How does one treat a malnourished child? Common sense suggests a proper meal. Not good enough, says the Union Ministry of Women and Child Development. Its prescription is supplying an 80-g ready-to-eat dosage of 10 minerals and vitamins in specific proportions, besides proteins and carbohydrates. In other words, just pop a pill or munch a biscuit for your meal--no fussing about cooking and cleaning dishes. Taste? The child will acquire it; it's fun food.
Nutritionists and most people associated with planning and monitoring the ministry's Integrated Child Development Services (icds) find this approach distasteful. They see in it a move to serve the scheme on a platter to private contractors and the food industry eager to pry open rural markets. As if to confirm their fears, Renuka Chowdhury, union minister of state for women and child development, proposed public-private partnership in the icds scheme last month."If contractors are allowed, corruption will increase. If it is just 50 per cent at present, it is likely to become 90 per cent," says N C Saxena, food commissioner the supreme court appointed to monitor the governments' food and nutrition schemes. Chowdhury also wants centre to have a greater say in the state-implemented scheme.
icds aims to provide the right supplementary nutrition to children in the age group of 6 months to six years and is the world's biggest such scheme, covering 58 million children. Over a hundred million children are waiting for the scheme to reach them. But despite the centre having spent Rs 5,000 crore under the scheme in 2007-08, half the children in India under the age of five are still severely malnourished. The draft eleventh Five Year Plan has now allocated Rs 52,000 crore (or a little more than Rs 10,000 crore a year) for the scheme. Although the stress is on providing hot cooked food through anganwadis and self-help groups, the size and budget of the scheme make it lucrative to private players.
Contractors are hungry, too Until 2006 the supplementary nutrition programme (snp) of icds was completely state-funded, and each state's secretary to the department of women and child development would invite tenders for contracts to procure and supply food, especially for younger children. "The fact that these contracts are often sizeable--ranging between Rs 25 crore and Rs 250 crore--makes them prone to corruption. Over time tenders for these contracts have been drawn to favour key players (contractors) and irregularities remain the norm rather than the exception," states the 2006 Focus Report prepared by food commissioners (see box Contractor system the rot within).
In 2004, the supreme court banned contractors from supplying food to anganwadis under icds, but barely six states complied. The ruling came in the right-to-food case filed by the activist group People's Union for Civil Liberties in 2001. Chief secretaries of several states have appeared before the court for violation of the law. Uttar Pradesh invited tenders for contracts after the 2004 order and the contracts extend up to 2010. On December 13, 2006, the apex court ordered chief secretaries of states and union territories to submit affidavits giving details of the steps taken towards complying with its 2004 orders. It also told chief secretaries to give a timeframe within which decentralization of the supply of food under snp would be completed. Yet Uttar Pradesh invited tenders in January 2007, though the bids have not been opened. Santosh Mehrotra, principal adviser to the planning commission, says if states introduce contracts now, the chief secretaries might go to jail for contempt of court.
Such is the stranglehold of contractors that food commissioners in their December 2007 report pointed out that nine states and union territories still used private traders. Some states have come up with clever ways of bypassing court orders. Chhattisgarh calls its contractors "manufacturers" and Maharashtra, while ordering removal of contractors and handing over of snp to mahila mandals and self-help groups, inserted a clause allowing cooperative federations to supply in areas where such organizations were not present. Since federations source all the supplies through private traders, this allowed contractors a back door entry to the icds system. The matter is in court.
In September last year, food commissioners Saxena and Harsh Mander wrote to the prime minister that the "entire feeding programme was riddled with corruption and leakages since the supply of food, the ready to eat food powders, had passed into the hands of private contractors. Not only were these calorifically inadequate and culturally inappropriate, most of the time they never even reached the beneficiaries".
| Today food deficits are being disguised as micronutrient deficiencies. When
children get adequate and appropriate food, micronutrient deficiency will
disappear in over 90% children, says nutritionist Veena Shatrugna
Public-private partnership will only increase contractors' role. "Contractor raj does not allow for monitoring to be decentralized or for the community or panchayats to exercise any control whatsoever on the nature and quality of food given at the anganwadi
, or even whether it reached the centre at all," writes Biraj Patnaik, principal advisor to the office of the food commissioners, in the Focus Report. Recognizing this, the draft eleventh Five Year Plan emphasizes that under snp
, three- to six-year-olds should get hot cooked meal, while those up to three years should get locally procured nutritious take-home food.
