Last Mile Nutrition in India

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What is the last-mile in nutrition?

The “last-mile” indicates the distance between where we are today, and where we aim to go for any given indicator.

Malnutrition in India is a complex issue. The country grows sufficient food, has a functional democratic system with effective feedback mechanisms, the world’s largest public distribution system in place for food delivery, and an extensive network of state mechanisms to reach every citizen in the country. Substantial policy attention has also been paid to health and nutrition issues in recent years. Despite these advances, malnutrition rates remain high across the country. In response to this “silent emergency”, the Government of India launched the National Nutrition Mission referred to as the Poshan Abhiyan in March 2018.

With the launch of the National Nutrition Mission, the government of India has clearly elucidated where it aims to be by 2022 with targets set for reducing stunting, underweight, low birth weight and anemia in women, while the National Family Health Survey of 2016 provides the baseline in terms of the nutrition situation today (Table 1). 

Table 1. India’s National Nutrition Mission Targets for 2022

Indicator

Where we are today?

Where we aim to go?

Low Birth Weight

14.3%

8%

Stunting among children (0-5 years old)

38.4%

25%

Underweight (0-5 years old)

37%

30

Anemia in Women (15-49 years old)

51%

42%

Why is India still lagging behind?

With the last-mile for nutrition in India so clearly defined, many are left wondering why India is still lagging behind achieving key nutrition indicators. To answer that question, it is important to understand the three most pressing issues in the last-mile nutrition landscape in India:

1. Affordability: The availability of affordable nutritious and safe food in the market is one of the most important components to fight malnutrition in a country. However, in India, the high cost of nutritious food is further driving up malnutrition, according to the World Bank report The Cost of Nutritious Food in South Asia. As per the study, in India, prices have increased the fastest for vegetables, fruits, seafood, and meat products, and slowest for energy-dense food with generally poor nutrient content, such as beverages, sugar, and oils and fats.

2. Accessibility: Not only are nutritious foods not affordable for low-income consumers but ensuring availability through distribution and retail channels remains a challenge. In India distributing nutritious food as a public health measure is still not a political imperative and the Public Distribution System (PDS) – a large-scale government scheme for food security – does not promote dietary diversity for those relying on subsidized food. In a report issued two years ago on the role played by PDS rations in shaping nutritional security, the NITI Aayog found that families below the poverty line consumed more cereals and less milk compared to their more affluent counterparts.

3. Awareness: Lack of knowledge about nutritious food choices, or low appeal of those food products, further compounds issues of malnutrition in India. For example, there is next to no awareness on what constitutes a balanced diet on a limited budget, the age at which an infant should first be given complementary foods, the proper growth of adolescent girls and boys, adequate pregnancy weight gain, and the importance of sanitation and hygiene. This information deficit is often highest among the most vulnerable in India, such as families who work in agriculture/construction labour, where the majority of wasted children are found.

How do we get there?

To chart a roadmap for achieving the last-mile for nutrition in India, Sight and Life assembled a group of leading experts and practitioners, all of whom are innovating within both government and market-based approaches in the food system to improve the health of nutritionally vulnerable populations in India.

Three tasks were set out for these experts:

  1. Unlock the barriers and challenges in both the demand and the supply side that must be tackled to see real progress in making nutritious foods and services available to the last-mile consumer;
  2. Reinforce perspectives on successful strategies to build sustainable and scalable initiatives towards improving nutrition; and
  3. Showcase innovative approaches and collaborative partnerships which will have a bold impact in the next decade towards solving the issue of making nutritious foods accessible and affordable to all Indian citizens.

The expert group discussions culminated in a panel discussion at the World Congress of Food Science and Technology (IUFOST) 2018, which was moderated by Dr. Klaus Kraemer, Managing Director of Sight and Life, and included presentations on:

                 Dr. Klaus Kraemer, Managing Director, Sight and Life
  • What is the role of Tata Trusts in last-mile nutrition in India?: Ishaprasad Bhagwat, Program Manager of Maternal, Infant and Young Child Nutrition at Tata Trusts, a philanthropic organization facilitating programs and the implementation of different approaches, presented on how government channels can be strengthened, to reach the last-mile consumer in India.
Ishaprasad Bhagwat, Program Manager  of Maternal, Infant and Young Child Nutrition, Tata Trusts
  • What is the role of IPE Global in last-mile nutrition in India? Raghwesh Ranjan, Director of Social and Economic Empowerment at IPE Global, a key development partner, showcased how they are helping state governments effectively implement reforms in the nutrition space. They are also working with communities to create demand for good nutrition and empower them to demand better services from the state.
Raghwesh Ranjan, Director- Social and Economic Empowerment, IPE Global
  • What is the role of DSM in last-mile nutrition in India?: Ruchira Jaitly, Director of Nutrition Challenges and Strategy at DSM, a private sector company, presented on their role in investing in purely market-based innovations and approaches for last-mile nutrition. She showcased how DSM built a disruptive B2C (business to consumer) social business that has the potential to address the nutrition gap with locally relevant solutions.
Ruchira Jaitly, Director-Strategy and Nutrition Challenges, DSM
  • What is the role of Sight and Life in last-mile Nutrition in India? Kalpana Beesabathuni, Global Lead for Technology and Entrepreneurship at Sight and Life, a nutrition think tank, showcased a new innovation called the ‘Nutrition Kiosk’ which aims to drive both demand and supply of affordable nutritious foods and services. Sight and Life’s core strength lies in generating new insights into nutrition and turning them into sustainable programs and business models.
Kalpana Beesabathuni, Global Lead-Technology and Entrepreneurship, Sight and Life
  • What is the role of emerging technologies last-mile Nutrition in India?: Gurvinder Ahluwalia, Co-Founder, and COO at Digital Twin Labs/Beyond Protocol showcased how the company is leading the way in looking at how emerging digital opportunities empower last-mile households to meet their essential nutritional needs according to their priorities.
Gurvinder Ahluwalia, Co-Founder and COO, Digital Twin Labs and Founder and CEO, Beyond Protocol

“This expert group was carefully assembled by Sight and Life because we wanted to showcase pivotal actors in the entire food and nutrition ecosystem that are required to holistically nourish the last-mile consumer,” said Dr. Klaus Kraemer, at the end of the panel discussion. He noted that the involvement of this broad stakeholder base allows us to harness synergies for demand and supply across sectors.

As a follow-up to the panel discussion, Sight and Life will be sharing videos and presentations from the panel discussion on our website. Stay tuned for more information!