India features prominently in the recently released 2016 Global Nutrition Report. The report focuses on the recent nutrition-related progress and commitments made globally against malnutrition and identifies opportunities for action, with a particular focus on the commitments and actions necessary to end malnutrition in all its forms by 2030. The report is extremely relevant to India as it is home to over one-third of the world’s stunted children (with the 4th highest rate of stunting and wasting globally) and the largest number of undernourished people. In recent years, rates of people overweight and with diabetes have been increasing rapidly as well. The recent establishment of the Sustainable Development Goals and the UN’s labelling of the coming decade as the ‘The Decade of Action on Nutrition’ shows that there is renewed awareness and commitment to tackling the varied challenges of malnutrition.
The authors stress that one of the reasons they are hopeful that malnutrition can be ended globally by 2030 is because they believe that India can be a significant part of the solution, highlighting that India has recently significantly accelerated its reduction in malnutrition and that the country has almost doubled the rate of stunting reduction over the past decade. Another reason that is highlighted in the report is that economic arguments for investing in nutrition are being adopted by mainstream economists globally. The report provides India’s 2016 budget as an example in which India’s Ministry of Finance devotes an entire chapter to the importance of combating malnutrition and stresses that health and nutrition programs offer very high returns on investment. Indeed one of the key messages from the report is that the economic returns on investments preventing malnutrition are extremely high at $16 for every dollar $1 invested. Statistics in the report, however, illustrate that India still has a long way to go and continues to be off-course to reach global targets for wasting and stunting.
Panel 7.2 provides an overview of the amount of financing made available for nutrition programs in India in 2016. Overall, the Indian government allocated approximately US$5.3 billion in support of nutrition-specific programs such as the Integrated Child Development Services Scheme and the National Health Mission. This however, is $700 million less than what IFPRI researchers Menon, McDonald, and Chakrabarti estimate India requires for nutrition-specific programs in order to achieve global nutrition targets. The budget also allocates $31.6 billion to several programs aimed at improving the underlying determinants of nutrition, such as the Public Distribution System (PDS), which focuses on food security, and the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). The panel also identifies recent changes in the country’s fiscal architecture that allows states more control over their own budget as an opportunity for states to increase their commitment to nutrition and allocate additional financing.
A key recommendation of the report is that in order to achieve effective reductions in malnutrition significant political commitment is necessary on the National and sub-national levels. On numerous occasions the report refers to the success achieved by India’s state of Maharashtra Nutrition Mission through a public declaration of intent to reduce malnutrition. This was followed by rapid increases in spending which led to rapid declines in stunting rates. The report highlights that such clear political commitments are necessary for achieving targets but also need to be matched with clear time bound nutrition targets. In panel 3.3 the report analyses nutrition mission in six India states. The panel shows that by establishing the nutrition missions the states show political commitment but finds that this commitment is not matched by clear time bound targets. The authors thus argue that the setting of these targets and aligning them with global targets is more likely to achieve reductions in malnutrition.
The report also calls for a nutrition data revolution to create disaggregated data on nutrition that will support future investments. In particular the report argues that the demand for nutrition data at the level of the subnational administrative unit is increasing and lacking globally. India (2015-2016) together with Kenya (2014) are the only countries where surveys on the lowest administrative level have taken place. The disaggregation of this data is can support further interventions against malnutrition in India.
Currently, the majority of India’s malnutrition issues originate in undernutrition. The report stresses that policies for low and middle income countries, such as India, need to focus predominantly on combating undernutrition whilst also developing interventions that can deal with increasing rates of overweightness and diabetes. The report stresses that India and other countries should adopt successful lessons from other countries such as Brazil, Ghana, Peru and Vietnam that have managed to achieve rapid reductions in undernutrition. For instance, in the case of Ghana, rapid reductions in undernutrition have been achieved in recent years through a combination of policies that include: the implementation of community based acute malnutrition programs, a child centred health strategy, a supportive agricultural policy for smallholders, and the development of a national health insurance scheme. In Brazil, the report highlights that over many years the political commitment to tackling undernutrition has steadily strengthened, culminating in a law enshrining the right to food in Brazil’s constitution in 2010, allowing for long-term interventions.
For a summary from the perspective of global food security, see this blog.
Supplementary online materials: including nutrition indicators regional and country profiles and data sets can be accessed here.
By: Bas Paris