food security bill: Way forward to optimal nutrition Prema ramachandran NutritioN foundation of india, New delhi. 21 st November, 2013

Transcription

1 food security bill: Way forward to optimal nutrition Prema ramachandran NutritioN foundation of india, New delhi. 21 st November, 2013

2 Perspective Food price inflation Food security act NSI s Comments suggestions on FSA NFI s comments Dr Gopalan s suggestions FSA and related sectors agriculture economic development dietary intake nutritional status

3 perspective

4 Sixty five years ago India became independent five years after Bengal famine. India was not self sufficient in food production The country faced two major nutritional problems: threat of famine and the resultant acute starvation due to low agricultural production and the lack of an appropriate food distribution system chronic energy and micronutrient deficiencies due to: low dietary intake because of poverty and low purchasing power; high prevalence of infection because of poor access to safedrinking water, sanitation and health care; poor utilization of available facilities due to low literacy and lack of awareness

5 SucceSS Story : Green revolution from ship-to-mouth to self-sufficiency in a decade Initiatives to achieve self sufficiency in food production Investment in irrigation Fertilizer production and subsidy Land reforms R&D support for development of high yielding strains Lab-to-land extension education Farm level procurement at minimum support price PerhaPs this is a good example of what IndIans can do when they were driven to a corner. to day this effort will be labeled as mission mode, public private partnership to achieve a national goal

6 nutrition & health status in 1970 Over 70% of India s population were poor; They spent over 70% of their income on food Despite this expenditure, over 70% were undernourished Morbidity due to infections was high and these extracted a heavy nutrition toll Access to essential health care was low Longevity at birth was low mere self sufficiency in food grain production will not improve household food security or nutritional status of individuals

7 Holistic strategy for improving food security among the poor Criterion used for identification of poor expenditure group with energy intake <2100 Kcals for urban population and < 2400 Kcals for rural population Strategy Identify people living below poverty line Improve their purchasing power through employment programmes Provide them with essential goods (subsidized food grains, food supplementation programmes) & services free of cost (safe drinking water, sanitation, education and essential health care) based on need and not on ability to pay It was expected that these steps will improve food security and will result in reduction in under-nutrition and micronutrient deficiency rates.

8 Review of the current situation in 2012 prior to the formulation of the Twelfth Five Year Plan indicated that GDP growth in India was over 7% - India was the second fastest growing economy There has been slow but steady decline in poverty Country remained self sufficient in food production There was improvement in household food security But Since 2005 food price inflation continues to be high, posing a threat to household food security Underweight and micronutrient deficiency rates remained high Simultaneously over-nutrition is emerging as a major problems in all segments of the population

9 EmErging threat of food price inflation in india Food Non Food GDP growth rates From 2005 India has witnessed high food inflation Till 2009 GDP growth rate was higher than food inflation Since then GDP growth has dipped and food inflation continues to rise

10 35.0% 30.0% AnnuAl inflation rate in price of food stuffs 25.0% 20.0% 15.0% 10.0% 5.0% Cereals Pulses Fruit&veg Meat Milk Edible oils 0.0% -5.0% % Annual inflation for cereals was about 10% between 2006 and 2010 but dipped to 5.3 percent in Pulse prices showed two peak periods of inflation: 31.5% in and 22.4% in The annual inflation rates for vegetables ranged between 8% in 2005 to 11.5% in and rose to 16.4% in

11 There were growing concerns that sustained increase in food price inflation may adversely affect the household food security and nutritional status of the citizens In September 2013, India became the first country to enact Food Security legislation though which over two third of the citizens are entitled to get subsidised food grains through the Public Distribution System.

12 Food security act 2013 Main provisions

13 National Food Security Act aims to improve household food security by providing subsidised food grains as a legal entitlement to over 67% of Indian citizens. Priority households are entitled to 5 kgs of foodgrains/ person/ month. The poorest of the poor (Antyodaya) households are entitled to 35 kgs/ household/ month. The combined coverage of Priority and Antyodaya households (called eligible households ) is up to 75% of the rural population and up to 50% of the urban population.

