Archive for the ‘government’ Category

Guess Who’s Coming To Dinner?

You may be wondering why I am resurrecting a schmaltzy 1967 American rom-com movie, fifty years after we saw it on screens in India. True, it played on the theme of interracial marriage, so relevant in these days of “love jihad”. But that is not why I dwell on the guest who is coming to dinner. I am intrigued, and not a little amused, by the recent directive from the Prime Minister, no less, to his party MPs and Ministers to dine with Dalit families. That, more than seventy years after independence and after the enactment of a progressive Constitution that enjoins the virtues, among others, of equality and fraternity, elected representatives who represent all citizens, including its disadvantaged poor, have to be issued a firman to break rotis with those traditionally beyond the pale of the caste system is a telling commentary on the deep cleavages that still fissure Indian society.

What strikes me as ludicrous is that those representing the people have to be told to interact with them. Recent months have seen stories of Chief Ministers, belonging to the dispensation ruling at the centre, eating at Dalit houses. We have been fed with salacious details of how plates, food and water were organised from outside so that the VIP could be captured on celluloid enjoying his victuals in the Dalit house. A very recent news report has detailed the elaborate exercise of a ruling party MP dining at a Dalit house. This former civil service colleague took to politics after a career in the civil services. I wondered whether he didn’t find this entire exercise unreal, given the interaction that civil servants get to have with all sections of society in the course of travels across villages and towns during their working years.

From personal experience, my extensive travels across Maharashtra have taken me to tribal habitations, Dalit vastis and urban slums. I have been privileged to be the guest of poor families, who have shared tea (often without milk), poha and any other food item in the house with the unexpected guest. Many politicians I have known have also accepted food and drink readily during their tours, without bothering about the caste, religion or social status of their hosts. Which is why I find it inexplicable that a national political party finds it necessary to impose a diktat on its party men (and women) to interdine with members of a particular social group. Does this imply that, over the past four years, these peoples’ representatives have given the cold shoulder to the poor and disadvantaged, to the extent of not even visiting their humble dwellings and sharing chai-biskut with them?

What I find more reprehensible are the accounts of apparently stage-managed dinners. There have been reports of meals at certain locations being organised from outside the Dalit vasti, although the actual consumption by the VIP took place in a Dalit home. More to the point, the visits to the Dalit habitations, whether by a Chief Minister, Minister, MP or MLA, do not often see any tangible improvement in the living conditions of local residents, partly because of the poor governance and infrastructure systems in place and more so because of the lack of opportunities for benefiting from economic growth processes.

That such publicised dinner visits reek of symbolism is one of the unfortunate spinoffs of such exercises, captured beautifully by the inimitable Hemant Morparia in a recent cartoon.

While there are many sincere politicians at different levels, there is no denying that, in the race for one upmanship that politics, in India and elsewhere, has descended to, photo opportunities are used to advance ones’ reputation in the eyes of those who matter, especially in these days of Twitter, Facebook and WhatsApp. It would be extremely heartening if the visit by a Minister / MP / MLA was followed up with intensive efforts to address the shortcomings in delivery of public services that were observed during the visit. Unfortunately, such visits tend to be one-off instances, restricted to mentions in the press and reports to political superiors on one’s efforts, spectacle rather than substance.

The other issue of concern is the widening gulf between the elected representatives and their electorate. Sighting an MP/MLA in the constituency between two elections is akin to spotting a black swan. Why, even getting to see the local corporator on the streets is a rarer occurrence than seeing a blue moon. MPs/MLAs, many of whom do not even regularly stay in the constituencies that elected them, have no system of judging the extent to which they are meeting the specific requests of their constituents (with honourable exceptions like Shashi Tharoor and Jay Panda). The result is a growing disillusionment and cynicism in the electorate, which looks to extract short-term benefits near election time, a dangerous trend in a democracy.

Having reached the ranks of the senior citizenry some time back, I feel entitled to offer my two bits of advice to MPs and MLAs.  Firstly, do try to leave your constituency looking somewhat better than when you first got elected. Insist on certain standards of efficient public service delivery, especially in the areas of health care, education and food security. It is saddening to see the ramshackle state of the public health services, ICDS and public distribution systems in constituencies that have been the pocket boroughs of particular individuals or families for years on end. Use technology to monitor processes and outcomes and develop a cadre of local youth who can facilitate the reach of basic services to the public, particularly the poor and disadvantaged.

Secondly, please use your term(s) in elected office to meaningfully contribute to the passage of effective laws that improve the economic and social conditions of your fellow citizens. This will require less of rushing to the well of the legislature and disrupting business to drive home some inane political agenda. Let me assure you that the public is heartily sick of these shenanigans and, at the first availability of a suitable substitute, will boot you out of office.

Thirdly, make it a habit to spend at least two or three days a week travelling to every area of your constituency. You have over 1800 days in office, enough to cover most villages and towns in your area. Drop in unannounced into homes, preferably in the late evenings, when you can meet with families and groups and share their joys and sorrows, as well as understand their grievances. Forget the meals, sharing a cup of tea, where you pour half the sweet concoction from the cup into a saucer and offer the latter to your host, will create a bond between you. Will this guarantee your reelection? Sadly not, elections are won and lost on a host of other considerations — religion, caste, emotions and money power. But you will have the enduring satisfaction of having participated in the lives of your less fortunate fellow women and men, giving them the strength to live another day, month and year to fight the ongoing battles of their lives.

