India is a world leader on many fronts; unfortunately malnutrition is one. “Home to one-third of the world’s undernourished children,” India has some of the highest global incidences of stunting, wasting, and underweight children. Though the country has made great strides towards improving nutrition through innovations in
micro-nutrient fortification and food processing to combat hidden hunger, nutrition is a socioeconomically complex issue requiring an equally well designed solution.
Research suggests that the “first 1,000 days following conception” are the most critical developmental phase, and “poor maternal and child nutrition is the cause of “10 percent of the global burden of disease,” with health impacts extending far beyond pregnancy and young childhood into late adulthood. At the same time, the impact of good nutrition extends across a woman’s life cycle and so the window for innovative nutrition intervention cannot be limited to pregnancy & birth.
A healthy girl child becomes a healthy mother who will conceive and deliver a healthy child. Jose O Mora and Penelope S Nestel articulate in, Improving prenatal nutrition in developing countries: strategies, prospects, and challenges:
“To have an effect on women’s health and nutritional status, programs that are socially, economically, culturally, and biologically appropriate are needed throughout the female life cycle, beginning as early as possible…women’s health and nutrition have to be considered as part of an inter generational continuum under the rubric of reproductive and child health (ie, pre-and postnatal care, including family planning, child survival, child development, school health, and adolescent health)”
Given this complexity of the challenge, our research demonstrates that sustainable innovation in the nutrition space requires a multi-stakeholder approach that links nutritive food, large scale behavior change initiatives and a robust delivery system to effectively and affordably reach millions of women and children across India.
Feed a (pregnant) Woman, Feed a Community
One of India’s most notable programs aimed at addressing malnutrition among women and children, the Dular Project (Dular means “love” in Hindi) is a joint initiative of the Integrated Child Development Services Scheme (ICDS) in Jharkhand and Bihar and UNICEF. The Dular Program works to improve the nutritional status of women and children by establishing a “community-based tracking system of the health status of women and of children 0-36 of age by neighborhood-based local resource persons (LRPs).” By utilizing local community members, the Dular Program enables locally sourced “bright spots” to become the focus of the intervention.
The program works to increase prenatal care, raise awareness about the importance of breastfeeding and colostrum feeding (colostrum is the first substance excreted from the mammary glands following delivery and is extremely beneficial for infants), as well as improve nutritional practices among women and children.
Program evaluations of the Dular Project have been overwhelmingly positive, showing that young children in Dular villages were 4 times as likely to receive colostrum and were 45% less like to be malnourished. Based on the program’s success, it has since been extended to several more districts in the two states reaching millions of additional women and children.
The success of the Dular Project clearly demonstrates the importance of finding locally appropriate solutions to nutrition challenges. By engaging the community, The Dular Project was able to decrease malnutrition and increase health among women, their children, and the community at large.
Attacking Malnutrition through the Hungry Child
Approaching the issue of childhood hunger and malnutrition from a different angle, one of India’s greatest nutrition initiatives has been the Government of India’s Mid-Day Meal Scheme. The Mid-Day Meal Scheme has effectively reduced the burden of childhood hunger by providing free meals to more than 12 crore primary school-going children each day. For many children, this is one of the only nutritious meals they receive, and the impact of this intervention extends beyond a full belly. Proper nutrition contributes to increased focus and attention enabling students to perform better in school. Furthermore, distributing nutritious food to young children during a pivotal developmental stage has a lasting impact as they grow.
Akshaya Patra, with its tagline, Unlimited Food for Education, is an NGO that has partnered with the Government of India to extend the reach of its Mid-Day Meal Scheme. With its bold mission, to ensure that no child is denied an education due to hunger, and their beautifully engineered kitchens, amazingly coordinated assembly line processes, and perfectly timed delivery system, Akshaya Patra reaches 1,394,757 children at 10,631 schools in 22 locations across 9 states of India each day with hot, nutritious food.
One visit to Akshaya Patra’s kitchens is enough to comprehend the scale at which they are tackling the nutrition challenge. Industrial sized vats bubble and boil as kgs of rice, dhal, and vegetables are perfectly cooked. In another corner, large silver dhabas shimmy down a conveyer belt where they are expertly filled and then seamlessly moved into trucks for delivery. To ensure the food arrives hot, despite a long journey, all of Akshaya Patra’s delivery trucks are insulated. Akshaya Patra even accommodates differences in regional cuisine and taste, with south Indian kitchens serving rice while the north Indian kitchens use an industrial sized roti-maker, which spits out 40,000 rotis per hour!
Akshaya Patra has been recognized at multiple forums for their innovation in service delivery. Akshaya Patra combines ccale of delivery with a deep understanding of the local palate and a cost effective, large scale production method that transforms the mid-day meal program into a potent tool to combat malnutrition in early school going years.
Unlike many domains where entrepreneurial innovators have an opportunity to create sustainable solutions that start with small impact, nutrition initiatives require scale from day 1. Solutions in this space require large scale design, complex stakeholder management, strong partnerships with Government, non-profit & for-profit organizations, and a deep desire to help women and families change generations of old behaviors. These will be the keys to solving India’s nutrition challenge in this decade.
About the Author: Research & Project Manager at Innovation Alchemy, Hannah Rosenfeld explores the intersection of design and social impact & supports entrepreneurs in thoughtfully crafting products and services to transform under served communities.