- The percentage of overweight children in India has increased: NFHS-5
- Experts called to priorities malnutrition among children in budget
- Experts suggest increase in funding under food safety net programmes
New Delhi: As all focus shifts to the presentation of the Union Budget for the financial year 2021-22, on February 1, health and nutrition experts hope the budget will focus more on the nutrition crisis and the COVID-19 related additional burden. According to the experts, the ongoing COVID-19 pandemic is having a ripple effect as it exacerbates existing crises – hunger, malnutrition, lack of income which has pushed poor people further into poverty resulting in a lack of access to healthcare and nutrition. The State of Food Security and Nutrition in the World Report 2020 shows that India continues to have the largest population of food insecure people accounting for 22 per cent of the global burden of food insecurity. As per the report, the food security and nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio-economic impacts of the COVID-19 pandemic.
India has various food safety programmes yet people are going hungry. Is it due to poorly drafted policies or shoddy implementation of schemes or the lack of budget? NDTV spoke to experts and activists for their budget recommendations and expectations to deal with issues of malnutrition, health and hygiene and in turn, achieve malnutrition free healthy India.
A New National Legislation On Food And Nutrition
The National Food Security Act, 2013 (NFSA 2013) covers legal entitlements for existing food security programmes – mid-day meal scheme, Integrated Child Development Services (ICDS) scheme, Public Distribution System (PDS) and Pradhan Mantri Matru Vandana Yojana (PMMVY) – maternity benefit programme.
Basanta Kumar Kar, Recipient of Global Nutrition Leadership and Transform Nutrition Champion Award, believes NFSA-2013 is grossly inadequate and India needs new national legislation on food and nutrition to address all forms of malnutrition and deal with farmer’s security; sustainable food and nutrition security; food safety including management of food and nutrition value chain; preserving bio safety and bio diversity.
Dr Dipa Sinha from Dr. B. R. Ambedkar University Delhi said the underlying cause behind overweight or obesity among children is poor diet. She said,
It is not the problem of rich eating junk food. It is the problem of everyone not being able to access a healthy diet.
Dr Sinha and Mr Kar called for a regulation to prevent misuse of ultra-processed food for the children and the way it is advertised to them. Mr Kar said,
Introduce sugary taxes and stop trans-fats across the states, our supermarket receipts should give us calories count. Perhaps we can use ‘traffic light’ kind of labels on food packaging that can help people eat better and caution them for products that are high in fat or are bad for their overall health.
Additionally, to tackle malnutrition, it is essential to address hidden hunger – a lack of micronutrients such as vitamins and minerals. For the same, dietary diversity, supplementation and fortification would be keys, said Mr Kar. But, as per experts, food fortification – the addition of micronutrients (vitamins and minerals) to foods irrespective of whether or not the nutrients were originally present in the food – is no magic bullet to eradicating malnutrition. Elaborating on the same, Dr Sinha said,
Food fortification addresses single micro-nutrient like iron fortification but iron absorption reduces among malnourished people. People are not just anaemic; they are also stunted and wasted. We have an iron supplementation program which needs to be strengthened.
In addition to this, Dr Sinha asked to remove the limitation on the number of births on maternity entitlement for pregnant and lactating mothers.
Currently, a pregnant woman or lactating mother is entitled to Rs. 5,000 for the first live birth. Given the circumstances we are in, the limitation on the number of births should be removed. I think this will be good for the economy as well; if the government spends, it will contribute to the local economy, said Dr Sinha.
Increase Spending Under Public Distribution System And Provide Diversified Food
Under the PDS, wheat, rice, kerosene, and other food items are offered through a network of fair price shops. If we look at the budget allocated to food subsidy, it has not been steady. While in the financial year 2018-19, Rs. 1,69,323 crore was allocated, in 2019-20 the budget estimate for allocation was increased to Rs. 1,84,220 crore. However, in the financial year 2020-21, the money allocated to food subsidy was dropped by 37.26 per cent to Rs. 1,15,569.68 crore.
According to Dr Dipa Sinha, who is also the advisor to the Right to Food Campaign, schemes like PDS are under-funded and lack nutritious food. She said,
Providing diversified food items does not mean including only rice and wheat. People are unable to afford pulses and oil and I think these items should be made part of the PDS.
As per the demands of the Right to Food Campaign, which were presented in an online budget consultation, the government should make provisions for a universal public distribution system that provides every individual with 10 kg grain, 1.5 kg pulses and 800 gm cooking oil.