 

Reducing Child Malnutrition – Action Backed By Data

After many stops and starts, the National Nutrition Mission (NNM) is being launched by the Prime Minister on 8 March (International Women’s Day) at Jhunjhunu in Rajasthan. I have heard some rumblings about the NNM’s excessive focus on data monitoring and the lack of a specific programmatic focus. This is but to be expected from the Indian intelligentsia, which always looks upwards for policy and programme inspiration. In the last fifteen years, we have been snowed under with programmes designed to improve access to healthcare, employment and food. Most of these programmes have not fitted in with the lumbering public service delivery mechanisms that are a characteristic of most Indian state governments. Additionally, their implementation has been bedeviled by inadequate budgetary provisions. It is time that we move from policy obsession to action focus, as admirably enunciated by my friend Sanjeev Ahluwalia in his recent article (Junk Policy for Action). Hence, my two bits on what needs to be done in the sphere of reducing child malnutrition.

For a start, with the Fourteenth Finance Commission mandating an increased devolution of central financial resources to the states from 32% to 42%, the time has come for state governments to stop crying that they are being deprived of “mother’s milk” by the centre. Along with such budgetary provisions as accrue to them from the centre, state governments need to responsibly start making significant budget provisions for the nutrition, health and education sectors, which will contribute most to reducing the incidence of child malnutrition and mortality. States also need to take a hard look at their policies for supplementary nutrition provision to mothers and children under the Integrated Child Development Services (ICDS) programme. This area that has seen phenomenal corruption enriching contractors, politicians and bureaucrats and has drawn the ire of even the Supreme Court but has not altered politico-bureaucratic behaviour in the least, except the search for more ingenious methods to pull wool over the eyes of the Court. Schemes like the Karnataka Mathru Poorna programme, which provides a hot midday meal to pregnant and nursing mothers, need to be replicated, with close social monitoring to minimise leakages. Supplementary nutrition to children in anganwadis (and, where they are under-3, at home) needs to rely on local food preparation by mothers’ and self-help groups.

At the same time, the central government can help matters by acting as a funnel for data dissemination and technical advice. A huge volume of data relating to maternal and child health and nutrition process and outcome indicators flows into the central government data servers every month. The ICDS monthly progress report is supposed to be sent online every month by all state governments to the Ministry of Women & Child Development, Government of India (MWCD). Even if it is sent (itself a matter for investigation), no one looks at it, let alone sends analysed data back to the state government for remedial action. The Mother and Child Tracking System (MCTS) was introduced by the Ministry of Health & Family Welfare, Government of India (MOHFW) with much fanfare in 2011 to track the health and nutrition status of mothers and children from conception through delivery to the time the child reaches the age of 5 years. Not a byte of this voluminous data collected over the past seven years has been made available to, or has been used by, state government health and nutrition machineries to improve their capabilities to better serve mothers and children. If the NITI Aayog, MWCD and MOHFW work together to make all this extremely useful field-level data available to state government formations right down to the anganwadi and health sub-centre levels, they will have contributed more to reducing child malnutrition and mortality than all the central government efforts over the past forty years.

But having all the data is not enough; using it judiciously is even more crucial to successful outcomes. Since the Prime Minister is launching the NNM in Rajasthan, an example from that state will highlight what I mean. May I refer you to a report in the Hindustan Times of 27 February 2018 (Programme to address all malnutrition causes). This piece details the programme to tackle severe wasting or severe acute malnutrition (SAM) through community involvement, known in nutrition circles as Community Management of Acute Malnutrition (CMAM). The first phase of the CMAM initiative was undertaken in 2015-16 in 41 blocks in 13 districts of Rajasthan. That over 2.25 lakh under-5 children were screened and nearly 10,000 children were enrolled in the programme, of whom over 90% are reported to have recovered from SAM is good news. At the same time, this is still touching only the tip of the iceberg. These 13 districts are home to over 24.50 lakh under-5 children, of whom, if one goes by the latest National Family Health Survey (NFHS-4) figures, over 2.50 lakh children fall in the SAM category. Even if one takes just a cross-section of blocks in these 13 districts, the CMAM screening of 2015-16 ought to have uncovered a far greater number of SAM children than 10,000. Screening of entire child populations in selected areas was probably the reason for the lower number of SAM children identified, since the ICDS-health machinery would have been able to reach only a limited number of children with the resources available. Since the ICDS is supposed to record weights of all under-5 children monthly, it would have been a far more effective strategy to identify severely underweight (SUW) children (those with weights less than three standard deviations below normal) and then record the heights of these SUW children to arrive at an accurate assessment of the number of severely wasted children.

