Fiscal Challenges in Scaling Up Nutrition Interventions

Four states—Bihar, Chhattisgarh, Odisha, and Uttar Pradesh—together account for around 45% of stunted children in India. The existing literature makes a case for delivery of a host of specific interventions referred to as the direct nutrition interventions, along with sector-wise or systemic interventions, to bring about significant reductions in prevalence of stunting among children. An analysis of the delivery of DNIs in the said states shows that apart from the decline in fiscal priority for the DNIs during 2014–15 to 2017–18, there are also significant resource gaps for some of these interventions, which underscores the need for enhancing fiscal priority for these interventions.

The authors are grateful to Satish Agnihotri, Deepak Dey and Subrat Das for reviewing and suggesting improvements in the preliminary drafts. They would also like to thank Khwaja Mohammad Zaid and Mohammad Arsalan for their research support. In addition, they would like to acknowledge Harriet Torlesse for her review and comments on the advanced draft, as also the anonymous peer reviewer/s for very useful feedback on an earlier draft of this article.

Globally, 25% of children below five years of age (approximately 1,560 lakh) have stunted growth due to chronic nutrition deprivation in utero, early childhood or both (UNICEF, WHO and World Bank 2016) and almost a third of them live in India. Around 38.4% children below five years of age in India are stunted, as per the National Family Health Survey-4 (NFHS-4), 2015–16 (IIPS 2016). Hence, India’s nutrition action/inaction affects numbers globally. Nutrition-specific interventions or direct nutrition interventions (DNIs), that can reduce child stunting significantly by addressing the immediate causes of undernutrition, arising out of inadequate diet and disease, are well known (Bhutta et al 2013). Also, most of these are included in India’s national policy framework (Menon et al 2015).

Evidence base on nutrition interventions that address stunting is strong globally. However, research on the public investment in these interventions in India and their delivery is still evolving. India has a federal fiscal architecture, where the responsibility for financing of critical social sectors (which are relevant from the nutrition perspective), is shared between the union and the state governments. The recent changes in the fiscal architecture of the country, such as the recommendations of the Fourteenth Finance Commission (Ministry of Finance 2015) and the restructuring of the centrally sponsored schemes (CSS) (NITI Aayog 2015), have on the one hand enhanced the fiscal autonomy of the states, by increasing the share of untied funds in transfers from the union government to the states.