Child nutrition: Covid-19 poses a huge public policy challenge

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By Vineeta Hariharan

The child nutrition challenge: Covid-19 brought with it the twin challenges of overburdened health systems which impaired service delivery of critical health and nutrition interventions for children, coupled with the economic impact of the pandemic which reduced the frequency and quality of meals consumed by households. All this led to increased risk of child malnutrition.

It has been predicted that child malnutrition could increase by up to 10-20% because of Covid-19, and an additional 6000 children could die every day from preventable causes because of the disruption in health services (UNICEF, 2019)
 Further, it is a well-known fact that persistent food insecurity is not only detrimental to children’s long-term health but also damages their cognitive development and learning abilities.

Financial constraints due to the pandemic has also impacted the dietary intake of poor households as they shifted towards cheaper and less nutritious food. Past research shows that in low-income countries, nutrient-rich vegetables, fruits, animal-sourced food is 10 times more expensive than calories from staple food like rice, wheat, maize, cassava.

We also faced challenges of our Public Distribution Systems (PDS) being more focused on staple crops and calorie adequacy rather than access to balanced diets and improving dietary diversity for the poor. Since only rice, wheat, sugar and kerosene were provided to consumers, access to PDS increased the availability of cereals but did not have any impact on the consumption of other micronutrient rich foods.

Migrant workers, who already faced the brunt of the lockdown, have also been unable to access ration in their current city of residence since the PDS is linked to the place of origin. We also faced challenges of significant staff vacancies at sub- centres, Community Health Centres (CHCs), Primary Health Centres (PHCs) and district hospitals, as well as gaps in basic infrastructure at these facilities (MoHFW, 2019) which indirectly also adversely impacted child nutrition.

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Intervention by Union and state governments

The Union government has taken several pro-active as well as reactive measures to redress the child nutrition challenge. A summary of its efforts reflects the seriousness with which it handles the problem.

  • In 2015, India committed to achieve the Sustainable Development Goal (SDG) of zero hunger. As a step towards meeting the targets by 2030, the Government of India launched the Prime Minister’s Overarching Scheme for Holistic Nutrition (POSHAN) Abhiyan in 2017. Targets were set to reduce stunting, under-nutrition and low birth weight by two per cent each and anaemia by three per cent by 2022.
  • The Supplementary Nutrition Programme (SNP) under Anganwadi Services (erstwhile Integrated Child Development Services – ICDS) and MDM are two large-scale programmes delivering food entitlements to children in India. 64 million children in the age group of six months to six years benefit from dry rations or hot cooked meals under SNP (MWCD, 2020). 115.9 million school-going children in classes IVIII benefit from one hot cooked meal a day under MDM (MDM Portal).
  • Union finance minister Nirmala Sitharaman announced a plan to merge the existing Supplementary Nutrition Programme (SNP) and the Poshan Abhiyan to strengthen nutritional content, delivery, outreach and outcome during her Budget 2021-22 speech February 1, 2021. The new scheme would now be called Mission Poshan 2.0.
  • The outlay on major schemes in the budget shows that the Saksham Anganwadi and Poshan 2.0 has a budgetary estimate of Rs 20,105 crore for the year 2021-22.
    These two include those formed by merging the Umbrella ICDS-Anganwadi Services, Poshan Abhiyan, Scheme for Adolescent Girls and National Creche Scheme.
  • Further, as part of Government of India’s drive during the Azadi Ka Amrit Mahotsav, celebrations to ensure speedy& intensive outreach, the entire month of September, has been declared as the POSHAN Maah and subdivided into weekly themes for focused and assimilated approach towards improving Holistic Nutrition.

The wide gamut of activities during this year broadly focuses on plantation drive for POSHAN VATIKA by all the stakeholders in the space available at Anganwadis, School Premises, Gram Panchayats and other places, Yoga and AYUSH for nutrition, distribution of Nutrition Kits comprising of regional nutritious food and identification of SAM (Severe acute malnutrition) children with Supervised Supplementary Feeding Program and sensitization/awareness drive for COVID vaccination.

A Poshan Tracker application has also been rolled out by Ministry of Women and Child Development for real time monitoring and tracking of nutrition strengthening approach at Anganwadi Centre (AWC) and service deliveries of Anganwadi Workers (AWWs) levels.

Festive outreach measures, leveraging on popular sentiment are useful IEC tools and make substantive impacts on improving the effectiveness of flagship programmes. With the closure of Anganwadis and schools following the lockdowns during the pandemic, the Government of India and several State Governments took various measures to ensure last mile outreach.

