National Nutritional Programmes In India

date 14/07/2012

PresenterDr Utpal Sharma

PG Student,

ModeratorDr Debadeep KalitaAssistant Professor

Department of Community Medicine Gauhati medical college, Guwahati

Introduction

With independence……

Threat of famine and the resultant acute starvation due to low agricultural production and the lack of an appropriate food distribution system

Chronic energy and micronutrient deficiencies due to: Low dietary intake because of poverty and low purchasing power;High prevalence of infection because of poor access to safe-drinking water, sanitation and health care;Poor utilization of available facilities due to low literacy and lack of awareness.

Before independence……..1st phase- 1930’s the clinical/medical phase

Cont….2nd phase- The food production phase in 1940’sOver few past decades India attained self sufficiency in food production in 1970 through

various interventions:Green revolution Public distribution systemR&D in the field of nutrition by NIN & CFTRI

3rd phase-the community phase….Direct interventions through national nutritional programmes in late1960’s and early 70’s

with inception of ‘5-year plans’Number of short-term measures to combat problems of malnutrition.Undernutrition is found mostly in rural areas

4th phase- the multi sectoral phase…..

Nutritional programmes in indiaMinistry of Rural DevelopmentApplied nutrition programme

Ministry of Social WelfareIntegrated child development services schemeBalwadi nutrition programme Special nutrition programme

Ministry of Health and Family WelfareNational nutritional anemia prophylaxis programmeNational prophylaxis programme for prevention of blindness due to vitamin A deficiencyNational iodine deficiency disorder control programme

Ministry of EducationMid-day meal programme

Applied nutrition programme

One of the earliest nutritional programmes.This project was started in Orissa on 1963Later extended to Tamilnadu and UP

Objectives:Promoting production and of protective food such Vegetables and fruits Ensure their consumption by pregnant & lactating women and children.

1973 its extended to all states in INDIA

Services Nutritional education Nutrition worth 25 paise for children and 50 paise for pregnant and

lactating women for 52 days in a year

The programme maintained by Ministry of Rural Development.

Balwadi nutrition programmeThis was started in 1970 under the department of social welfare through voluntary organisations.Voluntary organisations receiving the grants are responsible for the running of this program

Beneficiary group Preschool children 3-5years of age.

Services300kcal and 10gm protein for 270 days in a year.Also provide with pre school education

Balawadis are being phased out because universalization of ICDS

Special nutrition programmeStarted in 1970 by Ministry of Social Welfare. Operation in urban slums, tribal areas and backward rural areas.Operated under minimum need programmeMain aim is to improve nutritional status in targeted group.

Beneficiary group Children below 6 years Pregnant and lactating women

Services Preschool children : 300kcal and 10-12gm protein Pregnant & lactating mothers :500kcal and 25 gm proteinTotal of 300 days in a year

Fund for nutrition component of ICDS programme was shared with SNP budget This programme is gradually being merged into ICDS

Integrated child development service(ICDS)

schemeInitiated-Oct.2,1975, in 33 CD Blocks under 5th Five Year PlanUnder aegis of Ministry of social welfare In succession to objectives of National Children's Policy (Aug. 1974)World’s largest program for early childhood developmentCentrally sponsored scheme implemented by state/UT govts.

Rationale

Routine MCH services not reaching target Population

Nutritional component not covered by Health services

Need for community participation

Objectives Lay the foundation for proper psychological, physical and social development of childImprove nutritional & health status of childrenReduce incidence of mortality, morbidity, malnutrition and school drop-outsEnhance the capability of mother & familyAchieve effective coordination among various departments

Beneficiaries Children < 6 yearsPregnant & Lactating womenWomen in Reproductive age group (15-44 yr)Adolescent Girls (in selected Blocks)

Services Supplementary nutritionNon-formal pre-school educationImmunizationHealth Check-upReferral servicesNutrition and Health Education

Administration of the schemeCommunity development block-Rural areasTribal blocks-tribal areasWards/ slums –urban areas

Service through Anganwadi:

Population (Previously)

Type AWC/Population Mini AWCUrban 500-1500 Nil Rural 500-1500 150-500Tribal 300-1500 150-300

Population (Currently)

Urban 400-800 Nil Rural 400-800 150-400Tribal 300-800 150-300

Department of Women & Child Development, Ministry of Human Resource DevelopmentCentral level

Department of social welfareState level

District level

CDPO (100 villages)

Medical officer (20-25) villages

Mukhya sevika (20-25 AWC)

Multipurpose worker (F) (4-5 no.)

Anganwadi worker (5-6 Anganwadi centres)

ORGANIZATION

ICDS

SUPPLEMENTARY NUTRITION Supplementary feeding and Growth monitoring. Prophylaxis against Vit. A deficiency. Control of Nutritional Anemia. ACTIVITIES

Target group identified from community. They are provided supplementary feeding support for 300 days in a year. Weight for age growth cards are maintained for all children < 6 years. Severely malnourished children are given special supplementary feeding and referred to medical services.

