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(GIST OF YOJANA) Decentralished Approach to Tackling Nutrition [MAY-2018]

(GIST OF YOJANA) Decentralished Approach to Tackling Nutrition

[MAY-2018]

Decentralished Approach to Tackling Nutrition

Where should the government invest if it wants to maximise India’s long-run economic growth, given fiscal and capacity constraints? This was the question posed in the 2015-16 Economic Survey. The short answer “the highest economic returns to public investment in human capital in India lie in maternal and early-life health and nutrition interventions” (Ministry of Finance, 2016). It is a well-recognised fact that globally, nutrition-related factors contribute to about 45 percent of child deaths under age 5. India is no exception 33 per cent of the total disease burden was caused by maternal, neonatal and nutritional diseases. (Institute for Health Metrics and Evaluation, Public Health Foundation of India, and Indian Council for Medical Research, 2017). Tackling malnutrition, however, is no easy task. Nutritional interventions for children in isolation can have only a modest impact. Instead, what is required is a holistic and comprehensive plan -with multiple interventions ranging from increased access to health services right from adolescent stages, improved diet and supplements such as fortification, counselling and improved sanitation. Moreover, given the different forms of malnutrition, the timing and type of nutritional interventions can also make a significant difference. While wasting or low weight for height is usually the symptom of acute under nutrition due to insufficient food intake or diseases such as diarrhoea; Stunting or low height for age refers to chronic malnutrition which occurs over time (generally occur before age two) and its effects are largely irreversible.
While these numbers are worrying, Over the last year, momentum around nutrition has been steadily building. Union and State governments along with other stakeholders have acknowledged nutrition as a key component of development. On September 20, 2017, the Government of India committed to investing Rs. 12,000 crores over the next 3 years for improving maternal and child health and increasing the cost norms of the Supplementary Nutrition Programme (Press Information Bureau, 2017). This was accompanied by the launch last month of National Nutrition Mission (NNM) with a three-year ' budget of Rs. 9046.17 crore commencing from 2017-18 with a vow to make India free from malnutrition by making POSHAN Abhiyan the next “Jan Andolan”. (press Information Bureau, 2018).

Flexible Financing

The first step in ensuring the success of the programme is to get the financing right. Not only are costs of delivering nutrition interventions different across states and districts, but analysis undertaken of the NFHS at both the state and district level, as well as the previous Rapid Survey of Children (RSOC), have highlighted significant inter-state and intra-state variation on achievement in nutritional outcomes. (Chakrabarti, Kapur, Vaid, and Menon, 2017; NITI Aayog, n.d.). For instance, while less than 17 per cent of children under 5 are stunted in Kerala, the proportion is over 40 per cent in Uttar Pradesh and Madhya Pradesh. Similarly, while districts in Bihar and Jharkhand have the highest prevalence of wasting; districts in Uttar Pradesh and Madhya Pradesh topped the list in terms of high levels of stunning. (NITI Aayog, n.d.).

The government has already announced incentivising states through finances by providing performance incentives. Additionally, however, it will be essential to also provide enhanced flexibility such that states or even districts can choose from a basket of interventions based on their current level of nutritional development. This, in turn, may even require pooling resources across ministries or departments. Given the multidimensionality of nutrition, it would probably do more good if relevant ministries/departments could set aside a proportion of their budgets to tackle nutrition. As previously mentioned, there is no real point in spending resources on skill development if our children do not have the cognitive ability or productivity developed in the early years. Moreover, through the implementation of a common platform for real-time monitoring at the last mile will further enable the ability to use the data to make local decisions. Thus, if for instance a state or a district or even a panchayat wants to tackle nutrition by focusing on ending open defecation, it should have the flexibility to determine its own roadmap.