14 On going programmes of food supplementation to pregnant and lactating women and preschool and school children will be supported. The type of supplements and the composition of supplements for different groups is given below Category Type of food Energy Protein 6-36 mth Take home rations yr Morning snacks Hot cooked meal Under nourished Take home rations children 6mth-6yr 6-11yr Hot cooked meal yr Hot cooked meal Pregnant and lactating women Take home rations

15 The Central Government is to determine the state-wise coverage of proportion of the rural/urban population from Census. The identification of eligible households is the responsibility state governments. of Eligible households will receive subsidised food grains through Targeted Public distribution system ( TPDS). The issue prices are: Rs 3/kg for rice, Rs2/kg for wheat and Rs 1 /kg for millets. The issue price may be revised after three years.

16 Responsibility of the central government is to procure food grains, create and maintain adequate modern food storage facilities to prevent wastage, allocate and transport food grains to states. The state governments will take delivery of the food grains and ensure its transport and distribution up through the targeted public distribution system. Peoples representatives in the local self government will monitor the implementation at local level right upto the households or places where the food supplementation programmes are implemented. There will be social audit of the programme at all levels. Appropriate grievance redressed mechanisms will be set up and these will include call centres, help lines, designated nodal officers.

17 Food security act 2013 Other provisions

18 Adequate food production to meet the needs of growing population is an essential prerequisite for implementation of food security act. Therefore, the Act calls for revitalisation of agriculture through: agrarian reforms through measures to secure interests of small and marginal farmers increase in investments in agriculture, including research development, extension services, micro and minor irrigation and power to increase productivity and production increasing livelihood security of the farmers by the way of remunerative prices access to inputs credit irrigation, power and crop insurance prohibiting unwarranted diversion of land and water from food production.

19 Streamlining the storage and distribution system is essential to ensure access to food by all those who are eligible The Act envisages improvement in procurement, storage and movement of food grains by incentivising the decentralised procurement of food grains geographical diversification of procurement operations augmentation of adequate decentralised modern storage giving top priority food grain movement by rail from surplus states to other states.

20 Recognising the importance of effective transparent and efficient distribution system for successful implementation of the provisions the Act requires that central and state governments shall endeavour to progressively undertake PDS reforms, including: doorstep delivery of food grains; ICT applications and end-to-end computerisation; leveraging aadhaar (Unique Identification card) for identification of entitled beneficiaries; full transparency of records; preference to public institutions or bodies in licensing of fair price shops; management of fair price shops by women or their collectives; diversification of commodities distributed under the PDS.

21 Food grains alone will not be sufficient to improve nutritional status of the population. The food security act has made a provision for supply of other foods stuffs as and when needed or possible in future. Improving access to food alone might not be adequate to improve nutritional status of the population if there is nutrient loss due to infections. Therefore the Act also calls for improvement in access to safe drinking water and improvement in environmental sanitation to prevent infections health care for early detection and effective management of infections to prevent nutrient loss and deterioration in nutritional status

22 Food security act 2013 suggestions from nsi

23 Modifications suggested by nsi Definitions of technical terms: Nutritionists use the term malnutrition to encompass undernutrition, micronutrient deficiencies, and overnutrition. The word undernutrition should be used in the Bill instead of malnutrition when referring to the condition that develops due to inadequate food intake. The term children with wasting should be used in place of severely underweight children. About 40% of Indian children are stunted and under weight but most of them have appropriate weight for their height. Only about 17% are with wasting (have low BMI as per WHO standards ) and would respond by correction of wasting in response to food supplements.

24 The purpose of food is not merely to assuage hunger but to improve nutritional status and health. Apart from cereals, other foods such as millets, pulses and legumes, oils, and vegetables are very important for a balanced nutritious diet. While it may not be currently possible to distribute all or even some of these, to a large number of households through the public distribution system, no food and nutrition security programme can be complete without addressing the need for adequate protein and vegetables There are three major, inter-related nutritional problems anaemia, low birth weight and stunting which have remained intractable for decades. Food Security Bill should include long-term measures to address these three problems

25 It is essential that the guidelines for adequate pulses and legumes in the hot cooked meal are followed in ICDS and MDM programmes. Vegetable cultivation and consumption should be encouraged through horticulture programmes, incentives and community education. Implementation of guideline that vegetables should be part of hot cooked meals under MDM and ICDS should be monitored and ensured The community kitchens envisaged in the Bill can play a major role by providing regionally relished low-cost balanced meals to preschool and school children, and encouraging households to adopt these recipes. Provisions for all these exist in current guidelines; effective implementation is the need

