.
The Registrar General of India has confirmed that India’s maternal mortality rate was 97 during 2018-2020. During 2001-03, it was 301. The infant mortality rate was 58 in 2005. In 2021 it was 27. While we have reasons to be less unhappy, we still have a long way to go. The pace of decline, however, has gained momentum post-2005.
The National Rural Health Mission (NRHM) was launched in 2005 to provide accessible and affordable healthcare through a public system of primary healthcare. And to provide secondary and tertiary care services in public systems alongside the private capacity to ensure good quality services at effective rates. Unfortunately, allocations for NRHM did not keep pace. But, it seems to have had a positive impact on many indicators. Health facilities started looking better with untied funds, doctors, drugs and diagnostics became a reality, institutional deliveries jumped, vacancies of ANMs (Auxiliary Nurse Midwife) and nurses started getting filled up, and the community’s ASHA worker started putting pressure on public systems to perform by getting patients there.
First, NRHM had a clear thrust on crafting credible public systems in primary health. Community connect, human resource capacity mattered and flexible financial resources were available at all levels. Second, the central, state and local government partnership with civil society, with the full involvement of frontline workers was a thrust. Planning had to begin from below. Community monitoring was civil society led. Third, the approach was pragmatic and provided for diversity of state-specific interventions. The decentralised planning process, where the states came up with their annual plans on the basis of district health action plans, became the norm.
Fourth, institution building was facilitated in work with panchayats and facility-specific Rogi Kalyan Samitis or hospital management committees. Civil society was engaged in community action through the Population Foundation of India. Professionals were brought in to improve processes. Over 60 per cent of funds were to be spent at the district level and untied grants were made available to every level of the health institution.
Unfortunately, nutrition has not seen this kind of initiative. The fifth National Family Health Survey 2019-21 reports 35.5 per cent of children under 5 are stunted, 19.3 per cent are wasted, and 32.1 per cent are underweight. These are unacceptable levels. The Poshan Abhiyan, though innovative, is still not addressing the institutional decentralised public action challenge yet.
Unfortunately, in our initiatives for nutrition, we have remained compartmentalised and fragmented. The ICDS is seen as a nutrition initiative, but the institutional role of local panchayats and communities with untied financial resources is still lagging. Nutrition does not lend itself to narrow departmentalism and such non-institutional wider partnerships are destined to fail.
The multi-dimensionality of under-nutrition makes it imperative that ICDS is revamped to converge with health, education, water, sanitation, and food security at all levels, under the local government umbrella. Given the diverse conditions, it is important to allow for context-specific and need-based prioritisation at every Anganwadi centre by allowing flexibility through decentralised local action, made possible by accountable decentralised financing.
The 12 reorganisation principles for nutrition success, should be the following: (i) Let the gram panchayat, gram sabha, women’s collectives of livelihood mission and other community organisations be responsible for education, health, nutrition, skills and diversified livelihoods; (ii) panchayat-led committees of the concerned wider departments are needed at the block and district zila parishad levels as well; (iii) operationalise village-specific planning process with decentralised financial resources; (iv) allow simultaneous interventions for all wider determinants of nutrition; (v) assess for additional care givers with capacity development to ensure household visits and intensity of monitoring needed for outcomes in nutrition; (vi) encourage diversity of local food including millets, served hot; (vii) ensure availability of basic drugs and equipment for healthcare and growth monitoring in each village; (viii) intensify behavior change communication; (ix) institutionalise monthly health days at every Anganwadi centre with community connect and parental involvement; (x) create a platform for adolescent girls in every village for empowerment and for diversified livelihoods through skills; (xi) decentralised district plans based on village plans should be the basis for interventions to ensure anganwadis face no deficits like no buildings or no untied resources; and (xii) move to a “leaving no one behind”, rights-based approach to ensure universal coverage of the under six, adolescent girls and pregnant women for all needs.
