This ppt gives detailed information about the policies, current status of malnutrition and integrated approach to solve malnutrition.

1. National policies for Food and Nutrition ; Current
nutritional situation of malnutrition ; Integrated approach
to solve the problems of malnutrition in India.
Submitted by
Tamilselvan. T

2. MALNUTRITION
 It is a condition results from eating a diet in which nutrients are
either not enough or are too much such that the diet causes health
problems.
 Malnutrition is failure to achieve nutrient requirements, which can
impair physical and/or mental health. It may result from consuming
too little food or a imbalance of key nutrients.

3. The Government of India is making a comprehensive approach towards the
solution of malnutrition problem in country. The policies and programmes are
broadly divided under the following heads :
1. Increasing the production of Food grains
2. Better utilization of food resources by use of food technology
3. Teaching the common man about the better utilization of the existing foods
already available.
4. To protect the vulnerable groups by preventing against certain nutritional
deficiency diseases and supplementary feeding of most vulnerable
segments.
5. Associated health measures which could indirectly improve the nutritional
status of the people.

4. National policies for Malnutrition
The programmes implemented are:
DIRECT NUTRITION PROGRAMMES:
Ministry of Health and Family welfare
1. National Vitamin A prophylaxis programme
2. National Nutritional Anemia prophylaxis programme for mother and
children
3. National goiter control programme
Ministry of Human Resource Development
1. ICDS Scheme
2. Special Nutrition programme
3. Balwadi feeding programme
4. Mid-day meal programme

5. Ministry of food and civil supplies
1. Nutrition education and extension
2. Food fortification programme
INDIRECT NUTRITION PROGRAMMES:
Ministry of Health and Family welfare
1. Primary health care services.
2. Immunization programmes
3. Family welfare programmes.
Ministry of food and civil supplies
1. Storage of food grains and general warehousing
2. Public food distribution systems

6. Ministry of Agriculture and Rural Development
1. Krishi vigyan kendras.(KVK)
2. National Rural Employment Programme (NREP)
3. Rural Landless Employment Guarantee Programme (RLEGP)
4. Integrated Rural Development Programme (IRDP)
5. Training of Rural Youth for Self-Employment (TRYSEM)
6. National Food for Work programme (NFFWP)

7. National policies for food and Nutrition :
 ICDS scheme
 Antodaya Anna Yojana (AAY)
 Annapurna Scheme
 Balwadi nutrition programme
 Special nutrition programme
 Mid-day meal programme
 TamilNadu Integrated Nutrition Programme (TINP)

8.  Public Distribution system
 Wheat based nutrition program
 Vitamin A prophylaxis programme
 Nutritional Anemia prophylaxis programme for mother and children
 National goiter control programme

9. INTEGRATED CHILD DEVELOPMENT SERVICES:
It remains the worlds most unique early childhood development
programme.
 It was launched on 2nd October ,1975 in pursuance of the national policy for
children in 33 experimental blocks.
 It is the largest nutrition program implemented by the government of India.
 This scheme was funded by Central govt. of India and partly by UNICEF.
 This scheme comes under Ministry of social welfare.
 The ICDS is implemented through Anganwadi centers. At present 13.42
lakh operational anganwadi’ s in India.

10. OBJECTIVES:
 To improve the nutrition and health status of children aged 0-6 years.
 To lay the foundations for proper psychological, physical and social
development of the child.
 To reduce the incidence of mortality, morbidity, malnutrition and school
drop-out.
 To achieve effective coordinated policy and its implementation amongst
the various departments to promote child development.
To enhance the capability of the mother to look after the normal health
and nutritional needs of the child through proper nutrition and health
education.

11. Beneficiaries under ICDS :
1. Child below 6 years
2. Pregnant and lactating mothers
3. Women in the age group of 15-44 years residing in socially
backward villages and urban slums.
Beneficiaries getting supplementary foods under ICDS :
Children 6- 35 months 59.3 %
Children 36-71 months 27 %
Pregnant women 47 %
Lactating mothers 72.9 %

12. Services provided under ICDS scheme:
 Supplementary Nutrition
 Immunization.
 Health check up
 Referral services
 Treatment of minor illnesses
 Nutrition and health education to women
 Preschool education to children in the age group of 3-6 years
 Convergence of other supportive services like water supply, sanitation

13. SPECIAL NUTRITION PROGRAMME:
 This programme launched in 1970-71 to provide supplementary feeding
for children in 0-3 years age group living in tribal areas and urban slums.
 It later extended to children 3-6 years , Pregnant and nursing mothers.
 The daily supplementation consists of 200-300 calories and 10-12g of
protein/ child / day.
 Also 500 calories and 25g of protein / month / day.
 Supplementary food provided for 300 days in a year.
 Folic and Iron tablets are also provided.

