CHILDREN IN INDIA
HOW TO ACHIEVE HEALTH
By improving host resistance to
By improving environmental safety
By improving health systems designed
to increase the likelihood, efficiency &
effectiveness of the first two goals
PROGRAMMES FOR COMMUNICABLE
1. National Vector Borne Diseases Control
2. Revised National Tuberculosis Control
3. National Leprosy Eradication Programme
4. National AIDS Control Programme
5. Universal Immunization Programme
6. National Guinea worm Eradication Programme
7. Yaws Control Programme
8. Integrated Disease Surveillance Programme
NON COMMUNICABLE DISEASES
1. National Cancer Control Program
2. National Mental Health Program
3. National Diabetes Control Program
4. National Program for Control and treatment
of Occupational Diseases
5. National Program for Control of Blindness
6. National program for control of diabetes,
cardiovascular disease and stroke
7. National program for prevention and control
NATIONAL NUTRITIONAL PROGRAMS
Integrated Child Development Services
Midday Meal Programme
Special Nutrition Programme (SNP)
National Nutritional Anemia Prophylaxis
National Iodine Deficiency Disorders
PROGRAMS RELATED TO SYSTEM
1. National Rural Health Mission
2. Reproductive and Child Health
3. National Water supply & Sanitation
4. 20 Points Programme
NATIONAL HEALTH POLICIES
National Health Policy 2002
National Population Policy 2000
National AIDS control and Prevention Policy
National Blood Policy
National Policy for empowerment of Women
National Charter for Children
National Youth Policy 2001998
National Nutrition Policy
Various national health programs are currently in
operation for the improvement of child health and
prevention of childhood diseases. The brief lists of
these programms are:
Reproductive and Child Health Program.
Universal Immunization Program
Integrated Child Development Services Scheme
School Health Program
THE REPRODUCTIVE AND CHILD HEALTH (RCH)
It was launched in October 1997. The main aim of the
programme is to reduce infant, child and maternal mortality
The main objectives of the programme in its first phase were:
To improve the implementation and management of policy
by using a participatory planning approach and
strengthening institutions to maximum utilization of the
To improve quality, coverage and effectiveness of existing
Family Welfare services
To gradually expand the scope and coverage of the
Family Welfare services to eventually come to a
defined package of essential RCH services.
Progressively expand the scope and content of
existing FW services to include more elements of a
defined package of essential
Give importance to disadvantaged areas of districts
or cities by increasing the quality and infrastructure
of Family Welfare services
RCH-I had a number of successful and unsuccessful
outcomes. Base line statistics were recorded in 1998-99
and compared to 2002-03.
Percentage of women receiving any ANC rose by about
12 % to reach 77.2%. But use of government health
facilities has declined.
Use of contraceptives increased by 3.3 % to 52.0 %,
while family planning due to spacing method rose by
3.3% to 10.7 %. Use of permanent methods did not
Infant mortality came down from 71to 63 but the aim of
universal immunization was far from reach. Polio though
reduced has not met the eradication target.
Not enough attention was paid to awareness of
diarrhoea management and Acute Respiratory Infection
danger signs hence resulting in a rise of case incidents.
The child health programmes is now its second
Following are the aims of the programme:
Expand services to the entire sector of Family
Welfare beyond RCH scope
Holding States accountable by involving them in the
development of the programme
Decentralization for better services
Allowing states to adjust and improve programmes
features according to their direct needs.
Improving monitoring and evaluation processes at the
District, state and the Central level to ensure improved
Give performance based funding, by rewarding good
performers and supporting weak performers.
Pool together financial support from external sources
Encourage coordination and convergence, within and
outside the sector to maximize use resources as well as
infra structural facilities
The recommended package of services:
For the mothers:
Tetanus Toxoid Immunization
Prevention and treatment of anaemia
Antenatal care and early identification of maternal
Deliveries by trained personnel
Promotion of institutional deliveries
Management of obstetric emergencies
For the children:
Essential newborn care
Exclusive breast feeding and weaning
Appropriate management of diarrhoea
Appropriate management of ARI
Vitamin A prophylaxis
Treatment of Anemia
For eligible couple:
• Prevention of pregnancy
• Safe abortion
Prevention and treatment of reproductive tract infection
(RTI) and sexually transmitted diseases (STD).