Supplementary nutrition

Revised financial norms for food supplement

Beneficiary Pre-revised Revised w.e.f. Feb. 2009

Calories (KCal) Protein (G)

Calories (KCal)

Protein(G)

Children (6-72 months) 300 8-10 500 12-15Severely malnourished children (6-72 months)

600 20 800 20-25

Pregnant & Lactating 500 15-20 600 18-20

Category Pre-revised Revised w.e.f June 2010

Children (6-72 months) Rs. 2.00 Rs.4.84Severely malnourished children (6-72 months)

Rs. 2.70 Rs.5.82

Pregnant & Lactating Rs. 2.30 Rs.6.00

Wheat-based nutrition programme

Centrally sponsored programme, launched in 1986.Implemented by the Ministry of Women & Child DevelopmentProgramme follows the norms of SNP.Providing nutritious/ energy food to children below 6 years of

age and expectant /lactating women from disadvantaged sectionsImplemented through ICDSFood grains supplied under the programme- used to prepare

food for supplementary nutrition in ICDS

Nutrition Programme for Adolescent Girls

Introduced in the year 2002-2003 with 100% Central Assistance

Aims1. Improve Nutritional and health status adolescent girls.2. Provide nutrition and health education to the beneficiaries.3. Empower adolescent girls through increased awareness to take better care of their personal health and nutrition needs. 

BeneficiariesAdolescent girls <35 KgPregnant women <45 kg

Services 6 Kg ration per month for three months consecutively.Implemented through the A.W. Centres Weighing four times in a year on the basis of the body weight, issuance of live rice will continue for 3 months.In Assam, Kokrajhar and Karbi-Anglong as pilot districts.

ICDS and AssamTotal of 230 blocks Total 58118 functioning AWCsFeeding days covered in 2011-12- 177days (target 300days)Food sponsored for programme -90% of budget in NE states.

New

Provision of breakfast @ Rs 2 since 2010-11 to be continued till 2013

National nutritional anemia prophylaxis programme

Programme was launched during 4th 5-year plan in 1970 by the Ministry of Health and Family Welfare Prevention of nutritional anemia in mothers and children

Rationale Supplementary iron on daily basis is considered necessary in developing countries because approaches like food fortification and dietary modification are long term options.

Requirements during 2nd and 3rd trimester can’t be made by daily intake.Majority of girls are anemic , even in their adolescence.

Souce: Gopalan C. child care in india: emerging challenger bull.1993Deleterious effect on neural tube development in folic acid development during 1st 4 weeks of pregnancy Source: Rosenberg IH. Folic acid and neural tube defect . Time for action? New Eng J.Med; 1992

Beneficiaries Children 1-5years of ageExpecting and lactating mothersFamily planning (IUD) acceptors

PolicyExpecting and lactating mothers as well as IUD acceptors -60 mg of elemental iron + 0.5 mg folate everyday for 100 days.Children 1-5 years- 20mg of elemental iron + 0.1 mg folate everyday for 100 days.

In the pursuit of prevention of anemia in country….

1991-Renamed as ‘National nutritional anemia control programme’.

Beneficiaries redefined- extended to both anemic and non-anemic lactating& expecting mothers and 1-5years children.Dosage of iron- from 60 mg to 100mg of elemental iron daily.IEC regarding increase consumption of iron-rich food

1992-programme was made integral part of CSSM programme

100mg Fe+0.5 folate for 100days started along 1st dose of inj T.TTherapeutic dose- 2 tabs of Irofol for 100 days.

1997- Programme is integrated with RCH…..2005- Programme is integrated with NRHM……

2007 -new directives from MoH&FW, GoI6-12 months infants be included in the programme .Dose for under 5 children in liquid formulation.Children 6-10years & adolescent 11-18years included

Recommended dose:6-59month children-liquid 20 mg Fe+ 0.1 mg Folate for 100 days6-10 years-1 tab. 30 mg Fe+ 0.25 mg Folate for 100 days.Adolescent & adults-1 tab. 100 mg Fe+ 0.5 mg Folate for 100 days Folic acid tab.(500μg) is given in 1st trimester in first 4 weeks.

New

Pilot districts as Kamrup and Dibrugarh selected for iron sucrose injection

Beneficiaries : Moderate and severe anemia with Hb <9gm/dl detected in 2nd

trimester and early 3rd trimester, not responding to IFA oral tablet.

Dosage : 100 mg per 5ml, 2 ampoules for each beneficiaries.

Weekly Iron and Folic acid supplimentation programme for adolescents

Also known as WIFS-Blue campaign.Nodal agency- Ministry of H&FWBeneficiaries-Adolescent girls/boys enrolled in school, 6th- 12th std.Adolescent girls not enrolled in schools

Services IFA tablet to target population on weekly basis on a fixed day(Monday) for 52 weeks.Biannual deworming (February and August)

IMPLEMENTATION

In-school students Ministry of education

Out of school studentsMinistry of Social Welfare

National prophylaxis programme against nutritional blindness due to vitamin A deficiency

Launched in 1970 as a centrally sponsored scheme by Ministry of H&FW, GoI.Component of National programme for control of blindness1976

Rationale

Target group- all children 1-3 years of age.Activity –Megadose of vit.A (2 lac IU) orally every six months

Human liver can store vitamin A when consumed in excess of daily requirements. The stored Vitamin A is released when in need

In the run……8th 5-year plan- vitamin A supplementation linked with immunization programme.10th 5-year plan- Megadoses to given biannually in pre-summer & pre-winter period.2006-07-to cover all the children in 6months to 5 years age.

