India underspends on nutrition, new programme yet to be implemented

The guidelines of the restructured scheme, Saksham Anganwadi and POSHAN 2.0, are still being worked out and POSHAN 2.0 has not yet been approved, an RTI response revealed

In 2021, the government consolidated several programmes for children, adolescent girls and creches, supplementary nutrition and POSHAN (Prime Minister's Overarching Scheme for Holistic Nourishment) into an umbrella programme called Saksham Anganwadi and POSHAN 2.0. But there is confusion over the objectives and implementation of the new programme, and the government continues to underspend on nutrition, our analysis found. 

"Allocations for anganwadi services, supplementary nutrition, and POSHAN Abhiyaan are grossly inadequate and also not even keeping pace with inflation," said Dipa Sinha, an assistant professor at Ambedkar University. 

As the budget for the next financial year will be presented before Parliament on February 1, 2022, we take a look at the current state of spending on nutrition, key for child health and wellbeing. 

Consolidated programme, high malnourishment 

Two flagship centrally sponsored schemes spearhead the government's response to malnutrition: Launched in 1975, the Integrated Child Development Services (ICDS) aims at providing basic education, health, and nutrition services for early childhood development. A major component under ICDS is the Supplementary Nutrition Programme (SNP). Under SNP, hot cooked meals are provided to children aged three to six years for 300 days based on their malnutrition levels, and 'take-home rations' are provided to children aged six months to three years, pregnant women, and lactating mothers through ICDS. In addition, SNP is also provided specifically for adolescent girls under the Scheme for Adolescent Girls (SAG). 

The second programme, the POSHAN Abhiyaan, was launched in March 2018 to improve nutritional outcomes considering the life cycle of a person. It aimed to reduce the prevalence of malnutrition among children under six years, adolescent girls, and pregnant and lactating women by 2022. 

The restructuring of these programmes into Saksham Anganwadi and POSHAN 2.0 would "strengthen nutritional content, delivery, outreach, and outcomes", Finance Minister Nirmala Sitharaman said in her budget speech on February 1, 2021. 

This is critical, as in India, as of 2017, 68% of all deaths of children under five, or 1,953 per day could be attributed to malnutrition. Malnutrition also increases healthcare costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health. 

In addition, the latest health data show only a small reduction in malnourishment across the country. There were a larger proportion of children who were short for their age (known as stunting) in 13 states and UTs. Stunting is linked with poor cognitive development and future opportunities. The proportion of wasted children (low weight for height) increased in nine states. Wasting reflects short-term disease and mortality, as per WHO. 

"Given the very slow improvements in nutrition status of children in the country, it is imperative that much more be done," said Sinha. 

The increase in malnourishment was despite a larger proportion of children covered under ICDS, show data from the National Family Health Survey. 

Administrative data available from the ICDS Management Information System, however, paint a different picture; the number of eligible people availing SNP services decreased. Between March 2016 and March 2021, beneficiaries receiving SNP fell by 19% from 102 million to 83.2 million. For children, it fell from 82.9 million to 67.5 million. In contrast, from 2016 to 2021, the number of children aged six months to six years was estimated to increase by 7.6%, our calculations show. During the same period, the number of children, three to six years, receiving pre-school education (PSE) declined by 34% from 35 million to 23 million. 

What the government spends on 

Budgets for nutrition programmes have been stagnating. In both 2019-20 and 2020-21, ICDS budgets fell compared to the previous year. SAG budgets have been declining as well, and in 2021-22, budgets for SNP declined. 

Further, if inflation is considered, the ICDS budget in 2018-19 (Rs 13,049 crore) was higher than allocations for Saksham Anganwadi and POSHAN 2.0 in 2021-22 (Rs 12,741 crore). 

Underfunding and underspending 

In addition to lower allocations across years, budgets remain significantly lower than requirement. There are two ways to measure these gaps: First, by estimating the required funds to deliver SNP at 100% coverage using the population, and comparing this to actual allocations. Second, by studying what SNP budgets would look like if they accounted for changes in unit costs due to inflation. 

Funds required if the programme covered every targeted beneficiary: In 2021-22, at full coverage, an estimated Rs 42,033 crore was required to fund SNP. Total approved budgets (using both union and state shares), was Rs 17,392 crore or 41% of required costs. 

The proportion the approved budget was less than half what was required in 19 states and UTs, including Karnataka (48%), Himachal Pradesh (44%), Jharkhand (37%), Gujarat (34%), Uttar Pradesh (34%), Kerala (33%), Bihar (33%), Rajasthan (25%), Haryana (14%), and Punjab (13%). On the other hand, north-eastern states, such as Nagaland and Manipur, allocated more than the estimated requirement. 

For this calculation, we estimated required funds at 'full coverage', i.e., 100% of the estimated target population, by multiplying the estimated target population (using state-wise growth rates) by the government-defined unit cost of providing supplementary nutrition. 

These were then compared with total approvals. Funds for SNP are shared equally between the Centre and states. While the central shares approved are publicly available, state shares are not. Thus, the total approved budget has been estimated assuming that the state contributed its entire share as well. This method, however, does not account for states adding extra funds over and above their share or running other SNP schemes. 

Adjusted for inflation: The last time the government changed SNP costs was in September 2017 when the Cabinet Committee on Economic Affairs approved a rate of Rs 8 per day for child beneficiaries. 

Between October 2017 and October 2021, India had 20% food and beverage inflation. Accounting for this, the per day costs as of October 2021 would be Rs 9.58 instead of Rs 8 for children; Rs 11.37 instead of Rs 9.50 for pregnant women, lactating mothers, and adolescent girls; and Rs 14.36 instead of Rs 12 for severely malnourished children. 

Based on the inflation-adjusted cost, the SNP would require Rs 50,414 crore in 2021-22, of which the actual budget was only 34%. If the inflated costs were considered, the highest budget rise would be in Uttar Pradesh (Rs 1,906 crore), Bihar (Rs 981 crore), and West Bengal (Rs 646 crore). 

Delays in releasing funds for POSHAN, small amounts disbursed 

Over the last three years to 2021, lower amounts have been released and spent under the POSHAN Abhiyaan. Since the inception of the scheme in 2017, Rs 5,313 crore has been released by the Union government, accounting for 53% of the total allocations (Rs 10,111 crore till 2020-21). Till March 31, 2021, Rs 2,986 crore or 56% of total central funds released had been spent. 

Need more funding, smarter spending 

The lack of funding has not gone unnoticed. In its 333rd report, the Rajya Sabha Committee on education, women, children, youth and sports recommended that, in view of the gross underutilisation of funds under important schemes like POSHAN Abhiyaan, there was a need to focus on outcomes. Sakshan Anganwadi and Poshan 2.0 was meant to include an 'outcome based' monitoring framework. 

Yet, as per a response to a Right to Information request, dated December 14, 2021, the guidelines of the restructured scheme are still being worked out and POSHAN 2.0 has not yet been approved. In the interim, the existing schemes are functioning as before, but continue to be severely underfunded, as our analysis shows. 

With the onset of the Covid-19 pandemic, which increased vulnerability to malnutrition, there is an even more pressing need to focus on nutrition. The new SNP budget should factor in inflation and expand its reach to cover all children in need of supplementary nourishment. 

"While this requires multiple strategies involving multiple stakeholders, POSHAN Abhiyaan is the flagship scheme and anganwadi centres are the main platform through which all interventions are to be planned," said Sinha. "Therefore, better funding for SNP, as well as workers' honorarium, infrastructure etc. is needed, as well as filling up staff vacancies, and finally, greater political priority to nutrition which should also be reflected in resources allocated."