Health

Why Odisha's nutrition budget, the first in India, is a cut above the rest

Odisha supports its nutrition agenda through agricultural policies, the public distribution system among others

 
By Anupam Srivastava
Published: Wednesday 26 February 2020
In the fight against malnutrition, it is easy to focus on the larger perspective and not have a sense of how several pieces in the puzzle constitute the whole Photo: Wikimedia Commons

Odisha has become the first Indian state to draw up a nutrition budget in the country. The idea of a thematic budget for nutrition is a unique one in India where an inter-departmental approach is followed. Key participants in this approach include anganwadi centres, schools and health institutions.

Additionally, Odisha supports its nutrition agenda through agricultural policies, the public distribution system and several other programmes which contribute to better nutritional outcomes.

In the fight against malnutrition, it is easy to focus on the larger perspective and not have a sense of how several pieces in the puzzle constitute the whole.

A review of department-wise nutrition allocations was conducted, on the basis of which an overall budget was developed.

In accordance with global thinking around nutrition, the state took stock of its budgets under two types of interventions: ‘nutrition-specific’ and ‘nutrition-sensitive’ interventions. In other words, these interventions are direct and indirect, respectively.

Medical journal The Lancet defines nutrition-specific interventions as “immediate determinants of foetal and child nutrition and development: Adequate food and nutrient intake, feeding, care-giving and parenting practices and low burden of infectious diseases”.

Nutrition-sensitive interventions, according to The Lancet, “address the underlying determinants of foetal and child nutrition and development: Food security, adequate care-giving resources at maternal, household and community levels and access to health services and a safe and hygienic environment”.

A social environment that holistically supports nutritional requirements of its people works through multiple interventions. However, this also makes the scenario complex and difficult to map. While developing its nutrition budget, the Odisha government mapped programme environments and measured both kinds of interventions.

Additionally, it calculated the previous year’s figures under those budget heads, and compared these with allocations made for the next financial year.

A state analysis showed that the Department of Women & Child Development and Mission Shakti had the highest share with seven nutrition-specific schemes, followed by Food Security & Consumer Welfare with three schemes and School & Mass Education with two such schemes.

However, there are many more departments which run nutrition-sensitive schemes.

They include Food Supply & Consumer Welfare, School & Mass Education, ST & SC Development, Health & Family Welfare, Housing & Urban Development, Panchayati Raj & Drinking Water, Agriculture & Farmers Empowerment and Fisheries & Animal Resource Development.

In an analysis, UNICEF Bhubaneswar stated that the allocation of Rs 5,210 crore for nutrition-specific interventions was an increase by 30 per cent compared to the allocation in 2018-2019.

On the other hand, Rs 23,753 crore allocated for nutrition-sensitive interventions was an increase of nearly 70 per cent in the last two years.

“Odisha has taken a leadership position in the entire country through the path-breaking announcement of a nutrition budget,” said Monika Nielsen, UNICEF Odisha’s chief of field office.

Odisha made some achievements in the decade between National Family Health Survey (NFHS) three (2005-06) and NFHS 4 (2015-16). One of these was that the proportion of malnourished children under the age of five in the state declined to 34.4 per cent from 40.7 per cent.

But there is intra-state disparity. Malnutrition is as high as 51.8 per cent in districts like Malkangiri (according to NFHS 4), while several other districts are way below the state average in their performance.

Odisha’s state-level data thus is not uniformly indicative of improved performance.

The proportion of ‘wasted’ (weight for height) children increased to 20.4 per cent from 19.6 per cent (NFHS 3 to NFHS4), while the proportion of ‘severely wasted’ children increased to 6.4 per cent from 5.2 per cent.

The trends however are in conformity with national averages which show a decline in the proportion of malnourished or underweight children and an increase in wasted and severely wasted children.

Malnutrition is a complex outcome of something which has gone wrong in the life of a child: Poverty in their families, inaccessibility to food and nutrition before and after birth and infections and illnesses are some of the factors.

Therefore, a holistic approach requires addressing issues at every level. This is why anganwadi centres provide food to children under five years and schools give mid-day meals with iron and folic acid to deal with anaemia. Similarly, nutrition rehabilitation centres set up in district hospitals try to help improve the nutritional status of malnourished children.

Mapping nutrition components of public welfare-oriented schemes is likely to help government and programme managers monitor these measures better and help make important breakthroughs.

One way of ensuring commitment is to give a higher budgetary allocation to both nutrition-specific and nutrition-sensitive schemes, say experts.

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