Auditorías sociales para revitalizar la gobernanza nutricional durante el COVID
Autor: Basanta Kumar Kar
Good Governance is Good Policy: Nutrition Social Audit is a perfect fit in pandemic times
Good nutrition is a good life. Good nutrition has the power and potential to prevent infection, child mortality, transform demographic dividend, growth, productivity, and social injustice which is necessary for peaceful coexistence and a sustainable planet. Nutrition plays a key role in achieving human capital potential and global development. The importance of nutrition in the Post-2015 Sustainable Development Goals assumes significance as it will be a key driver in achieving other goals and targets.
In this novel COVID-19 times, getting to a ‘pandemic infection-free world calls for a ‘Malnutrition Free World’. Increasing evidence suggests, malnutrition increases susceptibility to infections; and infectious diseases also cause malnutrition; resulting in perpetuating a vicious cycle of poverty, morbidity, and mortality. The malnutrition compounded by the pandemic infection signals an impending famine and the women and children are the hardest hit.
As per the Global Nutrition Report (GNR) 2020, one in every nine people in the world is hungry, almost a quarter of all children under five years of age are stunted, and one in every three is overweight or obese. The double burden of malnutrition, where undernutrition coexists with overweight, obesity, and other diet-related non-communicable diseases (NCDs) and Child Wasting; a condition of acute malnutrition when a child struggles to survive and thrive need emergent attention. The reported cases of deaths of the children due to severe wasting or malnutrition as an underlying once in a while causes spurts in media attention and dies down.
For example, a country like India which faces a Double Burden (with both obesity/overweight and under nutrition together) of malnutrition has witnessed an increase in childhood wasting in 10 years — from 19.8% to 21% (NFHS-III and IV). A large number of wasted children fall under the Severe Acute Malnutrition (SAM) bracket who are referred to NRC (Nutrition Rehabilitation Centers) which in today’s times witness disruptions.
Micronutrient malnutrition, such as deficiencies of essential minerals and vitamins, is all-pervasive. These Micronutrient deficiencies result in low productivity, poor cognitive, and physical development which has serious impacts in later phases of life.
Post-COVID times are an opportunity to establish credibility given massive funds coming in through various government schemes, international agencies, and corporates. Social Audits would stop nutrition disruption, drive social justice, social behavior, and boost people’s trust in the system and ensure high rates of compliance with inclusive policies that will result in healthier outcomes.
Here, a powerful tool like a Social Audit can therefore help in bridging gaps in existing food and health systems in addressing micronutrient malnutrition popularly known as hidden hunger for healthier outcomes.
There is a dire need for global attention towards revitalizing nutrition transparency and good governance, make nutrition a top investment priority, revitalize the local food system, work on nutritional self-reliance and thus empower the present and future generation to prevent an impending famine.
Social Audit as a powerful participatory process on good governance following social distancing norms will help bridge gaps between the set mandates and bring efficiency within the health and food systems. Social audits conducted in COVID times for severely affected malnourished children and pregnant and lactating mothers will help in improving access and control over resources. It can prevent mortality, morbidity, and infection too.
During this pandemic time, along with disruptions in nutrition services and supplies, some of the vested interest food industries have been promoting ultra-processed food and breastmilk substitutes thus affecting the health of the children. The Social Audit due to its inherent elements on just and equitable governance can prevent vested interest and ensure public interest. It can strengthen entitlements and reduce deprivations. During COVID times, the monitoring of the entitlements and deprivations can save life and livelihoods significantly.
My tryst with Social Audit
My personal experience and analysis show that myths and misconceptions; economic constraints; high levels of social, geographical, economic, and policy level exclusions; inter and intrahousehold disparities as a result of gender inequity and social injustice, poor governance are the underlying causes of poor nutrition and health.
When Social Audit was first introduced by me in the Jagatsinghpur district of coastal Odisha (India), after the Super cyclone in 1999 for food and nutrition program; it proved to be hugely beneficial for the marginalized who used be a passive recipient of the dole for generations. It empowered them to raise questions on the dilution of their entitlements and engage in dialogues. The result was exemplary as it improved equitable distribution; resource, organization credibility, and access with dignity.
Similar results were overserved in Bastar district, Chhattisgarh (India), tribal districts of Jharkhand (India), Dhaka slums, and Mymensingh district of Bangladesh. It challenged unequal power relations, empowered the voiceless marginalized women, community, and local governments. It reaffirmed my belief that this is the foundation of fair, equitable governance which enhances community participation for effective monitoring and drives out food and nutrition frauds and corruption.
Over the last two decades, I have seen how social audits ensure transparency and public accountability and enable the marginalized to gain access and control over health and nutrition resources in a dignified manner.
