Commitment To Action: Ensuring Nutrition Financing In India
Village women listening to health workers
As the Union government gears up to present its budget for the financial year (FY) 2021-22 on February 1, one hopes that programmes to reduce malnutrition are prioritised. The onset of the pandemic, subsequent lockdown, and slowdown of service delivery have exacerbated the vulnerability of those malnourished – in particular, pregnant women, young mothers, and children. Loss of livelihood and consequent decline in real incomes during the pandemic is estimated to result in a significant increase in malnutrition. As per one estimate, even a 9.5 per cent decline in the Gross Domestic Product (GDP) in India could result in an additional 3.946 million children wasted . To put this into perspective: India’s first quarter GDP estimates suggested a contraction by 22.8 per cent . With the second quarter also in the negative , the situation looks grim. Government’s own administrative data suggest a slowdown in service provision particularly for immunisation, counselling, check-ups, and micronutrient provision.
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While low revenues may mean that substantial increases in money for nutrition may not be possible, we believe that there are still ways to ensure more nutrition for the money. Here’s how:-
First, at the very least, budgets for all nutrition interventions shouldn’t be decreased. Even prior to the pandemic, estimations on budgets required to provide essential nutrition services at scale remained lower than funds allocated. For example, for the Supplementary Nutrition Programme (SNP), allocations in FY 2019-20 were only 44 per cent of required costs . This gap between requirements and allocations exist even in the Ministry’s own estimations. In FY 2019-20, the budget for the Integrated Child Development Services (ICDS) was only 73 per cent of funds requested by the Ministry . Similarly, for National Health Mission (NHM), under which several nutrition interventions run, only 78 per cent of projected budgets were allocated . Further decreasing allocations would have dire consequences on the ability to deliver services and reach the last mile.
Second, is ensuring that the distribution of finances is equitable – both across States and across districts and blocks within a state. States have differing capacities to respond to the financial challenges posed by the pandemic. Some such as Assam, Bihar, and Chhattisgarh depend more on fund transfers from the Union government , and require extra support. Typically fund releases are dependent on meeting certain conditionalities including fund utilisation, addition of state share, and submission of reports. Under the NHM since 2017, 20 per cent of the funds have also been linked to meeting performance benchmarks . For this year specifically, the distribution of finances across States and districts must focus more on need than these conditionalities.
Third, it is important to remember that higher budgets are necessary but not sufficient. While we need more money for nutrition, we should also be able to use the available funds efficiently. This entails prioritising interventions that are cost effective, and improving both fund flows and utilisation. Some examples of cost effective interventions include the provision of micronutrients like Iron and Folic Acid, and counselling to improve health seeking behaviour. These can be implemented with ease, especially when combined with the current efforts of door-to-door service provision such as the delivery of rations. Simultaneously, there are examples within States of stronger fund flow systems. Madhya Pradesh, has taken a leap forward in improving fund flows to the lowest levels with its ‘e-Vitta Pravah’ system, which has the potential to improve utilisation as well.
The fact that, in India, 1,935 children die of malnutrition related causes every day has been amply recognised. The government has committed to reducing malnutrition with, for instance, the launch of the POSHAN Abhiyaan which has completed 1,000 days of functioning. One hopes that this momentum can be maintained. With the ongoing pandemic and its disruptive effects, both Union and State governments have to be creative to ensure adequate financing for nutrition.
(AvaniKapur is a Fellow at the Centre for Policy Research (CPR) and Director of the Accountability Initiative. While Ritwik Shukla works as a Research Associate at the Accountability Initiative, Centre for Policy Research)