The news report states that the Mission Director of the National Health Mission, Rajasthan claims success for the CMAM exercise. Apart from the low numbers of SAM children reached, there is no supporting evidence to show the extent of non-relapse into SAM of the over 9000 children who are supposed to have moved out of SAM. I would be rather sceptical of a CMAM programme which does not give specific data on the same children one year after their release from the facility where they underwent treatment. The Rajasthan government now plans to expand the programme of Integrated Management of Acute Malnutrition (IMAM) to 50 blocks in 20 districts (which include the original 13 districts) of the state. IMAM is a programme developed in geographical contexts where civil strife and ethnic unrest lead to worsening of children’s nutrition status. It has to be applied cautiously in settings where child malnutrition is a chronic condition rather than an emergency situation. Rather than getting caught up in acronyms, it is desirable to focus on the fundamentals. The 20 chosen districts have an under-5 child population of over 45 lakhs, with a reasonable estimate (based on NFHS-4 data) of about 5 lakh SAM children. To avoid spreading resources (financial and manpower) too thin and to get the maximum mileage for the money spent, it would be advisable to track the weight of every child in every anganwadi in these districts and to identify the anganwadis with the maximum burden of SAM children. The heights of children falling in the SUW category could be recorded by a health functionary, who would also assess any prevalence of disease in the child requiring treatment. These SAM children could then be treated under the prescribed SAM protocols, with the highest-incidence anganwadis being taken up first, and other lesser-incidence anganwadis being taken up subsequently, depending on the financial and organisational capacity to treat the children. The condition of these children should be followed up for a year subsequently by the three As, the Auxiliary Nurse Midwife (ANM), the Accredited Social Health Activist (ASHA) and the Anganwadi Worker (AWW).

I am not discounting the importance of an integrated approach to treating child malnutrition, covering behavioural changes in families and communities and the need to focus on policy interventions in nutrition-sensitive sectors like drinking water, sanitation, hygiene and livelihoods. What I am worried about is that in the enthusiasm to do too many things, the central issue of tackling the immediate problem of SAM will be lost sight of. This is the reason why the Rajmata Jijau Mother-Child Health and Nutrition Mission of Maharashtra, the first of its kind in the country, focused on specific action areas in a sequential order, with fairly gratifying outcomes. Unless we adopt the same talisman that Gandhiji adopted, substituting the “most malnourished child” for the “poorest and weakest man”, we are unlikely to remove what has been, and continues to be, a blot on India’s development story.

Delhi-rium on the Delhi-gation of Powers

Since my recent Facebook post (shared also on the IAS Association page) has stirred a hornet’s nest, with retired and serving civil servants as well as concerned citizens voicing their opinions, I am constrained to bring out this blog on the AAP vs. AP episode (for the uninitiated, AAP refers to the Aam Aadmi Party, currently governing Delhi and AP refers to Anshu Prakash, a member of my erstwhile service and currently at the centre of a tornado for which he is in no way responsible). The facts have been aired ad nauseam on print, electronic and social media, but they bear repetition because so many of the principal actors have given their own versions or sidestepped the fundamental issue altogether.

A Chief Secretary (CS), the highest civilian functionary on the bureaucratic side of the state government, attends a meeting called by the Chief Minister (CM) at midnight. The subject of the meeting is shrouded in doubt — while the CS has mentioned in his police complaint that the discussion was regarding the release of TV advertisements on the completion of three years in office of the AAP government, the AAP has, through a written statement and through the mouth of its Deputy CM, claimed that the meeting was about the non-release of food rations because of faulty implementation of the Aadhaar scheme. Aspersions are being cast on the contention of the CS that he was assaulted by two persons in the presence of the CM and Deputy CM. Even the written complaint of the CS to the police, the record of his medical examination the next morning and the statement before a magistrate by the CM’s Adviser are being discounted, though these are now the subject of police investigations.

In my Facebook post, I had raised certain fundamental questions, none of which have been answered to this day. Calling the CS alone for a meeting, which took place at midnight, without summoning the concerned departmental secretaries, with some (apparently) MLAs present, on a subject that did not require overnight resolution, is itself enough to raise eyebrows. The studied silence of the head of the government on a complaint of assault (in his presence) of his senior most civil servant, is even more perplexing. But what takes the cake is the blasé attempt to pretend nothing ever happened, even after all the documentary evidence that is now in the public domain. And now, we have an article in a leading national daily by a leading AAP spokesperson (Ashish Khetan: Indian Express, 24 February 2018) which is a litany of complaints about the asymmetric division of powers between the Governments of India and Delhi.

The Government of National Capital Territory of Delhi Act of India, 1991 (NCT Act) has inter alia laid down the procedure for elections to the Legislative Assembly and specified the duties and responsibilities of the Lieutenant Governor and Ministers (including the Chief Minister). It is clear that there is an ocean of difference between the provisions governing the functioning of the Delhi government and those relating to any other state government in India. Public order, police, land and services are subjects not under the control of the Delhi Government. This has been the ground-level position ever since elected governments came to power in Delhi since 1993. But even when the parties in power in the Delhi government and at the national level were of different political persuasions, business was conducted smoothly between the two governments and little friction was evident. The situation changed after the 2015 Delhi Assembly elections, when the BJP was steamrollered by the AAP, which came to power with a staggering majority.

