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How Inclusive is the Eleventh Five Year Plan? - People's Mid Term Appraisal - A Review of Selected Sectors31 Dec 2010
By foregrounding the need for "inclusive growth", the Eleventh Five Year Plan (EFYP) sought to make a major shift in the development strategy of the Indian state.
Malnutrition rates among both adults and children in India are unacceptably high. Almost half the children under the age of three are underweight and one-third adult women have a body mass index less than normal. This is so even when compared with much poorer countries in Africa and in other parts of the world. In terms of the Global Hunger Index (GHI) recently released by the International Food Policy Research Institute (IFPRI) India’s performance is very poor. India’s GHI 2008 score of 23.7, gives it a rank of 66th out of 88 countries.
According to the India Hunger Index report this score indicates “continued poor performance at reducing hunger in India”. India ranks below several countries in Sub-Saharan Africa, such as Cameroon, Kenya, Nigeria, and Sudan; even though per capita income in these countries is much lower than in India.
According to the India State Hunger Index (ISHI), which is constructed using the same method and indicators as the GHI1, not a single state in the country falls in the “low hunger” or “moderate hunger” category defined by the GHI 2008. Most states fall in the “alarming” category, with one state—Madhya Pradesh—falling in the “extremely alarming” category. Four states fall in the “serious” category.
It is cause for further concern that there is not much improvement in the malnutrition rates in the country in the last ten years. The per cent of children under three years of age who are underweight is 46% according to the National Family Health Survey (NFHS) 3 conducted in 2005-06. This is only a percentage point fall from 47% from the NFHS 2 conducted seven years back in 1998-993. Similarly high rates of malnutrition are found even when we look at other measures such as stunting (height for age) or wasting (weight for height). Among adults a third of women have a BMI, less than normal (i.e. 18.5) and 28.1% men have a BMI which is less than normal.
The results of the NFHS show very high levels of anaemia among young children, women and pregnant women and this has risen from NFHS-2 to NFHS-3. Almost 80% of the children under three are anaemic and around 56% women are anaemic. Anaemia levels among men are much lower but still very high in absolute terms, with almost one in four men in the reproductive age group being anaemic.
With such high levels of hunger and nutrition in the country, it must be recognised that malnutrition is a result of access to sufficient and nutritious food and also other factors such as breastfeeding, infections such as malaria and pneumonia, as well as larger factors such as poverty and gender inequality. “Poverty impacts malnutrition in multifarious ways – by reducing purchasing power for good quality calorie dense foods, by reducing access to health care, by giving rise to physical environments lacking in safe water and sanitation and by impact on education” (Working Group for Children under Six, 2007). Therefore, strategies to address malnutrition must include increasing access to sustainable livelihoods, reducing poverty and greater economic and social equality, along with direct interventions towards prevention and treatment of malnutrition such as supplementary nutrition, nutrition counselling and growth monitoring, breastfeeding support and promotion and treating childhood illnesses (diarrhoea, pneumonia)
In spite of such appalling levels of malnutrition in the country and a wide-ranging number of food-related schemes, India’s record on direct nutrition programmes has been quite poor. The Integrated Child Development Services (ICDS) scheme, the largest direct intervention for addressing malnutrition in the country was until recently not a universal programme, had limited coverage and poor resources.
The other programme that involves direct food transfer4 is the Public Distribution System (PDS). However, its main objective, at least until the late 70s was primarily price stabilisation and only in 1987 –88, was PDS added to the Minimum Needs Programme to “ensure availability of essential items at reasonable prices to the vulnerable sections of the population” (MSSRF-WFP, 2008). The PDS can only have limited impact on nutrition status as it currently reaches out to a small proportion of the population (only some of those who possess “below the poverty line (BPL)” ration cards) and provides only cereals in most places. It, however, has the potential to contribute significantly to food security, especially of poor families.
The problem of hunger and malnutrition in the country was brought to centre-stage in 2001 through a Public Interest Litigation (PIL) in the Supreme Court filed by the Peoples’ Union for Civil Liberties (PUCL) on the right to food. With food stocks overflowing in the FCI godowns when there were reports of starvation deaths from different parts of the country, the PUCL argued that “the right to food is a fundamental right of all Indian citizens, and demands that the country’s gigantic food stocks (about 50 million tonnes of grain at that time) should be used without delay to prevent hunger and starvation.”
In the last eight years the Supreme Court has passed more than 50 interim orders in this case, converting many government schemes into legal entitlements – this includes a universal ICDS, universal mid day meal programme, old age pensions, maternity benefits and the benefits under the TPDS5.
The Supreme Court orders, increased civil society action (e.g. the Right to Food campaign), greater political priority to addressing malnutrition (e.g. “universalisation with quality” of the ICDS was part of the Common Minimum Programme of the previous government, and it is repeatedly mentioned by the Prime Minister during Independence Day speeches) and the embarrassment over the NFHS-3 results showing no reduction in malnutrition in spite of unprecedented economic growth, has resulted in greater attention to malnutrition and ICDS in recent times.
This commitment is also reflected, to some extent, in the Eleventh Five Year Plan (EFYP) in which the budget allocation for ICDS has increased four times (in nominal terms) compared to the Tenth Plan. The chapter on nutrition in the Eleventh Plan focuses mainly on the ICDS scheme and the PDS.This commitment is also reflected, to some extent, in the Eleventh Five Year Plan (EFYP) in which the budget allocation for ICDS has increased four times (in nominal terms) compared to the Tenth Plan. The chapter on nutrition in the Eleventh Plan focuses mainly on the ICDS scheme and the PDS.