Women of reproductive age must receive:
Importance of care of girl child
Optimal timing & spacing of birth
Small family norms
Use and choice of contraceptives
Prevention of RTI / STI
Information on Availability of
IUD & sterilization services
Family Planning Services
UNIVERSAL IMMUNIZATION PROGRAMME
Sponsored by Central Government
Funding Pattern-It is a Centrally sponsored scheme, so
the total funding is managed by the Central
Ministry/Department- Department of Health & Family
Description-Universal immunization programme, UIP,
was launched in 1985 in a phased manner.
Immunization is one of the most cost effective
interventions for disease prevention. Traditionally, the
major thrust of immunization services has been the
reduction of infant and child mortality.
Immunisaton is an important vehicle for health promotion
and therefore is a true national investment. As per NFHS 3
data, full immunization coverage in Odisha was 52 percent
and no immunization was 9 percent.
Evaluated coverage by UNICEF in the last 3 years
indicates that there is a decline in coverage of all antigens.
Proportion of districts achieving 80 percent of DPT3
coverage has also decreased.
As per NHFS 3, full immunization has increased to 51.8
percent of children from 12 to 23 months and sustained
efforts can increase it further.
Districts will provide equitable, efficient and safe
immunization services to all infants and pregnant women.
The aim is to achieve 100 percentages of full
immunization status by 2009 to 2010 and to maintain it
The objectives of the mission are:
I. Contribute to global eradication of Polio by 2007.
II. Elimination of Neonatal Tetanus, Diphtheria and Pertussis
III. Establish sufficient sustainable and accountable fund flow
at all levels.
IV. Ensure that there is sustained demand and reduced
social barriers to access immunization services.
The strategies of the programme are:
I. Reducing drop outs rate and missed opportunities.
II. Strengthen institutional training at all levels.
III. Strengthen coordination and review meeting at all levels.
IV. Strengthening micro planning processes in all districts
and urban areas.
V. Strengthening coordination with national operational
guidelines, supervision practices and prioritizing poorly
performing districts and under served populations.
VI. Reaching the under served by influencing behavior at
household level through BCC.
INTEGRATED CHILD DEVELOPMENT
ICDS being implemented by Ministry of Women and
Child Development is the world’s largest programme
aimed at enhancing the health, nutrition and learning
opportunities of infants, young children (O-6 years) and
It is the foremost symbol of India’s commitment to its
children – India’s response to the challenge of providing
pre school education on one hand and breaking the
vicious cycle of malnutrition, mortality and morbidity o the
The Scheme provides an integrated approach for converging
basic services through community based workers and
The services are provided at a centre called the ‘Anganwadi’,
which literally means a courtyard play centre, a childcare
centre located within the village itself.
The package of services provided are:
Pre-school non-formal education and
Nutrition and health education
It is a centrally sponsored scheme implemented
through the State Governments with 100% financial
assistance from the Central Government for all inputs other
than supplementary nutrition which the States were to
provide from their own resources.
However, from the year 2005-06, the Government of
India has decided to provide Central assistance to States for
supplementary nutrition also to the extent of 50% of the
actual expenditure incurred by States or 50% of the cost
norms, whichever is less.
SCHOOL HEALTH PROGRAM
School Health program is a program for school health service
under National Rural Health Mission, which has been
necessitated and launched in fulfilling the vision of NRHM to
provide effective health care to population throughout the
It also focuses on effective integration of health concerns
through decentralized management at district with
determinant of health like sanitation, hygiene, nutrition, safe
drinking water, gender and social concern.
The School Health Programme intends to cover 12,88,750
Government and private aided schools covering around 22
Crore students all over India
The School health programme is the only public sector
programme specifically focused on school age children.
Its main focus is to address the health needs of children,
both physical and mental, and in addition, it provides for
nutrition interventions, yoga facilities and counseling.
It responds to an increased need, increases the efficacy of
other investments in child development, ensures good
current and future health, better educational outcomes and
improves social equity and all the services are provided for
in a cost effective manner.
COMPONENTS OF SCHOOL HEALTH PROGRAM:
1. Screening, health care
Screening of general health, assessment of
Anaemia/Nutritional status, visual acuity, hearing problems,
dental check up, common skin conditions, Heart defects,
physical disabilities, learning disorders, behavior problems,
Basic medicine kit will be provided to take care of common
ailments prevalent among young school going children.