The challenge of undernutrition can be tackled effectively over a short period if the thrust is correct. The recently released NFHS-V brings out the unfinished agenda and the slow rate of decline in undernutrition. Nutrition as a subject does not lend itself to narrow departmentalism. It calls for a whole-of-government and whole-of-society approach. Technology can at best be a means and monitoring too has to become local. Panchayats and community organisations are the best way forward. But the nutrition challenge is also a women’s empowerment challenge. It requires a behaviour change in favour of exclusive breastfeeding, natural foods instead of junk food, and clean water and sanitation.
We should never give up efforts at crafting a credible public healthcare system. Let us begin re-crafting our nutrition initiative, learning from the hits and misses.
Source: The Indian Express, 5/12/22
India’s hunger problem: Why the Global Hunger Index, FAO data aren’t to blame
India’s ranking results from the use of the Indian government’s official statistics, the National Family Health Survey, which reveals disconcertingly high rates of child mortality and chronic malnutrition in India, despite clear progress in the past few years. The Global Hunger Index was informed by the same official source.
This refers to the article, ‘Trivialising hunger‘ (IE, November 10). The article is spurred by the Global Hunger Index 2022, which ranks India 107th out of the 121 countries monitored in 2021. The report is published by Concern Worldwide, an international NGO, using one of FAO’s statistics, among others, to compute its index. While we agree with the seriousness of hunger and the importance of rigorous monitoring to inform policy, the article contains several serious errors.
FAO is committed to valid and reliable food security measures. Food security exists when all people at all times have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life. It is only by identifying those who are food insecure that effective policies can be designed to address the root causes of the problem.
The article attempts to undermine technical aspects of the way FAO measures food security to argue that the report’s ranking doesn’t reflect the reality and that food insecurity is not a problem in India. The fact: India’s ranking results from the use of the Indian government’s official statistics, the National Family Health Survey, which reveals the rates of acute malnutrition in children under the age of five to be among the highest in the world. The same official data source also confirms that disconcertingly high rates of child mortality and chronic malnutrition persist in India, despite clear progress in the past few years. The Global Hunger Index was informed by the same official data source.
“Is an increase in child stunting and child wasting necessarily bad?”, the article asks. The stunted and wasted children are those who would have died, it contends, had it not been for the decline in child mortality rates. We argue that falling child mortality rates are not a consolation for the fact that a large proportion of children still suffer from the devastating consequences of acute and chronic malnutrition. The article also criticises an indicator FAO uses to measure food security, the prevalence of undernourishment. This indicator was scrutinised and approved by countries through the UN Statistical CommissiThe article makes two fundamental mistakes. First, it wrongly assumes that the prevalence of undernourishment is simply based on survey data collected by FAO using the Food Insecurity Experience Scale (FIES). The fact is, it is computed using data on national food balances and consumption at the household level. The most recent food consumption data available for India is from 2011, when the results of the 68th round of the NSS were released. Regrettably, FAO does not have access to more updated data, including the results from the 75th round of the same survey on consumer expenditures conducted in 2017-2018, which is not publicly available. The second mistake is a lack of understanding regarding how FAO’s FIES data are processed to ensure valid, reliable measures of the severity of food insecurity across countries. In 2013, FAO started the “Voices of the Hungry” project, engaging global academic and political communities, because the international community didn’t have a way to identify and monitor food insecure households and individuals in a comparable manner across countries.on and the UN Economic and Social Council in 2015 to monitor the UN’s SDGs.
This effort resulted in the development of statistical protocols that ensure the different translations, adaptations and nuanced interpretations of the FIES survey questions in 180 languages — such as the difference between “running out of food” and “having less food,” which the article mentions — do not affect the information obtained.
All of the methodological details regarding the way FAO measures food security are public knowledge and explained every year in the technical notes of the UN’s annual food security and nutrition report and FAO’s data and statistics website. Moreover, for the last four years, FAO has been actively collaborating with the Ministry of Statistics and Programme Implementation to include FIES data into official national data collection initiatives and to align the national SDG indicators to the global SDG monitoring framework. We stand ready to continue working with the government of India to strengthen food security statistics and achieve the common mission of a sustainable and food secure world for all.
Written by Carlo Cafiero
Source: The Indian Express, 3/12/22
Friday, December 02, 2022
Quote of the Day December 2, 2022
“In this world it is not what we take up, but what we give up, that makes us rich.”
