Cash transfers as an answer to malnutrition

According to a recent World Bank Report, India is paying about 9-10 per cent income penalty on account of the fact that roughly three-fourth of the present workforce suffered from stunting in childhood. Early onset of stunting hampers mental and physical growth, adversely affects lifelong learning capacities and results in lower adult productivity.

Recently published National Family Health Survey data makes for a depressing read, with a third of our child population being stunted and more than half the women in the reproductive age-group being anaemic. Despite large-scale interventions addressing nutritional status such as the National Health Mission (NHM), Integrated Child Development Services (ICDS) and the Swachch Bharat Mission (SBM), the pace of reduction of malnutrition has been suboptimal. This is all the more discouraging when juxtaposed with our economic growth trajectory.

Traditionally, our approach to food has been narrow. We have inherently weighed in favour of in-kind transfers, whether it is making available foodgrain through Public Distribution System (PDS) or providing nutritious, cooked meals or energy-dense Take Home Rations (THR) at our Anganwadi Centres (AWC). Today, we have some of the largest food and nutrition programmes in the world,.but unfortunately, in many states they are marred by pilferage and leakages. This underscores the need for considering alternative tactics to address malnutrition.

Globally, Conditional Cash Transfers (CCTs) have emerged as an effective policy tool in driving developmental change. Evidence of successes of programmes like Progressa and Bolsa Familia successful in reducing poverty, bridging inequality and inducing desired behavioural changes have been documented through rigorous third party evaluations. Similar results have been observed in the case of Mamata in Odhisa.

Despite the evidence, however, we see overwhelming support for in-kind transfers citing the example of the southern States who have admittedly run fairly successful meal programmes. What is often missed out is the critical role played by the underlying social capital in these States. The difference in social capital makes the replicability of such successes context-specific. Early evaluations of the Hausla Poshan Yojana in Uttar Pradesh indicate that it has attained only limited success, mainly due to low enrolment of pregnant women and their unwillingness to partake of food at AWCs.

A recent study to test the efficacy of CCTs in a low socio-economic development context was undertaken through a pilot programme in Gaya, Bihar. It credited ₹250 a month to the bank accounts of eligible women for 30 months, provided they fulfilled certain conditions.

Impact on nutritional outcomes : It achieved sharp reduction in the proportion of underweight children — over five times what was achieved nationally over the last decade. Wasting worsened slightly at the national level, while it recorded a significantly higher decrease in two years. However, it had no impact on child stunting; that would require addressing sanitation, hygiene, drinking water, uptake of health services, etc.

Spending patterns : The extra cash was predominantly used to diversify diets, with increases in consumption of meat, milk, vegetables and sugar. It led to the introduction of semi-solid foods for infants aged 6-8 months. Clearly, cash in the hands of the women, with the right kind of ‘messaging’ and attached to conditions that are under their control, can make significant dents in breaking the cycle of malnutrition.

Reaching the intended beneficiaries : Although all women irrespective of their socio-economic status were eligible to receive benefits, there was only 50 per cent enrolment for a number of reasons: lack of awareness of the programme, pregnant women having gone to their native homes, seasonal migration and discrimination by field workers. Addressing these issues is crucial. In addition, activities enhancing financial inclusion and accessibility to banking services need to be in-built into the programme.

The dramatic transformative impact of CCTs should be reason enough for State governments to consider it.

Kumar and Palit are associated with the NITI Aayog. The views are personal

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