A New Look At Take Home Rations
Dr Rajan Sankar of Tata Trusts and Ms Kalpana Beesabathuni of Sight and Life discuss a new initiative to improve the government's #TakeHomeRation programme
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Transcript
00:00 Hello and welcome to this edition of Outlook Ocean special series on the pandemic and nutrition.
00:05 I'm your host Ramananda Sindhupta.
00:08 Today we are going to talk about take-home rations of THR and our special guest today
00:16 is Dr. Rajan Shankar, Director of the India Nutrition Initiative of Tata Trusts
00:20 and Ms. Kalpana Visabhumi, Global Lead Technology and Entrepreneurship, Site and Life.
00:29 In an effort to strengthen the existing THR program, the India Nutrition Initiative
00:33 of Tata Trusts along with Site and Life has published a THR compendium
00:38 which details recommendations that can easily improve the already existing program. Thank you
00:45 so very much for joining us Dr. Shankar. It's always a pleasure to have you with us and thank
00:49 you Ms. Visabhumi for joining us too. Let me begin this by asking Dr. Shankar the first question.
00:57 Dr. Shankar, how has the pandemic impacted the THR program of the government
01:01 and what kind of long and short-term impact do you foresee due to this disruption?
01:06 Thank you, thank you Ram, thank you for inviting me and Kalpana on this and your interest in our
01:16 THR compendium. I think this pandemic has not left anything untouched and certainly it's such a big
01:28 crisis and in any crisis the most affected are women and children and they are the ones who
01:36 really benefit with this what has come to be known as the take-home ration. It's just a supplementary
01:42 food that is given to women and children in the ICDSR, Integrated Child Development Services as
01:52 a part of the six or seven services that they provide. This is the beginning of the pandemic
02:00 and more to say the kind of measures that we adopted to contain the pandemic, there is a lockdown.
02:08 It was almost stopped, there was no way they could do it but the heartening thing was that
02:15 as the lockdown prolonged, state after state found ways and means to take the take-home ration to the
02:24 people. There are very interesting anecdotes that have come from many places but I think over a
02:31 period of last six months, states have all adopted different ways and means to take this essential
02:41 food supplement to many of the families who are food insecure during this difficult phase
02:49 but it's still not perfect. It hasn't come back to the pre-covid level of reaching something like
02:57 90 million children and 17-18 million pregnant lactating women but it's not the zero in the
03:05 first two weeks that we face after the beginning of lockdown but somewhere in between but it's
03:12 really heartening to see state after state and civil society actors joining hands to take this up
03:21 forward. Thank you. That's interesting you said that 90 million is that what you said 90 million
03:30 children. Yes, see there are 90 million children who are beneficiaries of this ICDS system
03:39 that about a third of them nearly half of them get food at the ICDS center which is cooked and
03:48 served to them because these are children who are three years and above who come there for
03:53 preschool learning. They have this preschool training and they come there so they're all given
04:01 cooked meal but the other category children who are six months to three years old they don't come
04:09 every day they come either once a fortnight or once a month at that time their growth monitoring
04:19 is done and then they are given the supplementary food to take home and to be given to them. So
04:26 together they're about 90 million and pregnant and lactating women who benefit from this are close to
04:34 17 to 19 million that number varies. Those are very large numbers you're talking about.
04:40 How can the private sector help the government in delivering this nutrition and take-home
04:52 lessons and what are the challenges involved given that the government is usually a bit
04:56 trippy about getting the private sector involved in most of these things.
