The Karnataka Budget 2023-24 gave a much-needed push to the nutrition sector, focusing on anganwadis which are at the core of providing services to the poor. Attempts have been made to address the concerns raised by the Second Karnataka Administrative Reforms Commission (KARC2) headed by former Chief Secretary T M Vijaya Bhaskar.
The recent report (the fourth) of the Karnataka Administrative Reforms Commission, released by Basavaraj Bommai on February 3, 2023, has given a few significant recommendations for addressing malnutrition in a comprehensive manner.
The report speaks of the need to increase the number of eggs given to Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) children aged 6 months to 3 years from three per week to five. Similarly, it has also recommended for giving 2 eggs per week to normal children as well. The report recommended the need for extending the scheme for adolescent girls in the 15-18 age group from aspirational districts to other districts as well, covering an estimated population of 6 lakhs at the cost of Rs 180 crore to address the intergenerational issues of malnutrition, child marriages, teenage pregnancies, Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR).
It also suggested the creation of a separate directorate for child development and women empowerment and development. The report stressed the need for measuring malnutrition among children in a periodical manner by linking Poshan tracker with the Student Achievement Tracking System (SATS), which can be a very powerful tool to track dropouts and take corrective actions.
While all the recommendations have not been implemented fully, budget 2023-24 indicates a few important proposals informed by the KARC2 report 4 that can go a long way in addressing the malnutrition issues in the state.
One of the important administrative changes the government is making to address malnutrition is by creating a separate Department of Child Nutrition. The proposal to start Arogya Pushti on the lines of Mathru Poorna (full meal and IFA tablets) for eligible married women for a period of six months, with a special emphasis on aspirational taluks, is a very good move to address the intergenerational challenges of the nutritional cycle.
The scheme “Vatsalya”, aimed at screening all children in rural areas in the age group 0-6 years every 6 months for their health and other growth parameters, is a strategic move as it not only addresses the health and nutrition aspects but also helps to track them for their early learning and enrolment in schools.
Similarly, the proposal to provide nutrition to adolescent girls who have dropped out of schools has been extended to all aspirational taluks (earlier, it was only in Raichur and Yadgiri). The decision to open 4,000 child care centres in urban areas and 500 kindergartens in rural areas in convergence with NREGS is a welcome move and can help daily wage labourers significantly.
The decision to open 3,538 new anganwadis at a cost of Rs 270 crore and construct 1,000 anganwadi buildings (250 in urban areas) is a significant move that will help the poor to access services at the nearby anganwadis. The monthly honorariums of anganwadi workers, helpers have been increased, apart from provisioning for gratuity for them.
The additional nutrition cost by way of one full meal, milk (Ksheera Bhagya) and Srusti (eggs) for children and women has been increased by 94 per cent, from Rs 460 crore in the current year (2022-23 RE) to Rs 893 crore for the year 2023-24.
The NFHS-5, which came out in 2019-20, pointed out that the effect of these state level interventions is varied across districts, with some showing impressive progress while others are still lagging behind. For instance, between 2015-16 and 2019-20, there was an overall decrease in the number of children under 5 years who are wasted (low weight for height) across the state.
But five economically and socially advanced districts (Dakshina Kannada, Uttara Kannada, Chikkamagaluru, Kodagu and Shivamogga) showed an increase in these numbers. Similarly, districts which previously in 2015-16 were having the lowest stunting (low height for given age) numbers showed an increase in 2019-20. Therefore, although increase in overall nutrition expenditure of the state did lead to some positive outcomes, this did not translate equally in all districts.
One of the important reasons for this could be that currently nutrition budgets to districts are estimated based on unit costs set by the central government in 2017 and not curated towards individual districts. The unit costs of nutrition Mathru Poorna scheme set in 2018 as well as the Poshan 2.0 (erstwhile ICDS) needs to be adjusted for inflation every year and enhanced for greater benefits.
Initiatives taken during the Covid-19 pandemic in Yadgiri offers good lessons for nutrition management as indicated by the study conducted by the Centre for Budget and Policy Studies, Bengaluru.
District-level nutrition governance can come up with innovative, proactive and timely solutions to maintain the nutritional health of the most vulnerable.
It was seen that Yadgiri, which has one of the state’s poorest nutrition indicators (57 per cent of its children under 5 years were stunted), made a rational decision of providing take-home rations in pre-packaged kits prepared by the Mahila Supplementary Nutritious Food Production and Training Centres (MSPTC), unlike in Tumakuru where it was providing rations.
This enabled easy delivery of rations to families of children under five years of age during the pandemic.
There was another important initiative during the Covid months in Yadgiri. Anganwadi helpers personally ensured that SAM children consumed boiled eggs or nutrimix under their supervision, and then uploaded photographs of the same with their block level Child Development Project Officer.
To ensure that the egg supply was uninterrupted during the pandemic and unaffected by the fluctuating commodity prices, a tendering process was undertaken in Yadgiri and eggs were supplied to AWCs across the district by the Karnataka Food and Civil Supplies Corporation (KFCSC).
A decentralised governance approach can make a significant difference in the effectiveness of nutrition delivery systems. Similarly, the annual revision of unit costs, combined with monitoring the growth parameters of children from the beginning, can go a long way towards achieving the health and nutrition goals of the state.
(Gayathri Raghuraman is a consultant, Sridhar Prasad a research adviser and Madhusudhan Rao B V a senior research adviser at the Centre for Budget and Policy Studies, Bengaluru)