How Big is the HUNGER Problem in India???

India is failing its rural poor with 230 million people being undernourished — the highest for any country in the world. Malnutrition accounts for nearly 50% of child deaths in India .According to the latest report on the state of food insecurity in rural India, more than 1.5 million children are at risk of becoming malnourished because of rising global food prices. The United Nations World Food Programme report points more than 27% of the world’s undernourished population lives in India while 43% of children (under 5 years) in the country are underweight. The figure is among the highest in the world. The proportion of stunted children (under-5) at 48% is again among the highest in the world. Every second child in the country is stunted, according to the health ministry’s figures.

Shocking isn’t it? But where does the cause lie?

The failure does not lie in any operational inability to produce more food, but a far reaching failure to make the poor of the country able to afford enough food. Firstly let’s talk about the food policy, and in particular food prices policy. Why is it the case that the large expenditure on food subsidy in India does not achieve more in reducing undernourishment? Part of the answer lies in the fact that the subsidy is mainly geared to keep food prices high for the sellers of food – farmers in general – rather than to make food prices low for the buyers of food. Secondly, the ambitious Targeted Public Distribution System (TPDS) is failing. Apart from failing to serve the intended goal of reduction of food subsidies, the TPDS also is leading to greater food insecurity for large sections of the poor and the near-poor. These targeting errors arise due to imperfect information, inexact measurement of household characteristics, corruption and inefficiency. Another problem, I feel, of the TPDS is the issue of quantity of grain that a household is entitled to. The TPDS initially restricted the allotments to BPL households to 10 kg per month. For a family of five, this amounted to 2 kg per capita. Using the ICMR recommended norm of 330 grams per day, the requirement per person per month would be 11 kg and that for a family of five would be 55 kg. Thirdly and most importantly the governments apathy. It is shameful that in a country where so many people go hungry it is left to the media and other agencies to highlight the pathetic state of affairs.

What, then, should we do, indeed what can we do? People have to go hungry if they do not have the means to buy enough food. Hunger is primarily a problem of general poverty, and thus overall economic growth and its distributional pattern cannot but be important in solving the hunger problem. It is particularly critical to pay attention to employment opportunities, other ways of acquiring economic means, and also food prices, which influence people’s ability to buy food, and thus affect the food entitlement they effectively enjoy. The public distribution system must be strengthened and it must be ensured that the food the government sets aside for BPL families is distributed to them through effective agencies. We must increase allocation through PDS, give food grain through the NREGA, offload the excess stock in the market, but not feed it to the rats.

Given our democratic system, nothing is as important as clear-headed public discussions of the causes of deprivation and the possibility of successful public intervention. Public action includes not only what is done for the public by the state, but also what is done by the public for itself. It includes what people can do by demanding remedial action and through making governments accountable. The lives and well-being of hundreds of millions of people will depend on the extent to which our public discussion can be broadened and be made more informed. I hope we manage to have some impact.


Underlying causes of hunger in India
· Falling per capita food production (especially in the last ten years).
· Increasing share of surplus states and large farmers in food production, resulting in export of artificial surplus reducing availability of food grains.
· Increasing inequality, with marginal increase in the per capita expenditure of the population’s economically poor. From their meager income, the poor are forced to spend more on medicines, education, transport, fuel, etc., which reduces the share of their expenditure on food.
· Poor access of the lower income population to expensive foods such as pulses, vegetables, oils, fruits, and meat products, which provide essential proteins, fats and micro nutrients.
· Low status of women in Indian society, their early marriage, low weight at pregnancy and illiteracy leading to low weight of new born babies.
· Poor children practices, such as not immediately cultivating the habit of regular breastfeeding after.

Some common features of poverty in India:
· Poverty is concentrated in the poorer states such as Uttar Pradesh, Bihar and Jharkhand, which account for 27 per cent of the country’s population but 30 per cent of India’s poor lived there in 1973-74, which increased to 41 per cent by 2005.
· Three quarters of the poor live in rural areas and depend on agriculture.


There has been hardly any decline in poverty for the scheduled tribe households: almost half of them continue to be below the poverty line Although poverty amongst Scheduled Castes has declined from 46 to 37 per cent during 1993-2004 (Planning Commission 2008), the caste systems confines those from lower castes to a limited number of poorly paid, often socially stigmatized occupational niches from which there is no escape.
· Many states, in the northern and western parts of the country, are characterized by long standing and deeply entrenched social inequalities associated with gender.


