Tracking Nutrition Financing in Rajasthan

1 Tracking Nutrition Financing in RajasthanAnalysing past and current Financing allocations for malnutrition in Rajasthan and comparing against resource needs to conduct a gap assessmentRifaiyat Mahbub, Tess Ryckman, Anupama Dathan, Robert HechtResults for Development InstituteFebruary 2016 Results for Development Institute (R4D) is a nonprofit organisation whose mission is to unlock solutions to tough development challenges that prevent people in low- and middle-income countries from realising their full potential. Using varied approaches in multiple sectors, including global education, global health, governance, and market dynamics, R4D supports the discovery and implementation of new ideas for reducing poverty and improving lives around the report was authored by R4D with funding provided by the Children's Investment Fund Foundation (CIFF).

2 We are grateful to the Coalition for Food and Nutrition Services (CFNS) for thoughtful : This work was supported by the Children s Investment Fund Foundation, (UK). Any opinions, findings, conclusions, or recommendations are those of the authors and do not reflect the views of Children s Investment Fund Foundation, (UK) or its CIFF: The Children's Investment Fund Foundation is an independent philanthropic organisation, headquartered in London with offices in Nairobi and New Delhi. CIFF works to transform the lives of poor and vulnerable children in developing countries. Areas of work include children and mothers' health and Nutrition , children's education and welfare, and smart ways to slowdown and stop climate change.

3 CIFF places significant emphasis on quality data and evidence to measure and evaluate progress with partners to achieve large-scale and sustainable impact. Find more information at 2016 Results for Development Institute 1111 19th Street, , Suite 700, Washington, DC 20036 Tracking Nutrition Financing in Rajasthan Table of ContentsExecutive Summary 1 Introduction 2 Methodologies Used for Budget Analysis 4 Estimating government Nutrition Financing Using State Budgets 4 Estimating Development Partner Nutrition Financing Using the OECD-DAC Database 7 Estimating Out-of-Pocket Nutrition Financing 7 Estimates of Nutrition Financing and Expenditure 9 Nutrition Funding Available through State Budget 9 Breakdown by Sector 11 Breakdown by Scheme 12 Nutrition Funding from Development Partners 16 Combined Nutrition Financing from the government and Development Partners 17 Resource Needs Analysis and Gap Assessment 18 Policy Implications 23 Moving Forward 26 Annexes 30 Annex I

4 Description of CSS 30 Annex II 2014 2015 BE, RE, and Reported Expenditure for Key CSS 32 Annex III Kapur and Haddad Classification of Nutrition -Specific and -Sensitive Programmes 34 Annex IV Proposed R4D Methodology to Weight Nutrition Interventions 35 Annex V Mapping of all Schemes Included in Financing Analysis to Sectors 37 Annex VI Sector and Scheme Breakdowns of Nutrition Financing in Rajasthan 38 Annex VII Description, Target Populations and Unit Costs of India Plus Interventions 40 Tracking Nutrition Financing in Rajasthan 1 Executive SummaryOver the past year, the government of the Indian state of Rajasthan has declared Nutrition to be a key priority and has been translating that commitment into action through activities such as working with partners to roll out a new Community-based Management of Acute Malnutrition (CMAM) programme in the state.

5 However, a lack of analysis on total Nutrition Financing in the state has limited the Rajasthan government 's ability to incorporate an evidence-based understanding of Nutrition funding into its budgeting and planning process. Before the analysis in this paper was conducted, existing budget and finance documents had not been synthesised and analysed to generate an estimate of the total funding going towards Nutrition programmes in Rajasthan . Meanwhile, the need to provide clarity around the Financing situation has grown even greater in light of the ongoing fiscal devolution, in which the central Indian government will increase the share of untied transfers to states while reducing the share of funding tied to Centrally Sponsored Schemes (CSS) through which most Nutrition Financing has historically Results for Development Institute (R4D) has developed a comprehensive analysis of Financing for Nutrition in Rajasthan .

6 We have combined this Financing analysis with a costing exercise to estimate the gap between resource needs and available funding. Our Financing analysis shows that billion was originally budgeted for Nutrition -relevant programmes in Rajasthan in 2014 2015 (this was revised downwards to billion halfway through 2014 2015) and billion was budgeted for the current fiscal year (2015 2016). Out of these totals, funding for the Integrated Child Development Services (ICDS) made up between 21% and 24% of total Financing , the National Health Mission (NHM) budget accounted for 3%-8%, and Mid-Day Meals (MDM) made up approximately 8%. Other major streams of funding came through food security schemes, such as the Public Distribution System (PDS) and the National Food Security Mission, water, sanitation, and hygiene (WASH) schemes, and the agriculture sector.

7 Development partner spending in 2013 amounted to an almost-negligible million, 64% of which came through health gap analysis shows that only 31% of total Nutrition -specific resource needs are being met in Areas like Infant and Young Child Feeding (IYCF) and micronutrient supplementation are particularly under-funded. A resource gap also exists for severe acute malnutrition (SAM) management despite the government having significantly increased funding for this area in recent years. This area will become increasingly critical as the new CMAM pilot scales up. Meanwhile, the government devotes significant funding to poorly-targeted food schemes, such as MDM. Such schemes do not focus on children under five, an age after which reversing malnutrition becomes much more difficult; most interventions have maximum impact during the first thousand days of life (conception to age two).

8 The findings of our Financing and gap analyses indicate that the government could consider reallocating funding to programmes that focus better on key target populations including babies in the first one thousand days of life and women of reproductive age; give greater priority to certain high-impact, cost-effective programmes; and leverage more funding from other Nutrition -sensitive sectors, especially if social sector funding is constrained in the coming years as a result of devolution. An increased transfer of untied funds to the states presents an opportunity to optimise spending: states may be able to design new schemes and restructure existing ones to better fit their respective nutritional needs and contexts.

9 That being said, devolution also represents a risk; states will have to actively prioritise Nutrition and social sector funding to prevent cuts in these areas. A Nutrition coordinating body at the state level could provide the information necessary for policymakers to appropriately prioritise and target Nutrition Financing , monitor funding and progress under devolution, leverage more Nutrition -targeted funding from Nutrition -sensitive sectors, and hold Nutrition -relevant departments accountable for This analysis is somewhat preliminary because further disaggregation of programmes and other specific activities described in the report are required to precisely match costed interventions with Indian schemes. 2 Despite rapid economic growth over the last decade, India continues to struggle to provide access to basic food and healthcare to large sections of its population.

10 The state of Nutrition is particularly dire. The prevalence of underweight children in India is twice that of Sub-Saharan Africa; in fact, more than a third of the world s low birth weight infants live in Even with large increases in financial allocations to programmes that tackle hunger and poor health, India is home to 43% of the world s malnourished, amounting to 191 million people 16% of its to India s third National Family Health Survey (NFHS-3), of children under five in Rajasthan were stunted and were wasted in 2005 2006. The more recent Rapid Survey of Children (RSOC) indicates that in 2013 2014, of children under five were stunted and wasted. Although both stunting and wasting rates have declined over time, significant efforts remain necessary to combat malnutrition in the importance of tackling malnutrition, the central and state governments have launched schemes that attempt to address the burden of poor nutritional outcomes in Rajasthan .