Aakar Patel | Vital areas in kids’ health left ignored in Budget 2021
Poshan Abhiyan, the flagship programme meant to improve nutritional outcomes by 2022, was also damaged
The Union Budget delivered earlier this month was praised for two things. First, that it was spending money in the right place: capital expenditure, which would create value over the long term. And second, that it was transparent. The deficit is three times what it should be, but at least the government has accepted it. Perhaps these two things are enough to make it a good Budget, though one doesn’t know. There has not really been any Budget I can remember that made any difference to most people’s lives, except perhaps one, and that was in 1991.
However, it is clear the Budget has ignored something that was really urgent. The National Family Health Survey 2019-20, conducted by the government, revealed some terrible numbers.
On four key metrics which represent the nutritional status of children, states recorded a significant fall in 2019-20 compared to the levels in 2015-16. In states like Gujarat, Maharashtra and West Bengal, the share of anaemic and wasted (low weight for height) children was significantly higher than the levels recorded 15 years earlier in 2005-06. This indicated a reversal of progress that had been hard to win. Even in states such as Kerala, which continued to lead in these indicators, the levels recorded in 2019-20 were poorer than the 2015-16 figures.
The survey put out data for 22 states and Union territories and an analysis of 10 major states was conducted. Anaemia among children was higher in all the 10 states in 2019-20 compared to 2015-16. In Gujarat, Himachal, Maharashtra and West Bengal, a higher percentage of children were anaemic in 2019-20 than were in 2005-06. The percentage of wasted (low weight for height) children was higher in half of the 10 states. In Assam, Gujarat, Karnataka, Maharashtra and West Ben-gal, a higher percentage of children were wasted in 2019-20 compared to 2005-06. In 7 of the 10 states analysed, a higher percentage of children were underweight (low weight for age) in 2019-20 compared to 2015-16.
Stunting (low height for age) was higher in six out of the 10 states compared to 2015-16. The study also found that the incidence of diarrhoea had increased in half the states, including Andhra Pradesh, Bihar, Gujarat, Maharashtra, Karnataka and West Bengal. In Bihar it was up from 10.4 per cent in 2015-16 to 13.7 per cent in 2019-20. This is the reality of the situation. We can debate what has caused this and that can wait for another day. The problem is that the Budget that was presented by Nirmala Sitharaman did not acknowledge and therefore didn’t accommodate this problem. The mid-day meal scheme, on which crores of children depended for their one good meal of the day, found its budget cut from Rs.13,400 crore in FY 2021 to Rs.11,500 crore in 2022. This was lower in nominal terms than what it had been seven years earlier. Inflation adjusted, it was 38 per cent lower. The Integrated Child Development Scheme (ICDS), meant to provide pre-school children with food, education, primary healthcare, immunisation, health checkups and referral services to children under six and their mothers, was also lower in nominal terms, at Rs.16,888 crore in FY 2022 versus Rs.18,691 crore in 2014-15. The programme, running rural anganwadis or creches, is meant to improve the nutritional and health status of children “to lay the foundation for proper psychological, physical and social development of the child”, to “reduce the incidence of mortality, morbidity, malnutrition and school dropouts”, and “to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education”.
Inflation adjusted, this figure was 36 per cent lower for 2022 than it had been the year Prime Minister Narendra Modi took over.
Poshan Abhiyan, the flagship programme meant to improve nutritional outcomes by 2022, was also damaged. The government had released only 46 per cent of the annual outlay by October 31, and for 2022 the budget was cut by 27 per cent.
The drinking water and sanitation department saw its budget officially rise from Rs.21,000 crore to Rs.60,030 crore, but of that Rs.50,000 crore was for the “Central road and infrastructure fund”, suggesting a fudge to avoid embarrassing questions. The numbers seemed deliberately made hard to compare with previous spends. ICDS was clubbed with Poshan Abhiyan, the Scheme for Adolescent Girls and the National Creche Scheme, and the whole thing was called Saksham. Its budget for 2022 was less than the previous year’s budget for ICDS alone. The Pradhan Mantri Matru Vandana Yojana, the Centre’s maternity benefit programme, was clubbed with the Beti Bachao Beti Padhao scheme for girls’ education, the Mahila Shakti Kendra and other general gender budgeting, and the whole thing was called Samarthya. It received Rs.2,522 crore for 2022, less than the Rs.2,858 crore allocated in 2021.
The allocation for Ayushman Bharat (dubbed “Modicare” by Amit Shah) was the same for 2022, Rs.6,400 crore, as it was for the year before. There was no provision for minimum wage and health insurance for the Anganwadi and Accredited Social Health Activist (Asha) workers, the individuals whom Mr Modi had called “Covid warriors”.
The numbers are not going to improve themselves. They will need external intervention from the government, but that has not happened in this Budget. Whether it was wise on an issue that concerns crores of our children we will not know till the government conducts the next survey.