Full disclosure: This interview was done on 2nd June 2018 at Bangalore, when the ministers and portfolio allocations had not been done in the newly elected Karnataka government.
You are a career bureaucrat, a 1972 batch IAS officer, a nutrition champion, a prolific writer. What were the life incidences which made you so dedicated to nutrition? Why this enduring interest?
As a citizen, an administrator, I was aware of malnutrition in India, but not in a very knowledgable way. . It is only after I was appointed Joint Secretary at the Ministry of Women and Child Development at the Government of India in 1999,that I had my first brush with the subject. I had to comment about the World Bank paper India-Wasting Away: The crisis of malnutrition in India. That was an eye opener, and I realized the real meaning of malnutrition, its extent, its long term impact on our human resources, our public health, our economy. The subject never left me after that. .
My subsequent readings showed how India was on track from Bhore Committee report in 1946 till the 5th Five Year Plan. But with the launch of the flagship programme Integrated Child Development Scheme, in 1975, we believed we had found the solution to the problem, and no further interventions were required. That belief continues even today among our policy makers. However, malnutrition continues to be India’s Achilles heel. Occasionally, whenever some distressing statistics are brought out in some national or international report, there is some discussion or some editorials about it. But no economist talks much about it, even though it is so pivotal. The subject is complex only to the extent that it is inter-generational and inter-sectoral.. In India, it isn’t addressed too seriously, and comprehensively, perhaps, because the solutions are so simple. They require no complex modeling, no algebraic formula. As I have often said, part of the problem is that the solution is so simple.
Hence my interest!
Programmes addressing malnutrition are simple interventions. But they require administrative stamina and skill, operational knowledge, rigorous monitoring and push for implementation. The knowledge for implementation in the context of India comes from field experience, which, require substantial experience at field and State level. . So implementation is more challenging than programme design, but the focus seems to be disproportionately on the latter than the former.
As Director General of CAPART, in 2006-7, I had the opportunity to put on ground my hypothesis on addressing malnutrition in two most backward, tribal blocks in Thane District, Maharastra. The results spoke for themselves.
I continued writing. At CAPART I wrote, Malnutrition, An Emergency: What it costs India, published by CAPART in 2008. Subsequently as Secretary of Department of North East Region, DONER, (the last position I held in the Government of India) I continued writing on nutrition, engaging in implementation, shaping programmes.
Hence the enduring interest!
Tell our readers about Karnataka Comprehensive Nutrition Mission, KCNM, its genesis, its current state of play. Considering it is one of the first state nutrition missions to be established, what can other state missions learn from KCNM?
In 2011, there was a spate of malnutrition deaths in northern Karnataka. I was asked whether I could do something to help the State Government in addressing the problem.. That’s how the Karnataka Comprehensive Nutrition Mission was set up by the Government of Karnataka in 2012.
The proof of concept was established in the State Government Pilot Projects, after which the first funding support came from the World Bank, through the Japan Social Development Trust Fund. The State Government, through the Department of Rural Development and Panchayati Raj and the engagement of the Mission Director-State Rural Livelihoods Mission shows the level of its commitment .
As for what other state nutrition missions can learn. I think every state is unique and their nutrition missions have their own challenges and objectives. We have opened our mission for scrutiny, visits and study tours. It is up to the state missions to take what they feel appropriate.
I have written about the Karnataka Multi-Sectoral Nutrition Project. But what continues to impress me is that KCNM went to Gulbarga and Raichur, two of their most backward blocks. And as if that wasn’t enough, to one of the most deprived communities, the Lambanis. What gave the courage?
We should see this from the mothers’ and the communities’ perspective. When the region is so backward and the community so poor, the mothers, the families are only too keen to do anything to improve their situation, particularly of their children.. . The region, the community needs the programme the most.
Community mobilization can actually take off much easier in such situations. And such regions can show the quickest results too.
The other interesting aspect is the combination of energy dense food with behavior change messages. So there is something tangible like the energy dense food packets being distributed, then there are these messages intensively imparted. How was the programme conceptualized?