Referral Cards for priority services at District / Sub-District
As per national schedule
Fixed day activity
Coupled with education about the issue
3. Micronutrient (Vitamin A & IFA) management:
Weekly supervised distribution of Iron-Folate tablets coupled
with education about the issue
Administration of Vitamin-A in needy cases.
As per national guidelines
Biannually supervised schedule
Siblings of students also to be covered
5. Health Promoting Schools:
Regular practice of Yoga, Physical education, health
Peer leaders as health educators.
Adolescent health education-existing in few places
Linkages with the out of school children
Health clubs, Health cabinets
First Aid room/corners or clinics.
6. Capacity building
7. Monitoring & Evaluation
8. Mid Day Meal
The various nutritional programmes are in operation in
India since 1st five year plan period.
International agencies such as WHO, UNICEF, FAO,
CARE are assisting the Govt. in these programmes of
India to improve nutrition of the people with special
emphasis on mother & children.
FUNCTIONS FALL IN 3 CATEGORIES
To eradicate major causes of
-Increase food production
-Provide safe drinking water
-improve environmental sanitation
-control of communicable diseases
-nutritional education to the
-promoting kitchen garden
Aspects specially related to
women and children
-to improve the employment
opportunities for women
-provision of better health
care to parents & children
-promoting breast feeding
-weaning at right time
Special reference to
pregnant & lactating
-to raise nutritional status through nutritional
-promoting small handicrafts scheme through
Vitamin-A Prophylaxis Program.
Prophylaxis against nutritional anemia.
Control of iodine deficiency disorders.
Applied nutritional program.
Special nutrition program.
Balwadi nutrition program.
Midday meal program.
Integrated child development services scheme.
Launched by Ministry of Health and Family Welfare
On the basis of technology developed at NIN this
Component- control of Blindness
Beneficiary group – preschool children 200,000 IU
of oily preparation of Vitamin A (retinol palmitate
110mg) administered orally every 6 months for
every preschool child above 1 year.
Age of the child Quantity of vitamin A
At 9th month 1,00,000 IU
15th - 16th months Mega dose of 2,00,000 IU
18 - 24 months 2,00,000 IU
24 - 30 months 2,00,000 IU
30 - 36 months 2,00,000 IU
1 IU is equivalent to 0.3 microgram of retinol.
Vitamin A deficiency increases the severity of
mortality from measles and diarrhea.
Increased infectious morbidity and mortality is
apparent even before the appearance of
Improving the vitamin A status of deficient children
aged 6 months to 6 years can dramatically reduce
their morbidity and mortality from infection
Prompt administration of large doses of vitamin A to
children with moderate to severe measles,
particularly if they may be vitamin A deficient, can
reduce individual mortality by 50% and prevent or
moderate the severity of complications.
The programme was launched in 1970 to prevent
nutritional anemia in mothers and children.
the expected and nursing mothers as well as
acceptors of family planning are given one tablet of
iron and folic acid containing 60 mg elementary iron
which was raised to 100 mg elementary iron,
however folic acid content remained same (0.5 mg
of folic acid).
Children in the age group of 1-5 years are given
one tablet of iron containing 20 mg elementary iron
(60 mg of ferrous sulphate and 0.1 mg of folic acid)
daily for a period of 100 days.
This programme is being taken up by Maternal and
Child Health (MCH) Division of Ministry of Health
and Family Welfare.
Now it is part of RCH programme.
National programmes to control and prevent
anemia have not been successful.
Experiences from other countries in controlling
moderately-severe anemia guide to adopt long term
measures i.e. fortification of food items like milk,
cereal, sugar, salt with iron.
Nutrition education to improve dietary intakes in
family for receiving needed macro/micro nutrients
as protein, iron and vitamins like folic acid, B,C, etc.
for hemoglobin synthesis is important.
Nutritional Anemia Control Programme should be
comprehensive and incorporate nutrition education
through school health and ICDs infrastructure to promote
regular intake of iron/ folic acid-rich foods, to promote
intake of food which helps in absorption of iron and folic
acid and adequate intake of food.
The technology for the control of anemia through iron
fortification of common salt has also been developed at
the NIN, Hyderabad.
The government of India, launched the National
Goiter control programme (NGCP) in 1962.
It aimed at replacement of ordinary salt by iodised
salt, particularly in the goiter endemic regions.
The program of universal iodisation of edible salt
was started from first April 1986 in phases with the
aim of total salt iodisation by 1992.
IN 1992, the NGCP was renamed as national iodine
deficiency disorder control programme.
