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Approaches to malnutrition and the writ of a compartmented government

By Rahul Goswami

The absence of inter-sectoral programmes covering the entire lifecycle of women and children in particular and requiring coordination between different ministries such as women and child development, health and family welfare, agriculture, food processing and human resource development, is the reason why, at the start of the Twelfth Five-Year Plan period (2012-17), the fundamental causes of malnutrition in India remain as they were during the First Five-Year Plan

For at least the last two Five-Year Plan periods (the Tenth and Eleventh, 2002-07 and 2007-12), nutritionists and food welfare practitioners in India have been advocating multi-sectoral approaches for first reducing, then extinguishing, malnutrition. As a community, their shared view has been that no single intervention can eradicate malnutrition -- whether in the health or education sectors, whether by bolstering farm and rural livelihoods with employment guarantee programmes, or through supporting self-help groups and expanding rural credit.

Towards this primary recommendation, although the advice has been to develop, in step, a package of interventions that are widely inter-sectoral so as to address at least a majority of the causes, the Government of India at the central level has been disinterested. An inter-sectoral approach that is designed to work together from the start (rather than to find linkages halfway through a plan period, as has happened with the Eleventh Plan) has been argued for by administrators and academics, NGOs and programme evaluators. Far too many programmes -- conceived of as ‘interventions’ by various line departments of the concerned ministries -- have aimed at improving a single index, such as enrolment percentages of children within a school-going age-group, or meeting a goal in covering households in a region for sanitation. Apart from being a sink for public monies in the long-term -- for, once the unitary objective is met the programme is wound up, the utilisation certificates are duly filed --- they are a dreadfully inefficient way of using money in the best way possible.

That is why the direction taken by thinking on rural development over the last decade is that efforts in major sectors must be simultaneous so that the benefit of one intervention does not quickly diminish because another has been left incomplete, or has not been addressed at all. It is, in fact, to allow the combined benefits of spending on development to work that planning at the local level (the block or zilla if not the gram panchayat) with devolvement of powers to panchayats was encouraged by legislation and by financial support. That devolvement where labour and therefore income is concerned has been advanced, even if piecemeal and in a limited manner, by panchayats setting their work agendas for MGNREGA activity.

The large number of evaluations of ICDS and the midday meal programme, and the lessons learnt from them have, for the last two plan periods, pointed to the need for such programmes to cover the entire lifecycle of women and children. Only such an approach will create an immediate impact within one generation on the nutritional status of the three critical links of malnutrition: children, adolescent girls, and women. When this is the platform from which different ministries and their partners work, that is when the benefits will be sustainable enough to break the inter-generational cycle, and when these development gaps will not be transferred to the following generation.

This absence of coherence between the ministries involved -- women and child development, health and family welfare, agriculture, food processing industries, food and consumer affairs, human resource development -- is the reason why, at the start of the Twelfth Five-Year Plan period (2012-17), the fundamental causes of malnutrition in India remain as they were during the First Five-Year Plan. The inter-generational cycle is as prevalent now as it was then: low birth weight babies, underweight children, malnourished and anaemic adolescent girls and pregnant women.

The new Food Security Act has become a first step -- although incomplete and with its scope diluted -- to legalising what must be a universal entitlement to food and thereby helping break the inter-generational cycle which is marked most visibly by malnutrition. Yet the present provisions for basic entitlements fall short: the 35 kg of rice or wheat for a family in a month will cost that family Rs 3 per kg and is to sustain the family’s (typical) five members. At about 235 grams a day of cereal, a family member will be provided about 650 kcal, whereas the recommended dietary allowance ought to be no lower than 2,400 kcal. Will the balance come from cereals purchased outside the PDS and outside the food-based remedial programmes? At what cost? And what other much-needed expenses will they displace?

The understanding of household expenditure on food staples and on cost of living has progressed steadily since the beginning of ‘liberalisation’ of the Indian economy, over 20 years ago. However, this understanding has not informed central planning approaches nor the designs of our major ministries concerned with food, health, social sector programmes and the wellbeing of our population. In its present forms, the Government of India’s articulation of anti-poverty measures is at best a clumsy response to the prevention of starvation -- it is by no means a considered long-term response to the dispelling of chronic poverty, to the abatement of deprivation and to guaranteeing food and nutritional security for our citizens.

(Rahul Goswami researches rural economies with a focus on agro-ecology. He is a consultant with the National Agricultural Innovation Project, Ministry of Agriculture, and is an examiner for UNESCO’s Culture Sector, on intangible cultural heritage. He writes on issues concerning food and energy)

Infochange News & Features, July 2012