Despite impressive economic progress, nearly 20% Indian children under five are wasted, 38% stunted and 35% underweight. In addition, nearly half of women are anaemic. We also lag behind on key nutrition-specific and sensitive interventions such as exclusive breastfeeding, complementary feeding and micronutrient supplementation. Clearly, malnutrition is the biggest development challenge.
The Integrated Child Development Services (ICDS) Scheme was launched in 1975 as the first pan-India programmatic response piloted in 33 blocks of the country, for improving nutrition and health status of children below six through supplementary feeding, nutrition and health education and convergence with health services at an Anganwadi centre (AWC), right in villages and urban slums. The programme is now expanded to almost 14 lakh AWCs and mini AWCs which will cover more than 50% children below six. The National Nutrition Policy in 1993, with Women and Child Development (WCD ) ministry as the nodal department, was designed as a multi-sectoral strategy for eradicating malnutrition and achieving appropriate nutritional status for all. Alas, targets for 2000 AD could not be achieved as there is general consensus that among nearly 40% of under-five children deaths, malnutrition is a major contributor. In between, there were attempts to address malnutrition among adolescent girls, thus recognizing inter-generational factors contributing to low birth weight along with low mean age at marriage for girls. Clearly, the ICDS programme over the last 45 years failed to tackle childhood malnutrition as somehow promised integration or convergence was lacking, leakages were rampant and community perceived as mainly oatmeal distribution (daliya banto) centres.
India has a young population and the country is poised to reap benefits of this window of opportunity. Around two-thirds of the working population in India are earning 13% less than other normal working people because of stunting in childhood— being excessively short for their age—one of the world’s highest such reductions in per capita income, as per a World Bank policy research paper.
Children with stunted growth must endure adverse outcomes later in life: They suffer from impaired brain development, which leads to lower cognitive and socio-emotional skills and lower levels of educational attainment. The National Nutrition Mission (NNM) provides an overarching policy and programme framework to address these issues. The mission clearly lays down goals for expediting rates of reduction in underweight, stunting, low birth weight and anaemia in a time-bound manner with clear targets- i.e. 2% reduction in stunting, underweight, wasting and low birth weight per annum and 3% reduction in anaemia in women/adolescent girls. Initial reports are encouraging—stunting rates have come down to 34.7% as per some media reports quoting government sources.
Global as well as domestic experiences show the effectiveness of direct cash transfers in improving healthy behaviours. Bihar demonstrated direct cash transfers resulting in improved nutritional outcomes. Unfortunately, policy commitment for the same is rather ambiguous. Similarly, the mission does not explain as how severely malnourished children are going to be managed as the numbers are huge. The present capacity for treatment through Nutritional Rehabilitation Centres in public systems is highly constrained in terms of number of beds available. There has to be programmatic focus on community-based management of severe malnutrition. It is in this context that private sector participation can be considered by using imaginative demand-side financing instruments such as vouchers.