The 35-year-old Integrated Child Development Services (ICDS), the world’s largest programme for the health of children under six, was supposed to change the lives of poor, under-nourished children. But it has had only a marginal impact on malnutrition and infant mortality rates. The expanded, revamped scheme will roll out in 200 districts, with the overall budget for the next five years set at Rs. 1.28 lakh crore, an increase of nearly 300% over the previous five.
The meeting at the PMO and two other seemingly diverse events of the past week present new opportunities and represent the enduring shame and frustration of a country that knows its economic progress means little as long as half its children continue to be stunted, diseased or otherwise reduced.
The first event is the murder last week of Uttar Pradesh liquor baron Ponty Chadha, overlord of contracts for nutrient-rich, take-home ICDS rations in India’s most populous and its second-most malnourished state. The ICDS in Uttar Pradesh, a state where more children die and are malnourished than in entire countries, represents much that is wrong with India’s approach to hunger, hobbled as it is by corruption, substandard food and a classic politician-contractor nexus. The UP government must now scrap manipulated tenders, due to be opened this month: With conditions requiring earnest money of R45 crore and R25 crore in past contracts, they were meant to perpetuate Chadha’s monopoly over the business of malnourishment. If UP’s energetic, young chief minister can turn over his state’s nutrition contracts to women’s group and local communities — as the Supreme Court has mandated — India’s battle against malnutrition would be greatly stirred.
The timing could not be better.
Three days ago, Bollywood star Aamir Khan shared the stage with the president and prime minister (amid embarrassing sycophancy by Congress MP Krishna Tirath who called Indira Gandhi “Rashtra maa” or national mother) as the brand-ambassador of India’s renewed attempt to eradicate what the prime minister refers to as “a national shame”. Khan can bring long-overdue attention to the conundrum that is India’s malnutrition, which reduces only marginally as the poor become not-so-poor and does not appear to concern Indians as much as it does the rest of the world.
Created in 1975, the ICDS covers more than 91 million children, pregnant and lactating mothers through 1.3 million (as of last month) crèches, or anganwadis, where about 2.3 million female health workers constitute the frontline of the fight against malnutrition. They advise mothers, weigh and immunise children, provide take-home rations and supplemental nutrition.
The ICDS represents all that is good and bad about Indian governance.
The negatives are manifest in India’s marginally pared malnutrition indicators, in the criticism that the ICDS does not appear to reach those who need it most. The ICDS is unfailingly mentioned in most courses that teach nutrition across the world, but it is also criticised internationally for being a failure and a waste of money.
The government now realises that malnutrition is a combination of factors that include nutritious food, healthcare and sanitation. The ICDS, some argue, is on the cusp of maturity. You might rightly ask, “Were not 35 years enough?”
But the ICDS was not universalised until a Supreme Court order on November 28, 2001. That order resulted from the tenacious efforts of a handful of activists, shamed and angered enough by widespread hunger to do something about it. Not many Indians know that for 11 years the Supreme Court has effectively set and monitored many of India’s anti-hunger policies, including the successful school mid-day meal programme, also the world’s largest.
You could roughly compare the ICDS with India’s highway system. The route has been mapped, the asphalt has been laid. It may be bumpy, woefully inadequate in many parts, and falls short of significant impact. But the infrastructure is in place. There is no one who seriously questions the concept of the ICDS.
So, what must now change?
The paramount need is excellence in implementation and loosening of established positions by stakeholders.
Activists who led the great push against malnutrition are understandably suspicious of the involvement of private companies, many of whom bribe politicians and manipulate nutrition contracts. But, as the experience of Thailand and Mexico indicate, India needs the expertise of nutritionists, consultants and industrial-production methods to deliver nutrition with scientific precision. To resist any kind of expert and commercial involvement at this stage — though it is important to keep professional “contractors” out, something state governments and the Centre have still not done — is to risk slowing the ICDS and other anti-hunger schemes.
As for well-meaning experts, with access to much-needed international funding, it is important to realise that the political and social context to tackling malnutrition lies in female self-help groups and village communities. Many individual officials and workers have delivered sterling results as well, one reason why malnutrition indices, however limited, are down.
There is much to ponder, from big picture to the details: since 34 million children under six get pre-school education at crèches, why not merge them with primary schools and health centres? Should the salaries of child-health workers be doubled, or tripled, from the current R3,000 (often less) a month? Should one-size-fits-all nutritional guidelines be reviewed?
The government has done well to provide renewed attention to malnutrition. It is now time for everyone to come together and join battle for the body and soul of India.
Samar Halarnkar is a Bangalore-based journalist
The views expressed by the author are personal