The 2022 Global Hunger Index (GHI) has brought more unwelcome news for India as it ranks globally on a key indicator of human development. India ranked 107 out of 121 countries. The government of India immediately tried to discredit the index in its attempt to deny the report’s findings, going so far as to call it a conspiracy against India.
The GHI is an important indicator of nutrition, especially in children, as it looks at stunted growth, underweight and mortality among children, as well as caloric deficits across the population. And this is by no means an international conspiracy – India’s 2019-21 National Family Health Survey (NFHS-5) reported that among children under five years of age, 35.5% were stunted, 19.3% were wasteful and 32.1% were underweight .
Government schemes do not deliver
Experts have proposed several approaches to address the problem of chronic malnutrition, many of which are featured in the already existing centrally sponsored programs. However, gaps remain in the way they are funded and implemented, in what might be called the plumbing of these schemes.
For example, the Government of India is implementing Saksham Anganwadi and the Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) 2.0 scheme (which now includes the Integrated Child Development Services (ICDS) scheme), which seeks to work with adolescent girls, pregnant women , nursing mothers and children under three years of age. However, the budget for this scheme for FY2022-23 was ₹20,263 crore which is less than 1% more than the actual expenditure in FY2020-21 – an increase of less than 1% over two years.
The other flagship program of the Government of India is the PM POSHAN, or Pradhan Mantri Poshan Shakti Nirman, formerly known as the Mid-Day Meal Program (National Program of Mid-Day Meal in Schools). The budget for FY2022-23 was 21% lower than the expenditure in FY2020-21 at ₹10,233.75 crore. Even accepting that 2020-21 was an exceptional year (due to the COVID-19 pandemic), it is clear that the allocated budgets are nowhere near the funds needed to sustain the nutrition in the country. improve.
A budget overview from the Accountability Initiative reports that the per capita cost of the supplemental nutrition program (one of the largest components of this scheme) has not increased since 2017 and remains severely underfunded, accounting for only 41% of the funds needed . The budget letter also mentions that more than 50% of Child Development Project Officer (CDPO) positions were vacant in Jharkhand, Assam, Uttar Pradesh and Rajasthan, indicating severe manpower constraints in successfully implementing the all-important plan. And while PM POSHAN (or MDM) is widely recognized as a revolutionary plan that has improved access to education for children across the country, it is often embroiled in controversy over what should be included in the midday meals provided in schools. Social audits intended to allow community oversight of the quality of service in schools are not routinely performed.
In summary, not only are major nutrition programs underfunded, but available resources are not being spent effectively. Solving these schemes is the obvious answer to tackling India’s multidimensional nutrition challenge.
Cash transfers and the dependency factor
Cash transfers seem to be a favored solution for various interventions in the social sector in India today, including the health and nutrition sector. Much is made of the JAM trinity (Jan Dhan bank accounts, Aadhaar, Mobile). Equally attractive is the feature of cash transfers as a mechanism that yields rich political dividends. Building on the digital infrastructure available in India, it would be possible to target the right beneficiaries (i.e. pregnant women and families with children under the age of five). Cash also has the advantage of broadening choice at the household level, as they decide for themselves what to put on their plate.
But evidence of the impact of cash transfer on infant nutrition in India is limited so far. Evidence from elsewhere primarily indicates that while cash transfers improve household food security, they do not necessarily translate into better infant nutrition outcomes.
The effect of cash transfers is also limited in a context where food prices are volatile and inflation depletes the value of cash. Likewise, there are social factors such as ‘son preference’, which unfortunately is still prevalent in India and can influence decisions at the household level in meeting the nutritional needs of sons and daughters. This calls for a comprehensive social education program – money alone cannot solve this. Furthermore, a study of the Mamata program in Odisha targeting pregnant and lactating women showed that there were persistent socio-economic discrepancies in the receipt of cash transfers, especially when compared to entitlements received through the Public Distribution System (PDS ). So cash can be part of the solution, but in itself it is not a panacea.
Back to basic
Malnutrition has been the scourge of India for years. Political battles over malnutrition will not help; neither does thinking in silos. It is clear that malnutrition continues due to the poor economic conditions in large parts of the country, the poor state of India’s agriculture, persistent levels of unsafe sanitation, etc.
Cash transfers play a role here, especially in regions of acute need, where household purchasing power is very low. Cash transfers can also be used to drive behavior change in terms of seeking more institutional support. Food rations via IBS and special supplements for the target group of pregnant and nursing mothers, infants and young children are essential.
Persistently underfunded and poorly implemented public programs (such as the former ICDS and MDM programs) must bear much of the blame for India’s malnutrition problem. But getting these schemes right will require greater involvement from local government and local community groups in designing and delivering tailored nutritional interventions. A comprehensive program targeting adolescent girls is needed to address the intergenerational nature of malnutrition.
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The imperative of this hour is to make tackling child malnutrition the top priority of the government all year round. POSHAN Utsav for a month may be a good optics, but it is not a substitute for the arduous daily work.
Suvojit Chattopadhyay works on governance and public sector reform projects in South Asia and sub-Saharan Africa