93528 SAFANSI The South Asia Food and Nutrition Security Initiative FOOD AND NUTRITION SECURITY IN TRIBAL AREAS IN INDIA Background in ST communities, approximately 54 percent of children under the age of five are stunted, 55 percent Malnutrition is one of India’s most serious and are underweight, and 28 percent experience wasting. persistent problems. As of 2007, an estimated 43 Such figures are observably higher than national rates. percent of children under five are underweight, a rate Figure 1 shows a map of the Tribal States in India. more than double that of Sub-Saharan Africa, and five times greater than that of China. Approximately 48 Figure 1. Tribal States in India2 percent of Indians are stunted, 20 percent are wasted, 70 percent are anemic, and 57 percent are vitamin A deficient.1 Despite the targeted efforts of national programs, progress has been slow. A more recent study from 2011, conducted across 100 districts, observed that the percentage of children under five who are underweight is 42 percent, representing only a 1 percentage decrease since 2007. Indeed, the stunting figure among children under five also increased to 59 percent. While nutrition outcomes across India are poor, they are typically worse in tribal areas. Sixty percent of the burden of malnutrition occurs in seven states: Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, and Uttar Pradesh. These states, lag in terms of per capita income and human development indicators, and also possess significant proportions of Scheduled Castes (SCs) and Scheduled Tribes (STs). Traditionally Scheduled Castes have faced social segregation and discrimination, and Scheduled Tribes have been isolated and excluded physically and, hence, socially (Beetle, 1991 cited in World Bank The Approach: Creating Livelihood report, p. 38). India’s ‘indigenous peoples’ number Opportunities for the Poor about 104 million and account for 8.6 percent of the overall population. The South Asia Food and Nutrition Security Initiative (SAFANSI) has provided funding to the National Rural It is within these communities that individuals face Livelihoods Mission (NRLM) to strengthen the capacity some of the direst nutritional outcomes. For instance, of government and/or communities to deliver effective 1 2 International Institute for Population Sciences (IIPS) and Macro Chandramouli, C. 2013. Release of Primary Census Abstract Data International. 2007. National Family Health Survey (NFHS Highlights, Census of India 2011, Registrar General and Census 3), 2005-6: India: Vol I: Mumbai, IIPS Commissioner of India, Ministry of Home Affairs October 2014 South Asia Region food and nutrition security interventions in tribal and conflict-affected areas. The NRLM, as implemented by the Ministry of Rural Development, possesses a budget of over US$5billion, and has been designed to support state-level livelihood projects across the country. Modeled on livelihoods experiences in Andhra Pradesh, the program seeks to extend the outreach of poverty alleviation programs and build livelihood activities in rural areas by building capacity, creating livelihood opportunities and organizing institutions for the poor.3 This study seeks to examine how the NRLM can enhance the effectiveness of the program’s core livelihoods focus, while strengthening the capacity of This program works to build livelihood activities in rural areas like Jharkhand. the Government of India (GoI) to deliver (or support) (World Bank) effective FNS interventions in tribal areas. This would be achieved by (1) developing the evidence base for was an intervention by the Child in Need Institute and designing pilot interventions to improve food and that focused on hand washing and clean water use nutrition security in tribal areas; and (2) implementing behavior change in Gumla, Jharkhand. the pilots and assessing improvements in nutrition and food security in the areas selected. As such, the study Behavior change related to clean drinking water and aims to do the following: hand washing is critical to improving health conditions in tribal areas in India. (Curt Carnemark, World Bank) • Develop the evidence base on those constraints which STs face with regard to achieving food Leveraging Community Involvement to security and favorable nutritional outcomes; Improve Nutrition • Examine approaches which have been used Mobilized communities are capable of implementing to address issues of poor nutrition elsewhere in a range of interventions focused on the most relevant India or abroad to identify interventions that could sub-issues tied to nutrition outcomes. Not surprisingly, be effective in tribal areas; and the majority of nutrition interventions focused on • Recommend models for improving FNS in tribal essential services for pregnant women, lactating areas within the context of NRLM. mothers, infants and young children. However, there were also interventions that focused on mitigating The three pilots implemented were in Jharkhand and seasonal food insecurity or improving diversity of diet. Odisha, through civil society partners. The first was Others focused on improving access to and quality of an intervention by the M.S. Swaminathan Research existing services or managing service delivery entirely. Foundation aimed to improve access to a range of There are several options for NRLM to consider or government entitlement schemes that directly impact present to communities themselves to choose from. food and nutrition security outcomes in the tribal areas of Koraput district, Odisha. The second was an Additionally, to be successful, community groups need intervention by Jagruti that set out to support the revival a tremendous amount of sustained support in the form of cultivation of traditional rice and millet varieties in of capacity building, technical support, and financial Daringbari, Kandhamal