In March 2021, months before the Global Hunger Index ranked India at 101 out of 116 countries, the Centre restructured key schemes that address the nutrition of children, pregnant and lactating women.
But despite a large-scale restructuring, the Centre has done little to address deficiencies and gaps in India’s food and healthcare distribution system.
An analysis of budgetary allocations and funds utilised indicate that actual government expenditure on nutritional health had increased by a negligible 1% while the number of beneficiaries of the crucial Integrated Child Development Services have reduced despite the pandemic distress.
Fiscal allocation
The chart shows the collective budget allocation for the government’s nutrition schemes from 2017-’18 to 2023-’24. The 2023 budgetary allocation increased by just 1% from 2022 – from Rs 20,263 crore to Rs 20,554 crore.
Since the financial year 2021-’22, only 94% of the outlined budget was disbursed by Centre making it difficult for the government to assign additional funds to address under-nourishment or food security challenges after the pandemic.
In March 2021, the government merged the Integrated Child Development Services scheme, Scheme for Adolescent Girls and POSHAN Abhiyan into Saksham Anganwadi. The Scheme for Adolescent Girls relates to the nutritional and non-nutritional requirements of adolescent girls between the age of 11-14.
But it is the Integrated Child Development Services scheme that is key as it provides basic nutrition for children, ensuring lower maternal and child mortality.
As of June 30 last year, the Integrated Child Development Services scheme was providing supplementary nutrition, immunisation and pre-school education to 3.03 crore children between the age of three to six years, according to the Ministry of Women and Child Development Annual Report 2022-’23.
The supplementary nutrition programme, which accounts for the largest share of the Integrated Child Development Services scheme’s budget, provides hot, cooked meals and take-home ration for children and pregnant and lactating mothers. Hot, cooked meals are distributed through anganwadis, which provide nutrition and healthcare support for children and pregnant and lactating mothers.
Poshan Abhiyan, launched in March 2018 for “high-impact” interventions during the first 1,000 days of a baby’s life, was also merged with the supplementary nutrition programme into Mission Poshan 2.0.
From the financial year 2016-’17 to 2021-’22, there was a steady decline in the number of beneficiaries of the Integrated Child Development Services scheme – from 10.23 crore to 8.95 crore.
It is difficult to understand why such a vital scheme saw a general decline in its beneficiaries. More grassroots research that takes into consideration the pandemic that had led to widespread financial and food distress might be able to shed light on how the marginalised were affected and what role state-sponsored nutrition schemes played in supporting them.
A study conducted in poor urban settlements of Delhi from January to May 2022 found that the Integrated Child Development Services scheme was not being used to its full potential because of ineffective distribution across the health system and with beneficiaries doubting its utility. The study said that only 57.8% of women surveyed availed of supplementary nutrition services.
Beneficiaries can find it challenging to reach anganwadi centres, making it inconvenient to visit them regularly. Periodic protests by anganwadi workers seeking salary increases lead to temporary disruptions. There are also instances of women saying that the take-home rations are of poor quality and taste bad.
The chart above shows the amount of funds approved and released at the beginning of the financial year and how much was eventually used.
From 2017-’18 to 2021-’22, the budget approved for the supplementary nutrition programme rose from Rs 7,585 crore to Rs 9,163 crore, an almost 21% increase. But in the financial year 2021-’22, during the Covid-19 pandemic, the budget approved reduced from Rs 10,106 crore to Rs 8,963 crore. The budget amount released has also improved over the years from Rs 7,906 to Rs 9,295 crore. Data on the funds utilised in 2021-’22 was not available.
In 2019, though, funds used exceeded the amount released and approved, which may be due to the availability of the unspent balance of the previous financial year. This suggests that there may have been underutilisation of the budget in the previous year.
But on the whole, the supplementary nutrition programme remains underfunded, according to a report by the Centre for Policy Research think tank. The report, Mission Saksham Anganwadi and Poshan 2.0, says that in the financial year 2022-’23, the supplementary nutrition programme needed funds to the tune of Rs 45,198 crore. These estimates were calculated based on the current needs of beneficiaries.
Inadequate funding, thus, may result in the programme’s inability to reach and cover all intended or eligible beneficiaries. It also means that the budget for the crucial nutrition programme may already be struggling with rising food inflation.
A report by the Centre for Policy Research points out that in 2017, food prices for the supplementary nutrition programme were cost adjusted by the Cabinet Committee on Economic Affairs. “These prices should have risen by 28% as per CPI [Consumer Price Index] numbers, but no revision of prices has been conducted so far,” says the report.
Over time, the inflation-adjusted purchasing power of the allocated budget will diminish due to rising food inflation. If budget allocations fail to account for inflation, they may fall short of meeting the cost to implement existing and new government schemes. In case of nutrition schemes, this can result in a reduction of the quantity and quality of support.
In 2021, the supplementary nutrition programme was integrated with the 2018 Poshan Abhiyaan scheme to form Poshan 2.0. But Poshan 2.0 has also grappled with funding release and low fiscal expenditure, according to studies by the Centre for Policy Research.
The think tank report points out that the scheme was allocated Rs 10,111 crore till the financial year 2020-’21 and no new allocations were made in 2021-’22 with unspent funds left to be utilised. “Only 52% of allocated funds were released and just 66% were used by March 2022, raising concerns about program effectiveness,” says the report.
Anganwadis in poor shape
As important as the Integrated Child Development Services scheme and Poshan 2.0 have been to providing basic nutrition and healthcare support, it is the vast network of Anganwadis and the Accredited Social Health Activists, or ASHA, across the country that ensure these schemes reach beneficiaries. Yet, these basic community-based networks suffer infrastructural and funding neglect from the central as well many state-governments.
An analysis by the non-profit PRS of the Women and Child Development ministry’s budget grants, found that as of 2021-’22, at least 21% of the anganwadis lacked basic toilet facilities while 12% did not have access to drinking water facilities. The 2022 Standing Committee on Women and Child Development pointed out that inadequate facilities at anganwadis were compelling low-income families to turn to paid alternatives.
Poor funding also means that health workers are paid only an honorarium yet expected to take on extensive healthcare work. ASHA workers have protested frequently seeking a hike in their paltry honorarium, the most recent being in Delhi in October.
Despite the restructuring of these nutrition schemes, overlaps remain, further burdening health workers. Such structural inadequacies can make it more difficult for the government health system to recognise and enrol malnourished children in nutrition programmes.
The way forward?
Addressing India’s hunger and nutritional deficiencies will require a multi-pronged approach and increased budgetary allocations and disbursements. Adequate funding for existing schemes will go towards ensuring the successful implementation of basic nutrition programmes. The utilisation of released funds should also be substantially improved so that intended beneficiaries receive the support they urgently require.
Increased funding is only the first step towards building a comprehensive nutritional safety net. A more thorough structural fix will aim to address how hunger and poor nutrition intersect with a range of other social concerns that affect many Indians, such as health, hygiene and money.
Deepanshu Mohan is Professor of Economics and Director of the Centre for New Economics Studies, OP Jindal Global University. Aryan Govindakrishnan and Jheel Doshi are Research Assistants at the Centre for New Economics Studies and members of the InfoSphere team.
This is the second part of a two-part series by CNES InfoSphere team analysing India’s macro-nutritional landscape drawn from different metrics to cross-validate and test the findings of the recent Global Hunger Index report, ranking India at 111 out of 125 nations. To review InfoSphere’s work, please see its website here. Read the first part here.