It is obvious to anyone that there is no love lost between these two parties. But, unfortunately, the mutual acrimony has poisoned the very functioning of democratic governance in Delhi. “Give and take” has been replaced by “thrust and parry”, with the odds heavily loaded in favour of the central government. Gone are the days when a Congress CM could informally obtain her choice as CS from even the NDA government. The collateral fallout has been the grinding of the bureaucracy between the BJP and AAP wheels. But what has been most unfortunate has been the conviction in the AAP that civil servants deputed to the Delhi government are Greeks in Trojan Horses fulfilling the agenda of the central government and are hell-bent on sabotaging the honest efforts of the state government to improve the lot of its people (and thereby improve future re-election prospects). This has led to the current impasse, where the fourth CS seems to be on his way out within a span of three years.

Civil servants are bound to serve the government of the day, whatever its political hue. During my service days in Maharashtra, we moved seamlessly between BJP-Shiv Sena and Congress-NCP governments, with not even a ripple in the bureaucracy as the reins of power were handed over from one to the other. Colleagues from other states with more combative political formations were surprised that the Maharashtra CS and senior officers were not disturbed even after the transfer of power. At the end of the day, since the permanent bureaucracy (whether All-India or state services) are recruited through open competition, the only scope for politicians lies in juggling officers around.

What did occasion surprise was the volatile reaction across wide sections of the Delhi civil services to the incident involving the Delhi CS. It seems to indicate a simmering resentment about the way the bureaucracy has been perceived (and treated) by the political executive over the past three years. Anti-corruption pogroms reminiscent of the French Reign of Terror are great for popular consumption, but, when not accompanied by systemic reforms, occasion insecurity in the civil service. This angry response from the Delhi bureaucracy should serve as a warning signal to the AAP leadership. You may have an astounding mandate from the people and be riding the wave of public popularity, but governance ultimately has to be through the permanent bureaucracy. Appointment of any number of party commissars and Parliamentary Secretaries can never substitute for the cutting edge that services the aam aurat/aadmi. Debasing the value of the civil service and treating them with contempt will lower the motivation and morale of even the honest, sincere workers (of whom there are many) and lead to a fall in the quality of public service delivery.

Of course, there are issues that need to taken up with the central government and the judiciary, when the state government feels its legitimate powers are being whittled down or that not enough powers have been vested in the state government to enable it to carry out its duties and responsibilities. There are democratic avenues for resolving such matters, including, finally, the court of the people, which assembles once every five years to give its verdict. Good work will be recognised and (hopefully) rewarded at the appropriate time. But frustration with legal shackles should not be vented on the bureaucratic whipping boy (and, increasingly, girl). As AAP seeks to widen its all-India reach, it would be salutary to remember that Delhi is not Bharat and that solutions have always to be sought within the constitutional framework.

 

The Twenty-first Century Animal Farm

The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.” (George Orwell: Animal Farm)

कुछ तो ख़ासियत है इस प्रजातंत्र मे
वोट देता हूँ फकीरों को कंबख्त शहंशाह बन जाते हैं

(There is something special about this republic;

I vote for ascetics, the wretched fellows become emperors)

(Source: unknown)

December 2017 was a milestone in Indian jurisprudence. Three CBI courts, two in Delhi and one in Ranchi, delivered judgments in corruption cases that have exercised the public mind over the past many years. The verdicts were a mixed bag: while former bureaucrats were indicted in two of the cases, politicians got away fully in one case and partially in another case. The fodder scam related to a straightforward loot of the government treasury while the coal and 2G spectrum scams involved the questionable use of discretion at the highest levels of government in the allocation of natural resources, one below the ground and the other in the air. That discretion is still alive and kicking in the government is confirmed by the replies to a recent RTI query that stated that two successive Ministers of the Human Resource Development Ministry of the Government of India have, in the past three years, recommended, as against their annual quota of 450 cases, over 35,000 cases of students for admission to Kendriya Vidyalayas, of which nearly 20,000 have actually got admission.

Which begs the question: are governments, even those which swear by eradication of corruption, really different from one another? An answer to this is sought to be given by a book  The Dictator’s Handbook: Why Bad Behavior is Almost Always Good Politics. The authors, Bruce Bueno de Mesquita and Alastair Smith, have, based on years of research and field studies, concluded that leaders are only concerned about power: concepts like “national interest” and “welfare of the people” are relevant to them only insofar as they promote the perpetuation of their power. It is irrelevant whether the leaders are despots or democrats — what preoccupies them ultimately is how to secure power and, having occupied the hot seat, how to stay on there for as long as possible.

In this quest for power, three groups are relevant to the politician. These are the interchangeables, the influentials and the essentials. The interchangeables are those who choose their governments: in the case of India, the entire population above the age of eighteen. In the “first past the post principle” that governs Indian elections, it is enough if, say, in a three-cornered contest where 60% of the electorate votes, the winning candidate secures 21% of the vote. The size of the interchangeables that determines the outcome of the election is then barely a fifth of the voting population.

Given the social cleavages in India along ethnic and religious lines (more pronounced in rural areas and small towns), a candidate from a dominant ethnic or religious group needs to marshal the support of her group to emerge victorious at the hustings. It is here that the influentials matter: composed of those who can control “vote banks” through use of money and muscle power as well as through their command over ethnic-based patronage structures.

But, in the final analysis, the ability of the leader to acquire and retain power depends on her essentials, those in his inner circle who have access to funds and control the party bureaucracy. These essentials are a necessary evil: they help propel the leader to the top, but the leader is always uneasily aware that many among them harbour ambitions of replacing her.

