More than a dozen reports have emerged of children taken ill after consuming milk in government schools. Frenzied reactions are witnessed and panic buttons are pushed at the crisis hour. The hysteria subsides and the status quo continues, which is mostly a brief calm before another storm. Several question marks remain on the safety and sustainability of the ambitious free milk distribution initiative since its much publicised flag off.
No doubt, the intention of providing an additional source of nutrition along with a meal is noble. However, its implementation comes with questions – monetary, infrastructure and clinical. A program of such popularity, impact and scale needs an economically viable, systematic and scientific approach to realise its desired objectives.
Mid-Day Meal Scheme is one of the most promising programs to directly tackle classroom hunger and promote education. This Scheme has the potential to counter the three interconnected issues of illiteracy, hunger and poverty. Since 2001 when the Supreme Court of India formally mandated that cooked mid-day meal should be provided to every child at all government schools and government assisted primary schools, this program has received much appreciation and impact on classroom hunger, literacy and health, yet the nation as a whole has a long way to go.
The Government of India and all State Governments have been constantly trying to improve this programme with new inclusions in the meal menu. Items like fruits, milk and egg are some of the proposals by policy makers. Indeed the proposed additional items will boost overall nutrition of the meal but the question of feasibility arises immediately amongst all the implementers of the Mid-Day Meal Scheme.
Lately, the issue of inclusion of milk in mid-day meal has come to the forefront of speculation due to incidences of children falling ill after milk consumption and also due to the inconsistency found in the quality of milk. Undoubtedly, milk is a source of calcium, protein, vitamin, minerals, carbohydrates, fat and enzymes; however, can we really afford to provide safe, hygienic and quality milk to children at all mid-day meal beneficiary schools? Presently, Karnataka and Madhya Pradesh have taken the initiative to incorporate milk as one of the menu item in mid-day meal. But, there have been questions raised repeatedly regarding the quality of the milk. Let’s skim through a few of the considerations if milk in mid-day meal has to become a full proof nationwide programme.
The 2015-16 Union Budget of India has sanctioned Rs. 9,236 crore towards the Mid-Day Meal Scheme which is a huge slash from the previous year’s (2014-15) Rs. 13,215 crore. The current budget allows expenditure of Rs. 3.58 per meal for primary school children and Rs. 5.38 for secondary school children. The paradox is when the sanctioned budget is not enough to cover the primary meal cost, there are proposals by policy makers to introduce milk in the menu which itself costs Rs. 8 per child. Despite this evident financial deficit, mid-day meal implementers are persuaded to provide milk to the beneficiaries.
The thought of introducing milk is indeed a step forward but it also raises concerns regarding its implementation. Providing the core meal with decreased annual budget is already causing a stress. Now, there is a fresh directive to supply milk without any provision of subsidy or separate milk budget.
Provider to consumer
The storage and supply chain infrastructure for an easily perishable food product like milk certainly has to be state-of-the-art quality. Climatic conditions also have to be given equivalent consideration if the milk scheme has to be made a nation-wide program. Due to short shelf-life of milk, it requires a cold storage facility for storage and transportation with a temperature of 4 – 8 degree Celsius. However, the entire set-up of cold storage is a cost incurring activity and with the current budget allocation it seems near to being impractical. Despite the scenario, implementers have acted as facilitators in milk by supplying its beneficiary schools with sachets of flavored milk which is processed, packed and sealed by reputed milk federations. Though the implementers continue to supply milk with limited infrastructure, it is more a matter of following a mandate.
It is evident that for the milk distribution to reach its full potential with guaranteed quality and safety, investment on supply chain infrastructure is a must. Otherwise, untoward incidences of receiving poor quality milk, ill effects on children, inconsumable milk and the like will become unavoidable. It does not really reflect a long term enterprise to serve milk without proper infrastructural arrangement conducive to storage and transportation of milk.
Milk is rich in nutrients essential for human health, including Vitamins A, D, and B12, minerals such as potassium, calcium, phosphorus, zinc, magnesium, and protein. It is one of easiest source of obtaining required calcium. Apart from the health benefits, it is also important to be aware of the clinical intolerance aspect of milk among some children when the Government is looking for a mass scale milk distribution programme. Milk allergy, lactose intolerance and cows’ milk protein allergy (CMPA) are some of the clinical conditions to be considered.
