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Published 22 September
2009, doi:10.1136/bmj.b3886
Cite this as: BMJ 2009;339:b3886
India
makes little progress on child malnutrition despite steady economic growth
Ganapati
Mudur
1 New Delhi
Poor oversight of nutrition programmes, faulty project design, and a lack of focus on the most needy population groups are frustrating India’s efforts to reduce child malnutrition, a publication from the Institute of Development Studies at the University of Sussex has said.
Despite India’s steady economic growth of an average of more than 6% in the past 15 years, the percentage of children under 3 years of age who are underweight fell by only six percentage points between 1993 and 2006, from 52% to 46%, says the latest issue of the IDS Bulletin, which comprises analytical papers from economists and nutrition policy experts.
At this rate of progress the United Nations’ millennium development goal target of reducing the number of people suffering from hunger by 50% will be reached in India only in 2043 rather than the target year of 2015, said Lawrence Haddad, director of the institute, who is also coeditor of the report.
Government surveys show that about half of India’s 150 million children under 6 are underweight. India’s Integrated Child Development Services, which were launched in 1975 to deliver preschool education, immunisation, and nutrition services to children aged under 6, has been plagued by bad policies and faulty implementation, the report’s authors claim.
"Nutrition services are not reaching those who need it the most," said Nisha Srivastava, professor of economics at the University of Allahabad and an author of one of the papers. "The Integrated Child Development Services programme staff are overworked. There are no incentives, no rewards for good work done, and a lack of motivation."
Studies in some states indicate that poor people from marginalised and socially excluded groups do not have adequate access to the services. Health surveys show that 30% of children under 6 months of age are underweight, but nutrition interventions do not seem to be reaching many children aged under 24 months, Dr Haddad said.
He said that India would need to strengthen its efforts to ensure that adequate nutrition reaches these younger children, to generate more frequent data on nutrition, and to use performance audits to guide its child nutrition policies.
The bulletin also cautions that India’s child development programme has neglected issues such as personnel management and monitoring of results. A study in 2007 had detected "pilferage, wastage, and lack of quality assurance" in nutrition delivery services.
The feeding programme has passed into the hands of the private contractors who supplied ready to eat nutrition powders that were culturally inappropriate and inadequate and that in many cases never reached the intended recipients, the 2007 study said.
But some nutrition experts not associated with the report argued that it would be unfair to attribute the slow pace of change entirely to problems with the Integrated Child Development Services.
"This programme has had many achievements," said Umesh Kapil, professor of public health nutrition at the All India Institute of Medical Services, New Delhi. "It has reduced infant mortality, improved health services, and contributed to women’s empowerment."
"We need to look beyond nutrition to address this lingering malnutrition," Dr Kapil added. "We need horizontal [economic] development for all sections of society to derive the benefits of economic growth."
Cite
this as: BMJ 2009;339:b3886