Apart from allocation of funds, their release, approval and reporting also need to be streamlined
India enjoys the status of a food-surplus country and yet, every third child in the country was found to be malnourished in the Comprehensive National Nutrition Survey, 2016-18. Only 9.6 per cent of children aged 6-23 months received an adequate diet, according to the National Family Health Survey (NFHS), 2015-16.
Chronic malnutrition did not improve in children below five in the last five years and acute malnutrition in the age group worsened, the recent NFHS which was released in December 2020 found.
While these data pertain to the period before the novel coronavirus disease (COVID-19) pandemic, the situation is likely to have aggravated. The ripple effect of the crisis could adversely impact the quality of life of children, including the nutritional status of vulnerable kids.
The existing government programmes to address food insecurity and malnutrition such as targeted public distribution system (TPDS), mid-day meals (MDM), Integrated Child Development Services (ICDS) and Poshan Abhiyan were also disrupted since March 2020 due to the lockdowns.
Even though the government extended several support mechanisms in the trying times, there is great risk with the overburdened health systems. There might be lack of attention to other health and nutrition-related interventions, which includes immunisation, antenatal care and micronutrient supplementation, among others.
Child nutrition will need better public provisioning in the coming days. In a web discussion with academicians, subject experts and non-profits working on child health and nutrition organised by Child Rights and You (CRY) and Centre for Budget and Governance Accountability (CBGA) on January 25, the role of the Union Budget 2021-2022 in mitigating these crises were highlighted.
A quick glance at the last three Union Budgets shows that allocations towards anganwadi services increased from Rs 15,245.19 crore in 2017-18 to Rs 19,916.41 crore in 2020-21. Similarly, allocations for National Nutrition Mission have increased from Rs 1,500 crore to Rs 3,700 crore in the same period.
The pandemic has impacted nutrition delivery services and nutritional status of pregnant women, children below 6 years and adolescent girls significantly, said Puja Marwaha, CEO of CRY, citing examples from the NGO’s intervention areas in 19 states. The organisation provides seeds and manure to vulnerable families to develop kitchen gardens. This project to provide nutritional security paid off especially during the pandemic, said Marwaha.
Such micro-level interventions are critical but not enough, she said. “Unless challenges related to adequacy in budgetary allocations and bottlenecks in utilisation are addressed, we will be unable to mitigate the loss caused due to pandemics such as COVID-19. We are hopeful that allocations towards child development and nutrition will see an exponential increase in the coming years,” she added.
Sustaining demand for higher allocations is crucial because resource absorption of certain schemes is good but of others in low, said Shruti Ambast, senior policy analyst of CBGA. “Our district-level budget analysis of in districts and four states shows high fund utilisation in important centrally-sponsored schemes like SSA, ICDS, MGNREGS in 2017-2018 and 2018-2019. But, fund utilisation was relatively lower for MDM and NHM,” she said.
Apart from allocation of funds, their release, approval and reporting also need to be streamlined to remove bottlenecks in public financing, said Avani Kapur, director of Accountability Initiative. “We can start small but decentralisation is key, especially in nutrition schemes.”
Not just children
Nutritional security of adolescent boys and girls and challenges faced by women frontline workers also need to be covered in the Budget, the experts noted.
“Out of school adolescents is a group which is vulnerable to under-nutrition amid the pandemic. And it is not just girls, out of school adolescent boys are equally vulnerable and there are no mechanism to reach to boys,” said Mini Varghese, country director of Nutrition International.
Pre-pregnancy well-being of women is crucial for maternal and child health, said Shweta Khandelwal, head of nutrition research, Public Health Foundation of India. With early marriage, conception, multiple pregnancies, nutritional requirements of the country’s women are often not met and their health and care environments are poor.
“Only giving ration to pregnant women, mothers won’t help. We also need to strengthen the social safety nets for women and relook at nutrition component,” Khandelwal added.
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