14.  The cost of supplementation same as ICDS scheme.
 The programme is implemented through a network of Balwadi’s , which
are located at the village/community level.
 During fifth five year plan in was included in Minimum Needs
Programme.
 This comes under Ministry of social welfare .It is now merged with
ICDS scheme.

15. BALWADI FEEDING PROGRAMME:
 This programme launched by Ministry of social welfare in 1970.
 It is mainly for pre-school children implemented through Balwadi's and day
care centers.
 The children are given Pre school education and the supplementary nutrition
provided contains 300 calories and 10g of protein for 270 days in a year.
 The target group is provided food supplements to 1/3 of total energy
requirement and half of protein requirements.
 The programs were launched to enhance the admissions and retain students
in the school to improve literacy and also to improve the health status of
children

16. Balwadi's are being run by the five national voluntary organization.

17. MID-DAY MEAL PROGRAMME:
 This programme was launched in 1962 by the Ministry of education and
was implemented throughout the country for school children in age group
of 6-11 years of age.
 The program was launched to enhance the admissions and retain students
in the school to improve literacy and also improve health status of
children.
 The meal should be hygienic that demands monitoring of the raw
material and cooked preparation by trained personnel.
 The children in classes 1-8 th could be included as beneficiaries of the
program.

18. PRINCIPLES:
1. Supplement the children, not substitute to home diet
2. 1/3 of total energy requirement/day and ½ of total protein
requirement/day.
3. Reasonably low cost
4. Easily prepared at schools.
5. As for as locally available food.
6. Change menu frequently.
This program is Centrally sponsored and assisted by CARE ( cooperative
of American relief everywhere).

20. APPLIED NUTRITION PROGRAMME (ANP) :
 It was first implemented in Orissa & Andhra Pradesh in 1962.
 By the 1973, the whole country was covered by the scheme.
 The program was initiated as a centrally sponsored scheme but now is
being implemented by the states.
 This programme till date is the best conceived nutrition programme but
it could not achieve the desired results due to management failure.
ANP is at present a non-expandable, low priority programme as
compared to other nutrition programmes implemented by the states.

21. Objectives:
To make people conscious of their nutritional needs.
To increase production of nutritious foods and its consumption
To provide supplementary nutrition to vulnerable groups through local
production of foods.
Beneficiaries :
Children between 3-6 years
Pregnant and lactating mothers.

22. Activities:
 ANP envisaged production of nutritious food by people themselves and
to be consumed by them to improve their own nutritional status.
 Poultry farming, horticulture, beehive keeping, kitchen gardening and
nutrition education were the main activities in the program.
 Also, supplementary nutrition was provided to children and women
beneficiaries.
 The programme is implemented under the supervision of Block
Development Officer.

23. WHEAT BASED NUTRITION PROGRAMME:
 The WNP is a centrally sponsored scheme started in 1986.
 Initially , this scheme was meant to cover additional beneficiaries who
could not be covered by the ICDS projects. However , from 1990, only
the beneficiaries of the central sector ICDS projects are provided
supplementary nutrition under this scheme.
OBJECTIVES:
 To enlarge the scope of existing nutrition program by covering additional
beneficiaries, i.e., preschool children and nursing and expectant mothers
through wheat based supplementary nutrition.

24. Beneficiaries:
 Children of preschool age
 Nursing and expectant mothers in disadvantaged areas.
Activities:
 Under this scheme supplementary nutrition is provided to the preschool
children and pregnant and expectant mothers.
The scheme consists of two components:
 The centrally funded component
 State funded component.

25. Centrally funded component:
Under the centrally sponsored WNP , supplementary
food containing 300 calories and 10 gm of protein is given to children and
500 calories and 20 gm of protein to expectant and nursing mothers.
Assistance at a cost norm of 75 paise per beneficiary per day for 25 days in
a month is provided.
 Out of 75 paise, the GOI contributes 50 paise and the balance 25 paise is
borne by the concerned state governments themselves

26. State funded component:
under this component, wheat was initially provided to
the state governments at a subsidy of Rs. 700 per month to provide
supplementary nutrition to the beneficiaries covered by the state
government nutrition program.
 From 1989, no subsidy is given to the state governments. The states
are, however, now provided wheat at the public distribution system (PDS)
rate.

