Assessing Child Malnutrition at the Parliamentary Constituency level

A new study, supported by the Harvard Centre for Population and Development Studies and Tata Trusts, has used data from the National Family Health Survey 2016 to develop and apply two geographic information systems methodologies to provide estimates of four child malnutrition indicators i.e. stunting, wasting, underweight and anemia across the 543 parliamentary constituencies in the country.
 
The monitoring and surveillance of health and well-being indicators in India usually focus on states and districts. Prominent sources of data like the National Family Health Survey 2016 (NFHS-4),the NITI Aayog Aspirational Districts Programme etc. Report district-level outcomes, thereby making the district a unit of interest and evidence-based intervention in policy discourse. The increased policy focus on districts is cyclical as it necessitates the collection of more data at the district level.
 
The parliamentary constituency (PC) is a decentralized geographical unit that holds substantial political influence in India because these are represented by the Members of the Parliament of the Lok Sabha, directly elected by the people. This study emphasises upon the need to focus on PC-level data, as unlike districts, there is direct governmental accountability in case of PCs, since MPs are directly responsible for the policy vision and implementation as well as well-being of their constituents.
 
Other than the direct representation of people, PCs hold relevance because of the resource allocations by the national government. Under the 1993 Members of Parliament Local Area Development Scheme (MPLADS), each MP may receive up to ₹ 5 crores annually for undertaking development projects in their respective PCs (MoSPI 2017a). In order to determine appropriate interventions, the MP will require current and accurate economic, infrastructural and demographic data/estimates specific to the PC.
 
However, the lack of PC-level data shifts the policy discourse away from PCs, thereby discouraging data collection at that level. The proposed novel methodologies aim to address this data gap, by generating child malnutrition estimates at the PC-level, using data from three main sources i.e. the NFHS-4, the global demographic and health surveys (DHS) conducted across a wide range of low- and middle-income countries every five years and the boundary shapefiles for PCs and districts i.e.the “India–Map of Parliamentary Constituencies (2014).”
 
These can perform three functions. (1) Presenting a state-of-the-art geographic information system-based methodology to use district-level estimates and create a “crosswalk” to generate PC-level estimates (2) Presenting a method of generating PC-level estimates by directly aggregating individual data for instances wherein individual data can be linked to their PCs (3) Applying these methodologies to rank PCs based on child malnutrition indicators and assessing patterns of PC variability across them.
 
Three salient findings can be attributed to this study.
 

• Prevalence of the four indicators of interest is highly variable across PCs and state-level analysis suggests that the relative importance of PC-level data varies across states

• Moderate/high correlations between malnutrition indicators at the PC-level indicate that several PCs experience a multiple burden of child malnutrition that must be addressed concurrently

• Several PCs in Madhya Pradesh and Jharkhand with high prevalence represent the highest priority for health interventions while other PCs show low prevalence for all indicators. These represent positive deviant PCs that should be investigated to elucidate the best practices for child nutrition in a particular state

 
Karnataka, Maharashtra and Odisha have PCs in the top and bottom two quintiles across many indicators. The substantial PC-level and intra-state variations across child malnutrition indicators can be attributed to the underlying distribution of risk factors (for example, household poverty – PCs with large proportions of poor households show high prevalence of child malnutrition). The proposed methodology can be extended to estimate outcomes at other geopolitical levels like assembly constituencies (ACs) as well. MLAs represent smaller geographical units than MPs so better-informed local interventions can increase accountability for both, MLAs and MPs.
 
The financial resources (MPLADS) also impact the occurrence of child malnutrition at the PC-level. The MPLADS can potentially exert significant influence over the PC-level health outcomes, since “preference is given to works relating to national priorities, such as … public health” (MoSPI 2016).The distinct nutritional profiles for each PC entail the need for interventions to cater to local contexts. Programmes like the SPARC, Parliamentary Research Service (PRS), and Legislative Assistants to Members of Parliament (LAMP)can support MPs in making informed policy and financial decisions.
 
Within the context of political business cycles, defined as the “increased spending by governments just before elections in the hope of staying power”, the role of MPs is particularly significant vis-v-is MPLADS spending. MPs vying for re-election in 2014 strategically spent the bulk of their allotted MPLADS funds towards the end of their term (Blair 2017). The large PC-specific variations can help understand the magnitude of differences across health and development indicators and the extent to which these differences are a consequence of PC-specific processes, as opposed to reflecting endogenous characteristics.
 
This study can complement policy discourse with data and timely evidence at the local level, thereby empowering MPs to target their goals (of the POSHAN Abhiyan programme and other nutrition interventions) effectively and the constituents to ask the right questions. The level of awareness and demands of the constituents can significantly ensure more proactive and consistent implementation of MPLADS funds, governed by development needs rather than political motives.
 
India Outbound
January 28, 2019
 

source https://indiaoutbound.org/assessing-child-malnutrition-at-the-parliamentary-constituency-level/