Preventing Under-Nutrition Crisis in India: A Comprehensive Approach

The report highlights the growing issue of poor nutrition in India due to various determinants. While efforts have been made by the government and other organizations to provide nutritional benefits, particularly for those below the poverty line, there are still barriers that hinder these efforts. To prevent such issues, it is recommended to adopt technology similar to other nations, while rejecting obsolete technologies to save budget costs. This summary provides an overview of the key points in the report regarding poor nutrition in India.

POOR NUTRITION: FIGHTING WITH A GLOBAL
CHALLENGE THROUGH HEALTH TECHNOLOGY
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Table of Contents
Introduction......................................................................................................................................2
1. Framing the problem....................................................................................................................3
1.1 The health issue: Health concern at the national level and what does the health system in
India wants to address..................................................................................................................4
1.2 How big is the problem..........................................................................................................4
1.3 Stakeholders...........................................................................................................................6
2. Proposed health technology.........................................................................................................6
2.1 Search for health technology evidence..................................................................................6
2.2 Quality of the evidence: Brief critical appraisal of the paper you selected, using a CASP
Critical Appraisal tool..................................................................................................................7
2.3 Other sources of evidence......................................................................................................9
2.4 Brief description of the technology to be introduced; Prevention Program..........................9
3. Barriers to adopting the technology...........................................................................................12
Health care finance: what public/private funding is available?.................................................13
Insurance markets:.....................................................................................................................14
4. Recommendations......................................................................................................................14
Conclusion.....................................................................................................................................15
Reference list.................................................................................................................................17
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Introduction
Malnutrition is considered as a multi-dimensional issue. The term ‘malnutrition' means either too
much or too little nutrients. It can cause various health issues, such as diabetes, stunted growth,
heart disease and so on. The present assignment seeks to focus on the problem of malnutrition
which is regarded as one of the burning health issues in India. As per the National Family Health
Survey report at least 7% of children (below five years) in India are underweight (Sahu et al.
2015). According to UNICEF, India stands 10th among the nations with a huge number of
underweight children. The report of the UNICEF further suggests the fact that in terms of the
number of stunted children, India stands 17th globally. In spite of impressive economic growth,
the issue of malnourishment in India is really a matter of great concern (Burza et al. 2015). The
present study also seeks to discuss why India needs a well-developed health technology in order
to address this burning issue.
1. Framing the problem
Globally, every country suffers from varied forms of under nutrition. Poor nutrition is regarded
as an underlying cause of mortality and/or death of a huge number of children on a global level
(Gainhealth.org 2019). Under nutritiontypically includes wasting, stunting and low body weight.
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Figure 1: The global prevalence of malnutrition
(Source: Data.unicef.org 2019)
However, many parts of India also suffer the extreme brunt of malnutrition which is why it is
often regarded as a detrimental factor to bad health (Business-standard.com 2019). Nearly 44%
of children below 5 years are highly underweight in India. Also, there are multiple shreds of
literature that have shown the probable causes of certain diseases due to the tremendous effect of
poor nutrition during the gestation period (pregnancy).This, in turn, leads to growth retardation,
lowered cognitive abilities and many more (Meenakshi 2016). In the year 2018, the Global
Nutrition Report has successively exhibited that India holds approximately 1/3rd of the global
burden of major malnutrition (Indiatoday.in 2019). Such issues strongly enhance healthcare
costs, reduced productivity and bring slow economic progression. All these reasons have
together perpetuated such poor health conditions and poverty cycle in India.
Therefore, this particular piece of report intends to frame this “malnutrition” problem and goes
into elaborating the implication of the same in India.
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1.1 The health issue: Health concern at the national level and what does the health system
in India wants to address.
As mentioned in the above section, the consequences of such poor nutrition in India are highly
alarming and create quite a stir among the remote areas. Nearly with 46.6 million stunted kids,
India has gradually deserves special mention in this regard (Indiatoday.in 2019). This is one
ofthe massive health concerns in India that categorically require immediate improvisation for its
complete eradication.
