Nourish to Flourish: Reducing malnutrition
Vikash Kumar Jha
We may eventually come to realize that chastity is
no more a virtue than malnutrition.
Social and gender injustice.
Leakage in government scheme.
Lack of awareness among people
Concentration of productive
assets in few hand
Malnourished India, We still have 17.5% population undernourished
Centralization of governance
After National Nutrition Policy 1993 and National Plan of Action,
1995 no national programs or policies for eradicating malnutrition
A 2013 report from the London-based Institution of Mechanical
Researchers, “Global food: waste not, want not”, finds India wastes a
quantity of wheat equivalent to the entire production of Australia every
year, of which 21 million tons perishes every year due to a lack of
inadequate storage and distribution.
Aside from food grains India loses 12 million tons of fruits and 21
million tons of vegetables every year due to a lack of cold storage
facility, according to a 2009 study by the United Nations Environment
Lack of Awareness
Midday meal scheme, Integrated child development
scheme, National Children's Fund, National Plan of
Action for Children are few major step taken by
government toward malnutrition but they remain
insufficient due to lack of awareness of common people.
Many liable people remain untouched from government
The first law of thermodynamics applies as strictly to the human engine as to mechanical engines. Since the
overwhelming share of calories consumed by the malnourished populations is required for BMR and essential
maintenance… the typical individual in the labour force had relatively small amounts of energy left for work.
A big leap has been taken by the Government of India towards the eradication of
Malnutrition from India this year by bringing National Food Security Bill
In 2009, nearly 8% children of the children aged
12-23 months did not receive even a single vaccine
Corporate Social Responsibility Disruptive Interventional Innovations
Corporate Social Responsibility (CSR) should be made more active. A fixed
percentage of the profits(say 1%) of the corporates can be dedicated for the cause
of malnutrition. Perks like tax exemption for these companies can make them
much happier in giving. Corporate participation also can publicize the importance
of nourishment through advertisements.
Positive deviance and liberating structures represent
'disruptive' interventional innovations, yet they have been
successful in tackling complex social or organizational
challenges. This approach has already been successfully
employed in over 40 countries to address a wide variety of
social and organizational purposes, including decreasing
malnutrition and infant and maternal mortality
in Vietnam and Pakistan.
Positive deviance means that in every community, there
exist certain individuals or groups whose uncommon
behaviors and strategies enable them to find better solutions
to problems than their peers. Similarly, liberating structures'
mean the availability of newly-developed and codified
methods, practices and activities that quickly foster lively
participation in groups of any size.
India’s position in the Human Development Report for 2008 is 134 from (128 of previous year), (China
ranks 91, Sri Lanka 102 and Bangladesh 146).
Macronutrient F (19-30 y.o.) M (19-30 y.o.)
1940 – 2200
36 – 46
2550 – 2900
44 – 60
Fat 15 – 33% 15 – 33%
Solutions and their merits
Reforms at the Society level Reforms in Electronic and Print media
Introduction of Home Science as a subject with a significant weightage in all the schools irrespective of the stream
would bring awareness among people. This will encourage people to have a balanced diet which in itself is a very big
step towards eradicating malnutrition from India.
Activities like NSS(National Service Scheme) should be made introduced in all
the colleges of the country and these activities should be organized strictly.
A lot of food is wasted in big fat Indian weddings. A survey shows
that annually, Bangalore alone wastes 943 tons of quality food during
weddings. "This is enough to feed 2.6 cr. people a normal Indian
5%(1 out of 20) advertisements should be dedicated to awareness about nutritious
diet in Electronic Media. A page or two of the Print media(all the newspapers and
Magazines) can be dedicated to tis ad campaign. Film stars and other celebrities
should be encouraged to do the ad campaign.
Malnutrition has been termed a ‘National Shame’by Prime Minister Dr. Manmohan Singh
Assuming total of 250 working days, total money lost in a year = Rs. 1,197,775,957,500 = US$ 29,944,398,937
approx. (1 US$= Rs. 40/-) = Approx. US $ 29 Billion.
Solutions and their merits
What does malnutrition cost us??
Malnutrition negatively impacts the GDP as it reduces physical/
cognitive growth, reduces productivity and earnings of individuals, and
results in economic loss to the nation. Total money lost by entire adult
population per day is Rs. 4,791,103,830 due to low productivity.
It lowers the resistance of the body to infections and capacity to recover
from illness and adds to the health costs of the nation.
Protein Calorie Intake, Micronutrient Intake, Infections and illness,
Nature of Occupation determine working capacity and income
Based on the findings of NNMB repeat surveys in the years 1988-90 and
1996-97, that 30% of the households consume less than 70% of energy
requirement, an attempt has been made to calculate loss of productivity
in adults, and the resultant economic loss to the nation as a result of
malnutrition. This equals approximately US $ 29 Billion (4% of GDP).
