Direct Interventions Against Hunger

A Right to Food The Wider Relevance of India’s Experience

IF YOU THINK MID DAY MEALS ARE A WASTE OF RESOURCES?

YOU ARE NOT ALONE!

BUT I INVITE YOU TO THINK AGAIN…

Hunger and Malnutrition: Key Trends

• Nearly 2/3 of the world’s hungry people live in

the Asia and the Pacific (FAO)

• More than 70% of the world's underweight

children live in just 10 countries, with more than

50% located in South Asia alone (UNICEF)

• South Asia and Sub-Saharan Africa have the

highest hunger levels (IFPRI)

• Malnutrition—an NCD closely interlinked with

infectious diseases

The pressing concern of access in

South Asia

• Aggregate food availability hides distribution

issues, especially food availability among

the poor

• Hunger trends are alarming, despite gains in

poverty reduction

• Malnutrition seen as a largely rural issue,

but increasingly becoming an urban problem

Some policy responses for access

• Food-for-work programmes that target

vulnerable populations – Bangladesh

• PDS to manage available foodgrains

through procurement and distribution – China: manage food scarcity, grain prices, no special poverty

targeting

– India: direct grain to disadvantaged groups, control prices

• Mid-day meals – today’s focus – Bangladesh, India, Sri Lanka

From a state to the country

The case

of India

Argument

• Nutritional deprivation overlaps with

material poverty, but is quite distinct –

needs to be separately addressed

• Developed countries also re-

discovering this, most recent being

Scotland 2006-07

• Example of India--TN since 1982 –

feeding at preschool and school levels

(self-targeting, free, nutritious, publicly

visible) and expansion nationally

• The experience – potential enormous

but benefits not automatic

• Costs, financing – fiscal implications

• Messages

Consider our meetings: which get better participation? With or without refreshments?

Relevance of India: a state is like a country

•India – population 1.1

billion in 28 states/UTs

– More like 25 countries

•Population of individual

states in India compares

with country populations

–Andhra Pradesh 76 m;

Tamil Nadu 62 m

– Philippines 88 m; RoK

48 m

– Nepal 28 m; Malaysia

24 m; Sri Lanka 20 m

Extreme contrasts:

India shining…

• High savings, high investment -

• FDI growing

• Corporate entrepreneurial stories

plenty – world class

• High stock of human capital - can

unshackle country’s strengths

• High growth rate, poverty % falling

(22%), ability to survive financial

crisis, well capitalised banks

… but also whining…

Malnutrition nearly twice

poverty: invisible, persistent

and urgent

• Under 5 malnutrition: >42% (NFHS3)

• Primary school malnutrition: 48-54%

• Add micronutrient deficiencies (iron & folic acid, calcium, iodine)

– a majority of the women are anemic (56% & increasing)

– Anemia among 6-14 years 14-96%

• Newer problems: lifestyle related malnutrition and NCDs – obesity, high BP, diabetes, coronary heart disease, etc.

• Highest rate of stunted growth among children

Inadequate Nutrition, Illness, Growth Faltering:

Tracking a Child to 36 Months

Key D–Diarrhoea, BC– Bronchitis, BN- Bronchopneumonia, CEL– Cellulitis, CONJ– Conjunctivitis, FUO- Fever of unknown

origin, I- Impetigo, M –Measles, T -Oral Thrush, S –Stomatitis, URI -Upper Respiratory Infection

Source: UNICEF, 1983

We

igh

t i

n K

ilo

gra

ms

Age in Months

107

109

111

113

115

117

119

121

123

BR

AZ

IL

CO

ST

A R

ICA

GU

AT

EM

ALA

HA

ITI

JA

MA

ICA

NIG

ER

IA

IND

IA

HO

NG

KO

NG

cm

Mean height of 7 years old boys of high socioeconomic status Mean height of 7 years old boys of low socioeconomic status

NCHS

Percentiles

50th

25th

10th

5th

Adapted from Martorell and Habicht, 1988

Ethnic vis-à-vis Socioeconomic Factors:

Height Variations Among Seven Year Olds

Does right to food make sense?

Easier to assert than to understand or

operationalise

•Conceptually less clear

than other rights, such as

–right to info, right to

free speech

• Whom does one enforce

it against and how?

–Parents? Society?

The State?

• Akin to a right to

education, once it gets

social legitimacy, it’s

likely to take hold

Tamil Nadu, a

pioneer (1982)

• For the first time,

hardest to reach

population covered –

preschoolers (2-5 years)

• Food became an

integral part of school –

like a blackboard

• Centers function daily

- Buildings in place

- Earmarked staff in

place (cook,

helper, organizer –

women predominate)

- Staff training budgeted

- Equipment in place

(scales, utensils,

mats…)

De facto right: a soft right

Nutrition investments grew over time

• Coverage increased

• Menu nourishing, varied –

rice, sambar, different

vegetables, weekly egg,

supplements

• Health linkages established

• Attention to nutritionally

vulnerable groups

• Policy formulated for a

malnutrition free TN (2003)

Centres Number of participants

Type of centre Number of

centres Children

Adults: AN/PN &

pensioners* Total

Pre-school, child welfare

centres (predominantly ICDS,

rural & urban) covering ages 6

- 60 months & nutritionally

vulnerable adults

50,433 1,814,000 570,000 2,384,000

School Noon Meal Programme

Centres (rural & urban)

covering ages 5 - 14 years

41,663 6,268,000 Nil 6,268,000

Total 92,096 8,082,000 570,000 8,652,000

Note: * AN/PN = Ante-natal/post-natal women, i.e., pregnant or nursing women

Source: Government of Tamil Nadu 2008. Policy Note 2008-09, Social Welfare and Nutritious Meal Programme Department