A milk allergy is a food allergy, an adverse immune reaction to one or more of the constituents of milk from any animal (most commonly alpha S1-casein, a protein in cow’s milk). This milk-induced allergic reaction can involve anaphylaxis, a serious and potentially life-threatening condition. Lactose intolerance occurs when a person lacks the enzyme lactase to metabolize lactose, a type of natural milk sugar found in milk and dairy products. Cow’s milk is the leading cause of allergic reactions in young children and in one of eight foods that are responsible for 90 percent of childhood allergies.
Cows’ milk protein allergy (CMPA) is delayed reaction to the milk protein that is normally harmless to the non-allergic, tolerant individual. It can take several hours, or even up to 72 hours to produce a clinical effect making it difficult for immediate diagnosis. This indicates that when we are planning for an extended menu, we should also ensure that proper medical records of children are available with school authority as the first level groundwork to avoid untoward medical incidences.
But factors for milk intolerance do not end with these clinical symptoms. In one case, the reason behind children falling sick immediately after consuming milk was quite perplexing. It was found that the quality of milk was not an issue for the children to fall sick, rather the incidence occurred due to children’s digestive system not being able to assimilate the beverage. Firstly, the beneficiaries were not used to consuming milk regularly. Secondly, the consumption of milk on empty stomach (as it was served in the morning) led to a gastric reaction in children. This incident is an eye-opener that introduction of a new item in the mid-day meal menu should be gradual.
Learning from other successful models around the world
We can take leads from this existing milk scheme model in the UK to implement a working structure for milk procurement, storage and supply with necessary modifications based on our need. The European School Milk Scheme is intended to encourage consumption amongst children of healthy dairy products containing important vitamins and minerals. It is also accompanied by an impact assessment that evaluates alternative scenarios for the evolution of the policy on the basis of extensive quantitative and qualitative analysis.
According to the School Food Plan, schools across England must make milk available for every child who wants it in primary schools, secondary schools, special schools and pupil referral units from 1 January 2015. Milk should be made available during core school hours i.e. mid-morning break, mid-afternoon break or lunchtime so that children will benefit from the rehydration and energy boost halfway through the morning or afternoon.
The type of milk that can be provided are lower-fat milk (not more that 1.8% fat content, such as semi-skimmed, skimmed or 1% fat milk) and Lactose-reduced milk or plain soya milk for lactose intolerant children. Under the Department of Health Nursery Milk Scheme all children under five years old attending a day care or early years settings are eligible to receive, free of charge. Currently, all children aged between 5 and 18 who are eligible for free school meals (where the school claims a Pupil Premium) must be offered free milk. Schools may use the dedicated schools grant to fund the provision of milk for eligible pupils. To help reduce the cost, schools can participate in the EU School Milk Subsidy Scheme.
Cool Milk Scheme is one such scheme running successfully. Cool Milk is an organisation facilitating the government milk scheme by working in partnership with over 140 local authorities across UK to provide milk at schools. It ensures complete compliance with legislation as well as offers a comprehensive and transparent audit trail. Cool Milk also partners with the Children’s Food Trust, LACA and Change4life to make sure that its operation is in association with school food and catering experts.
Cool Milk works with a network of distributors who buy pasteurised milk from dairy processors approved by the UK Food Standards Agency. The distributors deliver the milk in refrigerated vehicles to the schools and nurseries that are registered with the scheme. The school or nursery takes the responsibility of segregating lactose intolerant children based on medical information provided by the parents. These children are offered water or juice instead of milk.
The Cool Milk Scheme provides a complete solution for under-5 and over-5 milk provision at schools. Cool Milk claims relevant government subsidies and pay the distributors thereby providing for a cashless scheme with minimal administration enabling schools to focus their time on delivering universal infant free school meals. It provides free fridge, marketing materials, posters and stickers to promote the scheme to children and their families. A fully transparent audit trail for the Department of Health, Department for Education, Office for Standards in Education, Children’s Services and Skills (Ofsted) and school governors demonstrating compliance with the new legislation is also a part of the Cool Milk Scheme.
Agreeing to all the health benefits that milk can provide among growing children, we also need to bear in mind the criticality of storage, quality, clinical relevance and most importantly budget. Indeed a great proposal, but it would be wise to make it a nation-wide program only when we are ready to meet all the basic requirements to ensure that the young consumers will be safe at all cost.
By Santa Sikha Sarmmah