How India can escape the curse of child malnutrition.
Imagine if three thousand Indians died every day from swine flu. The number is closer to ten a day but the malady still draws media attention. More than three thousand Indians a day die from malnutrition — babies and toddlers — and yet the press focus on swine flu. On September 9, 2009 Google News India listed 49,000 stories on swine flu and just 2,500 stories on malnutrition.
Economic growth in India has also failed nutrition. In most countries growth is linked to a reduction in malnutrition but in India they are ships passing in the night. Real per capita GDP has grown by nearly four per cent year on year over the past 15 years. Over the same period, the percentage of malnourished infants barely moved: from 52 to 46 per cent.
At current rates, India will not meet the Millennium Development Goal target until 2043 — not 2015 as planned. As a result a further generation is condemned to the brain damage, poorer education and early death that result from malnutrition. China has already met its 2015 target.
Failure at several levels
I have been working with more than 30 Indian authors on a new report ‘Lifting the Curse: Overcoming Persistent Undernutrition in India,’ which argues that this problem reflects a failure of governance at several levels of Indian society. The report identifies a number of problems in nutrition service delivery. Services are not provided where they are needed. Some groups of citizens are systematically excluded from services. Services are of low quality. Accountability for service provision is weak. Leadership is fragmented. Awareness of the problem is poor. Year on year nutrition data are not available to enable monitoring of progress.
Nutrition, it seems, is nobody’s responsibility. To its great credit the government is expanding funding to the Integrated Child Development Services (ICDS), the main programme tasked with malnutrition reduction among infants, but without governance reforms this could be a case of throwing good money after bad.
So what should be done? First, fund communities and local governments to undertake social audits of the ICDS services actually delivered. Let the ultimate customers rate the provision and make the results public. This will put pressure on local MPs and local providers.
Second, give the Comptroller and Auditor-General a bigger role in monitoring government action on nutrition. Their work is already cited by many, and they should be empowered to do more.
Third, simplify ICDS. There are too many interventions and too many age groups. It is complex to run, especially given the thousands of different contexts it has to adapt to. At the moment it tries to be all things to all people and runs the risk of satisfying none.
Fourth, find an effective cross-ministry mechanism to deliver food, care and health in combinations that work. Efforts to lift the curse of malnutrition must be unified.
Fifth, historically excluded groups must be involved in the design, outreach and delivery of nutrition programmes, reaching out to women from these groups in particular.
Sixth, introduce simpler but more frequent monitoring of nutrition status so that civil society and the media can hold the government and non-state actors to account for year on year slippage and reward them for progress.
Finally, develop new ways of teaching and doing research on how to improve nutrition. Reducing malnutrition is not just about health, agriculture and economics. It is also about politics, governance and power.
The persistence of extraordinary levels of child malnutrition in the midst of a whirlwind of economic growth — maintained even in the midst of the global recession — must seem like a curse. But the Government of India can act to dramatically change the situation. September’s National Nutrition Week is not enough, every day should be Nutrition Day if India is to escape the duality of being an economic powerhouse and nutritional weakling. By tackling governance of malnutrition, the Indian government can lift the curse and raise the stature of its children. It will also raise its own standing in the world.
(Lawrence Haddad is Director of the Institute of Development Studies, U.K. and editor of IDS Bulletin 40.4 ‘Lifting the Curse: Overcoming Persistent Undernutrition in India’ published by the Institute of Development Studies (IDS), in partnership with the U.K. Department for International Development (DFID).)