The Centre increased the cooking cost of MDM in April for the year 2020-21, from Rs. 4.48 to Rs. 4.97 for primary children, from Rs. 6.71 to Rs. 7.45 for upper primary children (MDM Portal, 2020). An ad hoc grant of Rs. 2567 crore was also released to States for this purpose. In a later order, the MHRD asked States to provide pulses, oil etc. (equivalent to cooking cost) along with food grains as Food Security Allowance (FSA) to eligible children instead of transferring the cooking cost to children/their parent’s bank accounts (MDM Portal).

The Ministry of Health and Family Welfare (MoHFW) also issued directions to all States/UTs on “Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health plus Nutrition services during and post COVID-19 pandemic.” The directions include home delivery of IFA, and other essential medicine like ORS, calcium and zinc, to target beneficiaries in containment zones.

Further in the efforts to redress the challenges of lack of access to balanced diets, the Government of India has launched the Centrally Sponsored Scheme on “Fortification of Rice and its distribution under Public Distribution System” for a period of three years beginning 2019-20 with a total budget outlay of Rs. 174.64 crore. The rice will be fortified with iron, folic acid and vitamin B-12. Nine States of Andhra Pradesh, Kerala, Karnataka, Maharashtra, Odisha, Gujarat, Uttar Pradesh, Assam & Tamil Nadu had consented and identified their respective districts for implementation of the Pilot Scheme (PIB, 2020g).

The Central Government has also been encouraging the production of millets in a mission mode under the National Food Security Mission. Also in an attempt to provide holistic basket of diet in the PDS outlets, There is now a growing trend towards the introduction of millets under the PDS since 2018. NITI Aayog is also pushing for the introduction of millets in SNP and MDM (Gupta,2020).

The ‘One Nation One Ration Card’ scheme was introduced by the Government of India to redress the challenges of lack of access of the migrant workers to rations and to ensure nation-wide portability of the ration card 24 States/UT so far have enabled (ONORC) w.e.f 1st August 2020 covering 80 per cent of the total National Food Security Act (NFSA) beneficiaries.

The narrative on the efforts of the Government in outreach during the pandemic, will not be complete without the mention of the Pradhan Mantri Garib Kalyan Yojana where more than 80 crore poor people were given 5 kg of wheat or rice and 1 kg of preferred pulses for free every month which was extended through the Covid-19 period.

State government efforts

Several State Governments have also adopted noteworthy outreach measures during the pandemic. Some of them being:

  • Highly subsidized cooked meals distributed to the urban poor through community kitchens such as the Amma Canteens in Tamil Nadu, Mukhyamantri Dal- Bhat Yojana in Jharkhand, the Annapurna 
Rasoi in Rajasthan, etc. (Parajuli, 2020) and others efforts in States of Kerala, Uttar Pradesh, Maharashtra, Odisha etc. (D’costa, 2020)
  • In Madhya Pradesh, provision of ration has been made unconditional without any requirement of eligibility slips as mandated by the National Food Security Scheme.
  • Odisha Government provided food for all sick, indigent, destitute persons and migrant workers with the State Disaster Response Fund. Free kitchens have also been set up in every Gram Panchayat to provide free cooked meals to needy people.
  • A few States have taken initiatives to expand the items provided under the PDS to ensure dietary diversification. Kerala and Tamil Nadu are providing millets, while Chhattisgarh provides iodized salt, black gram and pulses to the poorer households in addition to mandatory grains (Pingali et al, 2017). The Government of Odisha is set to introduce Ragi as part of the SNP for the first time and it will also be distributed as a part of the PDS in 14 districts (Shalya, 2020).
  • Some of laudable state specific interventions to address the challenges of malnutrition of tribal children are:
  • Gujarat government’s ‘Doodh Sanjeevani Yojana’ since 2006- 07, to improve and enrich the level of nutrition of primary school going tribal students.
  • Atal Bal Aarogya Evam Poshan Mission in Madhya Pradesh launched in 2010 to bring about a systematic reduction in child malnutrition.

Recommendations for effective implementation

  • Implementing Government programmes in a country as vast and diverse as India, is always ridden with last mile challenges. Some of the effective means of ensuring outreach of government programmes are articulated below:
  • Creation of a cadre of professionals for village and block administration and institutionalizing the same. This is essential to enable informed decisions on the needs and to formulate projects to be able to effectively utilize all the funds flowing in to these units.
  • Concepts and practices like Nutri gardens and Zero Budget Natural Farming needs to be scaled up across the country to ensure cost effective means for production of nutritious diets.

There also needs to greater efforts at effective advertisements and campaigns on child nutrition with catchy slogans to educate the masses on nutritious baskets and diets. Finally, universal coverage of all households and grama panchayats with all the government programmes catering to the deficits or needs of the households to ensure saturation of basic, social, digital and economic amenities is the key mantra for successful outreach of all programmes.

(Vineeta Hariharan is public policy leader based in New Delhi. She is Chief, Externaly Aided Missions, Ministry of Micro Small and Medium Enterprises.)