We just completed a writer’s workshop for an IDRC supported collection of papers for an upcoming NCAER-IDS book on Indian public policy
priorities for nutrition.
The workshop comes at a good time with Prime Minister Modi's government only a few weeks old.
Many of
the participants felt that the new government generated a new opportunity to
put undernutrition prevention higher on the political agenda.
Why the optimism?
A
new government and a new opportunity for undernutrition reduction
First, there was a sense that the Congress
Government really failed on undernutrition reduction. There has been no government funded nutrition
survey since 2006. The PM’s Nutrition
Council took over 1000 days to meet after its formation. There is no focal point for nutrition
anywhere in the central government.
India has chosen not to become a member of SUN. The Total Sanitation Programme focuses on
subsidies for hardware rather than on the behaviour change needed to end open
defecation. The list goes on. New governments like to pick up on things
that outgoing government failed to do.
The only way is up.
Second, Prime Minister Modi was a Chief
Minister of a state, Gujarat. States
have been the source of inspiration for those of us who care about
undernutriton reduction in India.
Maharashtra, Karnataka, Chhattisgarh and Odisha have led the way –
reforming seemingly unreformable programmes (e.g. PDS and ICDS). The space for the states to set higher
expectations for the centre will probably expand under Modi’s government.
Third, the ruling BJP party manifesto
talked a lot about undernutrition reduction and prevention--and in an informed
way. Manifesto pledges often end up as
empty promises, but these pledges were not necessary to win votes, and yet they were made. Someone seems to care, at least at
the moment.
Fourth, the government has also pledged to
tackle sanitation, putting a toilet in every home by 2020. While this may not be the best strategy—as Dean Spears noted, often
toilets are not used by some household members even if the toilet is working,
preferring the traditional practice of open defecation—it is a step in the
right direction and something to build on.
Fifth, resources do not seem to be a strictly
binding constraint (we were repeatedly told by participants—official and
otherwise). The commitment in the 12th
5 year Plan is to increase spending on social services.
Finally, the Government-- emboldened by its
large majority-- is seeking “out of the box” thinking on nutrition. Perhaps some programmes will be radically altered.
Set against this optimism is a real worry that
a “grow the economy now, distribute later” mentality will take over and
social programmes will be seen as handouts rather than investments in the
future.
Seizing
the opportunity
The nutrition community has to seize this
opportunity and manage the risks along the way.
First, we must emphasize the notion that
undernutrition is a marker of development and that undernutrition reduction is
a maker of development. If you want
sustained economic growth, invest in child growth. If you want the demographic dividend to
materialize, invest in infant nutrition now. If you want to help avert a crisis in diabetes, hypertension
and obesity in 25-30 years, invest in the nutrition of adolescent girls and
newborns and infants now. If Modi is to make the 21st century India’s century, he has to get rid of undernutrition -- fast.
Second, we need to support the Government
to set out an Indian vision for nutrition.
If the various new (non-Government) all-India surveys (i.e. the Indian Human
development Report data and the new UNICEF survey) are to be believed (they are
unpublished and I have not seen them), then stunting in 2012-13 is about
35-37%. This is a decline of about 1.5
percentage points a year since the 48% of 2006.
That is very respectable. Now push that to 2% (still below what Bangladesh has managed) and India can get
to below 20% by 2020. 20% stunting by 2020. That’s a target worth fighting for. Can India beat this target before its 75th anniversary of Independence in 2022?
Third, there needs to be a high level focal point in
the central government. The person should be the public face of the
government’s public commitment to undernutrition reduction, preferably in
national mission mode. They would be a
respected public figure who transcends political parties and for whom this is
their main pursuit. Perhaps an ex-President. Their job would be to inspire and
lead all stakeholders, convene and facilitate various initiatives, and report
to the public, annually, on what the government has achieved. Such a person has not been in place for at least the
past 10 years. I don’t even know who to
direct this blog to! Who is responsible
for undernutrition reduction in India?
No one can tell me.
Fourth, we need to convince the government
that data collection on nutrition is in its interest. How can you diagnose the problem and prioritize
action without a series of comparable data points 3-4 years apart? In addition to the 2014 NFHS-4 there should be
a 2017 NFHS-5 and a 2020 NFHS-6. If we
were talking about economic data collection there would be no discussion about
periodicity—annual surveys are automatic.
Nutrition data are just as vital to guide investments in the nation’s
destiny. We would not run an economic
policy based on data from 2006 (two World Cups ago!) so why would we do the same
for nutrition policy?
Fifth, we need to urge the new Government
to invest in Indian researchers working on this topic. Externally funded research is helpful but it
is no substitute for Indian Government funded research. For the latter, the government has to work
out for itself what information it needs and the evidence thus generated will
be less easily dismissed if the government supported it.
Finally, there are just some areas which we
know need urgent attention, no matter what: efforts to reduce open defecation, ICDS
reform to focus it more on 0-3 year olds, efforts to improve the nutrition of
adolescent girls, and attention to the price increases of non-staple foods
which tend to be higher in micronutrients.
Undernutrition
reduction is everyone’s responsibility
The new Government has a once in a decade
opportunity to make its mark on undernutrition and leave an enduring legacy to
the nation.
The rest of us have an
opportunity to urge and support it to do so.
Let’s seize the moment: write your MP, write those op-eds, blog like
never before, tweet the relevant killer facts and articles, work with
filmmakers to make videos about undernutriton, inspire your students to work on
it, talk to your doctors about it and convince your influential friends from
all walks of life about its existence and importance.
Undernutrition reduction is everyone’s
business and everyone’s responsibility, not just the government’s.
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