How the Pandemic affected nutrition in India
Dr. Francesco Branca, Head of Nutrition WHO, Dr. Shweta Khandelwal, professor at the Public Health Foundation India, Mr. Chanchalapathi Dasa, Vice-chairman of Akshaya Patra Foundation, Dr. Sujeet Ranjan Executive Director of the Coalition for Food and Nutrition Security and Dr. Arjan de Wagt, Head-Nutrition UNICEF India share their insights.
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00:00:00 Hello and welcome to this special webinar on 1000 days in the pandemic. I'm your host
00:00:07 Aminanda Sengupta and we have a really illustrious list of panelists lined up today. Before I
00:00:14 introduce them, a quick word about why we are running this program and what we hope
00:00:17 to achieve. Outlook has launched this campaign to understand the implications of this pandemic
00:00:23 on the government's 1000 day program. We would also like to examine ways and means to ensure
00:00:28 that it is brought back on track, perhaps in a more effective manner while adhering
00:00:33 to the restrictions imposed on us like social distancing. In the process, we also hope to
00:00:39 bring about awareness about this program among people who may not understand why this program
00:00:43 is so critical, not just for expectant mothers and their children, not just for the nation,
00:00:49 but the entire world. With that, let me start introducing our panelists today. We have Dr.
00:00:55 Francesco Branca, head of nutrition WHO, who has logged in all the way from Geneva. Thank
00:01:02 you, sir, for that. Dr. Shweta Kancheval, professor at the Public Health Foundation
00:01:08 of India. Mr. Chanchalapati Dasa, vice chairman of Akshaya Patra. Dr. Sudhir Tharanjan, executive
00:01:16 director of the Coalition for Food and Nutrition Security. And of course, Dr. Aryan Deewaad,
00:01:23 head of nutrition, Unicef India. Let me start off with Dr. Branca. Dr. Branca, if you could
00:01:28 give us a sort of a global perspective on how this 1000 days program has been impacted
00:01:34 by the pandemic, particularly in developing nations. And what steps has WHO taken to sort
00:01:41 of elevate the challenges that this pandemic has brought us? First, let me thank Outlook
00:01:49 and Poshan for the opportunity to discuss these issues. We all know that early nutrition
00:01:55 is so critical for child health, for giant growth and development, but also for long-term
00:02:01 health, the prevention of non-communicable diseases and the long-term performance on
00:02:06 physical mental health, educational attainment, job success, salaries. So that's so critical.
00:02:12 And the world is still affected by a large number of children who are malnourished. We
00:02:21 have 144 million children with stunting and 47 million children with wasting. And these
00:02:27 are our latest estimates. So we're doing a bit better, but what is happening is now that
00:02:35 the pandemic is probably going to push us back. I must say that I'd like really to praise
00:02:41 the government of India for having made the fight to malnutrition a priority. And this
00:02:48 requires really action in multiple sectors, certainly health, social support and food
00:02:54 system. Now COVID-19 has had an impact in all those systems. We have seen an increase
00:03:01 in food insecurity, with closure of markets, decline in agricultural production, disruption
00:03:07 of household economic job losses and an impact on dietary adequacy. And we have seen a major
00:03:15 impact on health system. Now WHO has just completed an assessment in 70 countries and
00:03:22 are just looking at the services that are really for having an impact on child nutrition.
00:03:31 We have in 45% of the countries, a partial disruption of the services to manage malnutrition,
00:03:40 5% with complete disruption. Immunization services, 54% partially disrupted, 17% completely
00:03:48 disrupted. Antenatal care, 59% partial disruption. Even facility-based births have been disrupted
00:03:56 in a third of the countries. And I must say that we're concerned to see that India is
00:04:01 reported a large degree of disruption. And this is due to the fact that people don't
00:04:07 go to the services. I mean, they are restricted by the breakdown of transport, they cancel
00:04:13 appointments and preventive services have suffered a lot. So health systems have perhaps
00:04:22 in this last few months failed to address the needs of this particular groups. And this
00:04:33 actually adds up to a deterioration of care practices. I mean, in some countries there's
00:04:37 been even the recommendation to separate mothers and/or caregivers from children due to quarantine.
00:04:46 And that has led to a problem to breastfeeding. But we anticipate now that this is going to
00:04:53 have an impact on nutrition. We anticipated probably something in the order of 10 to 20%
00:05:01 more children which will show malnutrition. And that's really a striking figure. So WHO
00:05:09 is working really to maintain essential services. We have been in the context of the COVID response.
00:05:19 We've been supporting countries, first of all, with equipment supplies, with supporting
00:05:27 the capacities of the staff, mainly for the COVID response, but now also to highlight
00:05:34 the need to maintain essential services. There's been several guidance documents produced there
00:05:41 and WHO has worked with governments and partners to provide support to health services. I must
00:05:46 say that 60% of the countries have made a plan. So there's been a partial success in
00:05:53 making sure that this health services wouldn't be disrupted and also having a way forward
00:06:00 to correct it. And finally, particularly on nutrition, WHO is working with sister agencies,
00:06:09 particularly UNICEF, World Food Programme and FAO to launch a call to action to address
00:06:16 the impending increase in malnutrition. Thank you.
00:06:22 I think we'd really love to get involved with that programme if we can. I think if, you
00:06:26 know, if Alihan and you could tell us how we can help, we'd be more than happy to sort
00:06:30 of help you in any which way we can. But, you know, I'll come to you, Dr. Khandelwal.
00:06:35 Could you tell us a bit about what happens when this programme actually gets disrupted
00:06:40 and the sort of economic and social implications of it, both in the short and long term? Why
00:06:45 are we so concerned about it?
