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Strengthening nutrition-sensitivity of social protection programmes in India: What will it take?

Strengthening nutrition-sensitivity of social protection programmes in India: What will it take?

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This presentation by Suman Chakrabarti, IFPRI was shown at the Transform Nutrition - Evidence for Action regional meeting in Kathmandu, Nepal on 8 July 2017. This one-day event shared Transform Nutrition evidence on key issues related to nutrition policy in Nepal, Bangladesh and India, lessons on strategies for change from other contexts and discuss the relevance and applicability of the research findings to policies/programmes that aim to address nutrition in South Asia.

This presentation by Suman Chakrabarti, IFPRI was shown at the Transform Nutrition - Evidence for Action regional meeting in Kathmandu, Nepal on 8 July 2017. This one-day event shared Transform Nutrition evidence on key issues related to nutrition policy in Nepal, Bangladesh and India, lessons on strategies for change from other contexts and discuss the relevance and applicability of the research findings to policies/programmes that aim to address nutrition in South Asia.

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Strengthening nutrition-sensitivity of social protection programmes in India: What will it take?

  1. 1. Strengthening nutrition-sensitivity of social protection programs in India Suman Chakrabarti with Kalyani Raghunathan, Purnima Menon and Harold Alderman
  2. 2. The WHA targets for nutrition – is India on track? Notes: Targets based on author’s estimate. No data on child overweight in 2016 were available from the NFHS 4. Reported figure is from a pooled sample of AHS and DLHS4 weighted by population.
  3. 3. Basic features of Right to Work and Right to Food programs in India Feature Right to work Right to food (NFSA) MGNREGA TPDS MDMS Mandated/reformed in 2005 2013 2013 Eligible population All rural households AAY, BPL and APL families Children aged 6- 14 in government and government- aided schools Basic provisions 100 days of unskilled manual work per household per year, at a govt. specified minimum wage 5 kg per person per month of rice, wheat and coarse cereals available through ration shops at 3/2/1 rupees per kg, respectively. A free lunch at school providing 12 grams of protein and 450 calories per child per meal. Nutrition oriented actions/interventions introduced No Yes, fortification and diversification of the food basket Yes, fortification, diversification of food provided, deworming and micro-nutrients
  4. 4. A framework for maximizing nutrition sensitivity Ruel and Alderman (2013) outline three approaches that social protection programs can take to have a greater impact on nutrition, i.e. be more ‘nutrition-sensitive’. 1.addressing the underlying determinants of fetal and childhood nutrition and development 2.incorporate specific nutrition goals and actions 3.serve as delivery platforms for nutrition-specific interventions
  5. 5. Applying the framework – Public Distribution System 1. The basic mandate: improve food security Ensure that the scheme reaches the intended target population with low levels of leakage. Coverage of the Targeted Public Distribution System by consumption expenditure quintiles and years (NSS-CES)
  6. 6. Public Distribution System 1. Fulfill the basic mandate first! 2. Specific nutrition goals : Subsidize pulses? Chakrabarti, Kishore & Roy (2016) find that impact is positive but small on total pulses consumed. Fortification of cereals? Raghunathan, Chakrabarti, Kishore, Scott (2017- ongoing) find that impact on anaemia is positive in Tamil Nadu but none in Punjab. 3. Make ration shops delivery platforms for ORS, DFS and nutrition BCC for improved IYCF practices? – no studies found
  7. 7. Applying the framework – The Mid-day Meal Scheme 1. The basic mandate: improve food and nutrition intake in schools and increase attendance. Routinely monitor and focus on nutritional content, hygiene, and infrastructure (Shukla 2014, Planning Commission 2010, Chhabra & Rao 2014) Coverage of the Mid-day meal scheme by gender and years (NSS-CES)
