Views | Will the Budget have a major impact on malnutrition?

Views | Will the Budget have a major impact on malnutrition?

The emphasis on malnutrition in this year’s Union budget signals a welcome commitment at the highest level to tackle the problem. But merely throwing more money on a handful of state institutions won’t make a difference.

In his budget speech last week, finance minister Pranab Mukherjee announced a multi-sectoral programme to address maternal and child malnutrition in 200 high burden districts that will harness schemes of varied departments ranging from healthcare to sanitation and drinking water.

To its credit, the Union government seems to have finally woken up to the gravity of the problem after years of inaction and rightly emphasized a multi-pronged approach. The move to focus on the worst affected areas to start with, also makes sense as inequality in malnutrition rates in India is higher than in most other nations, according to a February Save the Children report.

Yet, the key to improving India’s dismal child health statistics will lie in getting the details right. Child malnutrition rates in India are nearly twice that of poorer nations in sub-Saharan Africa.

The first challenge as in any multi-pronged programme will be in getting different departments to work together towards a common goal and also to ensure that all states assign top priority to the programme.

Ideally, a small team at the prime minister’s office or in any designated nodal ministry should co-ordinate the strategy and review progress. If the government works on a five-year plan, say, it should be broken up into yearly or semi-annual targets and based on those targets, outcomes for each department and state, as well as for each district needs to be fixed and disclosed to the public.

A credible and transparent monitoring process is a sine quo non for the success of such a mission. Without proper monitoring and accountability, this effort could end up with little to show in terms of outcomes, just as in several government initiatives. Since state governments will implement the schemes, the Centre’s key role apart from funding the schemes will be to fix accountability at the outset, and publish reliable statistics on child health outcomes as frequently as possible.

A base-line survey must be conducted now at least in the selected districts, to enable evaluation of state interventions later. Although Integrated Child Development Services (ICDS) data is available for each block, such data is not exhaustive. The Centre should also organize social audits or fund independent surveys to complement its database. The results must be publicly available to ensure that heads roll whenever a state, a district or a concerned department falters.

Provision of safe drinking water and sanitation can play a vital role in reducing the spread of infections and thereby the chances of malnourishment. Two other agencies will form the backbone of the state’s strategy --- ICDS that runs more than a million crèches or ‘anganwadis’ across the country, and the health department.

ICDS suffers from the handicap of having to serve too many goals through its army of ill-paid and ill-trained volunteers. In its current avatar, ICDS focuses mainly on supplementary nutrition for children older than three, missing the critical window of first 1000 days of life when nutrition interventions are most effective.

Mukherjee in his budget speech indicated that community-level health workers will be involved in the fight against malnutrition. They will probably be ideally placed to cater to the needs of children below two and pregnant mothers, helping them tide over infections and to counsel them on basic good health norms. Simple and inexpensive strategies such as exclusive breast-feeding for the first six months can dent malnutrition rates significantly.

Since two anganwadi workers are appointed in each centre, at least one of them can be trained as a nutrition counselor, so that she can help families tweak the diet for a child to make it more nutritious, within the family food budget constraints. ICDS saw a 58% jump in allocation in its budget this year and needs to use that money to retrain its workers on a war footing, and also to provide them with higher incentives for superior performance.

In most of the high-burden districts, many of them tribal, the administrative capabilities of the state are weak and the Centre and states may have to consider incentives to get better officers in those parts and fill up vacancies. Ideally, blocks or ‘talukas’ rather than districts should be targeted by the state, since in many high-burden districts, only a few blocks account for the bulk of malnourished children.

Success would depend on the ability of the government to shun the trodden path. A business-as-usual approach is unlikely to dent malnutrition rates in a country where every second child is malnourished. ICDS itself is the prime example of how a business-as-usual approach fails: started as a temporary programme in 1975, it has lasted 36 years without any significant impact on malnutrition.

Also Read | Views | The policy paralysis on malnutrition

Close