India’s malnutrition problem

(GS Mains 2: Issues relating to poverty and hunger.)

Context:

• The Global Hunger Index (GHI) 2022 ranked India 107 out of 121 countries.
• The Hunger Hotspots Outlook (2022-23) report by the Food and Agriculture Organization of the United Nations (FAO) and World Food Programme (WFP) forebodes escalating hunger, as over 205 million people across 45 countries will need emergency food assistance to survive.

About Global Hunger Index:

• The Global Hunger Index (GHI) is a tool for comprehensively measuring and tracking hunger at global, regional, and national levels. 
• The GHI score is calculated on a 100-point scale reflecting the severity of hunger, where zero is the best score (no hunger) and 100 is the worst.
• It is known that GHI Countries are ranked on the basis of four indicators, these are- Under nourishment – Inadequate availability of food in proportion to the population. Child Stunting- Short height for age ratio in children below 5 years of age. Child Wasting- low weight to height ratio in children below 5 years of age. Child Mortality Rate – Mortality rate of children below 5 years of age.

Gaps in schemes:

• India's National Family Health Survey (NFHS-5) from 2019-21 reported that in children below the age of five years, 35.5% were stunted, 19.3% showed wasting, and 32.1% were underweight.
• Experts have suggested several approaches to address the problem of chronic malnutrition, many of which feature in the centrally-sponsored schemes that already exist.

• The Government of India implements the Saksham Anganwadi and Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) 2.0 scheme (which now includes the Integrated Child Development Services (ICDS) scheme), which seeks to work with adolescent girls, pregnant women, nursing mothers and children below three. 
• However, the budget for this scheme for FY2022-23 was ₹20,263 crore, which is less than 1% more than the actual spend in FY 2020-21
• The other flagship scheme of the Government of India is the PM POSHAN, or Pradhan Mantri Poshan Shakti Nirman, known previously as the Mid-Day Meal scheme (National Programme of Mid-Day Meal in Schools). 
• The budget for FY2022-23 at ₹10,233.75 crore was 21% lower than the expenditure in FY2020-21 shows nowhere near the scale of the funds that are required to improve nutrition in the country.
• Not only are key nutrition schemes underfunded, but it is also the case that the funds available are not being spent effectively thus, fixing these schemes is the obvious answer to addressing India’s multi-dimensional nutrition challenge.

Option of cash transfer:

• Cash transfers seem to be a favoured solution for several social sector interventions in India today, and this includes the health and nutrition sectors via JAM trinity (Jan Dhan bank accounts, Aadhaar, Mobile). 
• Riding on the digital infrastructure available in India, it is said that targeting the right beneficiaries (i.epregnant women and families with children under the age of five) is possible. 
• Cash also has the advantage of expanding choice at the household level, as they make decisions on what to put on their plates.

Limited impact:

• Evidence from elsewhere too suggests primarily that while cash transfers improve household food security, they do not necessarily translate into improved child nutrition outcomes.
• The effect of cash transfers is also limited in a context where food prices are volatile and inflation depletes the value of cash. 
• Equally, there are social factors such as ‘son preference’, which sadly continues to be prevalent in India and can influence household-level decisions when responding to the nutrition needs of sons and daughters. 
• Further, a study of the Mamata scheme in Odisha that targeted pregnant and lactating women, showed that there were persistent socio-economic discrepancies in the receipt of cash transfers, especially in comparison to entitlements received through the Public Distribution System (PDS) shows cash may be part of the solution, but on its own, it is no panacea.

Balancing approach:

• Malnutrition has been India’s scourge for several years now and it is clear now that malnutrition persists due to depressed economic conditions in large parts of the country, the poor state of agriculture in India, persistent levels of unsafe sanitation practices, etc.
• Cash transfers have a role to play here, especially in regions experiencing acute distress, where household purchasing power is very depressed
• Cash transfers can also be used to incentivise behavioural change in terms of seeking greater institutional support. 
• But food rations through PDS and special supplements for the target group of pregnant and lactating mothers, and infants and young children, are essential.

Conclusion:

• Getting public programmes right requires greater involvement of local government and local community groups in the design and delivery of tailored nutrition interventions.