Health

Bihar failing to curb stunting among children due to inadequate fund, poor utilisation

Stunting, which causes irreversible damage, is highest among children in Bihar, where the share of state budget assigned for social welfare is on decline

 
By Isha Bajpai
Last Updated: Tuesday 01 May 2018
Stunting causes physical and neurocognitive damage that is irreversible in most cases. Credit: Kumar Sambhav Shrivastava
Stunting causes physical and neurocognitive damage that is irreversible in most cases. Credit: Kumar Sambhav Shrivastava Stunting causes physical and neurocognitive damage that is irreversible in most cases. Credit: Kumar Sambhav Shrivastava

Stunting, which, according to the United Nations Children’s Fund, reflects chronic undernutrition during the most critical periods of growth, is the highest among children in Bihar, says a study. The state has 48 per cent stunted children and yet, the allocation in the state budget for nutrition-specific intervention has decreased from 1.9 per cent to 1.5 per cent between 2014-15 and 2017-18.

Stunting causes physical and neurocognitive damage that is irreversible in most cases. Stunted children have stunted bodies and brains and live stunted lives, hampering development of societies.

The Centre for Budget and Governance Accountability (CBGA), in collaboration with UNICEF India, examined some aspects of public financing for nutrition in Bihar by studying budget outlays and expenditure data of 17 Direct Nutrition Interventions (DNIs) included in India’s policy framework for the last four fiscal years.

“A set of DNIs, when delivered at 90 per cent coverage, can reduce child stunting by 20 per cent. These DNIs are delivered through centrally sponsored schemes of two departments in the state,” says the study while adding that five of nine DNIs in the state utilise less than 10 per cent of the assigned funds.

Good care giving, breastfeeding and complementary feeding, treatment of severe acute malnutrition, micronutrient supplementation, deworming and diarrhoea control, nutrition of pregnant and lactating women, and health interventions are examples of DNIs.

Declining budget

When the state budget registered an 88 per cent hike (from Rs 94,698 crore in 2014-15 to Rs 178,399 crore in 2017-18) and the health budget became more than double (Rs 3,610 crore in 2014-15 to Rs 7,921 crore in 2017-18), the money allocated for the social welfare department increased by just little over 54 per cent, from Rs 4,883 crore in 2014-15 to Rs 7,561 crore in 2017-18.

First two bars show actual expenditure, third one is on revised estimates and the last on budget estimates.

“The health department’s budget constituted 3.8 per cent of the total state budget in 2014-15, which increased to 5.4 per cent in 2016-17 before dropping to 4.4 per cent in 2017-18. On the other hand, the social welfare department’s budget constituted 5.2 per cent of the total state budget in 2014-15, and declined to 4.2 per cent in 2017-18,” highlighted the report.

Problem with fund utilisation

The study finds systemic bottlenecks like weak decentralised planning and budgeting, and human resource and infrastructure shortages responsible for constraining fund utilisation.

One example of this highlighted in the study is block health action plan (BHAP). The BHAPs, for almost half the blocks in the state, were prepared without inputs from villages, and for other half, BHAP were not prepared at all during 2010-15.

“To address the high levels of child stunting, Bihar needs to significantly increase its investment in nutrition. The resource gaps for almost all DNIs analysed need to be addressed at the earliest. For this, both the Union and Bihar government should increase the budget outlays for the centrally sponsored schemes and within them, budgets for the DNIs,” says the study.

While reiterating that there is a lot to be done in Bihar, the researchers highlight only 10 per cent of the pregnant women in the state consumed iron-folic acid supplements, 35 per cent of children were breastfed within an hour of birth, and only 7.3 per cent of breastfed children received adequate diet.

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