27. NATIONAL NUTRITIONAL ANEMIA PROPHYLAXIS
PROGRAMME
 Nutritional anemia is major public health problem in India.
 The NNAPP was started in 1970.
 It is a centrally sponsored scheme.
 Anemia especially affects women in the reproductive age group and
young children.
 It is estimated that over 50% of pregnant women suffer from anemia.
 Fortification of salt with iron. a universally consumed dietary article. has
been identified as a measure to control anemia.

28.  Under the programme, the expectant and nursing mothers as well as
women acceptors of family planning are given one tablet of iron and folic
acid containing 60 mg elemental iron (180mg of ferrous sulphate and 0.5
mg of folic acid)
 Children in the age group 1-5 years are given one tablet of iron
containing 20 mg elemental iron (60 mg of ferrous sulphate and 0.1 mg
folic acid) daily for a period of 100 days.
 This programme covered children and pregnant women with hemoglobin
level less than 8 gm per cent and 10gm percent respectively.

29. Objectives:
 Assess the baseline prevalence of nutritional anemia in mothers and
young children through estimation of hemoglobin levels.
 To put the mothers and children with low Hb levels (less than 10 and
less than 8 g, respectively) on anti anemia treatment.
 To put the mother with Hb level more than 10 g/dl and children with Hb
more than 8 g/dl on the prophylaxis program.
 To monitor continuously the quality of the tablets , distribution and
consumption of the supplements.
 To assess periodically the Hb of the beneficiaries
 To motivate the mother to consume the tablets through relevant nutrition
education (and to give to their children).

30. NATIONAL VITAMIN A PROPHYLAXIS PROGRAM:
 Vitamin –A deficiency is a major public health problem among
preschool children in India.
 It was launched in 1970 and presently covers 30 million beneficiaries.
 The program comprises a long term and a short term
Strategy.
The Short term intervention focuses on administration of
Mega doses of vitamin-A on periodic basis,
the Long term strategy emphasizes on dietary intervention to
increase the intake of food which are rich in vitamin-A.

31. Objectives:
 The specific objective o the program is to reduce the diseases and
prevent blindness due to vitamin-A deficiency.
Activities:
 A massive dose of vitamin-A is given every 6 months to children
between the ages of 6 months to 5 years.
 The scheme give priority to children aged between 6 months to 3 years
as a highest prevalence of clinical sign of vitamin-A deficiency are
reported in this age group.
In 1980, the Department of Food introduced a scheme of
Fortification of Milk with Vitamin A to prevent nutritional blindness.

32. The Recommended schedule for Dose Administration:
 6-11 months old - one dose of 1,00,000 IU
 1-5 years old - 2,00,000 IU every six months.
 A child is expected to receive a total 10 doses of vitamin-A before his
fifth birthday.
 The long term strategy emphasize the improvement of dietary intake of
vitamin-A through regular consumption of vitamin-A rich food such as
dark green leafy vegetable, yellow vegetables and fruits, dairy products
and the promotion of breast feeding.

33. NATIONAL GOITRE CONTROL PROGRAMME:
 The National Goiter Control Program was launched by the government
of India in 1962 in the goiter belt in the Himalayan region and iodized
salt was supplied in goiter endemic areas.
 Later on in 1986 this program was changed to National Iodine
Deficiency Disorders Control Program (NIDDCP) because the problem
was found to be widespread and more than the problem of goiter.

34. Objectives:
 To conduct the initial surveys to assess the magnitude of the iodine
deficiency disorder.
 To supply iodized salt in place of common salt to the entire country.
 To conduct resurveys to assess the impact of iodized salt after 5 years.
Beneficiaries:
 All people residing in endemic and non-endemic areas for IDD are the
intended beneficiaries. However , the endemic areas are to be given
priority.

35. Activities:
 Iodization of salt: In order to control the problem of IDD, the
government of India has initiated steps since 1st April , 1986 for universal
iodization of edible salt in a phased manner by the year 1992.
 Notification for banning use of non-iodized salt: The sale of non-iodized
salt has been banned completely in 18 states and partially in 6 states. The
government stands firmly committed to universal iodization of salt.
 Establishment of Goiter cell
 Information , education and communication activities.

