Global Hunger Index 2021: India needs to do more on child nutrition, responsive village-level governance
The GHI ranking given to India is certainly a wake-up call for the country, writes Partha Pratim Mitra for South Asia Monitor
The Global Hunger Index (GHI) is a peer-reviewed annual report, jointly brought out by Concern Worldwide and Welthungerlife, which is designed to measure and track hunger at different levels and motivate action by countries to reduce food hunger among their citizens. In the 2021 Global Hunger Index, India ranks 101st out of the 116 countries - below even Pakistan, Bangladesh and Nepal in South Asia - where sufficient data is available to calculate scores. India with a score of 27.5 has been put in the serious category by the two bodies. The range of scores that have been given is 9.9 or less as ‘low’,10-19.9 as ‘moderate”, 20.0 - 34.9 as ‘serious’, 35.0 - 49.9 as ‘alarming ‘, and 50 and above as’ very alarming’.35.0–49.9
GHI scores are calculated using a three-step process that draws on available data from various sources to capture the multidimensional nature of hunger.
As a first step, for each country, values are determined for four indicators:
Undernourishment - the share of the population that is undernourished (that is, whose caloric intake is insufficient);
Child wasting - the share of children under the age of five who are wasted (that is, who have low weight for their height, reflecting acute undernutrition);
Child stunting - the share of children under the age of five who are stunted (that is, who have low height for their age, reflecting chronic undernutrition);
and Child mortality - the mortality rate of children under the age of five
Second, each of the four component indicators is given a standardized score on a 100-point scale based on the highest observed level for the indicator on a global scale in recent decades.
Third, standardized scores are aggregated to calculate the GHI score for each country, with each of the three dimensions (inadequate food
supply; child mortality; and child undernutrition, which is composed equally of child stunting and child wasting) given equal weight.
This three-step process results in GHI scores on a 100-point GHI Severity Scale, where 0 is the best score (no hunger) and 100 is the worst. In practice, neither of these extremes is reached. A value of 0 would mean that a country had no undernourished people in the population, no children younger than five who were wasted or stunted, and no children who died before their fifth birthday. A value of 100 would signify that a country’s undernourishment, child wasting, child stunting, and child mortality levels were each at approximately the highest levels observed worldwide in recent decades.
The key to understanding a country’s GHI score lies in that country’s indicator values, especially when compared with the indicator values for other countries. For the calculation of the 2021 GHI scores, undernourishment data are from 2018–2020; child stunting and child wasting data are from 2016–2020, and child mortality data are from 2019. In 2021, owing to the Covid-19 pandemic, the values of some of the GHI component indicators, and in turn the GHI scores, are expected to worsen, but any changes that occur in 2021 are not reflected in the data and scores in this year’s report.[i]
Wake-up call, scheme shortcomings
The GHI ranking given to India is certainly a wake-up call for the country. Policymakers, administrations, and the entire governance machinery must view it seriously for taking corrective measures. A look at the index a little more closely shows that while India has done better as shown by the trends of indicator values on child stunting and child mortality in 2021 as compared to 2012, the areas of concern are undernourishment and wasting among children where the situation as shown by the indicator values in 2021 has deteriorated as compared to 2012.
On the issue of undernourishment of children which is the main source of the other problems associated with hunger and deprivation, the Integrated Child Development Scheme (ICDS) of the central government plays an important role. ICDS was launched on 2nd October 1975. The beneficiaries under ICDS are children in the age group of 0-6 years, pregnant women, and lactating mothers and focus on
(i) improving the nutritional and health status of children in the age-group 0-6 years;
(ii) to lay the foundation for proper psychological, physical and social development of the child;
(iii) to reduce the incidence of mortality, morbidity, malnutrition, and school dropout;
(iv) to achieve effective co-ordination of policy and implementation amongst the various departments to promote child development; and
(v) to enhance the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education[ii]
An evaluation study of the ICDS program by the erstwhile Planning Commission has pointed towards (i) Huge infrastructure and resource requirements to fulfill all the stated objectives of the program; (ii) Dilution of focus on the malnourished; (iii) Possibility of leakage/wastage arising out of weak monitoring and evaluation and the need for better-targeted intervention under the program; (iv) services having a direct and immediate impact on malnourishment, morbidity and mortality have not been effectively delivered while services that are not so important and are subsidiary have been better delivered' (v). Funds under the Supplementary Nutrition Programme, which is the most important component of ICDS were not fully being utilized for any tangible improvement in the nutritional status of children' (vi) The institution of Gram Sabha (village council) be utilized to sensitize people about the entitlement of services under ICDS.[iii]
Various studies, Bihar's Uddepan scheme
Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015–2016, a more recent study presents (a) socioeconomic pattern in service uptake across rural and urban India, and (b) continuity in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0–72 months) in India. Estimates of the study suggested a high concordance between service utilization by mothers and their children ( 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuity of services of ICDS from mother to the child if service utilization commences at pregnancy[iv]
Some other studies have mentioned the lack of own Anganwadi (A typical Anganwadi center provides basic health care in a village. It is a part of the Indian public health care system) building, where the ICDS program is housed, inadequate space for activities, lack of teaching materials, problems in eliciting the Supplementary Nutrition Programme (SNP) due to inadequacy or irregularity of the supplementary nutrition supply, and absence of separate kitchen. [v]
An evaluation study of, the ‘Uddeepan’ program (Uddepan is a cluster approach for nodal Anganwadi Centres), implemented in the eastern state of Bihar. shows that children in rural Bihar have suffered from persistently high rates of malnutrition, The data from the (2015–2016) round of the National Family Health Survey (NFHS) has estimated that 49 percent of children under the age of five are stunted while 45 percent are underweight. These trends are frequently attributed to the low quality of Anganwadi centers (AWCs), the village-level institution responsible for delivering maternal and child nutrition and health services, through ICDS.