00:06:47 Sure. So as we have been discussing and Dr. Branko also referred to it, the first thousand
00:06:53 days are a very critical window of opportunity. They are a window of vulnerability as well
00:06:59 as opportunity because, you know, that those 1000 days make up your entire future's adult
00:07:04 life. Health and well-being is determined by those first thousand days. So it's very,
00:07:09 very important that improvements in nutrition during this period, which are going to have
00:07:13 the greatest impact in population with poor nutrition, for example, come into play because
00:07:18 of these first thousand days. And it's not now that we are discovering the importance
00:07:23 of nutrition overall in health and well-being. Adam Smith, for example, in 1776, 250 years
00:07:29 ago, you know, he believed and he said, he propagated that the wealth of nations depends
00:07:34 in part on health and on nutrition skills as well as knowledge of their people. And
00:07:39 poor health and nutrition as well as lack of education, you know, lowers economic productivity
00:07:44 as well. So you see all these concepts of productivity, of health and of nutrition are
00:07:50 very, very much interrelated. In terms of the impact which you're asking me to talk
00:07:54 about, I have summarised it as huge, you know, H, U, G, E. One is on human capital. H is
00:08:00 for human capital. And I will discuss each of these four in just a little bit. The second
00:08:04 is the undernourishment overall. So H is the human capital, U is the undernourishment,
00:08:10 G is for growth and development. The implications on growth and development cannot be missed.
00:08:15 And fourth is the E, which is the economic implications. So when I talk about this huge
00:08:21 burden of, you know, issues which India is going to face, it's really a lot of factors
00:08:27 interplaying and panning out in front of you. Now, when I said human capital, it has got
00:08:33 a very, very direct relationship with the first thousand days, because not only the
00:08:38 brain development occurs at a maximum speed during that time and leaves an impression
00:08:43 for overall life, the productivity gets impacted. There's a short stature being stunted, which
00:08:49 is also linked with economic implications later on. There are delivery complications,
00:08:54 which happen because of poor nutrition during these first thousand days. There is rising
00:08:58 overweight obesity these days, which has a link with gestational diabetes. We know that
00:09:03 if children are born small, they are low birth weight or they are born small, they are bound
00:09:09 to have a lot of high chances to get diabetes in later future, cardiovascular risks in later
00:09:15 future. So, you know, also poor IYCF, immediately after, because thousand days is also two years
00:09:21 of the child's existence in the world. And that time, what are we feeding the child?
00:09:26 How are the infant, young child feeding practices panning out? And in that context, the COVID,
00:09:32 which is right now, you know, disrupting everything will make a huge, huge impact. There's also
00:09:38 a lot of micronutrient deficiencies, which we will see in the kids to come, not only
00:09:44 because India already has a huge burden of micronutrient deficiencies, but also because
00:09:49 now the nutritious foods per se, the supply chain of those nutritious foods have been
00:09:53 hampered and they are disrupted. And so as it is, you know, the poor or even in general
00:10:00 ways, people switch to cheapest caloric intake, not on the nutrient dense foods always. And
00:10:06 right now, these nutrient dense foods are as it is, you know, impacted. And therefore,
00:10:13 all these implications on micronutrient deficiencies also are going to come to play. So that was
00:10:18 the edge, which is human capital. Then the undernourishment overall, we already know
00:10:22 we have 38% standard, 21% wasted in India. The kid numbers are, and every day, 70,000
00:10:29 kids are being born in India. Imagine the implications you are having on life. And this
00:10:35 is the birth, 70,000 are being born. So of course, the pregnancy time, the people, the
00:10:39 children who are in their first two years of life, this is a huge number we are talking
00:10:44 about. So there is a profound impact of COVID on all these services as we go along. Growth
00:10:50 and development, as I already discussed, it will have not only implications for productivity
00:10:55 of these children, but also health for later life. And economic implications, not only
00:10:59 the food prices are going to go spiralling up, which is making it difficult for people,
00:11:04 you know, as so-called, who have access and information, very difficult for us to consume
00:11:10 the five foods and vegetables every day. Imagine the people who are just very, very far from
00:11:14 this dream, so as to say. In addition, we also know that there is also an equal, in
00:11:22 fact, a very, very high returns of investment. So if I invest a dollar in nutrition programs,
00:11:28 I get $18 worth of benefits in the general global picture. But for India, particularly,
00:11:36 this has been worked out to be in fact twice as high, about $36. So even more a case to
00:11:42 sort of act now. I'll stop here and then probably we'll take questions more because I can go
00:11:48 on. And Dilwal, for putting such a huge problem into perspective, I mean, it really helps
00:11:56 us understand this whole thing. Dr. Deva, you know, UNICEF has done some really fantastic
00:12:02 work in the field of nutrition, not just in India, but across the world. But could you
00:12:07 tell us something about the challenges that you face while sort of performing your way
00:12:14 of reaching out to, you know, reaching nutrition to the right people, particularly during the
00:12:19 times of the lockdown. And more importantly, you know, I'm not talking about just UNICEF
00:12:24 per se, but maybe your partners or maybe even the government. Maybe you found some innovative
00:12:30 ways in which this was being addressed. If you can think of some, maybe you could just
00:12:34 tell us. Yeah. Thank you very much. And first of all,
00:12:40 congratulations again to Outlook portion about taking nutrition on, as you have been doing
00:12:45 for the last year. And I always say that having the media and publishers be part of the fight
00:12:50 against malnutrition is an essential component. I've been in India now more than three years.
00:12:57 I've never seen a government response like an Indian nutrition so successful and so committed.
