1. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Outline
Outline
1 Motivation
The Indian Enigma
Determinants of malnutrition
2 Action Plan for overcoming malnutrition
Multisectoral approach recommendations
Government programmes

2. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Outline
1 Motivation
The Indian Enigma
Determinants of malnutrition
2 Action Plan for overcoming malnutrition
Multisectoral approach recommendations
Government programmes

3. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
High incidence of malnutrition in India
Magnitude of the Problem
Despite a fast growing economy, high incidence of
malnutrition, food insecurity and rural poverty in India
20% of the Indian population in 2001-‘03 was food insecure
as against 25% in 1990-‘92, an improvement
In more recent years, in 2009-‘10, 21% of Indians were food
insecure, a deterioration in food security
Source: Ministry of Agriculture, GOI 2007; FAO 2010

4. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
High incidence of malnutrition in India
Magnitude of the Problem
Despite a fast growing economy, high incidence of
malnutrition, food insecurity and rural poverty in India
20% of the Indian population in 2001-‘03 was food insecure
as against 25% in 1990-‘92, an improvement
In more recent years, in 2009-‘10, 21% of Indians were food
insecure, a deterioration in food security
Source: Ministry of Agriculture, GOI 2007; FAO 2010

5. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
High incidence of malnutrition in India
Magnitude of the Problem
Despite a fast growing economy, high incidence of
malnutrition, food insecurity and rural poverty in India
20% of the Indian population in 2001-‘03 was food insecure
as against 25% in 1990-‘92, an improvement
In more recent years, in 2009-‘10, 21% of Indians were food
insecure, a deterioration in food security
Source: Ministry of Agriculture, GOI 2007; FAO 2010

6. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Malnutrition and Anemia Rates
Widespread and high among children
Almost half of children under five (48%) are stunted, an
indicator of chronic malnutrition;
43% are underweight; wasting affects 20% (has increased
since NHFS-II)
24% are severely stunted and 16% are severely underweight
(slight improvement since NFHS-II)
70% of children 6-59 months are anemic; primarily due to
poor nutrition
Girls and boys are equally likely to be undernourished;
Undernourishment substantially higher in rural areas,
though 40% of urban children were stunted and 33%
underweight in 2005-‘06
Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)

7. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Malnutrition and Anemia Rates
Widespread and high among children
Almost half of children under five (48%) are stunted, an
indicator of chronic malnutrition;
43% are underweight; wasting affects 20% (has increased
since NHFS-II)
24% are severely stunted and 16% are severely underweight
(slight improvement since NFHS-II)
70% of children 6-59 months are anemic; primarily due to
poor nutrition
Girls and boys are equally likely to be undernourished;
Undernourishment substantially higher in rural areas,
though 40% of urban children were stunted and 33%
underweight in 2005-‘06
Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)

8. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Malnutrition and Anemia Rates
Widespread and high among children
Almost half of children under five (48%) are stunted, an
indicator of chronic malnutrition;
43% are underweight; wasting affects 20% (has increased
since NHFS-II)
24% are severely stunted and 16% are severely underweight
(slight improvement since NFHS-II)
70% of children 6-59 months are anemic; primarily due to
poor nutrition
Girls and boys are equally likely to be undernourished;
Undernourishment substantially higher in rural areas,
though 40% of urban children were stunted and 33%
underweight in 2005-‘06
Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)

9. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Malnutrition and Anemia Rates
Widespread and high among children
Almost half of children under five (48%) are stunted, an
indicator of chronic malnutrition;
43% are underweight; wasting affects 20% (has increased
since NHFS-II)
24% are severely stunted and 16% are severely underweight
(slight improvement since NFHS-II)
70% of children 6-59 months are anemic; primarily due to
poor nutrition
Girls and boys are equally likely to be undernourished;
Undernourishment substantially higher in rural areas,
though 40% of urban children were stunted and 33%
underweight in 2005-‘06
Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)

10. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Malnutrition and Anemia Rates
Widespread and high among children
Almost half of children under five (48%) are stunted, an
indicator of chronic malnutrition;
43% are underweight; wasting affects 20% (has increased
since NHFS-II)
24% are severely stunted and 16% are severely underweight
(slight improvement since NFHS-II)
70% of children 6-59 months are anemic; primarily due to
poor nutrition
Girls and boys are equally likely to be undernourished;
Undernourishment substantially higher in rural areas,
though 40% of urban children were stunted and 33%
underweight in 2005-‘06
Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)

11. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Nutrition statistics
Desc. %age
% infants w/low birthweight, ‘05-‘09 28
Early initiation of breastfeeding (%), ‘05-‘09 41
% children (‘05-‘09) excl. breastfed (< 6 mo.) 46
% children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57
% children (‘05-‘09) still breastfeeding (20-23 mo.) 77
% < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48
% < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43
% < 5 (‘03 -‘09) underweight (WHO), severe 16
% < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20
% < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48
Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66
% of households consuming iodized salt, ‘03-‘09 51

12. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Nutrition statistics
Desc. %age
% infants w/low birthweight, ‘05-‘09 28
Early initiation of breastfeeding (%), ‘05-‘09 41
% children (‘05-‘09) excl. breastfed (< 6 mo.) 46
% children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57
% children (‘05-‘09) still breastfeeding (20-23 mo.) 77
% < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48
% < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43
% < 5 (‘03 -‘09) underweight (WHO), severe 16
% < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20
% < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48
Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66
% of households consuming iodized salt, ‘03-‘09 51

13. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Nutrition statistics
Desc. %age
% infants w/low birthweight, ‘05-‘09 28
Early initiation of breastfeeding (%), ‘05-‘09 41
% children (‘05-‘09) excl. breastfed (< 6 mo.) 46
% children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57
% children (‘05-‘09) still breastfeeding (20-23 mo.) 77
% < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48
% < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43
% < 5 (‘03 -‘09) underweight (WHO), severe 16
% < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20
% < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48
Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66
% of households consuming iodized salt, ‘03-‘09 51

14. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Outline
1 Motivation
The Indian Enigma
Determinants of malnutrition
2 Action Plan for overcoming malnutrition
Multisectoral approach recommendations
Government programmes

15. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Economic, environmental & cultural
determinants of malnutrition
Poor purchasing power & poverty
Livelihood insecurity
Inequalities in asset distribution & control including gender
inequalities
Absence of safe drinking water, poor sanitation & hygiene
Inadequate knowledge of nutrition; cultural beliefs &
practices (e.g. expelling colostrum)
Cultural shift to less nutritious food consumption;
discriminatory intra-family food distribution
High workload of women; inadequate time for infant &
child care and feeding
Early marriage
Source: Coalition for Sustainable Nutrition Security in India 2010

16. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Economic, environmental & cultural
determinants of malnutrition
Poor purchasing power & poverty
Livelihood insecurity
Inequalities in asset distribution & control including gender
inequalities
Absence of safe drinking water, poor sanitation & hygiene
Inadequate knowledge of nutrition; cultural beliefs &
practices (e.g. expelling colostrum)
Cultural shift to less nutritious food consumption;
discriminatory intra-family food distribution
High workload of women; inadequate time for infant &
child care and feeding
Early marriage
Source: Coalition for Sustainable Nutrition Security in India 2010

17. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Economic, environmental & cultural
determinants of malnutrition
Poor purchasing power & poverty
Livelihood insecurity
Inequalities in asset distribution & control including gender
inequalities
Absence of safe drinking water, poor sanitation & hygiene
Inadequate knowledge of nutrition; cultural beliefs &
practices (e.g. expelling colostrum)
Cultural shift to less nutritious food consumption;
discriminatory intra-family food distribution
High workload of women; inadequate time for infant &
child care and feeding
Early marriage
Source: Coalition for Sustainable Nutrition Security in India 2010

18. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Agricultural and health
determinants of malnutrition
Nutritional concerns not considered in cropping and
farming systems
Limited availability of nutrient rich food; fewer home
gardens; conversion to cash crops
Seasonal food shortages; inequities in food distribution
Weak health service systems; inadequate human resources,
in public health nutrition
Weak health and nutrition educational systems
Poor utilization of services; recurrent infections; poor and
vulnerable not reached
Lack of nutrition-issues awareness, poor infant and young
child feeding practices
Source: Coalition for Sustainable Nutrition Security in India 2010

19. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Agricultural and health
determinants of malnutrition
Nutritional concerns not considered in cropping and
farming systems
Limited availability of nutrient rich food; fewer home
gardens; conversion to cash crops
Seasonal food shortages; inequities in food distribution
Weak health service systems; inadequate human resources,
in public health nutrition
Weak health and nutrition educational systems
Poor utilization of services; recurrent infections; poor and
vulnerable not reached
Lack of nutrition-issues awareness, poor infant and young
child feeding practices
Source: Coalition for Sustainable Nutrition Security in India 2010

20. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Policy & administration
determinants of malnutrition
Vertical programs not coordinated; lack of central
coordination for nutrition extension
Lack of nutrition surveillance system focused on nutritional
outcomes
Decision making not evidence based; weak implementation
& monitoring, poor governance
Source: Coalition for Sustainable Nutrition Security in India 2010

21. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Outline
1 Motivation
The Indian Enigma
Determinants of malnutrition
2 Action Plan for overcoming malnutrition
Multisectoral approach recommendations
Government programmes

22. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Women & Child Development programmes
1 Proven, essential nutrition interventions
Breastfeeding within hour of birth; exclusive for first six
months; timely introduction of complementary food
Age-appropriate complementary feeding (quality, quantity
& frequency)
Hygienic infant and child feeding practices, safe drinking
water & basic sanitation
Therapeutic feeding of children; including ready to use
therapeutic foods, through a community-based approach
combined with a facility based approach for children with
Severe Acute Malnutrition
Improved nutrition for women; iron and folic acid
supplementation; deworming for adolescents, pregnant
women and lactating mothers

23. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Women & Child Development programmes
1 Proven, essential nutrition interventions
Breastfeeding within hour of birth; exclusive for first six
months; timely introduction of complementary food
Age-appropriate complementary feeding (quality, quantity
& frequency)
Hygienic infant and child feeding practices, safe drinking
water & basic sanitation
Therapeutic feeding of children; including ready to use
therapeutic foods, through a community-based approach
combined with a facility based approach for children with
Severe Acute Malnutrition
Improved nutrition for women; iron and folic acid
supplementation; deworming for adolescents, pregnant
women and lactating mothers

24. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Health & Family Welfare programmes
2 Proven, essential primary health care interventions
Full immunisation and biannual vitamin A supplementation
with deworming for infants and young children
Appropriate and active feeding of children during illness,
including ORS and zinc supplementation during diarrhea
Improved nutrition for women, including iron and folic acid
supplements
Therapeutic feeding, including ready to use food, and care
for children with SAM
Address micro-nutrient malnutrition in a holistic manner

25. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Health & Family Welfare programmes
2 Proven, essential primary health care interventions
Full immunisation and biannual vitamin A supplementation
with deworming for infants and young children
Appropriate and active feeding of children during illness,
including ORS and zinc supplementation during diarrhea
Improved nutrition for women, including iron and folic acid
supplements
Therapeutic feeding, including ready to use food, and care
for children with SAM
Address micro-nutrient malnutrition in a holistic manner

26. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Rural Development
3 Promote personal hygiene, environmental sanitation, safe
drinking water and food safety
Promote use of safe drinking water
Encourage personal hygiene, environmental sanitation,
especially use of toilets and hand washing with soap
Safe food handling practices during storage, cooking and
eating

27. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Rural Development
3 Promote personal hygiene, environmental sanitation, safe
drinking water and food safety
Promote use of safe drinking water
Encourage personal hygiene, environmental sanitation,
especially use of toilets and hand washing with soap
Safe food handling practices during storage, cooking and
eating

28. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Agriculture
4 Integrate household food and nutrition security in design of
cropping and farming systems
Promote agricultural & horticulture programmes & policies;
increase supply and consumption of safe, nutritious foods;
promote food based remedies for nutritional maladies, with
an emphasis on micronutrient deficiencies; mainstream
nutrition considerations into NHM and Rastriya Krishi Vikas
Yojana
Expand availability of low cost nutritious foods in rural
areas through PDS, SHG; include quality complementary
food for children, 6-24 months
Review Mid-day meal scheme to improve food quality and
add nutrition education

29. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Agriculture
4 Integrate household food and nutrition security in design of
cropping and farming systems
National Commission of Farmers made recommendations
on
1 proven gains from intensive agriculture
2 developing contingency plans for extreme weather
3 improving production & productivity
4 promoting water use efficiency
5 remunerative prices for farm commodities

30. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Panchyati Raj, Min. WCD, Min. I&B
5 Expand and improve nutrition education, awareness and
involvement at community level
Involve PRI in nutrition security
1 Improve sensitisation and training of PRI members on
priority issues
2 Promote Village Health and Sanitation Committees overseen
by Gram Sabhas; focus on nutrition
3 PRI role in monitoring functions and outcomes of nutrition
programmes at community level
4 Awareness of entitlements among poor households,
particularly women using entitlement cards
ICT for nutrition education and M&E; Gyan Choupal,
Grameen Gyan Abiyan Movement

31. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Panchyati Raj, Min. WCD, Min. I&B
5 Expand and improve nutrition education, awareness and
involvement at community level
Involve PRI in nutrition security
1 Improve sensitisation and training of PRI members on
priority issues
2 Promote Village Health and Sanitation Committees overseen
by Gram Sabhas; focus on nutrition
3 PRI role in monitoring functions and outcomes of nutrition
programmes at community level
4 Awareness of entitlements among poor households,
particularly women using entitlement cards
ICT for nutrition education and M&E; Gyan Choupal,
Grameen Gyan Abiyan Movement

32. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Panchyati Raj, Min. WCD, Min. I&B
5 Expand and improve nutrition education, awareness and
involvement at community level
Clear Government guidelines on priority interventions &
target groups on nutrition; evidence based
Nutrition education and counselling skills of frontline
workers, AWW, ANM, ASHA; public health nutritionist
cadre
Nutrition education in schools; empower and educate
women’s SHG, NGO, CBO, PPP and corporate philanthropy
with appropriate regulations to protect public health

33. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
To achieve nutrition security
with leadership from Min. Panchyati Raj, Min. WCD, Min. I&B
5 Expand and improve nutrition education, awareness and
involvement at community level
Clear Government guidelines on priority interventions &
target groups on nutrition; evidence based
Nutrition education and counselling skills of frontline
workers, AWW, ANM, ASHA; public health nutritionist
cadre
Nutrition education in schools; empower and educate
women’s SHG, NGO, CBO, PPP and corporate philanthropy
with appropriate regulations to protect public health

34. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Outline
1 Motivation
The Indian Enigma
Determinants of malnutrition
2 Action Plan for overcoming malnutrition
Multisectoral approach recommendations
Government programmes

35. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Ongoing Government programmes with a life cycle
focus
Pregnant & lactating women ICDS, RCH-II, NRHM
Children 0-3 years ICDS, RCH-II, NRHM, Integrated Mgmt of
Neonatal & Child Illness (IMNCI), Rajiv Gandhi
National Cr` che Scheme
e
Children 0-6 year ICDS, RCH-II, NRHM, Rajiv Gandhi National
Cr` che Scheme
e
School going children 6-14 years Mid day meals, Sarva Shiksha
Abiyan
Adolescent girls 10-19 years Nutrition Programme for
Adolescent Girls (NPAG), Sabla

36. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Ongoing Government programmes with a life cycle
focus
Pregnant & lactating women ICDS, RCH-II, NRHM
Children 0-3 years ICDS, RCH-II, NRHM, Integrated Mgmt of
Neonatal & Child Illness (IMNCI), Rajiv Gandhi
National Cr` che Scheme
e
Children 0-6 year ICDS, RCH-II, NRHM, Rajiv Gandhi National
Cr` che Scheme
e
School going children 6-14 years Mid day meals, Sarva Shiksha
Abiyan
Adolescent girls 10-19 years Nutrition Programme for
Adolescent Girls (NPAG), Sabla

37. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Ongoing Government programmes with a life cycle
focus
Adults Food for Work, Aam Admi Bima Yojana, NREGS,
Skill Development Mission, Women welfare &
support programme, Adult literacy programme
Below Poverty Line population PDS
Entire population Rashtriya Krishi Vikas Yojana, Food Security
Mission, Safe Drinking Water & Sanitation
Programme, NHM, National Iodine Deficiency
Disorders Control Programme (NIDDCP),
Nutrition Education and Extension, Bharat Nirman

38. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Ongoing Government programmes with a life cycle
focus
Adults Food for Work, Aam Admi Bima Yojana, NREGS,
Skill Development Mission, Women welfare &
support programme, Adult literacy programme
Below Poverty Line population PDS
Entire population Rashtriya Krishi Vikas Yojana, Food Security
Mission, Safe Drinking Water & Sanitation
Programme, NHM, National Iodine Deficiency
Disorders Control Programme (NIDDCP),
Nutrition Education and Extension, Bharat Nirman

39. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Nutrition security
used by Expert Task Force in analysis in India
Context Enabling environment, Convergence, High level
integration mechanism, Monitoring& Evaluation,
Political Commitment, Institutional reform
Inputs Health & nutrition delivery - preventative &
curative including BCC, food fortification (public,
private), target most vulnerable, ICDS, NRHM,
PDS, MDM, NREGP, NUHM
Outputs Improve production, access to drinking water &
sanitation, environment
Outcomes Awareness, adoption, behaviour change, access,
storage, intra-household, distribution services/net,
equity, participation, optimal growth &
development and sustained livelihood

40. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Nutrition security
used by Expert Task Force in analysis in India
Context Enabling environment, Convergence, High level
integration mechanism, Monitoring& Evaluation,
Political Commitment, Institutional reform
Inputs Health & nutrition delivery - preventative &
curative including BCC, food fortification (public,
private), target most vulnerable, ICDS, NRHM,
PDS, MDM, NREGP, NUHM
Outputs Improve production, access to drinking water &
sanitation, environment
Outcomes Awareness, adoption, behaviour change, access,
storage, intra-household, distribution services/net,
equity, participation, optimal growth &
development and sustained livelihood

41. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming Malnutrition
Five point Charter for Overcoming Malnutrition
1 Institutional structures for public policy and coordinated
action in nutrition
2 Learning from success: unique to universal
3 Action at Local level: coordinating food & nutrition security
system. Regular meetings, sensitize and build capacity of
key leaders, introduce nutrition workers, nutrition
education and communication, M&E, support and motivate
Frontline Workers
4 Action at State level: coordinating nutrition security
initiatives
5 Action at National level: Mainstream Nutrition in national
missions

42. Appendix
For Reference I
Sources Contents
The Coalition for Sustainable Nutrition Security in India
A Leadership Agenda for Action.
Sustainable Nutrition Security in India, 2010.
The Coalition for Sustainable Nutrition Security in India
Block Operational Guidelines To Achieve Nutrition Security.
Sustainable Nutrition Security in India, 2010.