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Widespread malnutrition warrants urgent measures

opinionWidespread malnutrition warrants urgent measures

Zero budgeting of all ongoing central and state schemes needed.

The Union government’s recent National Family and Health Survey, as well as Niti Aayog’s Multi-Dimensional Index on Poverty have, in part, corroborated India’s slippage in rankings in the Global Hunger Index, 2021. Without going into the methodological limitations of each study, especially the global analysis on hunger, what’s clear is that concerted ameliorative action is urgently warranted for improving the nutritional levels.
As per NHFS-5 there have been negligible gains in the overall nutritional outcomes over the years since 2015-16. A new cause for concern is the rise in anaemia across all age groups, particularly amongst children and women. The spike has been the highest among children in the age group 6-59 months, where it rose from 58.6% to 67.1%. It is also higher in teenage girls, i.e. the 15-19-year age group, and expectant and nursing women between the ages of 15 to 49 years. The prevalence in rural areas was found higher at 68.1% versus 64.2% in urban areas. Working first towards immediately arresting this rise and then investing in lowering it significantly, over time, should help improve India’s overall multi-dimensional poverty as well as translate into improved rankings in the future indices on hunger.
The required remedial course correction has to occur not merely at the concerned tiers of government and in their policies but also within all households. A successful outcome is highly dependent on effecting a change in the familial values and practices in vogue. Paying as much attention to the nutritional needs of the girl-child as of infant sons, and catering to the unique requirements of expectant and nursing mothers, must become an invaluable ingredient of the strengthened approach. Fortunately, the Union government is now conscious of addressing this issue more seriously as was signalled by Prime Minister Modi a few days ago, when in a meeting called with the state governments on another issue, he decided to talk about the Poshan Abhiyaan or the National Nutrition Programme and proposed that henceforth, it be run on mission mode. This scheme had sought to lower the prevalence of anaemia among children aged 6-59 months by 9% but the progress hitherto, as revealed by the NHFS, has been tardy and with widely varied outcomes, across states.
One of the first issues to be addressed is to facilitate a steady source of income for poor households. Till such time as a variant of universal basic income is put in place, the Union Government would do well to continue the direct benefit transfer, PM Kisan, for farmers and landless labour. The annual grant also needs to be increased in the next Budget from the existing Rs 6,000 to Rs 9,000 i.e., from a monthly Rs 500 to Rs 750, with a step up in the following two years to Rs 12,000 viz. Rs 1,000 per month. Taking such a measure for benefitting the rural residents is called for since the incidence of malnutrition across all age groups has been found to be higher in villages than in urban settings.
The free 5 kg a month of cereal (wheat or rice) being given to every person covered by the Public Distribution Scheme ever since the Covid-19 pandemic began in April 2020, too needs to be continued. But it needs to be focused for the BPL (below poverty level) families and not all the 800 mn ration card holders extended this facility currently. With multi-dimensional poverty estimated by Niti Aayog at 25.1% of the population, this would reduce the beneficiaries to 325 mn and make the relief more affordable for the Union Government. The National Food Security Act, 2013 binds the State to ensure that nobody goes to bed hungry and there is no starvation. Such a measure would be a step in that direction. For the foreseeable future, Food Corporation of India holds adequate quantities of cereals to meet the requirement of poor families. The continuation of MSP, as announced by the government, should continue to replenish its cereal stocks.
The minimum support price scheme at present covers 23 crops and now includes millets besides wheat and paddy. On grounds of their better nutritional values, the easy to grow pearl millets and a range of small millets need to be included in the options available to the BPL beneficiaries of the PM Garib Kalyan Anna Yojana. Since most millets can be grown in arid lands, the resultant demand of it being available under the PDS would give their growers, mostly small and marginal farmers, the requisite offtake assurance. Incidentally, 2023 was globally declared as the Year of Millets by the UN General Assembly by a resolution moved by India and supported by 70 other countries.
In the context of avoiding hunger and minimising malnutrition, the Mahatma Gandhi National Rural Employment Guarantee Scheme or MNREGA has an important role to play. It has been under implementation since 2006. Considerable experience is now available to meaningfully revisit it. To start with, the annual guaranteed provision of work per household needs to be enhanced to 150 days from the present 100 days. Equally warranted is to ensure that this significant fallback social security measure results in a fair wage being paid for the hours of work put in. Therefore, the rate should not be lower than the prevalent minimum wage rate in that geographical region. Moreover, year after year, it has been noticed that the initially approved Union Budget for the year does not adequately provide for the scheme and supplementation of funds has to be regularly sought by the Ministry of Rural Development administering it. This aspect commonly makes the state governments who implement the scheme on behalf of the Centre, to slow down the pace of providing work besides delaying the due payments of the workers.
