PUBLIC POLICIES AND PROGRAMMES TOWARDS APPROPRIATE NUTRITION
The major public policy towards better nutrition is, ‘of course’, radical land reforms with transfer of land reforms with transfer of land owned by the well-off to the poorest households. About 40% of the total land amounting to 140 million acres is owned and operated by the top 8% households, with over 8 hectares per household. About 47% households, who are either landless or own less than 1 hectare of land, operate only 7% of the land, that is, about 24 million acres.
The government till date has not been able to redistribute more than one percent of the total agricultural land.
With such land redistribution should go policies for ensuring soild and water conservation, irrigation and drainage that are ecologically sound and as far as possible within the control of the people of the area. For those poor who donot have access to land, but depend on the flow and cycle of natural resources--be it forest products, fisheries, animal carcass--a policy of appropriate resource conservation that ensures this section of their livelihood is necessary. Traditional agricultural and livestock practices which have been successful and contribute to ecological balance should not only be conserved but researched into further as to what we could learn from them for wider application. Pesticides and fertilizers should be minimised with greater focus on natural pest management and natural, organic methods of increasing soil fertility.
Agribusiness that promotes food fadsand processed food that removes nutrients and makes it difficult for ordinary peopleto have access to the original foods, should be discouraged. Likewise, refining of cereals, polishing of rice, hydrogeneration of oils, exporting of oil cake, diverting of grains to meet industry and whole host of such processes, should be severly discouraged if not banned.
After agrculture, traditonal handloms and handicrafts is the largest source of employment in the country. Policies which favour organised big industry over poor craftsmenshould be seen for what they are, displacing people and impoverishing them. Such policies need to be abandoned.
What is suggested above is indicative of the policies and trends that need to be adopted. Appendix 5. The Choice Before Us’ by Madhav Gadgil explores further the appropriate policies with respect to deforestationand poor people: (We include it here having emphasised previously the nutritional context of deforestation in poor people’s lives). As Gadgil puts it,"..we must return to our cultural roots, with a respect for nature as a habitat for humanity, not contempt for it as a warehouse of commodities. We must move away from society in which the influential can now cut down magnificent old mango trees to multiply money for their plywood mills; towards one that treasures its heritage, of culture and of nature. We must transform this inequitous society in which poor peasants are being forced to cut down the mango trees in their yards to fill their belly, into one in which they will be secure enough to continue decorating their houses with is tender leaves and inflorescences to remind their brides and bridegrooms of the arrival of the sprintime.
Short of radical and reforms, there are atleast two major nutrition related public programmes: the Public Distribution System(PDS) or the system of rationshops and fair price shopsand the Integrated Child Development Services (ICDS). There are other programmes which have a bearing on nuturitional status: the food for work programmes, the EGS (Employment Guarantee Scheme) in Maharashtr and now the latest of these: the Jawahar Rojgar Yojana and the Indira Mahila Rojgar Yojana. We will not be considering these here but for mentioning their importance in promoting purchasing capacity through an attempt to promote minimum wages...which in turn ought to be based on calorie requirements of the rural working class poor.

ICDS
ICDS is a centrally sponsored countrywide programme, aiming to influence the pre-natal and post-natal enviornment of the child. The program aims to achieve the following four objectives:

1. to improve the nutritional status of children 0-6 years via supplementary feeding to "selected" beneficiaries;
2. to encourage school enrollment via early pre-school stimulation program for children 3-6 years old;
3. to enhance the mother’s awareness via health and nutrition education, and
4. to coordinate with health departmentsto ensure delivery of the required health inputs inluding immunisation to children and mothers, so that both morbidity and mortality rates decline over time. A package of six services are thus delivered through ICDS: health check-up, immunisation, referal services, supplementary nutrition, non-formal education, nutrition and helth education to mothers.

