National nutrition programs

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  • 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.
  • 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.
  • 26.
  • 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
  • 30. •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
  • 31. •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
  • 32. Strategies: •Iodiseentireedible saltin thecountryby1992. •Banofnon-iodisedsaltunderPFA act(1954) •Increase the consumption of iodized salt (not the amount ofsalt) NATIONALIODINE DEFICIENCYDISORDERCONTROL PROGRAM
  • 33. UNICEF global databases2011,fromMultiple Indicator Cluster Surveys (MICS),Demographic and Health Surveys (DHS)and other national surveys
  • 34. NATIONALFOOD SECURITYBILL,2011 •Righttoaccessoffoodsecurity •Entitlementsofpregnantandlactatingwomen •Entitlementsofchildren attheagegroup of0– 6yrs •Middaymeal tochildren •Preventionandtreatmentof child malnutrition •Entitlementofdestitutepeople •Entitlementofhomelesspeople •Emergency anddisasteraffectedpeople •Rightofpersonsliving in starvation •Constitutionof nationalfoodcommission
  • 35. 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%.
  • 36. 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).
  • 37. FUTURERECOMMENDATIONS •Supplementaryfoodshouldbeviewed andusedonlyas avehicle forproviding otherservices underthe ICDSscheme. • Supplementaryfoodsshouldbecereal based,palatableandofgoodquality. • Fortificationoffoodswith micronutrients:it shouldbemainlyconsideredwith ironandiodine. • Nutritionalcounselling ofmothersthroughICDSscheme forpromotionof nutritionandhealthofchildren. • Communitybasedrehabilitationofseverely malnourishedchildrenthrough integratedhealthandnutritioninterventions.
  • 38. CONCLUSION •Nutritionaffectsgrowthanddevelopment ofa person. •Atleastthe development ofInternationalStandardsandNationallegislation, are essential toprotectandpromotenationalfoodsecurityandpublic health •Civil societywill havetoplayamoreactiverole. •Theconceptoffoodsecuritymustberecapturedandreframedin publicand environment terms.
  • 39. REFERENCES •Vir, SheilaC. PublicHealthNutritioninDevelopingCountries.2011.Wodland Publishing Ltd • • nutrition_supplementation_programmes • • • g.pdf?sequence=1 • us_t2/en/ • •
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