Coverage in Tamil Nadu, 2007-08

Trends in Nutrition of Participating Children,

0-36, Months in Tamil Nadu, 1983 - 2008

Source: Office of the Project Coordinator, ICDS, GoTN

0

10

20

30

40

50

60

70

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

Pe

rce

nt

Normal

Grade I

Grade II

Grade III & IV

Scaling up:

judicial

intervention

• Supreme court orders of 28 Nov 2001

– All government & assisted primary schools to

provide cooked MDMs in six months

– For children below six food under the ICDS

– Parents can demand school meals and

enforce through courts if necessary

• Why the Supreme Court?

– The PUCL filed a PIL for ‘Right to Food’

• Most states missed the

deadline

• Initially seen as a

managerial and fiscal

nightmare

• Yet, steady expansion of

MDMs - most states, after

some reluctance, complied

(Rajasthan, Karnataka &

even Bihar, UP)

Mixed experiences in scaling up: state to nation

Finally, the Food Bill was signed by the cabinet

in 2011 with near-universal coverage

Monthly subsidized food grains/meals at “free or

affordable prices” to 770 million or 64% of population,

including homeless, disaster-affected or living in starvation & women headed HHs

Source: Mail today, December 19, 2011

FOOD FOR

THOUGHT…

Potential is ENORMOUS… • Beyond what is commonly known –

hunger, health, malnutrition

• Breaks cycle of inter-generational

transmission of malnutrition (LBW

etc…)

• Efficiency – reduced work-day losses,

medical expenses

• Promotes social equity

• Helps school readiness - social &

cognitive development

• Supports education – better

attendance, reduced classroom hunger

• Promotes gender equality- women and

girls benefit

• Inculcates habits of personal hygiene

But limitations need to be

recognized…

• Health-nutrition benefits

- substitution / take

home rations

- poor quality

- ignoring non-food factors

- poor nutrition knowledge

• Education - food cannot

substitute teachers

• Social equity – segregation

could be widened or revealed

• Political will – may be

inconsistent

In the past, even in Tamil Nadu, 1974

• Headmaster manages school meals

• Uses help of teachers

• Distracts from teaching

• Variations in quality from school to school

• Daily struggle for school management

• Gap – no dedicated staff

(CARE, 1974)

Chhattisgarh, 2003

• Cooking in a soot covered classroom,

swarming pupils, utensils inadequate,

cook struggles, gets children to help

• Teacher wishes school feeding be

stopped– distracts children, classroom

turns filthy after food, there is no

teaching after lunch

• Gap: inadequate funding, infrastructure

& management, and political will

(Ref: Dreze & Goyal, 2003)

Rajas-

than,

2003

• Well managed

logistics &

monitoring,

political will in

place

• However,

identical meal

everyday (ghoogri

– boiled wheat &

jaggery)

• Weak

infrastructure

• Upper caste

children bring

own food—

privilege or

discrimination?

• Gap—under

funded

Tamil Nadu, 2003 – 2010

Funding – first call on the states

resources

Addresses intra-household issues

–-removes existing social biases

Universal feeding contributes to

common dining and socialisation

of children at a very early age (as

against targeted feeding)

Preference for Dalits and widows

among staff

Community watch and

participation helps retain

regularity and quality

• Pressure from above—sustained political will ensured public policy attention backed by budgetary allocations

• Pressure from below—program very popular, seen as a right (cut leakages)

• While political will triggered demand from below, the demand, in turn, contributed to the RETENTION of political will over time (regardless of party in power)

Three Features of Interest

Costs and

Financing

1. Cost components

• Recurring (ingredients, tpt,

conversion, admin)

• Maintenance & replacement

(wear and tear)

• Capital (infrastructure,

utensils, mats etc.)

2. Recurring cost

estimate per capita

(local prices)

• TOTAL = INR 3.95 or USD

0.09 (US$1 = INR 45)

3. In TN it is about 2-4%

of total annual revenue

expenditure

(11 year budget data)

Financing

1. Financing: centre-

state sharing

• Recurring -

prohibition lifted, PDS

grains, local

contributions

• Capital, replacement

– ongoing schemes

made eligible

2. Minimizing macro

fiscal burden

• Inter-ministerial

synergies

•Project education to

donors

•Institutional changes

– village or slum as

unit

Overall Messages

• Direct nutrition interventions have the potential to

address five challenges:

• poverty, hunger-nutrition, health, education &

social equity

• But the effects ARE NOT AUTOMATIC: they depend

upon the design, quality of implementation including

plugging leakages, budget ‘proofing’

• Hence the criticality of:

- Pressure from above

- Pressure from below

- Administrative and technical capacities

• Poor design & implementation can DO MORE HARM

THAN GOOD

• One needs to have realistic expectations about

effects--there are a number of ‘other’ contributory

factors

• Need to progress from a food based to knowledge

based approach

• A two-pronged strategy

- Prevention for those not

yet malnourished

-Management of malnutrition

for those affected

• Fiscal prudence through

inputs focused by socio-

economic groups

-Knowledge for the better off

-Subsidized inputs-cum-

knowledge for the worse off

-Universalize with quality

(e.g. focus on government

funded institutions and

universalize)

To Conclude…

THANK YOU

Should we really let our people starve … when the world has the

technology and resources?