05:01 Right thank you Mr. Sengupta. It's a very pertinent question and I'm glad that you are
05:08 reviewing the work that's been done in the THR compendium and thanks to Dr. Shankar and
05:13 Tinni as well for getting us at Saturn Life involved. It's been a very fascinating I would
05:20 say journey looking at the best practices as well as you know what are the challenges
05:26 involved in getting the private sector. So we reviewed a number of initiatives, pilots, reports
05:32 done by a range of organizations that Dr. Shankar has described for working and bringing THR
05:38 in the last mile. Now THR can be produced and delivered in a range of centralized and
05:45 decentralized models and both have their own sets of advantages and drawbacks and each state would
05:51 need to do their own assessment of what would be the preferred model and then match the private
05:57 sector's expertise and capabilities. Now when you say Mr. Sengupta private sector, private sector is
06:02 very heterogeneous. There are diverse domains, there are companies that range from ingredient
06:07 suppliers to THR, food producers who make the THR, to logistics but also data management and
06:13 diagnostics companies for quality assurance can be involved and broadly I think they could bring
06:18 three areas of support to the government. The first one I would say is around affordability,
06:24 making THR affordable to the masses. Now private sector that's been involved in the centralized
06:30 production model, they have the technical know-how to leverage economies of scale
06:35 to make it really affordable and the second area I would say is assured quality. Now medium to
06:43 some of these large-scale production facilities that the state governments have involved in the
06:46 centralized models, it's possible for them to make THR not only of high quality but also add the
06:53 required amount of micronutrients required for these vulnerable children and women and further
06:59 when we look at the decentralized production models, companies in the diagnostic space,
07:05 they could address the delayed feedback from external quality testing of the THR which
07:11 prevents timely supply of THR in these models and finally the third area I would say is efficiency.
07:18 You know the ICDS has rolled out the common application software which fundamentally
07:24 changes data availability and making it accessible for review through digital dashboards but only in
07:31 very isolated cases is the data directly tied to the formal governance structure but also management
07:38 performance or awarding of contracts for THR and payments of THR to both of the models,
07:44 centralized or decentralized. So there's an efficiency, there's actually an opportunity
07:48 to improve the efficiency of the data management and link it to better THR production and delivery.
07:53 Now when you talk about challenges, I broadly see challenges in two aspects. One is there's
07:59 the lack of guaranteed contracts and demand from ICDS. Now this is especially problematic
08:06 for decentralized models because a lot of them are on a small scale and especially self-help groups,
08:12 they are very much dependent on their working capital on the demand that or the contracts
08:17 awarded by the ICDS. So we need some kind of guarantees for them to make it a more efficient
08:22 process and finally I would say we need a little more coordination between the private sector and
08:28 communities especially those that are involved in the decentralized production models because
08:33 there are many communities and groups to engage with but how do we make sure the delivery is
08:37 happening in a timely manner is something we need to look after. I mean one of the reasons why I was
08:45 asking is that you know you have a lot of these fast-moving consumer goods in place that you know
08:50 they deliver to the remotest of areas, is there a way to leverage their ability to sort of reach
08:55 those areas to DHR? It's possible but even these FMCG companies they rely on logistics players,
09:05 a lot of logistics, large logistics players. So what is it and again it's dependent on from
09:12 state to state, varies from state to state whether it's urban or rural reach but your fundamental
09:17 question is there a way? The answer is yes there is a way and it should be individual state
09:21 government's decision to figure out the right mechanism to improve reach. Okay.
09:28 See if I may add to that Ram, the question is right now there is no big issue I mean in the
09:38 sense that we have 1.4 million Anganwadi centers across the country, 1.38 million to be precise.
09:48 They all of them serve DHR to the dependent population whether they're getting it from
09:56 the centralized or a decentralized thing there's no issue there. The real issue is about the quality
10:06 and food safety and standardizing what is provided even across a state or a district.
