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  • 1. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOutline Outline 1 Motivation The Indian Enigma Determinants of malnutrition 2 Action Plan for overcoming malnutrition Multisectoral approach recommendations Government programmes
  • 2. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOutline 1 Motivation The Indian Enigma Determinants of malnutrition 2 Action Plan for overcoming malnutrition Multisectoral approach recommendations Government programmes
  • 3. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionHigh incidence of malnutrition in IndiaMagnitude of the Problem Despite a fast growing economy, high incidence of malnutrition, food insecurity and rural poverty in India 20% of the Indian population in 2001-‘03 was food insecure as against 25% in 1990-‘92, an improvement In more recent years, in 2009-‘10, 21% of Indians were food insecure, a deterioration in food security Source: Ministry of Agriculture, GOI 2007; FAO 2010
  • 4. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionHigh incidence of malnutrition in IndiaMagnitude of the Problem Despite a fast growing economy, high incidence of malnutrition, food insecurity and rural poverty in India 20% of the Indian population in 2001-‘03 was food insecure as against 25% in 1990-‘92, an improvement In more recent years, in 2009-‘10, 21% of Indians were food insecure, a deterioration in food security Source: Ministry of Agriculture, GOI 2007; FAO 2010
  • 5. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionHigh incidence of malnutrition in IndiaMagnitude of the Problem Despite a fast growing economy, high incidence of malnutrition, food insecurity and rural poverty in India 20% of the Indian population in 2001-‘03 was food insecure as against 25% in 1990-‘92, an improvement In more recent years, in 2009-‘10, 21% of Indians were food insecure, a deterioration in food security Source: Ministry of Agriculture, GOI 2007; FAO 2010
  • 6. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionMalnutrition and Anemia RatesWidespread and high among children Almost half of children under five (48%) are stunted, an indicator of chronic malnutrition; 43% are underweight; wasting affects 20% (has increased since NHFS-II) 24% are severely stunted and 16% are severely underweight (slight improvement since NFHS-II) 70% of children 6-59 months are anemic; primarily due to poor nutrition Girls and boys are equally likely to be undernourished; Undernourishment substantially higher in rural areas, though 40% of urban children were stunted and 33% underweight in 2005-‘06 Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)
  • 7. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionMalnutrition and Anemia RatesWidespread and high among children Almost half of children under five (48%) are stunted, an indicator of chronic malnutrition; 43% are underweight; wasting affects 20% (has increased since NHFS-II) 24% are severely stunted and 16% are severely underweight (slight improvement since NFHS-II) 70% of children 6-59 months are anemic; primarily due to poor nutrition Girls and boys are equally likely to be undernourished; Undernourishment substantially higher in rural areas, though 40% of urban children were stunted and 33% underweight in 2005-‘06 Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)
  • 8. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionMalnutrition and Anemia RatesWidespread and high among children Almost half of children under five (48%) are stunted, an indicator of chronic malnutrition; 43% are underweight; wasting affects 20% (has increased since NHFS-II) 24% are severely stunted and 16% are severely underweight (slight improvement since NFHS-II) 70% of children 6-59 months are anemic; primarily due to poor nutrition Girls and boys are equally likely to be undernourished; Undernourishment substantially higher in rural areas, though 40% of urban children were stunted and 33% underweight in 2005-‘06 Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)
  • 9. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionMalnutrition and Anemia RatesWidespread and high among children Almost half of children under five (48%) are stunted, an indicator of chronic malnutrition; 43% are underweight; wasting affects 20% (has increased since NHFS-II) 24% are severely stunted and 16% are severely underweight (slight improvement since NFHS-II) 70% of children 6-59 months are anemic; primarily due to poor nutrition Girls and boys are equally likely to be undernourished; Undernourishment substantially higher in rural areas, though 40% of urban children were stunted and 33% underweight in 2005-‘06 Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)
