CONCERN WOLRDWIDE

Policy on severe acute malnutrition must focus on providing locally made food and not allow imported, packaged food

Feed malnutrition with policy

India has eight million malnourished children. Yet the country has no policy on what food should be given to treat malnutrition. Lack of policy has led international development agencies to adopt varied approaches like giving highly nutritious ready-to-use food. Such measures have often led to confusion and stand-offs with the government. unicef, for example, imported and distributed packaged food in Madhya Pradesh and Bihar last year, without permission from the Ministry of Women and Child Development. The ministry revealed this information in response to a right to information application filed in June this year.

unicef had distributed Plumpy’Nut, categorized as a ready-to-use therapeutic food (rutf). who considers it nutritious. rutfs have been used in several African countries and yielded positive results among the severely malnourished population there.

But imported rutfs are not acceptable in India, a ministry official said. “We told unicef they should ship out any such consignments left,” said Shreeranjan, joint secretary in the ministry, and in-charge of the food and nutrition board.

unicef defended distribution of Plumpy’Nut on the ground that the state authorities had requested for rutfs, citing emergencies. “We have documents to prove Bihar asked us to procure rutfs. Floods last year led to an emergency,” a unicef spokesperson said. Sachin Jain of the Right to Food campaign’s Madhya Pradesh chapter said unicef had distributed Plumpy’Nut in one block of Khandwa district but there was no emergency as such. Plumpy’Nut is an expensive option.

There is a clear definition of emergencies in the Constitution and the situation in the two states did not fit that definition, said Shreeranjan. “They should have at least kept the nodal ministry—us—in the loop.”

In the absence of a policy, organizations like unicef follow who guidelines. “If the government does not have any regulation, shouldn’t we just give the severely acute malnourished children food that is accepted even by who?” asked a member of an international agency. She did not want to be named.

Arun Gupta of the International Baby Food Action Network, Asia, said who had issued guidelines on rutfs without investigating their effect on children. “Instead of using locally available food, these agencies are bent on bringing patented, imported foods that cost more,” he added.

Cipla, an Indian company, has developed an indigenous rutf, which is an affordable version of Plumpy’Nut. But the company exports it to Africa because there is no demand in India, said Amar Lulla, the company’s ceo.


Local v global

Jain said India is just a “market” for the international agencies. “They cite hygiene as a problem with local solutions.” The agencies expand their market by indiscriminatly giving packaged foods to even those who suffer from milder forms of malnutrition.

A doctor at All Institute of Medical Sciences (aiims) in Delhi said although there are anecdotal evidences of locally made therapeutic foods being effective, there have been no scientific studies. “Severe acute malnourished children are in dire need of high energy foods that pack all essential nutrients. It does not matter if it is imported or locally produced as long as it works,” said Umesh Kapil, head of the nutrition department at aiims.

Biraj Patnaik, principal advisor to India’s right to food campaign, agreed. “ rutfs are not bad but the country needs a protocol for using these. The government has to act.” In fact, paediatricians had given recommendations on guidelines in 2006 but the health ministry has not done any work yet. When asked about the child development ministry’s stand on policy, Shreeranjan said policies on therapeutic foods were not in the child development ministry’s domain. “Policy on rutfs is the health ministry’s concern.”