26 India has a major public health problem of hidden hunger caused by micronutrient deficiencies. Indian diets are qualitatively deficient in proteins and micronutrients. Unless this problem is addressed, merely supplying plentiful calories through cereals may not be enough. The Bill may take note of these pressing needs and acknowledge the necessity of addressing them as the programme proceeds, by offering incentives for production of these items and making them economically accessible to vulnerable sections. A provision to add other items exists but type of food stuff and time frame of introduction of these have not been defined Efforts to get iodised salt into the food security bill did not succeed

27 Food security act 2013 Comments and suggestions from nfi

28 Food grains alone cannot provide a balanced meal needed for nutrition security. States like Chattisgarh and Tamil Nadu provide pulses at subsidized cost through PDS There has been attempts to provide oil, iodised and iron and iodine fortified salt through PDS at subsidized cost However it will never be possible to provide all the food stuffs at a subsidised cost to all the needy. There is an urgent need for a nutrition awareness campaign with focus on women (who are head of the household for the ration card) on how the money saved because of subsidised food grains (approximately Rs kg) can be used for purchasing the other food stuffs such as vegetables pulses etc so that the family can have balanced food The importance of nutrition education is indicated; content is to be defined based on the ground situation

29 There is a foot note below the table providing the nutrient content for the supplementary feeding programme, stating that energy dense food, fortified with micronutrient upto 50% of the RDA will be provided The supplementary food provided in ICDs and MDM is not energy dense or micronutrient dense. It is region specific low cost balanced meal consisting of cereals, pulses, oil and vegetables. The norms for the food items to be used in cooking the hot cooked meal in ICDS and MDM haves already been laid down. It is therefore suggested that this foot note may be deleted. This was done as both health and education ministries sent this comment

30 Way forward : comments given by dr gopalan We need to plan to day for what should be done tomorrow In the short term, handouts and heavily subsidized food entitlements will help to alleviate hunger and food deprivation in the most vulnerable sections. However, this cannot be a long-term solution for large sections of the population. The Bill should incorporate long-term measures for skill development of work force and steps to improve income. Above all, a strong national multimedia programme focusing on nutrition education and awareness building should be put in place immediately so as to pay dividends in the future.

31 Food security act 2013 Sectoral contributions and impact

32 food security act and agriculture Agriculture sector has laid down the foundation for sustainable nutrition oriented agriculture in the last decade National Food Security Mission was launched in August 2007 to increase production of rice, wheat through productivity increase increase in pulses production through area expansion and productivity enhancement in a sustainable manner ; The National Horticultural Mission was set-up to facilitate diversification of food production at farm level and meet the increasing need for fruits and vegetables among consumers India s food grain production has grown as envisaged. India will remain self sufficient in food grain production till Pulse production has grown by 2 MT/ year in the last two years and India is expected to become self sufficient in pulses by India can meet the growing need for vegetables and fruits.

33 food security act and economic development Many economists worry that with implementation of the food security act, the already high food subsidy may double and seriously impair ability of the government to invest in developmental activities. This in turn can lead to slower economic growth and all its adverse consequences

34 Food security act 2013 Dietary intake and nutritional status

35 UniqUe indians : gdp rise goes with fall in energy intake gdp at factor cost calorie rural calorie urban In the last decade India was the second fastest growing economy Increase in GDP growth rate and percapita income was accompanied by a progressive reduction in energy consumption. But average intake is still adequate to meet the energy requirement because of the reduced physical activity. This reduction might have protected Indians from rapid rise in overnutrition rates

36 Cereals (Kg)consumed by rural expenditure classes ( NSSO) Rural Expenditure classes / consumption kg/mth Years Cereals are the major source of energy in in Indian diets Over the last four decades the differences in cereal (and energy intake) between urban and rural and different expenditure tertiles have narrowed As of cereal intakes are essentially similar in all groups and is adequate to meet the cereal requirements of Indians. FSA may however protect the population from future price shocks

