health programs

1. SEMINAR
ON
NATIONAL HEALTH PROGRAMMES
FOR CHILDREN IN INDIA
Presented to:
Mrs. Gurkiran Kaur
Assistant professor
Child Health Nursing
Dasmesh college of Nursing,Fdk
Presented by:
Ramna Rani
Msc.(N) 1st year
Child Health Nursing
Dasmesh college of Nursing, Fdk

2. NATIONAL HEALTH
PROGRAMMES FOR
CHILDREN IN INDIA

3. HOW TO ACHIEVE HEALTH
By improving host resistance to
environmental hazards
By improving environmental safety
By improving health systems designed to
increase the likelihood, efficiency &
effectiveness of the first two goals

4. NATIONAL NUTRITIONAL PROGRAMS
 Integrated Child Development Services
Scheme
 Midday Meal Programme
 Special Nutrition Programme (SNP)
 National Nutritional Anemia Prophylaxis
Programme
 National Iodine Deficiency Disorders
Control Programme

5. 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
 Nutritional Program

7. THE REPRODUCTIVE AND CHILD HEALTH (RCH)
PROGRAMME
It was launched in October 1997. The main aim of the programme
is to reduce infant, child and maternal mortality rates.
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 project resources
 To improve quality, coverage and effectiveness of existing
Family Welfare services

8.  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

9. 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
change.
 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.

10. The child health programmes is now its
second phase: RCH-II.
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.

11.  Improving monitoring and evaluation processes at the
District, state and the Central level to ensure improved
program implementation.
 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.

12. The recommended package of services:
For the mothers:
 Tetanus Toxoid Immunization
 Prevention and treatment of anaemia
 Antenatal care and early identification of maternal
complications
 Deliveries by trained personnel
 Promotion of institutional deliveries
 Management of obstetric emergencies
 Birth spacing

13. For the children:
 Essential newborn care
 Exclusive breast feeding and weaning
 Immunization
 Appropriate management of diarrhoea
 Appropriate management ofARI
 Vitamin Aprophylaxis
 Treatment ofAnemia
For eligible couple:
 • Prevention of pregnancy
 • Safe abortion
Prevention and treatment of reproductive tract infection
(RTI) and sexually transmitted diseases (STD).

14. Women of reproductive age must receive:
Counselling on
 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
 MTP Services
 IUD & sterilization services
Family Planning Services
 Condom distribution
 Oral contraceptives
 IUD

15. UNIVERSAL IMMUNIZATION PROGRAMME
 Sponsored by Central Government
 Funding Pattern-It is a Centrally sponsored scheme, so the
total funding is managed by the Central Government.
 Ministry/Department- Department of Health & Family
Welfare Department
 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.

16.  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.

17. The aim is to achieve 100 percentages of full immunization
status by 2009 to 2010 and to maintain it for long.
The objectives of the mission are:
I. Contribute to global eradication of Polio by 2007.
II. Elimination of Neonatal Tetanus, Diphtheria and Pertussis by
2009.
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.

18. 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.

20. INTEGRATED CHILD DEVELOPMENT
SERVICES (ICDS)
 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 their mothers.
 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 other.

21. The Scheme provides an integrated approach for converging basic
services through community based workers and helpers.
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:
 Supplementary nutrition,
 Immunization,
 Health check-up
 Referral services,
 Pre-school non-formal education and
 Nutrition and health education

22. 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.

23. 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 country.
 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

24.  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.

25. COMPONENTS OF SCHOOL HEALTH PROGRAM:
1. Screening, health care
and referral:
 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, etc.
 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
hospitals.

26. 2. Immunisation:
 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.
4. De-worming:
 As per national guidelines
 Biannually supervised schedule
 Siblings of students also to be covered

27. 5. Health Promoting Schools:
 Counseling services
 Regular practice of Yoga, Physical education, health
education
 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

30. INTRODUCTION
 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.

31. FUNCTIONS FALL IN 3 CATEGORIES
Toeradicatemajorcausesof malnutrition.
-Increase food production
-Provide safe drinking water
-improve environmental sanitation
-control of communicable diseases
-nutritional education to the
masses
-promoting kitchen garden

32. CONT…….
Aspectsspeciallyrelatedtowomenand children
-to improve the employment opportunities for women
-provision of better health care to parents & children
-promoting breast feeding
-weaning at right time

33. CONT…….
Special reference to pregnant and
lactating mothers
-to raise nutritional status through nutritional
education
-promoting small handicrafts scheme through
self employment

34.  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.

