Nutrition programs in India

1. NATIONAL NUTRITION
PROGRAMS
Palak Agrawal
M18FN10
MOUNT CARMEL COLLEGE

2. HISTORY
BEFORE INDEPENDENCE:
•1st Phase-1930sclinical medical phase
WITH INDEPENDENCE:
•Threatoffamine withresultantacutestarvationdueto lowagricultural
productionandthe lackofan appropriatefooddistributionsystem
•Chronicenergy andmicronutrientdeficiencies duelow dietaryintake,
poverty,lowsanitation,infections,low awarenessandliteracy.

3. •2ndphase-The foodproductionphasein 1940’s
- Over thefew pastdecades,Indiaattainedself sufficiencyin foodproduction
throughvarious interventions:
 Green revolution
 Public distributionsystem
 R&Din thefield ofnutritionbyNIN &CFTRI
•3rdphase-Thecommunityphase
- DirectinterventionsthroughNationalNutritionalProgrammesin late1960’s
andearly70’swithinception of‘5-yearplans’
- Numberofshort-termmeasurestocombatproblemsofmalnutrition.
HISTORY

4. •Under nutrition is by far the most important single
causeofillness anddeathglobally.
•Nutrition section under Family Welfare Division is
responsible for National Nutrition Programs in co-
ordination with other organizations for improving the
nutritional status of children, pregnant women and
adolescents
BACKGROUND

5. •Nutrition interventions are cost effective investments
for attaining many of the Sustainable Development
Goals
•Since the year 2000, several global movements have
advocatednutritionfordevelopment
•The Constitution (2015) ensures the right to food,
healthandnutritiontoall citizens
BACKGROUND

6. VISION
Attainment of the highest possible level of health and well-being
for all, through preventive and promotive health careand
universal accessto goodquality health services without anyone
having to face financial hardships as a consequence

7. OBJECTIVES
•Toimprovethehealthstatusofpeoplethroughcorrectedaction
•To expand preventive, promotive, curative, palliative and rehabilitative
services providedthroughpublichealthsectorwithfocuson quality
•Toprogressively achieve Universal Health Coverage

8. Stunting and underweight in India are 20 times as high as
would beexpected in a healthy, well-nourished population

9. DIRECT PROGRAMS
1. Integrated Child DevelopmentServices
(ICDS) Scheme
2. Nutrition ProgramsFor AdolescentGirls
3. Nutrition Advocacy and AwarenessGeneral
Programsfor Food And Nutrition Board (FNB).
4. Follow Up Action ForNational Nutrition
Policy, 1993
5. Ministry of Health and Family Welfare
• Iron and FolicAcid Supplementation for PregnantWomen.
• Vitamin A Supplementation for Childrenof 9-36Months AgeGroup.
• National Iodine DeficiencyDisorderControl Program.
• Programsfor Communicable and Non-Communicable diseases

10. INDIRECTPROGRAMS
 DepartmentofAgriculture andCo-operation
- IncreasedFoodProduction
- HorticultureInterventions
 RuralandUrbanDevelopment
- FoodforWorkProgram
- SafeDrinkingWaterandAlleviation Program
- NationalRuralEmploymentGuaranteeScheme
- MinistryofHealth
- NationalRuralHealth Mission
- PovertyAlleviation Program
- IMNCI

11. INDIRECTPROGRAMS
 FoodAnd PublicDistribution
- TargetedPublic DistributionSystem
- AntodayaAnnaYojana
- AnnapurnaScheme
 DepartmentOfWomen AndChild Development
- VariousWomen’sWelfareandSupportPrograms
 DepartmentofEducationandLiteracy
- SarvaSikshaAbhiyan
- AdultLiteracyProgram
- MiddayMeal forPrimarySchoolChildren.

12. VARIOUS NATIONAL NUTRITION
PROGRAMS

13. •TheprogramwasmaintainedbyMinistryofRuralDevelopment
•Oneoftheearliestnutritionalprogrammes.
•This projectwasstartedin Orissain 1963
•LaterextendedtoTamilNaduandUttarPradesh
Objectives:
•Promotingproductionandofprotectivefoodsuch Vegetablesandfruits
•Ensuringconsumptionbypregnant&lactatingwomenandchildren.
In 1973it extendedtoall statesin INDIA
Services:
•Nutritionaleducation
•Nutrition worth 25 paise for children and 50 paise for pregnant and lactating women for 52
daysin a year.
APPLIED NUTRITION PROGRAM

14. •This was started in 1970 under the Department of Social
Welfarethroughvoluntaryorganisations
•Voluntary organisations receiving the grants
areresponsiblefortherunning ofthisprogram
Beneficiary group :
•Preschoolchildren 3-5yearsofage
Services:
•300kcaland10gm proteinfor270daysin a year
•Also providewithpreschooleducation
•Balawadis are being phased out because of universalization
ofICDS
BALWADI NUTRITION PROGRAM