Ideally, there could be nothing better than a mother feeding for child , food of her choice, in her own home. Failing that, the objectives ofd ICDS are laudable because it is aimed at children and women among whom malnutrition is heavily concentrated and because the projects have been generally set up in areas of acute malnutrition (such as tribal areas). In the Seventh Plan, the furher focus was expected to be on rural areas with scheduled caste population and slums.
Operationally, the delivery of services is through the Anganwadi Centre. The responsibility of the Anganwadi Worker (AWW) includes non-formal pre-school education for the older children, organisation of supplementary feeding after identifying eligible children and mothers, imparting health and nutrition education to women; educating parents by home visits; eliciting community support and participation; primary health care for children and mothers and referring the needy to medical personnel (under the health department); liasingwith local organisations like Mahila Mandals and finally maintaining record and furnishing progress reports. The AWW receives supervision and guidnce from a supervisor who normally looks after 20 AWWs. A full time Child Development Project Officer is in charge of each ICDS Project. The health infrastructure in ICDS areas is provided by one Auxiliary Nurse Mid-wife (ANM), one Lady Health Visitor ( to supervise the work of four ANMs) and one doctor per block. All these health services are the responsibility of the Health Department.
Selection of areas of need are through identification of blocks. Once a block is selected, theoretically all villages in the block are eligible for ICDS with a ratio of one centre per 1000 people in rural and urban areas, and 700 in tribal areas (See Table 12 on percentage of severley malnourished children in ICDS project areas in 1984). Table 12 shows that the area targeting of needy children as to mere spreading of the programme is fairly efficient.

Table 12
Percentage of Severely Malnourished Children in ICD Project Areas (Base Line) in 1984 and corresponding State Averages (1982)

There have been scores of studies done on ICDS, evaluating, critiquing and debating various points of the programme. Major points emerging from such debates appear to be:

1. The programme as it is now in operation is titled in favour of older children at the expense of under threes among whom malnutrition is highest.
2. The coverage of pregnant women seems to be unsatisfactory as also the PHC health linkages, referral services, mother counselling and malnutrition education.
3. The impact on nutritional status varies across project areas, rural and tribal projects being worse than others.
4. There are tremendous weaknesses in the programme as it stands with respect to recruitment, training and supervision of core workers.
5. The anganwadi workers are overlooked for more than 50% of the time with record keeping, feeding and pre-school. As a consequence, the anganwadi worker tilts towards the casier task of handling 3-6 year old children.
6. The programme has failed to clicit community participation in any meaningful way at most places--the ICDS is seen as a Government Centren rather than a point of community action.

Nearly half of the AWWs under ICDS did not belong to the local village, with this proportion becoming 75% in tribal blocks. Nearly 8% of the AWWs in a sample study2 belonged to upper castes especially in rural blocks. In effect, upper caste women seemed to to have cornered AWW jobs. There are in rality reeports of poor quality of food to children, bungling in terms of money,etc.(See box on ‘Snatching Food
from Hungry Childre"). Caste status of AWWs asis the experience of many field workers, inhibits community participation especially from schedule castes.

Tamil Nadu Integrated Nutrition Project(TINP):
We discuss now briefly the TINP here and reasons for its apparent effectiveness as compared to the ICDS programme.
The TINP covers 9000 villages in rural Tamil Nadu with a population of over ten million. Instead of Anganwadi, we have here a Community Nutrition Centre (CNC) with a Community Nutrition Worker (CNW) and helper. All children under three are weighed,with other community helth interventions being similar to ICDS except that here the focus is on 6-36 months rather than 0-6 year children in ICDS.
There is no pre-school. There is nutrition education and supplementary feeding for a limited number of pregnant and lacting women. Mid term evaluations indicate the reduction of severe malnutrition rates to 8-9% from 15-20% over a four year period. In project areas, the decline in percentage terms was 32 to 50% as compared to 12% in control blocks. Every project area unlike the ICDS,reflected progressive reduction in incidence of severe malnutrition.
The important differences of the TINP with ICDS are in the following areas:

1. Focus on only 6-36 months children.
2. Job description of CNWs are very focussed: she conducts an initial survey of the village, weighs all children, identifies at-risk children, prepares growth charts for these children and monitors growth even as supplementary feeding is given to these children. The CNW also adminsters ORT, vitamin A, where necessary, and organises mothers’ working groups (for involevment and community participation in the above activities. Thus the focus is on pregnant women, mothers and 6-36 months old children. There is no pre-school and no 3-6 years old children to overburden the CNW as in ICDS (not that the pre-school activities arenot important).
3. There are also significant differences related to selection and training of CNWs under TINP and the AWWs under ICDS.