Poverty is connected with vulnerability and shocks, compounded by general uncertainty with respect to livelihood and life. At the macro level, food grain availability in India is calculated as 87.5 per cent of the gross production (the rest is estimated as requirement for seeds, farm animal feed and waste) plus net imports, minus changes in government stocks. Assuming no net change in private stocks, this can be taken as a good proxy for overall food grain consumption in the country. During the last fifty years before independence, Food grain availability declined from 545 grams to 407 grams per head per day.


Hunger in India: 'The real cause is lack of political will'

Overview of Malnutrition Situation in India...!!!

Malnutrition and Anaemia Rates Are High among Children

National Family Healthy Survey (NFHS-3 ) 2005-2006 India National Reports

• 38.4% of children under age three are stunted, that is too short for their age and 46% are underweight that is too thin for their age. Both indicators have slightly improved from 1998-99.
   
• Wasting, defined as an abnormally low weight for the child's height affects 19% of children under age three with a slight deterioration from 1998-99.
   
• Overall, girls and boys are about equally likely to be undernourished. Under-nutrition is higher in rural areas and is strongly correlated with the level of maternal education showing a two-fold difference between non-educated mothers and 10-year and above educated mothers. This may be linked to a stark difference in access to a nutritious diet and complementary feeding at 6-9 months.
   
• Most children under age three are anemic (79.2%). The prevalence is slightly higher in rural areas and among non-educated mothers. High prevalence of anaemia may be linked to poor variety of diet, poor hygienic conditions and limited access to iron supplementation.

Improvements Needed in Infant and Child Feeding and Micronutrient Intake

• While breastfeeding is nearly universal in India, less than half of children (46%) are fed only breast milk for the first 6 months, as recommended. Exclusive breastfeeding is slightly higher among the non-educated mothers and in rural areas. Work conditions and access to breast milk substitutes may impact the feeding pattern among urban and better educated mothers.
   
• Only 23.4% of children are breastfed within one hour of birth and the prevalence is significantly lower among the non-educated mothers and in rural areas. However, there has been an overall improvement from 9.5% in 1992-93 and 16% in 1998-99.
   
• Only 55.8% of children aged 6-9 months receive solid or semisolid food and breast milk. Although the percentage is significantly lower among non-educated mothers and in rural areas, the prevalence in urban areas and among well-educated mothers is still less than 70% making complementary feeding a high-priority to be addressed.
   
• Only 44 percent of breastfeeding children 6-23 months are fed at least the minimum recommended number of times per day (twice a day for children 6-8 months and three times for children 9-23 months) and only 36 percent are given food from at least 3 food groups, as recommended to ensure adequate diversity in their diet.
   
• Just 25% of children age 6-35 months received vitamin A supplements in the six months before the survey. The Government of India recommends twice yearly vitamin A supplements for children age 6-59 months.

A significant percentage of Women and Men Are Either Too Thin or Too Fat

• Malnutrition and anaemia are common among Indian adults. Both malnutrition and anaemia have increased among women since 1998-99.
   
• 33% of married women and 28% of men are too thin, according to the body mass index (BMI), an indicator derived from height and weight measurements. Underweight is most common among the poor, the rural population, adults who have no education and scheduled castes and scheduled tribes.
   
• Overweight and obesity, the other side of malnutrition, is a growing problem in India, affecting almost 15% of women and 12% of men. Overweight and obesity are most common in urban areas, in wealthier households, and among older adults, Sikhs and those with more education.

Anaemia Is Widespread

• 56.2% of women and 24.3% of men suffer from anaemia, and have lower than normal levels of blood haemoglobin. Anaemia has increased in ever-married women from 1998-99. Among pregnant women, anaemia has increased from 50% to almost 58%.
   
• Only 22.3% of pregnant women consume Iron and Folic Acid supplementation for 90 days and the percentage is less than 10% among the non-educated women compared to 50% among the well-educated. Also the disparity between rural and urban areas is significant (18% and 34.5% respectively)

Many Households Are Vulnerable to Iodine Deficiency

Iodine deficiency, which can lead to mental retardation, goitre, and complications of pregnancy, is easily prevented by using salt fortified with iodine. Only 51 percent of Indian households use adequately iodized salt, however. 

Indian Finance Minister's Budget Includes 58% Increase For Malnutrition Programs

Friday, March 16, 2012

Indian Finance Minister Pranab Mukherjee's "budget includes a big boost in spending on reducing malnutrition," with an increase for malnutrition programs of "58 percent in fiscal 2012-13 to 158 billion rupees, or about $3 billion," the Wall Street Journal's "India Real Time" blog reports. "Despite its rapid economic growth, India has struggled with persistently high rates of malnutrition, far worse than many worse-performing economies," according to the blog.