PDS has proved to be a lifeline during the pandemic as people who had lost livelihood were able to get their share of ration through this scheme. According to Dr Shweta Khandelwal, Head, Nutrition Research and Additional Professor at Public Health Foundation of India, programmes like PDS need to be further strengthened and intensified for future exigencies.
If we invest in strengthening processes, systems, we may be in a better position to stall the disruption in services and the additional burden of malnutrition due to pandemics like COVID -19, said Dr Khandelwal.
Enhance Budgetary Allocation For Mid-day Meal And Integrated Child Development Services
The Right to Food Campaign has called for enhanced budgets for mid-day meal programme and Integrated Child Development Services (ICDS) Scheme to ensure that nutritious hot cooked meals, including eggs, are provided through Anganwadi centres and schools. If we look at the money allocated to the MDM scheme, for two consecutive financial years – 2013-14 and 2014-15, Rs. 13,215 crore was allocated. But in the following year 2015-16, the budget allocation dropped to Rs. 9,236.40 crore. The steep drop was soon followed by an upward graph. Year after year, the budget estimate for mid-day meal scheme rose and in the year 2019-20, Rs. 11,000 crore was allocated. The budget allocation remains stagnant for the year 2020-21.
To address the needs of ICDS scheme under the Ministry of Women and Child Development, in the Union Budget for 2018-19, expenditure of Rs. 23,088.28 crore was estimated. While in the financial year 2019-20, the budget allocation increased to Rs. 27,584.37 crore, in 2020-21, it was further increased to Rs. 28,557.38 crore.
Talking more about the expansion of policies, Dr Sinha said,
People who are not able to access cereals cannot include fruits and vegetables in their diet. At least in the programmes where the government is giving food like in schools or under PDS, don’t give processed food. Don’t give just one meal which is good.
According to Dr Shweta Khandelwal, the two major nutrition related programs ICDS and MDM are not operating efficiently. She said,
Data from the National Statistical Office (NSO) 2019 shows that even prior to COVID-19, only 50 per cent of rural and 21.4 per cent of urban children reported that a free mid-day meal was provided by the institution. The National Education Policy (NEP), 2020 has recommended that provisions be made for serving breakfast along with the mid-day meals to improve foundational learning. In order to effectively implement these recommendations, the government will have to significantly increase the budget for MDM in the current and forthcoming financial years.
Expansion of these schemes also involves investing in nutrition sensitive interventions responsible for well-nourished children like safe drinking water, safe sanitation, women empowerment, and others.
Invest In Public And Primary Healthcare
From a budget outlay of Rs. 62,659.12 crores for the healthcare sector in 2019-20 to Rs. 69,000 crores in 2020-21, the budget allocated to the healthcare sector has increased over the years but currently, the major concern is an increase in inequities due to COVID-19.
Domestic government health expenditure as percentage of Gross Domestic Product (GDP) is only 1.3 per cent. A major concern is the out-of-pocket (OOP) expenditure which contributes to 64 per cent of the total health expenditure, and the brunt of this is borne by the poor and vulnerable population, said Dr Rajesh Khanna, Deputy Director of Health and Nutrition at Save the Children.
He noted that COVID-19 has worsened the existing inequities. A rise in unemployment and a drop in income levels has led to more and more people struggling to access health services. This threatens to reduce service coverage and increase the risk of morbidity and mortality among the children.
Dr Khanna called to increase the health budget and, invest proportionately more in public health and primary health care on a priority basis and added,
In the present situation, it becomes critical for the government to increase the health budget to 2.5 per cent of GDP. This will facilitate achieving one of the universal health coverage (UHC) targets of reducing percentage of households facing catastrophic health expenditure by 25 per cent by 2025.
Dr Khanna also suggested increasing the entitlements of Janani Shishu Suraksha Karyakaram (JSSK) for children upto 2 years from the present age of 1 year. He said,
Children till the age of 2 years are more susceptible to infections with high risks of mortality and morbidity and this has now increased with the COVID-19 pandemic.
Invest And Scale Up Local And Sustainable Solutions
Dr Shweta Khandelwal suggested scaling up locally proven best practices to innovatively eradicate multiple forms of malnutrition. She proposed creating nutrition gardens; POSHAN warriors or monitors in schools and communities to promote nutrition; use of technology to scale up efforts around nutrition counseling, monitoring of severely acute malnourished or vulnerable populations and others. She said, this will require investments in smart technology for yielding cost-effective benefits later on.