00:13:04 It was slightly over two years ago. It was 8th of March, 2018, when the prime minister
00:13:10 launched portion Abhijan. And when it was launched, I was wondering, hey, is this another
00:13:16 promise, another document, another strategy? But actually what we have seen in the last
00:13:22 two years is very high level leadership from the prime minister all the way to chief ministers
00:13:29 to other ministers, all the way up to district and community level, a lot of action and awareness
00:13:35 on the importance of nutrition. And I've never seen it in my career working on nutrition
00:13:39 now for 25 years, that kind of leadership and that having resulting in action on the
00:13:46 ground. If you look at, for instance, portion month in September last year or early March,
00:13:52 if you see the number of people mobilized to get awareness around nutrition has been
00:13:56 amazing. There are all significant financial investment promised by the government. And
00:14:02 it's important to recognize because about half of the children have underweight or have
00:14:08 wasting that too thin or they too short, but half the children under five have one form
00:14:12 of malnutrition already as mentioned. But again, I want to start with the government
00:14:17 response of portion Abhijan because that has been amazing. And I know that many of us working
00:14:22 in India as partners from the academia, civil society, but definitely also the UN, we have
00:14:29 been amazed about this and we've all put our weight behind this government program. It's
00:14:34 an amazing program. It's an amazing promise to the children of India. And we started seeing
00:14:39 the initial results. We started seeing that malnutrition rates seem to be going down based
00:14:45 on some preliminary state data started going down slightly faster in the last few years
00:14:51 compared to the 10 years from 2016 to 2000, sorry, 2006 to 2016. So there was an asteration
00:14:58 in reduction of malnutrition and then COVID came. Yeah. And as my peers, as the colleagues
00:15:04 have said, things have really fallen down. What I'm also worried about is that what is
00:15:10 going to happen with portion Abhijan, the intensity of the guidance and the leadership
00:15:15 in portion Abhijan all the way from the prime minister, but that has been going down all
00:15:19 the way to everyone at the community level. Can we get it back again? Maybe not today,
00:15:26 maybe not tomorrow, but very, very soon again, because I know that everybody's busy with
00:15:30 COVID, but that leadership that made a difference. A lot of the services have stopped. And as
00:15:39 we, as you said, we've been working hard with government to see how can you restart services
00:15:43 again? And there's some good examples, Rajasthan, Maharashtra examples where I can value workers
00:15:51 on the frontline workers starting using within the WhatsApp groups to share information because
00:15:56 again, didn't bring people together anymore. And the group meetings were stopped. And for
00:16:01 instance, then in Rajasthan, they've been scaling it up to get nutrition messages out
00:16:06 to more than 20,000 WhatsApp groups. In Maharashtra, they saw the governance for the success of
00:16:12 the WhatsApp groups and started institutionalizing it and really supporting other body workers
00:16:17 to use that. We saw that at the beginning of the COVID crisis, that nutrition rehabilitation
00:16:24 centers were being closed. And that are centers in hospitals where the most severe cases of
00:16:31 malnourished children are being treated. They were being closed because the health workers
00:16:36 were needed or the space was needed. But in the last month, we started seeing that in
00:16:43 several states, they're trying to reopen it again. And actually, I have some preliminary
00:16:49 data from some places. We see when it comes to access to services, we start seeing a U-shape
00:16:56 where in March, all the services are basically being stopped. In March, April, not much is
00:17:02 happening. But we started to see towards the end of April and May, slowly we see services
00:17:08 starting a little bit again. And most many cases in an adjusted way. I call this COVID
00:17:14 sensitive nutrition programming. COVID sensitive delivering of nutrition programs. A very successful
00:17:22 program that the government has. And many of the partners are supporting that are village
00:17:26 health, sanitation and nutrition days. Where one day in a month, immunization is given,
00:17:34 awareness of nutrition is given, weighing is done of children. And that a mass campaign
00:17:41 kind of approaches. And we see the several states, if instead of doing it in one day,
00:17:47 they might spread it over more days and reduce the number of people and also give protective
00:17:53 measures to the agro-wildlife workers and the ASHA workers. So that indeed they are
00:17:58 protected. They're using the mouth caps, the face masks, they're using sterilization methods.
00:18:05 So we see a lot of these kinds of efforts. Two weeks ago, the Ministry of Health released
00:18:11 guidance for further, I don't support normalization, but the guidance to the states to restart
00:18:19 many of the services again. But also the Ministry of Health recognizes that, yes, we have to
00:18:25 prevent death to COVID, but not at the expense of death due to other childhood illnesses
00:18:32 and any common illnesses or also from malnutrition. And I know that UNICEF and WHO and the NGO
00:18:41 communities and all of us, we are supporting state level governments and district level
00:18:45 governments to try to translate this guidance by the Ministry of Health and by Ministry
00:18:50 of WCD to reorient front line workers on how can we continue providing these essential
00:18:56 services. But not only that, it's not only about the services. We also have to go to
00:19:02 the communities. We hear that many people are afraid of going to the health workers,
00:19:08 afraid of going to health facilities. And we also have to help people to be aware, how
00:19:15 can you protect yourself about COVID? But also how can you continue seeking services
00:19:21 when you are pregnant? And as Dr. Branca said, indeed, there is data from India that
00:19:28 seems to suggest that uptake of A&C services have reduced. Yeah, but we have to make people
00:19:35 aware, don't be afraid. Here and there, we have to explain where they can get access
00:19:41 to the services again. So that indeed, the access to services and the uptake of services
00:19:48 will continue. Thank you. Okay. Okay. Great. I think that gives us things. Mr. Das, I would
00:19:56 probably ask you the same question I asked Dr. Deho, but in a different way. Akshaya
00:20:01 Patra has one of the world's largest food programs. And it's a really fantastic job
00:20:08 of feeding the hungry, particularly the migrants who are trying to return home, things like
00:20:13 that during that time of the pandemic. But I'd like to hear from you, about the kind
00:20:18 of challenges you faced in doing this while you were implementing this, what kind of challenges
00:20:23 did you face? What kind of obstacles did you face? And the second part of that question
00:20:28 would be that, did you ever come across a different set of, let's say a pregnant woman
00:20:35 before she treated differently or was it just a generic kind of a food program? Okay. Thanks
00:20:43 everybody. Thanks Outlook portion for having Akshaya Patra in this panel. Yes. You know,
00:20:51 as you said that we have been doing the, at the very ground level work in the last two
00:21:00 and a half months during the lockdown in our country. And we have been doing two things
00:21:07 as you know that Akshaya Patra has about, we have about 52 centralized kitchens in different
00:21:14 parts of the country and about 30 or 33 kitchens are active and we are cooking meals and serving
00:21:24 to different people. And we have also been distributing grocery kits so that, you know,
00:21:32 in this particular situation where contact with people also is a bit of a challenge.
00:21:39 And so we give away a grocery kit, essential grocery kit, which will have essential groceries
00:21:46 for 21 days, two meals a day. That's about 42 meals. So that's another important thing.