The proposed budget includes a "plan to reorganize the Integrated Child Development Services, the central government-led initiative that has been in charge of the nation's malnutrition programs, which are run by the states," the blog writes. According to Prime Minister Manmohan Singh, "[t]he goal ... was to create a program that tackles the many causes of malnutrition -- among them, poor maternal health, bad sanitation, dirty water -- in a comprehensive fashion," 

M Ward East Project by TISS...!!!

Transforming M East Ward 
“Poverty is not an accident. Like slavery and apartheid, it is man-made and can be removed by the actions of human beings.” - Nelson Mandela 


M-Ward Initiative is founded in the belief in the emergent space of wisdom within people to plan and implement strategic change while ensuring that their actions enable justice and equity for all. It is an opportunity to demonstrate as a model, inclusive urban planning and development including agency of communities based on empowerment, effective generation of knowledge and transformational leadership.

Women in Baiganwadi have turned beauty into a thriving business. Image courtesy: TISS

M East Ward in Mumbai is a microcosm of the city: an extreme example of skewed development. 

Consider these facts:
• Over 77% of the M Ward population live in slums
• Most people in the slums have no access to basic services including safe water, sanitation, healthcare and housing
• The population per hospital is 66,881; that per dispensary 27,438 and that per Anganwadi center 2175
• The area is highly vulnerable to environmental hazards
• 65 % of Mumbai's resettlement has taken place in M Ward
• It has been the most neglected ward from the point of view of infrastructure and human development 
• It has the lowest Human Development Index for the city of Mumbai (0.05) and ranks 24 among the 24 wards in the city.
 
TISS M Ward Initiative Situated in the M Ward, Tata Institute of Social Sciences has taken on the challenge of transforming it through strategic interventions that will bring about the well-being of its population and environment.

TISS wishes to co-create a new reality - engaging communities, government, the municipality, civil society, the corporate sector, academics and activists - that can become a model of true, inclusive and democratic development paradigm.
We want to work together with the people of M–East Ward to create conditions that substantially reduce child malnutrition, infant and child mortality; enhance access to quality elementary and secondary education, increase school enrolment and retention levels; enhance employability of youth and adults through skill development; and better the living condition and welfare of the people.


The work has begun! 
TISS has deployed its students (1500 Masters and Doctoral) and faculty to do a preliminary survey in the M-East Ward in Mumbai from the 28th of November to 4th December 2011. The students, staff and the faculty have been extensively working on this initiative.
Based on the findings of the survey, community volunteers and TISS facilitators will start the process of Micro Level Planning in each locality of the slums. The community will review the data collected, identify ways to address each of the issues and develop plans to improve their life situation and environment. Peoples' plans, locality–wise, will be compiled and printed by end of April 2012. The full-pledged program work will start from June 2012 and continue until May 2015.
TISS proposes a five year program during which living conditions and welfare of the people will improve significantly by creating a holistic, results-oriented and inclusive urban development model that will ensure social justice and dignity for all. 
TISS believe it is possible to achieve this if we all work together with commitment towards a common goal. 


Source: TISS

HIV/AIDS in India: Fact Sheet

With an estimated 5.7 million people living with HIV/AIDS, India has the highest HIV/AIDS prevalence in the world, according to UNAIDS.1 Among 15-49 year olds, an estimated 5.2 million are living with the disease, according to India’s National AIDS Control Organisation (NACO).2 Still, India’s prevalence rate (the percent of the adult popu­lation estimated to be infected with HIV) is relatively low. However, India is considered to be a “next wave” country; that is, it stands at a critical point in its epidemic, with HIV poised to expand, but where large-scale prevention and other interventions today could help to contain a more serious epidemic in the future.3,4 As the second most populous nation in the world,5 even a small increase in India’s HIV/AIDS prevalence rate would represent a significant component of the world’s HIV/AIDS burden.

Background

• The first case of HIV disease was documented in India in 1986.

• Later that year, the Government of India (GOI) established a National AIDS Committee under the Ministry of Health & Family Welfare to formulate a strategy for responding to HIV/AIDS in the country. It launched a National AIDS Control Programme (NACP) in 1987.

