11 August 2020
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Introduction
Despite considerable progress made over the decade, India still carries the burden of undernutrition with 38.4, 21, and 35.8 per cent of children under five facing stunting, wasting, and underweight respectively, more than 50 per cent of children and women being anaemic, and 31.5 per cent of women having less than normal body mass index (BMI).[i]
Interventions by the government to combat undernutrition are covered under Integrated Child Development Services (ICDS), National Health Mission (NHM), and National Nutrition Mission (NNM) directly and PDS indirectly. Budget 2021 saw a mention of nutrition after more than half a decade with a provision of Rs. 35,600 crore for “nutrition-related programmes”. While it is not specified, which schemes will be covered under this allocation, five nutrition-specific schemes- Anganwadi Services (core ICDS), NNM, Rajiv Gandhi National Creche Scheme, Pradhan Mantri Matru Vandana Yojana (PMMVY) and Scheme for Adolescent Girls also saw an increase in allocation by 15 per cent from the previous year revised budget (RE), along with 9 per cent increase in allocation of POSHAN Abhiyaan. However, the allocation for food subsidy reflecting the amount paid by the government to Food Corporation of India (FCI) for procurement of food grains to be provided under PDS saw a cut of Rs. 68,650 crore from the previous year budget estimates (BE).
As such, in a nation like India, where the prevalence of undernutrition is high and efforts are inconsistent, nutrition takes greater importance than ever. Not only adequate diet and nutrition is important for strengthening the immune system as emphasised by the WHO but also because the unexpected pandemic will cause irrevocable damage to the nutrition related progress made by the country by escalating both the immediate and underlying causes of nutrition. Achieving national and global nutrition target 2030 will become much more difficult, as loss of livelihood, disrupted informal sector, and the resulting growth in poverty in the event of economic shutdown is bound to push back nutrition related progress both directly and indirectly.
COVID-19 escalates both direct and indirect causes of undernutrition
The lockdown has disrupted the nutrition specific interventions such as food provision to children and women under Supplementary Nutrition Programme and Mid-day Meal. As anganwadi centres are directed to restrict their functioning to only provide take home ration, and schools are shut, beneficiaries are missing out on both hot cooked meal provided at the anganwadi centres and mid-day meals provided at schools. All this affecting the diet received by many at the cusp of undernutrition will worsen the situation. Further, with the public healthcare system overburdened with the COVID-19, and ASHA and anganwadi workers redirected towards spreading information and tracking COVID-19, other health concern takes a backseat. Tracking and treatment of Severe Acute Malnutrition (SAM) children also becomes difficult with the anganwadi centers shut, and many malnourished children will fall under SAM. Unable to bear the dual burden of regular health work and additional COVID-19 responsibilities, without adequate government assistance like safety measures, risk allowance, 600,000 ASHA workers have gone on a nation-wide strike, adding another blow to the already weak system.
On the other hand, the disrupted economy that pushes many into absolute poverty and hunger by adversely affecting agriculture, food security, employment and livelihood will worsen the underlying factors behind undernutrition that will take a long time and a large budget to overcome. India has about 90 per cent of working population in the informal sector. As per International Labour Organisation’s estimates, about 400 million workers in the informal sector in India might fall deeper into poverty due to the lockdown measures in the face of COVID-19 pandemic. United Nations University reports that 104 million people in India will fall below the World Bank-determined poverty line of $3.2 (Rs. 240) a day, increasing the percent of people below the poverty line in the country form 60 per cent to 68 per cent. This growing poverty weakening the household food security will spur undernutrition in the country.
UN's World Food Programme has stated the number of people facing acute hunger could double from 135 million in 2019 to 265 million in 2020 worldwide due to the COVID-19 pandemic. A study covering 5000 households in 12 states conducted by Transforming Rural India Foundation (TRIF) states 50 percent of the surveyed households have already reduced number of meals in the face of food insecurity. While national food security is strong and there is no worry about running out of food as of now, with Food Corporation of India having a food inventory of 77 million tons in March 2020, household and community level food security might not hold if the national food inventory is not used in this time of emergency to cater to the poor. The government has indeed undertaken measures.