00:21:54 All put together, we have distributed about 63 million meals in the last two and a half
00:22:02 months, both cooked meals and the grocery kits. And yes, in terms of the challenges,
00:22:11 you know what happened in most of the places in the country when this happened, the summer
00:22:18 vacations had already begun and our kitchens were already shut down. During summer, we
00:22:24 don't operate summer vacations. And so most of the employees in our kitchens, we have
00:22:30 about 7,000 employees and they all had returned to their hometowns, small villages. And so
00:22:41 there were probably in and around the kitchen facility, maybe about 25% of the employees
00:22:48 were from the immediate vicinity of the kitchen. So when the government started asking us to
00:22:54 prepare meals and distribute them in different vulnerable sections of the society, the first
00:23:02 challenge that we had was that we didn't have people. We didn't have the right kind of people,
00:23:07 enough people to cook. And it was very difficult to bring them back. They were 150 kilometres
00:23:15 to 900 kilometres away in different parts of the countries. So we had a lot of challenge
00:23:23 getting people to work. And I remember in places like Lucknow and in places like Mathura
00:23:32 in Uttar Pradesh, people had gone away to their homes and we had a very hard time to
00:23:37 get them back. And so we would, our HR department and different people in the department would
00:23:45 continuously be reaching out to people to call them to come and work. And they would
00:23:51 say, no, we cannot. And the parents of these workers sometimes would take the phone and
00:23:56 say, you want my son to die? Here the prime minister is telling, don't step out of the
00:24:02 house and you are telling my son to come and work. You know, these kind of, by and large,
00:24:07 we had these kind of challenges. And the governments were very, very supportive because of the
00:24:18 breakdown of the supply chain and all of that, we would not get raw materials. And then there
00:24:24 was one agricultural market in Bangalore, which was shut down and it was being opened
00:24:31 only once a week. And for our requirement, they just specially opened it and made all
00:24:38 kinds of provisions. So we have seen that the local governments and at different levels
00:24:45 were very responsive. We had a lot of support from them. It was mainly a challenge of getting
00:24:51 the workforce to cook and to prepare the meals and distribute. So that was the main challenge.
00:25:00 And I would also say the positive side, the governments were very responsive and our donors,
00:25:05 we had a large number of donors. They all came forward, individual donors, corporate
00:25:10 donors. They all wanted to help how we can help and reach out to children and people,
00:25:17 not just children. So that's the response that we had, I would suggest, I would say.
00:25:25 So much, Mr. Das. Dr. Ranjan, I recall an interview of yours where you spoke of the
00:25:31 importance of civil society in sort of ensuring that nutrition reaches the people who need
00:25:36 it the most. Would you like to elaborate a bit on that?
00:25:40 Yeah, thank you very much, Mr. Sengupta and thanks for having me here. And you have raised
00:25:50 a very valid question. And as we know it very well that India is not battling COVID-19 outbreaks
00:25:59 only. We are also fighting under nutrition in the country. So we are having dual burden
00:26:06 on our country, existing under nutrition and under nutrition induced by COVID-19. And here
00:26:13 the role of civil society organization, because coalition is a group of policy makers, program
00:26:19 leaders, civil society organizations. So the role of civil society organizations, especially
00:26:27 today and in coming days, we feel like it's a very great role, very critical role, very
00:26:34 important role they have to play. Even with so much of negativity, there is a silver lining
00:26:43 for this sector, which will make the country stronger and make its own place much relevant
00:26:50 in coming days. The crisis, this COVID-19, the crisis brought us together again, because
00:26:59 I'm from this sector for last 25 years. And I have seen this, this phase when this, all
00:27:09 the civil society organization, NGOs, NGOs, how we have come together with more focused
00:27:16 deliverance and objectives to make India, to make our country a stronger country and
00:27:24 how we should learn managing its human resources. Because personally, like when I'm, when I
00:27:31 was interacting with all our civil society organizations, it was felt that how the capacity
00:27:37 of the civil society organization, how we can deliver the best, understand the best
00:27:42 and support, contribute in a very meaningful manner. And COVID-19 is a unique opportunity,
00:27:52 is a unique opportunity to reform our civil society organization and especially the public
00:27:59 health nutrition sector and a strong public health system in our country will benefit
00:28:07 everyone. And there is no better time than now to make it happen or make it in reality.
00:28:16 Number one, I was based on the discussion I had with all our civil society organizations,
00:28:22 who are a member of this coalition, like to boost the public private partnership, to build
00:28:29 the data culture, to engage the communities in a more effective, meaningful manner, and
00:28:36 to engage private healthcare services and to invest, to encourage them, influence them
00:28:43 to invest in public health. So if you reform our public health system now, it will create
00:28:50 an opportunity for ripple effect in other areas too, like in terms of nutrition, water
00:28:58 and sanitation and other social sectors. So like civil society organization, including
00:29:07 self-help groups, like it's can play a very active role in the supporting solution to
00:29:14 the local level, such as a promotion of a nutrition garden to generate self-reliant
00:29:22 populations, support capacity building efforts, nutrition security, even the technology, how
00:29:31 the technology innovation in agriculture, in data collection, in our counseling, how
00:29:37 we are reaching to the mothers, reaching to the family, building the capacity of mothers
00:29:42 with regard to the feeding practices. So there is an important role that they have to play
00:29:48 and that we are ready to do that. Then the role of even the, I'm also including
00:29:56 Panchayati Raj institution in our country. That's a very, very strong and like Gram Swaraj,
00:30:02 which Mahatma Gandhi was always talking about. The role of Panchayati Raj institution can
00:30:09 facilitate the availability, accessibility, and the, also the counseling for proper utilization
00:30:17 of services at community level, at household level. So the role of civil society organization,
00:30:24 including self-help group and PRI will definitely make a great role. And the private sectors
00:30:33 plays a significant role in the social development, a right time to explore public private partnership
00:30:39 and a safe opportunity for creating a sustainable public health ecosystem. Thank you very much.
00:30:45 Dr. Ranjan, you know, Dr. Branka, this pandemic doesn't look like it's going away anytime
00:30:52 soon. We're going to, I mean, even if we get a sort of a vaccine and then by the time it
00:30:58 is sort of used and everything, WHO, I assume, has already sort of talked out a plan to sort
00:31:04 of work around or, you know, try to ensure that its nutrition goals are not impacted
00:31:10 by this thing. Would you like to sort of elaborate on a few steps that you might have taken and
00:31:16 how do, how you plan to sort of, you know, address this whole thing, if you have any
00:31:20 such plans in mind, both short term and long term? Yeah, thank you very much. I think it's
00:31:26 a, it's a, it's an important question. And I think this somehow was already referred
00:31:32 to by some of my other colleague panelists, particularly Mr. Ranjan, who is referring
00:31:38 to COVID-19 as an opportunity. So yes, indeed, there's an element of a response that is still
00:31:47 has to happen. And unfortunately we still have an expanding pandemic. We don't know
00:31:53 what the perspective is about its end, but certainly we're looking into a few more months
00:32:02 until we have vaccines and therapeutics and better diagnostics. WHO is working with many
00:32:09 partners on an accelerator to have all this element as public goods. And there is a major
00:32:18 commitment by several partners on this. So we hope to be responding to the pandemic,
00:32:23 but at the same time on food and nutrition, we need to take action in a number of ways.