The Indian political scene over the past seventy years has seen the evolution of three distinct cultures, two of which have risen and ebbed with the passage of time, while the third one is presently at its apogee. The first was the Congress culture, which was virtually unchallenged till 1967 but thereafter faced challenges from regional formations till its upset in the 1990s followed (after a ten-year second honeymoon) by its greatest electoral disaster in India’s electoral history. This culture relied on powerful caste leaders marshalling votes of their fellow caste-persons for the Congress, aided by the use of muscle and money. Post-1975, the leader always centralised power in a small coterie of essentials, with leadership of state governments and state party units being decided by the High Command, essentially composed of the leader and her trusted lieutenants. For unhesitatingly accepting the suzerainty of the leader, the state satraps (and their Delhi counterparts) were allowed to exercise patronage in a variety of government functions – procurement contracts, allocation of scarce resources (including even government housing) and postings and transfers of government servants. Post-1991, the patronage also extended to the allocation of natural resources, as the opening up of the economy led to the drying up of some traditional sources of patronage. Of course, an eagle eye was kept on all these functionaries to ensure that they delivered an adequate share of the unearned economic rent to the top, apart from checking any efforts to assert independence from the High Command.

As the middle castes started asserting their right to a share of the economic and political pie, the Subaltern culture developed from the 1970s onwards, slowly at first and, with the ossification of the Congress, more pronouncedly from the 1980s onwards. More and more states spun away from the Congress universe, through the coming to power of regional parties, mostly with pronounced family and caste ties. These parties also relied on the same formula of interchangeables-influentials-essentials. Inner-party democracy was a joke and the leader cult was propagated with renewed vigour right across India, from Kashmir to Kanyakumari and from Dibang to Dwaraka. The composition of interchangeables changed with the formation of new caste and religious alliances, with the promise of Utopia to groups which had suffered from disastrous governance and lack of access to basic human facilities. But the leader and her essentials still governed with the support of influentials. These influentials were virtually allotted jagirs which they could exploit like the zamindars of yore. The bahubali (strongman) phenomenon was aided by weak state capacity in public service delivery and the virtual absence of the rule of law. While the leader and her essentials milked the state coffers, the influentials resorted to extortion, kidnapping and murder to enforce their writ and extract economic rent.

We are now in the Treta Yuga of the BJP-Hindutva culture, epitomised by a strong leader and a fully subservient party structure. Retail corruption at the central level appears to have been phased out, though the same cannot necessarily be said for states under the control of the party. The power of the essentials at the centre has been curbed, at least for the time being, with decision-making centralised in the Prime Minister’s Office. Influentials have been accommodated with MP posts or with institutional sinecures. At lower levels of the district and small towns, influentials have been given latitude to demonise minority communities, employing the icons of pseudo-patriotism, the cow and women’s honour. This, it is hoped, will keep alive the influentials’ enthusiasm to mobilise the interchangeables to support a specific sectarian ideology.

With every new political party adopting one or more (or a mix) of the three cultures enumerated above, it is difficult to be optimistic about a new socio-political culture developing in the country. This is why, despite so much heat and light being generated on essential political and administrative reforms, my prognosis remains that:

  • effective Lokpal and Lokayukta systems will never see the light of day;
  • reforms in electoral funding will be half-hearted and opaque, designed to serve the interests of self-perpetuating politicians. In any case, corruption in the public space is related to basic human greed and not just high costs of contesting elections;
  • political functionaries will never give up their basic right to patronage, be it in procurement, transfers or resource allocation: the variation will only be in whether such discretion is exercised at a wholesale or retail level;
  • administrative (including police) reforms will receive only lip service since no political formation in India wishes to forego its royal prerogative to manipulate the official machinery to meet its partisan ends. The CBI (and also other investigative agencies like the Directorate of Revenue Intelligence and the Income Tax Department) will continue to be used to inconvenience political opponents and those with differing political views;
  • judicial reforms, especially in the criminal justice sphere, will be halting and piecemeal. No political outfit wishes to expose its essentials and influentials to rigorous scrutiny of the law and mutual back-scratching will allow “business as usual” to continue unchecked.

What does all this imply for the future of the inhabitants of India’s Animal Farm? The politician will continue her operations as always, untroubled by public opinion or by that inner voice that lesser mortals call “conscience”. The ordinary citizen will continue to trudge her way to the polling booth every five years, giving another chance to the incumbent or garlanding a new suitor in the fond hope that her lot will improve. And what of my former tribe of civil servants? They would be well-advised not to follow in the footsteps of Boxer, the faithful workhorse of Orwell’s Animal Farm, who was despatched to the slaughter-house as a reward for his unremitting and honest toil on the farm.

 

 

Child malnutrition: Using data more effectively

The National Nutrition Strategy (NNS), released by the NITI Aayog in September 2017, is an important milestone in India’s long fight against child malnutrition. And not just because it points to a welcome focus on child malnutrition at the highest levels of the Central government. It is in the wake of the release of this strategy that, perhaps for the first time, we are seeing a clear focus on data related to child nutrition.