10:15 There's so much variability because it's so much decentralized. So and at that kind of a
10:22 decentralized one if you have to provide the bigger players are genuinely not interested
10:29 though at the aggregate level it looks very big. The real problem when this was looked at by many
10:36 of the civil societies was that at aggregate level we look at oh there's 30 million children or 80
10:44 million children but then it gets fragmented when it comes to an Anganwadi center. There's something
10:51 like 30 beneficiaries, 20 beneficiaries and the big fellows it's not they there is so much
10:57 difficulty in the logistics involved in distributing it to that level. So the stock out
11:03 was a common problem and children were not getting it or getting it late. That is why the decentralized
11:10 ones where the communities are very I mean one the people involved they have something at stake
11:18 they directly are involved and they're doing it for their children and the logistically it is so
11:25 much easier and the other issue that they brought out was about the local acceptance and they
11:33 understand the palatability, they understand what is locally available, what is acceptable
11:40 and they were the biggest advantages but then the problem is to make it standardized form
11:47 and ensure that they are all fortified and also provide you know bring in that lens of food safety
11:54 then this model can work very well. That's what I would like to say we don't need newer players,
12:02 bigger players to come. The current one is serving them but it requires few modifications,
12:11 additions to make it better. We haven't said anywhere issues with the decentralized model,
12:19 they work very well but they can work and it can become so much better with some hand-holding
12:27 support and the various points brilliantly brought out by Kalpana in terms of some kind
12:33 of an assured buy-back providing them some technology support, providing them quality
12:39 assurance support and things like that. But you know isn't there some kind of a mismatch between
12:45 what we just said in terms of decentralization where you know each state has handles its own
12:51 DHR program and quality control because quality control I suspect would have to be a
12:56 more of a centralized kind of a thing. See what is provided there I mean I'll leave it to Kalpana,
13:04 I'm sure answer this. What is provided there is a very simple
13:12 you know food. You take a cereal, you take a pulse, you know they are roasted, pulverized,
13:19 you know blended and you know you can add micronutrients and make sure that you know it
13:26 has some shelf life and that is the share is so low and then it is provided and that can be
13:33 made into different recipes given to children. So it's we're not talking about a high
13:42 food process food that is to be manufactured by you know people with the sophisticated machinery.
13:49 Kalpana would you just describe that? Yes, perhaps you would also like to tell us you know that
13:57 how can we ensure that people actually use local produce instead of a sort of a generic packet
14:04 which may not be sort of you know always palatable to local taste. Yeah, I know that's an
14:10 interesting question but actually I don't see catering to local tastes or preferences is much
14:19 of an issue because if you look at all of the THR, the variety we see in the states, they're all the
14:24 primary ingredients are all based on local palate. You know the formats in THR are upma, khichdi,
14:31 halwa, all is a simple blended foods and they're easy to mix. You bring in two or three different
14:36 primary ingredients, one like cereal based and one a legume based. You mix it, grind it and then you
14:41 add additional vitamins and minerals for especially for younger children and package it and then give
14:47 it. So the primary ingredients are already I would say catered to local taste whether it's a
14:53 rice eating primary, rice eating states or wheat eating states. But what we need to focus more upon
15:00 here is the nutritional composition and food safety of THR and in the editorial Dr. Shankar
15:06 nicely describes THR. I think we should go beyond just filling bellies but filling the nutritional
15:11 gaps and they're also in the companion. There are some other nice articles by Dr. Shankar,
15:16 Sharika and Purnima which elaborate on these issues and quality whether it's centralized or
15:23 decentralized what you brought up Dr. Sengupta. I think Dr. Shankar has already explained very well.
15:28 It depends. Centralized facilities have a set of quality control and assurance systems which are
15:34 more standardized which are easily known and can be monitored because it's all in one place.
15:39 Whereas the decentralized model is also possible to maintain good quality and assurance but we
15:45 haven't yet, we are yet to what we say we have yet to standardize that process of what it would look
15:50 like to ensure assured quality in a decentralized system. Dr. Shankar I'll come back to you sir.
16:03 One of the things that this nutrition THR applies to is this thousand day program
16:08 which is essentially to do with the mothers and children up to three years old.
16:14 How is that sort of package different from what is the standard THR and how
16:23 difficult is it to bring that particular segment of it back on track because that has a lot more
16:29 impact in terms of long term and short term. Yeah thanks. You know this THR program in fact
16:40 the ICDS started way back in 75 and they started providing some supplementary food
16:49 as early as 1963 in India in what they called as a applied nutrition program
16:56 and they started giving it to the right target group much before all these terms were coined
17:05 as first thousand days. It just as targeted to women who are pregnant and children in the first
17:13 three years of age. Now the first thousand days we say from conception to the second birthday of a
17:19 child. This is the time women when they are pregnant their energy requirement is higher
17:27 and also the requirement for certain nutrients is higher. So that has to be provided as a supplement
17:36 that is there's not a replacement meal there's a supplement to whatever they are eating.
