The NITI Aayog published nutrition charts on 17 January this year. As India recognises nutrition as a national issue and gears up for the National Nutrition Mission (NNM), publishing such data helps a wide variety of persons associated with the healthcare and nutrition ecosystem in our country to get into action mode and aid in the implementation of the mission.
The Global Nutrition Report 2015 estimates that investment in nutrition has a cost-benefit ratio of 1:16 for 40 low- and middle-income countries. Moreover, such an investment is recognised globally as both a critical development imperative and a pathway for the fulfillment of human rights.
The Aayog data represents the current state of nutrition in our country. Data collection from across national and district levels paints a real-time picture of progress and outcome assessment. This transparency is a huge welcome step; it will help in such ways as providing a data-driven approach to problem-solving, analytical and timely choosing of appropriate policy intervention, drawing of best practices introduced in different states in achieving targets, involvement of relevant non-governmental organisations (NGOs) for grassroots information dissemination and improving cooperative and competitive federalism by corresponding incentivisation of the best-performing states.
This data calls for an urgent and well thought-out plan of action to improve the nutritional outcomes of the country.
Indicators Used
The key indicators that the report includes are ‘stunting’, ‘wasting’ and ‘underweight’.
Stunting (low height for age), a direct consequence of malnourishment, is a key indicator to understand the nutrition status of various states and districts. The overall stunting rate of the country is 38.4 per cent, and the United Nations International Children’s Emergency Fund (UNICEF) places this at “High” as it is between 30 per cent and 40 per cent. Kerala is the best-performing state with 19.7 per cent stunting, and Bihar records the highest stunting rate, at 48.3 per cent.
The stunting map suggests that the states in the middle region, namely Rajasthan, Madhya Pradesh and Uttar Pradesh, have high levels of stunting, the plateau states have reasonably low levels, and the northernmost and southernmost states seem to be performing well. Including Maharashtra and Gujarat, the picture is similar to that seen in the ‘underweight’ indicator.
While stunting is a chronic problem, ‘wasting’ is a relatively short-term issue that can be rectified with the help of a proper nutrition plan. Without cure, however, this could lead to ailments like tuberculosis and chronic diarrhoea. The northeastern states have reasonably low rates of wasting while western India has high levels of it. Mizoram is the best-performing state for this indicator, and Jharkhand records the highest wasting rate.
Anaemia is still a major cause for concern, with India being among countries that have a very high percentage of anaemic people. While the northeastern states, Kashmir, Kerala and Tamil Nadu are better off, Jharkhand, Madhya Pradesh and Haryana register a high prevalence of anaemia. It is especially alarming among children in the age group of six to 59 months. Assam records the highest rate of change with 33 per cent improvement.
The prevalence of anaemia among women in the northeastern states is quite less, while Jharkhand and Haryana record more than 60 per cent prevalence.
We see from the various visualisations that states in the northeast score reasonably high on the Nutritional Index, indicating a healthier population, while a few states like Jharkhand, Uttar Pradesh and Haryana require a strong nutrition plan in place.
When trying to tackle the problem on a large scale, it’s convenient but also risky to adopt a quick-fix solution to boost nutrition levels. The Ministry of Women and Child Development was proactive in issuing a notification that the ready-to-use therapeutic food (RUTF), which is a mixture of peanut, oil and other ingredients, does not have scientific backing and therefore cannot be accepted as a policy of the government. This happened when some states were trying to use it to tackle nutrition problems.
It would be interesting to go beyond these numbers and analyse contributing factors like healthcare support and budget, pre-natal care and so on in each of these states to make the data more robust.
Now that we have data that offers us a good picture of the problems, what could be some potential solutions?
The NITI Aayog has detailed key strategies to tackle the nutrition problem in their “Nourishing India” document. It highlights the role of multiple stakeholders including the panchayats, service delivery models and specific interventions to boost nutrition. What could make the solution more locally and globally optimum is:
a) Encouragement of local food cultivation that will ensure sustainable consumption combined with nutritional benefits
b) Integration of insights from yoga and Ayurveda as these Indian systems offer concrete insights and frameworks to understand the state of the health of an individual and a collective society, and can provide scalable health solutions.