Soon after the NNS was released, the Ministry of Women & Child Development (MWCD) held a national-level workshop with top policy makers, health and nutrition experts, and district collectors from over a hundred districts in the country. It was here that the spotlight was turned on child nutrition data, with the MWCD highlighting the performance of states in improving child nutrition indicators between the 2005 and 2015 National Family Health Surveys (NFHS-3 and NFHS-4, respectively).

It went on to commend three states—Chhattisgarh, Arunachal Pradesh and Gujarat, in that order—for performing the best in reducing under-5 child stunting over the 10-year period. However, the selection of these three states seems incongruent with NFHS-3 and -4 data, which shows Arunachal Pradesh, Tripura and Himachal Pradesh as having the greatest percentage declines in stunting between 2005 and 2015. Chhattisgarh and Gujarat, in contrast, came in only sixth and eleventh, respectively, in the state rankings (highlighted in the table below).

Ramani table

Why the discrepancy when the data was available?

The criterion for selecting states was based on the absolute percentage reduction in stunting between 2005 and 2015. This method was flawed (and embarrassing) on two counts.
First, it failed to follow an accepted statistical principle: when computing reductions in any variable, the percentage fall relates to the reduction in value in relation to the previous base value. Second, it disregarded the NNS data, which had already highlighted reductions in stunting rates across different states over the 10-year period, rightly based on percentage reductions over the NFHS-3 percentages.

Further, departing from the NNS figures and rewarding states for good performance unnecessarily raises questions as to whether the Central government wished to name certain states because their political affiliations coincided with those of the party ruling at the Centre.

What the numbers don’t tell us

It is significant to note that the largest decreases have been recorded in the less populated states (under 25 million people). Larger states, with their high population densities (often in congested urban sprawls), their geographical diversity and greater administrative challenges, are often likely to find the issue of stunting reduction more difficult to tackle.

Also important to recognise is that states like Goa, Kerala and Tamil Nadu—already well ahead in indicators like stunting rates—would never win any national prize for reducing child stunting. This is because their base is already low and the scope for further improvement is, therefore, circumscribed. This may well demotivate the ICDS machinery in such states.

Since the NITI Aayog and the MWCD are going to use a new Nutrition Monitoring System (NMS) to identify states/districts/blocks that are performing well and those that are lagging, it is even more critical to employ a rational methodology in order to get a true picture of the progress registered in any area.

What we can do to get the numbers right

There are a few steps that can help present a more accurate picture for policy making.

Categorisation of states
A three-tier state structure could be developed to assess performance between successive surveys of malnutrition, whether of stunting, underweight or wasting. For instance, in the case of stunting rates, states could be classified into three categories, as detailed in the tables below.

Ramani table 2

Increase frequency of district-level surveys
With NFHS-4 releasing district surveys along with the state surveys, for the first time we have a picture of the districts’ performance in different states and the worst indicators in respect of the three parameters of stunting, under weight and wasting. We need national surveys to be carried out more often so our attention remains focused on the problem.

Regular monitoring and use of critical data
We need greater commitment from the state and Central governments to develop systems for regular collection, monitoring and use of data on child growth. For instance, child growth monitoring has been highlighted as an important component of the ICDS for many years, but has largely been ignored in practice.

While all states are required to send monthly weight data of all children in all ICDS projects to the centre, the MWCD and the states have paid no attention to this data till date. States (barring Maharashtra) do not publish this data on their websites either, although the Right to Information Act mandates placing all such information in the public domain. The result is the extremely dubious quality of data.

Specific focus on indicators and districts with poor progress
NFHS-4 lists the top 100 districts with the highest underweight rates as well as the top 100 with the highest stunting rates. While as many as 55 districts overlap across both these lists, 32 belong to just three states: Bihar, Madhya Pradesh and Uttar Pradesh.

Interestingly, the NFHS-4 data shows a prevalence of high wasting rates in most states, including those that have performed better in reducing child and infant mortality rates in the past decade.
In general, while reduction in stunting percentage rates has been reasonable to very good in many states, reduction in percentages of underweight children has not been so encouraging.

With wasting remaining alarmingly high in many districts, taking up programmes to reduce severe or moderate acute malnutrition through state and community efforts will have to be one of the major focus areas of governments in different states.

Going forward, the MWCD and NITI Aayog will be faced with the onerous job of working with different states, especially Category A states, in devising practical, workable plans and programmes to make a significant impact on child malnutrition.

The first steps have been taken, with the NNS publication and the decision to set up the National Nutrition Mission. However, unless these are backed up by enlightened leadership at the Central and state levels, with a dedicated resolve to reduce the incidence of child malnutrition in all three aspects, India will continue to be an underperformer in an area that is key to the future of its population.

This article was originally published on India Development Review (IDR), the country’s first independent online media platform for leaders in the development community. You can access the article here

Rushing In Where Angels Fear To Tread

News reports stated that an eleven years old girl from Simdega district in Jharkhand died apparently because her family could not get their food grain entitlement as their ration card was not Aadhaar-linked. I say “apparently” because, in this post-truth age, one never knows how to separate fact and fiction in media reports. There will also be the usual controversy over whether health or nutrition factors were primarily responsible for her mortality, with all commentators blissfully unaware of the close linkages between the two. But, knowing how things work in India that is Bharat, I am certain that the failure to link their Aadhaar numbers to their ration cards must have cost many families access to subsidised food grains. This view is bolstered by reports that seem to confirm that the ration card of the family in question was not linked to the Aadhaar card.