• NACO, established in 1992 by the Ministry with major support from the World Bank, is the implementing entity of the National AIDS Control Programme. Phase I of the Programme started that year; Phase II followed in 1999. Phase III is slated to begin in 2006.

• NACO has facilitated the development of 38 State AIDS Control Societies (SACS), which operate in all states and Union Territories and in three cities.

• The GOI’s overall HIV/AIDS budget for NACO in FY 2005-2006 was US $103 million, and is expected to total US $138 million in FY2006-2007.

Current National Estimates

NACO, UNAIDS, and other international experts develop estimates of HIV prevalence (people living with the disease) and incidence (new HIV infections) in India:

• As of the end of 2005, UNAIDS estimates that there were 5.7 mil­lion people of all ages living with HIV/AIDS in India. NACO esti­mates that there were 5.2 million adults, aged 15-49, at this same point in time.

• HIV/AIDS prevalence among adults in India is still relatively low, at 0.9%, as estimated by both UNAIDS and NACO(once a coun­try’s prevalence rate is greater than 1%, it is considered to have a “generalized epidemic” and HIV may spread more rapidly).

• India accounts for 75% of HIV/AIDS prevalence in South/South East Asia and 15% of global prevalence.1 By comparison; India represents 20% of the world’s population.

• National prevalence rates mask variations by region and sub­population. In 2005, five Indian states had high HIV/AIDS preva­lence (>1% in antenatal clinics)—Andhra Pradesh, Karnataka, Maharashtra, Manipur, and Nagaland—as did 95 districts within states. HIV prevalence of >10% was found at 34 STD sites.

• Most HIV infections in India are due to heterosexual transmission.4,6 In the North East, however, injection drug use is the main mode of transmission. Commercial sex work and sex between men also drive the HIV epidemic in parts of India. Large-scale popu­lation mobility and migration, primarily through male migrant labour, further contribute to the spread of disease.

• NACO estimates that women accounted for 38% of India’s adult HIV/AIDS prevalence in 2005.

• The majority of people living with HIV/AIDS in India are from rural areas (57% in 2005).

• Young adults, aged15-29, account for 32% of AIDS cases reported in India over the course of the epidemic.39 Among those aged 15-24, the number of young women living with HIV/AIDS has been estimated to be almost twice that of young men.

• Tuberculosis (TB) and HIV are intersecting epidemics. Those infected with HIV are more susceptible to TB infection, and TB dis­ease may progress more quickly in those infected with HIV. TB is the most common opportunistic infection among people living with HIV/AIDS in India.

Key Trends

• According to NACO, the number of adults (15-49) living with HIV/AIDS in India has increased by 35% since 2000, although it has been rela­tively stable for the past two years, increasing by 2% between 2003 and 2005. UNAIDS estimates that overall HIV/AIDS prevalence among those 15 and older increased by 8% between 2003 and 2005. Both UNAIDS and NACO estimate that the prevalence rate remained stable, at 0.9%, over this same period.

• NACO also collects AIDS case surveillance data from SACS but these data only provide a snapshot of the epidemic, given the delay in progression from HIV infection to an AIDS diagnosis and the large number of people living with HIV who do not know their status. This is the case in every country, including the United States.

• Data on new HIV infections in India are not currently available. One way to approximate this figure is to apply India’s share of the global total of people estimated to be living with HIV/AIDS (15%) to the global total of estimated new HIV infections (4 million), yielding an estimate that approximately 600,000 Indians may have been newly infected with HIV last year.

Projections

Several different projections have been developed to model the potential impact of the epidemic in India over time, including:

• U.S. National Intelligence Council (NIC): in 2002, NIC projected that by 2010, India could have 20 to 25 million people living with HIV/AIDS, the highest number of any country in the world.

• Eberstadt: Researcher Nicholas Eberstadt modeled several scenar­ios to project the epidemic’s impact between 2000 and 2025. For example, he projected that life expectancy in India in 2025 could fall by 3-13 years, depending on epidemic severity.

• World Health Organization (WHO) and United Nations: The WHO estimated that HIV/AIDS caused 3% of all deaths and 17% of deaths due to infectious diseases in India in 2002. If current HIV/AIDS trends continue, by 2033, HIV could account for 17% of all deaths and 40% of deaths from infectious disease. They are expected to be lower due to HIV/AIDS.

• India’s Office of the Registrar General and Census Commissioner recently released demographic projections, estimating that there could be 11 million deaths due to HIV in India between 2001 and 2026.