17:44 Similarly for children six months to two years is a time in situations like India
17:51 in the poorer households children start to falter in their growth. They don't maintain the normal
17:58 trajectory of growth that is because first six months children are ideally fed only on mother's
18:07 milk that is what we call the period of exclusive breastfeeding nothing else is to be given. From
18:14 six months onwards till to two years or beyond breastfeeding is continued but that will not
18:21 suffice the requirement of the child. So you need to give additional food which is added on to the
18:28 breast milk that is what you call the complementary food. The complementary food is a special food
18:35 this can be prepared at home it can also be processed and given from outside.
18:40 This food is a dense food like the child has a very small stomach you know the gastric capacity
18:48 is small but the energy requirement as well as the mineral vitamins and mineral requirement
18:56 is probably the highest per kilogram of body weight particularly for certain minerals like
19:02 iron and zinc the requirement is very high it cannot be met unless given from outside.
19:09 So the point is these two groups require supplementary food to what they eat and you
19:16 have the THR that serves as the right supplementary food. So our argument is there was a time when
19:25 there was a lot of food insecurity in India not saying it has disappeared but substantially less
19:31 than what it was when these programs started where the main the idea behind THR was give every family
19:40 some you know food that would go into the family pot and mitigate the energy deficit to some extent.
19:50 So they focused only on providing certain energy that is give them 500 calories put 14 or 18 grams
19:57 of protein for children 12 grams for pregnant women 18 grams and that would take care.
20:02 But now that we have moved you know advanced quite considerably what we need to do is turn
20:09 these THR to align with what the international recommendations as the ideal supplementary food
20:17 for pregnant women. Similarly can we turn this THR into a good complementary food for children
20:27 below 3 years you know in that case it would really you know provide the missing things in
20:36 their poor diet at home and the idea should not be to replace the poor diet at home with a very poor
20:44 THR. It should be an ideal supplement that aligns with international recommendations
20:51 our own ICMR recommendations why international recommendation as an ideal supplement
20:57 for pregnant and lactating mothers and similarly for children.
21:02 Scott now I'll come back to you with another question because you know
21:09 one of the things that I noticed in this compendium is that all states should consider
21:15 having at least one separate take-home ration product formulated for children
21:19 6 to 36 months and separately one for pregnant and lactating women.
21:24 We already have an issue in providing one basic THR how do you sort of you know talk about two
21:31 of them separately. I think primarily what the difference between them is the nutritional
21:38 composition. Pregnant and lactating women have a higher nutritional needs than the younger children
21:47 so what that means is the micro ingredients is what changes for the two groups.
21:53 From a food processing perspective or managing the food production perspective the base ingredients
22:00 the base mix is the same so procurement of raw materials then sorting them out into the two
22:07 groups and then producing the blending them is a common process for both and that takes up majority
22:15 of both the time effort and energy in the food production process. Now comes the
22:20 later stage where you add additional nutrients depending on the age group and that comes at a
22:25 much later stage and addition can be tweaked for example you can run one shift for children
22:32 another shift for pregnant and lactating women but at least the procurement is the same which is the
22:36 large component of both the cost structure but also the effort required and since that's take
22:42 since the base is the same for both groups it's a I would say it's a it's a small issue compared
22:48 to the other larger issues we have for THR. Now you're saying that it's not necessarily that they
22:54 are radically different sort of packages for each. It's not radically different from a raw material
23:00 perspective from a processing perspective yes yeah what is what is different is the adding
23:08 the micro ingredients required for the different age groups but that's a small I would say that's
23:14 a small processing step involved and it does not involve a lot of effort nor does it involve a lot
23:19 of cost or capital. What about at the distribution level I mean I assume that most of these are
23:26 distributed by unemployed workers and people at that level would they have to be trained to do
23:31 this separately as in you know that this package is for mothers this package is for children.
23:36 I see Dr. Shankar nodding his head. Dr. Shankar would you like to go ahead.