15. •It was initiated in Oct.2, 1975, under 5th Five Year Plan
underMinistryof SocialWelfare
•World’slargestprogramforearlychildhooddevelopment
Beneficiary group :
•Children <6 years
•Pregnant& Lactatingwomen
•Womenin Reproductiveagegroup(15-44yrs)
•Adolescent Girls(in selectedBlocks)
INTEGRATED CHILD DEVELOPMENTSERVICE (ICDS)
SCHEME

16. Objectives:
•Lay the foundation for proper psychological, physical and
social development ofchild
•Improvenutritional&healthstatusof children
of0-6yearsofage
•Reduce incidence of mortality, morbidity, malnutrition and
schooldrop-outs
•Enhancethecapabilityofmother& family
•Achieve effective coordinationamongvariousdepartments
INTEGRATED CHILD DEVELOPMENTSERVICE (ICDS)
SCHEME

17. Services:
•Supplementarynutrition
•Non-formalpre-schooleducation
•Immunization
•Health Check-up
•Referralservices
•NutritionandHealth Education
Administration of the scheme:
•Communitydevelopment block-Ruralareas
•Tribalblocks-tribalareas
•Wards/slums –urbanareas
INTEGRATED CHILD DEVELOPMENTSERVICE (ICDS)
SCHEME

18. Introduced in the year 2002-2003 with 100% Central
Assistance
Aim :
•Improvenutritionalandhealthstatusofadolescentgirls.
•Providenutritionandhealtheducationtothebeneficiaries.
•Empower adolescent girls through increased awareness to
takebettercareoftheirpersonalhealthandnutritionneeds.
NUTRITION PROGRAMS FOR ADOLESCENT GIRLS

19. Beneficiaries :
•Adolescent girls<35 Kg
•Pregnantwomen<45 kg
Services:
•6Kgrationpermonthforthreemonthsconsecutively.
•ImplementedthroughtheA.W.Centres
•Weighing four times in a year on the basis of the body
weigh
•In Assam,KokrajharandKarbi-Anglongaspilotdistricts.
NUTRITION PROGRAMS FOR ADOLESCENT GIRLS

20. •Launched in 1961 by the Ministry of Education and was
implemented throughout the country for school children
in theagegroupof6-11yearsofage
Aim :
•To enhance the admissions and retain students in the
school
•To improve literacy and also to improve the health
statusofchildren
MIDDAY MEAL PROGRAM

21. Services :
• The target group is provided food to provide 1/3rd of the
total energy requirements and half of the protein
requirement
Recommendations made by Nutrition
Foundations:
•The children in classes 1-8th could be included as
beneficiaries of the program as being practiced in the state
ofGujaratandTamil Nadu
•Themealshouldbehygienic
•In urban areas a centralized kitchen should be prepared,
transportedandservedhygienically
MIDDAY MEAL PROGRAM

22. • It was launched during 4th 5-year plan in 1970 by the
MinistryofHealth andFamily Welfare
Beneficiaries:
•Children 1-5yearsof age
•Expectingandlactatingmothers
•Family planningacceptors
Policy
•Expecting and lactating -60 mg of elemental iron + 0.5
mgfolateeverydayfor100days.
•Children 1-5 years- 20mg of elemental iron + 0.1 mg
folateeverydayfor100days.
NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS
PROGRAM

23. 2007- New directives from Ministry of
Health and Family Welfare
•6-12monthsinfantsshouldbeincluded
•Doseforunder5children in liquid formulation
•Children 6-10years& adolescent11-18yearsincluded
NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS
PROGRAM

24. Recommendeddosage:
•6-59month children -liquid 20 mg Fe+ 0.1 mg Folate for
100days
•6-10years-1 tab.30 mgFe+ 0.25mgFolatefor100days.
•Adolescent & adults- 1 tab. 100 mg Fe+ 0.5 mg Folate for
100days
•Folic acid tab.(500μg) is given in 1st trimester in first 4
weeks.
NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS
PROGRAM

25. https://www.nejm.org/doi/full/10.1056/nejmra1201534

26. http://nnmbindia.org/NNMBReport06Nov20.pdf

27. •Launched in 1970 as a centrally sponsored scheme by
MinistryofHealth andFamily Welfare
Beneficiaries:
•All children 1-3yearsofage
Services:
•Megadose of vitamin A (2 lac IU) orally every six
months
NATIONAL PROPHYLAXIS PROGRAM AGAINST NUTRITIONAL BLINDNESS DUE TO
VITAMIN A DEFICIENCY

28. In the Run:
•8th 5-year plan- vitamin A supplementation linked
withimmunizationprogramme
•10th 5-year plan- Megadoses to be given biannually
in pre-summer& pre-winterperiod
•2006-07- To cover all the children in 6months to 5
yearsage
NATIONAL PROPHYLAXIS PROGRAM AGAINST NUTRITIONAL BLINDNESS DUE TO
VITAMIN A DEFICIENCY

