Righting the wrongs: Beyond affirmative action

The core of India’s malnutrition puzzle lies in institutional functioning. There are succssful examples, though few

 
By Biraj Swain
Published: Friday 25 July 2014

The core of India’s malnutrition puzzle lies in institutional functioning. There are succssful examples, though few

While, the programmatic and institutional challenges are many, all is not lost. Other than the federal policies, provisions and constitutional guarantees, committed civil society organisations, resurgent Dalit movements are challenging the norm and scripting success. Almost all civil society organisations which have demonstrated impact insist that working on empowerment, with local community and governance structures, in a rights and entitlements framework is an essential model. But the importance of fostering a zero tolerance to discrimination and building a society where fault-lines of caste are eroded soon is the absolute first step. Hence the national leader, Dalit icon and Indian constitution’s original author, Shri BR Ambedkar’s call, “Educate, Agitate, Organise!”

How to reduce child malnutrition is not a mystery. The causal determinants are well known, driven by interaction between food intake, health status and provision of child and maternal care. Moreover Indian government had been active for decades in food policy and has a long standing programme like ICDS. The core thesis is that malnutrition is not only a dimension of current (and future) inequalities but is also casually related to unequal institutional structure. The elite capture of policy-making spaces, and implementation mechanism and the tendency of local officials transforming themselves into small-time local elites ensure the lack of public services to the marginalized and the perpetuation of discrimination. That Laxmanpur-Bathe, which witnessed massacre of 58 Dalits, had all the high-caste accused acquitted after 15 years of protracted trial and the media chose to black-out the incident instead of giving it wall-to-wall coverage and outrage, shows a concerning elite capture of the media too. As long as pivotal democratic institutions and public service delivery mechanisms are prone to elite capture, the Dalits getting adequate services and more, would be a chimera. It is not merely income vs nutrition but the overall spending and its reach to the needy plays significant role in it.

The core of India’s malnutrition puzzle lies in institutional functioning. Given the nature of the problem, India’s public resources and examples of relative success within India (say in Tamil Nadu) public action has the potential to be effective. However, if the thesis is correct, effective change will be primarily about transformation of institutional structures and processes rather than just techniques and management.

Prioritizing politics and power is more important than technical fixes. Supporting data-generation, people’s movements, pro-small farmer, pro-food producer policies would go a long way in making policies and programmes pro-nutrition, like rain-fed agriculture, support price for millets (which are semi-arid tropics, small farmers/marginal farmers’ produce).

Harnessing data revolution 1.0 is as important before clamouring for a data revolution 2.0. The public discourse around data deficit and data dishonesty and need for greater and better investments in data-generation has been on a peak, both from health, economics and development practitioners. But what happens when some of the most robust data-sets are either not asking the key questions around disaggregation or not releasing the unit-level data in time when they are relevant for effective planning? During the course of writing of this paper, various challenges were encountered with data re-analysis which has consequent call for action. For example, while NFHS trend analysis was possible, in cases like frontline staff home-visits and access to safe drinking water, comparision was impossible because the questions had changed from NFHS 2 to NFHS 3. Similarly accessing raw data free of cost for further analysis also seems like an uphill task.

Considering the intimidating nature of institutions in India towards normal citizens in general and Dalits/Adivasis, specifically, investment needs to be made in service-provider attitude to serve under a rights and entitlement framework and move away from a patronage and clientelism world-view. Similarly, marginalized communities, including Dalits, need to be provided with a template/benchmark of best services/inclusive and effective for them to organize, mobilize and agitate for the best food, nutrition and public health programmes. Community level awareness and advocacy for mobilizing the demand side is important.

From Odisha to Gujarat, states with integrated planning, have displayed more impactful results. The provisions under Integrated Approach to Planning with leverage from central assistance, Special Component Plan (SCP) etc display that a good plan will be equally matched by resources too. Karnataka’s Nutrition Mission is also an encouraging move in the same direction. SCP and Tribal Sub Plan (TSP) require contextualized bottom up planning and resource enhancement and pooling from the federal level. Unfortuantely planning capacity is woefully lacking and coupled with the perverse practice of states reporting pro forma allocation and diverting central assistance to non-Dalit/non-Tribal purposes gives rise to a toxic cycle of failure. Hence investing in building planning capacity, bringing transparency in fund sought and used for Dalits and Adivasis and integrated planning at every step, will go a long way in ensuring success.

