This Yr’s Finances Is Essential to Guarantee a Complete Vitamin Response

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The disruption to nutritional services caused by the pandemic has exacerbated India’s existing strain of malnutrition. Children were not given lunchtime meals and supplements under the Anganwadi service system under which they were registered. Critical health services such as immunization, iron folic acid and calcium supplements, treatment of acute malnutrition, prenatal and postnatal checkups, and other child reproductive health studies have been suspended due to limited mobility.

Several surveys have shown that many were not earning an income during the lockdown and food intake by vulnerable communities has decreased significantly. The quantity and quality of food consumption decreased in around 74% of the Dalit families surveyed and in around 54% of the Adivasis surveyed. Unrestrained exclusion errors in the direction of welfare systems have increased. Although state governments have taken home delivery measures, there have been many loopholes.

These negative impacts of the COVID-19 crisis on nutrition indicators go beyond the reversals reported in the most recent data from NFHS-5 (2019-20). Survey results for 22 states and union territories clearly show that key child malnutrition findings are stagnating – stunting, waste, and the percentage of underweight children in several states. Thirteen states and UTs saw an increase in the percentage of stunted children under five compared to NFHS 4 (2015-16), while twelve states reported an increase in wasted children under five and 16 increased underweight children.

One of the most worrying effects of the pandemic has been on the nutritional needs of the disadvantaged. Although the government has indicated minimal disruption to nutritional programs through its “timely interventions”, the urgent need to address the challenges and ensure they do not exclude anyone remains high. At this critical point, when the budget is due to be presented, we have the opportunity to take transformative approaches and make significant investments to face the adversities and challenges faced by many of the country’s citizens.

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Direct nutrition interventions require greater public funding

The center and state governments share the resources required for programs to deliver nutritional interventions. These programs, which focus on direct nutritional interventions, come under the auspices of the Ministry of Women’s and Child Development (MWCD) and the Ministry of Health and Family Welfare (MoHFW). The pattern of spending under the ICDS has shown that a higher allocation is required. The last report of the Standing Parliamentary Committee pointed to consistent shortcomings between the demands of the Node Ministry for Women’s and Child Development and the allocations assigned to it. Given the intensity of the malnutrition problem in India, the provisions for additional measures for marginalized children need to be revised when designing the Supplementary Nutrition Program (SNP). In addition, the government must draw up an adequate budget. All of this requires that nutrition programs be given a much higher priority in the upcoming household.

Allocation bottlenecks in MWCD programs (2020-21) [In Rs crores]

To plan Projected demand Actual assignment BE Percentage of demand not met
Anganwadi Services 24810 20532 17%
POSHAN Abhiyan 2500 3700 48% (additional)
PMMVY 2875 2500 13%
Scheme for adolescent girls 350 250 28%

The proportion of the total eligible population covered by the Anganwadi services was very low. It includes 48% of children, 51% of pregnant women and 48% of breastfeeding women. To address the disruptions in the food supply, additional high priority actions need to be taken and supported by adequate resources to ensure expanded coverage and better targeting.

A stronger public nutrition workforce

The proportion of the centre’s contribution to the salary component of the Anganwadi services has decreased since 2017/18, when a large number of sanctioned positions were cut. In addition, the share of the salary component in the overall central financing of the system has continuously decreased. This is a blatant systemic problem within the system, and even fiscally stronger states have vacancies at various levels. Since the states are unable to fund these positions, they have asked for higher tax support for salaries in their Annual Program Implementation Plans (APIPs). If important positions such as CDPO (Child Development Project Officer) remain vacant, this hinders the implementation of the system and the quality of the service provision.

The institutionalized presence of AWWs, AWHs, ASHAs and ANMs proved to be an important resource in the fight against the pandemic. There are well known concerns about their working conditions: They work under great pressure and are not adequately compensated for their work. The loopholes deserve immediate government action, most importantly, their fees need to be increased and combined with adequate social security benefits.

Invest in sectors that offer nutrition-sensitive programs

Optimal nutrition is the result of interrelated factors related to immediate, underlying, and fundamental determinants. Diet-sensitive interventions address the underlying determinants of malnutrition and are critical to nutrition in the general policy framework. Stagnation in nutrition outcomes occurred at a time when underlying health indicators such as hygiene and LPG access were improving rapidly, raising some fundamental questions. The overall assessment is that the approach of relying on programs that support direct nutrition interventions is not enough to achieve nutrition goals.

We certainly need further analysis to understand the factors behind these results, as the period the survey was conducted was marked by an economic slowdown. These results are likely to correlate with changes in family income over this period. After all, the adverse effects of falling incomes have the greatest impact on the feed bowls of the most vulnerable.

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The pandemic has underscored the importance of strengthening public supplies of food, health, sanitation and other measures. The diet-related threats would persist after the pandemic. In low-income countries, calories from nutrient-rich, non-staple foods like eggs and vegetables can be 10 times more expensive than calories from rice, corn, and wheat (Headey and Alderman (2019)).

The allocation to a number of nutrition-sensitive systems, including lunchtime and the public distribution system, was found to have decreased by 19% in the last Union budget compared to the previous year. Expanding public services through investment in a number of important health, nutrition, food security and drinking water programs is needed to achieve better nutritional outcomes. Securing income through job opportunities and strengthening poverty reduction programs are just as important. The government’s response to the first pandemic budget can be a good start to taking steps to expand these programs.

A helper helps children with the fulfillment of their duties in an Anganwadi center in the Kancheepuram district in Chennai, India, on Thursday December 12, 2019. Photo: Burhaan Kinu / International International Services / Flickr, CC BY 2.0

A revision of the unit cost for ICDS components is required

The cost standards for the centrally funded programs are set by the government of the Union. Unit costs for the different categories of beneficiaries under the Complementary Foods Program (SNP) component of the program were last revised in 2017, and although the government also approved annual cost indexing for future rate increases, the rate has stagnated since then. In accordance with the first report of the 15th Finance Commission (valid for 2020-21), this budget is expected to lead to increased cost norms for SNP.

In order for Anganwadi Centers to play their role in efficiently delivering high quality services, they need appropriate facilities, improved power supplies and adequate physical space. For this purpose, the unit costs for building new centers must be recalculated. The budget support for construction costs, which is provided in agreement with the Ministry of Rural Development under the MNREGA, has to be increased by 7 billion rupees per building, as the program has been implemented for four years. In recognition of this, the state governments have already called for an increase in the unit costs per building.

Happy Pant can be reached at the Center for Budget and Governance Accountability in New Delhi and at happy@cbgainmdia.org. The views expressed are those of the author and do not necessarily reflect the position of CBGA.