New Delhi: India has entered Unlock 2.0, but the impact of the COVID-19 pandemic on nutrition is going to be felt in the years to come. The provision of nutrition services through various schemes of the Union and State government were hit during the lockdown (from 24 March - 31 May), and are yet to fully recover. The lack of adequate nutrition is likely to impact some groups much harder than others, such as pregnant women, and children below the age of 2. Gaps at these ages can lead to lifelong challenges such as cognitive impairment, poor health, and anaemia.
The Government of India’s Integrated Child Development Services (ICDS) is a major programme aimed at providing basic education, health, and nutrition services for early childhood development. The scheme is delivered through a network of Anganwadi Centres which are available in every village and run by Anganwadi workers (AWWs) and helpers (AWHs).
As of June 2019, India has 13.78 lakh Anganwadi centres, 13.21 lakh AWWs, and 11.82 lakh AWHs. In over 45 years of its functioning, the scheme has become the backbone of India’s nutritional efforts. At the Accountability Initiative, Centre for Policy Research, we have tracked the scheme’s progress for almost a decade and have found that there were several areas of concern that have existed even prior to the pandemic. The COVID-19 crisis is likely to deepen these.
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The first challenge is with respect to insufficient coverage. ICDS is a universal scheme, which means all pregnant women, lactating mothers, and children (6 months - 6 years) are eligible for its services if they need them. As of June 2019, as many as 8.36 crore people received supplementary nutrition in the form of Hot Cooked Meals (HCM), or Take Home Rations (pre-cooked food, or rations such as dal) from ICDS.
While this may seem like a large number of people, if we compare the number of children (6 months - 6 years) who should receive supplementary nutrition with those who actually received it, there is a large shortfall. In 2019, in 21 states and UTs, less than half the eligible children actually got supplementary nutrition through ICDS.
An associated concern is making sure that, if received, supplementary nutrition is consumed by people. For example, THR is often shared with the entire family, especially those meant for pregnant women and lactating mothers. This implies they do not receive the nutrition supplement as envisaged by the scheme.
The pandemic and the lockdown has also led to the temporary closure of Anganwadi Centres to prevent the virus’ spread. More families will require nutrition and early education services in the near future as a large number of migrant workers head home. Anganwadi centres too will have to adapt to the new situation and start to maintain physical distancing and other protocols, all of which will take time. Moreover, since livelihoods have been affected and cash flows are low - meeting even daily food requirements has been a challenge. Maintaining nutrition levels for pregnant women and lactating mothers will be even harder.
Moreover, Anganwadi Centres rely on Anganwadi Workers (AWWs) and other staff. They are responsible for various activities like counselling, maternal care, early childhood education, amongst others. Unfortunately, since they are categorised as volunteers and contractual labour under the government’s current ICDS guidelines, they are not given a fixed wage. They receive an honorarium which is significantly lower than the minimum wage for skilled government workers offered in most states. In October 2018, the honorarium was finally increased after an 8-year gap from ₹3,000 to ₹4,500 for workers and ₹1,500 to ₹2,250 for helpers. Despite this increase, their honoraria remain abysmally low. There have been numerous instances that even these amounts are not paid on time - resulting in strikes across several states such as Bihar and Jharkhand.
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In COVID-19 times, these Corona Warriors are playing a crucial role in going house-to-house to spread awareness and conduct surveys. In fact, as per the Union government’s COVID-19 containment plan, AWWs have been given a substantial role in awareness generation and basic screening of symptoms. Yet, when we spoke to some of them to know about their experiences (available here), they have to do their regular jobs as well as COVID-19 related tasks, and lack resources to carry out these tasks. In such circumstances, it can prove difficult for them to provide the attention and care needed on nutrition and early education under ICDS. Also, with state revenues low, there is a danger that expenditures will be directed towards other urgent needs such as hospital beds, protective equipment, rations, and so on, at the cost of adequate compensation to these frontline workers.
So, how can these concerns be addressed?
In India, where 68% of deaths of children under 5 are due to malnutrition (see here for more), a disruption in service delivery induced by the lockdown and the pandemic, can have long-lasting effects for children born around this time. It is heartening to see that several states have announced measures related to ensuring nutrition services, including providing dry rations in lieu of HCM and THR to those registered in Anganwadis. There are, however, a few things to be cautious of:
First, coverage will need to be expanded beyond just previously registered beneficiaries. Thus, it is imperative that the government re-assess the number of people who need access to these services via regular surveys conducted by AWWs. The current door-to-door awareness campaigns for COVID-19 can be leveraged to assess the number of people in the area to prevent anyone from being left out.
Second, ensuring that supplementary nutrition reaches pregnant women and children and to ensure that risk of infection is avoided, doorstep delivery of ration may be required as is being done by states such as Odisha. Some states - like Jharkhand - have disbursed several months of ration at once to minimise frequent contact. However, this needs to be juxtaposed with the availability of storage space in homes.
Another option is to provide cash transfers should the provision of food be challenging in certain areas. This is what the Bihar government has done by providing cash every month in lieu of supplementary nutrition to Anganwadi beneficiaries. However, if cash transfers are used, it will be important to ensure that all beneficiaries have accounts, that the money reaches them in a timely manner, and that they are able to utilise the money.
Third, since the sharing of THR is driven by a lack of food, and given the limited availability of food during the lockdown, counselling women on adequate diets is important. Such counselling can occur when THR is provided, or when health workers visit households to spread awareness. These platforms can be supplemented by radio and mass media campaigns as well.
Finally, ring-fencing funds allocated for nutrition to ensure the provision of key services is a must. This means that all nutrition-related funds, including AWW honoraria, should be released in full and on time. The last few years have seen a significant push to eradicate malnutrition via the Union government’s POSHAN Abhiyaan and various campaigns within it. The outbreak of the pandemic and the subsequent lockdown has halted many of these activities. Picking up the pace once again is crucial for India’s continued fight against malnutrition.
Avani Kapur, Director, Accountability Initiative
Ritwik Shukla, Research Associate, Accountability Initiative
Avantika Shrivastava, Senior Communications Officer, Accountability Initiative
