National nutrition policy of india

Dr Soni RaniPGT- 2nd Year

Department Of Community Medicine Katihar Medical College

The Nutrition Status of India

Calorie Intake ( NSSO)

Rural- 2400 KcalUrban- 2100 Kcal

Poverty- a vicious cycle

Nutritional Programme In India

Nutrition Policy Interventions

• The Strategy: Nutrition is a multi-sectoral issue and needs to be tackled at various levels.

• Nutrition affects development as much as development affects nutrition.

• It is therefore important to tackle the problem of nutrition both through-

• Direct nutrition intervention for specially vulnerable groups and

• Indirect or long term interventions.


A. Direct Intervention-Short Term

1. Nutrition Intervention for specially vulnerable

groups.

2. Fortification of Essential Foods

3. Popularisation of Low Cost Nutritious Food

4. Control of Micro-Nutrient Deficiencies

amongst vulnerable Groups

Nutrition Intervention for specially

vulnerable groups.

• Expanding the Safety Net:- The Universal Immunization Programme,Oral Rehydration Therapy and the Integrated Child Development Services (ICDS) have had a considerable impact on child survival and extreme forms of malnutrition.

• Presently ICDS covers around 15.3 million children (most of them in the rural areas).

• It should be our conscious policy to cover the remaining 15.46 million children who arc nutritionally at risk by extending ICDS to all the remaining 2388 of the country.


vulnerable groups.

• Presently growth monitoring has become a one-way process and the mothers are mere passive observers of the entire process.

• This needs to be changed because after all nutrition management of the children will have to be done by the mothers at home.

• Growth monitoring combined with adequate nutrition and health education empower mother to manage the nutrition needs of her children effectively.


vulnerable groups• Reaching the Adolescent Girls- Including the

adolescent girl within 'the ambit of' ICDS should be intensified so that they are made ready for a safe motherhood.

• Their nutritional status (including iron supplementation in the body) is improved and they are given some skill up gradation training in home-based skills and covered by non-formal education (particularly nutrition and health education.)

• All adolescent girls from poor families should be covered through the ICDS in all CD blocks of the country and 50% of urban slums.


vulnerable groups

• Ensuring better coverage of expectant

women:

• In order to achieve a target of 10% incidence of

low birth weight better coverage should include

supplementary nutrition right from 1st trimester.

• This should continue during the major period of

lactation at least for the first one year after

pregnancy.

Fortification of Essential Foods

• Essential food items shall be fortified with appropriate nutrients. for example, salt with iodine and/or iron.

• Research in iron fortification of rice and other cereals should be intensified.

• The distribution of iodized salt should cover all the population in endemic areas of the country to reduce the iodine deficiency to below endemic levels.

Popularization of Low Cost Nutritious

Food

• Efforts to produce and popularize low cost

nutritious foods from indigenous and locally

available raw material shall be intensified.

• It is necessary to involve women particularly in

this activity.

Control of Micro-Nutrient Deficiencies

• It is necessary to intensify all these efforts and

work on a specific time frame.

• Nutritional blindness should be completely

eradicated by the year 2000 A.D.

• The National Nutritional Anaemia Prophylaxis

Programme should be extended and

strengthened to reduce anaemia in expectant

women to 25% .


B. Indirect Intervention-Long Term

Food Security-

• A per capita availability of 215 kg/person/year

of food grains needs to be attained.

• This requires production of 250 million tonnes

of food grains per year and buffer stocks of 30-

35 million tonnes in order to guard against

exigencies such as flood and droughts.

Improvement of Dietary pattern

• Improving the dietary pattern by promoting the

production and increasing the per capita

availability of nutritionally rich foods.

• The Green Revolution has bias towards wheat,

coarse grains and pulses, which constitute the

poor man's staple & protein requirements, have

not received adequate attention.

Improvement of Dietary pattern

• The prices of pulses, which were below cereal

prices before the Green Revolution are now

almost double the price of cereals.

• Our Food Policy should be consistent with our

national nutritional needs .for this there is need

for the introduction of appropriate Incentives.

pricing and taxation policies.

