Sustainability in nutrition by capacity building

Sustainability in Nutrition by Capacity Building

-Manisha

Table of Contents:

Introduction Literature review Objectives Methodology Observations and Analysis Conclusions Recommendations

Introduction 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 productivity.

Contd….

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.

Contd….

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

sustained.

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).

Contd….

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 areas.

Contd….

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 .

Contd….

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 nutrition issues

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.

Contd….

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 sharing food.

Awareness regarding Nutritional requirements of the vulnerable groups

Behavior pattern

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 malnutrition.

Contd….

Community Participation

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 children.”

- Vulimiri Ramalingaswami, "The Asian Enigma" .

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Existing Policies In ICDS For SNP

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;

Contd….

[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.

Contd….

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)]

Strengths: 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.

Weaknesses: Excessive dependence on NGOs and/or external funding.

Contd….

Opportunities: 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, accessibility.

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 not possible.

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 OECD)

Factors Affecting the Sustainability of the Programs in Nutrition

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, and communities;

Facilitating healthful and ecologically sustainable food choices;

Conducting clinical assessments and nutrition counseling;

Designing and implementing public health nutrition assessments and programs;

Contd….

Understanding and applying principles of nutritional epidemiology;

Applying nutrition science and exercise science principles to recreational and competitive athletes;

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-help efforts.

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 appropriately.

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 nutrition activities.

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.

Methodology

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.

Contd….

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 participants.

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

Responses of the Participants of the Groups

1. Do you know about the nutrition and its impact on growth?

Response:

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 understanding nutrition?

Response:

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 consuming it?

Response:

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?

Response:

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?

Response:

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?

Response:

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?

Response:

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.

Conclusion 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 availability.

Contd….

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.

Contd….

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.

Contd….

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.

Recommendations Sustainability in nutrition by capacity building can be achieved through following

initiatives:

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.

Recommendations

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 determinants.

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