1. Union Budget 2017: Declining investment, increasing malnutrition – The story of our country’s children

Union Budget 2017: Declining investment, increasing malnutrition – The story of our country’s children

India, with a Global Hunger Index (GHI) score of 28.5 ranks at a poor 97 among 118 developing countries listed, which is much lower than where it stood in 2000, when it was ranked 83.

New Delhi | Published: February 1, 2017 9:36 AM
India, with a Global Hunger Index (GHI) score of 28.5 ranks at a poor 97 among 118 developing countries listed, which is much lower than where it stood in 2000, when it was ranked 83. (Reuters) India, with a Global Hunger Index (GHI) score of 28.5 ranks at a poor 97 among 118 developing countries listed, which is much lower than where it stood in 2000, when it was ranked 83. (Reuters)

“Nothing is more important than that the child must have a strong and healthy body. The body is the first thing to attain to virtue. I know we are the poorest nation in the world, and we cannot afford to do much. We can only work on the lines of least resistance. We should see at least that our children are well fed. The machine of the child’s body should never be exhausted” – Swami Vivekanand

For the first time in over 100 years, India’s economy has overtaken that of the United Kingdom. Our country now stands as the world’s sixth largest economy by Gross Domestic Product (GDP) after the United States, China, Japan, Germany and France. The pace of our growth led us to surpass China when we were declared the fastest growing large economy, in data released early last year.

While India has experienced rapid economic growth, it has continually struggled to meet development indicators. India, with a Global Hunger Index (GHI) score of 28.5 ranks at a poor 97 among 118 developing countries listed, which is much lower than where it stood in 2000, when it was ranked 83. Even countries like Bangladesh have steered ahead of India with an improved GHI score of 27.1.

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India fares miserably, with grave statistics in all four key parameters taken into account by GHI – which include shares of undernourished population, wasted and stunted children aged under 5, and infant mortality rate of the same age group. Rapid Survey on Children (RSOC) data released by the Government in 2013-14 revealed that 39% of children under the age of five in India, are stunted, which is chronic malnourishment over a long period of time.

About 15% are wasted which indicates acute malnourishment with sudden weight loss and about 29% are underweight. As per the National Family Health Survey, which is perhaps the only comprehensive source of data on nutrition, 70 % of children under 5 were anaemic in 2005-06. It is saddening to note that the data released for 12 states in 2015-16 also reveal this figure to be over 50% for states like West Bengal, Andhra Pradesh, Bihar, Tamil Nadu, Uttarakhand etc.10 out of 12 states surveyed have not been able to reduce the Infant mortality rate even by 2 percentage points annually. In India, 40 infants out of every 1000 don’t get to celebrate their first birthday.

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This incremental change in the situation on ground forces us to rethink the strategies we have adopted to combat malnutrition.

India’s Integrated Child Development Scheme (ICDS), which is one of the world’s largest schemes providing for care and nutrition to children under 6 years, through around 13.5 million Anganwadis, covers only 50 per cent of these children. India, continues to host one of the largest number of children suffering from malnutrition in the world. Our experience working with realties on ground brings forth the ostensible gaps service delivery mechanisms. Take for instance, the fact that even when standardized systems for growth monitoring have been chartered out, many Anganwadis lack upgraded equipment, leading to measurement of only underweight, leaving out the important aspects of stunting and wasting. This, coupled with minimal training of Anganwadi workers, adds to the challenge.

Similarly, nutritional assessment will not make any impact on the status of the child, if adequate time is not spent on counselling of parents of these undernourished children, which is clearly a struggle. In many instances, even the major component of an Anganwadi centre, the nutritional supplement provided to children, gets affected as service is marred by delayed flow of funds.

The inadequacy of human resources within Anganwadis is yet another area of foremost concern. As on March 2015, 14,673 posts of Anganwadi Supervisor, 62,970 posts of Anganwadi Workers and 1,18,609 posts of Anganwadi helpers were vacant. An estimated number of staggering 18 lakh children would be devoid of ICDS in absence of ICDS personnel position filled. To even dream of a universal coverage as envisaged under the re-structured ICDS, adequate funding is a prime requisite.

The budget allocation for the ICDS scheme, has declined by 9.6%, from 15,584 cr (RE 2015-16) to 14,862 cr (BE 2016-17). Considering Revised Expenditure for the last 4 years and Budget Estimate for the current financial year, the total allocation for ICDS scheme has been Rs. 78203 crores as against Rs. 1,23,580 crore proposed during the 12th Five Year Plan (- Rs. 45377 crore). It is rather interesting to see that the budget allocation from 2012-13 to 2015-16 has decreased, which seems irrational if we consider the rising inflation and costs. The lack of increased budget will definitely reflect in the quality of services provided at Anganwadis, which are already struggling with resource crunch and infrastructure woes.

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Ref: pg 18 of PSC report demand for grants 2016-17 (report no 278)

Out of the 14 lakh sanctioned AWCs (Anganwadi Centres), there are 13.49 lakh operational AWCs as on December 31, 2015. 30% of AWCs do not have drinking water facilities within the premises and only half of them, about 49.38%, have toilet facilities. While we want to lay solid foundations of adequate nutrition and pre-schooling education for our young children, how do we expect them to get the same, when basic necessities like toilets and drinking water are not provided to all? We easily reject a scheme for not being functional, in light of non-optimal outcomes, when in fact what we need is to strengthen the inherent design and inadequacies of the scheme for impact to be visible on ground. A robust scheme such as ICDS, which is the only one to serve the needs of children in the age group of 0-6, has the potential to bring critical change, if it were provisioned with greater resources.

Increased investment by Centre and state is imperative to provide our children with the nutrition, care and education they should early on in their life. It means we need to look at identifying, in the first place, all forms of malnutrition – stunting, wasting and underweight children, for which investment in measuring mechanisms and training of Anganwadi works is essential. Community based management of malnutrition is a proven strong strategy to combat malnutrition and thus required investment to make it a reality across the country. We need to emphasize on making NRCs (National Rehabilitation Centre), which play a vital role in management of severe malnutrition, accessible and functional as this has remained limited in many places.

The latest policy talks of a vision of a re-structured ICDS involving a core package of services such as Early Childhood Care Education and Development (ECCED), Care and Nutrition counselling – Maternal and Child, Health Services, Community Mobilisation, awareness and advocacy. The transition of Anganwadis to education centres as well is possible with additional human resources for pre-school education, and investing in them and their training is non-negotiable. We need to change our approach to Anganwadis as just centres of distribution of supplementary nutrition but as centres of care, nutrition and pre-school education with reach to every last child below the age of six.

(The article has been written by Komal Ganotra, Director, Policy, Research and Advocacy for CRY – Child Rights and You. All the views expressed are personal)

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