Improving the purchasing power

• Poverty alleviation programmes, like the Integrated Rural Development Programme (IRDP) and employment generation schemes like JawaharRozgar Yojana, Nehru Rozgar Yojana and DWCRA are to be re-oriented and restructured to make a forceful dent on the purchasing power of the lowest economic segments of the population.

• In all poverty alleviation programmes nutritional objectives shall be incorporated explicitly and the nutritional benefits of income generation shall be taken for granted.

Public Distribution System

• Ensuring an equitable food distribution, through the expansion of the public-distribution system not only in urban areas but throughout the country.

• The Public Distribution System should be strengthened especially during the monsoon months for 'giving special rations at specially subsidized rates for at least four months (July -October) to the seasonally hat risk" population.

• The beneficiaries of this programmes should be landless laborers , their families and the migrant labourers and their families.

Land Reforms

• Implementing land reform measures so that the

vulnerability of the landless and the landed poor

could be reduced.

• This will include both tenural reforms as well as

implementation of ceiling laws.

Health & Family Welfare

• The population in the reproductive age group

shall be empowered through education to be

responsible for their own family size.

• Through intensive family welfare and

motivational measures: small family norm and

adequate spacing shall be encouraged so that the

food available to the family is sufficient for

proper nutrition of the members.

Basic Health and Nutrition Knowledge

• Basic health and nutrition knowledge With

special focus on wholesome infant feeding

practices, shall be imparted to the people

extensively and effectively.

• Nutrition and health education concepts shall be

effectively integrated into the school curriculum

as well as into all nutrition programmes.

Prevention of Food Adulteration

• Prevention of food adulteration must be

strengthened by gearing up the enforcement

machinery.

Nutrition Surveillance

• The NNMB and NIN of ICMR need to be

strengthened so that periodical monitoring of

the nutritional status of children adolescent girls,

and pregnant and lactating mothers below the

poverty line takes place.

• it is necessary for the NNMB to be accountable

to Ministry of women and child development so

far as Nutrition Surveillance is concerned.

Monitoring of Nutrition Programmes

• Monitoring of Nutrition Programmes (viz ICDS) and of Nutrition Education and Demonstration by the Food & Nutrition Board, through all its 67 centers & field units, should be continued.

• The transfer of food and nutrition board to MOWCD has already ensure an integrated set up to deal with the problem of nutrition with adequate technical & field level set up.

Research

• Research into various aspects of nutrition, both

on the consumption side as well as the

supply side, is another essential aspect of the

strategy.

• Research should enable selection of new

varieties of food with high nutrition value

which can be within the purchasing power of

the poor.

Equal Remuneration

• Special efforts should be made to improve the effectiveness of programmes related to women.

• The wages of women shall be at par with that of men in order to improve women's economic status.

• This requires a stricter enforcement of the Equal Remuneration act with Special emphasis will have to be given for expanding employment opportunities for women.

Communication

• The Department of Women, and Child Development will have a well-established, permanent Communications Division with adequate staff and fund support.

• The existing facilities in the Song and Drama Division and the Directorate of Advertising and Visual Publicity (DAVP) in the Ministry of Information and Broadcasting could help in a big way to improve nutrition and health education.

• The media policy shall focus on ways and means to combat malnutrition among girl children, adolescent girls and women in the reproductive age group.

Minimum Wage Administration

• A special legislation should be introduced for

providing agricultural women laborers the

Minimum support, and at least 60 days leave by

the 'employer in the last trimester of her

pregnancy.

• The legislation should take care of Excessive

loss of energy during the working seasons has

serious nutritional implications.

Community Participation

• Generating awareness among the community.

• involving the community through their Panchayats

• Actual participation, particularly of women in food production and processing.

• promoting schemes relating to kitchen gardens, food preservation , preparation of weaning foods and other food processing units both at the home level as well as the community levels

• Generation of effective demand at the level of the community.

Education and Literacy

• Education & Literacy particularly that of

women, is a key determinant for better

nutritional status.

