The proposal of the state women and child development (WCD) department to start providing energy dense nutritious food (EDNF) for malnourished children has met with dissent from not just activists, but also from within the tribal development department.
Documents accessed by The Sunday Express under the Right To Information (RTI) Act, show that just a month before WCD issued tenders for contentious EDNF in July 2017, the tribal department had warned against the proposed benefits of the packaged food to combat malnutrition.
EDNF, also called ready to use therapeutic food (RUTF), is fortified paste of peanuts, oil, sugar, vitamins, milk powder and mineral supplements for treating malnourished children aged between six months and six years.
In a note on June 6, 2017, Manisha Verma, Principal Secretary (Tribal Development) wrote, “It was seen that difference between home augmented foods group and commercial RUTF were not significant.” The department added: “Local therapeutic food is cost effective compared to industrial RUTF prepared dishes.”
The department also said that short-term RUTF treatment is prone to relapse and the cure rates declined to 15 per cent four months after treatment is stopped. The note suggested that WCD should instead focus on “strengthening service delivery, nutrition education and behavioural change communication strategies as preventive measures” to combat malnourishment.
On WDC’s take-home ration scheme, the tribal development department noted that the scheme “has been questioned on grounds of quality, palatability and social acceptance”. The department suggested that locally made hot cooked meals that are socially more acceptable and nutritionally rich are used to fight malnourishment.
In an internal spat between the departments, in a correspondence a week later, WCD stated that successful trials in Sion hospital and Nandurbar were observed to treat several acute malnourished children with EDNF. It added that states like Rajasthan and Madhya Pradesh are already moving towards using EDNF. The EDNF tender in Maharashtra was released in July 2017, estimating 85,452 beneficiaries.
In a letter to Chief Minister Devendra Fadnavis in August 2017, Nutrition Advocacy in Public interest (NAPi) had stated that EDNF has no scientific evidence of reducing mortality in children under five. “Sixteen weeks after intervention, the overall proportion of children cured dwindled to 15 per cent,” it added.
Dr Arun Gupta, a child health and nutrition advocate and a member of NAPi, told The Sunday Express: “Even Rajasthan government has issued an order to buy EDNF. We have written to Niti Aayog two days ago pointing out that states are going ahead with EDNF without approval. There is need to issue clear instructions.”
Meanwhile, the National Technical Board on Nutrition, formed after PMO’s instructions to consult with states about EDNF implementation, has received only one proposal on EDNF from Madhya Pradesh. In its minutes of the meeting on August 28, 2018, the technical board observed that it needs more time to deliberate on EDNF’s efficacy. While Maharashtra did not apply for approval from the technical board, WCD officials said the board has been notified.
Data as on September 2018 from the Integrated Child Development Services shows there are 88,363 several acute malnourished and 5.5 lakh moderately acute malnourished children in the state.