Data from a recently published paper examining the effects of the 2020 Covid-19 lockdown by Jean Dreze and Anmol Somanchi reflects the dire state of the looming malnutrition crisis in India.
In a co-authored article around April 2020, we argued that the “hidden costs of this pandemic” (and the administrative response to it) are probably most evident in a) the psychosocial costs resulting from falling income, rising unemployment for India most strongly population group at risk; and b) the food distribution table among the lower social and economic groups (worst impact on women and children).
Dreze and Somanchi’s work, along with other recent empirical evidence, provides evidence of these two “hidden costs,” and even more so of the latter.
A troubling situation in India’s paradoxical food landscape, where obesity plagues India’s ultra-rich upper class and malnutrition at the bottom of the pyramid, can also be seen in the pre-pandemic era.
Figures from the 4th National Family Health Survey show that 53.1% of all women between the ages of 15 and 49 are anemic. A shockingly high rate of malnourished mothers results in lightweight, malnourished babies and young children, whose lack of food in the womb can have lifelong consequences for them and their families. Twenty-one percent of all children under the age of 5 remain unproductive or wasted (low weight to height), according to Indian Child Waste Statistics.
In 2017, the Government of India recognized the critical importance of supporting maternal health and childcare and launched the Pradhan Mantri Matru Vandana Yojana – a centrally sponsored conditional money transfer program.
Under the system, pregnant women and nursing mothers are entitled to 5,000 rupees for their first live birth, provided certain conditions are met. The cash incentive is paid in three installments, with the first 1,000 rupees awarded if the pregnancy is registered early at an Anganwadi center (often with the help of an accredited Social Health Activist or ASHA employee).
COVID warriors Anganwadi workers make regular home visits to areas that are difficult to access in order to take advantage of the various services within the scope of ICDS, i.e. counseling mothers on # preventive care, weighing pregnant women, # growth monitoring of children and #IFA administration. pic.twitter.com/4SYK4uu66r
– Art of Giving (@artofgiving_net) June 18, 2021
Once the beneficiary receives at least one antenatal exam, they will be eligible for the second installment (from Rs 2,000). The Union government supplements this program with the Pradhan Mantri Surakshit Matritva Abhiyan, which offers all pregnant women free, universal prenatal care. The final installment (Rs 2,000) is paid after the child is born and vaccinated. Between fiscal years 2018 and 2020, nearly 1.75 Eligible Principal Beneficiaries received Rs 5,931.95 crores.
By making the money transfer conditional, the government hoped to motivate mothers to participate in basic (self) care for mothers and children. The money provided offers the expectant mothers financial support to meet their nutritional needs.
However, the implementation of such programs on the basis of the basis was often fraught with structural deficiencies. Initially, the efficiency of conditional cash transfers was questioned in view of the high administrative burden (or “bureaucratic overload”) associated with such factors as identifying eligible beneficiaries, targeting and monitoring disbursements to them, and ensuring the desired objectives are met actual implementation of a certain scheme.
In addition, complaints about late payments of “earmarked transfers” have intensified, especially since the pandemic.
Pandemic in focus
Shockingly, even after a year and a half since the pandemic harmed Indian citizens, especially the poor, the government’s fiscal priority in allocating more funding to existing programs is still shockingly low. The focus is only on providing grain, supported by the public distribution system, to the poorest, rather than supporting it with more funding for existing nutritional welfare programs.
In a rhetorical pitch to allocate most of the government funding to the pandemic, budget spending shows how the Union government has given up its social and financial responsibility to other equally serious health issues (click here for a discussion of the poor implementation of existing family planning measures during the pandemic ).
Existing Union-sponsored programs have been allocated around Rs.2,500 billion each year for the past two fiscal years. But in the 2021-22 fiscal year, the Pradhan Mantri Surakshit Matritva Abhiyan was merged with other programs under Mission Shakti for the protection and empowerment of women. By amalgamating the Rs 2,500 billion budget with other programs, the effective allocation of Pradhan Mantri Surakshit Matritva Abhiyan has therefore been significantly reduced.
Given the logistical and administrative challenges of the pandemic, a recent study by IPE Global in Rajasthan state provides micro-snapshots of poor health and nutrition program implementation in places like Baran, Jhunjhunu, Jodhpur and Udaipur during the 2020 embargo period especially on the assessment of the state of maternal and child care in Rajasthan during the pandemic.
