India’s Directorate General of Registry has confirmed that India’s maternal mortality rate was 97 between 2018 and 2020. Between 2001 and 2003 she was 301. In 2005 the infant mortality rate was 58. In 2021 there were 27. There are several reasons for lowering unhappiness, but there is still a long way to go. However, since 2005 the pace of decline has picked up momentum.
The National Rural Health Mission (NRHM) was launched in 2005 to provide accessible and affordable health care through the public system of primary health care. and to provide secondary and tertiary health services in the public system, in parallel with private capacity to ensure quality services at effective rates. Unfortunately, NRHM quotas were not keeping up. But it seems to have had a positive impact on many metrics. Health facilities are looking better with untied funds, doctors, medicines and diagnostics are a reality, institutional deliveries are booming, ANM and nurse vacancies are starting to fill, and he is in the community. of ASHA workers began putting pressure on the public system. By taking the patient there.
What explains these benefits?
First, NRHM had a clear drive to build a responsible public system in primary care. Community connectivity, human resource capacity were critical, and flexible financial resources were available at all levels. Second, partnerships between central, state and local governments and civil society, with full engagement of frontline workers, were critical. Planning had to start from the bottom up. Community oversight was led by civil society. Third, the approach was pragmatic and offered a diversity of state-specific interventions. A decentralized planning process has become the norm, with states developing annual plans based on local health action plans.
Fourth, institutional building was facilitated by working with panchayat and institution-specific Rogi Kalyan Samitis or hospital management committees. Civil society participated in community activities through the Population Foundation of India. Experts were brought in to improve the process. More than 60% of his funding is to be spent at the district level, with untied grants available at all levels of the medical institution.
Unfortunately, nutrition science has not seen this kind of initiative. In the 5th National Family Health Survey 2019-21, she reported that 35.5% of children under the age of 5 were stunted, 19.3% were spenders and 32.1% were underweight. These are unacceptable levels. Poshan Abhiyan, though innovative, has not yet addressed the challenges of institutional decentralized public action.
Unfortunately, our nutrition initiatives remain compartmentalized and fragmented. Although ICDS is considered a nutrition initiative, the institutional role of local panchayat and communities is still lagging due to untethered funding sources. Nutrition does not lend itself to narrow sectorism, and such non-institutional wider partnerships are doomed to failure.
The multifaceted nature of undernutrition makes it imperative to revamp the ICDS to converge health, education, water, sanitation and food security at all levels under the umbrella of local government. Given the variety of circumstances, situation-specific need-based prioritization across all Anganwadi centers by allowing flexibility through decentralized local actions enabled by accountable and decentralized funding It is important to allow
The 12 restructuring principles for nutritional success should be: (ii) There is also a need for relevant broader departmental panchayat-led committees at the Jira parish level in blocks and districts. (iii) operationalize village-specific planning processes with decentralized funding; (iv) enable simultaneous interventions for all of the broader determinants of nutrition; (v) Assess additional care providers and develop capacity to ensure the intensity of home visits and monitoring necessary for nutritional outcomes. (vi) Encouraging the diversity of local cuisine, including millet, and serving it piping hot; (vii) ensure the availability of basic medicines and equipment for health care and growth monitoring in each village; (viii) Strengthen communication on behavior change. (ix) Institutionalize monthly health days in all Anganwadi centres, with community connections and parental involvement. (x) Create a platform for adolescent girls in every village to empower them and earn a diverse livelihood through their skills. (xi) Decentralized district planning based on village plans should be the basis for interventions to prevent Anganwadi from facing deficits such as buildings and unfixed resources. (xii) Move to a “leave no one behind” rights-based approach and ensure universal coverage of all needs of adolescent girls under six and pregnant women;
With the right impetus, the problem of undernutrition can be effectively addressed in the short term. The recently released NFHS-V highlights an unfinished agenda and a slow decline in undernutrition. Nutrition as a subject does not lend itself to narrow sectorism. It requires a whole-of-government and whole-of-society approach. Technology is at best a means, and monitoring must also be local. Panchayats and community organizations are the best way to go. But the nutrition challenge is also a women’s empowerment challenge. Behavioral changes are needed in favor of exclusive breastfeeding, whole foods instead of junk her food, clean water and sanitation.
We should never give up our efforts to build a reliable public healthcare system. Learn from your successes and failures and start rebuilding your nutrition initiatives.
The author used to belong to IAS.Views are personal
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