  • 10. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionMalnutrition and Anemia RatesWidespread and high among children Almost half of children under five (48%) are stunted, an indicator of chronic malnutrition; 43% are underweight; wasting affects 20% (has increased since NHFS-II) 24% are severely stunted and 16% are severely underweight (slight improvement since NFHS-II) 70% of children 6-59 months are anemic; primarily due to poor nutrition Girls and boys are equally likely to be undernourished; Undernourishment substantially higher in rural areas, though 40% of urban children were stunted and 33% underweight in 2005-‘06 Source: NFHS-II (1998-‘99) & NFHS III (2005-‘06)
  • 11. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionNutrition statistics Desc. %age % infants w/low birthweight, ‘05-‘09 28 Early initiation of breastfeeding (%), ‘05-‘09 41 % children (‘05-‘09) excl. breastfed (< 6 mo.) 46 % children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57 % children (‘05-‘09) still breastfeeding (20-23 mo.) 77 % < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48 % < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43 % < 5 (‘03 -‘09) underweight (WHO), severe 16 % < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20 % < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48 Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66 % of households consuming iodized salt, ‘03-‘09 51
  • 12. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionNutrition statistics Desc. %age % infants w/low birthweight, ‘05-‘09 28 Early initiation of breastfeeding (%), ‘05-‘09 41 % children (‘05-‘09) excl. breastfed (< 6 mo.) 46 % children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57 % children (‘05-‘09) still breastfeeding (20-23 mo.) 77 % < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48 % < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43 % < 5 (‘03 -‘09) underweight (WHO), severe 16 % < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20 % < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48 Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66 % of households consuming iodized salt, ‘03-‘09 51
  • 13. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionNutrition statistics Desc. %age % infants w/low birthweight, ‘05-‘09 28 Early initiation of breastfeeding (%), ‘05-‘09 41 % children (‘05-‘09) excl. breastfed (< 6 mo.) 46 % children (‘05-‘09) breastfed w/compl. food (6-9 mo.) 57 % children (‘05-‘09) still breastfeeding (20-23 mo.) 77 % < 5 (‘03 -‘09) underweight (NCHS/WHO), mod. & severe 48 % < 5 (‘03 -‘09) underweight (WHO), mod.& severe 43 % < 5 (‘03 -‘09) underweight (WHO), severe 16 % < 5 (‘03 -‘09) wasting (WHO), mod. & severe 20 % < 5 (‘03 -‘09) stunting (WHO), mod. & severe 48 Vit. A suppl. (6-59 mo.) ‘09, full coverage (%) 66 % of households consuming iodized salt, ‘03-‘09 51
  • 14. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOutline 1 Motivation The Indian Enigma Determinants of malnutrition 2 Action Plan for overcoming malnutrition Multisectoral approach recommendations Government programmes
  • 15. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionEconomic, environmental & culturaldeterminants of malnutrition Poor purchasing power & poverty Livelihood insecurity Inequalities in asset distribution & control including gender inequalities Absence of safe drinking water, poor sanitation & hygiene Inadequate knowledge of nutrition; cultural beliefs & practices (e.g. expelling colostrum) Cultural shift to less nutritious food consumption; discriminatory intra-family food distribution High workload of women; inadequate time for infant & child care and feeding Early marriage Source: Coalition for Sustainable Nutrition Security in India 2010
  • 16. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionEconomic, environmental & culturaldeterminants of malnutrition Poor purchasing power & poverty Livelihood insecurity Inequalities in asset distribution & control including gender inequalities Absence of safe drinking water, poor sanitation & hygiene Inadequate knowledge of nutrition; cultural beliefs & practices (e.g. expelling colostrum) Cultural shift to less nutritious food consumption; discriminatory intra-family food distribution High workload of women; inadequate time for infant & child care and feeding Early marriage Source: Coalition for Sustainable Nutrition Security in India 2010