In these areas, the involvement of the AYUSH Ministry in designing a comprehensive nutrition plan will prove highly beneficial.
The NITI Aayog data has great potential to become the basis for an all-round nutrition plan. What would be important at this stage is to involve multiple stakeholders, including successful civil societies, holistic health systems experts and local community experts, among others, to design a plan that helps tackle the problem organically. While quick-fix standardised solutions can improve indicator numbers in a short period of time, for long-term and robust health benefits of children and expectant mothers, a holistic solution is necessary.
Recent Posts
- In the Large States category (overall), Chhattisgarh ranks 1st, followed by Odisha and Telangana, whereas, towards the bottom are Maharashtra at 16th, Assam at 17th and Gujarat at 18th. Gujarat is one State that has seen startling performance ranking 5th in the PAI 2021 Index outperforming traditionally good performing States like Andhra Pradesh and Karnataka, but ranks last in terms of Delta
- In the Small States category (overall), Nagaland tops, followed by Mizoram and Tripura. Towards the tail end of the overall Delta ranking is Uttarakhand (9th), Arunachal Pradesh (10th) and Meghalaya (11th). Nagaland despite being a poor performer in the PAI 2021 Index has come out to be the top performer in Delta, similarly, Mizoram’s performance in Delta is also reflected in it’s ranking in the PAI 2021 Index
- In terms of Equity, in the Large States category, Chhattisgarh has the best Delta rate on Equity indicators, this is also reflected in the performance of Chhattisgarh in the Equity Pillar where it ranks 4th. Following Chhattisgarh is Odisha ranking 2nd in Delta-Equity ranking, but ranks 17th in the Equity Pillar of PAI 2021. Telangana ranks 3rd in Delta-Equity ranking even though it is not a top performer in this Pillar in the overall PAI 2021 Index. Jharkhand (16th), Uttar Pradesh (17th) and Assam (18th) rank at the bottom with Uttar Pradesh’s performance in line with the PAI 2021 Index
- Odisha and Nagaland have shown the best year-on-year improvement under 12 Key Development indicators.
- In the 60:40 division States, the top three performers are Kerala, Goa and Tamil Nadu and, the bottom three performers are Uttar Pradesh, Jharkhand and Bihar.
- In the 90:10 division States, the top three performers were Himachal Pradesh, Sikkim and Mizoram; and, the bottom three performers are Manipur, Assam and Meghalaya.
- Among the 60:40 division States, Orissa, Chhattisgarh and Madhya Pradesh are the top three performers and Tamil Nadu, Telangana and Delhi appear as the bottom three performers.
- Among the 90:10 division States, the top three performers are Manipur, Arunachal Pradesh and Nagaland; and, the bottom three performers are Jammu and Kashmir, Uttarakhand and Himachal Pradesh
- Among the 60:40 division States, Goa, West Bengal and Delhi appear as the top three performers and Andhra Pradesh, Telangana and Bihar appear as the bottom three performers.
- Among the 90:10 division States, Mizoram, Himachal Pradesh and Tripura were the top three performers and Jammu & Kashmir, Nagaland and Arunachal Pradesh were the bottom three performers
- West Bengal, Bihar and Tamil Nadu were the top three States amongst the 60:40 division States; while Haryana, Punjab and Rajasthan appeared as the bottom three performers
- In the case of 90:10 division States, Mizoram, Assam and Tripura were the top three performers and Nagaland, Jammu & Kashmir and Uttarakhand featured as the bottom three
- Among the 60:40 division States, the top three performers are Kerala, Andhra Pradesh and Orissa and the bottom three performers are Madhya Pradesh, Jharkhand and Goa
- In the 90:10 division States, the top three performers are Mizoram, Sikkim and Nagaland and the bottom three performers are Manipur and Assam
In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance
The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.
Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.
The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.
The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)