India’s health system has put many extensive attempts to control the rampant occurrence of poor
nutrition since decades but the problem still persists. However, in 2017 enhanced food security
and its ready access has led to a lessernumber of malnourished Indians (Business-standard.com
2019). Even after this, India needs to formulate better ways to meet their nutrition goals.
1.2 How big is the problem
India encounters a unique and vast development paradox pertaining to their global economies.
But because of such a high number of undernourished children, India faces the extreme
consequences and mortality rate (Planningcommission.nic.in 2019). Therefore, the nutrition
challenges in India calls for immediate improvisation as a part of their critical development to
ensure faster and sustainable growth.
This problem is quite big because poor nutrition in India remains unacceptably high despite the
diligent Government efforts. The primary challenge is inevitably to reduce maternal under-
nutrition thereby preventing the occurrence of the same in their infants in the near future.
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Figure 2: Incidence of undernourishment in India
(Source: Business-standard.com 2019)
In general, malnutrition is held responsible for causingnumerous poor health conditions than any
other ailments. Also, the National Nutrition Strategy in India that primarily focuses all their
attention to address certain wide-ranging determinants ofunder-nutrition basically aims to
minimise inequalities and certain opportunity costs. This is conducted with the sole intent of
facilitating diagnostic work and other related policy actions.Pertaining to this, there are multiple
shreds of evidence whereapproximately 195.9 million population of India reportedly suffers from
extreme under-nutrition. Reports also mention that around 51.4% of women population are
considered anaemic (Indiafoodbanking.org 2019).
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Figure 3: Stunting rates of kids below 5 years in higher in India
(Source: Gainhealth.org 2019).
1.3 Stakeholders
In this regard, there are a wide-series of stakeholders associated with Indian malnutrition-
oriented problems. Because this has evidently become quite a common challenge, the list of
stakeholders is quite huge. The Indian Government, people belonging to below poverty line or
people with marginally low monthly income, the different health sectors including the wide-
ranging health professionals like the physicians, the nursing communities and also the varied
NGOs are all considered as the prospective stakeholders.
2. Proposed health technology
2.1 Search for health technology evidence
In order to find out suitable health technology evidence, I have searched in Google search
engine, Google Scholar, EBSCO, PubMed and so on. Although a number of hits appeared in the
results, only four of them were relevant. After going through each of the four pieces of evidence
minutely, I have finally chosen the paper named "The Use of Technology in Identifying
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Hospital Malnutrition". I have chosen the paper because it provides a succinct overview of the
chosen issue which is malnutrition. The paper also provides how health technology can be
implemented in order to address the issue of malnutrition. Furthermore, it also discusses the
scope of utilising technical tools in order to look into the issue of malnutrition (Trtovac and Lee
2018).
2.2 Quality of the evidence: Brief critical appraisal of the paper you selected, using a CASP
Critical Appraisal tool.
Critical Appraisal Tool (CASP)
Section A
1. Was there a clear statement of the aims of the research?
Yes
Comments: Yes, there was a clear statement regarding the aim of the research. It deals with the
use of technology to look into and evaluate the issue of malnutrition in the hospital atmosphere.
2. Is a qualitative methodology appropriate?
Yes
Comments: The researchers have conducted the study in compliance with the scoping review
framework of Arksey and O’ Malley.
3. Was the research design appropriate to address the aims of the research?
No
Comments: The research design adopted for the present research is not clearly mentioned. It is
not found in the entire research. Even the researchers have not provided any information about
their chosen research design.
4. Was the recruitment strategy appropriate to the aims of the research?
Yes
Comments: The recruitment strategy was quite appropriate for the present research. The
researchers have chosen primary articles with the intent to evaluate the issue of poor nutrition.
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5. Was the data collected in a way that addressed the research issue?
Yes
Comments: The recruitment strategy adopted by the researchers was quite relevant. In order to
harness relevant information, they have utilised three databases such as CINAHL, Scopus and
PubMed that provide stern outcomes.
6. Has the relationship between the researcher and participants been adequately
considered?
No
Comments: The association between researcher and participants was not clear in the present
research. The researchers have not discussed the potential influence of or5 bias while conducting
the research.
Section B
7. Have ethical issues been taken into consideration?
Can’t Tell
Comments: It is very difficult to mention whether ethical issues were taken into consideration
while conducting the research. In fact, the researchers have not provided any indication of how
the ethical issues were or might be potentially addressed.