The central government provides case grants for
health education and publicity campaign for
promoting the consumption of Iodised salt.
The central government also provides cash grants
for establishing IDD control cells in the state health
A national reference laboratory monitoring of IDD
has been set up at the bio-chemistry division of the
national institute of communicable disease, Delhi.
It monitors the Iodine content of salt in urine
The medical and paramedical personnel monitoring
laboratories have been established at the district
level also in many districts in allocation of
Rs.75,000/- district laboratory has been provided
for this purpose.
The programme was launched in the country in 1970-71
for the benefit of children below 6 years of age, pregnant
and nursing mothers.
Originally launched as a central programme and was
transferred to the state sector in fifth Five year plan as
part of the Minimum Needs Programme.
To improve the nutritional status of the target groups.
To improve the nutritional status of women, pre-
school children, pregnant women and lactating
women in urban, slums, tribal areas and drought
prove rural areas
The main activities of the program are:
-To provide supplementary nutrition
-To provide health services, including supply of
vitamin-A solution and iron and folic acid
It provides supplementary feeding of about 300
calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of
protein to expect at and nursing mothers for six
days a week.
This programme was operated under Minimum
The programme was taken up in rural areas
inhibited predominantly by lower socio-economic
groups in tribal and urban slums.
Fund for nutrition component of ICD programme is
taken from the SNP budget.
This supplement is provided for 300 days in a year.
This programme which was started in
It is under the overall charge of the Department
of Social Welfare.
It is being promoted with the help of four
national-level voluntary organisations, namely,
the Indian Council for Child Welfare, Harijan
Sewak Sangh, Bharatiya Adamjati Sewak
Sangh and Central Social Welfare Board.
Beneficiary group – 3 to 6 years.
Visualizes on the provision of
supplementary nutrition to the extent of 300
calories and 15 grams of protein during 250
days in a year for children attending
Started in 1975 in pursuance of the National Policy
Strong nutritional component in this programme is
in the form of
-Vitamin A prophylaxis
-Iron and folic acid distribution
children below 6 years
elderly pregnant and lactating women
medical referral services,
nutrition and health education to women
non formal education.
Service Delivery :
Each Anganwadi unit covers a population of about
A network of Mahila Mandals has been built up in
ICDS Project areas to help Anganwadi workers in
providing health and nutrition services.
The work of Anganwadis is supervised by
Field supervision is done by the Child Development
APPLIED NUTRITION PROGRAMME
The ANP was first introduced in 1960 in Orissa and
It was extended there after to Tamilnadu in 1961
and Uttar Pradesh in 1962, during 1973, it was
extended to all the states.
To make people conscious of their nutritional needs
To increase production of nutrition foods and their
To provide supplementary nutrition to vulnerable groups
through locally produced foods.
-Production of protective foods
-Training of functionaries involved in production of
-Nutrition education and demonstration
Children between 2-6 years, pregnant and lactating
The children and women are given supplementary
25paise / day / child , 50paise / women/day respectively.
A single supplementary meals is given weekly for 25
Studies show that ANP has not generated and
desired awareness for production and
consumption to protective food, the community
kitchens and school gardens could not function
properly. In reality the program lacked effective
supervision and has almost become defunct.
1st organised in 1957 in TamilNadu.
In operation since 1961 throughout the
AIM: 1/3rd of the required food per day
for the child be furnished through this
- To improve the nutritional status of children
and imparting nutritional education.
- To ensure universal primary education.
- To attract more children for admission to
schools and retain them to improve literacy rate
The feeding programme is the joint venture of
the health and educational department with aid
from UNICEF, CARE, and other agencies.
Skimmed milk, banana, rice meals etc. are
Cost is fixed as 12 paise per child.
supplement, not substitute
1/3 total energy and ½ total protein
locally available food
change menu frequently
It is further planned to introduce development
of vegetable gardens in schools.
Adding subject on nutrition in the curriculum to
motivate the young minds on the concepts of
nutrition for better health.
There are 70 million children who benefit
through this programme in India every year.
Have to study the food habits
of people, their views etc.
Needs to impart the
knowledge of importance of
good nutrition without hurting
their cultural habits.
Needs to demonstrate
simple recipes which are
affordable and locally available.
Needs to use all media of health education.
Needs to identify the malnourished children and
refer them appropriately to the nutrition
Assists in nutrition rehabilitation programme.
Takes part in research activities.