POSHAN Abhiyaan or National Nutrition Mission was launched in 2018 by the Government of India with an aim to tackle the burden of malnutrition, stunting and anaemia with a focus on women and under-five children. A holistic approach was adopted to improve nutritional outcomes for children, pregnant women and lactating mothers.
Four pillars of the strategy were developed to include inter-sectoral convergence for better service delivery, use of technology for real-time growth monitoring and tracking of women and children, intensified health and nutrition services for the first 1,000 days, and lastly, the Jan Andolan or People’s Movement.
One of the biggest players in the nutrition mission is the Anganwadi Centres (AWCs), which are responsible for tracking the beneficiaries in real-time during pregnancy, as well as the height and weight of the new born child on mobile phones and tablets given to them. The centres are also supposed to follow up with SMS alerts to those who are at risk. These ground-level monitors are a key factor in making informed decisions.
Another key player in this mission is ASHAs (Accredited Social Health Activist). ASHA didi, as they are called locally, are women from the community who work at ASHA centres. They are the real foot soldiers responsible for the ground-level Jan Andolan (People’s Movement) against malnutrition. They go door-to-door to ensure the delivery of public programmes and services. They have several responsibilities, be it nutrition, family planning, women’s health or administering the anti-filaria pill during Mass Drug Administration.
There is still massive scope for the improvement of the effectiveness of ASHA workers.
Firstly, it is their role of doorstep delivery of healthcare services that makes an ASHA the backbone of the healthcare system within a community.
They are recognised and welcomed in households because people in the community know them and trust them. However, they are not a part of the government wage structure. Their paid incentives are sometimes even less than that of any domestic help earning in cities. It is only social recognition and motivation that keeps them going.
It is essential to equip ASHA workers with the right tools and technology to reduce their workload and effectively document the data they capture during their household visits. Tools and technology clubbed with consistent training/capacity building and social recognition will make the role of ASHA centres more effective. The right and optimal usage of technology is essential, whether it is for ASHA or any ICDS workers.
Secondly, we cannot get far into achieving the goal of well-nourished India without engaging young boys and men into the conversation.
Patriarchy plays a superlative role in the cycle of malnutrition. In an Indian rural household, where the availability of food is limited, the man of the household will eat first, followed up by kids and then women, who will be left with very less food, resulting in undernourishment, anaemia, etc. When an under-nourished woman delivers a child, the new-born can be severely acutely malnourished or malnourished. And if that’s not the case, the already undernourished mother might not be able to breastfeed the baby adequately. And this starts the vicious cycle of intergenerational malnourishment or undernourishment, which, as per NFHS-5 data that shows an increase in malnutrition across India, is a big burden on the country.
This case, however, is not the only reason to sensitise our boys, who will grow up to make household decisions. There is a need to sensitise these boys on the economic benefits of nutrition. It is important to engage boys in a conversation on overall family nutrition, including girl child nutrition, and child and mother nutrition.
Lastly, focus on appropriate counselling on nutrition.
ASHA workers must ensure targeted counselling of each mother on getting appropriate nutrition during her pregnancy and after childbirth to ensure delivery of a healthy baby. The administration of Iron and Folic Acid and counselling of women on consuming this regularly is important to address the high burden of anaemia in this country.
If POSHAN Abhiyaan can focus on the above three strategies – equipping ASHAs with skills and technology, engaging young boys in the nutrition conversation, and targeted counselling of women and new mothers – we will be able to achieve our nutrition goals for the country and truly be a Swasth Bharat, Sreshth Bharat.
About the author: Iqra Razi is a Public Health Communicator, working in Footprint Global Communications. Find her on Twitter @razi_iqra.