Clearly Defined Functions

With funds in place, functions should follow. Despite attempts at convergence in the past, evidence from the field suggests that the integrated approach to nutrition services have not been able to achieve desired results. Each department usually implements programmes through a unique planning, budgeting and management system that holds officers accountable upward to the individual department. The multi-dimensional nature of nutrition, however, requires not just coordination amongst a host of ministries -water, sanitation, health, education, but most critically the ability to create a holistic plan focussed right from adolescent care to maternal and child health care. In order to strengthen coordination across Ministries and have clear lines of accountability, roles and responsibilities and accountabilities of each member within the bureaucracy will need to be clearly defined and articulated. Essential thus to the success of India’s nutrition strategy will be clearly defined institutional arrangements not just at the National level and state level (as already envisaged in the nutrition missions) but also in the districts that allow multiple levels of jurisdiction to work together. This further needs a clear and detailed articulation of roles and responsibilities across different layers of government and efforts to enhance capacity.

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Shaping Food Consumption

The National Food Security Act primarily focuses on providing food security via expansion of the PDS. However, the extent to which this would lead to nutritional security depends on how households respond to the availability of cheap cereals. There are two potential effects that PDS subsidies may have on household consumption decisions. Households continually try to balance their various needs including ensuring adequate caloric consumption, enhancing the quality of their diets, improving living conditions and investing in the health and education of household members. For households that value dietary diversity, being able to buy cheap cereals will free up money to purchase other foods such as milk, fruits, nuts, and perhaps eggs and meat (income effect). For households that have other dominating consumption needs, money saved by purchasing\subsidized cereals may be devoted to those needs and diverted from food expenditure (substitution effect). Which effect dominate remains an empirical question.

Public Distribution System

The Public Distribution System (PBS) in the country facilitates the supply of food grains and distribution of essential commodities to a large number of poor people through a network of Fair Price Shops (FPSs) at a subsidized price on a recurring basis. With a network of more than 4.9 lakh fair price shops claiming to distribute annually commodities worth more than Rs. 40,000 crore to about 190 million families, the PBS in India is perhaps the largest distribution network of its type in the world. The Public distribution system (PDS) is an Indian food Security System for the poor people established by the Government of India under the Ministry of Consumer Affairs, Food, and Public Distribution. White the Central government is responsible for procurement, storage, transportation, and bulk allocation of food grains, the State governments hold the responsibility for distributing the same to the consumers through the established network of approximately 5 lakh Fair Price Shops. Major commodities distributed include wheat, rice, sugar, and kerosene. The role of PDS in Shaping the Household and Nutritional Security was carried out by the erstwhile Independent Evaluation Office, now the Development Monitoring and Evaluation Office, on a request received from the Ministry of Agriculture, Government of India. The study was designed with an objective to explore the effectiveness of PDS in ensuring food and nutritional security to the beneficiaries. The other aspects explored were efficiency in PDS, the importance of food grains provided to the beneficiaries, balancing between cereal and non-cereal and food and non-food expenditures, effects of change in income on food expenditure/consumption pattern, etc.

Motivation

It has been observed that even though the Indian economy has achieved remarkable economic growth along with a decline in poverty over the last two decades, improvements in nutritional status have not kept pace with this economic growth. The National Sample Survey (NSS) data also documents that the per capita cereal consumption steadily declined for both the rural and urban population between 1993-94 and 2011-12.The reasons for the disjunction between economic advancement and nutritional improvement in India by analysing the role and performance of the Public Distribution System (PDS) in determining food consumption patterns and nutritional outcomes over a period of time. The PDS, conceptualized as one of the largest safety net programmes in the country, was envisaged as a means of dealing with nutritional deficiency by supplying rice, wheat, sugar and kerosene at highly subsidized price to the poor.

Income, Food and Nutrition Puzzles

Although we must rely on the National Family Health Survey of 2005-06 (International Institute for Population Sciences and Macro International, 2007) for national data on nutrition, the results from a variety of other surveys suggest only a modest improvement in the proportion of underweight children the poverty decline against trends in underweight children from the National Family Health Surveys 1, 2 and 3 surveys from the National Institute of Nutrition (National Nutrition Monitoring Bureau, 2012) and those from the National Council of Applied Economic Research and University of Maryland (Thorat and Desai, 2016).

