THE CONTENTIOUS energy-dense nutritious food (EDNF), commonly known as ready-to-use therapeutic food (RUTF), is set for a full-fledged roll-out in Maharashtra, with the state government commencing procurement for severely malnourished children. Officials at the Women and Child Development (WCD) department said that RUTF, in the form of a paste, will be provided to all Village Child Development Centres (VCDCs) for Severely Acute Malnourished (SAM) children registered with anganwadis. The process has begun after a delay of over a year due to initial objections by the central government and then a public interest litigation against it.
RUTF, is a high energy fortified paste of peanuts, oil, sugar, vitamins, milk powder and mineral supplements used for treating malnourished children. The paste is usually given to children aged between six months and six years, based on a doctor’s prescription. The packaged food remains contentious with several activists contending that hot cooked meals for children is a better method to treat malnourishment.
Following the state-wide rollout, activists, who moved the Bombay High Court against RUTF in 2017, are set to approach the court on January 11 seeking a stay.
“States were supposed to consult with National Technical Board on Nutrition before distributing RUTF. Maharashtra did not get an approval from the board,” said Purnima Upadhyay from the NGO Khoj. Till September 2018, only Madhya Pradesh had approached the board for approval to distribute RUTF.
Commissioner of Integrated Child Development Services, Indra Mallo, said “It is a state policy, not central. We have notified the central authority about Maharashtra’s decision to go ahead with RUTF.”
In August 2017, the Union Ministry of Health and Family Welfare had opined that RUTF is only “temporarily helpful in nutritional rehabilitation”. The Central Women and Child Development (WCD) ministry issued immediate notification to all states stating “the use of RUTF for management of malnutrition is not an accepted policy of the Government of India”.
In September 2017, Maharashtra had to halt its tender procedure to procure RUTF for 83,120 SAM children at a cost of Rs 32.66 crore following the central WCD notification. In November 2017, the PMO overruled directives of the Health and WCD ministries and allowed states to take an individual call on RUTF in consultation with newly constituted National Technical Board on Nutrition.
In September 2018, government issued a GR, declaring its decision to go ahead with RUTF. The latest state circular says a child can be given one to three packets per day, based on their weight, following a doctor’s prescription. While UNICEF supports RUTF along with community management, stating that it is cost effective, experts in India believe needs of a malnourished child may differ geographically.
In tribal district Nandurbar, a small scale study by Janarth Adivasi Vikas Sanstha found that children consuming RUTF could not consume any other food and witnessed change in dietary pattern. In the same district, a health department study showed 49 per cent efficacy in RUTF treatment. Of 7,927 SAM children, 3,886 were cured and discharged following RUTF treatment. Officials in Nandurbar, where packaged RUTF arrived this month, said that distribution will begin in few days.