Reimagining Public Health: Interview With Rajiv Kumar, Vice Chairperson, NITI Aayog

Q: We are almost halfway into the stated goal of the Poshan Abhiyaan – to make India malnutrition-free by 2022. What is your assessment of our progress so far?

 A: We have made steady progress over the last five years. The Poshan Abhiyaan was launched on 8 March 2018 (International Women’s Day), by the prime minister. Since then, we have set up the National Nutrition Council, and we are trying to achieve real-time monitoring of the nutrition status of children and women in the country. To that end, all our 11 lakh anganwadi workers are being connected to a dashboard in the Ministry of Women and Child Development (and about 60% have already been connected). I get a weekly report on all the necessary equipment that we need for measuring the height, weight and other relevant parameters of the children in each state. Some of the results are beginning to show. The Comprehensive National Nutrition Survey (CNNS) conducted by UNICEF showed that malnutrition levels have come down from 38.4% in 2016 to 35.7% in 2018. So far, they’ve come down by one percentage point a year, and we want to raise it to three percentage point [decline] per year. We can achieve that 3% reduction – the current pandemic has come in the way – but we will try very hard to achieve the target. The other part of the target is women’s nutrition.  Fifty per cent of women are anaemic in our country, and that’s harder to [address], but we are trying new forms of food fortification, including rice fortification.

Rajiv Kumar, Vice Chairperson, NITI Aayog

Q: What kind of impact has the outbreak of Covid-19 (and the subsequent lockdowns) had on our nutrition goals?

A: We are trying very hard that this does not deliver a big setback to our nutrition efforts and nutrition levels. We have tried to convert all anganwadis into supply conduits for take-home rations to mothers and children. Therefore, food that children used to have at the anganwadis is now packed and delivered as dry rations. Since Covid-19 kicked in, 8.3 crore children and 5.1 crore women have been given the take-home rations. Our efforts are very much on to make sure that Covid-19 does not derail our malnutrition targets.

Q: What would a holistic and co-ordinated Covid-19 response strategy look like in your opinion, one that prioritizes and provides for the nutritional needs of vulnerable groups and integrates nutrition? What advice has NITI Aayog been giving ministries on next steps?

A: Our effort has been to work not just with the state governments but also with panchayati raj institutions, gram pradhans and district administrations. We are specially focusing on the 112 Aspirational Districts, which have historically had the worst malnutrition levels; and in these districts we are also working with development partners and civil society organizations, such as the Bill & Melinda Gates Foundation and the Piramal Foundation. Our CEO has now written to 92,000 civil society organizations registered on DARPAN, the NITI portal for civil society organizations, to encourage them to work with the state governments and local agencies in keeping nutrition at the forefront andmaking sure that these targets are not set back.

Q: The World Food Programme has warned that the world currently is at the brink of a ‘hunger pandemic’. The United Nations has also called for extraordinary measures because they predict that ‘a spectre of multiple famines looms’ due to the ongoing pandemic. How far is India from a situation like this? What steps is India taking to prevent such a situation?

A: Thankfully, due to our past efforts, India is very far away from any such catastrophe or any hunger/ famine situation. One of our biggest achievements post-independence has been to achieve food security, and also to enact the National Food Security Act (NFSA). I am glad to say that there is a stock of 70 million tonnes of food grain with the FCI [Food Corporation of India], and this is prior to the rabi harvest coming in. This has given us the confidence we need to ramp up our food allocation for the vulnerable sections and also for the migrant workers. As the finance minister announced, 80 crore people have been given an additional five kilograms of food and one kilogram of pulses per month in light of the Covid crisis.

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Recently, we have also implemented the One Nation-One Ration Card, and 18 states are already on board. This is a digitized card, linked to the individual’s Aadhaar card, and will be valid for acquisition of food grains at NFS rates across all states. This reflects significant improvement in portability of food entitlements and thereby ensuring availability. The next step, of course, is going to be issuing them, and ensuring that Aadhaar is linked to this ration card. If you are a migrant worker with only your Aadhaar card with you and you have left your ration card behind with your family, you will still be able to access supplies under the NFSA. That’s a big step – a big achievement that has just been completed.

Further, there has been a decision to provide wheat and rice at heavily subsidized prices (actual amount of subsidy is being currently determined) to all NGOs and charity organizations that are providing cooked meals to migrant workers [and vulnerable groups] during these difficult times. More than 66% of our population is now covered by the NFSA, which means all of them are entitled to these very subsidized rates of food grains. Therefore, both things – purchasingpower, which was the cause of the 1942 famine in Bengal, and non-availability of, which was the cause of the 1967 Bihar famine – have been addressed more than adequately. I feel very confident to say that India will never face the spectre of hunger deaths and famines, now or ever in the future.