Henry Ward Beecher
“इस दुनिया में जो कुछ हम अर्जित करते हैं, उससे नहीं अपितु जो कुछ त्याग करते हैं, उससे समृद्ध बनते हैं।”
हैनरी वार्ड बीचर
Current Affairs- December 2, 2022
INDIA
– Nagaland: Hornbill Festival begins on statehood day, state created on Dec 1, 1963
– Armies of India and Singapore conduct Agni Warrior Exercise at Deolali (Maharashtra)
Advanced Light Helicopter Mk-III squadron of Indian Coast Guard commissioned in Chennai
– India to assume chairmanship of Wassenaar arrangement on 1 Jan 2023
– Wassenaar arrangement is a multilateral export control regime wherein member states exchange information on various issues like transfer of conventional arms
– Govt launches nationwide campaign for promotion of Digital Life Certificate for pensioners
– Haryana: International Gita Mahotsav-2022 being held in Kurukshetra
– Vinay Mohan Kwatra gets 16-month extension as foreign secretary from Jan 1
– Pre-matric scholarship for minority students to only those in class 9 & 10 from 2022-23; earlier from class 1 to 10
– Significant drop in volume of water in Ganga between 2002 and 2021: World Meteorological Organisation (WMO)
– Uttarakhand passes bill to make anti-conversion law more stringent; jail term and fine enhanced for forced conversion and “mass conversion”
– Atal Innovation Mission of NITI Aayog launches applications for Community Innovator Fellowship
ECONOMY & CORPORATE
– Private equity companies The Carlyle Group and Advent get conditional nod from RBI for acquiring 9.99% in Yes Bank
– RBI announces 4-tiered regulatory framework for urban cooperative banks based on the size of deposits
– 30-share BSE Sensex closes above 63,000 points for the 1st time on Nov 30
– Govt to launch 4th tranche of Bharat Bond ETF (exchange traded fund) from Dec 2; managed by Edelweiss Mutual Fund
– Prannoy Roy, Radhika Roy quit NDTV holding company (RRPR Holdings); Adani Group gains control over RRPR Holdings
Centre issues guidelines for MSOs (multi-system operators) to transmit local content
– Mumbai: Adani Group bags bid to redevelop Dharavi slums
– India’s first privately designed and operated rocket launchpad inaugurated at ISRO’s Satish Dhawan Space Centre (SDSC) in Sriharikota (AP); designer & operator: Agnikul Cosmos (domestic space startup)
– Union Minister for Civil Aviation Jyotiraditya Scindia launches Digi Yatra for 3 airports; enables contactless processing of passengers using Facial Recognition Technology (FRT)
WORLD
– World AIDS Day observed on Dec 1; UNAIDS issues “Equalize” slogan as a call to action
– ‘Gaslighting’ is Merriam-Webster’s word of 2022; meaning: mind-manipulating, grossly misleading, downright deceitful
SPORTS
– FIFA World Cup: Argentina, Poland, Australia & France enter Round of 16
– England become 1st team to score 500 runs on Day 1 of a Test; 506/4 at Rawalpindi Cricket Stadium in Pakistan
– Indian boxer Urvashi Singh wins two WBC titles by defeating Thailand’s Thanchanok Phanan in Colombo — WBC International Super Bantamweight title & WBC Asia Silver crown
A comprehensive guide to preparing for IELTS: Preparation strategy, schedule, and resources
An eight-step approach to build a solid preparation strategy. This includes improving vocabulary to building a study plan.
A common English proficiency test taken around the globe, IELTS is a fundamental requirement for admissions to many institutions worldwide. It is, therefore, imperative that you understand the test and have a reliable strategy that works for you. The test requires you to have a basic understanding of standard English conventions, common punctuations, diction, and a decent vocabulary. But, without a clear and easy-to-follow strategy, this can take a toll on any test taker.
Here is an eight-step approach to build a solid preparation strategy:
Understand the test
Avoid any surprises on the test day. Go through the IELTS pattern in detail.
Focus on the structure of the test, timing, and question types. Attempting a mock test before beginning preparation will help you identify your strengths and weaknesses.
