Sustainability in Nutrition by Capacity Building
Table of Contents:
Observations and Analysis
This study is about understanding capacity building measures
by which Sustainability in Nutrition can be achieved.
Sustainability in Nutrition is required because the
consequences of poor nutrition extend well beyond poor
quality of life and health. Poor nutrition affects our country’s
overall social welfare, human rights record and economy.
The national costs of malnutrition are very high: a vicious
intergenerational cycle of poor health, high death rates, poor
quality of life, decreased mental capacity and reduced worker
Malnutrition as a complex and multi-dimensional issue
affected by poverty, inadequate food consumption,
inequitable food distribution, improper infant and child
feeding and care practices, equity and gender imbalances,
poor sanitary and environmental conditions and limited
access to quality health, education and social services.
Sustainability is the continuous approach through behavioral
change, learning and adaptation. To achieve this, programs
need to engage in community organizing to help in behavior
change which can eventually take over the roles of program
and to create a sense of local investment in, control over and
ownership of the development process to ensure that it is
The Determinants Of
The Lack Of Nutrition In India
The effect of under nutrition
Morbidity, mortality, mental and physical development
The effect of under nutrition has great impact on mortality, morbidity and
physical development of a child which further leads to reduced socio-economic
productivity. Malnutrition is the major cause of mortality of the children under
five. Morbidity due to micronutrient deficiencies leads to damaging physical and
mental development of a child.
Malnutrition is defined here as the outcome of insufficient quality or quantity of
food intake and recurrent infectious diseases. It includes being underweight for
one’s age, too short for one’s age (stunted), too thin for one’s height (wasted) and
deficient in vitamins and minerals (micronutrient malnourished).
Productivity and economic growth
The consequences of under nutrition lead to poor quality of life, health and hence
social well being.
Poor nutrition affects the productive employment and economic participation of
the individuals as well.
The cognitive and physical effects of under-nutrition both underweight and
micronutrient deficiencies undermine capacity to learn resulting educational
attainment and hence the earning potential of the individual.
Malnutrition at any stage affects labor productivity, with adverse implications for
income and economic growth.
Supplementary Feeding and Nutrition
Prevalent Food Practices
Prevalent food practices in India due to lack of awareness and other factors lead to
malnutrition which is the imbalance of both macro and micro-nutrients. Under-
nutrition is due to inappropriate intake and inefficient biological utilization. Poor
feeding practices are obstacles to attaining and maintaining health of the
vulnerable age group .
11th Five year Plan Social Sector Volume II Chapter on Nutrition and Social
Safety Net reveals that in both rural and urban India, the share of food in total
expenditure continued to fall throughout the three decades prior to 2004–05. The
overall fall was from 73% to 55% in rural areas and from 64.5% to 42% in urban
Essential nutrition interventions
In India with a 500–600 kcal deficit in energy intake (almost 40% of their
requirement) and multiple nutrient deficiencies such as fat, calcium, iron,
riboflavin, vitamin C (all 50% deficit), and vitamin A (70% deficit) there is
massive inadequacy leading to malnutrition in children and adolescents .Studies
show that less than 30% of children have protein-calorie adequacy .
Essential primary health care interventions
There is lack of adequate health facilities, proper commutation to heath care
centers, timely interventions and sufficient monitoring. In the case of pregnant
and lactating mother there is a lack of proper education and hence the awareness
to the beneficiaries, their family and the community leading to ignorance which
ultimately leads towards the proxy ignorance of the child.
Weak health service systems, inadequate human resources, especially in public
health nutrition, weak health and nutrition educational systems, poor utilization of
services, recurrent infections, low immunization rates and lack of awareness of
Gender perspective in Nutrition
Intergenerational cycle of malnutrition
The vicious cycle of intergenerational malnutrition prevails when adolescent girls
are malnourished; it is evident that she will grow to a woman who is
undernourished and hence an underweight and malnourished child who will
ultimately lead to an adolescent who is under productive.
There is a need to understand that this intergenerational cycle cannot be broken
unless a healthy child is born & for that there is a need to concentrate on
nutritional education and outcome of the adolescent girls.
Food preferences in the households
Gender discrimination can be seen in the food preferences of the households
particularly in rural areas, men of the houses are considered to be more involved
in physical activity so they are given the larger share of the food by the women
who even prefer to prepare the food of their choice.
As the requirement and nutritional need of male and female are different; women
are more disadvantaged in fulfilling it. Girls also are taught to sacrifice even in
Awareness regarding Nutritional requirements of the vulnerable groups
Behavior pattern both at the beneficiaries‘ level and the community level is not
satisfactory. Reluctance as well as the lack of awareness regarding requirement of
the vulnerable group is the main cause of their suffering, inadequate knowledge of
nutrition adds to it.
