The malaise of malnutrition in India
As long as even one Indian goes to bed on an empty stomach, grand slogans of “sabka saath, sabka vikaas” will continue to ring hollowUpdated: Sep 27, 2016, 00:36 IST
India produces enough food to feed its people, yet in a cruel twist of irony, millions go to bed hungry. India is likely to be the most populous country by 2022, and on the brink of a demographic dividend, so investing in our human resources must be a priority. Nutrition, in particular, is inextricably linked to cognitive development, learning outcomes, productivity at work, and cumulatively, economic growth. More importantly, it is the state’s moral obligation -- Article 47 of the Directive Principles recognises it as a primary duty of the state to raise the standards of nutrition and living of its citizens.
Countless schemes — where’s the panacea?: Malnutrition levels have declined, but in absolute numbers we are doing abysmally. We are still home to a quarter of the world’s malnourished, with 194.5 million of them. The problem is not a dearth of schemes. There are a number of nutrition-specific schemes intended to tackle malnutrition — the Integrated Child Development Services (ICDS), Mid-Day Meal Scheme (MDMS) and Public Distribution System (PDS). Malnutrition is a multi-faceted, intergenerational problem that must seen in conjunction with a complex set of issues including income levels, education, sanitation, a life-cycle approach of how a girl child is fed and primary health care delivery systems in India.
The coverage of schemes remains patchy because of rampant leakages, and poor execution and monitoring. Where does the problem lie? The ground reality betrays vast gaps in the functioning of anganwadi centres -- private contractors siphoning off large sums, inadequately trained anganwadi workers and poor infrastructure.
Madhya Pradesh, for example, lost 19 children specifically to malnutrition in the last two months in Sheopur district. The state administration, instead of hastening to act, seems more content to sweep the real cause of these tragic deaths under the rug. Ten teams dispatched by the National Health Mission have already found 461 malnourished children across 106 villages in Sheopur. Madhya Pradesh has some of the worst health indicators, with the Infant Mortality Rate (IMR) at 51 deaths per every 1,000 live births, compared to the national IMR of 39. The state government has spent approximately Rs 2,503 crore on malnutrition in the last two years, but the Women and Child Development Department’s data shows that over 1.3 million children are malnourished. The healthcare system suffers from acute shortage of qualified doctors and poor medical facilities. Against a sanctioned strength of 7,000 doctors, the state only has 3,000 serving. Against a requirement of 1,989 primary and 497 community health centres, only 1,171 and 334 respectively are operating in the state.
A workable solution: Currently, our human capital, instead of catapulting us to economic superstardom, is being held back by skewed priorities. The economic loss that India undergoes on account of malnutrition is pegged at 2-3% of GDP, but it’s facetious to merely reduce this menace to numbers, for they fail to capture the magnitude of loss caused to the nation. Combating malnutrition is not a political choice. Better nutrition must not be seen as an outcome of economic growth; rather, a high nutritional status of citizens is a prerequisite for it.
For the world to achieve the Sustainable Development Goal of eradicating all forms of malnutrition by 2030, India needs to mobilise efforts on all fronts. We have in place the ICDS (nutrition security), PDS (food security) and MGNREGA (livelihood security), but these work in silos. Firstly, we need a nation-wide Malnutrition Eradication Mission, a single-point window to execute these schemes in a convergent manner, with clear timelines and targets, especially nutrition-specific outcomes. Even so, such a multi-sectoral agency will likely remain ineffective unless each department working under the mission, be it Women and Child Development (WCD) or Health, is made accountable for its own targets to an independent apex authority at the Centre. Second, it is important to leverage mobiles, tablets and information and communication technology (ICT) to collect robust data, and bolster the monitoring system through cross-validation and data audits. For instance, the data should reflect not only how much ration an anganwadi worker was given, but whether this tallied with how many beneficiaries actually received the food, and its impact over time. This is crucial because it reflects changing nutritional needs and tracks the impact of interventions. Third, it must be ensured that family members of those identified as malnourished receive guaranteed employment under the MGNREGA, thus improving food and household security. And finally, health facilities and nutritional rehabilitation centres (NRC) in high malnutrition-burden districts need to be equipped and staffed on a war footing. In this maze of government agencies, we cannot ignore the foot soldiers, i.e. specialist doctors, anganwadi workers, ASHAs (Accredited Social Health Activists) and ANMs (Auxiliary Nurse Midwife). In addition to providing them with proper training and incentive structures, the government must ensure that they are well-coordinated. They must not be treated as agents of delivery, but as empowered agents of change working towards a common goal.
It remains to be seen whether the Centre will prioritise basic dignity for all its citizens, before it whips up more delusions of grandeur. How can we realise the dreams of Skill India, Digital India and Make in India, even while one out of every three children fails to fully develop his/her physical and cognitive capacity? Making “smart cities” will achieve precious little if those who inhabit these are doomed to a life of chronic hunger. As long as even one Indian goes to bed on an empty stomach, grand slogans of “sabka saath, sabka vikaas” will continue to ring hollow.
Jyotiraditya M Scindia is an MP and the Congress party’s chief whip in the Lok Sabha
The views expressed are personal