Fixing India’s malnutrition problem
GS Paper 2: Issue related to Poverty and Hunger
Important for
Prelims exam: GHI, NFHS
Mains exam: Government policies to fight Malnutrition
Context
The Global Hunger Index (GHI) 2022 has brought more unwelcome news for India, as far as its global ranking on a vital indicator of human development is concerned. India ranked 107 out of 121 countries.
A glance over India’s malnutrition data
India’s National Family Health Survey (NFHS-5) from 2019-21 reported that in children below the age of five years, 35.5% were stunted, 19.3% showed wasting, and 32.1% were underweight.
What are the issues?
Experts have suggested several approaches to address the problem of chronic malnutrition, many of which feature in the centrally-sponsored schemes that already exist. However, gaps remain in how they are funded and implemented, in what one might call the plumbing of these schemes.
- Lower budgetary allocation for govt schemes: Even if we accept that 2020-21 was an exceptional year (due to the COVID-19 pandemic), it is clear that the budgets being allocated are nowhere near the scale of the funds that are required to improve nutrition in the country. For instance,
- The Government of India implements the Saksham Anganwadi and Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) 2.0 scheme. The budget for this scheme for FY2022-23 is less than 1%, more than the actual spends in FY2020-21 , an increase of less than 1% over two years.
- The other flagship scheme of the Government of India is the PM POSHAN, or Pradhan Mantri Poshan Shakti Nirman, known previously as the Mid-Day Meal scheme. The budget for FY2022-23 was 21% lower than the expenditure in FY2020-21.
- Lack of executive machinery: An Accountability Initiative budget brief reports that over 50% Child Development Project Officer (CDPO) posts were vacant in Jharkhand, Assam, Uttar Pradesh, and Rajasthan, pointing to severe manpower constraints in successfully implementing the scheme of such importance.
- Food provided doesn’t meet the nutritional requirement: While PM POSHAN (or MDM) is widely recognized as a revolutionary scheme that improved access to education for children nationwide, it is often embroiled in controversies around what should be included in the mid-day meals that are provided at schools and time and again, it has been highlighted by media that the food provided is neither good nor nutritious.
- Absence of social audit: Social audits that are meant to allow for community oversight of the quality of services provided in schools and ensuring the implementors’ accountability is not carried out routinely.
- Issue with the cash transfers: Evidences suggest that the impact of cash transfer on child nutrition in India is limited so far. Cash transfers improve household food security but they do not necessarily translate into improved child nutrition outcomes.
What should be the way forward?
- Expanding the scope of Direct Benefit and Cash transfers: Cash transfers seem to be a favoured solution for several social sector interventions in India today, and this includes the health and nutrition sectors. Much is made of the JAM trinity (Jan Dhan bank accounts, Aadhaar, Mobile).
Riding on the digital infrastructure available in India, it is said that targeting the right beneficiaries is possible. Cash transfers will help expanding choices at the household level, as they make decisions on what to put on their plates.
Cash transfers can incentivise behavioural change in terms of seeking greater institutional support.
- Improve the functioning of Government scheme: Persistently under-funded and poorly implemented public programmes (such as the erstwhile ICDS and MDM schemes) have been a significant cause. Greater involvement of local government and local community groups in the design and delivery of tailored nutrition interventions can make these schemes serve their purpose in an efficient manner.
- Reduce the food price volatility: The effect of cash transfers becomes limited in a context where food prices are volatile and inflation depletes the value of cash. Thus, making food prices stable would enable nutritional expenditure more effective.
- Fixing these schemes is the obvious answer to addressing India’s multi-dimensional nutrition challenge.
- Enlarge the PDS system: Food rations through PDS and special supplements for the target group of pregnant and lactating mothers, and infants and young children, are essential and more nutritious foods should be provided.
- Distribution of fortified rice through PDS has been a good initiative.
- Start comprehensive social education programmes: There are social factors such as ‘son preference’, which sadly continues to be prevalent in India and can influence household-level decisions when responding to the nutrition needs of sons and daughters. This calls for a comprehensive social education programme — cash alone cannot solve this.
A study of the Mamata scheme in Odisha that targeted pregnant and lactating women, showed that there were persistent socio-economic discrepancies in the receipt of cash transfers, especially in comparison to entitlements received through the Public Distribution System (PDS). Thus, cash may be part of the solution, but on its own, it is no panacea.
- A comprehensive programme targeting adolescent girls is required if the inter-generational nature of malnutrition is to be tackled.
Conclusion
Malnutrition has been India’s scourge for several years now. Political battles over malnutrition are not going to help, nor is continuing to think in silos. Cash transfers have a role to play here, especially in regions experiencing acute distress, where household purchasing power is very depressed.
The need of the hour is to make addressing child malnutrition the top priority of the government machinery, and all year around. A month-long POSHAN Utsav may be good optics, but is no substitute for painstaking everyday work.