Q: Agriculture has a key role to play as far as nutrition security is concerned. How well designed do you believe India’s agricultural policies are as far as this is concerned? Do you see any gaps that are being addressed on priority?

A: Quite often, we mistake nutrition to be the availability of cereals and food grain. Nutrition is more than that; nutrition is about getting the right balance of proteins, vitamins, fat, carbohydrates and other nutrients. These are also produced in the agricultural sector, and a non-diversified agricultural sector will not be able to deliver the necessary amount of fruits, vegetables, poultry products, fish and other forms of proteins. There, I think the good
news is that horticulture, fisheries and poultry have seen much higher growth over the last 10 years than they have seen in the past. Our farmers are beginning to diversify. This government is particularly laying emphasis on the procurement of non-wheat-and rice crops (millets, for example, because they provide much more nutrition than these two crops). We are trying to incentivize farmers to grow higher quantities of millets, lentils and other nutrition-rich crops, and I think we are succeeding. Our agriculture is diversifying, but we need to reduce the distance between the farmer and the consumer. The longer the supply chain, the more difficult it becomes for the consumer to obtain the necessary nutrition. The recent announcements by the finance minister permitting farmers to sell to anybody they like, and removal of the Essential Commodities Act will further reduce the distance between the farm and the fork. Lastly, as I mentioned earlier, fortification is important. We need to process our agricultural output, fortify it, standardize it, and the government is working on this and you will see results very soon. I think we are making agriculture more nutrition sensitive, more nutrition oriented, than what it was earlier.

Q: The Poshan Atlas, once developed, would be a unique database that maps food consumption patterns and links them with information on crop varieties. How will this help in addressing malnutrition or the control of non-communicable diseases like obesity and diabetes?

A: Once completed, it will be an amazing instrument for us. Given our diversity and India’s continental scale, one size will not fit all and we need a very heterogeneous basket of nutritional intake and inputs to be able to achieve our [nutrition] targets. The importance of local varieties of grains, cereals and millets is extremely important. The Poshan Atlas will give a complete breakdown – a very disaggregated picture of all that is being produced in different parts of the country. Once we get that, we can start to make changes at local levels to suit the needs and requirements of the population there. The Atlas would enable us to plan and intervene at a very micro level, where it matters. We will be able to intervene to ensure there are enough supplies of nutritious, locally adaptable food for children, and adults as well. The Atlas will be inherently connected to agriculture, and it will be able to help us improve agricultural productivity and agricultural diversity once we get that data. I am looking forward to the completion of the Atlas and I hope it will be completed within the year.

Q: Centrally sponsored schemes (CSS) have been criticized for their centralized nature and procedural inefficiencies. The current government has also emphasized that it wants to rationalize these schemes. In the specific context of financing nutrition- specific and nutrition-sensitive CSS, what kind of reforms do you believe are needed?

A: The first part of the question you asked is very important. We need to shift from input-based performance evaluation to outcome-based performance evaluation. The NITI Aayog has given the task to the Development Monitoring and Evaluation Office (DMEO), an affiliate organization of NITI Aayog. DMEO is in the process of completing an output-outcome based performance evaluation of nearly all the 300-odd centrally sponsored schemes. That could bring about a very big change. We have also created a 700-lines output-outcome performance matrix for all the budget heads. This outcome-based performance evaluation is likely to increasingly become the basis for allocating budgetary resources to
different schemes. So, we are making that move and we will achieve that. Regarding the second part of the question on financing, we have been allocating sufficient resources from the central budget for these big schemes like the National Health Mission and the Integrated Child Development Scheme. Resources have not been a constraint; the constraint has been the quality and effectiveness of implementation and delivery. Several international foundations and organizations are also interested in helping with financial resources in the nutritional effort. So, financing is not a problem because the central government is committed to providing as much as is required to achieve the target. But  if need be, we will not hesitate to go to the multilateral organizations to mobilize more resources.

Q: What kind of reforms does our federal fiscal structure need to maximize the impact of the schemes across states?

A: My understanding is that we need to financially empower the third tier of government (the urban local bodies and the panchayati raj institutions, which in effect implies the full implementation of Constitutional amendments 73 and 74) and make them accountable. The prime minister has said that the Poshan Abhiyaan should be converted into a Jan Andolan, and unless this is a social movement, we will not get rid of malnutrition, whether of our children or of women. It will happen only if the local leadership and local institutions get involved in it completely. For that to happen, we need to financially empower them and make them accountable by taking surveys and feedback from beneficiaries. I think that’s a governance reform is required to bring the delivery of public services under these schemes to expected levels.

 Next: CSR, Global Nutrition Report, and the Migrant Crisis

 Copyright Seminar Publications. This article was published in Seminar's June 2020 edition. Seminar is a monthly journal that discusses various national and international issues. Each issue of the journal focuses on a single problem, bringing together different viewpoints, to provide in-depth insights to readers and decision makers.