37 EnErgy requirement for actual weight Group Actual weight Requirement for actual wt Actual Intake Gap adult man adult woman pregnant lactating y y y boys y y y girls y y y There is no gap in adult men and women The gap between energy requirement for the actual weight and intake (NNMB) is high in pregnant, lactating women adolescents and lower in preschool and primary school children. All of them have access to ICDS and MDM programmes So the FSA may not result in substantial changes in energy intake FSA may however protect the population from future price shocks

38 NNMB data confirms the reduction in cereal and energy intake reported by the NSSO surveys. In ,pulse intake has almost reached 1975 levels The continued low vegetable intake is the major factor responsible for the high prevalence of micronutrient deficiencies. Nutrition education urging the households to use money saved from food grain subsidies to buy vegetables is needed

39 50 Intra-family differences in energy intake NNMB Adult and children adequate Adult adequate/child not adequate Adult and children in adequate Other combinations Since seventies there has been a rise in food secure families where adults and children get adequate food and fall food insecure ones. Currently in over half of the households adults get adequate energy but children do not Poor intra-family distribution of food and not lack of household food security that plays a major role in low dietary intake in children

40 Prevention of under nutrition in 0-59 months Attempt to achieve reduction in Low birth weight not an easy task Nutrition education is the critical intervention Exclusive breast feeding for first six months, Appropriate adequate complementary feeding 3-5 times a day from six months of age, Continued breast feeding and feeding family food 4-5 times a day upto 24 months, Feeding 2-5 year old children 4-6 times a day from family food consisting of cereals, pulses and vegetables. Timely immunisation, measures to prevent infections, and care and appropraite feeding during illness and convalescence. None of these are likely to be accelerated by the food security act

41 Intra family differences In nutritional status Data from NFHS 3 showed that child under nutrition rates are higher when the mother is undernourished But even when mother was over weight 20% of children are under weight Intra family differences in dietary intake and physical activity are sufficient enough to lead to differences in their nutritional status Food security act may improve household food security but is unlikely to have any effect on the intra family distribution of food, physical activity pattern.

42 Nutritional status of women NFHS NFHS <18.5 >25 Prevalence of both under and overnutrition are higher in women as compared to men In the highest quintile one third of the women are overnourished Between 1998 and 2006 there has been a 5% increase in over nutrition in women Reduction in physical activity is the most important factor responsible for the rise in overnutrition. Nutrition and health education on importance of increasing physical activity can halt and later reverse the rise in overnutrition and its health consequences

43 100% 90% BMI for age appropriate index to assess nutritional status Nutritional status of preschool 1.9 children % 70% PERCENT PREVALENCE 60% 50% 40% 30% 20% % % HT/A WT/A WT/HT BMI/A ANTHROPOMETRIC INDICES OVERNOURISHED NORMAL UN About half of preschool children are stunted and under-weight. Most of them have appropriate weight for their height If BMI for age is used as the criterion only 16% are under-nourished and 2% are over-nourished. Universal screening to identify wasted children, meeting their energy needs through food supplementation, providing health care to prevent nutrition toll of infection, will reverse wasting and prevent further stunting

44 Food security act 2013 Way forward

45 Normal ht normal wt & Normal BMI Normal ht low wt & Low BMI bmi for age in children to assess nutritional status in children Low ht low wt & normal BMI Low ht low wt & low BMI Low ht low wt& high BMI Stunting indicates cumulative past energy deficit. It can be arrested but not reversed Underweight is an important indicator of past and/ or current energy deficit. BMI for age takes into account weight for the current height and age ; it is an important indicator of current energy adequacy. Screening for low BMI for age and appropriate intervention can result in halving of the wasting rates in children and prevent stunting. This in turn will accelerate reduction in stunting rates from the current 1%/year

46 Global prevalence of normal nutrition More than 60 % of Indian population is normally nourished- a good start By a combination of population based FSA, feeding programmes for vulnerable groups, screening for under nutrition and overnutrition and providing individualized care we can achieve progressive increase in normally nourished healthy persons

47 Health If the provisions of the Food Security Act and the convergence in service delivery between related sectors envisaged in the Act are effectively implemented, it is possible to bring about substantial improvement in food security and nutritional status of Indians.

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