Malnutrition in India is a complex issue. The country grows sufficient food, has a functional democratic system with effective feedback mechanisms, the world’s largest public distribution system in place for food delivery and an extensive network of state mechanisms to reach every citizen in the country.
Enough policy attention has also been paid to health and nutrition issues in recent years for it to have been classified as having ‘strong’ Nutrition Governance (with the maximum score of 11) by the WHO’s Landscape Analysis study (WHO 2009). Yet, its malnutrition rates remain high.
This report seeks to understand why, despite many of the right ingredients, has India not had greater success with reducing the malnutrition of its children? It does so by analysing India’s recent policy experience with reducing rates of child malnutrition. It uses a series of interviews conducted in New Delhi in August 2011 to identify the main factors credited with the improvement in nutrition levels, and to understand the challenges that remain. In order to nuance the country study and to capture part of India’s complexity, a short case study of Orissa – based on additional interviews conducted in the state capital Bhubaneswar – is included to understand the state’s remarkable 10 point decrease in underweight figures between 1998-99 and 2005-06.
Following the introduction, Section 2 of the report considers issues of data and monitoring, Section 3 identifies the main factors that have contributed to India’s recent success with reducing malnutrition rates. Sections 4, 5 and 6 analyse why nutrition rates have not come down further or faster, and divide the explanations between; (a) a lack of horizontal coordination, (b) siloed, bureaucratic vertical articulation, and (c) inadequate financial outlays. Section 7 presents a case study of Orissa, a state that has demonstrated important improvements to reduce the incidence of malnutrition. Section 8 considers the challenges that remain and identifies key entry points for policy interventions.