According to a statement by the Ministry of Finance in 2016, “the highest economic returns to public investment in human capital in India lie in maternal and early-life health and nutrition interventions. The World Development Report published the most striking visual representation of the impact that5 poor nutrition can have on deprivation in the brain.  Focussed on the global learning crisis, the report shows significant differences in the MRI scan of brain of 2 infants, one stunted, while the other wasn’t.

Economics of Nutrition:

Several billion dollars are lost in terms of GDP due to malnutrition. These are direct losses in physical productivity due to mortality and also indirect losses from poor cognitive skills, loss of schooling or due to increased health care costs. The return on investment prevented by Malnutrition is extremely high. The Global Nutrition Report of 2016 estimates that for every dollar invested in nutrition, yields a return of 16 dollars.

On paper and policy – the recent interventions on nutrition have all the right ingredients. Funds have been set aside, the need for a comprehensive approach is specified, institutional structures such as the National Council on India’s Nutritional Challenges and Executive Committees have been set up; nutrition specific and sensitive schemes have been mapped and access to sanitation facilities has simultaneously improved.

However, given the complexity and diversity of the issue, a routine centralised, target driven approach towards implementing the programme may not work. Instead, for the mission to succeed, a decentralised approach with a focus on the first principles – namely the 3 Fs – Funds, Functions and Functionaries will be critical.

1. Flexible Financing:

• The first step in ensuring the success of the programme is to get the financing right. Analysis undertaken of the NFHS as well as Rapid Survey of Children (RSOC) has highlighted significant inter-state and intra-state variation on achievement in nutritional outcomes.
• It will be essential to also provide essential flexibility such that the states or even the districts can choose from a basket of interventions based on their current level of nutritional development.
• If for instance, a state or a district or even a Panchayat wants to tackle nutrition by focusing on ending open defecation, it should have the flexibility of determining its own roadmap.

2. Clearly defined Functions:

In order to strengthen coordination across ministries and have clear lines of accountability, roles and responsibilities and accountabilities of each member within the bureaucracy will need to be clearly defined and articulated.

3. Focus on the Functionaries:

Finally, the lower and mid-level bureaucrats and front-line workers at the last mile are critical resources in the implementation of government schemes and can make or break the state’s ability to deliver on its promises.

For many years, the government has been grappling with acute shortage of staff. In such a scenario, the short-staffed delivery systems are only able to focus on routine activities. Softer items such as innovation, counselling and training are neglected. Long-term sustainable efforts at behavioural change will require fixing these capacity constraints urgently.