Short term strategyAdministation of supplemental dose of Vit. A in Arachis oil.6-11months-1 dose of 1 lac IU.1-5 years- 2 lac IU bianually.

Long term strategyPromotion of regular intake of Vit A- rich food.Feeding locally available food. Kitchen gardening of Vit A-rich food.

Treatment of Vit A defciencyImmediately after diagnosis-2 lac IU followed by another dose of 2 lac IU 1-4 weeks later.

National iodine deficiency disorder control programme

The beginning-Kangra valley study (1956-72)National Goitre Control Programme launched in 1962, at the end of 2nd 5-year plan by Ministry of H&FW ,GoI.Focuses on use of Iodised Salt – Replace of common salt with iodised salt, Cheapest method to control IDD.Use of Iodized oil Injection to those suffering from IDD, Oral administration as prophylaxis in IDD severe areas

Rationale

No State or UT in India is free from IDD, as evident from the surveys carried by ICMRIodine deficiency leads to a spectrum of disorders mostly affecting physical and mental developmentThe fact that human brain development is completed by 3 years of age , iodine deficiency in early age leads to permanent and irreversible damage.Fortification of salt is a preventive programme, can be considered as a ‘vaccine’

Dr V Ramalingaswami (1921 - 2001)

Journey of the programme…..The turning point- meeting of prime minister in 1983.1983- Universal iodisation of salt (30 ppm at manufacture level and 15ppm at consumption level)1992- programme renamed as ‘National iodine deficiency disorder control’

Objectives Surveys to assess the magnitude of IDD.Supply of iodised saltResurveys 5yearly to assess impact of iodised salt & IDDLab monitering of iodised salt and UIEHealth education.

Strategy Iodise entire edible salt in the countryby 1992.Ban of non-iodised salt under PFA act (1954).

NIDDCP and AssamGoitre survey- 18 districts covered since 2009Salt survey completed in 19 district (2012)42 blocks- >75% population using salt with <15ppm iodine content of saltIDD monitoring lab functional but UIE estimation yet to be started. UIE estimation done in state health laboratory, Bamunimaidan.3 iodisation plants exists in state- Dibrugarh, Lakhimpur and Guwahati

Mid-day meal programmeFirst started in Tamilnadu.Also known as School lunch programme.Programme in operation since 1961 under Ministry of Education.

Aim To provide at least one nourishing meal to school going children per day.

ObjectivesImprove the school attendanceReduce school drop outsBeneficial impact on child’s nutrition

Principles Supplement and not a substitute to home diet.Supply at least 1/3 of the energy requirement and 1/2 of the protein neededThe cost of meal should be reasonably low.Meal prepared easily in schools, no complicating cooking proceduresLocally available foods should be usedThe menu should be frequently changed

Akshaya patra Started in 2000, feeding 1500 children in 5 schools in Bangalore.Successfully involved private sector participation in the programme.Programme managed with a centralized kitchen that runs through a public/private partnership. Food delivered to schools in sealed and heat retaining containers just before the lunch break every day

Objectives Providing underprivileged children with a healthy, balanced meal . Reduce the dropout rate and increases classroom attendance.Improve socialization among castes, address malnutrition Empower women through employment.

Assam is the 8th state in the runLaunched on 19 feb 201020 thousand students of 260 schools of the district in the first phase.

Miscellenous Annapurna SchemeLaunched in 2000-2001 by Ministry of Rural Development Senior citizens of ≥65 years of age, not getting the pension under the National Old Age Pension Scheme (NOAPS) 10 kgs. of food grains/person/month are supplied free of cost.

Maa-moniUnder Assam Bikash Yojna.Beneficiaries are pregnant mothers Rs. 1000 provided for nutrition and ambulance

Antyodaya Anna YojnaLaunched in 25th Dec 2000Aim- to create hunger-free india in next 5 year and reform PDSTarget group- poor families who couldn’t afford food grains even at BPL ratesService- 35 kg/Family/month of wheat @Rs 2/- & rice @Rs 3/-

CM’s Vision for Women and Children 2016Yet to roll out….

Thank you

Nutrition programme for adolescent girls(Kishori shakti yojna)

Launched by Dept. of Women and Child Development ,Ministry of Human Resource Development in 1991 Targeted All adolescent girls in the age group of 11-18 years

common services1. Watch over menarche, 2. Immunization, 3. General health check-ups once in every six-months,4. Training for minor ailments, 5. De-worming, 6. Prophylactic measures against anemia, goiter, vitamin deficiency, etc., and7. Referral to PHC. District hospital in case of acute need.8. Girls are also provided supplementary nutrition at Rs. 2.50 per girl, per day