00:32:28 And I really would like to perhaps refer you to the very interesting policy brief that
00:32:35 the UN secretary general has issued a couple of weeks ago and to which basically all contributed
00:32:43 on the impact of COVID-19 on food security and nutrition. And that brief has three elements.
00:32:50 First, what we need to do is to mobilize, to save lives and livelihoods, focusing attention
00:32:59 where the risk is most acute, which means we need to declare that food production, marketing
00:33:05 and distribution are essential services everywhere. And we need to ensure the protection of food
00:33:12 workers and also avoid that trade barriers are established between countries. I mean,
00:33:19 there are scares around food, which is unsafe. These are inappropriate. So we need to make
00:33:24 sure that the food is produced, distributed and accessible to all. We need also, of course,
00:33:36 to preserve humanitarian food and nutritional assistance. And, you know, what we heard from
00:33:43 venerable Mr. Daza is important. This is actually happening in many parts of the world. I mean,
00:33:49 school food is not available because schools are closed or there's no system to do that,
00:33:54 but those systems have to be urgently put in place. The second important area is to
00:33:59 strengthen social protection system for nutrition. And, you know, I know that this is one of
00:34:06 the remittance of the Poshan Abhijan program in India. I mean, food and nutritional assistance
00:34:13 really need to be at the heart of social protection programs, more and more in cash, but of course,
00:34:21 also in kind. And then we need to strengthen the health system response for nutritional
00:34:27 care. I mean, the additional over 6 million children which will come with malnutrition
00:34:34 in the next months, we need to, first of all, you know, prevent this to happen, but then
00:34:40 we also need to be ready with stronger systems. At the moment, we're only able to serve about
00:34:49 one fifth of the world children with acute malnutrition. This number will increase. So
00:34:56 we need to also increase the capacity of those services. And the third element is really
00:35:02 the investment in a sustainable future. Again, considering the epidemic as an opportunity,
00:35:09 laying the foundation for a more inclusive, green and resilient recovery. WHO has just
00:35:16 launched a manifesto for a healthy recovery from COVID-19. Countries are making big investment
00:35:23 because of the economic crisis. It's the time to direct those investment to strengthening
00:35:30 the right services and making the right investment. For example, promoting healthy and sustainable
00:35:38 food systems. For example, strengthening health services, for example, ensuring an energy
00:35:48 transition and so forth, having more livable cities. I think this is really an important
00:35:55 message that we need to give. We cannot just go back to the previous situation. And again,
00:36:03 you know, I'd like to offer all of our services that we can in helping you promote these things
00:36:08 anytime that you feel the need to sort of, you know, need a media hand to sort of help
00:36:14 disseminate some of these things. I think it will help.
00:36:17 Dr. Khandelwal, I realised that you mentioned it earlier as well, but you know, they say
00:36:24 that even if a pregnant woman tests COVID positive, you know, after birth, she's still
00:36:31 expected to sort of breastfeed with certain restrictions. Could you sort of tell us why
00:36:35 it is that critical that, you know, that, you know, we earlier heard that there were
00:36:39 people being separated, but, you know, at the same time, there are recommendations that,
00:36:45 you know, even if the mother tests positive, that she should still try to breastfeed in
00:36:50 the first few days at least. Could you explain why that is so critical?
00:36:55 Right. So exclusive breastfeeding, as we all know, is very, very critical for the first
00:37:02 six months of life, especially. And that is essentially because it's the form of nutrition
00:37:08 which the child gets, A, which is unadulterated, which is natural, which is full of immune
00:37:13 boosters, and which is going to sort of set you for life. It's the first food which the
00:37:21 child gets from the mother, which is really trying to protect you for or ready you for
00:37:27 the later life. So, therefore, these percentages which we calculate of how many are exclusively
00:37:35 breastfed, you know, becomes very critical. In fact, WHO itself in their World Health
00:37:40 Assembly goals for 2025 indicated that the exclusive breastfeeding rates should be increased
00:37:46 by every country. And in that regard, India, for example, is at 54.9% exclusive breastfeeding.
00:37:54 But we must go beyond looking at that national composite number, because it ranges when you
00:38:00 see, when you actually see the diversity among so many of our states, it goes down to as
00:38:05 low as 35.8% in Meghalaya to 77.2% in Chhattisgarh. So there's a whole huge variety of issues,
00:38:14 which are, you know, people may think it's such a natural thing, and it's free of cost
00:38:18 in that sense, like, what's the big deal? But there is, there are so many issues involved
00:38:22 that we have not been able to advocate this message properly enough, or stress it enough
00:38:29 that, you know, forget 100%, even 80% exclusive breastfeeding to reach to that target has
00:38:35 been such a challenge. Of course, in the last decade, we've come from 46 to 59, or, you
00:38:40 know, 55%. So it's a very slow progress, which we are making on something which is doable.
