Over the last decade, momentum around nutrition has been steadily building: in 2012, the World Health Assembly (WHA) adopted the 2025 Global Targets for Maternal, Infant and Young Child Nutrition.

And on June 14, the latest edition of the Global Nutrition Report was released. It, however, did not have many nice things to say about the state of nutrition in India. As per the report, India’s progress in reducing the child under-nutrition rate in India is still well below what needs to be achieved as the country lags behind many poorer countries of Africa. 

The Global Nutrition Report, an independent and comprehensive annual review of the state of the world’s nutrition, is a multi-partner initiative that acts as a report card on the world’s nutrition – globally, regionally, and country by country – and on efforts to improve it. It assesses progress in meeting Global Nutrition Targets established by the WHA.

The third panel of the report that talks about the state nutrition missions in India, says, “Although declines in India’s child under-nutrition rates have accelerated since 2006, these faster developments are still well below the rates of progress needed to achieve the global nutrition targets adopted by the WHA to which India is a signatory. India lags behind many poorer countries in Africa south of the Sahara; at current rates of decline, India will achieve the current stunting rates of Ghana or Togo by 2030 and that of China by 2055. Further, nutritional status and progress in India vary markedly across its states. India urgently needs to take target setting to the subnational level to achieve global nutrition targets and Sustainable Development Goals (SDGs).”

Key points of the section (State nutrition missions in India) are:

•    Maharashtra is the first state in India to launch its independent state nutrition mission in the form of an autonomous technical and advisory body, in 2005, under the Department of Women and Child Development.   
•    Five other states followed and have launched their respective missions based on the Maharashtra model: Madhya Pradesh, Uttar Pradesh, Odisha, Gujarat, and Karnataka. All six state nutrition missions focus on the 1,000-day post conception period and commit to improving inter-sectoral coordination in order to improve child nutrition.   
•    Only two of the six states have clear, measurable targets for nutritional outcomes – Uttar Pradesh State Nutrition Mission and Odisha’s Nutrition Operation Plan. The action plan of Maharashtra’s Rajmata Jijau Mother-Child Health and Nutrition Mission includes monitoring of 10 important indicators related to maternal and child health but does not specify measurable targets and time frames for these indicators. The states of Gujarat, Madhya Pradesh, and Karnataka do not include any specific targets in their mission statements.   
•    Not all targets align with the global nutrition targets: Uttar Pradesh includes four of the six targets – it excludes low birth weight and overweight prevalence but includes underweight prevalence as an additional indicator that is not a global target. Odisha’s Nutrition Operation Plan includes only stunting, wasting, and underweight, excluding the other global targets of women’s anaemia, exclusive breastfeeding, child overweight, and low birth weight.   
•    In states that have targets, the targets are based on older data. For example, the Uttar Pradesh State Nutrition Mission’s plan for 2014–2024 is based on findings from India’s National Family Health Survey 3 (NFHS-3), from 2005–2006, and includes time-bound targets for stunting, wasting, underweight, exclusive breastfeeding, and women’s anaemia. Progress across the target indicators could instead be measured using the recently released Rapid Survey on Children 2014 data for baseline values to reflect the most recent status of undernutrition in the state. Likewise, Odisha’s Nutrition Operation Plan, aimed at accelerating underweight reduction in 15 high-burden districts of the state, includes targets for stunting, wasting, and underweight based on NFHS-3, 2005–2006 levels.

The report suggests that “an urgent action call is needed for all states to use new, updated data to report the current status of nutrition and set new targets.” It also says that one reason why the nutrition missions in India do not cover all targets enumerated is likely that they are typically housed in the state department or ministry of women and child development (WCD), whose agenda is supplementary nutrition. Issues that fall in the domain of other departments, such as health, do not get articulated in WCD departments’ plans or missions. This situation demonstrates the need for multi-sectoral missions or agencies, cutting across departments, with clearly defined and measurable targets and monitor-able action points for all sectors.

Key points from the section (Budgeting for nutrition in India) are:

•    First, in 2016, the Indian government, at the central level, allocated approximately $5.3 billion in total to nutrition-specific programs such as the Integrated Child Development Services Scheme and the National Health Mission. It allocated $31.6 billion in total to several programmes aimed at improving the underlying determinants of nutrition, such as the Public Distribution System (PDS), which focuses on food security, the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), which focuses on livelihood security in rural areas, and the Swachh Bharat Mission, which is focused on sanitation.    
•    Second, although a large amount of money is committed to nutrition-specific interventions, it falls $700 million short of the $6 billion per year Menon, McDonald, and Chakrabarti (2015) estimate is needed. The Indian government could meet this independently assessed target by increasing the budget 13 percent.   
•    Third, programmes such as the PDS (food subsidy) and MGNREGA (employment security) that target underlying determinants account for about 70 percent of India’s expenditure on nutrition. Such allocations, and those available from the central government for the sanitation mission, can help create more supportive home environments for improved nutrition, if well implemented. For all these programmes, the onus of strengthening centrally sponsored government schemes by reducing inefficiencies, improving targeting, and ensuring greater convergence of the schemes lies with the state governments.    
•    Finally, due to changes in the country’s fiscal architecture, there are now opportunities for states to increase their commitment to nutrition and allocate additional state financing. But there is a risk that states may not prioritise nutrition. Guidelines for prioritising and allocating financing available from the central government could help strengthen nutrition-financing efforts at the state level as well.