Malnutrition: How Budget 2017 can do justice to India’s starving children by making nutrition a national emergency

India is hungry. Not just for economic development and social justice, but for grain, for fruit, for seed, for poultry, for milk. The most rustic kind of hunger, is the hunger of both the father and the child for survival. India is one of the highest ranking countries in the world in children suffering from malnutrition. In its annual calculations of the Gross Hunger Index (GHI) for 2016, The International Food Policy Research Institute (IFPRI) placed India at 97 among 118 developing countries. Those worse than India were Niger, Chad, Ethiopia and Sierra Leone, Afghanistan and Pakistan. Neighbouring countries that scored better were Sri Lanka, Bangladesh, Nepal and China. [caption id=“attachment_1040861” align=“alignleft” width=“380”]  AFP[/caption] Commenting on the 2016 budget, Save the Children Foundation pointed out that the allocation for Mid-Day Meal (MDM)s scheme has been increased by only Rs 463.6 crore, which is an increase of only 5.09 percent from Rs 9,236.4 crore (2015-16 RE) to Rs 9,700 crore (2016-17 BE). The percentage share of MDMs in the total Union Budget allocation has gone down from 0.74 percent in 2014-15 (BE) to 0.49 percent in 2016-17 (BE). “India has one of the largest child development schemes known as Integrated Child Development Scheme (ICDS). After many years, the ICDS service is still awaiting universalisation and is failing to reach out to the most vulnerable children. These small hurdles become major for the children, who need it most,” says Devendra Tak of Save the Children. Tak points out that no single ministry or single intervention has been able to lead to rapid reductions in under-nutrition burden. Thus, delivering a set of essential nutrition interventions from diverse sectors is essential to create environments that foster optimal child growth and better nutrition for all. He cites examples of countries – Bangladesh, Brazil, Senegal, Vietnam and Thailand – where interventions have led to improvements. The percentage share of the Budget of Department of Health and Family Welfare was 1.96 percent in 2014-15 (BE) and has come down to 1.87 percent in 2016-17 (BE). “Although the National Food Security Act prescribes a minimum nutritional content that each child should get, the ICDS only covers 50 percent of the population. The per unit norms for supplementary nutrition were last revised in 2011.There should be some inflation indexing,” says Komal Ganatra of Child Relief & You (CRY). She asks if government salaries can be increased each year then why is children’s nutrition being compromised on. Each year, the coverage of the ICDS increases with the opening up of new centres, but the budget allocated remains just the same. This, as CRY points out, affects the quality and quantity of the Supplementary Nutrition Program (SNP). She goes on to point out that nutritional resource centres are district-centric and are far away from many small villages. “How can a newborn baby be left 30 km away from his or her home? Also, the Anganwadis can only declare a child ‘underweight’. Stunting and wasting that are two other pivotal indexes of malnourishment aren’t even quantified in India,” she explains.The National Family Health Survey 4 was conducted in 2014-15 in 29 states and six union territories,and it showed that 37 percent of children under the age of five are stunted. Bihar and Madhya Pradesh are the worst off, with 48 and 42 percent respectively of children stunted. According to research conducted by CRY, as on March 2015, 14,673 posts of Anganwadi Supervisor, 62,970 posts of Anganwadi Workers and 1,18,609 posts of Anganwadi helpers were vacant. Thishas worsened and adversely impacted the delivery of services. The Union Government has piloted the restructured ICDS which includes both comprehensive Early Childhood education as well as crèches for children (for care over 8 hours wherein both parents are engaged in economic roles) but universalizing the same remains a dream due to inadequacy of budgets. Save the Children Foundation suggests that the government must address the challenge of budgetary flows from the Centre to State Level, for this is where expenditures get delayed.Likewise, for the India Newborn Action Plan to realise its goals, it is important that Frontline Health Workers (namely ANMS and ASHAs) are skilled to practice essential and home based new born care. The Rashtriya Bal Suraksha Karyakram(RBSK), the experts feel, is an ambitious and much-needed program. However, there is lack of adequate numbers of the 18 Paramedic Disciplines needed at the District Level. It is recommended that the necessary number of paramedics be trained for all the districts, under special courses designed under the National Skills Development Mission. The National Nutrition Policy of 1993 ought to be updated. As the experts put it, nutrition is a national emergency and the budget must be sensitive to this.