The pandemic led disruptions of nutrition services have exacerbated India’s existing burden of undernutrition. Children did not get the mid-day meals and supplementary nutrition under the anganwadi services scheme they were registered under. Critical health services like immunisation, iron-folic acide and calcium supplementation, treatment of acute malnutrition, antenatal and postnatal check-ups, other reproductive child health checkup were halted due to restricted mobility.
Several surveys have shown that many had not earned any income during the lockdown, and the food intake by vulnerable communities significantly decreased. Quantity and quality of food consumption decreased for about 74% of the surveyed Dalit families and for about 54% of the surveyed Adivasis. Rampant exclusion errors in the targeting of welfare schemes were magnified. Though state governments instituted measures for home delivery, there were many gaps.
This negative impact of the COVID-19 crisis on nutritional indicators is over and above the reversals reported in the recent data of NFHS-5 (2019-20). The survey results covering 22 states and Union Territories present a vivid demonstration of stagnation in key child malnutrition outcomes – stunting, wasting and share of underweight children across several states. Thirteen states and UTs registered a surge in the percentage of stunted children under five years of age as compared to NFHS 4 (2015-16), whereas 12 states reported an increase in wasted children under the age of five, and 16 recorded a rise in underweight children.
One of the most disturbing effects of the pandemic has been on the nutritional needs of the disadvantaged. Though the government has been pointing to minimal disruption in the meals progarmmes due to its ‘timely interventions’, the acute need to overcome the challenges and ensuring that these do not exclude anyone remains high. At this critical juncture, when the Budget is about to be presented, we have the opportunity to adopt transformative approaches and make significant investments towards addressing the adversities and challenges that many of the country’s citizen’s face.
Direct nutrition interventions need greater public funding
The Centre and state governments share the funding required for programmes that deliver nutrition interventions. Those schemes focusing on direct nutrition interventions fall under the aegis of the Ministry of Women and Child Development (MWCD), and Ministry of Health and Family Welfare (MoHFW). The pattern of expenditure under ICDS has shown the need for higher allocation. The last Parliamentary Standing Committee report has pointed to consistent shortfalls between demands made by the nodal Ministry of Women and Child Development and allocations made to it. Considering the intensity of the problem of undernutrition in India, the design of Supplementary Nutrition Programme (SNP) needs a correction for provisions for additional measures for marginalised children, also, the government needs to budget at scale. All this necessitates that schemes important for nutrition are given a much higher priority in the upcoming budget.
Shortfalls in Allocations for Schemes of MWCD (2020-21) [In Rs crores]
|Scheme||Projected Demand||Actual Allocation BE||Percentage of demand not met|
|POSHAN Abhiyan||2500||3700||48% (additional)|
|Scheme for Adolescent Girls||350||250||28%|
The proportion of total eligible population covered under the anganwadi services has been very low. It includes 48% of children, 51% of pregnant women and 48% of lactating women. To address the disruptions in food supply, additional measures must be instituted on top priority and backed by adequate resources to ensure expanded coverage and better targeting.
A stronger public health nutrition workforce
The share of the Centre’s contribution to the salary component under anganwadi services has been declining since 2017-18, when it cut down a big number of sanctioned posts. Additionally, the share of the salary component in total Central funding for the scheme has been going down consistently. This is a glaring systemic issue under the scheme, and even fiscally stronger states have vacancies at different levels. This is so as the states are not in a position to fund these posts, they have been asking for higher fiscal support for salaries in their annual programme implementation plans (APIPs). When crucial positions like that of a child development project officers (CDPOs), lady supervisors remain vacant, it hinders the implementation of the scheme and the quality of service delivery.
The institutionalised presence of AWWs, AWHs, ASHAs, ANMs proved a vital resource in our fight against the pandemic. Concerns related to their working conditions are well known: they work under a lot of pressure, do not get compensated adequately for their work. The gaps merit immediate action by the government, most importantly, their honorarium needs to raised, and tied up with adequate social security benefits.
Invest in sectors providing nutrition-sensitive programmes
Optimal nutrition is the result of the inter-connected factors relating to immediate, underlying and basic determinants. Nutrition sensitive interventions address the underlying determinants of undernutrition, and are critical in the overall policy framework for nutrition. Stagnation in nutrition outcomes occurred at a time of rapid improvement in underlying indicators of health such as sanitation and LPG access, which raises some fundamental questions. The overall assessment is that the approach of relying on programmes supporting direct nutrition interventions is not enough to deliver on targets of nutrition.
We certainly need a deeper analysis to understand the factors behind these outcomes, since the period when the survey was conducted was marked by an economic slowdown. These results are likely to have a correlation with the changes in levels of family income in that period. After all, the adverse effects of falling income have the greatest impact on the food bowls of the most vulnerable.
The pandemic has underlined the importance of strengthening public provisioning for nutrition, health, sanitation and other interventions. The threats surrounding nutrition would continue to exist beyond the pandemic. In low-income countries, calories from nutrient-rich, non-staple foods such as eggs, and vegetables can be 10 times more expensive than calories from rice, maize and wheat (Headey and Alderman (2019).
The allocation for a set of nutrition-sensitive schemes including mid-day meals and the public distribution system was found to have reduced by 19% in the last Union Budget, compared to the previous year. Expansion of public services through investments in a range of important schemes under health, nutrition, food security, drinking water is necessary for achieving improved nutrition outcomes. Equally important is securing income through employment opportunities, and strengthened poverty alleviation programmes. The government’s response provided through the first pandemic Budget can be a good beginning to initiate steps for scaling up these programmes.
Revising unit costs for ICDS components is needed
The cost norms for the Centrally-sponsored schemes are fixed by the Union government. Unit costs for the different categories of beneficiaries under the supplementary nutrition programme (SNP) component of the scheme was last revised in 2017, and though the government also approved annual cost indexation for an increase in rates in future, but the rate has been stagnant since then. In line with the first report of the 15th Finance Commission (applicable for 2020-21), it is expected that this Budget factors in increased cost norms for SNP.
Further, for anganwadi centres to play their role in quality service delivery efficiently, they require proper facilities, improved power supply and adequate physical space. Towards this, the unit cost of constructing new centres needs need to be relooked. Budgetary support towards cost of construction being provided in convergence with the Ministry of Rural Development under the MNREGA must go up from Rs 7 lakh per building, as the scheme has completed four years of implementation. In recognition of this, the state governments have already been demanding that the unit cost per building be increased.
Happy Pant is with the Centre for Budget and Governance Accountability, New Delhi and can be reached at [email protected] . Views expressed are those of the author, and don’t necessarily reflect the position of CBGA.