Such interruptions in income flows especially in the drought prone and high malnutrition areas, directly impact the households’ food and nutrition intake. To minimise such glitches, giving a statutory backing to the responsibilities and obligations of the government and the beneficiaries under MNREGA must be urgently explored. The state government of Maharashtra, which had conceived the original Employment Guarantee Scheme way back in 1972, had found it desirable to do so. It, fairly soon thereafter had enacted such a law which inter alia, helped in extending a greater emotional and physical assurance to the job seekers in the rural parts of the state.
To locate the requisite funding for the envisaged heightened role of the Centre, a complete overhaul of the entire set of schemes going on for decades as well as the more recently started ones, is imperative. The principles of zero budgeting should be applied for the continuance of each measure entailing outlays and expenditures beyond an agreed threshold. Only those found relevant and cost effective, after the review, with appropriate recasting and built-in safeguards need be continued. This should include all the central, centrally sponsored and the state schemes.
Perhaps, the “most expensive” measure in use currently is the midday meal centrally sponsored scheme operated by the Union Ministry of HRD since 1976. It is aimed at meeting the food and nutrition requirements of children in primary and middle schools by providing them 720 calories of cooked food for five days a week during the school academic sessions. Year after year, the budgetary provisions and the reported expenditures for it have gone up even though the outcomes have been mixed. Broadly speaking, the administrations in the southern states have demonstrated innovativeness and the requisite care in implementation, while a majority, particularly the northern and eastern states have been lackadaisical and stereotyped. Their external and independent evaluations have been few while the more frequent internal ones have only been in the form of patting one another’s back.
The scheme for running the 13.6 lakh Anganwadi centres (AWCs), under the Integrated Child Development Scheme (ICDS) managed by the Union Ministry of Women & Child Development also warrants the zero-budget treatment. it has been operated for decades and provides a package of services comprising supplementary nutrition, immunisation, health check-up referral services to children below 6 years of age and expectant and nursing officers. However, the monitoring and evaluation has hitherto been mostly internal. Neither the adults of the beneficiary children, nor self-help groups or the village communities’ representatives are meaningfully engaged in the exercise. Independent evaluation is especially needed of the extensive non formal pre-school education imparted at a huge cost to children in the age group 3-6 years and the health and nutrition education to women in the age group of 15-45 years. Reports of extensive misuse of the dry rations supplied, the food served being under or over cooked, failure to procure from the market edible and quality vegetables and fruits listed on the weekly menu, and eggs being denied or stopped for socio political reasons are commonplace. Incidentally, during the ongoing covid pandemic, when the need for nutrition was higher than the normal times, these centres were surprisingly kept shut.
The programmes for nutrition for children in the vulnerable age group and pregnant women are funded by different ministries in the Union Government e.g. ICDS by the HRD, Anganwadis and Balwadis by the Ministry of Women and Child Development and free distribution of folic (iron) acid tablets and other health care programmes are undertaken by the Ministry of Health & Family Welfare. Unlike in the days of the Planning Commission when the annual planned expenditure of each central ministry and state government was reviewed and sanctioned by the Commission, no such overview now takes place of each segment implemented by different ministries and state governments. This gap needs to be fulfilled quickly with a credible independent agency evaluating the impact of each measure initiated. The real time monitoring mechanism of the Anganwadi and Balwadis and termed POSHAN run by the Ministry of Women & Child Development and on which over Rs 1, 000 crores has so far been spent, does not constitute an effective expenditure control.
The Centre must also differentiate amongst the states on the basis of their involvement and outcomes in the centrally sponsored schemes on nutrition. It is desirable to stop the funding in those states which have persistently failed to properly spend the central money. Only the states which acquit themselves well, demonstrate the requisite implementation skills and have put in place a favourable ecosystem supporting the objectives of the national mission of nutrition need be supported as liberally as being done at present (under a centrally sponsored scheme 60% of the cost is met while all central schemes are 100% funded by it). However, since the fund flow to each state is predetermined by the Finance Commissions, the money not given to a particular state, would need to be made good by increasing the allocation for another of its scheme or earmarked and put in a non-lapsable account of that state.
At the end of the day, the role of the parents in ensuring their children receive the right kind and quantity of nutritious food is primary. Making sure that teenage girls and expectant mothers receive their due share of the household pot plus additional nutrition, is the responsibility of the family, particularly the elders in a joint family arrangement. The State can ensure improved availability at affordable prices of food and other related inputs to ward off hunger besides arranging for greater awareness and literacy of women in general. Malnutrition avoidance thereafter largely remains an internal household issue. Together, fulfilling such a responsibility on a day-to-day basis and inculcation of positive gender and familial attitudes should lead to the right answer.
Dr Ajay Dua, a progressive economist, is a former Union Secretary.

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