In four of the five years of the NDA government’s first term, India has slipped in malnutrition parameters for young children and women, reversing some gains made under previous regimes. According to the latest government data, more of our children under five years of age have become stunted or wasted; more women and children have begun suffering from anaemia too in 2019-20 than in the previous survey.
By all indications, the government's much-touted ‘POSHAN Abhiyaan’, an acronym for Prime Minister’s Overarching Scheme for Holistic Nutrition, does not seem to have achieved much.
The National Family Health Survey-5 report shows that in the 22 states and UTs covered under phase I, a majority reported an increase in malnutrition parameters such as stunting and wasting of children, anaemia in children and in women between 15-49 years of age. Stunting refers to lower-than-expected height for age, wasting shows lower-than-expected weight for height and anaemia is a deficiency of haemoglobin in blood. The worsening parameters on malnutrition between 2015-20 could point to a far greater problem in the current year, when a global pandemic and consequent losses to the economy would have exacerbated hunger.
In Assam, nearly every fifth child under five years was wasted in 2019-20 against nearly every sixth in the previous survey. In women aged 15-49 years, anaemia had increased manifold, from not even one in two such women anaemic in 2015-16 in Assam, to nearly two in three four years later. Anaemia in children under five years of age has nearly doubled in the state.
Bihar now has at least every fifth under-5 child showing signs of wasting and another nearly 9% who are severely wasted. Goa has seen the number of stunted, under-5 kids jump from 20% to nearly 26% and the same age profile of kids with anaemia now well over the half-way mark at 53.2% versus 48.3% four years back. In Tripura, every third child is stunted, every sixth wasted and two in three now suffer from anaemia. Other states, too, have reported worsening parameters in stunting, wasting and anaemia.
A more comprehensive set of data points on malnutrition will emerge later, when a more detailed NFHS report is released next year. But suffice it to say from available numbers that gains seen in the last decade at least have already been reversed. In NFHS-3 or in 2005-06, nearly every second child under five was stunted but this had improved to almost one in three by 2015-16. A marked improvement had also been seen in the proportion of children who are underweight too during the 2005-2015 decade.
Launched in 2017, the POSHAN scheme's objectives included convergence with various ongoing programmes; incentivizing States/ UTs for achieving goals; IT enabled Real Time Monitoring and community mobilization. The total budget allocated at the start was Rs 9,046.17 crore, with the Centre’s share at Rs 2,849.54 crore.
Stiff targets had been fixed too: reduction in stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and low birth weight by 2%, 2%, 3% and 2% per annum respectively. Stunting was to be brought down from 38.4% as per NFHS-4 to 25% by 2022.
Nearly three years down the line, these lofty targets are likely to be missed. First, almost two-thirds of the budget allocated to Poshan Abhiyaan was lying unutilised till January this year.
The Parliamentary Standing Committee examining the Ministry of Women and Child Development’s demand for grants for 2020-21 has said in its report earlier this year that West Bengal had not joined the POSHAN Abhiyaan and Odisha started activities under this scheme only from October, 2019. Targets under some of the components could not be achieved due to slow roll out of activities by the States/UTs in some components.
The panel said that in 2017-18, budgetary allocation for the scheme was reduced to Rs 950 crore from Rs 1,500.00 crore in Budget Estimates; in 2018-19 it was raised marginally to Rs 3,061 crore from Rs 3,000 crore but only 84% of the allocation was used. In 2019-20, however, only about 33% of the allocation of Rs 3,400 crore was used up to 31st January, 2020.
Second, procurement of smart phones, deployment of data analysts etc under the scheme – essential for effective, on-the-ground monitoring - has been much slower than envisaged earlier.
And a Niti Ayog report card on the progress of the POSHAN Abhiyaan has said that while this scheme continues to play an important role in against malnutrition, “we need to now accelerate actions on multiple fronts….we need to quickly graduate to a POSHAN-plus strategy which, apart from continued strengthening the four pillars of the Abhiyaan, also requires renewed focus on other social determinants in addition to addressing the governance challenges of NHM/ ICDS delivery mechanisms”.
An expert who declined to be identified said that the increase in malnutrition parameters should not only be blamed on the middling success of the POSHAN Abhiyaan. “It is the first ever programme based on outcomes from nutritional status with specific commitments and annual targets for reduction in child stunting, wasting and anaemia. POSHAN is meant to forge convergence of all schemes for ending malnutrition. It provides a holistic, sectoral approach towards nutrition. Nobody was earlier talking of nutrition and anaemia as indicators.”
Along with increased nutritional interventions, more investment in social determinants, especially related to the status of girls and women (education during childhood, reducing early marriage and early pregnancy, improving care during and after pregnancy), poverty and food security, were important for reducing child stunting.
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