Karnataka’s multi-sectoral nutrition project, more than just nutrition!

Jul 2018 Biraj Swain Photo credit: Biplab

The Karnataka Assembly elections and the following drama in government formation gave us wall-to-wall coverage, schooled us on Lingayats, Veerashaivas, regional disparities between Bombay Karnataka, Mysore Karnataka and Hyderabad Karnataka. Heck, it even exposed how the Bharatiya Janata Party and the Congress IT cells were deep-diving into our social media accounts and brain-washing us for elections.

But what this electoral hyper-coverage did not do is put the spotlight on how Karnataka is tackling the poverty and deprivation in Hyderabad Karnataka region and why there is still hope! One such programme is the Karnataka multi-sectoral nutrition pilot project, running in two of the most backward blocks in Karnataka ie Chincholi in Gulbarga district and Devadurga in Raichur district. So here is our contribution to undo that black-out.

On the back of the spate of child malnutrition deaths in Raichur in 2011, while the then state Women and Child Development Minister, CC Patil, denied the reports, the then government of Karnataka set up the Karnataka Nutrition Mission. One of the first state nutrition missions in the entire country! And they got Veena S Rao, a career bureaucrat, nutrition champion (both in practice and academia), to shape the mission and its special programmes as its adviser. She had just retired from the Indian Administrative Services, where amongst other posts held, she had also been the Joint Secretary of the nodal ministry, Ministry of Women and Child Development, at the central government, leading the nutrition portfolio for the country. A detailed interview with Ms Rao will be published as the next episode of #ChildhoodMatters series.

Fast forward to 2015, the Karnataka Multi-sectoral Nutrition Pilot Project (KMNPP) took shape, with the funding of the Japan Social Development Fund (managed by the World Bank), under the aegis of Karnataka Nutrition Mission. Karnataka Health Promotion Trust, a leading non-profit in the health and social development space, is the implementing partner in the two blocks. So why does this initiative deserve public attention?

Some numbers first as per the project report:

*The stunting figures in the KMNPP haven’t changed much because it is a sticky indicator.

Considering the Karnataka intervention is with one of the most marginalized communities, i.e. the Lambanis, these are very good numbers in 18 months compared to the pan-India average. There has been an under-weight reduction by seven per cent from NFHS III (National Family Health Survey 2004-5) to NFHS IV (2015-16) and a stunting reduction of 10 per cent in 11 years pan India.

KMNPP’s approach has been different from routine nutrition interventions in India, especially the flagship programme i.e. the Integrated Child Development Scheme. How?

  • For starters, it has the Rural Development and Panchayati Raj ministry as its nodal and not the Women and Child Development. The choice of ministry is important, considering rural development is a heavy-weight ministry, has a larger remit, is the natural home of inter-sectoral coordination and addresses the remit of food security and livelihood security too.
  • On the site and community selection, Mohan HL, managing trustee of KHPT explains, “This project is being implemented in two most backward blocks of northern Karnataka ranking 173rd and 175th among the total 177 blocks in the state as per the Human Development report. The challenge, or rather, the opportunity for us through the program, was to ensure that the services and benefits reach the poorest of the poor populations. We undertook a multi-stage process to identify truly excluded households to be able to demonstrate results among populations most affected by under-nutrition. This method and the subsequent strategies were over and above what the government programme mandated. An evidence-based and community-centred approach was adopted in designing and implementing programs in order to showcase population-level impact. These approaches are cross-sectoral and the signature of KHPT.” The result? The author witnessed community engagement and an advanced level of awareness and articulation amongst Lambani women and children!
  • The programme takes a population approach hence nutrition via energy-dense food for children (from 0-3 years), adolescent girls (from 11-18 years) and mothers are the focus. The three cohorts are important to challenge the inter-generational malnutrition cycle.
  • The chronology of interventions is equally important. Intensive awareness campaigns were done with a cadre of Village Nutrition Volunteers (VNVs) so that awareness and information about nutritious food, good feeding practices, health-care, immunization programmes could be imparted to the families. The VNVs also supported the families in practising the new knowledge of food and feeding and accompanied mothers for health check-ups, immunisation. Much criticism has come in for behaviour change approaches which don’t take power and inequality amongst communities into consideration. The World Bank nudge team has even called for humility amongst behaviour change experts. This project goes to the core of that power and inequality by employing a cadre of behaviour change messengers who belong to the Lambani community and hence aren’t not preaching or talking down.
  • And as a final intervention, two state of the art units were set up in both the blocks for manufacturing nutritious energy-dense food, Shakti-Vita, for all the three target population groups. While the Indian market is flooded with baby food, formula milk, mothers’ drinks, from national and multi-national majors like Nestle and Horlicks, there is none to cater to the poor in the rural areas. These manufacturing units plug that gap with Shakti-Vita. The acceptance and demand for Shakti-Vita amongst the population (targeted by the programme and those not targeted too, like the adolescent boys) was phenomenal, as independently witnessed by the author.
  • That this project is being helmed by a former bureaucrat who understands administration and programme delivery at all levels, from gram panchayats to state head-quarters, helps too.

Back to the under-weight, wasting, stunting reduction numbers, KMNPP’s leads are circumspect, since the above are self-reported data. When the author visited the programme in end-May 2018, the project team had opened the intervention for an independent audit by National Institute of Nutrition. This step is more radical than we imagine because we are living in times where most governments and non-governments are cooking the books to write fictional accounts of success. Data manipulation is a go-to method for this. Even global high profile interventions helmed by leading economists like Jeffrey Sachs have been accused of being defensive about data. Journalist Nina Munk does a brilliant take-down of Jeffrey Sachs in her book The Idealist. Data manipulation in his flagship Millennium Villages Project is one of the issues Ms Munk discusses too. KMNPP opening its project data for external verification needs to be appreciated in this context too.

Other than addressing the maternal-child under-nutrition, one of the biggest impacts of this programme is that it set a benchmark for what a well-resourced public partnership programme can look like.

So this state of the art intervention in the back and beyond of Karnataka (if not India), why doesn’t it get written about as often? Rishikesh Desai, special correspondent with The Hindu explains, “Currently Indian media is obsessed with politics, and that too electoral politics. Development journalism, people’s journalism, has long been abandoned.” But he doesn’t blame the Indian media only for the lack of voice amongst the Lambanis. Considering they have such an inspiring nutrition programme, why aren’t they demanding more from the state, more in terms of health-care, education, road transport so on and so forth? What about citizen engagement of the Lambanis? Mr Desai adds, “It is not just the marginalization of the Lambanis (goat-herding is their major occupation, akin to Bakkarwals in Kashmir), which causes their reticence but it is the overall backwardness of Hyderabad Karnataka region, the continuing feudalism in land ownership and production relations, that makes the region reticent and backward. Add to that, the state has over 25 per cent vacancy in Hyderabad Karnataka in sanctioned positions, which, shrinks the ability of the state to deliver welfare. Vacancy is an Achilles heel of Karnataka administration. Electoral politics has also fostered vote-bank constituency and pay-back rather than active citizenship.” So what we are witnessing is something akin to Michael Walton’s clientelism theory.

So while the project is an evidence of the potential of the public sector partnerships, can it be a template for other public services like health and education to follow? Will it raise the ambitions of the citizens of Gulbarga, Raichur and Hyderabad Karnataka region from their state? One sure hopes so. We will watch. Hope the media does too.

 

Acknowledgements: The author would like to acknowledge the support of Karnataka Nutrition Mission for facilitating open access to the project sites and the support of ICFJ Washington DC in bringing this article.

The author can be reached at biraj_swain@hotmail.com.