The plan, however, leaves room for speculation by giving the option of either providing cooked meals through self-help groups, mothers' groups and village committees or giving micronutrient-fortified food. Fortified food opens avenues for central procurement and involvement of contractors, wholesale dealers and manufacturers. "I don't think the issue is settled. With the supreme court order in place, the decision of the planning commission or the Ministry of Women and Child Development does not really matter," says Mehrotra. While the ministry and the planning commission are at loggerheads, the central allocation under icds
is restricted to Rs 6,000 for 2008-09.
The ministry has been pushing for ready-to-eat packaged food for quiet some time. Soon after the National Family Health Survey 2005-06 revealed little progress in tackling malnutrition in the country, the Ministry of Women and Child Development--then a department under the human resources development ministry--issued a circular in January 2006, recommending providing micronutrients--vitamins and minerals--along with calorie and protein, to children covered under icds.
The health survey revealed that the percentage of underweight children below the age of three in the country had gone down just a notch from 47 in 1998-99 to 46 in 2005-06. It also stated that 80 per cent children in the age group of 6-35 months were anaemic. The circular cited evidence revealing a mild deficiency of micronutrients can adversely affect a child's development, immunity and growth. It specified contents of calcium, iron, zinc, iodine, vitamin A and B12, riboflavin, ascorbic acid and folic acid in the food (see table
). It also recommended that micronutrient content be fortified in the ready-to-eat energy food and provided through 80 gramme of supplementary nutrition or raw food be given to meet micronutrient specifications.
"It was very mischievous of the ministry to ask for home-cooked food with exact micronutrient specifications. The ministry knew it wouldn't be possible to maintain the minute specifications in cooked meal and the recourse would be ready-to-eat food," says Patnaik.
"The standards set by the ministry are such that they can only be met through pre-packaged food. We are equipped with proper provision for monitoring and an array of quality checks, which is not possible otherwise," says Deepak Agarwal, executive director, Continental Milkose, weaning food supplier in Uttar Pradesh.
But is packaged food nutritious? Not really. "Packaged foods usually have cereals and pulses with preservatives, hydrogenated fats and maybe trans fats, and they will have to be dehydrated while packaging. Nutrients are lost in dehydration. However, cooking vegetables, spices and herbs enhances the taste and nutritional value of the food," says Veena Shatrugna, deputy director of the National Institute of Nutrition, Hyderabad, and member of the planning commission's steering committee on nutrition.
Most importantly, she says, micronutrients need to come from natural food and not something which has been artificially fortified. "While natural food will ensure that it enters the food matrix, binds with it and slowly gets processed, chemicals in packaged food will require lots of enzyme secretion for proper absorption, and this could strain liver enzymes in the long run," warns Shatrugna. There are some 20 vitamins and minerals and nearly 300 phytonutrients, antioxidants and flavanoids in natural food. All of them are not available for fortification, she adds. "Each child has different demands and food intake capacities. We need to accustom our children to the local, traditional food," says Arun Gupta, national coordinator, Breastfeeding Promotion Network India (bpni
Though the programme is called supplementary, the fact remains that children in India have a deficiency of 500 calories per day. Today food deficits are being called micronutrient deficiencies, says Shatrugna, adding that when children get adequate and appropriate food, micronutrient deficiency will disappear in over 90 per cent children.
| Nutritionists argue that providing packaged food in the garb of
supplementary nutrition to children will give a perfect opportunity to the
processed food industry to enter the rural market
V K Khandelwal, general manager, Suruchi Foods, one of the contractors supplying weaning food in Uttar Pradesh, says though packaged food cannot provide the variety children may want, it definitely gives them the basic requirement. The contractors currently provide weaning and amylase-rich energy food--basically cereal, comprising maize, soyabean, wheat and sometimes milk powder, sterilised and ground. This can be mixed with water or milk or with wheat and made into chappatis.
Khandelwal also claims that packaged food is more hygienic than hot cooked food. "We ensure complete cleanliness and our food goes through lab tests conducted by the government. It is only after the product is cleared do we send our packets to the state," he says.
