Manipur's Journey Towards the Health SDGS: What's Achieved and what more is Needed?

India and its constituent states are committed to achieving universal health coverage (UHC) as a part of the Sustainable Development Goals (SDGs) 2030 by strengthening primary healthcare (PHC). The National Health Mission (NHM) has been a landmark effort at health systems strengthening, aiming to reboot both the architecture and service delivery. Manipur ranks fourth out of the eight states in the North East Region in the National Institution for Transforming India (NITI) Aayog's ranking for SDGs. The available evidence, drawing upon secondary datasets and available primary data, aims to unpack the progress made in health systems strengthening to interpret the journey toward achieving UHCs and SDGs. The progress made and the gaps in terms of human resources, infrastructure, service utilization, and reduction of out-of-pocket expenditure are interpreted in terms of critical social determinants such as geographic and ethnic divides. Newer policies, such as the Act East Policy and medical tourism, are examined in the context of current disparities and the potential to accelerate the journey towards achieving SDGs.

Rapid Survey of Wasting and Stunting in Children: Whats New, Whats Old and Whats the Buzz?

Nationwide Rapid Survey on Children (RSoC), conducted by the Ministry of Women and Child Development and UNICEF in 2013-14 showed a marked improvement in the status of the child malnutrition over the third National Family Health Survey (NFHS-3) that was conducted in 2005-06. Despite some impressive gains in the anthropometric indicators of malnutrition, the absolute levels remain high, and of concern. Despite these gains, the feeding indicators remain stagnant. The programmatic responses need to adopt a multi-sectoral comprehensive approach with regular and comprehensive nutrition surveillance and recognize the epidemiological diversity.

Can nutrition rehabilitation centers address severe malnutrition in India?

Madhya Pradesh has made remarkable progress in facility based management of severe acute malnutrition, and has developed a model that is being replicated in many states. India has uniquely high prevalence of both stunting and wasting, implying that both severe acute malnutrition and severe chronic malnutrition co-exist. This study sought to explore design issues of nutritional rehabilitation centers in order to inform its effectiveness in settings where the prevalence of chronic poverty and malnutrition is high. Our analysis attributes the limited success (marked by poor cure rates and high non-responder rates) to high prevalence of chronic malnutrition, particularly in nutritional rehabilitation centers located in pheripheral areas. There is a failure to recognize severe chronic malnutrition as an epidemiological entity and gear wide-ranging programmatic and social interventions.

Programmatic response to malnutrition in India, room for more than one elephant.

Programming platforms need to recognize the diversity of malnutrition epidemiology in India and choose appropriate implementation designs. With severe chronic malnutrition as the dominant epidemiologic entity, the net needs to be cast wide, focusing on food security, health care, agriculture, water and sanitation, livelihoods and womens empowerment. Community-based malnutrition treatment and prevention programs need to collaborate to complement treatment with socioeconomic and preventive interventions. Expansion of nutrition rehabilitation centers should be limited to areas/districts with high wasting. Pediatric services with nested nutrition services (including counseling) requires urgent strengthening. Continuum of Care is a weak link and requires strengthening to make both hospital and community-based models meaningful.