Community health workforce like the ASHAs and Anganwadi workers, who are gatekeepers for all essential health and nutrition services during and post COVID-19 pandemic have to become resilient and equipped with adequate protective gear and necessary training.
The nationwide lockdown to contain the spread of COVID-19 pandemic in India has led to severe disruption in the economy of the country. It has contributed to grim shocks in the local food and health systems.
But, the abruptness of the lockdown strategy impacted the most vulnerable sections of the population, particularly women and children from poor socio-economic households who have been dependent on daily wage incomes to sustain their health. The sudden loss of livelihoods led to mass migration crisis and hunger. According to UNICEF, the increase in joblessness and poverty due to the pandemic will lead to a rise in hunger as well as malnutrition in the country.
With the country now in ‘unlock-down’ mode, challenges of revamping efficiencies in the public health and local food systems need to be evaluated. The demand for nutritious food supply will gradually decline as poor, vulnerable and unemployed families will be compromising on their diets, causing their immunities to be further compromised and susceptible to deadly infections including COVID-19. Community health workforce like the ASHAs and Anganwadi workers, who are gatekeepers for all essential health and nutrition services during and post COVID-19 pandemic have to become resilient and equipped with adequate protective gear and necessary training.
While government schemes like POSHAN Abhiyaan (Nutrition Mission) and various stimulus packages announced like Pradhan Mantri Garib Kalyan Yojana, (PMGKY), Garib Kalyan Rojgar Abhiyan Yojana, Garib Kalyan Anna Yojna ensure looking after the vulnerable migrant lives, the effectiveness on the implementation will take time to monitor and evaluate in the months ahead.
Anganwadi centres/Nutrition Rehabilitation Centres (NRCs) across states have been directed to provide nutritious meals to children up to the age of six years and to pregnant and lactating mothers. Most state governments have arranged to deliver nutrition services and supplies through home visits by frontline workers — ASHAs and Anganwadi ‘Sewikas’.
These grass-root level functionaries engaged in COVID-19 related surveillance activities are overburdened and have less time to devote to their usual health and nutrition-related community duties. Entrusting them with additional responsibility to ensure proper distribution of locally produced energy-dense food to children and pregnant women should be substantially supported by local governing bodies.
Capturing the marginalised in a centralised system must also be significantly noted. In a crisis, it is vital to ensure that the health and nutrition services are accessed by most vulnerable as children with pre-existing “Moderate or Severe Acute Malnutrition” (MAM or SAM) living in their homes without any medical care and adequate supplementary nutrition need immediate care management.
According to the Global Nutrition Report 2020, 37.9 percent of India’s children under five years are stunted, and 20.8 percent are wasted, a form of malnutrition where children are too thin for their height. These numbers are much higher than in other developing countries where on an average 25 percent of children suffer stunting and 8.9 percent are victims of wasting. It is being predicted that a huge number of people will be pushed into dire poverty or starvation by complexities of unemployment and inaccessibility to government schemes and subsidies.
Non-COVID-19 health services have been disrupted heavily. At least 3,50,000 fewer people received outpatient treatment for diabetes, 1,50,000 fewer people received outpatient treatment for mental illness and nearly 1,00,000 fewer people received outpatient cancer treatment in March 2020 as compared to March 2019, according to an estimate. Several patients accessing TB treatments, getting screened for HIV and other diseases has fallen significantly, as many private hospitals and clinics shut services. Maternal health services and family planning services have also abruptly been halted.
All these normalcies in the operations of the public health system at all levels must be pushed by effective collaboration within the state departments, support from the Centre and other partners at the earliest. The consequences of COVID-19 crisis are likely to vary from state to state depending on efficiencies and will of the public administration systems in the long term.
With such an unprecedented, unexpected and unusual public health crisis, innovative solutions like the implementation of telehealth and teleconsultation strategies for monitoring, surveillance and management of cases and improving public distribution systems can leverage healthy outcomes in the community at large.
A national-level policy guideline for managing on community-based management of children with SAM should assume a high priority. A call for launching these guidelines with updated protocols for infection control, basic hygiene, physical distancing and initialising appropriate protein-based complementary feeding practices is crucial for combating all forms of malnutrition among children.
As per the latest report released by UNICEF Community based programme for children below 5 years of age with Severe Acute Malnutrition in India: Progress so far and lessons learned 2020, the pandemic may increase overall SAM burden in the country. The urgent need of this hour is to bring SAM management under the essential health and nutrition services and to ensure that continuity of services for the management of child wasting is sustained.
Essential health and nutrition services are an entitlement for malnourished children and not an obligation. Even though the challenges are enormous post-COVID-19, a system thinking approach for a renewed vision and an implementation framework for addressing all forms of malnutrition must be developed by the Centre and states. The aftershocks of COVID-19 and malnutrition will grow exponentially if it is not timely addressed.
The author is a Congress Rajya Sabha MP from Gujarat.
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