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  • 1. Nourish to Flourish: Reducing malnutrition Gaurav Kumar Prakash Vardhan Vikash Kumar Jha P.K.Aditya Yashavi Gautam Kumar We may eventually come to realize that chastity is no more a virtue than malnutrition.
  • 2. Causes Productive Assetlessness 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 Unemployment
  • 3. After National Nutrition Policy 1993 and National Plan of Action, 1995 no national programs or policies for eradicating malnutrition have appeared Governmental Failures 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 Programme (UNEP). 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 facilities. 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
  • 4. 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.) Energy (Kcal) Protein (g) 1940 – 2200 36 – 46 2550 – 2900 44 – 60 Fat 15 – 33% 15 – 33% Solutions and their merits
  • 5. Educational reforms 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 meal”. 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
  • 6. 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 generation capacity. 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 manifestations. 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 (Corporate Sector/PPP) Structure and monitor tightly integrated multi-sector interventions to address all or majority of the direct and indirect causes of malnutrition simultaneously. Initiate a sustained general public awareness campaign regarding proper nutritional practices within existing family budgets, and to create demand.
  • 7. 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 corrections 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 each Anganwadi 0-29 % 30-39 % 40-49 % 50 -100 % Children Under 3 years Who are Underweight (NFHS-3, 2005-2006) Productivity loss from stunting, iodine deficiency and iron deficiency resulting in loss of productivity 3% of GDP (Horton 1999)
  • 8. 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 areas (58.5%) 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.) o Stunting o Underweight o Wasting • Micro-nutrient deficiency o Iodine o Iron 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)
  • 9. 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 and volunteer requirement identified Direct recruitment from central/ state government offices Direct recruitment by reaching out to NGOs/ Voluntary organizations Online registration 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 cent)
  • 10. WHO 2009. Global health risks: mortality and burden of disease attributable to selected major risks. The program will be able to impact 5 million people every year through a network of 0.5 million volunteers Impact and Reach Volunteer Network 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.
  • 11. Challenge in implementing Risk Concept Government or corporates does not seem to funding for the above propose solution Volunteer enrollment minimal and key profession groups show no interest Society person may show less interest Implementation challenges Difficulty in integrating with government infrastructure and institutions 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
  • 12. 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 Development)
  • 13. Thank You!