 Hello and welcome to NewsClick. Today we are in conversation with Dr. Vandana Prasad who is with the Public Health Resource Network and we will be discussing an issue that often tends to be under-emphasized but it's a critical input into public health which is nutrition and especially nutrition of children and various estimates say that something between 25% to probably about half of our children are malnourished in different ways and there has been substantial amount of confusion in the last few months regarding the government's approach to the various programs that are targeted at addressing the issue of malnourishment. So Vandana, my first question really is what do you think is the confusion all about in the sense that we seem to be getting a lot of contradictory messages, a lot of pronouncements that are retracted back and many of these pertain to specific schemes of the government which have been running for a long time? Yeah I think that if we harken back to the National Food Security Act coming into being which basically followed a fairly substantial process of trying to understand public health nutrition, understand the schemes and programs, understand what kind of support and impetus and investments they would be requiring and then if you take it from there subsequent to that a course of very poor implementation over the last three or four years since it came into being followed by a certain very recent kind of again a thrust on public health nutrition but in a very confused manner as you were saying. So what we have seen is the act coming into being at a certain pinnacle of advocacy and civil society pressures and understanding of public health nutrition then a decline in terms of investments into these schemes and programs and the implementation of the act kind of a plateau phase and now a certain impetus but a very confused one. So which are the programs that we are talking about? We essentially when we speak of children we are talking of very major programs some of the largest in the whole world in fact the midday meal scheme is the largest midday you know school meal scheme in the whole world similarly the ICDS program which is over 45 years you know old which caters to children under the age of six so that's what's commonly known as the Anganwadi scheme. So caters to women in situations of pregnancy lactation, adolescent girls, children in all their situations of nutrition so in a sense is very comprehensive and tackles the whole life cycle understanding of malnutrition you know from adolescents to women to their children and so it's a very important program and also we have other programs now which are for CMAM so community management of acute malnutrition. So these are the arenas in which you know actions are required some actions are happening but in an arbitrary and confused manner and if I can just spell out some of the confusions that we've seen in the last few months as a matter of fact. In the backdrop of a few days ago a national nutrition mission has been you know launched something that we've been demanding that we need a policy framework to take nutrition forward in the country. So just to give instances there have been 13 pilots that were put forth by UNICEF in various parts of the country in poor deprived tribal areas to tackle severe acute malnutrition SAM in other words and many of these comprised of the distribution of radio use therapeutic food RUTF as it's commonly known and because there have been very many concerns about it many of us have been writing and speaking about the concerns about RUTF. So what are the concerns about RUTF? Well we have we've basically positioned that a community a truly community-based approach where local foods are used and where nutritional inputs can be made to enhance the quality of that food in terms of micronutrients and so on decentralized local production which is culturally acceptable those would be better and there's been recent evidence to suggest that that is indeed the case that they that can actually treat as well as prevent children from getting malnourished. So there's been a massive debate. So alongside these pilots we also had a letter from the WCD in no uncertain term saying that Ministry of Women and Child Development. Yes that giving RUTF is not part of the policy of the women and child development. So you know states in Maharashtra had already put out a tender to this effect and are there big companies involved in producing these? There are big companies and also Amol has also been roped in so the production varies from private companies like Compact and so on to cooperatives like Amol. But yes so it what it involves is a centralized production it definitely takes detracts from the power of the communities to you know understand nutrition to create their own sources. And if I understand there have been Supreme Court rulings about providing cooked food through some of these programs. Yes that is in another context I think Supreme Court rulings would probably not apply to the context of CMAM and RUTF they do allow for therapeutic foods it's not really spelt out in the NFSA. So this is the confusion here. Now the other things that have happened is many pronouncements by the Minister of WCD Menaka Gandhi saying many things and she is also not the first minister to say this but you know to suggest that the ICDS is not working and so supplementary nutrition program is not working and therefore it must be replaced by things like pre-packaged foods which would be you know which would have a certain standardization a certain quality and. So in a way marketization of what is seen what was basically a welfare measure right. Yes I mean in order to ostensibly to provide better nutrition to standardize it and to centralize it in some manner that is one thing and the other thing that has been said again and again is cash benefits like in many other now social schemes and programs that you know production causes leakage and distribution is a problem so and quality is a problem so let us just give cash in the hands of the needy and they will go and they will purchase their food as they as is required. Now the evidence suggests that cash benefits it's very obvious that you have cash but you don't have the stuff so if you don't have good quality foods available to you or if you don't understand what good quality foods are for your children and yourselves you would only buy what the market makes available to you which is really junk food I mean the penetration of junk food pre-packaged and so on even in very small hamlets is very high so where our food systems are not managing to work in the private sector is sitting there and making money out of very bad. But if we have pre-packaged foods which some claim you can maintain a certain level of quality and ingredients what is the problem with that? Many but just to I'll come to that point but the confusion is that straight after the minister made this statement a few days ago the secretary WCD has again put out a clarification to say that at least for hot cooked meals within the Anganwadi system which applies to children aged three years to six years there would be no move away from hot cooked meals to pre-packaged foods and possibly cash benefits or pre-packaged foods would be in the context of take home rations so there again there's a confusion one doesn't really understand how it's going to finally play out amongst all these things. Now coming back to the point of how it would be problematic to have pre-packaged foods firstly our experience with any of these things for example if you take ORS sachets which in a sense replaced the ability of families and communities to make home based fluids available for children with diarrhea again on the same basis that you know quality is a problem standardization is a problem and there was a complete shift away from home based fluids so we stopped training people we stopped educating people as to what these could be and they would be simple things like mar kapani if you understand you know what you cook rice in and then you put a bit of salt in it it could be coconut it could be what is freely available it could be dal kapani. So these things went out of practice they went out of government