29. Short term strategy:
•Administration of supplemental dose of Vitamin A in
groundnutoil.
•6-11months-1 doseof 1lacIU.
•1-5years-2 lacIUbiannually.
Long term strategy:
•Promotionofregular intakeofVitamin A-rich food
•Feeding locallyavailablefood.
•KitchengardeningofVitaminA-richfood.
NATIONAL PROPHYLAXIS PROGRAM AGAINST NUTRITIONAL BLINDNESS DUE TO
VITAMIN A DEFICIENCY

31. •National Goitre Control Programme launched in 1962, at
the end of 2nd 5-year plan by Ministry of Health and
Family welfare
•Focuses on use of Iodised Salt – Replace common salt
withiodisedsalt,cheapestmethodtocontrolIDD
•Use of Iodized oil injection to those suffering from IDD,
oraladministrationasprophylaxisin IDDsevere areas
NATIONALIODINE DEFICIENCYDISORDERCONTROL PROGRAM

32. •1983- Universal iodisation of salt (30 ppm at
manufacturelevel and15ppmatconsumptionlevel)
•1992- program renamed as ‘National iodine deficiency
disordercontrol
Objectives:
•SurveystoassessthemagnitudeofIDD.
• Supplyofiodisedsalt
•Resurveys5 yearlytoassessimpactofiodisedsalt&IDD
•Labmonitoringof iodisedsalt
NATIONALIODINE DEFICIENCYDISORDERCONTROL PROGRAM

33. Strategies:
•Iodiseentireedible saltin thecountryby1992.
•Banofnon-iodisedsaltunderPFA act(1954)
•Increase the consumption of iodized salt (not the amount
ofsalt)
NATIONALIODINE DEFICIENCYDISORDERCONTROL PROGRAM

34. UNICEF global databases2011,fromMultiple Indicator Cluster Surveys (MICS),Demographic
and Health Surveys (DHS)and other national surveys

35. NATIONALFOOD SECURITYBILL,2011
•Righttoaccessoffoodsecurity
•Entitlementsofpregnantandlactatingwomen
•Entitlementsofchildren attheagegroup of0– 6yrs
•Middaymeal tochildren
•Preventionandtreatmentof child malnutrition
•Entitlementofdestitutepeople
•Entitlementofhomelesspeople
•Emergency anddisasteraffectedpeople
•Rightofpersonsliving in starvation
•Constitutionof nationalfoodcommission

36. NATIONALNUTRTIONALGOALS,11th FIVEYEAR
PLAN
•Reducethe prevalenceofthe underweightin children under5 yearsupto20%.
•Eradicatetheprevalenceofundernutritionin children after5 years.
•First hourbreastfeedingratesto increaseto 80%.
•Exclusivebreastfeeding ratestoincreaseto90%.
•Complementaryfeeding rateatsix monthstoincreaseto90%.
• Reduceprevalenceofanemiain high riskgroup to25%.
• Eliminatevitamin A deficiency in childrenunder5yearsasa public health
problemandreducesubclinical deficiency ofVitaminA in children by50%.
• Reduceprevalenceofiodinedeficiency disordersto less than5%.

37. CURRENTSTATUS
•Indiais oneofthe fastestgrowing countriesin termsofpopulationand
economicsbutmajorityofpopulationatorbelow thepovertyline.
•The majorcauseofMalnutritionin Indiais EconomicInequality,due tothis
peoples diet lackin QualityandQuantity.
•India’sHunger is still worsethanAfricancountries.
•According toGlobalNutritionreport2016Indiaranksin Stunting –114outof
132countries, Wasting–120outof 130countries,Anemia –170outof185
countries.(ranksfromLowestto Highest).

39. FUTURERECOMMENDATIONS
•Supplementaryfoodshouldbeviewed andusedonlyas avehicle forproviding
otherservices underthe ICDSscheme.
• Supplementaryfoodsshouldbecereal based,palatableandofgoodquality.
• Fortificationoffoodswith micronutrients:it shouldbemainlyconsideredwith
ironandiodine.
• Nutritionalcounselling ofmothersthroughICDSscheme forpromotionof
nutritionandhealthofchildren.
• Communitybasedrehabilitationofseverely malnourishedchildrenthrough
integratedhealthandnutritioninterventions.

40. CONCLUSION
•Nutritionaffectsgrowthanddevelopment ofa person.
•Atleastthe development ofInternationalStandardsandNationallegislation, are
essential toprotectandpromotenationalfoodsecurityandpublic health
•Civil societywill havetoplayamoreactiverole.
•Theconceptoffoodsecuritymustberecapturedandreframedin publicand
environment terms.

41. REFERENCES
•Vir, SheilaC. PublicHealthNutritioninDevelopingCountries.2011.Wodland
Publishing Ltd
•https://mohfw.gov.in/
•https://www.researchgate.net/publication/21863221_National_
nutrition_supplementation_programmes
•https://www.who.int/en
•www.unicef.org
•https://apps.who.int/iris/bitstream/handle/10665/43894/9789241596657_en
g.pdf?sequence=1
•https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_stat
us_t2/en/
•https://nhm.gov.in/
•http://hetv.org/india/nfhs/index.html