  • 17. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionEconomic, environmental & culturaldeterminants of malnutrition Poor purchasing power & poverty Livelihood insecurity Inequalities in asset distribution & control including gender inequalities Absence of safe drinking water, poor sanitation & hygiene Inadequate knowledge of nutrition; cultural beliefs & practices (e.g. expelling colostrum) Cultural shift to less nutritious food consumption; discriminatory intra-family food distribution High workload of women; inadequate time for infant & child care and feeding Early marriage Source: Coalition for Sustainable Nutrition Security in India 2010
  • 18. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionAgricultural and healthdeterminants of malnutrition Nutritional concerns not considered in cropping and farming systems Limited availability of nutrient rich food; fewer home gardens; conversion to cash crops Seasonal food shortages; inequities in food distribution Weak health service systems; inadequate human resources, in public health nutrition Weak health and nutrition educational systems Poor utilization of services; recurrent infections; poor and vulnerable not reached Lack of nutrition-issues awareness, poor infant and young child feeding practices Source: Coalition for Sustainable Nutrition Security in India 2010
  • 19. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionAgricultural and healthdeterminants of malnutrition Nutritional concerns not considered in cropping and farming systems Limited availability of nutrient rich food; fewer home gardens; conversion to cash crops Seasonal food shortages; inequities in food distribution Weak health service systems; inadequate human resources, in public health nutrition Weak health and nutrition educational systems Poor utilization of services; recurrent infections; poor and vulnerable not reached Lack of nutrition-issues awareness, poor infant and young child feeding practices Source: Coalition for Sustainable Nutrition Security in India 2010
  • 20. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionPolicy & administrationdeterminants of malnutrition Vertical programs not coordinated; lack of central coordination for nutrition extension Lack of nutrition surveillance system focused on nutritional outcomes Decision making not evidence based; weak implementation & monitoring, poor governance Source: Coalition for Sustainable Nutrition Security in India 2010
  • 21. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOutline 1 Motivation The Indian Enigma Determinants of malnutrition 2 Action Plan for overcoming malnutrition Multisectoral approach recommendations Government programmes
  • 22. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Women & Child Development programmes 1 Proven, essential nutrition interventions Breastfeeding within hour of birth; exclusive for first six months; timely introduction of complementary food Age-appropriate complementary feeding (quality, quantity & frequency) Hygienic infant and child feeding practices, safe drinking water & basic sanitation Therapeutic feeding of children; including ready to use therapeutic foods, through a community-based approach combined with a facility based approach for children with Severe Acute Malnutrition Improved nutrition for women; iron and folic acid supplementation; deworming for adolescents, pregnant women and lactating mothers
  • 23. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Women & Child Development programmes 1 Proven, essential nutrition interventions Breastfeeding within hour of birth; exclusive for first six months; timely introduction of complementary food Age-appropriate complementary feeding (quality, quantity & frequency) Hygienic infant and child feeding practices, safe drinking water & basic sanitation Therapeutic feeding of children; including ready to use therapeutic foods, through a community-based approach combined with a facility based approach for children with Severe Acute Malnutrition Improved nutrition for women; iron and folic acid supplementation; deworming for adolescents, pregnant women and lactating mothers
  • 24. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Health & Family Welfare programmes 2 Proven, essential primary health care interventions Full immunisation and biannual vitamin A supplementation with deworming for infants and young children Appropriate and active feeding of children during illness, including ORS and zinc supplementation during diarrhea Improved nutrition for women, including iron and folic acid supplements Therapeutic feeding, including ready to use food, and care for children with SAM Address micro-nutrient malnutrition in a holistic manner
