The case for community-led action to fight malnutrition in rural India


India is host to more than 30% of child wasting globally, which is one of the main reasons for its deplorable child mortality rates also. What is even more surprising is the absolute stubbornness that this menace has shown over the last decade, despite huge amounts invested in building public infrastructure and trained human resources. The fact that about 20% of all Indian children are wasted is a harsh testimony that the present approach to handle this grave crisis needs to be relooked into and appropriately remodelled. This is essential to build a future Indian populace which is healthier, largely immune to diseases and happier. Given the humongous population still under its sway, Severe Acute Malnutrition (SAM) needs focussed attention and innovative approaches to handle the situation better.

In this context, the effectiveness of Community based Management of Acute Malnutrition (CMAM) approach needs to be emphasized. Not all SAM cases need institutional treatment. And given the huge disparity between demand and supply of public health infrastructure, alternative approaches to handle SAM would always be essential. Uncomplicated SAM is treated more effectively through an established CMAM model. Given the high Out Of Pocket Expenditure (OOPE) model on which the current health infra is based on, (especially the case with private establishments), the need for treating SAM children in the community using certain best practices cannot be over-emphasized.

A model where CMAM could supplement the in-patient facilities would always be a welcome change, considering the benefits that the target population receives. A far cry from the monotonous nutrition provided by food security schemes for poor and needy, a comprehensive CMAM approach ensures that adequate nutrition is made available and accessible to the SAM-afflicted children through Ready-To-use Therapeutic Food (RUTF) and home-based initiatives from healthcare extension workers. All this encompasses to create a positive environment, in which the child is cared for his immediate health concerns, and approach may be appropriately tweaked and customized according to requirements. This is more effective, efficient and economical in dealing with SAM. This also leads to minimal disruptions in the family from their everyday chores, as often happens in case of institutional treatment.

POSHAN Abhiyan launched by the Government of India to improve the nutritional status of malnourished children is a concerted effort in the right direction. CMAM approach could be a crucial pillar in this scheme, and enable it to assume larger proportions. Scaling the approach could also pave a sustainable pathway to take decisive actions for eradicating SAM. This multi-pronged approach is indispensable to handle child wasting in entirety, given that the dynamics behind SAM is not a simple cause-and-effect health condition.

Taking advantage of the already vast expanse of healthcare extension workers deployed on ground (Auxiliary Mid-Wives and Anganwadi workers), and successful programmes in Jharkhand, Bihar and Rajasthan already making CMAM a viable approach, it is time to push the pedestal to the next level. Provisioning energy dense RUTF could be one of the most cost effective ways to handle SAM at the community level. Complementing other health inputs, RUTF has been proven to make the child nourished with essential nutrients. Resultantly, the child gains weight and wasting is slowly but effectively handled.

India is at the cusp of leveraging the advantages accruing from a favourable demographic dividend. For it, a healthy workforce is essential. High-impact nutrition interventions like CMAM could go a long way in enabling the vision of healthy and prosperous children. The time to act is now.