• Ex- Kerala State which has the highest literacy

level, also has the best nutrition status despite

the fact that calorie intake in Kerala is not the

highest among all States in the country.

Improvement of the Status of Women

• women's employment ,does beneficial

household nutrition , both through increase in

household income as well as through an increase

in women's status, autonomy and decision-

making power.

• Educated women have greater roles in

household decision making, particularly those

relating to nutrition and feeding practices.

Administration and Monitoring

• For administration and monitoring National Nutrition Council under chairmanship of Prime minister and a coordination committee, under the secretary, Department of women and child development, has been recommended.

• Nutrition surveillance shall be task of NIN and NNMB.

• Similar set up has been recommended at the state level.

National Nutrition Policy Goals

National Plan Of Action On Nutrition

• As a follow-up of national nutrition policy, a

national plan of action was formulated in 1995

with sectoral commitments by fourteen nutrition

related ministries and departments.

• Action was started by these fourteen

departments/ministries to fulfill their

commitments.


• Ministry of agriculture started training

programme related to kitchen gardens, rearing

of goat, sheep, pig, fish culture

• The aim is to promote production and increased

availability of green leafy vegetables and other

nutritious food at household level.


• Ministry of forests and environments

involved local communities in growing nitration

rich fruits .

• Distributing seedling of plants producing fruits

rich in Vit- A.

• Ministry of civil supply has recast public

distribution system as TPDS, so that people

below poverty line were specially benefited.


• Ministry of tribal welfare launched a special program of grain banks in the most inaccessible tribal areas inhabited by primitive tribes.

• Ministry of education launched a nation wide programme of nutrition support to primary education ( MDM Scheme) in 1995.

• Ministry of information has been supporting by developing, telecasting and broadcasting messages on nutrition, family welfare, and other related themes.


• Ministry of health and family welfare

involved in prevention, early detection and

management of micronutrient deficiencies,

health and nutrition education, infection control

and promotion of small family norm to achieve

improved nutritional status.

• The goal of policy has been revised according to

11th and 12th five year plans.

Developments during 11th Plan( 2007-

12)

• The WHO child growth standards were introduced in 2008 under ICDS/NRHM for monitoring of growth and development of young child.

• The ICMR expert committee revised the RDA for Indians in 2010.

• Recommendations were made for energy requirements for reference children as well as energy requirement per KG to calculate the gap between requirement and intake.

• This is important measure as the country has entered the dual nutrition burden era.


12)

• NHM village and health sanitation committee were

expanded in July 2011 to include nutrition and

ICDS ( Now Village health, sanitation and nutrition

committee).

• Recognized as sub- committee of gram Panchayats.

• The use of double fortified salt ( DFS) was

mandated in government food supplementation

programme ( ICDS/MDM) for nutritional anemia.


12)

• RMNCH+A revised the strategy for IFA supplementation in Feb 2013.

• It includes national iron plus initiative, weekly iron and folic acid scheme and preventive use of folic acid in planned pregnancies during the pre conception phase.

• The national food security act passed in 2013 for ensuring food and nutritional security for people.

National Food Security Act- 2013.

• NFSA gives right to the people to receive

adequate quantity of food grains at affordable

prices.

• About two third, up to 75% of rural and 50%

of urban population will benefited by subsidized

food grains under TDPS, with uniform

entitlement of 5 kg per person per month.

• Eligible households to be identified by state.


• The poorest of poor households would continue to receive 35 kg food grains per household per month at subsidized prices under Antyodaya Anna Yojana.

• The eldest women of eighteen years of age or above will be head of households for issue of ration cards.

• If not available, the eldest male is to be head of household.

• Identification of beneficiaries will be done through Aadhar card.


• Food grains under TDPS will at be made available

at subsidized prices of rupees 3/2/1 per kg for rice,

wheat and coarse grains for a period of three years

from the date of commencement of the act.

• Thereafter prices will be suitably linked to

minimum support Price ( MSP).

• Food security allowance will be provided to entitled

beneficiaries in case of non supply of entitled food

grains or meals.


• There will be state and district level redressal mechanism with designated officers.

