Pooja Parvati, Kaushik Ganguly and Indranil Mukhopadhyay share their views on how the budget has faltered in addressing some of the basic concerns of primary education, primary healthcare and nutrition
In what has been a special budget, the fourth Union Budget of the BJP-led NDA seems to have faltered in addressing some of the basic concerns of primary education, primary healthcare and nutrition, even as it remains focussed on digitisation and technology. The circumstances that make this budget special are the persistent implications of a hastily-planned demonetisation, doing away with the Plan and Non-Plan classification as well as the timing of the budget announcement, put forward by a full month ostensibly to get legislative approvals for the budgetary proposals before the start of the new financial year. The Finance Minister (FM) gave his government a pat in the back by concluding the budget speech saying, since the aim is right and they have a goal in sight, the winds favour them propelling them to fly. We only wish that the FM had factored in some of the grave ground realities before taking off.
India carries nearly 40 per cent of the world’s stunting burden (UNICEF, 2013) and prevalence of other nutritional outcomes such as anaemia, wasting and low birth-weight is also persistently high. The low outcomes particularly with respect to health and nutrition are impacted significantly by socio-economic and cultural drivers that require serious policy attention backed by adequate budgetary resources. In this regard, the Budget announced setting up of Mahila Shakti Kendras that would provide one-stop convergent support services to rural women on opportunities for skill development, employment, digital literacy, health and nutrition. The Union Budget proposes Rs 500 crore for this initiative covering 14 lakh ICDS Anganwadi Centres (AWC). While a welcome step, a back-of-the-envelope calculation reveals that each AWC stands to receive a paltry sum of Rs 3500. Moreover, the mechanics of its implementation need more scrutiny.
The other pronouncement worth noting is the Rs 6000 conditional assistance to pregnant women to be transferred directly to their bank accounts who undergo institutional delivery and vaccinate their children. There seems to be an obsession within the government on cash transfers as a panacea to all the maladies that hobble our public service delivery mechanisms. Global evidence, particularly, celebrated examples from Latin America clearly suggest that cash transfers works only as a supplement to universal provisioning of quality essential services and needs rigorous tracking and monitoring to achieve its desired outcome.
The idea of the Janani Suraksha Yojana (JSY) was to complement the efforts of health system strengthening under National Health Mission, with conditional cash transfer to promote institutional delivery. While quality of care in public facilities likely to be hit because of the cash crunch under NHM, the additional money might provide incentives for mothers to shift to private sector for delivery. Their misery might aggravate as cost of care might increase and they might be subjected to unnecessary procedures. On an average, Rs15,000-20,000 is spent on deliveries in private facilities.
If one looks at the overall allocations on food and nutrition by the Union government, it is apparent that total spending since 2015-16 budget has stagnated, while outlays for important nutrition supplementation schemes for children like the national Mid-Day Meal (MDM) scheme and Integrated Child Development Services (ICDS) have declined.
Both these nutritional programmes have been the mainstay for improvement of nutritional status of children from poor and marginalised communities and a reduction in outlays seems rather antithetical to the pro-people posturing of the present government. More importantly, these schemes require significant strengthening in terms of upgradation of nutrition packages and unit costs and also delivery mechanisms.
At a time when the economy is in a state of crisis and downtrodden sections are particularly hit by demonetisation, Public Distribution System (PDS) offers a viable alternative as is evident from the increase in uptake in many states. Since the last three Union Budgets, the outlays for food subsidy have been continually cut. This year, even though allocations have been increased by Rs 10,000 crore, when adjusted for price inflation, there is actually a drop as compared to the 2015-16 allocations. A comprehensive expansion of PDS, with a focus on nutritionally rich food along with better quality of cereals would provide the much needed relief to people.
There is also an urgent need to frame nutrition and its prioritisation within Water, Sanitation and Hygiene (WASH) and Health sectors. This has been well-articulated by the Chief Economic Advisor in the Economic Survey 2016-17, as he points that the lack of access to sanitation practices, particularly for women, causes considerable insecurity and nutritional risks. Seen the other way around, nutritional risks are exacerbated by inadequate attention to linkages between nutrition and WASH and with health as well as poorly-built links among the departments that provide these services.
In this regard, the allocations to health sector has been increased by Rs10,600 crore. But given the virtual squeeze in spending since last few years making many central schemes including the National Health Mission come to a standstill, this increase may not be enough to revitalise the existing programmes. Furthermore, many ambitious targets have been set and lofty pronouncements made without adequate concrete financial backing.
These are extraordinary times. When people on the margins are barely able to scrounge two square meals, when news reports on hunger and malnutrition-related deaths are rather routine and not abhorred, the idea of strengthening the social safety net becomes increasingly relevant. If the polity lets the crisis of malnutrition go unseen and provides technological fixes, justice won’t be done to our future generations.