India Micronutrient National Investment Plan Launched

Sapna Dogra

The Micronutrient Initiative (MI), an international not-for-profit organisation, has launched the India Micronutrient National Investment Plan (IMNIP) for 2007-2010. Under this plan, 206 million high risk beneficiaries will be given micronutrient protection per year (average) over a five year period at an additional cost of Rs 587-733 crore per year (USD 130-163 million). The amount is about Rs 5.40 per capita per year, which is 50 times less than the estimated per capita yearly loss to GDP resulting from micronutrient deficiencies (Rs 284).

Informs Luc Laviolette, Regional Director, Asia, MI, "More than two billion people worldwide suffer from vitamin and mineral deficiencies, of which 35 per cent of them live in India. Women and children are the most affected and these deficiencies kill children and women, damage health, impair work capacity, impact reproduction, reduce intelligence and occupational choices."

The Investment Plan is the result of a highly participatory process carried out in 2005-06 by a task force consisting of representatives of Government departments, academic institutions, NGOs, the private sector and international organisations.

In addition to being an input to the 11th Plan which is currently being drafted, the Investment Plan constitutes a template for the interested state Governments to develop comparable micronutrient investment plans on the grounds, now well established, that the cost of a comprehensive programme to reduce micronutrient deficiencies will be far less than the cost of not addressing the problem.

According to the Laviolette, the BIMARU states are the most affected. However, anemia is very common in many southern states and rich northern states like Gujarat, Punjab and Haryana.

The big question is about the funds. Laviolette apprises that largely it would be government funding and the Government has been positive in its response. MI representatives have met the government people and the planning commission.

The proposed IMNIP expenditures should be viewed as an investment in the health and well being of children, adolescents, reproductive age women and the population as a whole.

While over extended periods of the time, economic growth alone could lead to reductions in some of these deficiencies, financial support of the interventions presented in this Investment Plan represents a commitment to provide for this generation cost-effective solutions that improve human well-being and enhance human resource potential. The World Bank estimates that it would take until 2034 for India to reach even the malnutrition rates currently observed in sub-Saharan Africa if it relies only on economic growth.

"For achieving this objective, a mission mode approach needs to be adopted for high level commitment,” says Laviolette adding that it should be spread through advocacy, co-ordination and implementation. The main aim of the MI investment plan is to scale up the ongoing activities to fight malnutrition.

TSR Subramanian, former Cabinet Secretary, Government of India and currently Chairperson of the Micronutrient Initiative India, says, the lower end total cost (Rs 587 crore per year) represents the highest priority interventions and will accounts for only 0.1 per cent of the total expenditure budget for 2005-06 and less than 5 per cent of the Central Health budget (2006-07).

"Given the small additional costs compared to the huge potential benefits in the field of public health, we are confident that these proposed interventions can be funded in the 11th Plan", he adds.

The IMNIP explicitly seeks to address those targets of the Planning Commission's 10th Five year Plan (2001-2006) that have yet been achieved, i.e.

• Eliminate Vitamin A deficiency as a public health problem.
• Reduce the prevalence of anemia by 25 per cent and moderate and severe anemia by 50 per cent in children, pregnant and lactating women, and adolescents.
• Achieve universal access to iodised salt.
• Generate district-wide data on iodized salt consumption.
• Reduce the prevalence of Iodine Deficiency Disorders (IDD) in the country to less than 10 per cent by 2010.

The report further recommends that a public-private-civic partnership be established, with a time-bound five-year plan specifying targets, priorities, interventions, delivery channels, investment and recurring costs. The report suggests that financing mechanisms and partnership arrangements be developed and adopted by the Central and State Governments. The private sector's role should be to develop, finance and implement programmes while the civic organisations could add value in terms of consumer protection, public education, media services, research as well as local commodity delivery. Some of the recommendations outlined in the report include strengthening and scaling up existing interventions with additional interventions and enhanced delivery systems to control vitamin and mineral deficiencies in India.

To elaborate further, the interventions recommended by the report include promotion of exclusive breastfeeding during the first six months; twice yearly Vitamin - A syrup for children in the age group of 9-59 months, home based fortification premix for children aged 6-24 months, nutri-candies for children in the age group of 24-72 months.

Vita-shakti to fortify the food for children aged 24-72 months in the ICDS and mid-day meals programmes, fortification of staple foods consumed by the poor (like wheat flour, oil, milk).