Praveen Kishore Development | Public Policy | Economics | Governance

Policy Challenges of Providing Supplementary Nutrition to Children in Bihar

01 Apr 2019 0 comment(s) Research Projects

Child Malnutrition in Bihar and the Alternative Ways of Nutrition Delivery

Bihar’s child malnutrition rate is higher than any other country in the world! It is the worst state in India in terms of prevalence of child malnutrition with more than half of all children below the age of five being underweight or stunted, and to add to this, around nine lakhs children are suffering from severe acute malnutrition. Despite such a worrying state, it is quite surprising that the issue of malnutrition has hardly been given much attention in government priorities and public discourse in Bihar. And this has been the case for many years. The ICDS program, the most important instrument to tackle the problem, similarly, has been getting a very step-motherly treatment. Though, it may be said that the governance and administrative performance of Bihar even in other sectors has not been encouraging despite some impressive growth numbers during past decade and half, the situation in ICDS is really worrying.

Provision of supplementary nutrition to children below the age of six through ICDS Anganwadi centres is the most important public policy intervention. Subsequent to Supreme Court decision in 2001, Bihar was one of the first states to completely decentralize the operation of supplementary nutrition program, and funds were started to be devolved to the level of Anganwadi Sevika, who was given the responsibility to procure and purchase food items locally and then cook and provide the hot cooked meal as well as take home ration to eligible beneficiaries. For children between the age of three to six years, it was mandated that hot cooked nutritious meals will be provided at Anganwadi centres. For children below three years of age (as well as for pregnant and lactating mothers and adolescent girls), it was mandated that they would be provided with take home ration (being rice and pulses, mostly) once in a month. However, since the beginning, there has been questions about efficacy and effectiveness of such a process. There is widespread feeling, not without basis, that the decentralised process has not improved the service delivery mechanism and that there is significant leakages and corruption. One independent study in 2013 found that as much as 53% of the fund was being lost through the leakages. Allegations of Sevika not cooking food as per prescribed menu, even not providing hot cooked meal at all on many days, shortage of utensils, non-availability of food grains, vegetables and other provisions due to bottlenecks and delays in devolution of funds through inefficient treasury mechanism were common. Other administrative and operational issues further affected the provision of supplementary nutrition. However, it must also be noted that this completely decentralized system has been able to keep the processed and semi-processed food industry, packaged food and nutritional supplement and other similar business interests and contractors at bay, and various related problems and possibility of corruption and undermining of the program have also been avoided. In addition, the use of local food, vegetable, eggs and other products has been encouraged and local decentralized market for such items has been strengthened.

Nevertheless, the quality and delivery of supplementary nutrition are far from satisfactory. Alternative models of providing nutrition have long been a tricky public policy question and various models have been proposed, some experiment and innovative models have been tried also in some of the states, though nothing concrete and convincing has yet been found which can take care of most of the vexing complex issues. Further, such models and mechanisms have to be context specific, taking care of social, political, organisational, geographical and various other parameters of state and locality into consideration. What has worked in Tamil Nadu may not necessarily work in Bihar or Punjab. It should be remembered that the crucial issues in provision of supplementary nutrition is procurement and supply chains – how best to organise them, how could they be made most efficient, effective and leakage free on the one hand, and the desirability and suitability of locally produced natural food products vis a vis processed, packaged and fortified food supplements towards nutritional outcomes. Various alternatives which are now generally considered feasible can be broadly classified in three broad groups, and these are discussed with specific reference to Bihar in the following paragraphs:

1. Full Decentralization: Going Local

• Completely decentralised structure, as is presently being followed in Bihar, involves full fund devolution to Sevika level, where Sevika is responsible for procurement at village/local level, and wherein some sort of local community and panchayat level representative’s participation in supervision, oversight and accountability of supplementary nutrition provision is designed. There is a prescribed daily menu to be followed at Anganwadi with quantities of each ingredients also specified for providing necessary nutrients. This has exactly been tried in Bihar, though with not very satisfactory results. Misalignment of economic incentives and opportunities of corruption and leakages at local level has giving rise to what can be called decentralized corruption. Despite these shortcomings, this model has used locally produced natural food products to the maximum extent possible.
• Involvement of women self-help group could be a possible strategy, especially in preparation of take home (dry) ration which is nutritionally better than the present approach where rice and pulses are given. Again, here procurement and preparation/some processing can be thought of within the overall design where women self-help groups or village community are involved and most of the procurement is done locally. However, it seems easier said than done. Local level knowledge of food products and practices need to be integrated into designing and devising natural nutritional food supplements.
• Village level women self-help group can also be engaged in preparing hot cooked meal and its distribution/management. If fact, this was almost tried in Bihar in 2013 when a policy decision was taken to involve self-help groups of national aajivika mission (NRLM) (called Jeevika in Bihar) in management of hot cooked meal in some select blocks where Jeevika groups have been performing better. However, subsequently, it could not be implemented when the administrative department of NRLM, (Rural Development) developed a cold foot over this proposal. It was feared by the mission authorities that involving Jeevika women in these activities and exposing them to substantial handling and management of money, and related purchases and procurement may have infecting and corrupting influence on these women, who have, after much difficulty and patience, been trained in the ethos of jeevika and self-help philosophy. This itself conveys a lot about what and how Anganwadi system is seen and perceived even by government itself in Bihar. It is also perhaps a reflection of the weakness of Jeevika mission’s achievements where the authorities are apprehensive that the corrupting influence of ICDS will be more effective and stronger then Jeevika self-help group’s positive influence on ICDS system in improving it.