Other studies conducted by Administrative Staff College of India in the
year 1996, CARE India and Linkages India 2003, confirm that 3% of
GDP is lost on account of malnutrition and its various types of
A National Strategy to Combat Malnutrition
Introduce nutrition and micro-nutrient interventions for the three critical
links of malnutrition viz. children 6 months – 6 years, adolescent girls, and
pregnant and lactating women to be prepared by SHGs from low cost,
locally available agricultural produce.
Introduce nutrition and micro-nutrient interventions for the general
population to bridge the protein-calorie gap by making available in the
market, protein-energy dense foods.
Make available low cost energy foods for the general population
Structure and monitor tightly integrated multi-sector interventions to
address all or majority of the direct and indirect causes of malnutrition
Initiate a sustained general public awareness campaign regarding proper
nutritional practices within existing family budgets, and to create demand.
Nutrition Monitoring and Surveillance
A computerized Central and Block level monitoring systems should be devised
with deliverable targets and time frames
An effective concurrent monitoring system through an external agency can also be
established for measuring outcomes, and for effecting changes and mid course
At the AW level, community based nutrition monitoring and surveillance through
ICDS infrastructure could include growth monitoring of infants and children and
weight monitoring of adolescent girls and women
Creating a data base on the nutritional status of children, adolescents and women in
50 -100 %
Children Under 3 years Who are Underweight
Productivity loss from stunting, iodine deficiency and iron deficiency resulting in
loss of productivity 3% of GDP (Horton 1999)
Nutritional Status of Men in India
28.1% of the men in India have Body Mass Index below normal
24.3% of the men in India are anemic
Percentage of men having below normal BMI and suffering from anemia is higher
in SC and ST population
The NFHS-3 demonstrates a worrying shortfall: barely half (51 per cent) of
pregnant women receive at least three antenatal visits, and
– perhaps even more shockingly – only 48 per cent of births during 2005-06 were
attended to by a trained birth attendant
As per Coverage Evaluation Survey, 2009, at national level, 61% of the children
aged 12-23 months have received full immunization. The coverage of
immunization was higher in urban areas (67.4%) compared to that in the rural
Types of malnutrition
• Severe Protein-Energy Malnutrition (>3 S.D.)
o Kwashiorkor (low protein)
o Marasmus (low calories)
• Mild/moderate under-nutrition (>2 S.D.)
• Micro-nutrient deficiency
o Vitamin A
o Vitamin D
• 88% of respondents were not aware of any nutritional screening tool designed to identify patients at risk of malnutrition
• Only 13% always referred a patient at risk of, or suffering from, malnutrition, to an NHS Dietician
• 40% never provided dietary advice to patients at risk of malnutrition prior to an elective admission to hospital.
(Nutricia Clinical Care/doctors.net.uk: 2005)
Volunteers should be recruited through online and offline
channels after assessing the area wise skills gap
Building the volunteer army
Recruitment Management & Mapping Implementation
We will understand the requirement at block
level for both urban and rural areas
Survey at block and panchayat level should be
done so its easier to identify the needs and
problem of area.
Complete district wise and block wise skills
Direct recruitment from central/ state
Direct recruitment by reaching out to
NGOs/ Voluntary organizations
Mobile based registration
1 Million+ volunteers across the country to be recruited
Awareness BuildingNeed of skills assessment Recruitment of volunteers
Large scale media and offline campaign to support
the volunteer recruitment drive
Both traditional and social media will be utilized to
spread the message
Posters/ Banners to be put up in high footfall urban
areas like shopping complexes, Railway stations
The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 per cent) and Kerala among the lowest (27 per
WHO 2009. Global health risks: mortality and burden of disease attributable to selected
The program will be able to impact 5 million people
every year through a network of 0.5 million
Impact and Reach
1 Million volunteers to be
recruited through the outreach drive
0.5 Million Professional
0.3 Million Retired Executives(army)
0.2 Million Students
Number of volunteer from specific area Should depend on its
malnutrition level .
India invests 3.4% of total budget on health which seem to Be very low as compare other develop nation and developing nation. USA invest 19.3% of its total budget on
health so as other develop nation.
Cast and gender level of reservation should be Provided so that no
section remain un touched from Development and government plan.
Challenge in implementing
Government or corporates does not seem
to funding for the above propose solution
Volunteer enrollment minimal and key profession groups show
Society person may show less interest
Difficulty in integrating with government infrastructure and
Tie-ups with other vendors for providing venues
and offline registration/interaction channels
The volunteer driven model of vocational training faces key concept and implementation risks
Bringing in industry leaders/ NGOs for curriculum and training inputs
Under Nutritional Child
References ( Appendix )
India’s position in the Human Development Report
National Family Health Survey report 2005-2006
World Bank Data Bank Report
National Rural Health Mission Health Statistics Information Portal
Association of Voluntary Agencies for Rural Development (AVARD)5(FF), Institutional Area
World health Organization 2009. Global health risks
Nutricia Clinical Care/doctors(.net.uk: 2005)
United Nations International Children's Emergency Fund Publications
Economic Survey of India 2013
London School Of Economics (LSE) : Blogs on India Issues
Hunger and Malnutrition in India: Status, Causes and Cures (Association of Voluntary Agencies for Rural