Logic determined the programming interventions. We wanted to address the root causes of malnutrition, hence reaching the age-groups where it is critical to make a lasting inter-generational impact meant, reaching the children in the 0-3 years age, adolescent girls in the 11-18 years age and the mothers (both pregnant and lactating). We had to make the programme personal. Government by nature is impersonal, hence the intensive behavior change communication can be done much better through NGOs, through members of the community like the Village Nutrition Volunteers, who can visit households and give one to one messages about better dietary practices, better child and maternal care practices, utilization of immunization and health care services.
We are also aware of the poverty in the households and the high dietary deficit in the poorest families. Hence, the additional high-quality supplementary food, the energy dense food to bridge this calorie-protein-micronutrient deficit. We took a conscious choice to make it free, so they got the value but without the price tag of the commercial products available in the market, like Horlicks and Nestles.
Let’s talk data. Tell us your thoughts on data collection and management. The KNMPP has taken a very strong approach to data. Why do you think this is so important? And what lessons does KMNPP’s approach to data have to offer, to other programmes in Karnataka and in other states?
Data is not just in the computer for monitoring and evaluation. It is a human thing. It is a tangible property of the every family in the programme, on the paper card, for the women, the girls. Data is information about their health, for the women, the girls, the children and their mothers. It has a ripple effect. Families are empowered through this information. You saw how the women were aware about the importance of weight gain during pregnancy, how the girls knew how to calculate their own Body Mass Index. That is because of the empowering and personalized approach to data that we took.
We used data not just for monitoring, but also as an education and communication tool.
What do you see as the future of the Karnataka Multi-sectoral Nutrition Pilot Project?
Wonderful, I hope it will be replicated in other Blocks as well. I am confident! The support from the bureaucracy and the political leaders for this initiative, gives us hope!
Any other actors and factors you would like to mention? The people who played a crucial role in shaping and implementing this project?
The Department and Secretary of “Rural Development and Panchayati Raj”, Dr Nagambika Devi, deserves a special mention. Her department is the natural home for inter-sectoral convergence. The commitment shown by the Rural Development department needs to be acknowledged.
I understand you have also made a course module on nutrition for the Akka Mahadevi Women’s University, Mount Carmel College and the Azim Premji University. Why so?
Nutrition as a discipline has always been located in Home Economics/Home Science. While they have trained the personnel on nutrition, the discipline’s location in Home Science/Home Economics resulted in over-feminising the topic.
Meanwhile we saw Health being taught in Public Policy programmes, Education being taught in Public Policy programmes. We thought, why not Nutrition and Malnutrition too. Hence I wrote a curriculum which was reviewed by some of the global experts and we introduced it in these universities and colleges.
Let’s change course a bit and discuss something contemporary and burning. How has bureaucracy changed from 70s to now? What advice would you have for the current bureaucrats?
India was independent for only 25 years when I joined the IAS. Now it is the 71st year of our independence. Much has changed in between. We adopted the Westminster model of administration which comprises of the political executive and the permanent bureaucracy. In the early 70s political representatives were still learning the ropes of governance. By late 80s and 90s the political leaders looked at themselves as the people’s representatives, the elected representatives while the bureaucracy was the appointed civil servants. So the working relationship evolved accordingly. There has been a shift in the perception and exercise of power. The current crop of bureaucracy is aware of it and functions accordingly. So I would say this is an ever evolving relationship. But the end result should be public good.
What are your thoughts on the current central government’s proposed changes in services selection and cadre allocation, on cadre allocation based on the performance during the training period in Lal Bahadur Sastry Academy rather than in the performance in the Union Public Service Commission, UPSC, exam? Will it affect the steel-frame of India?
I don’t know if the current government’s move on service and cadre allocation is a final view after consultation with the UPSC, the IAS associations. Or is it just testing the waters. The communiqué’ stated that it has come from the Prime Minister’s Office, PMO. But who from the PMO? I am informed that the State Governments are being consulted. It is still not very clear how a training institution will be converted into an impartial services recruitment institution.
I think it is not the final word and more is to come.
The readers are recommended to read Ms Veena S Rao’s paper Under-nutrition in India-A forgotten national nutrition policy without a national programme, published by the Indian National Science Academy, where she takes a deep-dive into the topic and traces its journey in policy, practice and discourse.
Acknowledgements: The author would like to acknowledge ICFJ Washington DC’s support in bringing this interview.
The author/interviewer can be reached at firstname.lastname@example.org