Coverage of TPDS

PDS cards are ubiquitous with households that do not own any card declining from 19 per cent to 14 per cent of the total households between2004-05 and 2011-12. Bureaucratic difficulties are seen as being the single most important reason for households not having a card. The proportion of households holding Below Poverty Line (BPL) or Antyodaya Anna Yojana (AAY) cards increased from 36 per cent of all households to 42 per cent between 2004-05 and 2011-12. Much of this increase comes from the expansion of the AAY programme. Although BPL and AAY card holders come from the poorer sections of the society, this concordance is not perfect. The use of the consumption-based poverty line cut-off suggested by the Tendulkar Committee indicates that only 29 per cent of the BPL cardholders are poor while 71 per cent are not poor. In contrast, about 13 per cent of the APL cardholders are poor while 87 per cent are not poor. Thus, many non-poor have BPL cards while ome of the poor are excluded from the ownership of BPL cards.

Access and Use of the TPDS

There was a striking rise in PDS use between 2004-05 and 2011-12. In 2011-12, about 27 per cent of all households purchased cereals from the PDS whereas, by 2011-12, this proportion had risen to 52.3 per cent. . Every category of cardholders has” recorded a growth in PDS use during the period under study. While almost all the BPL and AAY cardholders are seen to purchase PDS grains, as many as 32 per cent of the Above Poverty Line (APL) cardholders also use the PDS. Despite the increase in the use of PDS by the purchasing households, the amount of purchase or the share of PDS grain to the total grain consumed has remained more or less stable.

Targeting Efficiency

Exclusion errors in PDS targeting have declined between 2004-05 and 2011-12 while inclusion errors have increased. However, both types of errors remain high. This change can be attributed both to a decrease in the poverty levels as well as a slight increase in the number of cards being distributed to the whole population. Inclusion errors increased across all regions between 2004-05 and 201112 and were particularly high for the Southern states. While exclusion error are decreasing, they remain highest for the marginalized groups.

Role of BPL/AAY Subsidies in Shaping Food Expenditure

Application of the Propensity Score Matching (PSM) techniques highlights notable distinctions between consumption patterns of households with BPL/AAY cards and those not having access to these cards. The results show that at any given income level, households with BPL/AAY cards are more likely to buy cereals from PDS shops than those with APL cards. Since only BPL cardholders are eligible for subsidized cereals, this is not surprising. The expenditure incurred on food by households with BPL/AAY cards is less than the corresponding expenditure incurred by their counterparts who do not have these cards. Once implicit subsidies via PDS transfers are factored in, this difference is smaller but remains statistically significant. Households with BPL/AAY cards are ostensibly trying to obtain their caloric needs from cheaper cereals rather than from more expensive items like dairy, fruits, nuts and meats. Rising incomes lead to greater dietary diversification for households without BPL cards than the matched households with BPL cards.

National Food Security Act, 2013

The National Food Security Act, 2013 (NFSA) was enacted by the Government in the year 2013 to provide for food and nutritional security in human life cycle approach, by ensuring access to adequate quantity of quality food at affordable prices to people to live a life with dignity. The Act inter alia entitles up to 75 per cent of the rural population and up to 50 per cent of the urban population for receiving subsidized food grains under TPDS, thus covering about two-thirds of the population. Eligible households comprise of priority households and Antyodaya Anna Yojana (AAY) households. Persons belonging to priority households are entitled to receive 5 kg of foodgrains per person per month at subsidized prices of ` 3/2/1 per kg for rice/wheat/ coarse grains. AAY households, which constitute the poorest of the poor, will continue to receive 35 kg. of food grains per household per month @ `3/2/1 per kg for rice/wheat/coarse grains.

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