Improve your vocabulary
Vocabulary is a critical component of the test. Almost 25 per cent of your total marks, which are in the writing and speaking section, are dependent on your vocabulary. A daily reading habit is a must in this regard. Identify words that you do not know and create a list of their antonyms and synonyms.
Try making short sentences using those antonyms and synonyms. This will help you understand the contextual usage of each word.
Read faster
Improving your reading speed will help you identify essential passage parts quickly. It will also enable you to zero in on the important and right parts.
Read from the websites that mention the average reading time of the article. Time yourself and aim to finish the article within that specified time. Practice till you reach the reading speed of 400 words per minute.
Once you achieve the required rate, focus on tracing conjunctions. This will help you navigate the passage more accurately and efficiently. Remember, the author’s point of view is the main idea of the passage. So, pay attention to the lines where the author presents their opinion.
Create an idea bank
To improve your score in the writing and reading section, create your idea bank — a list of words that are new to you, topics that you like, news articles of interest, a list of ideas relevant to your field of work etc. Go through this idea bank before the test. It will provide variety to your sentences and improve your writing and speaking ability.
Record yourself while speaking
Ask your friends, family, siblings or batch-mates to feed questions and record your answers for the speaking task. Listening to your recordings will help you improve your speaking skills.
Immerse yourself in the English language
Surround yourself in an environment where you store English in your mind in active and passive ways. Watching movies or series, listening to songs, and talking or chatting with friends in English are fun ways to help you improve your command of the language while rejuvenating yourself.
Build a Study Plan
Divide your entire preparation into three phases and set a target score based on your admission requirements. In phase one, focus on understanding the fundamentals for your weak areas. Attempt topic-wise tests for your strong suits.
Once you have improved upon the weak areas, start trying topic-wise questions or tests. Track your speed and accuracy for each test or practice session. Revisit the errors made by you during the timed practice sessions for improvement.
Phase three of the preparation is all about practice. Test takers tend to practice mock tests intermittently. That is a common mistake and a big no!
Always make sure that you practice the complete test — start to finish — undistracted. Replicate a test-like environment at home and take the test exactly as per the instructions given. Record all the metrics for each test including accuracy, the time spent on each question, and your errors.
Get Feedback
Practice every day. In fact, practice all sections every day. While reading and listening are passive skills, they require you to process the information given and answer the questions.
However, writing and speaking are active skills where you make content independently. Feedback from an expert on all sections is crucial so as to identify your mistakes and work on the relevant skill.
The IELTS exam becomes easy if you study using the following resources:
1. Road to IELTS: Road to IELTS is the British Council’s official online preparation course. It’s an excellent resource to start your preparation.
2. The Official Cambridge Guide to IELTS: This book is suitable for both IELTS academic as well as general training.
3. Cambridge IELTS 17 Academic Student’s Book with Answers: This book gives access to authentic IELTS test papers. It also contains tips for each section and explains different question types.
4. Newspapers and magazines: Pick up national news daily for reading and speaking practice. Focus on the editorial section of the newspaper to cultivate a reading habit and improve vocabulary. You can also refer to magazines such as The National Geographic and Nature.
Lastly, writing the exam at the right time is extremely important. Begin with the end in mind and plan your IELTS test date in accordance with the university admissions deadline. Start preparing at least six months before the targeted score submission deadline to ensure that you have enough runway to prepare (30 to 60 days), practice (15 to 30 days), write the exam and repeat the entire process in case you don’t get the targeted IELTS score in the first attempt. And finally, the day before your exam, relax, sleep, and eat well.
Anubhav Seth
Source: Indian Express, 2/12/22
Why tracking migration is important for nutrition schemes
A plan that focuses on targeting and triaging the most vulnerable — a strategy that keeps them at the centre without silos — might just be what we need to move one step forward in improving the wellbeing of people.