Support provided by government relief package of Rs. 1.70 lakh crore announced in March to support vulnerable people under Pradhan Mantri Garib Kalyan Yojana (PMGKY) through cash schemes like Jan Dhan Yojana, PM Kisan Yojana, and other social welfare schemes for the old, widowed and disabled, as well as PMGKAY for free food grains through PDS for three months was less than adequate to maintain the household level food security. The new economic package of about 20 lakh crore announced on May 12th might help in the future indirectly through livelihood generation to those at the bottom by pumping money into the market but added nothing to the existing PMGKY either in terms of funds or in terms of extending the duration of the support. However, PMGKAY has been extended to provide free ration of 5 kgs of grains and 1 kg of channa, till the end of November by incurring an extra fund of Rs. 90,000 crore. Some states have also undertaken additional measures to overcome this, for example, the Jharkhand government announced to provide 10 kg of rice to 8 lakh people in state whose ration applications are pending, although only 35 percent of those received the ration. Further, this supplementary support might not be enough, both in terms of dietary diversity required to maintain nutrition and in terms of time period as it might be long before the economy recovers completely and these household starts earning.
What more can be done?
The above mentioned measures, implemented with a degree of arbitrariness between the centre and state governments, as well as local level of governance, might not be effective enough. In such a scenario, India will lose sight and momentum of its nutrition goals, if concentrated efforts are not taken to make up for the loss and check the growth of undernutrition resulting from this global pandemic. Therefore, a sustained effort is required, focussed on renewing and upholding livelihood opportunities and household food security by retaining the approved nutrition related annual budget and extra fund under PMGKY. Following interventions need to be taken, sustained and enhanced:
-Enhancing Mid-Day Meal, HCM and THR: New ways have to be devised to deliver the meals provided at the school and anganwadi centers till they are closed and these along with THR can be fortified with eggs, milk, nutrient-rich vegetables, fruits, etc. to enhance diet quality.
-Enhancing maternal and child nutrition interventions: Maternal and child nutrition related interventions such as PMMVY and management of SAM has to be reinforced by strengthening frontline workers and equipping them with protection gears and training.
-Fortifying the cadre of ASHA and anganwadi workers: The cadre of frontline health workers like ASHA and anganwadi workers should be fortified with timely payments, PPE kits, insurance for deaths on duty, risk allowance, etc.
-Ensuring household food security through PDS and community kitchens: To ensure access to food among the vulnerable population, emergency measures such as direct cash transfer, ration through PDS, community kitchens like that in Kerala and Jharkhand, direct deliveries of food have to be fortified and the conditions for accessing has to suspended temporarily to ensure hundred percent inclusiveness. In addition, to enhance diet quality, PDS can be extended to cover additional items such as pulses, sugar, cooking oil, etc.
-Maintaining national availability and supply chain of food: To ensure ongoing availability of food, food markets must be kept functioning and to that end, farmers, fishermen, small scale food producers and sellers etc. should be aided by the government through direct cash transfer programs, immediate access to credit, and directly purchasing of products.
Interrupted ICDS, NHM, and NNM interventions targeted at addressing undernutrition in the country, and deepening poverty and food insecurity in the face of COIVD-19 pandemic, spell out dire consequences for nutrition. To ensure that already heavy burden of undernutrition doesn’t become heavier, the approved budget for nutrition has to be sustained and gaps worsened by the pandemic needs to be checked.
[i] International Institute for Population Sciences (IIPS) and ICF. (2017). National Family Health Survey (NFHS-4), 2015-16: India. Mumbai, India: IIPS
The views expressed in this piece are those of the author, and don’t necessarily reflect the position of CBGA. You can reach Rahat Tasneem at rahat@cbgaindia.org.