Government Initiatives in

Health and Nutrition

Vinod Paul
MD, PhD, FAMS, FNASc, FASc, FNA
Member, NITI Aayog
NATIONAL INSTITUTION FOR TRANSFORMING INDIA
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 Key issues in childhood undernutrition

WASTED STUNTED
(Thin) (Short)
Normal height
60%
2005-05 2015-16
50%
48%

40%
38%

30%
20% 21%
20%

10%

NORMAL 0%

Stunting Wasting
Undernutrition trend by age
Childhood
6 months to 18 mo crucial
undernutrition
1. ~20% due to
small size at
Stunted birth;

2. ~25% due to
diarrhea and
Wasted
other
infections;
and

3. Rest ~55%
due to
suboptimal
feeding
 Challenge of optimum complementary feeding for children 6-24

100 40
Adequate diet 2006 Adequate diet 2016 Change
90
30
80

20
70

Percentage change
Percentage %

60
10

50
0
40

30 -10

20
-20
10

0 -30

Source: NFHS-3; NFHS-4

Adequate diet = child 6-24 fed either breastmilk/source of dairy; and age-appropriate number of food groups and age-appropriate number of meals per day
NFHS-3 indicator calculation by IFPRI; NFHS-4 indicator as reported in fact sheets.
Courtesy Avula
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 Childhood
‘Biology’ of undernutrition undernutrition
1. ~20% due to
Diarrhea / pneumonia
Suboptimal BF small size at
Poor care of low Suboptimal feeding birth;
birth weight babies
2. ~25% due to
diarrhoea
maternal nutrition / health

N and other
Genetics, epigenetics,

infections;
Small
and

Undernourished 3. Rest ~55%

due to
suboptimal
Pregnancy
1 2 3 4 5 6 7 8 9 10 11 12 feeding
Age in moths
 First 2 years of life are the key
• Undernutrition occurs in
the first and the second
year
• Period of rapid brain
growth and maturation:
80% by 2 years
• Linear growth failure in
this period is associated
with adult short stature
• Less schooling
• Low productivity, income
• Lower offspring
But ICDS services in this period have low birthweight (females)
focus: a design flaw
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 Package of Interventions
WASH Safe water, hand washing, safe disposal of feces
Iron-folic acid; Vitamin A; Deworming

SWACHH* Care of the malnourished child

Supplementary nutrition Recipe reformulation

Growth monitoring Address moderate malnutrition

ICDS*

Feeding counseling Breast feeding

Complementary feeding

Management of Severe Acute Malnutrition

Beti Bachao, beti padhao;Adolescent

Immunization Strengthen, and Expand Antigens

HEALTH*

Facility Early detection and treatment of diarrhea and pneumonia

Based New Community, Integrated Management of Neonatal and Childhood Illnesses
Born Care
Pre-pregnancy care

Antenatal Care

Home Home-based Young Child Care

Birth spacing
*predominant

Based
Institutiona
l Deliveries
role

New Born
Not to
Care scale

Pre-pregnancy Pregnancy Birth 6 weeks 6 months 1 year 2 years

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NNM | Objectives
Prevent & Reduce Stunting in Children (0-6 years) @2% per annum

Prevent & Reduce Under-Nutrition (Underweight Prevalence) in

Children (0-6 years) @2% per annum

Reduce Low Birth Weight (LBW) @2% per annum

Reduce Prevalence of Anaemia amongst Young Children (06-59

months) @3% per annum

Reduce Prevalence of Anaemia amongst Women and Adolescent Girls

(15-49 years) @3% per annum
4 Point Strategy
I. Convergence
[Inter-sectoral convergence for better service delivery]

II. Use of Technology (ICT)

[Real time growth monitoring and tracking of women and children; programme monitoring through
Dashboards]

III. Intensified Health & Nutrition Services for first 1000 days
[Immunization in High burden Districts- Rotavirus & Pneumococcal, Extended Home Based Care of
Infants from 06-24 months ; IYCF promotion]

IV. Mission as ‘Jan Andolan’

[Involving field workers, community and PRIs; strengthening VHSND]
 Poshan Abhiyan

Total funding: Rs.9046.17 crore

Pan India Coverage in a Phased Manner

1st Phase: 315 districts (including 201 districts

identified by NITI) in 2017-18

Mission as ‘Jan Andolan’

 Home based infant care
Packaging Evidence Based interventions

Growth Monitoring Platform using structured

home visits done by Outcome
Breast Feeding
ASHAs up to 1 year of
Complementary feeding age.
Prophylactic ORS Reduction Of
ECD
Diarrhoea And
Pneumonia and
IFA Supplementation Better Nutrition
Status
Immunization Home Visit
Hand Washing Schedule :
5 visits by ASHA-
Beginning of 4, 6,8,10
Care Seeking in Sickness and 12 months