Malnutrition in India is often blamed on non-implementation of welfare schemes. The argument has always been that the problem is not shortage of food but that it is rarely delivered to the needy. Recently, Mdecins Sans Frontires (msf), an international humanitarian organization, pointed out another dimension in the problem. It said that the kind of food, like nutrient-rich flour, multilateral organisations, including the World Food Programme, are providing is not suitable to meet the nutrition requirements of malnourished children. Instead, it suggested using ready-to-use, energy-dense food like Plumpy'nut, which is made of peanuts (see box: Nutritious nuts). The organization has used this product in its relief work in Africa and found it extremely useful.
In India, the Integrated Child Development Services (icds), under the Department of Women and Child Development, reaches out to undernourished children with staple food. msf, which is providing Plumpy'nut to the victims of Naxalite violence in Chhattisgarh and to aids -affected children in Manipur, is calling for un agencies and donors like the World Bank--which is providing loans to icds --to fund ready-to-use food in nutrition programmes.
No problem with that except that Plumpy'nut is a patented product and costs 3 euros (Rs 165) per kg. Treating a severely malnourished child requires feeding him or her 12.9 kg of the product over 10 weeks. For India, with 2.6 million severely malnourished children under the age of five, this will mean spending over Rs 30 per child per day. Add to that importation costs and the price may double. Now compare it with Rs 2.70 per day per child icds is providing for severely malnourished children in India and you will know we are talking of a quantum jump in expenditure.
Food for the malnourished is indeed a lucrative business in India, where half the children under the age of five are chronically malnourished. Recently, there have been efforts to promote other patented products like Sprinkles, a mixture of micronutrients, such as iron and zinc, with folic acid and vitamins A and C. There have been instances of multinational companies directly approaching state governments to get their products included in food programmes.
Umesh Kapil, professor, Department of Human Nutrition, All India Institute of Medical Sciences, Delhi, cautions: "There should be sufficient tests to ensure that they are effective in Indian conditions." Research should also be conducted to include other high-energy foods such as millet into ready-to-use products.
If msf 's recommendations are accepted, the worldwide demand for ready-to-use food will increase sharply. Specifically for Plumpy'nut about 258 million kg of it, costing Rs 4,125 crore, will be needed to treat the 20 million children who estimates have severe malnutrition in the world. The cost may even be higher given that powdered milk needed to make it is in short supply.
Is it possible to meet such demand? The current production capacity of the makers of Plumpy'nut, the French Nutriset, is estimated at 19 million kg. Those promoting ready-to-use food suggest local production will take care of the problem. Nutriset has not patented Plumpy'nut in India. Two companies, Cipla and Norway's Compact for life, are trying to make a generic version for use in the country. "The product, Nutrinut, is ready and is likely to be launched this year. This is not a substitute for food. Only children who do not have access to food or cannot digest it should be given the product," says Amar Lulla, ceo, Cipla Limited, Mumbai.
People working with communities in remote parts of the country, however, say providing such therapeutic food is not going to help. "You cannot call hunger a disease. The approach needs to be decentralised by roping in ngo s and self-help groups," says Yogesh Jain, paediatrician with the Jan Swasthya Sahyog (jss), a non-profit health organisation in Bilaspur, Chhattisgarh. "Short-term interventions are not the solution. The child is likely to become undernourished again once back home," adds A V Ramani, also working with jss.
To prevent a healthy or treated child from sliding back into malnourishment, msf wants that energy food be distributed to all children under the age of five. This is likely to make it part of the supplementary foods being provided through icds, the largest food and supplementation programme in the world, further increasing the cost. The weakest link nonetheless remains the delivery system.
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