India faces a huge burden of malnutrition rooted in its social, economic, and cultural asymmetries and challenges. According to the National Family Health Survey (NFHS)-4 conducted in 2014-15, for children under five years of age, 38.4 per cent were stunted (height-for-age), 21 per cent were wasted (weight-for-height), 7.5 per cent were severely wasted (weight-for-height), 35.8 per cent were underweight (weight-for-age) and 58.6 per cent were anaemic.
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These alarming statistics have further worsened, despite several targeted service delivery schemes and outreach programmes by the government. As per the NFHS-5 conducted in 2019, stunting has gone up in 13 states and wasting has gone up in 12 out of 22 states and UTs surveyed, respectively. This abysmal situation is further exacerbated by the emergence of COVID-19 which is expected to push many more children into malnutrition.
The worsening situation of malnutrition in India demands urgent attention and resources to prevent any further backsliding on nutrition indicators. With the revival of Mission Poshan and an allocation of Rs 20,105 crore earmarked for the new national nutrition programme, the government has shown intent to tackle malnutrition.
However, to fight the chronic burden of malnutrition and the simultaneous increase in severe acute malnutrition (SAM) in a holistic manner, more concerted efforts are needed. To achieve India’s “Sustainable Goal” target of reducing under-five mortality by 25 per cent by 2030, the country needs to revamp its strategy and adopt new methods of combating SAM.
Apart from the most popular method of treating children with acute malnutrition at the Bal Sewa Kendra (BSK) or Child Malnutrition Treatment Centers (MTCs), Community Management of Acute Malnutrition (CMAM) is a proven approach to manage SAM in children under five. CMAM involves timely detection and treatment of SAM children without medical complications with ready-to-use-nutrient-dense-foods at the community level itself.
At a time when the pandemic has disastrously upended access to basic healthcare for far-flung communities, leveraging this opportunity will go a long way in ensuring the last-mile delivery of health care services, should there be any other disruptions in the future.
Case Study-Odisha
In 2015, the Odisha government piloted CMAM in tribal-dominated Kandhamal district which had the highest levels of under 5-year child mortality in the state in 2012–13. A standard CMAM approach consisted of setting-up of treatment sites closer to the community, weekly monitoring of uncomplicated SAM children, an in-patient facility to admit children with SAM and associated medical complications along with provision of Modified Energy Dense Nutritional Food (EDNRF), Modified Hot Cook Meal (HCM) and Modified Take Home Ration (THR).
The targeted programme resulted in children achieving the desired weight after treatment, thereby significantly improving the nutritional status in the district. In fact, Odisha’s success in community-led and community-managed experiments in several fields including disaster management, forest management and waste management have become legendary now with only Kerala giving it some competition.
But while Kerala has been a forbearer of such praxis since long, Odisha has been able to reach this level in just the last 20 years with the advent of the Mission Shakti Programme — a scheme to organise women into self-help groups first as a livelihood initiative. In a similar vein, Rajasthan, Gujarat, and Uttar Pradesh are some of the other states that have also shown effectiveness towards this approach.
According to the CMAM Association of India, ready-to-use-nutrient-dense-food can ensure the recovery of a SAM child in two to three months at the community level in most of the cases and reduce the need for treatment at MTCs, ultimately reducing the chances of infections and the overall cost of treatment.
Currently, India does not have a framework or a set of guidelines to address the treatment and the prevention of SAM in children. But, as we gear towards the release of national guidelines for POSHAN 2.0, it is essential to streamline and integrate CMAM as a routine part of the government system.
Since, CMAM has the potential to tackle severe acute malnutrition by strengthening community health systems, a collaborative effort at the community level will ensure the efficient delivery of sustainable healthcare in times to come. Additionally, while prioritising SAM, learnings from best practices of other states, will hold the key to tackle the growing burden of malnutrition.