ACNW under TINP had to be married woman settled in the village with two healthy children, educated upto seventh class, preferably belonging to the Harijan Community. Efforts were made to locate such women who were acceptable to the whole village and persuade them to accept CNW jobs with low wages. Most CNWs have had deep roots in the villages. Also the training was location specific, at the block level for 60 days. The above features seemed to have facilitated more social interaction and discussion and participation of the whole village on MCH issues. These guidelines may have been there in ICDS, but do not seem to have been followed.
The upshot of this very brief comparison is that probably the ICDS can be improved with more staffing (saytwo AWWs per centre) and better recruitment, training and supervision of core workers.

Public Distribution system (PDS)
The rationale behind PDS is providing foodgrains at a lower than market price to vulnerable households especially as they have to put up with low incomes and seasonal fluctuations in incomes. Venugopal 1 has observed that the newly introduced Rs.2/- a kilo scheme, reduces the dependence of labourers on landlords for grain loans, by ensuring access to grain during the off season. Clearly, there is a strong case for strengthening coverage of PDS for rural poor and developing it as an instrument for increasing food access of poor households.
Table 13 shows the PDS supplies and percent of population 2 below poverty line being reached by PDS , substantial sections of the poor in India residing in Bihar,UP, MP and Rajasthan seem to be untouched by the PDS. A substantial share appears to be going to the big cities. Union Territories like Delhi seems to be getting 22% of the PDS foodgrains even though thye have only 1.6% of the all India population, below poverty line.
In actual practice, except for the states of Kerala, AP, Tamil Nadu and Gujarat,the coverage of PDS in rural areas is weak2 The coverage of rural areas is left to the initiative and resources of the state. Distribution of food supplies from the Centre to states is not sufficient. The deficit has to be met by purchases within the state, incurring additional subsidy which may or may not be forthcoming always. The Centralsupplies to state is often not in proportion to needs. Politics often governs the quota of supplies from Centre to State. With Congress-I ruling party at the Centre, non-Congress-I states suffer. In October 1989,the DMK Government formed a human chain in Tamil Nadu to highlight the consistently inadequate food release from the Centre. This was contrasted to an abnormally high release of food grains to Tamil Nadu in January 1989--an act widely interpreted as due to the then proximity of elections inTamil Nadu. Tamil Nadu in turn refuses to contribute to the Central Pool maintaining that it is most of the time a marginally deficient/surplus state. The politics of such electoral gimmickry often has adverse effects on poor people’s nutrition.
Otherwsie too, no serious efforts are made to restrict PDS food access to only poor households. Subbarao has tried to show how limiting food access to only poor can ensure food security to all critically vulnerable households
Assuming a minimum annual income support of Rs.100/- per household via public works programs (NREP and RLEGP), PDS would still have to effect a net income transfer of Rs.200/- per annum per household if the observed nutritional gap is to be filled. For introducing poor household to avail of PDS, we consider that a minimum differential of Re.1/- between the market price and the issue price under PDS ; or an issue price 30% lower than the former which ruled at Rs.3.50 during 1987, would be essential.

Table 13
PDS Supplies and Population Below Poverty Line
(Thousand Tonnes)

In other words, PDS would have to supply 200 kg per annum per household for effecting an annual income transfer of Rs.200. For 58 million poor households in the country, the annual foodgrains requirements would thus work out to be 11.6 million tonnes. At present the government is distributing 10 million tonnes and incurring a subsidy cost of Rs.7500 million or Rs.750 per tonne. Assuring such perfect targeting the scheme would cost only an extra Rs.1200 million and an additional 1.6 million tonnes.
In conclusion, it would appear that the two major nurition related interventions, ICDS and PDS, do not as yet add to an effective nutrition planning policy, although they appear to be reasonable policy responses to poverty and malnutrition. Strait jacketed programme design for both ICDS and PDS that does not take into account socio-cultural and population differences across states and within states seems to be a public wastage of money. The detailed, frequently updated data base, that is needed for a focussed implementation of nutrition programmes seem to be lacking. Reasources need to be made available for proper coverage of all needy populations. Lastly, such nutritional interventions not only reequire proper institutional back-up, but also proper integration with other development programmes with whole hearted political support, that does not use it as a lever for short-term gain of party politics. The current shortfall in resources in almost every state, both for ICDS and PDS do not indicate that nutrition as such is a high political priority--especially poor people’s nutrition.

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