district, Odisha. The third resources; all of this requires a substantial investment in time. The mobilizing agencies throughout the 3 research conducted had been working in the area and World Bank. 2014. Republic of India, India: Food Security and Nutrition in Tribal Areas. Report No: ACS9269 mobilizing those communities for a substantial period of time (measured in years) allowing them to build 2 relationships and establish trust. Indeed, developing food, delivery of optimal care and feeding practices, capacity and leadership skills of the community groups and access to health, water, sanitation, and other basic is the engine for community-driven approaches. If services. Additionally there is low consumption and lack community learning is generally essential for any of dietary diversity, derailing nutrition improvements. successful intervention, there appear to be two ways High poverty levels and low levels of income contribute of facilitating the process. The first by leveraging what to lower levels of food security, as well. Various the communities already know and understand, and government programs exist to address nutrition, but the second by creating opportunities for community implementation issues such as supply-side, service members to learn from their peers or important delivery and utilization challenges, often at the influencers. Finally, technical inputs must also be community level, constrain and reduce effectiveness. supplied from an external source. While there appears to be much that the National Rural Livelihoods Program could possibly do toward Culturally, days with three meals improving food and nutrition outcomes, a key constraint are considered to be good food to confident action is a weak evidence base for most days, on par with festivals or days community-based interventions. Nevertheless, those we discussed above were primarily chosen because when households earn a cash there was evidence documenting their effectiveness. income. These good days are from Community interventions by their very nature are December to January, and bad difficult to replicate, given the peculiarities of any days are September to November particular set of individuals in some unique context; and again in March and April. This this is especially so in tribal communities that are less suggests the seasonal variation in homogenous culturally and linguistically. food security noted from the data. Lessons Learned Though already known from the 2011 Census and other anthropomorphic data, it was reinforced by this Conclusion study that tribal communities lag in every major area In order to make sustainable and positive changes important for nutrition, including year-round access to going forward, it will be critical to support food and nutrition security as a core approach for tribal areas. With its grassroots focused, self-help group-driven implementation model, NRLM is optimally placed to improve tribal malnutrition by supporting communities to engage with existing programs and policies for food and nutrition. Empowered self-help groups could bridge service delivery gaps, increase awareness and utilization of programs, or advocate for improved coverage and service quality. Secondly, it is recommended that NRLM provide technical and financial assistance to the State Rural Livelihood Missions (SLRMs) for promoting community- led food and nutrition security activities in these tribal areas. A Social Observatory already exists at the center for assessing real time impact of the project, and it Behavior change related to clean drinking water and hand washing is critical to might prove a good model for the suggested tribal area improving health conditions in tribal and backward areas in India. (Curt Carnemark, World Bank) program which could take forward the “identify – pilot 3 – validate” learning cycle that this study has started in specifically, could be trained in one of three areas to a small way. do so. One area would lead efforts to manage food security, such as kitchen gardens or grain banks and to Additionally, creating an institutional space to undertake support the access and utilization of related programs. these activities, possibly in the form of a FNS committee A second area would be to lead efforts to support or task force, would increase chances of success. It is the adoption of optimal maternal and child care. This ultimately the State Rural Livelihood Missions that must would include support for behaviors related to hand plan, finance, and support the implementation of FNS washing, clean water use, toilet construction and use, interventions. Having a dedicated space to manage this breastfeeding, complimentary feeding, antenatal care process and activities will support these efforts. and supplemental nutrition for the mother and so on. Lastly, training a cadre of FNS community resource A third area of special training for community resource persons to assist the adoption of community-managed persons would be to support self-help groups or village FNS models in tribal areas will strengthen the approach. organizations to manage the local service delivery The specialized community resource people will of FNS-related schemes, especially a mid-day meal mobilize the community and self-help groups, and more scheme and public distribution system. Year-round access to food is critical to improving health outcomes. (John Isaac, World Bank) Partners SA FANSI Administered by: This results series highlights development results, operational innovations and lessons emerging from the South Asia Food and Nutrition Security Initiative (SAFANSI) of the World Bank South Asia region. Disclaimer: The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the Executive Directors of the International Bank for Reconstruction and Development / The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.