  8. 8. The Mid-day Meal Scheme 1. Fulfill the basic mandate first! 2. Specific nutrition goals : Fortification of cereals? – Evidence suggests impact is positive on outcomes studied (Fiedler et al. 2012, PATH 2009, Paithankar et al. 2015, Bhagwat, Gulati, et al. 2014, Bhagwat, Sankar, et al. 2014) Double fortified salt? – Potential for being cost-effective (Horton et al. 2011) 3. Make schools delivery platforms for deworming, IFA, and vitamin A supplementation for children? Already in MHFW portfolio but evidence on impact in thin (Gopaldas 2005, Bobonis et al. 2006).
  9. 9. Applying the framework – The MGNREGA 1. The basic mandate: improve household income and protect against adverse events. Reduce leakage and ensure timely payments. More research required impact on incomes, household food security, dietary diversity and nutrition Demand and coverage of the Mahatma Gandhi National Rural Employment Guarantee Scheme (2011-2012) (NSS-EUS)
  10. 10. The MGNREGA 1. Fulfill the basic mandate first! 2. Specific nutrition goals : -Construction of wells to improve access to safe drinking water. -Construction of toilets to reduce open defecation. -MGNREGA employees can be employed as cooks and helpers in the MDMS, caregivers in crèches and housekeepers in primary health centers to address labor shortfall. 3. Use MGNREGA to deliver maternity benefits (cash transfers) A MGNREGA maternity benefit would allow women to be compensated for lost wages from time off work, enabling exclusive breastfeeding and discouraging pregnant women from engaging in risky manual labour.
  11. 11. A synthesis of the framework Approach one Approach two Approach three Address the underlying determinants Incorporate specific nutrition goals and actions Delivery platforms for nutrition-specific interventions | | | Public distribution system _____ Openness in targeting, administrative reform, and technological upgrades. Cash transfers in some critical areas Cereal fortification or adding pulses Make oral rehydration salts (ORS), DFS, sachets for home fortification of food available at fair price shops | | | Mid-day meal scheme _____ Routinely monitor at the state level or district level, focus on nutritional content, hygiene, and infrastructure, and ensure that delivery meets government norms Cereal fortification, double fortified salt, or add fruits/eggs Deworming, vitamin A and iron tablets | | | Mahatma Gandhi national rural employment guarantee scheme (act) _____ Reduce leakage and ensure timely payments Construction of toilets within the village, employ workers in MDMS as cooks and helpers and set up crèches at worksites To provide a maternity benefit during the 1000 day window
  12. 12. But how much will it cost?
  13. 13. Key takeaways • Strengthening service delivery: All interventions have problems in implementation ranging from corruption, to not adhering to quality standards, to ensuring pro poor access.They must be addressed first. • Innovations: The use of flagship programs as delivery platforms emerges as a natural choice.Additions to existing platforms could include subsidizing new food items such as fruits, pulses and fortified cereals or even convergence between programs with specific goals. • Systems of monitoring and evaluation need to be imbedded as routine practices for all interventions. • Final policy actions must be based on rigorous cost-benefit analyses of all possible options for maximum impact and lowest cost.
  14. 14. Thank you
  15. 15. But how much will it cost? Intervention Estimated program cost in 2014 (per year) Estimated intervention/action cost for 2014 (per year) Estimated additional cost as a percentage =(3)/(1)*100 US$ million (1) `000 crore INR (2) US$ million (3) `000 crore INR (4) Diversification of food baskets Pulses through TPDS 16,744 109 3200.7 20.8 19.12 Bananas through MDMS 3,906 25 213.1 1.4 5.46 Eggs through MDMS 3,906 25 778.8 5.1 19.94 Fortification TPDS Wheat fortification through TPDS using large roller mills 4,722 31 13.0 0.1 0.27 Wheat fortification through TPDS using chakki plants 4,722 31 16.2 0.1 0.34 Rice fortification through TPDS using cold extrusion 12,022 78 586.6 3.8 4.88 MDMS Wheat fortification through MDMS using large roller mills 3,906 25 9.1 0.1 0.23 Rice fortification through MDMS in centralized kitchens 3,906 25 38.4 0.2 0.98 Double Fortified Salt through MDMS 3,906 25 31.7 0.2 0.81 Anthelmintics and micronutrients Deworming, vitamin A and iron tablets provided through MDMS 3,906 25 44.2 0.3 1.13

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