  • 25. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Health & Family Welfare programmes 2 Proven, essential primary health care interventions Full immunisation and biannual vitamin A supplementation with deworming for infants and young children Appropriate and active feeding of children during illness, including ORS and zinc supplementation during diarrhea Improved nutrition for women, including iron and folic acid supplements Therapeutic feeding, including ready to use food, and care for children with SAM Address micro-nutrient malnutrition in a holistic manner
  • 26. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Rural Development 3 Promote personal hygiene, environmental sanitation, safe drinking water and food safety Promote use of safe drinking water Encourage personal hygiene, environmental sanitation, especially use of toilets and hand washing with soap Safe food handling practices during storage, cooking and eating
  • 27. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Rural Development 3 Promote personal hygiene, environmental sanitation, safe drinking water and food safety Promote use of safe drinking water Encourage personal hygiene, environmental sanitation, especially use of toilets and hand washing with soap Safe food handling practices during storage, cooking and eating
  • 28. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Agriculture 4 Integrate household food and nutrition security in design of cropping and farming systems Promote agricultural & horticulture programmes & policies; increase supply and consumption of safe, nutritious foods; promote food based remedies for nutritional maladies, with an emphasis on micronutrient deficiencies; mainstream nutrition considerations into NHM and Rastriya Krishi Vikas Yojana Expand availability of low cost nutritious foods in rural areas through PDS, SHG; include quality complementary food for children, 6-24 months Review Mid-day meal scheme to improve food quality and add nutrition education
  • 29. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Agriculture 4 Integrate household food and nutrition security in design of cropping and farming systems National Commission of Farmers made recommendations on 1 proven gains from intensive agriculture 2 developing contingency plans for extreme weather 3 improving production & productivity 4 promoting water use efficiency 5 remunerative prices for farm commodities
  • 30. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Panchyati Raj, Min. WCD, Min. I&B 5 Expand and improve nutrition education, awareness and involvement at community level Involve PRI in nutrition security 1 Improve sensitisation and training of PRI members on priority issues 2 Promote Village Health and Sanitation Committees overseen by Gram Sabhas; focus on nutrition 3 PRI role in monitoring functions and outcomes of nutrition programmes at community level 4 Awareness of entitlements among poor households, particularly women using entitlement cards ICT for nutrition education and M&E; Gyan Choupal, Grameen Gyan Abiyan Movement
  • 31. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Panchyati Raj, Min. WCD, Min. I&B 5 Expand and improve nutrition education, awareness and involvement at community level Involve PRI in nutrition security 1 Improve sensitisation and training of PRI members on priority issues 2 Promote Village Health and Sanitation Committees overseen by Gram Sabhas; focus on nutrition 3 PRI role in monitoring functions and outcomes of nutrition programmes at community level 4 Awareness of entitlements among poor households, particularly women using entitlement cards ICT for nutrition education and M&E; Gyan Choupal, Grameen Gyan Abiyan Movement
  • 32. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Panchyati Raj, Min. WCD, Min. I&B 5 Expand and improve nutrition education, awareness and involvement at community level Clear Government guidelines on priority interventions & target groups on nutrition; evidence based Nutrition education and counselling skills of frontline workers, AWW, ANM, ASHA; public health nutritionist cadre Nutrition education in schools; empower and educate women’s SHG, NGO, CBO, PPP and corporate philanthropy with appropriate regulations to protect public health
  • 33. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionTo achieve nutrition securitywith leadership from Min. Panchyati Raj, Min. WCD, Min. I&B 5 Expand and improve nutrition education, awareness and involvement at community level Clear Government guidelines on priority interventions & target groups on nutrition; evidence based Nutrition education and counselling skills of frontline workers, AWW, ANM, ASHA; public health nutritionist cadre Nutrition education in schools; empower and educate women’s SHG, NGO, CBO, PPP and corporate philanthropy with appropriate regulations to protect public health
