Dr Jon Rohde on Outlook Poshan 2.0 Reach Each Child initiative launched by Outlook and Reckitt.
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00:00 [MUSIC PLAYING]
00:03 I'm delighted to be here and reflect
00:07 on the longstanding chronic problem of malnutrition
00:12 in India.
00:14 As some of you know, I have been involved in India
00:18 in the health and nutrition field for close on to 40 years,
00:22 or maybe a little more than that by now.
00:25 And it is frustrating for all of us
00:28 to recognize what a huge effort India has made,
00:31 and yet relatively small results have come from this.
00:36 The ICDS is surely the largest child nutrition and development
00:42 program in the world, and the investment in it
00:45 has been tremendous.
00:48 Sadly, there are just some flaws in the ICDS program
00:52 that have constantly weakened it and made it
00:57 so that only in very rare cases do
01:00 we see a measurable effect on nutrition in the community.
01:05 Let me take you back for a moment to the earliest work
01:10 when ICDS started in the 1970s.
01:16 It was modeled on the best thoughts of the time
01:21 that children needed to be seen each day
01:24 and given a food supplement.
01:26 They were sourced to be--
01:28 the Anganwadi was a program that had been developed years
01:32 before in India on a small scale,
01:34 and the government picked it up.
01:36 Dr. BN Tandon was the technical guide.
01:40 Now, at that time, the World Bank
01:42 was interested in assisting India
01:45 with the nutrition problem, and they
01:47 established the TINIP program, the Tamil Nadu Nutrition
01:52 Intervention Project, which eventually covered 10 districts
01:58 out of 22 in Tamil Nadu and had remarkably good results.
02:06 This, in contrast to the ICDS, what was the difference?
02:09 There still were community nutrition programs
02:13 like Anganwadis.
02:14 They didn't call them that.
02:16 They called it a community nutrition center.
02:19 The people who carried it out were recruited
02:24 from the villages themselves.
02:26 They were not from outside.
02:28 They were given the training, and then two days a month,
02:31 they were given upgrading by the same trainer that
02:34 had trained them originally at the block level.
02:37 Now, this really resulted in a trained workforce
02:43 of volunteers that was very powerful.
02:46 And the very basis of TINIP, and which I think
02:51 should be the basis of ICDS, is the monthly monitoring
02:56 of the growth of each child.
02:59 TINIP did not provide food supplements to everybody
03:02 every day.
03:03 TINIP had what they called a selective choice
03:07 of who needed to be fed.
03:10 Now, all children who were in grade three and grade four
03:13 malnutrition were included in those fed daily.
03:16 That was about 12% of the children.
03:19 However, more importantly, the monthly weighing
03:23 identified children who may be still normally nourished
03:27 or not severely malnourished, but who were
03:30 faltering in their weight.
03:32 Their weight was not gaining, and the mothers
03:36 were encouraged for two months in a row to feed more
03:41 and to pay attention to hygiene.
03:44 But if the child still didn't gain weight,
03:46 or in fact was losing weight, they
03:50 were enrolled in the program and given a daily food supplement
03:53 as well.
03:55 Now, eventually, over the course of 10 years
03:58 in the TINIP project, just about every child--
04:03 well, 80% of the children actually
04:06 required a period of feeding.
04:08 But it was only for a maximum of 90 days,
04:12 during which time every child began to gain weight again.
04:16 And the mothers were reinforced with nutrition education
04:21 daily, saying, you see, your child can gain weight
04:24 if you feed the child enough.
04:26 Now, you must pay attention, feeding frequently,
04:30 and so forth.
04:31 So this program really focused on growth monitoring.
04:35 The mothers had the growth card themselves
04:39 so they could see the trace of the weight going up or not
04:43 going up.
04:44 And it became the major educational tool.
04:48 Unfortunately, the ICDS, all the weight charts are in a book.
04:53 And so the mother never even sees them, and most of them
04:56 don't get recorded properly in any case.
04:59 But the weight chart became the educational tool
05:03 for these mothers.
05:04 She could see when she was being successful and when not simply
05:08 by the monthly weighing.
05:10 Importantly, the TINIP focused on the 0-
05:14 to 24-month-old child.
05:18 Actually, it carried them up to three years at 36 months.
05:21 But the real time of malnutrition developing
05:25 and becoming critical is in the first 24 months.
05:30 Well, my message for Outlook and Pochon
05:34 is that you should be convincing people everywhere you have
05:38 influence that they should put more emphasis on the young
05:42 child from birth up to two years of age,
05:46 with particular emphasis on monthly growth monitoring
05:51 and intervening with that child if faltering occurs.
05:55 A child is born fat and happy.
05:58 And if we wait until the child is thin and cranky,
06:04 we're not going to beat this problem.
06:06 But if we start at birth or even before in terms
06:09 of the mother's nutrition, I think
06:11 India can as shown even in the TINIP project.
06:15 And demonstration always works much more
06:17 than lectures and harassment, even from experts like me
06:22 or wherever they're from.
06:24 Just saying it doesn't do as much as seeing it.
06:27 And seeing is believing.
06:29 And we found Indonesia never had any food supplements.
06:33 But they have a nationwide program of growth monitoring
06:36 with a nationwide slogan that says a child who is well as he
06:43 grows in age grows in weight.
06:45 And that's what their goal is.
06:48 If you grow in age, you grow in weight.
06:50 If it doesn't, then be worried and do something about it.
06:54 So that should be Pochon's mantra, I think.
06:58 And the more places you can get to at least
07:00 try to focus on this, the better I think you'll spread the word.
07:07 (gentle music)
07:09 [Music]