36. TAMILNADU INTEGRATED NUTRITION PROJECT
(TINP)
This programme was started in 1982.
Aims:
 To increase health coverage of all under weight pre-school children and also
improve immunization programme.
 To reduce the incidence of PEM among children under 3 years of age.
 To reduce the infant mortality rate through immunization
 To reduce incidence of Vitamin A deficiency in children under 5 years of
age.
 Reduction in incidence of Nutritional Anemia in Pregnant and Nursing
women.

37. Beneficiaries:
1. Children of 6-36 months of age (< Normal wt.)
2. Pregnant and Lactating women belong to poor sections.
Four Components:
A). Nutrition and Growth Monitoring:
 TINP center for every 1500 population.
 Children below 3 years are weighed every month and children with
PEM are given supplementary feeding.
 Supplementary feeding is discontinued when child moves to higher
grade and weight gain of 500 gms over 1 month in 6-12 months age
groups and in 3 months in 13-36 months age group.

38. Pregnant women covered during last trimester of pregnancy and
Nursing women during the first four months of Nursing based on pre health
and Income criteria.
Supplementary food contains Wheat -35% , Jowar - 20 %, Jaggery- 25%
Edible oil – 10% and Roasted Bengal gram- 10%.
Children < 2 yrs - 40 gms / Day
Children between 2-3 yrs. - 80 gms / Day
Women - 80 gms / Day
Normally a child is covered under the project for 90 days.

39. 2). Health care:
 Iron tablets are also distributed to Pregnant and Lactating women.
 Children below 6 yrs of age are given Vitamin A solution.
3). Communication:
The community worker uses Traditional methods like Folk theatre
and arts and Folk songs for educating mothers about Immunization,
Nutrition importance, Methods of combating diarrhoea.
4). Monitoring:
The project staff monitor the impact of the project on the target
population.

40. ANTYODAYAANNA YOJANA (AAY)
 Launched in 2000 for the poorest of the poor.
 This scheme reflects the commitment of govt. of India to ensure food
security for all and create a hunger free India.
 Target group: Estimated that 5% of the population are unable to get 2
square meals a day.
 Identifies 1 crore families(5 crore people) out of the BPL families who
would be provided 35 kg per family per month.
 Food grains will be issued by the Govt. of India @2 Rs. per kg for
wheat and 3 Rs. Per kg of rice.

41. ANNAPURNA SCHEME:
 Aims at providing food security to meet the requirement of senior
citizens not receiving any old age pensions. (NOAPS).
 10 kg of food grains/month are to be provided ‘Free of cost’ to the
beneficiaries.
 Age of beneficiary should be 65 years or above.

42. PUBLIC DISTRIBUTION SYSTEM: (PDS)
 PDS in India is the largest distribution network of its kind in the
world.
 With a network of more than 4.62 lakh fair price shops distributing
commodities worth more than Rs. 30,000 crore annually about 160
million people.
 It supplies food grains namely wheat , Rice besides Sugar, Kerosene
and imported Edible oils.
 PDS implemented earlier was criticized of failure to serve the
population BPL due to its urban bias,
Limited coverage in the states with high concentration
of rural poor,
Lack of transparent and accountable arrangements for
delivery.

43.  so in 1997, The GOI launched the Targeted Public Distribution
System (TDPS) with focus on the poor.
 It gives food subsidy to BPL families, GOI increased the allocation
of food grains from 10 to 20 kg per family per month.
NATIONAL FOOD FOR WORK PROGRAMME: (NFFWP)
 Aims at protecting the real wages of workers besides increasing
nutritional standards of families of the Rural poor.
 Under the scheme, food grains are given part of wages to the rural
poor at rate of 5 kg per Monday at uniform BPL rate.
 It is centrally sponsored scheme and food grains are provided at free
of cost.

44. NATIONAL RURAL HEALTH MISSION (NRHM)
NRHM is now under National Health mission is an initiative undertaken
by GOI to address the health needs of under- served rural areas.
 Launched in April 2005 by PM Manmohan Singh.
 Initially tasked for 18 states which are having weak public health indicators.
 on May 1, 2013 the GOI launched National Urban Health Mission under
NHM.
 The thrust of the mission is on establishing a fully functional, community
owned, decentralized health delivery system with inter-sectoral convergence
at all levels, to ensure simultaneous action on a wide range of determinants of
health such as water, sanitation, education, nutrition, social and gender
equality

45. Rashtriya Bal Swasthya Karyakram (RBSK)
Under NHM, it is an initiative aiming at early identification and
early identification for children from Birth to18 years.
 It covers 4 D’s , i.e., Defects at birth, Deficiencies, Diseases and
Developmental delays including disability.
Screening :
1. At delivery points - Medical officers
2. From 48 hrs. – 6 weeks - ASHA at home .
3. 6 weeks to 6 years - Anganwadi centers.
4. 6 years to 18 years - School.