Claims of quality notwithstanding, there have been numerous problems with the ready-to-eat food supplied under snp
. Most take-home ration comprises either daliya
or energy food powder. There had been reports from many states that daliya
was being used as cattlefeed. In Andhra Pradesh, milch efficiency of cattle was even found to have improved, says Patnaik. In Delhi, the government was giving gram and puffed rice (channa-murmura
) under icds
and prior to that fruit bun, bread and biscuits. "These supplies were running into huge scandals. They would not reach the needy and the quality would not be good," alleges Sunita Bhasin, director, Swami Sivananda Memorial Institute, an ngo
that runs a kitchen for anganwadi
s in Delhi's Jehangirpuri.
Nutritionists argue the trend of providing packaged food in the garb of supplementary nutrition will give a perfect opportunity to the junk food industry. "Beneficiaries of the anganwadi
would be led to believe that only what is packaged is good for children and anything prepared at home or which is traditional is not healthy and nutritious. It will delegitimize our rich food diversity, preparing our children for hamburgers, pizzas and colas," says Shatrugna.
Suruchi Foods made no bones about its keenness to enter rural markets. "Food can be converted into fun food like chips and Kurkure laced with the right proportion of protein and calories. Moreover, traditional food is being replaced by packaged food in urban India, so why not in rural areas also," asks Khandelwal. "There is no denying the intention of private contractors and bigger companies like Unilever to introduce fun food in the rural market. They may promote it in the garb of health food or as a solution to malnourishment but it is never going to solve malnourishment among children," adds Gupta of bpni
Another argument against providing cooked meal is lack of infrastructure. And it is not completely devoid of merit. A ministry official revealed that packaged food was the best way out until infrastructure was put in place. This is especially the case in states coping with the 'one anganwadi
worker-one helper' format. "We have to face criticism for the quality of meal being served at the anganwadi
s. It is best if we can get it off our chests," says Mala Sonkar, district programme officer, Meerut, Uttar Pradesh.
A few anganwadis Down To Earth
visited in Meerut were small and unsafe. The food is cooked in the same room where children sit. "The amount allocated for rent for anganwadi
s is Rs 100. How big a room do you expect in the city for that amount?" asks Kavita Sharma, anganwadi
worker at a slum adopted by Meerut ngo
Janhit Foundation. Kavita, however, says ngo
involvement has improved the situation. "We had requested the families in the slum to allow us to use their kitchens on a rotational basis. They agreed," says Sanjeev Kumar, Janhit coordinator. There are other cases where ngo
and women's involvement has made a difference (see box Ladies' special
Tug of war
Charges against the current system are plenty poor quality of cooked food, corruption in procuring grains, acute shortage of manpower... But if the government is serious it should improve it rather than let the scheme slip into the hands of private players, says Patnaik. "And if with decentralization the mid-day meal scheme serving hot cooked meals could succeed, so can icds
," he adds. Attempts were made to introduce ready-to-eat food in the mid-day meal scheme as well. But on February 1, 2008, the union human resource development ministry turned down the industry proposal, supported by over 30 mp
s, to supply biscuits or pre-cooked meal to over 120 million children under the scheme.
In November 2007, the steering committee on nutrition wrote to Montek Singh Ahluwalia, the deputy chairman of the planning commission, that locally cooked meal was the best means of providing nutritious food to children in the age group of three to six years. The committee included Patnaik, Shatrugna and economist Jean Dreze. They emphasized that cooked meal will provide employment to poor women and the scheme can help in disseminating nutrition education. "Despite several instances of pilferage in the implementation of mid-day meal and icds
, Andhra Pradesh, Chhattisgarh, Himachal Pradesh, Gujarat, Kerala and Tamil Nadu have put in place enabling infrastructure and maintained quality and hygiene safeguards," says Jean Dreze.
The women and child development minister, however, seems to be pulling all strings possible to introduce centrally procured packaged food. Patnaik says it has commissioned a survey of anganwadi
s providing cooked meals to study the scheme's functioning. According to sources involved in the monitoring of the icds
, the survey is being conducted to give credence to the claims that the hot cooked meal has failed to address malnutrition. The National Institute of Public Cooperation and Child Development, Delhi, which is conducting the survey, refused to comment on it.
In March 2007, the ministry had submitted an affidavit in the supreme court questioning the logic of decentralizing the procurement of food grain and banning contractors, wholesalers and manufacturers. The judgement in the right-to-food case was not going in the ministry's favour, says Patnaik. In November last year, the ministry took away the icds
case from additional solicitor general Mohan Parasharan -- who was till than handling all the nine food schemes under the supreme court's purview -- and gave it to Vikas Singh. So much for showing concern.