I am not going into the merits of Aadhaar linkage to beneficiary schemes, on which enough heat and sound has been generated without any light. But I am concerned about the haste in rushing in to implement policy measures without adequate backup systems. This has a lot to do with the current obsession in governments to show results immediately. In the Jharkhand case, time could have been taken to ensure that most of the population had obtained Aadhaar cards and efforts could have been made over some months to ensure Aadhaar linkage with ration cards. But the childish enthusiasm of the political and administrative executive of Jharkhand to score brownie points with the higher-ups in Delhi probably led to their claiming that they had managed almost full linkage of ration cards with Aadhaar numbers.

The same issue bedevils MGNREGA payments in Jharkhand as well, with documented evidence that the system of online bank account transfers has resulted in inordinate delays in wage payments. If you think such poorly planned policies have troubled only the really poor, think again. Major financial decisions taken over the past year have played havoc with large segments of society, not because of lack of intrinsic merit, but because of the desire to impress the public that this is a “government that works”.

Demonetisation was intended to be the sledgehammer that would eliminate black money, check counterfeit currency and improve tax compliance through reliance on digital transactions. A year down the road, even after all the travails borne by the long-suffering public, it is evident that the black money scourge refuses to die, the introduction of more and more currency notes in different denominations will be a boon to counterfeiters and that tax compliance will become a reality only when simplified tax structures are in place and when sound legal systems exist to penalise defaulters quickly and effectively. Which begs the question of whether demonetisation could not have been handled in a more graduated fashion, with new currency notes going into circulation before the withdrawal of old currency notes.

The same thought haunts one when observing the hasty digitisation of the GST. Considering that it took thirteen years for this baby to be born, the infancy phase could have been handled better. The “tryst with destiny” has certainly altered the destiny of small retailers and merchants, many of whom find the process of filing returns excessively cumbersome. In its fourth month of implementation, technical glitches still thwart the filing of returns: GSTR1 filing for July has just been completed, with filings for subsequent months pushed to November. Despite the promises of the Union Finance Minister to process refunds expeditiously, CAs are of the view that refunds could take six months or more, affecting cash flows of businesses. Gradual phasing in of GST online systems with continuation of the service tax regime for some more months would probably have ensured less transitional pain.

Ramming Aadhaar compliance down the throats of income tax payers and bank account holders will, I suspect, unleash another Pandora’s Box in the months to come. Again, I am not questioning the rationale but the speed of expected compliance, consequences be damned. Filing income tax returns for FY 2016-17 required all those not having Aadhaar cards as of April 2017 to get them by July 2017. Pensioners and the elderly were particularly inconvenienced. Linking Aadhaar numbers to bank accounts has its own technical problems. Most banks have no robust online mechanism to enable the account holder to verify that her bank account is indeed Aadhaar-linked. Come February 2018, citizens may well be faced with the nightmare (actually, it should be called daymare) of their accounts being frozen, leading them to beg on the streets. The insistence on linking mobile numbers to Aadhaar numbers, apparently mandated by the Supreme Court, is yet another nuisance around the corner.

Make haste slowly” is a salutary motto for good governance. This tendency of the civil service is viewed unfavourably by professional politicians, obsessed with the five-year election itch: why, even an ex-bureaucrat like Arvind Kejriwal has commented unfavourably on IAS officers sitting on files. Many of us were roasted by Ministers and Chief Ministers when we insisted on listing on file the pros and cons of any decision, probably a reason for at least some of us being overlooked for prize postings. Pointing out all the possible implications of a decision ensures at least that, if Plan A goes wrong, Plans B and C can be put into operation. It is the current fashion to run down the 1991 economic reforms as being rather halting and piecemeal. As one who was in Delhi at that stage, I am happy that even those reforms that did take place at that time went through, given the attachment of establishment politicians to “crony socialism” and the hostility of an established elite to the whittling down of its gravy train.

The rush to push through major decisions has, no doubt, been influenced by the relatively narrow window before the 2019 general elections. If the favourable results take time to mature, the government may well have to reap the whirlwind of short-term resentment. In the present climate of harking back to our glorious past, I take the liberty of recounting the story of Bhasmasura. Blessed by Siva with the boon of turning whatever he touched to ashes, Bhasmasura sought to test the boon on his benefactor. It took the wiles of the damsel Mohini to persuade Bhasmasura (in the hope of acquiring her) to place his hand on his own head and be turned to ashes. Governments would do well to heed this parable. Chasing the electorate (Siva) to test its powers, the government (Bhasmasura) is finally enticed by Mohini (the election process) to destroy its continuance in power through unwise, ill thought out steps. Yet again I resort, ad nauseam ad infinitum, to my favourite quote:

Those who do not remember the past are condemned to repeat it.

This article was originally published on Indus Dictum, a site where thought leaders from diverse fields, spanning business and technology to politics and modern law, contribute unique insights and experiences. You can access the article here.

The commercialisation of nutrition – Maharashtra comes full circle

The flip-flops in India’s child nutrition policies are nowhere better exemplified than in the recent decision of the Maharashtra government to issue a tender for the supply of fortified ready-to-cook pre-mixes for feeding children, aged three to six years, in rural anganwadis.

