CB BureauCan India halve its malnutrition rate by 2015 – which is a
stated Millennium Development Goal (MDG)?
Highly unlikely, would be the answer in the current
scenario.
Unless:
- The
recognition of malnutrition as a critical area jumps out of policy documents,
research notes and thunderous speeches.
- The
public distribution system (PDS) is turned on its infamous, bulky and ill-fated
head.
- Benefits
of employment schemes, food-subsidy schemes, poverty-reduction schemes and
child-and-woman-development schemes reach the intended beneficiaries.
- Delivery
of nutrition service to communities with the highest concentration of poor is
made corruption-proof.
- The
delivery system becomes self-sustaining and works with clockwork precision”more
or less.
- ‘Inclusive
growth’ is paid more than lip service.
- ‘Inclusive
growth’ becomes more than ‘the term of the moment’.
- The
application of science and technology to achieving workable innovation in
nutrition becomes a vital part of the national nutritional strategy.
- There
is a national nutritional strategy.
To put it blandly, India’s progress in reducing child
malnutrition has been cumbersome. India has one of the highest rates of
underweight children in the world – nearly 40 per cent of the country’s small
children are malnourished. This is a higher percentage than most countries in
sub-Saharan Africa.
In annual terms, an estimated 2.5 million children die in
India. More than half of these deaths can be prevented if children are well
nourished. One reinforces the other: inadequate nutrition weakens the immune
system, increasing the risk of infectious disease; illness, for its part,
compromises a child’s nutritional count.
Over and above its linkage to half of all child deaths and
nearly a quarter of cases of disease, malnutrition has other equally critical
implications. For one, malnourished children tend not to reach their potential,
physically or mentally. This has a straight impact on productivity. According
to the World Bank, in low-income Asian countries physical impairments caused by
malnutrition make a difference of at least three per cent to GDP, in minus
terms.
In a fundamental way, the Integrated Childhood Development
Service (ICDS) has not worked. To quote a World
Bank (WB) report, ‘More attention has been given to increasing coverage
than to improving the quality of service delivery and to distributing food
rather than changing family-based feeding and caring behavior. This has
resulted in limited impact.’
Launched in 1975, the ICDS is the world’s biggest programme
for maternal and child health and nutrition. According to the programme, an
anganwadi centre with one teacher and an assistant are made available for every
1,000 people. Each centre has to provide nutritional care to pregnant women and
all children aged up to six years. Anganwadi centres also provide daily
pre-school childcare and education.
Stating that there is a mismatch between the programme’s
intentions and its actual implementation, the WB report defines the key
mismatches thus:
- The
dominant focus on food supplementation is to the detriment of other tasks
envisaged in the program which are crucial for improving child nutritional
outcomes. For example, not enough attention is given to improving childcare
behaviors, and on educating parents how to improve nutrition using the family
food budget.
- Older
children (between 3 years and 6 years) participate much more than younger ones
and children from wealthier households participate much more than poorer ones.
The program fails to preferentially target girls, lower castes or poorest
villages (all of whom are at higher risk of undernutrition).
- Although
program growth was greater in underserved than well-served areas during the
1990s, the poorest states and those with the highest levels of undernutrition
still have the lowest levels of program funding and coverage by ICDS activities.
In addition to these mismatches, the programme faces
substantial operational challenges – among these, inadequate worker skills,
shortage of equipment and poor. While the daily meals”meant to provide each
child with an extra 500 calories a day”are beneficial, they do not replace the
nutritional guidance the parents of young children need. Also, community
workers are overburdened, because they are expected to provide preschool
education to four-to-six-year-olds as well as nutrition services to all children
under six, with the consequence that most children under three”the group that
suffers most from malnutrition and who the government should be targeting most
seriously”do not get micronutrient supplements. Moreover, most of their parents
are not reached with counselling on better feeding and childcare practices. It
does not help matters that most growth retardation is determined by the age of
two and this process is irreversible.
The ICDS is emblematic of the malaise that defines public
services in India. There is nothing exceptional here. Nothing of the deviant.
None whatsoever of the worm in the apple. At the moment, the worms dominate.
There is a way out, though. There always is. Sometimes,
there is more than one way. The fact that there are examples”however stray”of
successful interventions (Bellary district in Karnataka) and
innovations/variations in ICDS from several states (the Integrated Nutrition
and Health Project [INHP] in nine states, the Dular scheme in Bihar, and the
Tamil Nadu Integrated Nutrition Project [TINP] in Tamil Nadu) suggest that the
promise for better implementation and for real impact holds.