00:38:48 So I think pushing, if you see Poshana Biyan's, you know, the mentor, Dr. Vinod Paul, and
00:38:54 others who are from NITI Aayog and others and from the ministry, they all have said
00:38:58 that these are things which are fixable, which are modifiable. And so therefore, I think
00:39:04 as nutritionists, as public health advocates, we should try and think about how we can promote
00:39:10 this better. How can we leave this message, perhaps the mothers need more support, perhaps
00:39:15 the nutrition counselling needs to be integrated early on, rather than just once after you've
00:39:20 delivered, maybe this is a message which has to go on and, you know, ringer in the mother's
00:39:24 tone as well as the whole family who should actually understand the importance of breastfeeding,
00:39:29 that this is not only the time for bonding between the mother and the child, but also
00:39:34 a very, very important source of nutrition, as well as health later on. So these are very,
00:39:40 very important factors for me, therefore. So you're saying that it is so important that
00:39:46 people are willing to sort of take the risk of even, you know, a COVID infected mother
00:39:51 still wanting to do it. It's that important. That's what I'm hearing. Yes. See, everybody,
00:39:56 everybody these days is very, you may have seen all social media everywhere is full of
00:40:01 finding ways to enhance your immunity, right? They're equating COVID fighting or COVID tackling
00:40:06 to immunity boosting or immunity enhancing. Although it's not, it's not the most appropriate
00:40:13 way to put it when we talk among scientists like ourselves, but immunity definitely is
00:40:17 a very important factor. And therefore, breast, nothing more than breastfeeding will give
00:40:23 you the initial immunity. So as to say, we all know that in India, especially the hygiene
00:40:27 practices are very poor. When you make those bottles and feed the children with those bottles,
00:40:32 there's a huge amount of costs of human lives, which are involved in terms of diarrhea, in
00:40:37 terms of other immune problems, which happen. So therefore breastfeeding, which is natural,
00:40:42 which is the most important food, like I mentioned again and again, is therefore the doctors
00:40:46 are being advised that the mother, are advising the mothers that, you know, maintaining proper
00:40:51 hygiene, you should breastfeed your child at least to give that initial food to the
00:40:55 child to build up the immune system. That's a very interesting point to make. Dr. Deborre,
00:41:03 you know, UNICEF with all its partners on the ground and already involved, I'm sure
00:41:09 that you have a very sort of a correct picture of how this not just a thousand day program,
00:41:16 but nutrition per se is being sort of dealt out, you know, in all the different states
00:41:22 of the country. So particularly when you come to this thousand day program, there's a lot
00:41:28 of disparity amongst various states. Now, do you think that's only attributable to sort
00:41:33 of economic reasons or are there sort of, you know, other infrastructural reasons or
00:41:38 what would you attribute that to? Why is there no uniformity in the way this program is being
00:41:43 implemented or, I mean, would you agree that there is a problem in uniformity or do you
00:41:48 think that that's just a? Well, there's definitely no uniformity if you look at the levels of
00:41:57 malnutrition in different parts of the country. But even within states, you see large variations
00:42:03 of levels of malnutrition as well. Even within districts, you see many differences. Globally,
00:42:09 we know, and for me, India is actually a very good example. We know that the number one
00:42:17 factor is not just money, it is about leadership. Yeah, and I think that particularly under
00:42:24 Poshna Abhijan, I think we're all very encouraged with the level of leadership that we saw at
00:42:28 all the levels. But same time, we also know that leadership is not enough. When I came
00:42:34 to India, I was very, very impressed with the broad set of high quality programs and
00:42:41 schemes. There are very few countries in the world that have a multi-sectoral comprehensive
00:42:48 program to address malnutrition like in India. You have social protection interventions,
00:42:53 you provide food and feeding to many different groups, vulnerable groups, from pregnant women
00:42:59 to children to the poorest. You have a lot of services from the health sector, from Ministry
00:43:06 of WCD. So I would say actually on paper, technically and programmatically, the programs
00:43:13 are very, very sound. Yeah, and that is for me, that's very encouraging. But the problem
00:43:18 is it's the implementation. I call that there's a problem in what I call C-square IQ. Let
00:43:24 me explain what that is. First of all, you might on paper, you might have the right programs,
00:43:30 but you need full coverage. That's the first C. If you don't reach all that needed, then
00:43:40 you don't have the impact. You might have a high impact intervention, but a high impact
00:43:43 intervention doesn't have the impact because you don't reach all. And I think there's a
00:43:48 challenge and we see in different parts of the country that coverage of take home ration,
00:43:53 coverage of vitamin A supplementation, coverage of iron folate, which is used for reduction
00:44:00 of anemia, significantly changes or is significantly different between different parts of the country,
00:44:07 but also within different states. So you need the coverage and the coverage, you need to
00:44:11 get to 80, 90% coverage because otherwise you're not going to get the impact. Then you
00:44:16 need continuity of services. And for me, an example is always, I love breastfeeding week
00:44:21 and September, August, September globally, obviously you have breastfeeding week, but
00:44:28 to be honest, I think we need 52 breastfeeding weeks. September is portion month. Well, and
00:44:38 a lot of education is done to educate people about good nutrition in September. But if
00:44:43 it's up to me, I would say we need continuity. We need 12 portion months to support understanding
00:44:50 and awareness around nutrition. That's not something you change by one message. You need
00:44:55 to continue that. And that is something that we saw during also during the COVID crisis,
00:45:01 there was a gap in the continuity of services. So there was a second C, the C squared IQ.
00:45:09 Then you need intensity of services. You know, I remember I once went on a road trip to Madhya
00:45:15 Pradesh. I drove 2,600 kilometres. I saw hundreds of art for Coca-Cola, for Pepsi, for Maggi
00:45:25 noodles for many products that we don't consider that healthy or nutritious. I saw one art
00:45:31 for one corner and building, which turned out to be in breastfeeding corner where women
00:45:36 could come to breastfeeding the child, one message in public space. So we need to have
00:45:43 the intensity of the messaging and of the services to have the impact. And that is what
00:45:48 is lacking. And there you see a big difference in different parts of the country. And last,
00:45:54 but definitely not least, even when you've got coverage and you've got continuity of
00:45:58 services, and even when you've got intensity of services, you need quality of services.
00:46:05 And sometimes maybe some of the food that is provided through some of the schemes is
00:46:10 not necessarily always the most nutritious foods. For the youngest children, six months
00:46:16 to 12 months, it's just a critical time. And the data shows that feeding practice of those
00:46:23 children are so poor. That is where malnutrition in India starts during pregnancy. After that,
00:46:32 things are not too bad. But then from six months to nine months to 12 months on, it
00:46:36 is very bad. Less than 10% of the children receiving the type of foods and the quantity
00:46:42 of food that they require. So we have to improve also the quality of food through the feeding
00:46:48 schemes. We have to provide, we have to improve the quality of counselling services, support
00:46:54 services. So I would say what I call C squared IQ, coverage, continuity, intensity and quality
00:47:01 of your existing packages. We don't need much more innovation. On paper, India has a brilliant
00:47:08 program. There are not many countries that have got such a comprehensive, well thought
00:47:13 through program. But the program needs to be delivered with C squared IQ. And if you
00:47:19 start analysing it, the states, the districts that do focus on the C squared IQ on all these
00:47:24 components have a much higher impact of the interventions and therefore also lower malnutrition
00:47:32 rates. Thank you very much.
