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Authored by Anil Nair and CV Madhukar PRS just concluded a workshop for MLAs from 50+ from more than a dozen states. What an AMAZING experience this was, even though this is the sixth such workshop we have held in this past year! This three day workshop on 'Mastering the Budget' was designed to help MLAs understand how to work with budget documents and numbers, find trends, understand the most critical macro numbers to track, etc. The second day of the workshop was tailored to reflect on the big thematic issues that have an impact on state finances. The Fiscal Responsibility and Budget Management Act, the Goods and Services Tax, the pattern of quantum of funds flow from the Centre to the state and local governments, the 13th Finance Commission, etc. The final day was devoted to doing an inter-state comparison of states on important budget parameters, and gleaning lessons from them. The idea for this budget workshop germinated at a previous workshop held at IIM Bangalore. The participating MLAs requested PRS to organise a special session on 'Mastering the Budget'. So this workshop was being organised as a result of their feedback. The choice of location was easy -- this was held at the National Institute for Public Finance and Policy in Delhi, which is amongst India's foremost institutions working on state budgets and public finance issues. Invitations were sent out to MLAs in several states. Responses started coming in within a few days, with about 70 confirmations. But there is always an uncertainty on the participation until the very last minute because elected politicians have immense demands on their time, at least some of which are unpredictable. So it was heartening to see that more than 50 MLAs came to the workshop representing 15 states -- Bihar, Rajasthan, Odisha, Uttar Pradesh, Assam, Kerala, West Bengal, Andhra Pradesh, Meghalaya, Tamil Nadu, Madhya Pradesh, Himachal Pradesh, Gujarat, Haryana, Manipur. The participants ranged from first time MLAs (about 50%), to a sitting Minister, a sitting Speaker, former Ministers, and senior leaders of political parties from some states. But the best part about the interaction in this workshop was that even on seemingly complex issues being discussed in the classroom, the MLAs were not mere recipients of 'gyan' that was being dished out. They had important questions to raise, and well articulated points of disagreement with the faculty, and brought in practical perspectives that might not have otherwise come up in the discussions. They went beyond the scope of the workshop to engage the economists on discussions on subjects like FDI in retail, state of India’s economy… Based on our experience of several workshops with MLAs, we want to share some observations about the participating MLAs: - There are MLAs in every state who want to understand substantive policy issues, and are willing to invest time and energy to do so. - When the MLAs participate in these workshops, they choose to do so on their own, and are not compelled by anyone to do so. - The sessions almost always begin and end on time, even in the freezing cold mornings in the Delhi winter. - The MLAs are very engaged in the discussions, ask questions, and bring in their experiences into the classroom discussions. - They keep partylines completely out of the substantive classroom discussions, and in the rare event that some new participant mentions anything partisan, other participants quickly ask him to avoid making any such mentions. In 2011, we have engaged with over 250 MLAs through these workshops and more. These workshops are just a starting point of what we hope will develop into a sustained, longer term engagement with MLAs on policy issues coming up in their states. In an important partnership with the Indian School of Business, Hyderabad, PRS has already conducted two workshops at the world class facilities at the ISB campus, and is planning to hold more in 2012. Just as PRS engages with about 300 MPs in Parliament, the hope is that more MLAs will be able to derive value from the work of PRS in the years to come, thereby making their decisions better informed. Some feedback from MLAs from our earlier workshops can be seen here: http://www.youtube.com/watch?v=9XlgKCp2bvs or http://www.youtube.com/watch?v=01kLLTVtJOU&feature=related or http://www.youtube.com/watch?v=WA4NZqCj2xk&feature=related
In the recent past, there has been a renewed discussion around nutrition in India. A few months ago, the Ministry of Health and Family Welfare had released the National Health Policy, 2017.[1] It highlighted the negative impact of malnutrition on the population’s productivity, and its contribution to mortality rates in the country. In light of the long term effects of malnutrition, across generations, the NITI Aayog released the National Nutrition Strategy this week. This post presents the current status of malnutrition in India and measures proposed by this Strategy.
What is malnutrition?
Malnutrition indicates that children are either too short for their age or too thin.[2] Children whose height is below the average for their age are considered to be stunted. Similarly, children whose weight is below the average for their age are considered thin for their height or wasted. Together, the stunted and wasted children are considered to be underweight – indicating a lack of proper nutritional intake and inadequate care post childbirth.