The latest Lancet nutrition series, June 2013, offers some inspiring examples of integrated planning under the Scaling Up Nutrition (SUN) movement and in countries like Senegal, Malawi, Guatemala et al. Such models need to be reviewed and best practices adapted. Mexican Oppurtunidales has been a trail-blazer globally and has lessons to offer India when coupled with their Social Protection schemes. Three key factors crucial for building and sustaining the momentum and for converting that momentum into results, are:

  • First, knowledge and evidence. Undernutrition is a multisectoral challenge that is open to various interpretations (eg, as a health, economic growth, intergenerational rights, or humanitarian issue)
  • Second, politics and governance. Various stakeholders and agencies, each with different and frequently competing agendas (especially in decentralised systems of governance), need to work together to reduce undernutrition
  • Third, capacity and resources. Human and organisational capacity need to encompass not only nutrition know-how, but also a set of soft-power skills to operate effectively across boundaries and disciplines, such as leadership for alliance building and networking, communication of the case for collaboration, leveraging of resources, and being able to convey evidence clearly to those in power



India’s own body of work (states especially Kerala, Tamil Nadu, Himachal Pradesh) on inclusive programming across sectors is immense. Addressing delivery and structural challenges, building on community partnerships and designing programmes with well-evolved targeting (like the flagship programmes of Reproductive Child Health, National Health Mission and Total Sanitation Campaign) or universalising them with exclusion filters and self-targetting like the Mahatma Gandhi National Rural Employment Guarantee Act and National Food Security Act will go a long way in addressing Dalit distress and consequently under-nutrition.

There is a dearth of literature on operationalisation challenges. The practise loop needs closing with new research which address operational issues too. Programming for addressing Dalit under-nutrition should take special care in addressing this lackunae. When success stories are adapted or replicated, policy externalities and enabling institutions that caused them, need to be investigated and resourced for too. The current agricultural focus on doing the same for women’s collectives in the 12th Five Year Plan, is a good step ahead. Similarly, inter-sectionality of nutrition and agriculture, health-water-sanitation and nutrition, rural development-food security and nutrition, governance and nutrition calls for research too . The lack of research on food inflation and nutrition linkage, inspite of India reeling under run-away food inflation for over seven years, is one such glaring gap. This will need new collaborative designs beyond systematic reviews, beyond Randomised Control Clinical Trials towards means testing etc . New rules, new optics and new frameworks need to be co-designed where communities are not just informants but influence key research questions too.

A very progressive provision like the SCP-TSP has been reduced to arithmetic exercise, switching finances, rather than topping them up. Andhra Pradesh has enacted a legislation to ensure TSP-SCP are implemented in letter and spirit. Nationally a coalition of Dalits and Adivasis is pushing for the same agenda. Supporting to enact a legislation which ensure marginalized communities and their habitats, especially the Dalits and Adivasis get additional finance, build their local planning capacities and script their development plans, requires joining of forces. This is a worthy agenda to support, not just for nutrition actors, but social justice advocates. Considering how social justice is inter-twined with nutrition, this definitely calls for investments from Nutrition actors too.

Demand side pressure has been celebrated as the silver bullet to build a responsive system from an effete one. This calls for resource investments at grass-roots level to build a cadre of Dalits/Adivasi leaders aware of their entitlements from nutrition sector and its determinant sectors and exert pressure on the public service delivery mechanism to make it deliver for the poor and marginalized, every single time. Investing in building such models in some of the caste/deprivation entrenched areas and tracking the transformation and the change would go a long way in establishing a real feasible model and its impact on people/societies and services. Rights and gains won, should not be eroded through secular, down-stream discrimination or faulty designs. Making every Dalit voice count, through consultation and co-design, needs to be the mantra.

Biraj Swain works on Poverty, Public Policy and Governance in South Asia and Horn East and Central Africa, Adjunct Faculty at Pondicherry Central University, SLU-Uppsala, UNESCO-MISARC

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