00:47:35 Yes. Thank you, Ayan. Mr. Tassa, I have a question for you. You, like I mentioned earlier,
00:47:45 you are one of the largest sort of feeding program, but it's mostly meant for school
00:47:49 children. Given the pandemic that we face now and given that most children are now not
00:47:55 really going back to school for some time, do you have any plans to sort of expand the
00:48:02 scope of your feeding program?
00:48:05 Yes. This has been one of the important things that's going on in our minds because we have
00:48:10 our kitchens with large capacity and all of them are idling. We are feeding as per the
00:48:16 different opportunities and requirements that have emerged. We were involved in feeding
00:48:22 the immigrant workers and people and labour force locked up in different circumstances.
00:48:30 So we have been doing all of these kinds of feeding programs, not necessarily the children
00:48:37 program. Children, mostly, most governments made the policy that we should distribute
00:48:43 dry ration through the schools and we have been doing that. And all of this discussion
00:48:49 is about the 1000 days of, in part, critical days of a child and the mother. I must mention
00:48:58 that apart from the midday meal program, we have also been feeding about 140,000 children
00:49:04 in Anganwadi centres. During the last two and a half months, quite a few Anganwadi centres
00:49:12 have become dysfunctional. It's just that the children are not coming there. The teach
00:49:18 mothers are not coming there. So quite a few are dysfunctional right now. And so it is
00:49:24 a very alarming. I'm hearing from all the experts that how important and significant
00:49:29 this is. Yes, we have wonderful programs. The challenge is in the implementation of
00:49:36 the program, the continuity that we just heard about. So this is actually the challenge.
00:49:43 And of course, in some governments have realized that in Gujarat recently, we were asked to
00:49:49 make some kind of a long shelf, a sweet preparation, which has a long shelf life so that they can
00:49:56 reach it to the children from the Anganwadi centres and their mothers and children can
00:50:01 take it home. So some attempts have been made, but it is a lot more needs to be done. So
00:50:07 we have been thinking that yes, whatever other kinds of opportunity feeding programs that
00:50:15 are available that come about, we are ready to be involved in. We have been reading that
00:50:22 how middle class families are going to run out of all their savings at the end of the
00:50:27 month of June. So if middle class families are going to have this problem, what to speak
00:50:33 of the even more vulnerable sections in our country. So it's a very, very serious matter.
00:50:40 And so we are very much contemplating working with the governments or with other organizations,
00:50:50 business corporations who can support. So how to make a most inexpensive but nutritious
00:50:58 meal and reach it to the people. So we have been working on these kinds of ideas and piloting
00:51:07 different ideas. Like in Bangalore, we have just started trying out going to the slum
00:51:14 areas where there is a need of these kinds of things and make one meal available every
00:51:21 day for children, women, elderly people, and whoever is in need of. So we have been contemplating
00:51:29 and we have been piloting in different parts of the country. And if we get the necessary
00:51:35 support, we want to scale up and we have the capacity to scale.
00:51:42 Thank you so much, Mr. Dasar. We are almost running out of time. So I'll try and close
00:51:46 this with Dr. Ranjan. Dr. Ranjan, some doctors and civic workers are actually arguing that
00:51:53 given the pandemic and the tremendous pressure it has put on the healthcare system and other
00:51:58 systems in place, that the thousand day program is perhaps can be put on the back burner for
00:52:04 a while. How would you react to that kind of an assessment?
00:52:09 I think this is a very pertinent question in the coming days. And if I see like in our
00:52:20 country, like zero hunger, and we know that zero hunger and good nutrition have the power
00:52:27 to transform the present and future generation. Malnutrition in our country remains a threat
00:52:35 to the survival, growth, and the development of the children. And child malnutrition happens
00:52:44 very early in life. Their nutritional status deteriorates rapidly over the first two years.
00:52:53 And once this damage is done, catch up and recovery are almost impossible. So like what
00:53:03 coalition, this is one of the important objective of coalition, like how to improving the quality
00:53:10 of food, the feeding practices with the help of all of our members and with the help of
00:53:18 the better good programming and the nutrition situation in India in the first two years,
00:53:24 that's the first thousand days. It's a represent as Dr. Shweta has rightly mentioned and Dr.
00:53:33 Aryan, like represent a critical window of opportunity to break the intergenerational
00:53:39 cycle of malnutrition. In this critical opportunity, if we are going to miss this critical opportunity,
00:53:47 we'll continue to self-perpetuate like the malnourished girl will become malnourished
00:53:55 woman who will birth a low birth weight infants who will suffer the poor malnutrition. So
00:54:02 this is the best opportunity and this is the best opportunity to break this vicious intergenerational
00:54:10 cycle in the very concrete, very like very concrete efforts and how to collaborate the
00:54:20 multi-sector planning is very important. Efforts in improving the nutrition of infant and young
00:54:25 child from conception through the first two years of life. And in the present scenario,
00:54:32 like after this COVID, we understand that the possible impact would reduce in the number
00:54:39 of meals per day. Hence the quality of food per meal as well. I think that has been reduced.
00:54:49 Ensuring diet diversity at the time of this COVID is also remain a challenge as the main
00:54:56 goal during this time is the health crisis and the lockdown. Basically the basic good
00:55:03 food, basic food is the most important thing. Therefore, the quality of diet is also compromised
00:55:10 at this juncture. And on behalf of the coalition, I would like to suggest like information technology
00:55:19 here can play a very important role because in this time, how to reach to the mothers,
00:55:25 how the proper counseling can be given to the family, to the mothers. So information
00:55:30 technology can be leveraged for ensuring many services related to maternal and child, especially
00:55:37 to ensure the like proper counseling during the thousand days as machine learning, as
00:55:43 well as the artificial intelligence. Maternal and child, such as the mobile phone for counseling
00:55:50 by the frontline workers, our ASHA worker, Anganwadi workers, even the ANMs use the remote
00:55:58 health advisory intervention. Already in India, we are having the remote advisory health services.
