Is Covid-19 a roadblock in Indias Poshan Abhiyan?
Covid-19 restrictions have impacted the midday meal due to the shutdown of schools, caused diversion of ASHA workers to Covid-19 related duties, and resulted in the closure of Anganwadi centers. (Representational image: IE)  By Dr K Madan Gopal,  The Covid-19 outbreak is probably one of the most difficult challenges that India has had to face since independence. No country was prepared to handle a pandemic of this nature. The governments response to the various challenges of this pandemic has been dynamic and evolving with situational demands. While the lockdown measures and travel restrictions helped curb the spread of the pandemic to a certain extent, various other tools such as testing and tracing, community-based approach to pandemic management, among others, have been crucial during these times. This pandemic has put our collective resilience to the test. On the one hand, the only way to better manage the spread of the pandemic was lockdown measures. On the other hand, the very same effort impacted other health services such as nutrition. The Azim Premji University conducted a Covid-19 Livelihood Survey in 2020, which found that two-thirds of the respondents had lost work during the lockdown in 2020. Further, almost 8 in 10 respondents were eating less food than before. The survey also found that the impact of job losses and food insecurity has been higher for marginalized groups and lower education levels. Covid-19 restrictions have impacted the midday meal due to the shutdown of schools, caused diversion of ASHA workers to Covid-19 related duties, and resulted in the closure of Anganwadi centers. Thus, Indias malnutrition problem has emerged as a pressing health emergency that may set back Indias gains made in improving nutritional indicators over the last few decades. UNICEF has in its report highlighted that child mortality in India is set to increase by 15.4%. The Ministry of Women and Child was quick to foresee the disruptions mentioned above and had issued a letter as early as March 2020 directing utilization of services of Anganwadi workers/helpers for doorstep delivery of supplementary nutrition. It also issued a guidance note for state governments to resume operations of Anganwadi centers dated November 11, 2020. While the circulars intended to protect Indias gains in the fight against malnutrition, the situation was quite different on the ground. Beneficiaries often only received reduced amounts of Take-Home Ration due to the closing down of many of the food manufacturing units and disruptions in the supply distribution chains. In addition to this, healthcare providers and civil society organizations have been at the forefront of dealing with the pandemic, resulting in reduced care for the malnourished and marginalized communities. With its ears on the ground, the Government has tried to minimize the impact on livelihood and malnutrition and announced a slew of measures. As per the Economic Survey (Chapter I, Vol 1) 2020-2021 as part of the governments fiscal policy response to the pandemic, INR 68,914 crore had been disbursed as of 31 December 2020 under the Pradhan Mantri Garib Kalyan Package to a total of 42.1 crore beneficiaries. The Government has also strengthened its commitment to malnutrition and increased the budgetary allocation for nutrition-related programs to INR 35,600 and provided for an additional INR 28,600 crore for women-related programs. The current situation is precarious and in addition to increased fiscal spending, it also requires immediate policy interventions. Firstly, state governments must ensure that each beneficiary receives the required nutrition at their doorstep or the Anganwadi centers whenever local conditions permit. Covid-19 is here to stay, and effective monitoring and supervision strategies need to be put in place to ensure that no restriction disrupts the food supply. Secondly, besides local fresh food, malnourished women and children must get access to nutrient-rich food. In addition to improving the nutrition level of women and children, this will also help ensure they have stronger immunities to fight the Covid-19 virus. Thirdly, there should be an increased focus on community-level management of severe acute malnutrition (SAM). The Covid-19 experience has highlighted the importance of community management which helped in effective contact tracing and monitoring of symptoms, facilitated doorstep delivery of medical care, reduced burden on hospitals, and helped dispel the stigma associated with the disease. Covid-19 restrictions make it difficult for children and their caregivers to frequent nutritional rehabilitation centers (NRCs), which are in any case present only at the block level. Most of the SAM cases dont require care at NRCs but need consistent care and monitoring at the community level. The focus should therefore be shifted to inexpensive and effective care that can be administered by individual community members with appropriate training. Fourthly, while the Government has introduced health insurance for all health workers, including ASHAs with an insurance cover of INR 50 lakh in case of loss of life due to COVID-19, there still exists hesitancy among them and has caused disruptions to the services provided by them. Asha and Anganwadi workers need to be provided with protective equipment and appropriate technology to continue monitoring women and children in villages both physically and remotely. Covid-19, a once-in-a-century crisis may have hit Indias progress, but all is not lost. As per the NHFS V Phase 1, which was conducted before the pandemic, India has recorded a declining infant mortality rate however the nutritional status of children below 5 years of age has worsened. It is only expected that the continued impact of Covid-19 will result in further deterioration of health indicators. The age-old adage prevention is better than care holds for the nutritional emergency in India because unless nutrition is given the importance it requires, both communicable and non-communicable diseases will wreak havoc among Indias vulnerable populations. Therefore, governments need to be extra vigilant and ensure that the citizens suffering from malnutrition get their timely dues and fulfill their Constitutional responsibility to raise the level of nutrition and the standard of living of its people. The author is Senior Consultant  Health, NITI Aayog. Views expressed are the columnists own.