• Provision have also been made for disclosure of records related to PDS, social audits and setting up of vigilance committee in order to ensure transparency and accountability.

• The bill provides for penalty to be impose on public servant or authority, if found guilty of falling to comply with relief recommended by the District Grievance redressal Officer ( DGRO).

Strategy during 12th five year Plan

Following strategies planned in 12th plan-

• The ICDS requires strengthening and restructuring

• A multi-sectoral programme to address maternal

and child malnutrition in selected 200 high-burden

districts would be prepared.

• This programme will bring together various

national programmes through strong institutional

and programmatic convergence at the State,

District, Block and Village levels.

Strategy during 12th five year Plan

• A nation-wide information, education and

communication campaign will be launched

against malnutrition.

• The Ministries that deal with Health, Drinking

Water Supply and Sanitation, School Education,

Agriculture and Food and Public Distribution

will bring strong nutrition focus to their

programmes.

Nutrition goal under 12th plan

Indicator Current level Twelfth plan

goal

1. Prevalence of

malnutrition in children

0-3 years ( Weight for age

below 2 SD)

45.9% 50% of NFHS

3 ( 2005-06)

levels

2. Prevalence of anemia

among women ( 15-49

years)

56.1% 28.0%

Constraints of National Nutrition Policy

• Malnutrition is till to be focused as a national

problem.

• Nutrition does not have the status of a separate

ministry nor even a department, and all existing

departments have their own mandates.

• Nutrition is not seen as an explicit goal by the

concerned sectors.


• Nutrition is invariably seen as synonymous with

feeding.

• State level actions on nutrition policy

instruments depend on directions supported by

resource allocations.

• ICDS need restructuring, focus on children 0-3

years, when malnutrition sets in and is most

prevalent.


• Growth monitoring not done in more than one

third children.

• Supplementary food of good quality often not

available and considered as replacement of

family food not supplement.

• Irregular supply of IFA tablets for many years

and only one fifth of pregnant lady consume

them regularly.


• Consumption of adequate iodized salt has

increased only 2 % between NFHS II and III.

• The PDS and subsequently TDPS have failed in

their objectives.

• Food stocks are currently at their lowest.

• The policy has failed to achieve its outcome

goals.


• More than half of pregnant women continue to have anemia and its increased among children less than 3 years of age.

• Proportion of underweight children is still very high and one third of married women have BMI below normal.

• From these observations it can be concluded that policy has failed to bring improvement in nutritional status of people.

Achievements

• National nutrition policy is based on logical consideration that nutrition is an outcome of complex array of factors i.e. agriculture, food production, purchasing power, market prices, knowledge, gender differences and food fads.

• Most of the short term and long term interventions envisioned in the policy have been implemented.

• ICDS has been universalized.

Achievements

• Kishori Shakti Yojana ( KSY) is being implemented in all the 6118 ICDS projects since 2006-07.

• Nutritional programme for them is operational only in 51 most backward districts.

• Mid day meal programme, national nutritionlanaemia prophylaxis programme and national iodine deficiency disorder control programmehave been in operation throughout the country.

Achievements

• Decline in prevalence of nutritional blindness

from about 1% to 0.6%.

• Neonatal hypothyroidism has been decline from

100/1000 live births to 18/1000 live births in

endemic districts.

• Zinc supplementation has been introduced

recently in RCH program.

Comments

• The largest PDS in world is desirable to introduce

state specific designs and implementation strategies.

• NNP should incorporate the measures directed at

emerging diet related problems like obesity, DM,

and Cardio vascular diseases.

• The policy should have long term perspective of

production and consumption of food in adequate

quantity and qualitatively rich in micronutrients,

vitamins and other protective elements.

Comments

• UN FAO has warned the goal of halving the number of undernourished people by 2015 can not be reached at present rate.

• It said India and Pakistan are among 17 countries where hunger has risen after falling steadily in early and mid 1990s.

• Globalization and modernization do not have any beneficial effect on the poor and under nourished people.

References

References

National nutrition policy of india

Health & Medicine