8. Was the data analysis sufficiently rigorous?
Yes
Comments: The data analysis of the research was sufficient. The researchers have used a
characterisation n and data synthesis form to include relevant data. They have also adopted
computer-based approaches in order to analyse data in an efficient manner.
9. Is there a clear statement of findings?
Yes
Comments: The researchers have presented the findings in compliance with the research
question. They have also incorporated their findings in this research quite ingeniously. They
have presented all their findings in detail so that readers can acquire a comprehensive idea about
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the issue of hospital malnutrition.
Section C
10. How valuable is the research?
Comments: The research succinctly presents the issue of hospital malnutrition. It has also paved
the way for further research on the issue. The limitation section of the research predominantly
deals with the areas that the present study failed to focus on. The research is also considered as
valuable because it can brush up the knowledge of the readers about the present issue.
2.3 Other sources of evidence
Various other sources of evidence that are followed in order to establish the present study
properly encompass multiple valued stakeholders’ opinion, public opinion and so on. A number
of people in the country are very well aware of this alarming issue. They think that Government
of India should work in collaboration with various other stakeholders in order to address this
serious issue (Rao and Swaminathan 2017). A number of non-government organisations and
charitable organisations are also well-acquainted with the issue. The research conducted by
Naandi Foundation in collaboration with various other NGOs reveals the fact that, the percentage
of malnourishment is at least 59% across 112 districts of India, which is 11% higher compared to
the data published by NFHS (Sittigand Singh 2017).
2.4 Brief description of the technology to be introduced- Prevention Program
Under-nutrition leads to nearly 45% of child death in many developing countries like India.
The overall developmental, socio-economic and the wide-ranging medical impacts pertaining to
the detrimental burden of under-nutrition are quite prolonged and serious for the individuals and
also their communities (Saxena 2018). There have been initiatives undertaken to mediate the
efficient management of such issues in many parts of India (Bhan 2019). Indian Government has
always been committed to address such nutritional challenges of the country.They have
conductedseveral constructive schemes and appreciable programs to ameliorate the current
nutritional situation of India. Proper ways to expand the same have also been formulated. Despite
several attempts, the existing problem continues to become a massive healthcare challenge in
India contributing to such a high mortality rate. There is an immediate need for a well-structured
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and comprehensive approach in the form of a prevention program that potentially
addressesthis.
This program will commence through effective nutritional schemes particularly in pregnant
females and under nourished children.
Objectives of the Program
o To create a sustainable and resilient diet system providing nutrient-rich food.
o To impeccably provide social protection to poor people.
o To provide occasional education and academic sessions pertaining to diet and nutrition in
several remote areas of India through the genuineefforts of different NGOs designed to serve
such purposes.
o To ensure that the country’s trade and other investment policies contribute towards
improving nutrition.
o To effectively develop supportive environments for the bare minimum nutrition at all ages.
o To promote and strengthen nutrition governance in each and every state of India.
 This prevention program must utilise the assembling power to assist the nation to align, set
and advocate policies and priorities that aim to progress nutrition in India and thereafter on a
global level in the near future. The implementation of well-refined and reliable nutrition-
based actions and its consistent monitoring will remarkably help the Indian Government to
distinctly evaluate certain relevant policies to note the program implementation and
subsequently the nutrition outcomes.All of the above-mentioned dimensions must follow
certain complementary approaches to reduce if not entirely eradicate under-nutrition cases
from India.
 This prevention program must focus on maintaining health equity with a sole commitment to
serving the underprivileged. Such efforts must primarily be included in the prevention
program to ameliorate the health conditions of the poorIndian population. The program must
implement such sustained efforts to minimise certain needless systematic variations
pertaining to assessing howhealth and its related determinants are spread in the nation
(Barnard 2016). There must not be any discrimination based on sex, ethnicity, age, culture,
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sexual orientation, education status, disability status, socio-economic status or any other
aspect for this matter. This equity program must provide:
o Balanced resource allocation.
o Adequate quality health services those are readily accessible.
o Sufficient health-based human resources.
o Affordable health expenses.