Existing nutrition supplementation programmes are not able to covering the entire
high risk group. Practices that lead to poor nutrition for example discrimination in
intra-familial food distribution, high workload for women, inadequate
micronutrients and improper food consumption during pregnancy, contribute to
According to FAO engaging women in improving community health is an important
component of equity in primary health care. Community participation approaches endeavor
to empower women with confidence and skills to adopt new and senior roles. This not only
promotes equity, but may also benefit child health outcomes as women are more likely to use
any improved knowledge or income for their children.
“However much a mother may love her children, it is all but impossible for her to provide high-quality
child care if she herself is poor and oppressed, illiterate and uninformed, anaemic and unhealthy, has
five or six other children, lives in a slum or shanty, has neither clean water nor safe sanitation, and if she
is without the necessary support either from health services, or from her society, or from the father of her
- Vulimiri Ramalingaswami, "The Asian Enigma" .
Schemes to overcome under-nutrition
India, acknowledging that the problem of malnutrition is multi-
dimensional, multi-sectoral and inter-generational in nature, introduced a
number of schemes to improve nutrition needs of children and pregnant
mothers from time to time under different Ministries, such as
[a] Ministry of Women and Child Development:
[i] Integrated Child Development Services
[ii] Kishori Shakti Yojana
[iii] Nutrition Program for Adolescent Girls
[iv] Rajiv Gandhi Scheme for Empowerment of Adolescent Girls;
[b] Ministry of Human Resource Development
[i] Mid-day Meals Program
[c] Ministry of Health and Family Welfare
[i] National Rural Health Mission
[ii]National Urban Health Mission
[d] Ministry of Agriculture
[i] National Food Security Mission
[ii] National Horticulture Mission
These schemes have had limited success to improve nutritional status, due
to fragmented leadership and coordination.
Integrated Child Development Services (ICDS) Scheme
Nutrition including Supplementary Nutrition
Nutrition including Supplementary Nutrition: This includes supplementary
feeding and growth monitoring; and prophylaxis against vitamin A deficiency and
control of nutritional anaemia.
All families in the community are surveyed, to identify children below the age of
six and pregnant & nursing mothers. They avail of supplementary feeding support
for 300 days in a year.
By providing supplementary feeding, the Anganwadi attempts to bridge the
caloric gap between the national recommended and average intake of children and
women in low income and disadvantaged communities.
Nutrition and Health Education
Nutrition, Health and Education (NHED) is a key element of the work of the
anganwadi worker. This forms part of BCC (Behaviour Change Communication)
strategy. This has the long term goal of capacity-building of women – especially
in the age group of 15-45 years – so that they can look after their own health,
nutrition and development needs as well as that of their children and families.
Food and Nutrition Board
Activities of Food & Nutrition Board include:
Nutrition Education and Training, both for the masses and for ICDS functionaries
Mass Nutrition Awareness Campaigns
Development, production and distribution of nutrition education/training material
Training in Home Scale Preservation of Fruits and Vegetables and Nutrition
Development and Promotion of locally available Nutritious Foods
Food Analysis and Standardization
Follow up action on National Nutrition Policy
Strategies to Achieve
Sustainability in Nutrition
Sustainable Reduction of Malnutrition
According to FAO, experience has shown that community-based
processes which are empowering and able to mobilize populations are
essential components of programmes for rapid and sustainable reduction
of undernutrition and malnutrition.
The activities under this heading seek to create a widespread
understanding of the underlying factors and processes that lead to
malnutrition, and to build the necessary programme activities and support
at the government and institutional levels to respond to identified needs,
and thus reverse the situation.
Strengths, Weaknesses, Opportunities and Constraints
The strengths, weaknesses, opportunities and constraints in relation to sustainability,
[Identified by FAO‘s in-depth study of nine programmes (2002)]
Institutionalization of the programme (through demonstrated funding
commitment, or ownership, or successful technology transfer);
Programmes long time-frame allows it to reach even the poorest communities.
Excessive dependence on NGOs and/or external funding.
Integration of activities into sectoral plans and other development programmes;
Planned government action to decentralize and improve land distribution;
Development of new technologies can provide answers to community problems.
Constraints (and threats):
Cessation of external funding;
Change in political orientation;
Successful community empowerment leading to unmet demand for services.
The Food and Nutrition Security Status in India
Availability, accessibility and absorption of food:
Food and nutrition security is broadly characterized by three pillars: availability,
Growth alone may not be able to ensure food security for the poor and vulnerable.
Social safety net programs and employment-generating programs will play an
important role in improving accessibility of food to the poor and vulnerable.