documents entirely they went out of our capacity building and the ORS sachets never reached and even today we have the you know we have not made a substantial dent into deaths happening from dehydration so I experience with having centralized production which is to be distributed throughout the country is not not high where food is concerned culture plays a major role also the local context I mean. So I mean just sorry to interrupt but on the issue of culture there's also been this move to link this with the drive towards vegetarianism in some places. Yes that too. Remove eggs from the diet is that something that you see as problematic. Yes because again you know as part of our understanding of nutrition and civil society pressure many states had actually started giving eggs in the Anganwadi scheme and still do continue even with the the budget in budgets that have been slashed so Odisha for example and in some it happened in the midday meal scheme but not in the Anganwadi scheme so you know there's a continuing thrust from communities and from also campaigns and movements and also public health nutritionists to say that this is a very good idea it does so many things it gives you the ideal you know a protein and its ideal bioavailable form it's quite relatively speaking it is cost effective it's hugely available in communities and if you promote poultry it will also enhance the livelihoods of the same communities whose children are you know malnourished so it makes a huge amount of sense but there is it's not yet there's no written dictate on the usage of eggs but there is there have been so many statements about vegetarianism and the country being largely vegetarian which is factually incorrect. So how much influence do you think the private sector has in some of these policies seem to be pushing towards the marketization of the supply chain of these schemes. Indeed here is where the you know the issue of conflict of interest really plays a role and this is also it's not very direct it's it's fairly oblique in you know how it pans out so what we have is technical resource agencies which have links to business and business I mean they themselves proclaim a business model they speak of win-win situations where business also thrives and nutrition also does well so to give an example gain is one such agency and the large donor agencies and donor partners for example Bill and Melinda Gates Foundation Clinton Foundation so fairly overtly placed their faith in the private sector. So which are the major companies the food and beverages companies which are really influential in. Well at the moment we are at a crossroads and you know India has not really opened out but the concerns are that we are now pushing and moving fast towards that opening out and there would be many so you know Nestle itself Danone these are the ones in the international scenario Nutriset has been the parent company for Britannia so biscuits have you know it is very interesting that you raise Britannia because if you look at complementary feeding in in the country today there are two facts which are very interesting one is that only 10 percent of our children are getting a high quality diet even a requisite diet at the age of six months to one year when it's very critical the other is that if I remember correctly the second or third commonest thing that is given to children for complementary feeding is biscuits and you don't think biscuits are a good thing to give not at all a good thing to give and we could do much better with home foods like Dalai Lai and Kichiri. No I'm asking this because a lot of people feel that it's okay for children to have biscuits. High fat high oil contents very poor micronutrient contents not cost effective not enough roughage plus inculcate socialization of that child to very sweet foods from the beginning I mean no nutritionist in the world would advocate biscuits as being your you know number one complementary food. Okay final two sort of issues that I wanted to ask you to comment on one is there's also been concern that budgetary support to some of these programs have either stagnated or there has been a compression in funds is that something that we are seeing as a trend currently. So again a big confusion there because a year ago when you know budgets have been slashed for the ICD central budgets were slashed alongside all the other social sector schemes so education suffered as well with the caveat or with the supposition that states are there's a devolution of funds to the states in general and they would have a larger pocket to you know to be able to put into ICDS and so on which didn't actually happen because states have their own priorities and the absolute transfer of monies to the state was very small the quantum itself was really very tiny so you took away a lot from the social sector you increased enhanced the quantum by some point some percent which didn't translate into increased budgets for the ICDS this was supplemented subsequently because it was realized that you know it's not tenable and we are I mean in the context where we are massively under invested anyway in these schemes and programs so that was one part that happened just very recently there's been another announcement that supplementary nutrition programs I mean the money allocator is going to be enhanced from six seven and nine respectively to eight nine rupees fifty paisa and twelve for children and pregnant and lactating adolescent and then management of severe acute malnutrition so now the budgets have been enhanced which is a good thing but the problem is now what root is I mean what root is this money going to go if the budgets are enhanced for them to be given as cash benefits and then you know on to the private sector and on to junk food that doesn't help nutrition so you essentially enhanced your investment for very poor returns or should we say that there has been a pronouncement that investment will be enhanced we don't have the evidence whether it has been enhanced still yes because pronouncements have been made in the past and it's taken years for that to actually translate on the ground but very recent this is just a few days old okay the last issue is about the workers who work in the schemes so there are some of the most underpaid workers in the public setup and Anganwari workers especially have organized themselves now and have been demanding for better conditions and wages now is there an issue also of how long can you run schemes such as this when you're not actually paying remunerative wages to the workers who run the scheme absolutely I mean it it must be recognized that the ICDS of the Anganwari scheme is very very fundamental in many ways it gives you the preschool component for education it gives you the early childhood health and nutrition components to manage and prevent malnutrition and also take action on child mortality under five mortality so it is really you know it really underpins all human development in some ways and we have been arguing for institutionalization of this scheme it's critical what we have seen is that kind of an attempt to somehow manage these things without institutionalizing it in terms of even infrastructure I mean you have you go into villages there are no buildings that still an Anganwari can call their own sometimes they're functioning under a tree or from a veranda the human resources as you said it's in a miserable situation because they're called honorary workers but they're they're really playing such a major role in probably easy to get away with because most of them are poor women poor women from the village so I would say that all the frontline I mean there's the Anganwari worker the Anganwari helper the cooks of the mid-day meal program the cooks who are related to the sg's in the you know Anganwari scheme and the Asha this would be the complete you know spectrum of human resource available in villages for very major action on you know with children with child mortality and child mobility and under nutrition and they are the most underserved and under invested in. Thank you Vandana and we'll keep coming back to you on issues such as this keep watching news click that is all we have for now thank you