• Asian Development Bank/UNAIDS: A 2004 report by ADB/UNAIDS estimates that HIV/AIDS could slow poverty reduction goals by 23% every year between 2003 and 2015.

• National Council of Applied Economic Research: NCAER analyzed the likely impact of HIV/AIDS over the period between 2002/2003 and 2015/2016 finding that if left unchecked, India’s economic growth could fall by 0.86 percentage points each year over the period.

• World Bank: A recent World Bank report examines alternate scenari­os for expanding antiretroviral therapy (ARV) in India, concluding that such an expansion is cost effective. However, without strengthened prevention efforts, the epidemic will not substantially slow.

HIV/AIDS Services/Activities

• Support Groups and Networks: As of 2003, there were 51 community care centres run by NGOs in India. NACO supports 17 networks of people living with HIV/AIDS. The Indian Network for People Living with HIV/AIDS, one of the largest associations of HIV-positive people in the world, has more than 20,000 members.

• HIV Counselling and Testing: There were 1,110 voluntary counselling and testing (VCT) centres in India as of December 2005, most of which are supported by NACO through the SACS. These centres served over 970,000 clients in 2005.

• HIV Prevention: The GOI, and donors including the United States, the United Kingdom, the Gates Foundation, and others, support a net­work of targeted interventions aimed at reducing transmission among those at highest risk. In August 2005, there were 965 interventions targeting female sex workers, injection drug users, men who have sex with men, migrant workers in slums, prisoners, street children, truckers, and individuals that meet multiple risk factor criteria.

• Antiretroviral Therapy (ART): As of December 2005, an estimated 52,000 people were receiving ART in India, less than 7% of the esti­mated 785,000 people in need of ART in the country. In November 2003, the GOI set a national target of providing free ART to 100,000 people through the public sector by 2007. By August 2005, 12,000 people were reported to be receiving treatment through the public sector. India is one of six countries which together comprise more than half of treatment need in low- and middle-income countries.

• Public Education Initiatives: The Heroes Project, a national initiative co-chaired by Richard Gere and Parmeshwar Godrej in partnership with the Kaiser Family Foundation and supported by a grant from the Gates Foundation’s Avahan India AIDS Initiative, works with a cross-section of Indian media and societal leaders on a coordinated HIV/AIDS campaign. Population Services International (PSI) con­ducts social marketing activities on HIV/AIDS that span 22 States and Union Territories as well as the national highway system. The BBC World Service Trust has a co-production partnership with NACO and Doordarshan, the government-supported broadcaster, on HIV/AIDS programming. There are other national and regional efforts to work with media on HIV/AIDS, including journalism programs developed by the Kaiser Family Foundation and others.

Generic Drugs: India is one of the key manufacturers of generic ARVs in the world which are sold within India and in other coun­tries, including those in sub-Saharan Africa. There is some concern that India’s recent compliance with the World Trade Organization’s requirements to protect product patents on medicines may drive up prices and affect supplies, particularly for second and third-line ARV treatment.

• HIV Vaccine Trials: The first Phase I clinical trial for an HIV vaccine recently began in India. Conducted by NACO, the Indian Council of Medical Research, and the International AIDS Vaccine Initiative (IAVI), the trial is taking place at the National AIDS Research Institute in Pune.

Major Donors/Other External Support

• Currently, more than 30 donor government agencies work with NACO, including: the Australian Agency for International Development; Canadian International Development Agency; Danish International Development Agency; Swedish International Development Cooperation Agency; UK Department for International Development; and U.S. Government.

• The U.S. Government provides bilateral assistance to India for HIV/AIDS, and support through its contributions to the Global Fund. USAID has supported activities in India since 1995 and CDC since 2001. India is not one of the 15 focus countries of the President’s Emergency Plan for AIDS Relief (PEPFAR), but has been identified as a country of “concern outside of the focus coun­tries.” U.S. bilateral aid for India was over $26 million in FY 2005, the largest outside of the 15 focus countries.

• The World Bank has been a main financier of NACO, providing $84 million for Phase I of the National AIDS Control Project and $191 million for Phase II.

• The Global Fund to Fight AIDS, Tuberculosis, and Malaria has approved two HIV/AIDS grants in India totaling $118,533,024 and one HIV/TB grant for $2,667,346.

• UNAIDS, UNDP, UNICEF, WHO, and the other UNAIDS co-spon­sors provide technical assistance and other support, through in-country offices and partnerships.

• The Gates Foundation has committed $200 million in India through its Avahan Initiative.

Source: The Kaiser Family Foundation