Strategies of Sustainable Development in practice
In practice an effective strategy for sustainable development brings together the
aspirations and capacities of government, civil society and the private sector to
create a vision for the future, and to work tactically and progressively towards it.
It identifies and builds on ‗what works‘, improves integration between
approaches, and provides a framework for making choices where integration is
Focusing on what is realistically achievable; an effective strategy will benefit
from comprehensive understanding, but will not be paralyzed by planning overly
comprehensive actions on many fronts at once. As a process of practical
institutional change aimed primarily at mainstreaming sustainability concerns, the
strategy is likely to be focused on only a few priority objectives.
(The DAC Guidelines Strategies for Sustainable Development
Factors Affecting the Sustainability of the Programs in
The sustainability of the program in nutrition is affected by the knowledge in
nutrition, nutrition education, and nutrition in clinical and public health settings.
In addition, the emphasis on
Designing and implementation of nutrition education with individuals, groups,
Facilitating healthful and ecologically sustainable food choices;
Conducting clinical assessments and nutrition counseling;
Designing and implementing public health nutrition assessments and programs;
Understanding and applying principles of nutritional epidemiology;
Applying nutrition science and exercise science principles to recreational and
Thinking critically and independently;
Acting collaboratively and effectively with others in organizations and
communities on important issues related to food, nutrition, and sustainability of
the food system;
Conduction of food and nutrition-related research.
Capacity Building for Sustainability in Nutrition
Necessity of Capacity Building for Sustainability in Nutrition
External support for program development
Full community participation in designing a health program is likely to lead to a
locally appropriate design that addresses community priorities. This may increase
program effectiveness and enhance community ownership of the program,
contributing to its sustainability and encouraging local people to invest their
resources in it.
If communities are taught how to seek and secure resources (including materials,
money, and human resources) from within and outside the community, they will
gain valuable skills that will enable them to try to sustain the program in the
future and be self reliant.
In the context of financial empowerment, the community can negotiate funding
for other health and development activities, enabling them to diversify their self-
Monitoring and evaluation
Community participation transfers measurement and analytical skills to the
community as they learn how to define indicators, and monitor and
evaluate in a way that is meaningful to them. The community therefore
becomes better able to analyze its actions and their effects and to respond
This will help maintain program effectiveness and sustainability.
Goals and Outcomes of a Community-Based Programme
Improvement in the health and nutritional status of pregnant and lactating
women, as well as children under five years of age; to assure adequate growth by
strengthening services and increasing community involvement in health and
Prime Minister Dr Manmohan Singh, while chairing the full Planning
Commission meeting on April 21, 2011, said
“The 12th plan objective must be faster,
more inclusive and also sustainable growth. We need to identify the critical areas
where existing policies and programs are not delivering results and should,
therefore, be strengthened or even restructured”.
OBJECTIVES OF THE PROJECT
To study sustainability in nutrition by capacity building through following initiatives:
To assess the impact of involving and educating locals to improve understanding
and ensure effective community participation.
To assess the awareness of 360 degree approach of child care starting right from
awareness and care for adolescent girls to the lactating mothers.
To identify dependence on the locally available resources & practices and
awareness about its nutritional quotients.
To assess different implementation models of nutrition programme and its impact.
Focus Group Discussions were organized in order to establish opinions from
different segments of the society.
The number of people per group was about five to seven. Numbers of groups was
five, comprising of similarity of participants in each group to be studied using one
or more meetings with each of several focus groups.
Focus group sessions usually last from one to two hours.
Neutral locations were helpful for avoiding either negative or positive
associations with a particular site.
Focus Group Discussions were conducted with participants representing a wide
range of groups in Mohan Garden area of New Delhi.
Five different groups were interacted with each comprising five to seven
Open discussions were arranged staring with each open-ended question; some
close-ended questions were asked in between to encourage the discussions.
Questions were well suited and were framed after reviewing the evidence and
literature about how to improve nutrition capability, the available Government
schemes and programmes directly or indirectly related to nutrition and the parallel
available programmes to improve nutrition.
Interaction with the beneficiaries and discussion
among them was encouraged in order to understand
the possibilities of building the capacity for nutrition
and its sustainability
Participants of Groups
Group 1: Adolescent Girls
Group 2: Pregnant women
Group 3: Lactating women
Group 4: Elder Women
Group 5: Men
1. Do you know about the nutrition and its impact on growth?
Some of the respondents were silent and some were very
enthusiastic, in spite of being educated very less knowledge was found among
them, they had heard and read about the protein, carbohydrate and vitamins but
knew less about their impact on growth.
Men were not very much concern about these and the women use to
follow what the elders say and as per their tradition.
The group of adolescent girls were much more aware about the
importance of the nutrition, one factor being their exposure and because most of
them were students.