23:40 Distribution levels we're talking about young children and the Anganwadi center so there's a
23:45 mother is always involved whether she brings the child to the Anganwadi center or whether she
23:50 herself comes to the Anganwadi center or the child in some cases the child takes back the
23:54 rations back with him or her back home. So distribution from the facility or from self-help
24:01 groups to the Anganwadi center is all combined yeah combined together with the with the child's
24:07 groups but from there from Anganwadi center to the mother's children is also non-issue because
24:11 both the mother and child should be seen as one unit at the Anganwadi center but typically the
24:16 mother brings the child or there's a pregnant woman coming to the center. So to me it's not
24:22 such a big difference on issue. Dr. Shankar would you like to add. Yeah you know that's precisely
24:28 I mean they always it's a diet they come together and it can be and also separating this food
24:35 would mean that the mother knows that this is specifically meant for a child
24:41 and when you have that a number of other things will also happen you can teach them you can
24:47 counsel them on the nutrition things. Now to go back to that question why are they different
24:53 you see we adults eat quantity we eat bulk so you can you the nutrient density is not
25:02 need not it's not to be the same as what you give a small child you know a child between six months
25:09 and two years specifically six months to one year the quantity that the child is going to eat or can
25:16 eat is very small so per 100 calories of food that the child takes the density of certain nutrients
25:25 is so much higher in the case of iron it is 12 times higher.
25:30 For what you would provide a pregnant woman so it's about the density it's a small quantity
25:40 you've got to pack all the nutrients within that small quantity that's a dense food and that you
25:45 have to give now what happens to children is you know they get a very small quantity of adult food
25:53 in the complementary period and they don't see that food is not dense enough so it doesn't give
26:00 them the required nutrients as adults we eat bulk so as you eat a larger quantity you get the minerals
26:08 and vitamins that you want if it has the right diversification so you need special food for
26:13 children that is why we need this separate package and it's logistically initially there
26:20 may be a little difficulty but as Kalpana explained that this group come together it is always a
26:27 mother who receive it for the child and if she so they will be able to handle it it won't be
26:34 so much a logistic problem. Okay, okay I have you know another interesting question here which says
26:43 that you know the ICPS mandates and nutrition suggested 50 percent of recommended dietary
26:48 allowance of nine micronutrients should be there in THR but this is not sufficient as beneficiaries
26:54 consume much less due to intra-household sharing so how do you assess that is increasing the THR
27:02 the only option or how does that work? So when you say how does that work means how do you how
27:10 does intra-household sharing happens or how do we ensure the child also how do we ensure that you
27:15 know the child gets the thing that is meant for the child. In a lot of good case studies or models
27:23 that we have seen or written about in this compendium there's always an added awareness
27:30 counseling or a behavior change component at the ICPS at the Anganwadi center level where the
27:36 Anganwadi worker is explaining to the mother and the child that this particular food is must be
27:43 used only for the child and it's different from your regular foods that you work that you make
27:47 at home that's one way of doing it and second in for example in Gujarat what we have seen is
27:53 the packaging they've made the packaging so drastically different one is for very child
27:57 friendly packaging which shows as a child food and the second is for the pregnant
28:03 pregnant women so it shows that one is a child's food second is an adult food and the third way
28:08 we've seen in some of these models is the consistency of the texture of the product itself
28:13 so it's more finely ground so when you when you actually prepare it it looks it's a bit more like
28:18 a mashed sort of a food which is given to very young children whereas for the adults it's more
28:24 coarser texture which is not child friendly so a lot of adults also don't eat mashed or very
28:31 gruely sort of food prepared for the children so these are some of the three ways that we have seen
28:36 how to differentiate or prevent intra-household sharing. Dr. Shankar is there anything else?
28:43 No I mean very very well put that's absolutely
28:47 addressing the cause as in you know intra-household sharing happens only because others are hungry too
28:54 so they feel that everybody can distribute it amongst themselves so is keeping the volume an
29:00 answer? I don't think I mean the answer is to increase volume I mean we have to
29:06 if there are food insecurity there are different ways to address it you know let's not convert
29:15 unless we make this as a special food for a specific category and provide it in the right way
29:22 it won't we can't expect that impact on pregnancy and you know the next generation
29:31 from that pregnancy to have a higher weight gain or you know the linear growth and you know all
29:37 the benefits associated and similarly to arrest the growth faltering in children so if there is
29:46 so much food insecurity in the families that face that they will require different instruments to
29:54 correct that the THR is for a specific purpose and the primary aim should be to address that.
30:03 Okay, there is a you know the compendium talks about something called RISD.