 This prevention program must emphasize on raising the funds by collaborating with a wide
range of non-government organisations.It must also include policies that persuade the
Government to join hands with international collaborators from where they could obtain
financial assistance. This way, it will improve the health services for the underprivileged.
The additional services that this prevention program might consider are:
1. Monthly counselling on healthy diet must be provided to underprivileged communities.
2. Supplementary nutrition must be provided by the government in areas where the number of
affected individuals are more.
3. Consistent growth monitoring and early childhood nutritional sessions must be invariably
conducted to ensure the proper dissemination of the new services.
4. Providing monthly immunisation to the new-born of poor undernourished families will be
solicited.
5. Proper management of infant illness and continuous health check-ups must be implemented
along with mandatory cashless treatments in areas with maximum people belonging to the
below poverty line.
Opportunity costs
This prevention program, to reduce under-nutrition in India would exhibit moderate opportunity
costs because the policymakers could utilise the same to make effective decisions. This is done
pertaining to the varied intervention options that they are committed to delivering similar
services.
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3. Barriers to adopting the technology
Adoption of this above technology-based prevention program will be quite difficult to implement
due to the following barriers.But with continual effort and strict monitoring, the implementation
might experience enormous success in minimising the mortality rate or other issues caused by
massive under-nutrition in India.The common barriers are:
o Inadequate leadership.
o Insufficient infrastructure in rural settings.
o Cost.
o Limited knowledge beyond the local levels.
o Time.
o Lack of continual push from
o Legality.
o Complexity.
Following is the brief elaboration of the varied barriers and other related aspects that must be
coherently considered during the adoption of the novel prevention program related to health.
Health equity: In India, health equity has inevitably been a prolonged guiding dimension of the
nation’s health policies (Berg and Anshika 2017).Because health expenses are highly responsible
for many families resulting in poverty, (Chakraborty and Chakraborti 2015) system
equalitiesmust be fairly chalked out. Otherwise, this existing barrier would impede every attempt
in the successful reduction of undernourishment in India.
Feasibility and health system considerations:Such aspects recognise the most feasible
interventions that might vary across countries and their different jurisdictions which might
potentially hinderthe smooth progression of the new program. This obstruction would happen
due to the varied legislation and intricate governance that mediates the existing Indian health
system-based programs.
Economic considerations: The financial budgeting and its impact remarkably influence health
service accessibility. Such economic considerations of a nation tend to acknowledge the fact that
the available budgetary resources tend to be constrained (Dang, Likhar and Alok 2016). Due to
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such an inadequate budget, the Indian Government fails to provide the desired benefits as
committed which are therefore regarded as a huge barrier. Unable to meet health care
expenditures, much of Indian households are continually falling into steep poverty and in turn
dying due to unattended treatments or interventions.
Societal implications: The varied social implications pertaining to healthcare creates certain
difficulties due to which health services fail to disseminate uniformly in the society. This
problem must be addressed by the proposed prevention program where the policymakers must
ensure accurate and consistent monitoring of any newly implemented healthcare-oriented
services to augment their effectiveness. It must be ensured that services are being experienced by
one and all and are not merely taking place in isolation serving individuals singly. Furthermore,
every month, occasional social programs will be allocated that will involve only the affected
undernourished people of a specific region. Such intensive interventions will make the
implementation of the same at thesystem-level.
Human rights & socio-cultural acceptability:Problems associated with this must follow the
criterion of staying in sync with the universal standards of human rights. Also, the socio-cultural
acceptability imposes a major barrierbecause of its time and context-specific nature.
Balance of certain health benefits & harms: This factorisa potential barrier that exhibits the
various magnitudes of the health-based impact of certain interventions (Ncbi.nlm.nih.gov 2019).
Benefits include the early detection and timely intervention of a disease which barely happens
among the poor Indian families. However, the implications of the harmful effects are even more
challenging.Raising the alarm for a potential harmful situation can, in turn, worsen a situation if
the quality evidence is poor. In such cases, people might be more deprived of specific
interventions.
Health care finance: what public/private funding is available?