2. How is the government program or parallel program helping you in
The response about these program were good, they told that the
understanding about such programs come from various government sources such
as pulse-polio camp, hospital and Anganwadi Centers. Ladli Yojna helped in
decrease in female infanticide and brought change in thinking of the people.
Although they went ahead in discussion but the overall participation was
overwhelming about these programs.
3. Are you aware about the nutrition content in food while cooking or
There was a mixed response regarding it some said that they know the use
of different ingredient while cooking in order to have the healthy diet; some said
that putting lid on the utensils while cooking restores the nutrients of the meal,
some said that they never thought about it.
4. Do you decide upon the meal for the family and for yourself?
There were different responses regarding it, general response was that the
person who cooks decide upon the meal for the family, they also said that
generally the person who decide upon the meal of the family knows better about
the taste and nutrition requirement of the family.
The response showed no gender bias in deciding upon the meal for the
family. In most of the family it is decided by the influential lady in the house.
5. Do you know that nutrition requirement of gender is different?
The response revealed that some of them knew about the different
nutritional requirement of women and men. They told that men and women
require different nutritional elements and women require more energy because
they take care of the whole family which makes her tired mentally and physically.
Women require nutrients such as Iodine, Calcium and Iron.
They told that during pregnancy, women require more nutrition which
they can get from milk, salads, fruits & sprouts. Women need to continue with
nutrient rich food after pregnancy also. So they discussed about the women‘s and
men‘s different requirement of nutrition.
6. How can sustainability in nutrition be achieved?
They said that for sustainability they need to have proper knowledge and
guidance about nutrient content of food item.
The packed food should have their nutrient content printed on it.
Newspaper or TV is the good medium for gaining such knowledge.
Mass media came out to be the most prominent source of creating
awareness about nutrition.
Government initiatives as well as other programs in this regard has proved
out to be very important and influential in this regard.
7. What are the important factors for capacity building in order to
achieve sustainability in Nutrition?
There were mixed response about important factors in order to
achieve sustainability in nutrition; the main concern for men and women were
about their capability in terms of their financial positions, where as the
adolescent girls were more interested in getting knowledge about nutrition.
The discussion indicates that nutrition capability is closely linked to
poverty and purchasing power. Improving girls‘ and women‘s education
can bring significant changes in nutrition improvement of the community
and that sustained changes in behaviors. Care of women before and
during pregnancy is important and recognized by the community as well
but men of the family also need to be involved in this process. Nutrition
services and information can bring behavior change rapidly, so role of
media is very crucial.
Empowerment of women in terms of food availability and accessibility
and their nutrition and health. Lower real food prices resulting from
increased food production can bring accessibility. Nutrition education or
other interventions can have a positive impact with adequate food
The government program or parallel programs help in understanding
about health and nutrition and such understanding comes from various
government sources such as pulse-polio camp, hospital and Anganwadi
Centers. Schemes empowering girls and women have been successful and
have brought about much change in the society.
Awareness regarding nutrition among adolescent girls is increasing which
is a good indication. They know the use of different ingredient while
cooking in order to have the healthy diet.
Generally the person who decides upon the meal of the family knows
better about the nutrition requirement of the family. The response showed
no gender bias in deciding upon the meal for the family. In most of the
family it is decided by the influential lady in the house.
It is revealed that people know about the different nutritional requirement
of women and men. Some know that men and women require different
nutritional elements and women require more energy because they take
care of the whole family which makes her tired mentally and physically.
Women require nutrients such as Iodine, Calcium and Iron.
They also knew that during pregnancy, women require more nutrition
which they can get from milk, salads, fruits & sprouts. Women need to
continue with nutrient rich food after pregnancy also.
Sustainability in nutrition can be achieved by proper knowledge and
guidance about nutrient content of food item. The packed food should
have their nutrient content printed on it. Newspaper or TV is the good
medium for gaining such knowledge.
The important factors in order to achieve sustainability in nutrition; the
main factor is the capability in terms of financial positions and other
factors included getting knowledge about nutrition.
Sustainability in nutrition by capacity building can be achieved through
Empowering women, especially girls through education about their
nutritional requirement, personal hygiene and health services.
Involving and educating PRIs and locals to improve understanding and
ensure effective community participation.
Creating awareness of 360 degree approach of child care starting right
from awareness and care for adolescent girls to the lactating mothers.
Increasing dependence on the locally available resources & practices and
awareness about its nutritional quotients. Lower real food prices resulting
from increased food production can bring accessibility as well.
Reduction of malnutrition from preventable causes by behavioral change
like maintaining sanitation, child care, being gender sensitive and
understanding mother-child relation.
Evolving cost effective locally sustainable models to meet
socioeconomic, environmental, behavioral, health and nutritional