30:13 Would you like to just elaborate on that a bit and tell us what exactly that means and you know
30:18 how that is aligned with the government program? Kalpana I mean she coined it and she should
30:26 come with that. Come Kalpana. Well it's just an acronym so it's easier for those of us who are
30:33 working in this area to remember but also advocate for with the states and the policymakers it's an
30:39 acronym R stands for refine THR composition and formulation, I stands for improving the THR
30:47 production and distribution, S for strengthening the monitoring and accountability and E for
30:53 enhancing the policy environment and basically what we're saying that after we ensure one way
31:01 is to ensure two different products which we just talked about one for pregnant women and one for
31:05 children and under the refining of the THR composition and formulation but also there
31:11 are ways to include higher quality protein and additional vitamins and minerals. For example,
31:16 India is a surplus country for milk production as well as milk powder. It's one of the most
31:21 affordable ingredients that can be added to any of the THR products and actually a lot of countries
31:27 in sub-saharan Africa import milk powder from us and the second is that it's been a while since the
31:34 composition was mandated many years ago, some incremental changes have been made
31:41 but we also have to critically look at the lowering the sugar content because currently
31:46 sugar accounts for most of the THR products 25% of the calories. So we need to go back and refine
31:52 these compositions to look at both the positive nutrients but also the negative nutrients
31:59 both for women and children and in terms of improving the production and distribution I
32:04 think we've already discussed several good points. Can we institute digital monitoring systems?
32:10 Again India is very good when it comes to technology platforms, we support many other
32:15 countries. Can we use the systems to provide feedback to the manufacturer on improving
32:21 either the taste, the formulation but also distribution to the Angadwadi center? Are
32:26 there any blockages? Can we link performance and timely reaching or timely distribution of THR
32:34 to their producers contracts and the payments and all of this could be done
32:38 technically because India has a capacity to do it but can we make it better for the THR program?
32:45 That's what we mean by improving the production system and in terms of strengthening monitoring
32:50 and accountability I think as I mentioned before both the quality assurance and control procedures
32:57 exist, they're different for both centralized and decentralized but what we need is an independent
33:02 oversight for these procedures and can we do regular now that we have digital dashboards,
33:07 can we do a regular review of the data and make it better? At the same time when you strengthen
33:13 those monitoring and accountability provides transparency which we can make it public.
33:18 And finally enhancing the policy and environment, now what this COVID, the pandemic has done is that
33:26 it's given us an opportunity to challenge our you know the traditional way of food production
33:31 and distribution and use resources more efficiently. Unlike many countries we have a fantastic THR
33:37 take-home ration in place which addresses all the issues that the pandemic has raised
33:41 or in food hygiene, distribution, access to nutrition, all of those can be solved with
33:46 this program. So in the short term I think what we need is a thorough assessment of the
33:50 individual state's capacity for production and distribution of THR and there are definitely
33:56 ways to reconfigure and improve THR especially during this pandemic. And in the long run
34:02 we need to every level whether it's national, state or local it deserves a re-evaluation. We need to
34:09 critically ask ourselves what is the goal of THR program? Is THR for food security which was
34:15 initially what Dr. Shankar was saying how it came about or is it fulfilling the only the nutrition
34:19 gaps now that many states are food secure or is it for livelihoods or all of the above. Now if you
34:26 find in this analysis of the legislative foundation of this program it concludes that you know the all
34:31 of the three objectives are contradicting or incompatible and their gaps exist definitely
34:36 a reform is necessary and that's what we mean by we need to enhance the policy environment.
34:42 But you know what you just said this rise thing now do we have to apply this separately to each
34:47 state or do you see it as a centralized program? I think each state has is at different levels.
34:54 Many states understand the differences between centralized and decentralized and it's possible
34:59 to have a mixed model approach maybe for urban areas you could do centralized urban and peri-urban.