As a response to these constraints, the state government had recommended a cluster approach that provides additional supervisory and managerial staff to a cluster of AWCs. The ‘Uddeepan’ program represents a pilot of such a cluster approach. The program provided one additional worker, the Uddeepika, to all the AWCs that fell within the ambit of the Gram Panchayat (GP), the lowest level of the elected institution in the country. The’Uddeepan’ program ended in early 2016. The learning from the evaluation study of the pilot program has been the inability of the pilot program, and the ICDS system more generally, to improve maternal knowledge through home visits reflecting the low ability of frontline workers and reinforcing the common view amongst households in the region that the primary objective of the ICDS system is to provide food rations.[vi]
Under the ICDS umbrella, multiple schemes such as Anganwadi services, schemes for Adolescent Girls, and Pradhan MantriMatruVandanaYojna (PMMVY) have been initiated. Additionally, Nutritional Rehabilitation Centres were established by the Ministry of Health and Family Welfare to treat severe malnutrition in children.
The PMMVY which falls within the ambit of the National Food Security Act 2013, is the maternity benefits program that provides partial wage compensation to pregnant and lactating women. The Comprehensive National Nutrition Survey 2016-18 (CNNS) on micronutrient deficiency and non-communicable diseases in children and adolescents, showed the co-existence of obesity and undernutrition. With the objective of extending inclusion and increasing the quality and quantity of services, the Ministry of Women and Child Development launched the National Nutrition Mission (POSHAN Abhiyaan) in 2017. with the objective of improving the nutritional status of children from 0-6 years, adolescent girls, pregnant women, and lactating mothers.
POSHAN Abhiyaan covers all 36 states and union territories. The mission is a conjunction of various schemes/programs, including the PMMVY, Anganwadi Services, Scheme for Adolescent Girls of Ministry of Women and Child Development (MWCD), National Health Mission (NHM) of Ministry of Health & Family Welfare, Swachh Bharat Mission of Ministry of Drinking Water & Sanitation (DW&S), Public Distribution System (PDS) of Ministry of Consumer Affairs, Drinking Water &Toilets with Ministry of Panchayati Raj, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) of Ministry of Rural Development (MoRD), Food & Public Distribution (CAF&PD), and other Urban local bodies through relevant Ministries.[vii]The idea is to bring about an integrated approach to development to establish synergy among different programs in planning and implementation and to optimize the benefits of the programs.
Studies on mother and child programs over the years have pointed to a few recurrent themes. Some of these themes revolve around lack of adequate building, inadequate utilization and diversion of funds, need for better targeting of beneficiaries, strong integration of the programs with the village level governance institutions, and need for adequate and qualified staff to so that the objectives of the programs and their benefits are more effectively communicated to the intended beneficiaries.
The GHI only provides an indicator to show that more needs to be done in the area of child nutrition and to make village-level governance more responsive for better reach, targeting, and awareness generation of beneficiaries among village households.
 Evaluation Report on Integrated Child Development, Planning Commission, Planning Commission March 2011 Serviceshttps://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/KtbxLrjVklptbHSVHsxKtmjzdJQWsgrZTg?projector=1&messagePartId=0.1
RajpalSunil, et al,2020, Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016International Journal of Environmental Research and Public, May 2020 Healthhttps://www.mdpi.com/journal/ijerph
Seidel Gundula Integrated,2021 Child Development Services (ICDS) Scheme in India - a tired horse or an ignored one. An evaluation in a tribal district of Maharashtra, Ind June 2021https://wwhttps://www.peertechzpublications.com/articles/ACMPH-7-246.php
 : Kochar, A,et al 2017. Impact of the Uddeepan programme on child health and nutrition in India, 3ie Impact Evaluation Report 65. New Delhi: International Initiative for Impact Evaluation (3ie). 3ie Impact Evaluation Report Series executive editors: Beryl Leach and Emmanuel Jimenez, https://reliefweb.int/sites/reliefweb.int/files/resources/ie65-uddeepan-child-nutrition-programme-india_0.pdf
Suri Shobha et al 2020, Towards a malnutrition-free India: Best practices and innovations from POSHAN, March 2020,Abhiyaanhttps://www.orfonline.org/research/towards-a-malnutrition-free-india-63290/
[iii] Evaluation Report on Integrated Child Development, Planning Commission, Planning Commission March 2011 Serviceshttps://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/KtbxLrjVklptbHSVHsxKtmjzdJQWsgrZTg?projector=1&messagePartId=0.1
[iv]Rajpal Sunil, et al,2020, Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016International Journal of Environmental Research and Public, May 2020 Healthhttps://www.mdpi.com/journal/ijerph
[v]Seidel Gundula Integrated,2021 Child Development Services (ICDS) Scheme in India - a tired horse or an ignored one. An evaluation in a tribal district of Maharashtra, Ind June 2021https://wwhttps://www.peertechzpublications.com/articles/ACMPH-7-246.php
[vi] : Kochar, A,et al 2017. Impact of the Uddeepan program on child health and nutrition in India, 3ie Impact Evaluation Report 65. New Delhi: International Initiative for Impact Evaluation (3ie). 3ie Impact Evaluation Report Series executive editors: Beryl Leach and Emmanuel Jimenez, https://reliefweb.int/sites/reliefweb.int/files/resources/ie65-uddeepan-child-nutrition-programme-india_0.pdf
[vii]Suri Shobha et al 2020, Towards a malnutrition-free India: Best practices and innovations from POSHAN, March 2020,Abhiyaanhttps://www.orfonline.org/research/towards-a-malnutrition-free-india-63290/
(The writer is a retired Indian Economic Service officer. The views expressed are personal. He can be contacted at firstname.lastname@example.org)