2. Semi-Decentralization: Mixing and Matching

• Semi-decentralised provision can be designed where procurement of provisions is managed at district or block level, thus vesting CDPO or District level officer with such responsibilities. The materials so procured are then distributed/supplied to the Anganwadi by the ICDS functionaries. In this manner, procurement and preparation activities are separated. Preparation, cooking and distribution is then handled at Anganwadi centre, based on prescribed menu and specified quantities. This can take care of various inefficiencies and local delays of decentralised preparation. Further distinction in procurement of storable food grains and other items, and perishable food like vegetables need to be made and it would be appropriate to leave the procurement of perishable goods at Anganwadi level.
• There is already a provision through which rice and wheat for ICDS use can be supplied by government procurement agency (Food Corporation of India, and respective state food corporations). This again was tried in Bihar but was found to be creating more problems than solving issues. There were frequent shortages, non-availability with FCI, poor quality of food grains, irregular supply, inflating supply through underweight food grain sacks, transportation and logistical issues and even plain reluctance on the part of FCI.
• In respect of take-home ration, semi-decentralized operations may have some distinct benefits. District or block level coordination and management of these activities with some women self-help group can be more efficient in comparison to village/Anganwadi level organization of preparation of take-home ration by these groups, due to the simple reason that very small self-help group often lack even the minimum level of organizational talents, and even simple processing may be difficult to efficiently organize at village level. Block level organization, where local self-help and other women groups are involved in procurement of locally produced food items as well as in preparation of dry nutritional supplement, under the overall supervision and leadership of CDPO, with oversight of community and village/panchayat level public representative seems to carry good potential.  

3. Involving Non-Government and Other Organizations in a Significant Way

• Cooperation with non-governmental organizations and other agencies, wherein the responsibility of preparation and distribution of hot cooked meal can be given to such agencies is another possibility. Such an arrangement involves establishment of centralised kitchens by these organizations from where cooked meals are then transported and distributed to the locations. The motivation obviously comes from mid-day meal schemes of schools wherein some states have successfully experimented with this model, at least for providing meals to school in parts of states.
• In fact, some preparatory work on this policy initiative was carried out in Bihar in 2013, and some specific bottlenecks were also identified and analysed. Unlike mid-day meal for schools wherein the supply chain and transportation arrangement are rather easier with widely spaced school each having 200 to 500 students, the case of Anganwadi is very different. In Bihar, most of the Anganwadi have around 40 children, and they are also located at closer distance. In many large villages, it is possible to find three to five Anganwadi centres. This requires a different type of supply chain arrangements where establishment of large centralised kitchen with cooking facilities for thousands of children may not be feasible. On the other hand, in urban areas of Bihar, the Anganwadi would again be clustered close by, and access roads will be mostly narrow, requiring specific small transportation vehicles. Further, the issue of present daily menu and what can efficiently and effectively be prepared in and supplied from a centralized kitchen may need to be rethought.
• In respect of take-home ration, involvement of non-government organization seems to be trickier. It may develop into a situation with the potential to allow back door entry to private operators and food processing industry. This is certainly not advisable. And it should also be kept in mind that ICDS, as a huge business and profit opportunity, has been eyed by such operators for long, Supreme Court’s 2001 and subsequent decisions arising out of this issue only. Further, the potential of enormously huge volume makes ICDS even more attractive, and even a slight opening would be grabbed by private operators. For example, if government decides that one piece of biscuit would be given to beneficiaries daily in Anganwadi in Bihar, it would generate a demand for 4 million biscuits daily in Bihar! 

The Research Work on this is undergoing.