It is that time of the year when discussions about India’s growth story reaches a feverish pitch. In the run-up to the Budget 2010, when gross domestic product (GDP) forecasts are being tracked as keenly as cricket scores, Planning Commission deputy chairman Montek Singh Ahluwalia warmed the cockles of our hearts by telling the crowd at Davos that India could emerge as the fastest growing economy in the world, overtaking China.

Will the GDP grow at seven per cent, eight per cent or more? Economists, bankers, corporates, academics and other assorted folks engaged in the game of number crunching, all have their own guesstimates. To that, we can hazard our own, while we wait for the Budget which will inevitably tells us what we can’t afford, but would not keep us from buying it.

But there is another “growth story” crying out for attention of our policymakers. In booming India, millions of children are not growing well. India has a higher percentage of undernourished children than Brazil, China, and even Namibia and Kenya. Given the numbers of affected, we cannot afford to sweep this problem under the carpet.

Last fortnight, I went to an International Consultation on Human Development in India where several experts argued that the challenge of child growth had to be accorded top priority not only for the sake of equity but also economic growth.

Malnutrition affects a child’s growth, brain development and school performance. Stunted children learn less than normal children and learn it slower. Malnutrition, thus, affects work performance leading to productivity losses. The World Bank estimates that preventing micronutrient deficiencies would increase GDP by at least $2.5 billion per year in India and China.

Consider some figures from United Nations Children’s Fund’s flagship publication, The State of the World’s Children 2009: 28 per cent of infants in India have low birth weight (2000-2007). The corresponding figure for Brazil is eight per cent and for China, two per cent. 47.9 per cent of children below the age of three in India are stunted. The corresponding figures for Brazil are 7.1 per cent, and for China, 21.8 per cent... 43.5 per cent children under five in India are underweight. The corresponding figure for Brazil is 2.2 per cent, and for China, 6.8 per cent.

In terms of growth, our children trail behind not only those in other emerging economies but also many countries whose economies are doing far worse than ours. In 1950, for example, the real per capita income in India was two-thirds of Kenya’s while today it stands at two-and-half times the Kenyan level. But 16.5 per cent of Kenya’s children under five are underweight against 43.5 per cent in India!

These chilling numbers are culled from a presentation made by T. Sundararaman, executive director of the National Health System Resource Centre, at the Consultation organised by the Institute for Human Development, a Delhi-based thinktank. The most disturbing feature is the slow rate of decline of malnutrition in the years between the second National Family Health Survey (1998-99) and the third National Family Health Survey (2005-06). These have been the boom years of the Indian economy.

Why are we in such a sorry state? A few insights I picked up at the Consultation are worth sharing. The ministry of health and family welfare’s allocations for health has shot up from Rs 10,040 crores in 2005-06 to Rs 22,641 crores in 2009-10: a rise of 125 per cent. Yet, the overall public expenditure on health (all ministries, Centre and state) as a percentage of GDP remains low at 1.39 (as of 2007-08). This is lower than Cuba (5.5 per cent), Namibia (4.7 per cent) and Sri Lanka (two per cent) to give three random examples from the developing world.

How is the situation of the ground? Just one example would suffice to make the point. India’s Integrated Child Development Services (ICDS) is the country’s primary response to early child development. Most states have a computerised ICDS monitoring system, but the available information is not used for taking corrective and remedial action or for analysis. For instance, each anganwadi centre reports on the number of malnourished children category-wise, but these figures are neither verified independently nor being used for assessing the effectiveness of programmes, N.C. Saxena, former secretary to the Planning Commission, pointed out in a discussion paper that was circulated at the Consultation.

Despite massive increases in the Union Budget and physical expansion of the programme in the last 10 years (there are now 1.5 ICDS centres per revenue village), the findings from the latest National Family Health Survey (NFHS III) show that a mere 32.9 per cent of children who live in an area covered by an ICDS centre had used any service from the centre in the 12 months preceding the survey.

Tackling malnutrition is not rocket science. But its prevention requires collaboration between several sectors — health, agriculture, education and community development. The challenge is to orchestrate programmes in all of these spheres and make each player accountable. An inspiring example is neighbouring Thailand, which has been highly successful in rapidly reducing the prevalence of malnutrition. One key to the very significant and rapid progress came with their Fifth Development Plan (1982-1986), which focused firmly on the people’s participation, instead of leaving the government to shoulder the entire burden. The primary healthcare approach was seen as a practical community-based and participatory mechanism to address persistent health problems, including malnutrition. This led to the training of village health communicators and health volunteers or mobilisers who, at the ratio of one mobiliser per 10 households, can be found in virtually every village with a countrywide force of over 5,00,000.

Within the country, there are innovative experiences one can learn from such as the Velugu Project of Andhra Pradesh.

The activists’ cry for equity and social justice go unheard. May be it is time to be the materialist, and position nutrition as an investment, rather than simply as a form of social spending that governments grant poor people to the degree that governments prioritise equity.

- Patralekha Chatterjee writes on development issues in India and other emerging economies and can be reached at patralekha.chatterjee@gmail.com [1]
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