49. CURRENT NUTRITIONAL SITUATION OF
MALNUTRITION
 India is one of the fastest growing countries in terms of population
and economics but majority of population at or below the poverty line.
 The major cause of Malnutrition in India is Economic Inequality,
due to this peoples diet lack in Quality and Quantity.
 India’s Hunger is still worse than African countries.
According to Global Nutrition report 2016 India ranks
in Stunting – 114 out of 132 countries , Wasting – 120 out of 130
countries, Anemia – 170 out of 185 countries. (ranks from Lowest to
Highest).

61. INTEGRATED APPROACH TO SOLVE THE PROBLEM
OF MALNUTRITION IN INDIA.
DIRECT INTERVENTIONS – SHORT TERM
1.Nutrition intervention for specially vulnerable groups.
a. Expanding the safety net.
Increasing the covering areas of ICDS and other nutrition
policies.
b. Growth Monitoring.
c. Reaching the Adolescent girls.
These group are more vulnerable and it is important to
creating awareness through Non-Formal education for particularly Nutrition
and Health Education.

62. d. Ensuring better coverage of Pregnant and lactating women.
Care should be taken to prevent Low birth of children
by educating mothers. Providing health tablets and importance of Breast
feeding should be explained.
2. Fortification of Essential foods.
Essential food items should be fortified with
appropriate nutrients.
ex: Salt with Iodine and/or Iron, Milk with Vitamin A.
3. Popularization of low-cost Nutritious foods:
Efforts to produce and popularize low cost nutritious
food from Indigenous and locally available raw materials.
4. Control of Micro- Nutrient Deficiencies among Vulnerable groups.

63. INDIRECT INTERVENTIONS – LONG TERM:
1. Food security :
Per capital availability of food grains need to be
attained. The average Indian had access to 2,455 kcal per day with protein -
60 gm and fat – 52.1 gm . Food grains availability is 510.8 gms / day.
2. Improvement of dietary pattern through production and
demonstration:
Increasing food production to meet growing needs.
3. Improving the purchasing power:
Implementing poverty alleviation programs to increase
purchasing power of the lowest economic segments of population.
Ex: IRDP.
4. Public distribution system :
Efficient use of PDS to ensure availability of essential
food items in subsidiary price in rural areas.

64. 5. Land reforms:
Implementing land reform measures so that the
vulnerability of landless and landed poor could be reduced. Creating
awareness for increasing production by modern practices.
6. Health and family welfare.
Facilities for increasing Health and Immunization
facilities shall be provided to all. Improved pre- natal and post- natal care to
ensure safe motherhood made accessible to all women.
7. Basic Health and Nutrition Knowledge.
8. Prevention of food Adulteration.
9. Nutrition Surveillance:
Periodical monitoring of Nutritional status of children,
Adolescent girls, Pregnant and Lactating mothers and based on data
policies have to be made.

65. 10. Research :
Research into various aspects of nutrition, both on the
consumption side as well as supply side.
Research should enable selection of new varieties of
food with high nutritional value which can be within the purchasing power
f poor and also which prevents malnutrition.
11. Communication
12. Minimum wage administration.
13. Education and Literacy.
14. Improvement of status of women.

66. REFERENCES
1. www. Indianpediatrics.net
2. www.ifpri.org
3. www. Transformnutrition.org
4. www.Wikipedia.org
6. www.unicef.org
5. India . Ministry of food and civil supplies, Food and Nutrition board.
Integrated Nutrition education- A handbook .1991.
6. India . Ministry of Human Resource Development , Department of
Women and child development . National nutrition policy. 1993.
7. Public health foundation of India, 2015. India health report –
Nutrition. New Delhi.
8. India. Ministry of statistics and Programme implementation.
Children in India – A statistical Appraisal. 2012.
9. International Food Policy Research Institute, 2016 , Global Health
Report from promise to impact, Washington