The annual healthcare finance corresponds to the allocation and the usageof resources in the
health sector. Varied Union and State level marginal policy interventions in India have been
formulated to address such financing gaps. With India’s public-private split pertaining to
healthcare expenses, it is inevitable that the public funding dominates in India.India’s Integrated
Child Development Service is an example (Downtoearth.org.in 2019). Several private
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sectorshave also implemented CSR practices to rise funding to provide food supplement to rural
areas.
Due to the lack of political dimensions, the economic constraints continue to persist in the
nation’s heart making the annual budget not increasing for many years. Thus, the cost is certainly
not adequate to address the mentioned demand with the existing healthcare financial budget of
India.
Insurance markets:
The health provision services remarkably vary from state to state. India’s health insurance has
been an emerging dimension of the country’s economy. Health systems in India mix both private
as well as public providers. India’s Rashtriya Swasthya BimaYojana (RSBY) is a government-
sponsored insurance scheme that intends to deliver services to the people under BPL (Karan, Yip
and Mahal 2017). The concerned beneficiaries are needed to pay INR 30 as the annual
registration cost pertaining to the hospital coverage of nearly INR 30,000 each year.
Although the current insurance manages to cover certain provisions, it does so only for the BPL
communities. Thus, added provisions are required to cover the whole of the prevention program.
4. Recommendations
Adopting technology in compliance with other nations
In order to detect the problem of malnutrition, necessary medical tools are required. Since most
of the cases of malnutrition in India are getting detected from rural areas, it is really challenging
for the government to deal with the burning issuer effectively. D-Tree international has
developed electronic decision trees in order to help the community health workers in determining
necessary action to deal with the issue effectively. D-Tree can also help to upgrade the medical
facilities in compliance with international clinical standards. The government of India needs to
develop such an application in order to detect the issue and thereby ensuring quality medical care
for the affected patients. Additionally, the Government should invest more with the intent to
implement a number of state-of-the-art technologies such as IOT, Mobile technology and so on
in order to deal with the issue in an effective way.
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Utilising some elements of technology
Malnutrition is a burning issue in India and every year a number of children die due to the same.
Since India is a developing nation, it is not possible for the Government to implement all the
cutting-edge technologies due to budgetary limitations. There are various technologies available
in the world that can be effective to deal with the issue of under nutrition directly or indirectly. In
order to utilise all those technologies, huge funding is required. A huge amount of money is also
required to train health workers. Therefore it is recommended that the government of India
should form an expert committee who can suggest the method of utilising some element of those
cutting-edge technologies. The Government needs to strengthen the ICDS reporting framework
by using some of the necessary elements of modern technology.
Rejecting obsolete technology
It is also recommended that the Government should stop using obsolete technology in order to
save a huge amount of money. Based on the context, the economic recommendation can also be
implemented. The government should allocate sufficient budget in order to appoint nutrition
counsellors both in rural and semi-urban areas. There are a number of programmes and policies
in India in order to combat the problem of malnutrition, such as Mid-day meal, Vitamin-A
supplementation, Weekly Iron and Folic Acid Supplementation and so on. Technology can help
the government to monitor the effectiveness of those policies and programmes. Therefore it is
recommended that the Government should shun obsolete technology in order to save more costs
and use the money to implement new ones. Hospitals and health care centres should be equipped
with sufficient tools to detect and address the grave issue of malnutrition.
Conclusion
In conclusion, it can be said that the emerging incidence of under nutrition is on a constant rise in
India due to the wide-ranging determinants as mentioned in the report. In this regard, the various
attempts taken both by the country’s Government and other relevant organisations have
reportedly provided certain nutritional benefits. Such benefits aid people belonging to the below
poverty line segment. Meanwhile, there had been certain barriers that co-exist in the nation’s
internal architecture that coherently impede the efforts undertaken by different agencies to
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minimise and/or eradicatethe growing risk of poor nutrition in India. The most probable attempt
to prevent such issues has been outlined through a prevention program mentioned above. Among
the recommendations, adopting technology in compliance with other nations will be impeccably
accepted whereas certain fragmented technological utilisation would invariably fail to deliver the
best possible outcomes. In addition, in a developing nation like India, rejection of obsolete
technologies to secure considerable budget cost has been highlighted in the above context.
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