Maharashtra has, for many years now, outsourced the supply of take home rations (THR) for mothers and children below the age of three years to so-called Mahila Sansthas that in turn have subcontracted this work to private manufacturers in the state and outside.

With the tendering for ready to cook pre-mixes, Maharashtra is turning the clock back on the important Supreme Court (SC) decision of 2004 that mandated state governments to serve hot cooked meals prepared by women self-help groups, or similar locally based women’s organisations, to children attending anganwadis.

What does this imply for the ICDS* supplementary nutrition programme and what are its likely ramifications?

Quality of food supply is the first and most important concern.
It is difficult to take at face value the tender stipulations that quality checks will be carried out by the supplier organisation at in-house laboratories. Nor can one take comfort from the provision for quality checks at independent laboratories ordered by the ICDS Commissioner. Public laboratories in India are notorious for delays in furnishing reports, enabling defaulters to get away.

The 2012 report of the SC Right to Food Commissioners to the SC highlighted the poor quality of THR supplies in Maharashtra. However, despite complaints about poor THR quality, no action has ever been taken in the past against politically powerful suppliers, either in Maharashtra or other states. In any case, public laboratories in India are notorious for delays in furnishing reports, enabling defaulters to get away.

There is also the issue of whether pre-mixes supplied to children will be as nutritious as hot cooked meals, apart from the question of palatability. Even adults who use pre-mixes to quickly rustle up upmaor sheera at home will testify that the pre-mixes’ taste is nowhere close to that of items prepared from fresh natural ingredients.

With a provision of only INR 6 per child per day, there is also the very real apprehension that the suppliers will be tempted to compromise on quality to maintain their profit margins.

Quantities of pre-mixes supplied to anganwadis, and used for meal preparation, will be the next issue.
At one time, probably about four decades ago, states such as Maharashtra and Gujarat set the standard for efficient, responsive administration. Unfortunately, these states too have degenerated in administrative efficiency and probity to the levels of their counterparts in northern and eastern India. The travesty that represents ICDS nutrition supplies in Uttar Pradesh has been well documented.

When the then Minister for Women & Child Development, Government of India pushed for commercial supply of food items in the ICDS in 2008, it did not meet with the approval of the Cabinet Committee on Economic Affairs (because it would open the doors to large-scale corruption).

The apprehensions of poor programme delivery are amplified by the top-down approach adopted in this tendering system. There is no mention anywhere in the tender document of social accountability through monitoring of supplies and service delivery by village level institutions like the gram panchayats, their health and nutrition committees and mothers’ groups, let alone their involvement in the process of meal preparation.

As one who was involved with the ICDS in Maharashtra through the first decade of this millennium, I can vouchsafe for the beneficial multiplier effects of involving local bodies from the Zilla Parishad to the Gram Panchayat, as well as local communities, in the management of child nutrition. In the present scenario, the pre-mix will be distributed from the project to the anganwadi, with no check on whether the right quantities are reaching the anganwadi.

Stipulations within the tender raise questions around corruption and the concentration of production among a handful of large players.
What is disturbing about the tender are the numerous conditions which straight away disqualify smaller groups from participating in the supply of nutrition to children. Although the tender document specifies that only women self-help groups, Mahila Mandals, Mahila Sansthas and village communities are eligible to bid, the requirements to be fulfilled by the successful bidder rule out the possibility of the tender being awarded to any small group.

There are onerous conditions regarding the high annual turnover needed to qualify, the need for a functional and operative licensed manufacturing unit and an in-house testing facility to test the quality of the premix. The three Mahila Sansthas that were awarded the THR contract had leased facilities for THR production from private agro-companies; ownership and operational control of the Sansthas as well as the companies were vested in the same family.

With the present tender also permitting the participation of Mahila Sansthas, there is ample scope for the same stratagem being employed to circumvent the SC rulings on contractors and private suppliers.

From an equity viewpoint too, the concentration of production in a few organisations denies economic benefits to a very large number of rural women’s groups, which earn their daily bread through the preparation of meals for children.

Ultimately, the issue boils down to whether government programme funds of about INR 2,500 crores should be channelled to a few organisations with, if previous experience is any guide, links to private producers.

Other states are adopting more equitable and empowering solutions
The move of Maharashtra to premix supplies comes at a time when other states are innovatively experimenting with public systems to improve nutrition supplies to mothers and children.

Karnataka has introduced eggs and milk in the daily diet for 3-6 years children, Orissa is promoting the cultivation of local millets and Chhattisgarh has improved its public distribution system to ensure regular food grain supplies to families.

As the foregoing discussion brings out, this policy serves neither the ends of efficiency (given the scope for possible quality and quantity aberrations), nor those of equity (concentration of supply in a few hands) or empowerment (with no role for participation of local governments and communities). Whether such a policy behoves a land that is the karmabhumi of Shahu Maharaj, Jyotiba Phule and Babasaheb Ambedkar is the question that ought to concern us today.

*ICDS (Integrated Child Development Services) is the largest programme in the world devoted to the care of pregnant and nursing mothers and children under six years of age.

This article was originally published on India Development Review (IDR), the country’s first independent online media platform for leaders in the development community. You can access the article here