35:04 Rural we definitely do more community-based self-help group approach and also the culture
35:12 varies how the THR is perceived varies. Their systems are at varied levels some are far more
35:18 advanced some need some more support. So I think each state given the size of a country requires a
35:25 customized their own approach and what the compendium does is it offers a plethora of
35:30 best practices across all of these models. It also shows what some states are good at doing some
35:35 states are need improvement so they can take a you know they can make their own recipe take
35:41 some of these best practices and customize it for themselves. How would you then sort of you know
35:46 take let's say something that has worked very well in one state how could you then try and
35:50 ensure that it is also sort of you know the other states come to know about it because then that
35:55 could again be the centralized approach right? Yeah I know that's good that's a good point I
35:59 think Dr. Shankar has lots of ideas on how to make this information more accessible to all states.
36:06 Dr. Patel.
36:07 Yeah I think it's time that you know it's a it started as a centrally sponsored program
36:18 and then now there is a share between of how they share the expenditure for this program
36:24 between center and states and that varies depending on what state it is you know. But
36:30 it's largely a centrally sponsored program so central government provides the broad
36:36 technique indications and the state governments to modify. But then as Kalpana put it very
36:46 eloquently on you know what this RISE could do it is it's a very powerful acronym and as she
36:53 described it captures the essential components that would make this a much better program
37:03 and serve the basic goal for which this was started. So every state could really apply this
37:12 many of them may be doing very well it is not to say that only if you see a problem that you have
37:19 to apply you should apply and use to tick the boxes to see where you are what needs greater
37:27 attention what is doing well and on the question of how do we have cross-fertilized successful
37:36 examples with other states I think yeah thanks for giving that idea maybe we will take your
37:43 help and organize a webinar and invite various states in present and also give this compendium
37:50 you know in the days of webinar it's so much easier for people to absorb that way
37:55 leading a companion you know it's a very very good example the thing that the way
38:03 the partners who did it under Kalpana's guidance the way they have put this together is
38:10 we are not judgmental on any one of the things the purpose here is not to say which is the best
38:16 way to do it is just to urge people to use this RISE and correct and do the best you don't have
38:25 to necessarily say you have to have a centralized form you've got to have so and so but we need to
38:31 apply this matrix to see where you are what needs to be attended to and corrected and how it can be
38:39 done and together how it can go to achieve the basic mission the basic goal of this program.
38:46 So that's the purpose and it's more to I don't think there is a you know such a prescription
38:53 there in the compendium it is just the truth to the you know word we've just compiled the whole
39:00 thing made it very broad and we'll be very happy if it is disseminated and people come to know
39:08 I'm sure they will each state and each district for that matter it's so decentralized would come
39:15 up with what is contextually appropriate and what is doable and that way step by steps things would
39:25 certainly improve. In fact we have sort of you know this conversation is getting quite fascinating
39:32 I wish we could continue for hours and hours but I think we're running a bit out of time but let me
39:37 ask the person I have a question that you know you've made this compendium I assume that you've
39:44 already presented it to the government present the state or the central government has there been a
39:50 reaction from them has there been any feedback from them so far or is it just I mean how how
39:56 my fundamental question is how do you ensure that it's obvious when the file that gathers
40:00 those new companies. You want to go Karthik? I mean I wasn't involved in reaching it Dr. Shankar.
40:11 One we haven't really taken up dissemination of this seriously but already there is a lot
40:22 of interest that has been shown few state governments have approached us I mean Tata
40:28 Trust and Tinney asking us to do a quick you know situation analysis of what is going on and suggest
40:39 what could be done to improve it. As it is THR is one of the central focus of the country's
40:48 portion Abhiyan. The government itself is taking a serious note of it trying to improve and make
40:57 this as an important instrument to you know avert the growth faltering in early childhood and also
41:04 improve pregnancy nutrition. So the timing is right but this one compilation if it is disseminated
41:14 wider and I think I would be very happy more and more people look at that metrics of rise to
41:26 make the THR a better program than what it is or be happy on how it is going.
41:33 We need to move on that and we haven't done much we've compiled it.
41:38 And we look to you Mr. Sengupta to spread the word. It's only been a few weeks since it's
41:45 out in the public domain. I would love to do this but you know let me ask a sort of a funny question
41:54 because there's something that has been big need and perhaps it's not directly linked to THR.
41:59 But I've always wondered that you know we've had nutrition programs right from as you said 1963 or
42:05 even before that. How is it that we still have so much of malnutrition, so much of something,
42:10 so much of wasting in this country? Where are we going wrong? What is the issue here?