It seemed like a data anomaly when we looked at the temporal pattern of malnourishment in the tribal sub-division of Dharni in Maharashtra’s Amravati district. An April peak in the number of children with Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) surprised us. The common sense of nutrition discourse dictates that the peak should be in monsoon when diarrhoea takes over, or in winter when hypothermia is the devil for children. We re-checked our data and went back to previous years — this only seemed to confirm our findings. Every year, for at least the past three years, numbers had peaked in April. And, this was no small peak. The numbers went up more than five times suddenly, with two tribal blocks having more SAM and MAM children than the rest of the 12 blocks combined. The numbers kept reducing steadily all year round before peaking again in April.
What was happening? After some discussions, we realised that several families were returning to Dharni from migrated places in March for Holi (the biggest festival here), then going back to fulfil contracts, only to come back “permanently” in the kharif season when cropping begins (there was a smaller peak at June). Our later pursuits revealed a more direct correlation in Nandurbar, a tribal district in Maharashtra, where a 2018 UNICEF study had followed the same cohort of children, before and after migration. SAM numbers increased fourfold, MAM too doubled — at least half of the migrated children. Given the geographical complications of migration as well as a lack of data, such studies have been few.
Migration became the buzzword during the Covid pandemic in cities. However, rural migration has continued for years. In tribal areas especially — owing to lack of industry, issues with forest rights, or its implementation, and lack of irrigation facilities — migration extends to six to eight months a year.
The first question that I asked myself was that if people are staying somewhere else for over half a year, wasn’t that place as much their home? Multiple government schemes — for strengthening education, health, connectivity, water supply, electricity — work on the assumption that people are going to stay in villages to reap the fruits of what this capital and operation will sow. This assumption falls flat in high migration areas and the understanding of an inter-relationship between long-term nutrition, migration and livelihood (including, most of all, MGNREGS) goes askew.
We decided to work on our findings last year and asked a few questions: Where were people migrating from the most? How many? Which were the highest-density in-migration places? We did get some answers, but they seemed vague. It stood out that in our nutrition surveys, the lack of migration data inflated the denominator (number of children being measured), especially because new births kept adding to it, leading to data that did not accurately reflect the situation. Since we were in the middle of migration season, we decided to meet these migrated families.
Three things that changed everything I have ever understood about migration came from field visits. The most distinct memory I have is of an interaction with a brick kiln owner who shook his head when I asked him “Kitne bacche honge idhar (how many kids are here?)”. He said “Ham bacche nahi ginte kyunki voh idhar kaam nahi karte (we don’t count children because they don’t work here).” No wonder, then, that there was an invisible set of people — especially pregnant/lactating women and children — who were not of any “use” here. We met many families. Coming face to face with our own prejudices was also important. We believe migration to be a bad thing, but here were multiple families being provided guaranteed wages — the word “guaranteed” being especially important because many people told us they would be happy to not work here if they got assured MGNREGS work back home.
The second learning happened when we met a nine-month-old who was due for MMR vaccination but wasn’t given the dose because he wasn’t due for it back home, and by the time he would go back, he would have missed it. Our assumption is that this time period of six to eight months must be leaving many children and pregnant women unvaccinated. This is not due to the lack of health or nutrition infrastructure or indifference — it is because of a lack of knowledge of these beneficiaries being here. Most of these brick kilns are around 1-2 km outside the villages and until there is intimation of some government contact, it is difficult for both giver and receiver to get in touch.
Portability as a concept is not new. But my third learning was that we have to start thinking about a system that does not rest completely on demand. Our questions — do you take ration from shops? Do you take your kids to anganwadis? — were answered in the negative. It did not surprise me. A Korku tribal population distress-migrating in a predominantly Marathi belt: Think of the bargaining power, especially of women and children. It doesn’t take much to join the dots.
Our learnings led us to start working on a migration tracking system as well as strengthening MGNREGS. But these inter-relationships need a deeper dive, especially in tribal areas, which constitute a higher density of malnutrition. SAM and MAM are the tip of the iceberg when we talk about nutrition. A long-term reduction in stunting and underweight and improving health will need us to understand the interplay of nutrition, livelihood and poverty. A plan that focuses on targeting and triaging the most vulnerable — a strategy that keeps them at the centre without silos — might just be what we need to move one step forward in improving the wellbeing of people.
Written by Mittali Sethi
Source: Indian Express, 2/12/22
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