Insights into Editorial: Nutrition and the Budget’s fine print
In Recent, the Global Hunger Index, reported that India suffers from “serious” hunger, ranked 102 out of 117 countries, and that just a tenth of children between six to 23 months are fed a minimum acceptable diet.
With the largest number of undernourished people in the world, India needs to hasten to achieve Sustainable Development Goal 2 of ‘Zero Hunger’ by 2030.
The Economic Survey notes that India should give special attention although the Budget has not explicitly spelt out nutrition in greater detail in many ways.
Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.
The term malnutrition covers two broad groups of conditions.
- One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
- The other is overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and cancer).
Plan and allocation in the Budget:
There are multiple dimensions of malnutrition that include calorific deficiency, protein hunger and micronutrient deficiency.
Existing schemes can well address India’s malnutrition dilemma.
An important approach to address nutrition is through agriculture. The Bharatiya Poshan Krishi Kosh which was launched in 2019 by Minister for Women and Child Development Smriti Irani, and Microsoft founder Bill Gates is a recent attempt to bridge this gap.
The urgency around nutrition was reflected in the Finance Minister’s Budget speech, as referred to the “unprecedented” scale of developments under the Prime Minister’s Overarching Scheme for Holistic Nutrition, or POSHAN Abhiyaan, the National Nutrition Mission with efforts to track the status of 10 crore households.
However, where are the gaps in addressing this concern:
First calorific deficiency:
- The Integrated Child Development Services (ICDS) scheme provides a package of services including supplementary nutrition, nutrition and health education, health check-ups and referral services addressing children, pregnant and lactating mothers and adolescent girls, key groups to address community malnutrition, and which also tackle calorific deficiency and beyond.
- For 2019-20, the allotment was Rs.27,584.37 crore but revised estimates are Rs.24,954.50 crore, which points to an underutilisation of resources.
- The allocation this year is marginally higher, but clearly, the emphasis needs to be on implementation.
- Another pathway to address hunger is the Mid-Day Meal Scheme, to enhance nutrition of schoolchildren.
- Here too, the issue is not with allocation but with expenditure. The 2019-20 Budget allocation was Rs.11,000 crore and revised estimates are only Rs.9,912 crore.
The second is protein hunger:
- Pulses are a major contributor to address protein hunger.
- However, a scheme for State and Union Territories aims to reach pulses into welfare schemes (Mid-Day Meal, Public Distribution System, ICDS) has revised estimates standing at just Rs.370 crore against Rs.800 crore allocation in the 2019-20 Budget.
One more important component is “Micronutrient” deficiency:
- The Horticulture Mission can be one of the ways to address micronutrient deficiency effectively, but here too implementation is low.
- In 2018-19, the Government of India launched a national millet mission which included renaming millets as “nutri-cereals” also launching a Year of Millets in 2018-19 to promote nutritious cereals in a campaign mode across the country.
- This could have been further emphasised in the Budget as well as in the National Food Security Mission (NFSM) which includes millets.
- As millets have the potential to address micronutrient deficiencies, the momentum given to these cereals needs to be sustained.
- Moving to POSHAN Abhiyaan, the National Nutrition Mission which is a major initiative to address malnutrition, had 72% of total expenditure going into “Information and Communication Technology enabled Real Time Monitoring for development and setting up Common Application Software and expenditure on components under behavioural change” according to Accountability Initiative.
- The focus of the bulk of the funding has been on technology, whereas, actually, it is convergence that is crucial to address nutrition.
- The Initiative also found on average that only 34% of funds released by the Government of India were spent from FY 2017-18 to FY 2019-20 till November 30, 2019.
Impact of linkage schemes:
With underspending, allocations for subsequent years will also be affected, limiting the possibility of increasing budgets and the focus on nutrition schemes.
Next is the agriculture-nutrition link, which is another piece of the puzzle. While agriculture dominated the initial Budget speech, the link between agriculture and nutrition was not explicit.
This link is important because about three-fifths of rural households are agricultural in India (National Sample Survey Office, 70th round) and malnutrition rates, particularly in rural areas are high (National Family Health Survey-4).
Therefore, agriculture-nutrition linkage schemes have potential for greater impact and need greater emphasis.
Way Forward: The following are suggestions to move forward:
- Focus on nutrition-related interventions, beyond digitisation;
- Intensify the convergence component of POSHAN Abhiyaan, using the platform to bring all departments in one place to address nutrition;
- Direct the announcement to form 10,000 farmer producer organisations with an allocation of Rs.500 crore to nutrition-based activities;
- Promotion of youth schemes to be directed to nutrition-agriculture link activities in rural areas;
- Give explicit emphasis and fund allocation to agriculture-nutrition linked schemes;
- Ensure early disbursement of funds and an optimum utilisation of schemes linked to nutrition.
- Improving the overall nutritional status of girls and women during the preconception and pregnancy period and providing quality antenatal care can positively influence low birth weight indicators.
- Focus is needed on major determinants like provision of clean drinking water, reducing rates of open defecation, improving women’s educational status, and food and nutrition security for the most vulnerable families.
- It is important to plan the reduction in malnutrition in a manner that is suitable for the trends and context of each State.
Nutrition goes beyond just food, with economic, health, water sanitation, gender perspectives and social norms contributing to better nutrition.
This is why implementation of multiple schemes can contribute to better nutrition.
The Economic Survey notes that “Food is not just an end in itself but also an essential ingredient in the growth of human capital and therefore important for national wealth creation”.
Malnutrition affects cognitive ability, workforce days and health, impacting as much as 16% of GDP (World Food Programme and World Bank).
In that sense, while Budget 2020-21 looks toward an ‘Aspirational India’, fixing the missing pieces on the plate, can make a difference not just to better nutrition but to build a wealthier nation too.