35.  Launched by Ministry of Health and Family Welfare in
1970.
 On the basis of technology developed at NIN this
was launched.
 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.

36. CONT…….
Age of the child Quantity of vitamin A
administered
At 9th month 1,00,000 IU
15th - 16th months Mega dose of 2,00,000 IU
2,00,000 IU
2,00,000 IU
18 - 24 months
24 - 30 months
30 - 36 months 2,00,000 IU

37.  1 IU is equivalent to 0.3 microgram of retinol.
 Vitamin A deficiency increases the severityof
mortality from measles and diarrhea.
 Increased infectious morbidity and mortality is
apparent even before the appearance of
xerophthalmia
 Improving the vitamin A status of deficient children
aged 6 months to 6 years can dramatically reduce their
morbidity and mortality from infection

38. CONT…….
 Prompt administration of large doses of vitamin Ato
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.

40. CONT……
 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).

41. CONT…...
 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.

42. CONT…….
 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.

43. CONT…….
 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.

45. CONT…….
 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.

46. CONT……
 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
directorates.
 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

47. CONT…….
 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.

50. SNP
 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.
 AIM-
Toimprove the nutritional status of the target groups.

51. CONT……
OBJECTIVES:
 Toimprove 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

52. CONT……..
 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
Need Programme.
 The programme was taken up in rural areas inhibited
predominantly by lower socio-economic groups in
tribal and urban slums.

53. CONT……..
 Fund for nutrition component of ICD programme is
taken from the SNP budget.
 This supplement is provided for 300 days in a year.

54.  This programme which was started in
December 1970.
 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.

55. CONT……..
 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 Balwadis.

56.  Started in 1975 in pursuance of the National Policy for
children.
 Strong nutritional component in this programme is in
the form of
-Supplementary nutrition
-Vitamin Aprophylaxis
-Iron and folic acid distribution

57. CONT…….
Beneficiary group:
 children below 6 years
 adolescent girls
 elderly pregnant and lactating women
Services:
 Supplementary nutrition,
 immunization
 Health checkups,
 medical referral services,
 nutrition and health education to women
 non formal education.

58. CONT………
Service Delivery :
Anganwadi Workers
 Each Anganwadi unit covers a population of about
1000.
 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
Mukhyasevikas.
 Field supervision is done by the Child
Development Project Officer(CDPO).

59. APPLIED NUTRITION PROGRAMME
 The ANP was first introduced in 1960 in Orissa and
Andhra Pradesh.
 It was extended there after to Tamilnadu in 1961 and
Uttar Pradesh in 1962, during 1973, it was extended
to all the states.
Specificobjectives:
 Tomake people conscious of their nutritional needs
 Toincrease production of nutrition foods and their
consumption.

60. CONT….
 Toprovide supplementary nutrition to vulnerable groups
through locally produced foods.
Components:
-Production of protective foods
-Training of functionaries involved in production of
these foods
-Nutrition education and demonstration

61. CONT….
Specific activities:
 Supplementary feeding
 Non-formal preschool education
 Nutrition education
 Poultry forming
 Providing better seeds and seedling
 Raising kitchen gardens

62. CONT……
Beneficiaries:
 Children between 2-6 years, pregnant and lactating
mothers.
 The children and women are given supplementary
nutrition's worth
25paise / day / child , 50paise / women/day respectively.
 A single supplementary meals is given weekly for 25
days/year.

64. CONT…..
Evaluation:
 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.

65.  Also known as School Lunch Programme.

66. CONT…..
 1st organised in 1957 inTamilNadu.
 In operation since 1961 throughout the country.
 AIM: 1/3rd of the required food per day for the child be
furnished through this programme.
 OBJECTIVE:
- Toimprove the nutritional status of children and
imparting nutritional education.
- Toensure universal primary education.
- Toattract more children for admission to schools and
retain them to improve literacy rate

67. CONT……
 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 provided.
 Cost is fixed as 12 paise per child.
Principles:
 supplement, not substitute
 1/3 total energy and ½ total protein
 low cost
 easily prepared
 locally available food
 change menu frequently

69. CONT......
 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.

70. 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.

71. CONT……
 Needs to use all media of health education.
 Needs to identify the malnourished children and
refer them appropriately to the nutrition
programme.
 Assists in nutrition rehabilitation programme.
 Takes part in research activities.