For several decades, India has faced the challenge of eradicating rampant malnutrition all age groups. Malnutrition can be defined as deficiencies, excesses, or imbalances in a person’s intake of nutrients, and is a problem big enough for India to make it a critical national priority.
To curb the malnutrition crises across the country, the government launched the POSHAN Abhiyaan (Prime Minister’s Overarching Scheme for Holistic Nutrition) to improve nutritional outcomes for children, pregnant women and lactating mothers. The initiative was launched on March 08, 2018 by the Prime Minister in Jhunjhunu, Rajasthan.
Initially, the scheme was targeted for three years until March 2021, covering key aspects of the prevailing malnutrition situation in the country; however, after understanding the impact and prospect, the government has amalgamated various programmes with similar objectives such as Supplementary Nutrition Programme and POSHAN Abhiyaan under one umbrella–Mission POSHAN 2.0—for creating synergies in operations and adopting an integrated approach in the nutrition services mechanism.
Need for POSHAN Abhiyaan
India has attempted several nutrition programmes over the last four decades, with formulation of the Integrated Child Development Services (ICDS) and nationwide execution of the mid-day meal scheme.
However, nutrition and stunting continue to be persisting challenges for the country.
While India’s malnutrition rates have dropped significantly, the country is still home to the largest number of stunted and wasted children (children with low weight-for-height) in the world. Owing to the cultural and geographical variance across states, combating malnutrition requires a granular approach. POSHAN Abhiyaan, the government’s national nutrition mission launched in 2018, aims to provide a convergence mechanism for the country’s response to malnutrition.
Principal goal of the POSHAN Abhiyaan is to improve nutritional status of children (0-6 years), adolescent girls, pregnant women and lactating mothers. POSHAN Abhiyaan is a three-year programme to ensure a holistic approach, covering all 36 states and union territories. The target of the mission is to bring down stunting in children (0-6 years), from 38.4% in 2016 to 25% by 2022. POSHAN Abhiyaan also aims to reduce anemia among women and adolescent girls (15-49 years) and improve birth weight. The strategy presents a unique opportunity to eradicate undernutrition in the grassroots. It is an overarching multi-ministerial convergence mission that is working towards a malnutrition-free India by 2022.
The mission is a conjunction of various schemes/programmes including the Pradhan Mantri Matru Vandana Yojana (PMMVY), Anganwadi Services, Scheme for Adolescent Girls under the Ministry of Women & Child Development (MoWCD), the National Health Mission (NHM) of the Ministry of Health & Family Welfare, Swachh Bharat Mission of the Ministry of Drinking Water & Sanitation (MoDW&S), Public Distribution System (PDS) of the Ministry of Consumer Affairs, Food & Public Distribution (MoCAF&PD) with the Ministry of Panchayati Raj (MoPR), Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) of the Ministry of Rural Development (MoRD) and other urban local bodies through relevant ministries.
The POSHAN Abhiyaan aims to target the unique 1,000-day window of childbirth and pre- and post- delivery support to mothers to reduce malnutrition. Implementation of the POSHAN Abhiyaan is hinged on key pillars of supporting development of services for the vulnerable populations: Technology (ICDS-Computer application software), Convergence Action Planning, Behavioral Change Communication and Capacity Building.
The POSHAN Abhiyaan aims to provide a platform for convergence of the four pillars discussed above. With the slogan ‘Jan Andolan’ (people’s movement), the POSHAN Abhiyaan intends to make the fight against malnutrition a national goal for each citizen.
As of March 2020, 2.51 billion people in the country have participated in the programme and recorded >36 million activities. A higher proportion of activities is focused on overall nutrition, anaemia, hygiene (water & sanitation), breastfeeding, growth monitoring and immunisation.
Functioning of the convergence action planning is undertaken through the following process:
Mission POSHAN 2.0 Scheme
Mission POSHAN 2.0 was launched by Finance Minister Nirmala Sitharaman in February 2021 to prevent any further backsliding of nutrition indicators. The announcement was made as the government decided to devote attention and resources towards integrating numerous nutrition schemes in the country. Mission POSHAN 2.0 brings together the Integrated Child Development Services (ICDS)—Anganwadi Services, Supplementary Nutrition Programme, POSHAN Abhiyaan, Scheme for Adolescent Girls and National Crèche Scheme.
The ICDS Scheme is primarily designed to bridge the gap between the Recommended Dietary Allowance (RDA) and the Average Daily Intake (ADI). The ICDS Anganwadi Services or the Saksham Anganwadi Scheme was designed to upgrade the Anganwadi infrastructure and transform them into learning and healthcare centres for children. The supplementary nutrition programme is one of the six services provided under the ICDS Scheme to improve the health and nutrition status of pregnant & lactating women and children aged 6 months–6 years. The ICDS has been implemented by the Ministry of Women and Child Development. The role of the Scheme for Adolescent Girls and the National Creche Scheme in Mission POSHAN 2.0 is yet to be defined.
The objective is to implement a comprehensive, unified strategy to strengthen nutritional content, delivery, outreach and outcome, with renewed focus on developing practices that nurture health, wellness and immunity to disease and malnutrition in the country. The goal is to have a collaborative effort in executing these programmes to counteract regression in the health and nutrition index.