42:14 I mean let's see how far we have come. We started off with such a worse state.
42:24 You know it's a country which used to have famines. People used to die of hunger and
42:28 I mean it's just you know things are improving. Even if you look at the NFHS4 data,
42:37 there's not one state that has not made progress. But the progress that we are making, I agree with
42:44 you, is so much slower than what is possible to achieve. What has been achieved in some of the
42:51 countries with similar socio-economic status. But also the other disheartening thing is the
42:58 progress with certain groups, say rural areas, poor people, women, you know certain socially
43:06 excluded group is much lower than what the aggregate figure shows. And also it seemed to be
43:13 clustered, concentrated in certain states and certain areas. So, we need a more in-depth look
43:22 into it and a greater targeting. See, the universalizing the programs at a stage when
43:29 it was uniformly bad was a very good idea and it should continue. But we can't expect this
43:37 universalized program to take care of some of the people who are vulnerable both because of
43:45 their poverty, because of social exclusions as well as geographical vulnerabilities.
43:52 So, people need to be targeted and special programs have to be launched. Fundamentally,
43:59 see poverty is the root cause of all this. Whatever we are trying to do, that's a long-term
44:07 objective and that's much harder. So, we are taking the shorter route to see how we can eliminate,
44:14 you know, malnutrition to the extent possible, even before lifting everyone out of poverty.
44:22 If that happens, a lot of this problem might, at least under nutrition, might go. So, what we need
44:29 is to continue with the universalized program. Let's not have this that we are not making
44:34 progress. We are making progress. We need to make progress even much faster and make progress in
44:41 certain groups who are really not benefiting today. So, target the most vulnerable both in
44:48 terms of, you know, other vulnerabilities and geographical vulnerabilities. We will do this
44:53 much faster than what we can and what we are currently doing. Thank you.
44:58 That's, you know, on that extremely positive kind of a note, I think I'd like to close the
45:04 here. But once, you know, we finish this conversation and sign off, I'd like to just
45:08 stay on for a couple of minutes after that because I have a couple of ideas.
45:11 That was Dr. Rajan Sankar of Tata Tata Trust and Ms. Kalpana Chettapathuni talking to us about
45:23 THR, the take-home ratings and why it's so important and the compendium that they've
45:29 just released on how to make it a better, leaner, more powerful initiative. Thank you so very much
45:35 for both of you for being here with us. I look forward to having you here again. Thank you so
45:40 much. So, again, I didn't think that. But, you know, I was just wondering since we are on the
45:46 subject, this is something that I found very, very fascinating. Perhaps there's a way in which we can
45:50 take this, you know, have the same conversation where we can get one representative from each
45:55 state talking to us and where we can again, you know, talk about this whole thing and sort of
46:01 tailor it to that particular state. Would that be of any help? I mean, we can take a couple of
46:06 large states and we could do webinars like this for them, get their health minister or somebody
46:12 involved and do that. Yeah, sorry. Yeah, we think it would be a great idea to get and also to get,
46:19 you know, if not all the states, some of the successful examples,
46:23 Kalpana has put together in the, you know, book for all the models. We have excellent
46:30 decentralized models. We've got very small women groups doing it well. We've got models like
46:36 Pudumbashree, successful models in Vareesa, centralized things in Telangana. So, we have
46:42 these representatives, you know, the government official describing it and even some of the,
46:47 you know, self-help group women who've been doing it so successfully.
46:51 What gain the Global Alliance for Improved Nutrition started several years ago in Rajasthan
46:57 and Banswara, those women are running a very small factory and very successfully. So, there are
47:03 models which we can bring in, ask them to talk and half of it can be a presentation of the big
47:12 findings of this compendium and we can close it with the rice. Thanks.
47:18 Let's put some more thoughts into this and take this forward. Thank you so much, Kalpana. And
47:22 as I said, please consider PostNYour platform. I'm totally at your disposal. Anything that we
47:27 can do to help promote this, I think we're doing, you know, a great job in terms of setting this.
47:33 It would be a great honor to have you. Thank you so much.
47:41 Thank you. Thank you. Thank you.
47:49 [BLANK_AUDIO]