What is the extent of malnutrition in India?
India’s performance on key malnutrition indicators is poor according to national and international studies. According to UNICEF, India was at the 10th spot among countries with the highest number of underweight children, and at the 17th spot for the highest number of stunted children in the world.[3]
Malnutrition affects chances of survival for children, increases their susceptibility to illness, reduces their ability to learn, and makes them less productive in later life.[4] It is estimated that malnutrition is a contributing factor in about one-third of all deaths of children under the age of 5.[5] Figure 1 looks at the key statistics on malnutrition for children in India.
Figure 1: Malnutrition in children under 5 years (2005-06 and 2015-16)
Sources: National Family Health Survey 3 & 4; PRS.
Over the decade between 2005 and 2015, there has been an overall reduction in the proportion of underweight children in India, mainly on account of an improvement in stunting. While the percentage of stunted children under 5 reduced from 48% in 2005-06 to 38.4% in 2015-16, there has been a rise in the percentage of children who are wasted from 19.8% to 21% during this period.[6],[7] A high increase in the incidence of wasting was noted in Punjab, Goa, Maharashtra, Karnataka, and Sikkim.[8]
The prevalence of underweight children was found to be higher in rural areas (38%) than urban areas (29%). According to WHO, infants weighing less than 2.5 Kg are 20 times more likely to die than heavier babies.2 In India, the national average weight at birth is less than 2.5 Kg for 19% of the children. The incidence of low birth-weight babies varied across different states, with Madhya Pradesh, Rajasthan and Uttar Pradesh witnessing the highest number of underweight childbirths at 23%.[9]
Further, more than half of India’s children are anaemic (58%), indicating an inadequate amount of haemoglobin in the blood. This is caused by a nutritional deficiency of iron and other essential minerals, and vitamins in the body.2
Is malnutrition witnessed only among children?
No. Among adults, 23% of women and 20% of men are considered undernourished in India. On the other hand, 21% of women and 19% of men are overweight or obese. The simultaneous occurrence of over nutrition and under-nutrition indicates that adults in India are suffering from a dual burden of malnutrition (abnormal thinness and obesity). This implies that about 56% of women and 61% of men are at normal weight for their height.
What does the National Nutrition Strategy propose?
Various government initiatives have been launched over the years which seek to improve the nutrition status in the country. These include the Integrated Child Development Services (ICDS), the National Health Mission, the Janani Suraksha Yojana, the Matritva Sahyog Yojana, the Mid-Day Meal Scheme, and the National Food Security Mission, among others. However, concerns regarding malnutrition have persisted despite improvements over the years. It is in this context that the National Nutrition Strategy has been released. Key features of the Strategy include:8
[1] National Health Policy, 2017, Ministry of Health and Family Welfare, March 16, 2017, http://mohfw.nic.in/showfile.php?lid=4275
[2] Nutrition in India, Ministry of Health and Family Welfare, 2005-06, http://rchiips.org/nfhs/nutrition_report_for_website_18sep09.pdf
[3] Unstarred Question No. 2759, Lok Sabha, Answered on March 17, 2017, http://164.100.47.190/loksabhaquestions/annex/11/AU2759.pdf
[4] Helping India Combat Persistently High Rates of Malnutrition, The World Bank, May 13, 2013, http://www.worldbank.org/en/news/feature/2013/05/13/helping-india-combat-persistently-high-rates-of-malnutrition
[5] Unstarred Question No. 4902, Lok Sabha, Answered on December 16, 2016, http://164.100.47.190/loksabhaquestions/annex/10/AU4902.pdf
[6] National Family Health Survey – 3, 2005-6, Ministry of Health and Family Welfare http://rchiips.org/nfhs/pdf/India.pdf
[7] National Family Health Survey – 4 , 2015-16, Ministry of Health and Family Welfare, http://rchiips.org/NFHS/pdf/NFHS4/India.pdf
[8] National Nutrition Strategy, 2017, NITI Aayog, September 2017, http://niti.gov.in/writereaddata/files/document_publication/Nutrition_Strategy_Booklet.pdf
[9] Rapid Survey On Children, Ministry of Women and Child Development, 2013-14, http://wcd.nic.in/sites/default/files/RSOC%20National%20Report%202013-14%20Final.pdf