  • 34. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOutline 1 Motivation The Indian Enigma Determinants of malnutrition 2 Action Plan for overcoming malnutrition Multisectoral approach recommendations Government programmes
  • 35. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOngoing Government programmes with a life cyclefocus Pregnant & lactating women ICDS, RCH-II, NRHM Children 0-3 years ICDS, RCH-II, NRHM, Integrated Mgmt of Neonatal & Child Illness (IMNCI), Rajiv Gandhi National Cr` che Scheme e Children 0-6 year ICDS, RCH-II, NRHM, Rajiv Gandhi National Cr` che Scheme e School going children 6-14 years Mid day meals, Sarva Shiksha Abiyan Adolescent girls 10-19 years Nutrition Programme for Adolescent Girls (NPAG), Sabla
  • 36. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOngoing Government programmes with a life cyclefocus Pregnant & lactating women ICDS, RCH-II, NRHM Children 0-3 years ICDS, RCH-II, NRHM, Integrated Mgmt of Neonatal & Child Illness (IMNCI), Rajiv Gandhi National Cr` che Scheme e Children 0-6 year ICDS, RCH-II, NRHM, Rajiv Gandhi National Cr` che Scheme e School going children 6-14 years Mid day meals, Sarva Shiksha Abiyan Adolescent girls 10-19 years Nutrition Programme for Adolescent Girls (NPAG), Sabla
  • 37. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOngoing Government programmes with a life cyclefocus Adults Food for Work, Aam Admi Bima Yojana, NREGS, Skill Development Mission, Women welfare & support programme, Adult literacy programme Below Poverty Line population PDS Entire population Rashtriya Krishi Vikas Yojana, Food Security Mission, Safe Drinking Water & Sanitation Programme, NHM, National Iodine Deficiency Disorders Control Programme (NIDDCP), Nutrition Education and Extension, Bharat Nirman
  • 38. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionOngoing Government programmes with a life cyclefocus Adults Food for Work, Aam Admi Bima Yojana, NREGS, Skill Development Mission, Women welfare & support programme, Adult literacy programme Below Poverty Line population PDS Entire population Rashtriya Krishi Vikas Yojana, Food Security Mission, Safe Drinking Water & Sanitation Programme, NHM, National Iodine Deficiency Disorders Control Programme (NIDDCP), Nutrition Education and Extension, Bharat Nirman
  • 39. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionNutrition securityused by Expert Task Force in analysis in India Context Enabling environment, Convergence, High level integration mechanism, Monitoring& Evaluation, Political Commitment, Institutional reform Inputs Health & nutrition delivery - preventative & curative including BCC, food fortification (public, private), target most vulnerable, ICDS, NRHM, PDS, MDM, NREGP, NUHM Outputs Improve production, access to drinking water & sanitation, environment Outcomes Awareness, adoption, behaviour change, access, storage, intra-household, distribution services/net, equity, participation, optimal growth & development and sustained livelihood
  • 40. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionNutrition securityused by Expert Task Force in analysis in India Context Enabling environment, Convergence, High level integration mechanism, Monitoring& Evaluation, Political Commitment, Institutional reform Inputs Health & nutrition delivery - preventative & curative including BCC, food fortification (public, private), target most vulnerable, ICDS, NRHM, PDS, MDM, NREGP, NUHM Outputs Improve production, access to drinking water & sanitation, environment Outcomes Awareness, adoption, behaviour change, access, storage, intra-household, distribution services/net, equity, participation, optimal growth & development and sustained livelihood
  • 41. Motivation Action Plan for overcoming malnutrition Five point Charter for Overcoming MalnutritionFive point Charter for Overcoming Malnutrition 1 Institutional structures for public policy and coordinated action in nutrition 2 Learning from success: unique to universal 3 Action at Local level: coordinating food & nutrition security system. Regular meetings, sensitize and build capacity of key leaders, introduce nutrition workers, nutrition education and communication, M&E, support and motivate Frontline Workers 4 Action at State level: coordinating nutrition security initiatives 5 Action at National level: Mainstream Nutrition in national missions
  • 42. AppendixFor Reference I Sources Contents The Coalition for Sustainable Nutrition Security in India A Leadership Agenda for Action. Sustainable Nutrition Security in India, 2010. The Coalition for Sustainable Nutrition Security in India Block Operational Guidelines To Achieve Nutrition Security. Sustainable Nutrition Security in India, 2010.