Outreach and Implementation
For this mission, the government has identified 112 aspirational districts for the initial phase. Implementation of this programme will be done by the Ministry of Women and Child Development in collaboration with the Ministry of Health and Family Welfare and the Ministry of Education under the aegis of Early Childhood Care and Education (ECCE) within the National Education Policy (NEP).
The Finance Ministry has earmarked an estimated budget of Rs. 20,105 crore (US$ 2,741 million) for the programme for FY2021-22. This is the overall estimate for five schemes that have been merged for Mission POSHAN 2.0. Segmented budget estimates have not yet been disclosed in the public domain. In the last fiscal cycle, actual expenditures on these five schemes stood at Rs. 18,927 crore (US$ 2,581 million).
Mission POSHAN: Key developments and initiatives
POSHAN Gyan Portal
On April 13, 2021, NITI Aayog, in partnership with the Bill and Melinda Gates Foundation and the Centre for Social and Behaviour Change, Ashoka University, launched POSHAN Gyan, a national digital repository on health and nutrition.
The repository enables search and has information pertaining to communication materials on 14 thematic areas of health and nutrition across diverse languages, media types, target audiences and sources. The POSHAN Gyan repository has been sourced from the Ministries of Health & Family Welfare and Women & Child Development. The website provides an intuitive interface for multiparametric searches, multiple downloads at any point in time, easy content sharing via social media and easy viewing on any type of smartphones.
POSHAN Tracker Mobile Application
One of the major objectives under the POSHAN Abhiyaan is to leverage technology for monitoring and improve service delivery for beneficiaries including children (0-6 years), pregnant women and lactating mothers. In this direction, a robust ICT-enabled platform—‘POSHAN Tracker’—was developed by the MoWCD and launched on January 13, 2021 to ensure real-time monitoring of providing supplementary nutrition for improving nutritional status of beneficiaries and real-time information for prompt supervision and management of services.
Pilot Programme under Mission POSHAN 2.0
In February 2021, the union government under Mission POSHAN 2.0 and in accordance with the Ministry of AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy) formulated a plan to develop a robust AYUSH-based nutrition and health system. For this, a pilot programme will be rolled out at ~10,000 Anganwadi centres to test the efficacy of AYUSH-based intervention and nutritional support in addressing problems of malnutrition and malnourishment. Data generated in this initiative will be scientifically evaluated and analysed by the MoWCD. The objective of the programme is to create a mechanism to promote “healthy diet and lifestyle modification as per Ayurveda” as well as prevent and overcome malnutrition by providing proper AYUSH care to pregnant and lactating mothers, and children at various stages.
Tackling Malnutrition during the Pandemic
The foremost strategy adopted by the centre to handle nutrition schemes and services during the Covid-19 crisis has been the provision of supplementary food and rations at the doorstep of beneficiaries through Anganwadi centres and workers. The life insurance cover for Anganwadi workers has been increased from Rs. 30,000 (US$ 400) to Rs. 200,000 (US$ 2,655) to boost their morale. Online training sessions have been organised by the MoWCD at which a total of 700,000 beneficiaries have discussed the necessary safety and security protocols for the pandemic and psychosocial issues it has thrown up. An effective policy is being worked out to open Anganwadi centres and amplify services. The reverse migration that occurred during the pandemic-induced lockdown, forcing many migrant workers and their families in urban areas to return to their villages, has increased the number of beneficiaries that local Anganwadi centres have to support.
Engaging the Private Sector in POSHAN Abhiyaan
In March 2019, IMPAct4Nutrtion, an initiative convened by UNICEF, Tata Trusts, Sight and Life, CSRBOX, CII, WeCan and NASSCOM Foundation was launched in New Delhi. IMPAct4Nutrition is a platform for the private sector to actively engage and build a social movement with their employees, customers and employees’ families who form a part of their business ecosystem and support the POSHAN Abhiyaan. The platform helps in engaging and supporting the private sector to increase nutrition awareness and improve Nutrition Literacy – or health, hygiene, food and literacy. Besides becoming a part of the POSHAN Abhiyaan, it has also given companies a chance to impact social and economic change by promoting malnutrition-free families.
The Road Ahead…
Spread of COVID-19 and subsequent lockdowns have made POSHAN Abhiyaan even more important as this pandemic brought several serious economic challenges for the whole economy, especially for the economically weak. Thus, to revamp the aggravated nutrition programme, the government has outlined a strong budgetary push for nutrition-specific programme under Mission POSHAN 2.0.
A national ‘Commitment to Action’ has been made to achieve nutrition security in an intensive, synchronised and effective manner despite the COVID-19 pandemic. The need of the hour is sustained leadership for food & nutrition security and a combined multisectoral approach to ensure that POSHAN Abhiyaan is being implemented with ambitious targets and supplementary actions. The ‘Commitment to Action’ aims to ensure adequate financing to deliver essential nutrition interventions at scale while monitoring equity. It will bolster the efforts during crisis to address food security including dietary diversity and access to adequate micronutrients, primary healthcare, safe drinking water, environmental and household sanitation, along with addressing gender-based issues such as women’s education and delaying the age of conception.
Proactive measures are needed to address the longstanding issues of malnutrition and food insecurity in the country. The imperative is to formulate structured, time-bound and location-specific strategies with due consideration to the effects of socioeconomic factors and impact of the pandemic. It is also crucial to create a comprehensive approach that will address the different sectors and dimensions of nutrition.