00:56:04 We can dial that is the helpline for getting all necessary health and nutrition services,
00:56:10 proper counseling and the portion helpline in some of the states during this COVID started
00:56:17 the portion helpline. Like recently after the cyclone West Bengal started portion helpline
00:56:23 under the ensuring healthcare immunization services and the regular counseling to the
00:56:28 mothers through the, um, through nutrition specialist. So this is an opportunity, how
00:56:35 we can take care of the, um, the thousand days, the mother, as well as the baby infant
00:56:43 and the first two years. And, um, I would also like to add like government of India
00:56:49 has already initiated the nutrition garden, how nutrition garden that should be largely
00:56:56 promoted to the mothers can participate in income generation activities and hence cater
00:57:03 to nutrition to their child and themselves. So the GIS tracking already ministry of rural
00:57:10 development, government of India has initiated this like GIS tracking to identify hotspots
00:57:17 at the block and your sector level can also be done with the required actions. So these
00:57:24 are the things I believe can play a very vital role to reach to all the mothers, to reach
00:57:31 to family and take good care of themselves so that we can have a kind of healthy, we
00:57:38 can provide a healthy baby and the healthy, their childhood and the adult. Thank you very
00:57:43 much. Thank you. You know, after listening to all of you, all I can say is that, you
00:57:49 know, if outlook and portion can help in any way to help you sort of, you know, disseminate
00:57:56 the kind of things that all of you are doing, please don't hesitate to reach out to us because
00:58:01 you know, it will be an honor to really help all of you if you can. And whatever little
00:58:05 baby can, I'd like you all to stay on for a minute after we close because you know,
00:58:09 I have a small request from all of you. Thank you so very much all of you for, you know,
00:58:15 coming and joining us. I know many of you came at extremely short notice and I'm really
00:58:20 hoping that, you know, for those of you who are not aware, this is a, you know, almost
00:58:25 like a three month campaign. So I'm hoping that some of you will rejoin us when we come
00:58:30 to some specific parts of it. Maybe you could, if not rejoin, maybe you can give us some
00:58:34 ideas on how we can work on it. Thank you so very much, Dr. Devaud, Dr. Vandilwal, Dr.
00:58:41 Banka, Dr. Ranjan, Ms. Madasa. I'm truly grateful for all of you taking time out for this. Did
00:58:48 that become an end of this program, a thousand days, but I urge all of you to look out for
00:58:54 the next webinar on this. Thank you so much. If you could just pause for a second. You
00:59:01 know, what we're hoping to do is that, you know, as part of our promotional thing, you
00:59:06 know, this is the request. If you could just sort of, you know, state your name and then
00:59:12 say hi. I mean, I'll use Dr. Devaud as an example. You could say, hi, I'm Dr. Devaud.
00:59:18 Watch me talk about a thousand days in nutrition on Outlook and we'll use each one of them
00:59:22 separately when we run this campaign so that, you know, it will help us sort of promote
00:59:26 it in some ways. So, I mean, if you have a problem with that, I can understand that it
00:59:30 would really help us a lot. So, Ariane, would you like to start? Just a quick thing saying
00:59:34 hi, I'm Ariane. I think the mic is on. Yeah, exactly. No, no. Hello. No, thanks for Outlook
00:59:42 portion for having UNICEF being part of this. I mean, we as UNICEF, we believe that the
00:59:48 first 1000 days of a child is the start of a lifetime. The first 1000 days is the start
00:59:55 of an individual's life. But investment is investment for a nation. And congratulations
01:00:01 to Outlook portion for giving attention to this 1000 days and the importance of nutrition
01:00:06 in those 1000 days. And I really hope that everybody will join all the activities going
01:00:12 to be all organised by Outlook portion around this. Thank you very much. Thank you, Dr.
01:00:18 Khandelwal. Hi, guys. My name is Shweta Khandelwal and I'm very excited and happy to be a part
01:00:24 of the Outlook portion webinar, which is talking on the first 1000 days. This is a very, very
01:00:30 important period. And I'm really, truly grateful for this opportunity. Thank you. Francesco
01:00:40 Branca, Director of Nutrition and Food Safety from WHO Geneva. Congratulations, Outlook
01:00:47 portion for bringing nutrition to the attention of the general population, particularly focusing
01:00:54 on the 1000 days. Really critical time that will shape not only the health, but future
01:01:03 performance of what will be the citizens of India. This is a critical time, but we can
01:01:12 all together find solutions to address the challenges and build back better. Thank you,
01:01:21 Dr. Khandelwal. Dr. Dasan. Hello, everybody. So happy to be part of this Outlook portion
01:01:31 seminar. I am Chanchalapati Das from Akshaya Patra Foundation. We have been involved in
01:01:38 providing meals to school children in the country last 20 years. But now we have been
01:01:44 involved in providing COVID relief activities. Now it's so important. India is a very, very
01:01:51 big country. We have a lot of complex problems and our leaders are dealing with so many things.
01:01:58 In the middle of that, this care and concern for the 1000 days of the mother and the child
01:02:06 is so important and that should not be lost. And some of it in the cracks, it should not
01:02:12 be lost. So it's important that Outlook portion has brought a special spotlight on this important
01:02:20 factor for the good of our country and for the good of all of humanity. Thank you. Dr.
01:02:29 Ranjan. Yeah, Namaskar everyone. This is Dr. Sajid Ranjan from the Coalition for Food and
01:02:36 Nutrition Security. And I'm very happy to be a part of Outlook portion. The coalition
01:02:42 is looking for good governance, good policies for nutrition awareness as well as collaboration.
01:02:50 So let's make it together. And I'm very much sure that together we'll make it. Thank you
01:02:55 very much. You know, I appreciate what you just said in the sense that I'm really going
01:03:01 to be looking forward to all of you, you know, the good wishes and your support for this
01:03:04 program because it's a three month long thing. And I just cannot do it without your help
01:03:09 and support and good wishes. With that, thank you so very much and a big, big namaste from
01:03:13 me to all of you. Thank you so much, all of you. Thank you.
01:03:18 [MUSIC]