Visit of the #IPE Global Team to observe the #PLA meeting on Dietary Diversity for Maternal and Child Health in Tonk, Rajasthan. #Ekjut. pic.twitter.com/XCkF39mUAw
– Hari Sharma (@ harisharma235) August 4, 2018
Deterioration in health services
Observed ethnographic results from the report suggest that maternal and child health and nutrition programs have been suspended, with regular health services such as screenings, vaccinations, and child growth monitoring being discontinued for respondents across the state (similar to the situation across the country) . .
Meanwhile, reproductive health workers (ASHAs and midwives) struggled to provide adequate services to the public. Due to restricted mobility, most reproductive medicine workers were forced to work from home and physical tests and exams were not performed.
ASHA staff, Anganwadi staff and midwives conducted online counseling sessions and provided extra pills and contraceptives during home visits, but their services were also limited due to administrative delays and a lack of technically skilled resources (most staff did not even have one Smartphone for use).
Inadequate personal protective equipment was provided to local health workers and most respondents’ families refused to seek physical assistance from these workers. We saw similar observations while working in the fields at our own center in Lucknow.
Hospitals and government health facilities were overwhelmed with Covid-19 patients and were unable to provide adequate delivery services for non-Covid-related treatments (including for high-risk pregnant women). With limited access to the high fees of private hospitals, many rural women were forced to opt for private delivery options, which proved economically burdensome and medically dangerous for their families.
These health professionals lead a PMSMA camp in the Jawalgera district of PHC Raichur, Karnataka and PHC Garbham, Vicianagram, Andhra Pradesh. pic.twitter.com/caF4bf4zYS
– UNICEF India (@UNICEFIndia) June 9, 2020
Further results from surveyed counties across Rajasthan show how the state government eventually made up for the time and loss of services in the early stages. Towards the end of 2020, maternal health indicators at both state and county levels were nearly the same as in 2019. Childcare became even more serious as the proportion of newborns weighing less than 2.5 kg in three out of four circles examined rose.
Amid falling incomes and a strained government health infrastructure, the robust functioning of Pradhan Mantri Surakshit Matritva Abhiyan should be vital during a public health emergency. According to the IPE report, only 27% of registered beneficiaries received their three 2020 installments. A woman in Jhunjhunu, Rajasthan said, “It has been more than eight months since I submitted my application. I even had my child, but not even received the first PMMVY payment. “
The conditions associated with each transfer made it difficult for most beneficiaries to receive their entitlements in a timely manner. Pregnant and nursing mothers have had difficulty accessing food when they need it most. In addition, the Rajasthani IPE results reported that despite meeting the conditions imposed on any legitimate money transfer, the highest beneficiaries did not receive their installment for months after the documents were submitted. The lack of direction and purpose is an important warning sign in assessing the success of such “condition-based” social programs.
There is a lot to do for the Union and the state governments in the future. Findings from the districts of Rajasthan and Uttar Pradesh as microcosmic case reflections show how conditional cash transfers are only effective to a limited extent in times of crisis. Systems like the Pradhan Mantri Surakshit Matritva Abhiyan are already plagued by bureaucratic overload and excessive centralization in the proper handling of claims.
There are also detailed challenges: for example, according to the original charter of Pradhan Mantri Surakshit Matritva Abhiyan, the program is only eligible for women who are pregnant with their first child in the household, while mothers in the family who are pregnant with a second Child is not entitled to support under the scheme. The reasons for this are unknown.
It is also time that a renewed focus on improving access to health care in the community through technology-enabled, decentralized processes translates into a real vision and action plan that will benefit the well-being of all key stakeholders involved, including the community’s recognized health workers. involve and ensure and treat their invaluable local work and contributions with dignity.
The authors thank Divya Balyan and Shipra Prakash along with her research team at IPE Global in Rajasthan for publishing their study and the reported results for this article. Insights into CNES ‘fieldwork in Uttar Pradesh can be found in the video essays by our visual storyboard team, which can be accessed here.
Deepanshu Mohan is Associate Professor and Director, Center for New Economics Studies, Jindal School of Liberal Arts and Humanities, OP Jindal Global University.
Vanshika Shah and Advaita Singh are Senior Research Analysts at CNES.