According to a study by Lancet 2019, multiple forms of malnutrition (MOM) reduce nearly 8 per cent of a nation’s economic growth. As the wealth of the nation depends not only on the skills and knowledge but health and nutrition of its people, it is high time that India caters to its eight million SAM children, if it aspires to be a $5-trillion economy by 2024-25.
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Petrol in India is cheaper than in countries like Hong Kong, Germany and the UK but costlier than in China, Brazil, Japan, the US, Russia, Pakistan and Sri Lanka, a Bank of Baroda Economics Research report showed.
Rising fuel prices in India have led to considerable debate on which government, state or central, should be lowering their taxes to keep prices under control.
The rise in fuel prices is mainly due to the global price of crude oil (raw material for making petrol and diesel) going up. Further, a stronger dollar has added to the cost of crude oil.
Amongst comparable countries (per capita wise), prices in India are higher than those in Vietnam, Kenya, Ukraine, Bangladesh, Nepal, Pakistan, Sri Lanka, and Venezuela. Countries that are major oil producers have much lower prices.
In the report, the Philippines has a comparable petrol price but has a per capita income higher than India by over 50 per cent.
Countries which have a lower per capita income like Kenya, Bangladesh, Nepal, Pakistan, and Venezuela have much lower prices of petrol and hence are impacted less than India.
“Therefore there is still a strong case for the government to consider lowering the taxes on fuel to protect the interest of the people,” the report argued.
India is the world’s third-biggest oil consuming and importing nation. It imports 85 per cent of its oil needs and so prices retail fuel at import parity rates.
With the global surge in energy prices, the cost of producing petrol, diesel and other petroleum products also went up for oil companies in India.
They raised petrol and diesel prices by Rs 10 a litre in just over a fortnight beginning March 22 but hit a pause button soon after as the move faced criticism and the opposition parties asked the government to cut taxes instead.
India imports most of its oil from a group of countries called the ‘OPEC +’ (i.e, Iran, Iraq, Saudi Arabia, Venezuela, Kuwait, United Arab Emirates, Russia, etc), which produces 40% of the world’s crude oil.
As they have the power to dictate fuel supply and prices, their decision of limiting the global supply reduces supply in India, thus raising prices
The government charges about 167% tax (excise) on petrol and 129% on diesel as compared to US (20%), UK (62%), Italy and Germany (65%).
The abominable excise duty is 2/3rd of the cost, and the base price, dealer commission and freight form the rest.
Here is an approximate break-up (in Rs):
a)Base Price | 39 |
b)Freight | 0.34 |
c) Price Charged to Dealers = (a+b) | 39.34 |
d) Excise Duty | 40.17 |
e) Dealer Commission | 4.68 |
f) VAT | 25.35 |
g) Retail Selling Price | 109.54 |
Looked closely, much of the cost of petrol and diesel is due to higher tax rate by govt, specifically excise duty.
So the question is why government is not reducing the prices ?
India, being a developing country, it does require gigantic amount of funding for its infrastructure projects as well as welfare schemes.
However, we as a society is yet to be tax-compliant. Many people evade the direct tax and that’s the reason why govt’s hands are tied. Govt. needs the money to fund various programs and at the same time it is not generating enough revenue from direct taxes.
That’s the reason why, govt is bumping up its revenue through higher indirect taxes such as GST or excise duty as in the case of petrol and diesel.
Direct taxes are progressive as it taxes according to an individuals’ income however indirect tax such as excise duty or GST are regressive in the sense that the poorest of the poor and richest of the rich have to pay the same amount.
Does not matter, if you are an auto-driver or owner of a Mercedes, end of the day both pay the same price for petrol/diesel-that’s why it is regressive in nature.
But unlike direct tax where tax evasion is rampant, indirect tax can not be evaded due to their very nature and as long as huge no of Indians keep evading direct taxes, indirect tax such as excise duty will be difficult for the govt to reduce, because it may reduce the revenue and hamper may programs of the govt.