Guiding principles of Social Audit: Multi-perspective, Inclusive, Comprehensive, Comparative, Regular and disclosure
Social Audit reflects the views of all the stakeholders who are directly or indirectly involved in the process of social change. It embraces all aspects of community benefit and performance along with that of the organization. A social audit gives a chance to appraise the organization’s performance with that of the government or other NGOs. It also ensures the maintenance of quality in a program. Thus, it hooks on to the accountability part of the stakeholders by exposing their budget vis-à-vis realization (program and administrative overheads and other heads of expenditure) for public scrutiny. The findings of the social audit are made available to all the stakeholders and the wider community per se the civil society.
During the social audits, the marginalized people specifically women get the opportunity to know their entitlements and deprivations. They understand the pilferage, corruption, and social biases that disrupt the nutrition supplies and services and excludes them in accessing these. By participating in the social audit processes; the poor and marginalized challenge the unequal power relations and question the decisions, program design, pilferage, and diluted public accountability. The process offers voice to the voiceless.
The social audit not only covers expenses or decisions but also covers equity and quality in program delivery and implementation. It is conducted with a multi-sectoral approach with the active participation of community members, local government bodies, frontline workers, district and state officials along with public health experts. An illustrative list of areas covered under the whole gamut of social audit is as follows:
- Selection and location of health and nutrition Centre
- Selection and identification of community members for key programs and entitlements
- Gender and caste-based segregated information
- Social, Geographical, economic, and policy level exclusions that cause deprivations
- Selection criteria of the people in quarantine and availing hospitalization during pandemic times
- Availability and accessibility of the Government and donor programs like Supplementary nutrition, vaccine and immunization services, supplementation programs,
- Access to Material, physical resources, and infrastructure
- Pilferage, leakage, and misappropriation of the fund
- Food quality and food waste
- Quality Home Contacts and inter-personal counseling to spread nutrition and health messages by the service providers
- The practice of hand hygiene, social distancing, and the use of masks to prevent infections
- Community mental health and psycho-social counseling
- Quality immunization, Antenatal care(ANC), maintenance of cold chain
- Quality cold chain maintenance, storage of drugs, medicines, and supplementary nutrition
India’s islands of excellence- Social Audit in public policy
India’s POSHAN Abhiyaan (National Nutrition Mission), shaped by the determination of the Prime Minister mandates social audit. The Ministry of Rural Development prescribes guidelines for social audits in the social development programs for transparency and public accountability. India’s food law’ National Food Security Act-2013 which mandates food and nutrition security in a life cycle approach also highlights that “the Central Government may if it considers necessary conduct or causes to be conducted a social audit through independent agencies having experience in the conduct of such audit”. India’s civil society has demonstrated numerous participatory processes in the social audit. These models from India can be scaled up effectively and creatively during this pandemic time in other countries to save lives and livelihoods.
The way forward
For a successful Social Audit, all elements of health, livelihoods, and nutrition-focused interventions need to be analyzed. Social Audit can create an enabling environment for the upcoming COVID vaccine delivery effectiveness. With technological advancements, certain forms of nutrition social audits can be conducted by following social distancing norms and virtually. The data generated through ongoing monitoring can feed into social audit dialogues. Social audits must also reflect the views of all stakeholders who are directly or indirectly involved in the process of social change to ensure quality and transparency.
Social Audit essentially involves three stages: preparatory, implementation, and monitoring. It needs to be institutionalized during pandemic times with updated guidelines on social distancing and infection control. The government functionaries present during the social audit need to prepare action taken report and submit to the concerned authorities on a timely basis.
Social Audit is a unique method to bring forth protected information for public interest and demands for action. In these challenging times, when the hardest hit vulnerable families are struggling to access their entitlements for a peaceful living; the Social Audit is a perfect fit for due diligence, value for money, and new community order. Skilling human resources, incentivizing local government bodies, and grassroots functionaries on conducting the Social Audit following social distancing norms during COVID Times will be a key driver of success.
Biografía del autor
Mr. Basanta Kumar Kar is an international development professional who has won numerous accolades and has a broad experience of leading and managing large country and regional programs in South and South East Asia with demonstrable results. He represents numerous Board and Governance structures, policy, advisory and technical bodies in South Asia. For his outstanding contribution to the health, nutrition, and poverty eradication endeavors; he was conferred with the most prestigious Global Nutrition Leadership Award(2019), ‘Hero of the Decade’ recognition for contribution to the Swachh and Swasth (Clean and Healthy) India (2019), Government of India recognition on contribution to the POSHAN Abhiyaan- National Nutrition Mission(2018), ‘Transform Nutrition Champion’ Award for India and Bangladesh(2016) War and Odisha Living Legend Award (2016). He authored numerous articles and collections of poems in English, including ‘The Unfold Pinnacle’ delves with real life stories on marginalised women and girls. He holds a degree in English literature, law, and a rural management degree from a premier rural management institute in Asia. He can be contacted at: Efirstname.lastname@example.org