3 February, 2021
Government budgets should be based on a sound diagnosis of the problem and a clear-sighted blueprint for addressing the challenges elicited.
Last month, data from Phase I of the NFHS-5 survey across 22 states and Union Territories showed how gains achieved in nutrition received a setback, as a majority of states recorded higher levels of stunting, wasting, underweight and anaemia compared to NFHS-4. This data casts doubt upon the ambitious targets set under POSHAN Abhiyan for reducing undernutrition.
The situation then got exacerbated due to COVID-led disruptions in delivery of meal programmes and other public services relevant to nutrition. In this situation, a considered response was expected out of the Union Budget. What was delivered fell far short of the mark.
A reduced budget
Four Centrally-sponsored schemes have been merged to form the new Saksham Anganwadi or Mission POSHAN 2.0. The schemes are anganwadi services, POSHAN Abhiyan, Scheme for Adolescent Girls, and National Creche Scheme.
This ‘rationalisation’ of schemes has been on the cards for many years, coming into effect with the recommendations of the Fifteenth Finance Commission. Pradhan Mantri Matru Vandana Yojana, another important nutrition scheme, has been grouped with Beti Bachao Beti Padhao, and two other schemes for women, under the new umbrella of Samarthya.
The allocation for Mission POSHAN 2.0 in 2021-22 shows a drop of as much as 18.5 per cent compared to the combined allocation for the four merged schemes in 2020-21. This indicates that the rationalisation exercise may have paved the way for shrinking the total resource envelope for nutrition interventions delivered under these schemes.
Figure 1: Total Expenditure / Allocation for Schemes Merged under the New POSHAN 2.0 (Rs. crore)
Source: Compiled by CBGA from Union Budget documents, various years.
Coverage of anganwadi services has been low in the last few years. The total number of beneficiaries of the Supplementary Nutrition Programme (SNP) has even fallen from Rs 10.2 crore in 2016 to Rs 8.6 crore in 2020, a drop of 15%. Incremental increases in the budget for the scheme, as seen in the past six years, will not be sufficient to expand coverage.
The government must accept the suggestion of several nutrition experts to provide eggs in school meals and anganwadis. If milk, eggs and other nutritive items are to be added to the programme, unit costs of the meals will also have to be raised.
Also, the budget allocated to the Ministry of Women and Child Development (MWCD) has fallen short of its budget demands for several years. The allocation of Rs 20,532 crore for anganwadi services in 2020-21 was against a demand of Rs 24,810 crore. The total allocation for Mission Poshan 2.0 in 2021-22, which also subsumes three other schemes, is less even when compared to this reduced allocation for the previous year. It was stated that an ‘intensified strategy’ would be undertaken under Mission POSHAN 2.0 to improve nutritional outcomes across 112 aspirational districts. With NFHS-5 showing an increase in undernutrition in many states, there remains a need to focus on nutrition outcomes beyond just these districts.
The two smaller schemes which have been merged also provide important public services, to distinct age groups. Scheme for Adolescent Girls addresses undernutrition among out-of-school girls between 11-14 years, and also provides them counselling, life skills and vocational training. The National Creche Scheme provides supplementary nutrition to children under six years, along with health monitoring and pre-school education. Importantly, creches support working women, which is critical at a time when female workforce participation rate is low and women who lost jobs during the pandemic are finding it hard to return to work.
Anganwadi services, of course, is an essential intervention addressing nutrition and development needs of young children and pregnant and lactating women. Lower allocations for these schemes, along with the lack of a clear implementation plan on how the services will be consolidated, indicate a lack of priority for nutrition.
Allocation dropped for nutrition sensitive schemes
Nutrition sensitive interventions are concerned with the larger environment which affects nutrition outcomes, including access to health services, water and sanitation facilities, food security, livelihoods and education levels. These are critical in the overall policy framework for nutrition. It notes better access to improved drinking water sources, and progress in use of clean fuel (LPG). But despite improvements in these underlying determinants, it has registered worsening of nutrition parameters, which raises some pertinent questions.
Schemes providing direct nutrition interventions are crucial to eradicating malnutrition, but a holistic approach of strengthening public services across important sectors like health, education, agriculture, employment and social protection needs to be followed in order to achieve a major nutrition impact, to see the malnutrition numbers go down. Schematic interventions in agriculture can determine the affordability and accessibility of food grains, and also ensure a critical minimum level of income for the vast majority. However, no significant increases in budgetary allocation has been witnessed for these schemes over the years.
Likewise, expenditure for social protection schemes like National Social Assistance Programme and school meal programmes (midday meal) also continue to be low in Budget 2021-22.
Withdrawal of sectoral grant for nutrition
The 15th Finance Commission had proposed in its initial report for 2020-21 a grant of Rs 7,735 crore for states, to strengthen supplementary nutrition. This recommendation has not been retained in the final report; the Commission has reiterated that the government should prioritise child and maternal nutrition through anganwadi services without making an associated budgetary recommendation.
Ramp up Central funds to address gaps in infrastructure
Another gap in the anganwadi infrastructure includes poor infrastructure, which needs improvement. In 2020, 28 percent of operational anganwadis did not have drinking water facilities, while 39 per cent of them did not have toilet facilities. As anganwadis begin to reopen with the pandemic still going on, there is an urgent need to address these gaps. Unit costs of construction, upgradation, repair and provision of water and toilet facilities should be reassessed, to account for inflation and provide better quality infrastructure.
In urban areas, states struggle to get land to set up anganwadis. As a result, 66% of urban anganwadis were running out of rented buildings, compared to 19 per cent of rural anganwadis. To avoid recurring expenditure on rent, the Centre has recommended that anganwadis can be co-located in nearby primary schools. Given lower coverage in urban areas, apart from changing the location, new anganwadis are also needed. The Centre should hike support to enable states to invest in setting up a sufficient number of anganwadis.