1. The document proposes solutions to reduce malnutrition in rural and urban India. In rural areas, it suggests linking food grain distribution through PDS to individual health monitoring data to identify malnutrition causes. It also proposes providing supplementary nutrition through PDS instead of AWCs. In urban areas, it suggests introducing diet plans in schools and a nutrition education subject to improve awareness. The proposals aim to more efficiently utilize existing government resources to reduce malnutrition.

1. NOURISH TO FLOURISH: REDUCING MALNUTRITION
TEAM DETAILS :
Coordinator : Kriti Bhayana
Team Members : Aarchie Gupta
Debanjana Dutta
Deepti Mittal
Manmeet Kaur
College : LADY HARDINGE MEDICAL COLLEGE

2. ABBREVIATIONS
 U5 Under 5 Years
 AWC Anganwadi Centre
 AWW Anganwadi Worker
 SN Supplementary Nutrition
 P&L Pregnant and Lactating Women
 PHC Primary Health Centre
 MCTS Mother and Child Tracking System
 THR Take Home Ration

3. MALNUTRITION is defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more
nutrients. It comprises four forms:
1. Under nutrition 2. Specific Deficiency 3. Over nutrition 4.Imbalance
However the problem that plagues our country the most is under nutrition. What makes the situation even more serious is that the
main victims of malnutrition are children under the age of 15. But children under the age of 5 years are hit the hardest.
GRADING OF MALNUTRITION:
CAUSES:
• Scarcity of suitable food.
• Lack of purchasing power of the family.
• Traditional beliefs and taboos about what one should eat.
• Poor maternal health.
• Infectious diseases.
To counter the lack of purchasing power of the family, the government has introduced food subsidies for such families. However, the
problems encountered in these plans were of uneven and inefficient distribution.
Degree of Malnutrition % of desired body weight for age and sex
Normal 90%-110%
Mild: Grade I (1st degree) 75%-89%
Moderate: Grade II (2nd
degree)
60%-74%
Severe: Grade III (3rd degree) <60%

4. RURAL SETUP:
PRESENT SCENARIO
I. Problems with provision of supplementary nutrition under the ICDS SCHEME at AWC:
Registration of beneficiaries: 49%
of eligible under 5s (U5s) are
actually registered.
Of those registered, only 64%
of U5s, 78% of pregnant &
lactating mothers and 42% of
adolescent girls received SN
(NOT necessarily 300 days or
as per entitlement).
Effective coverage of ICDS
beneficiaries for SN = Proportion
of beneficiaries actually getting SN
x Proportion of days SN received
out of 300 days in a year.
At the national level it was
41% among U5, 38%
among P&L women and
10% among adolescent
girls (for 2008‐09). 0
10
20
30
40
50
60
70
80
90
<12 23-Dec 24-35 36-47 48-59 60-71
Not receiving any
supplementary
nutrition
any services
Almost daily receiving
supplementary
nutrition
Figure 1: Percentage of children age 0-71 months receiving
services from an AWC
Inadequacy of infrastructure at AWC. Wide variations in the number of children enrolled per
AWW (Himachal Pradesh = 9; Uttar Pradesh = 65).
Wide divergence between official statistics and ground reality:
i) registered beneficiaries, ii) number of days SN served, iii)
nutritional status. etc.
Prevailing coverage norms: U5 40-42; 20-25 P& LM.

5. II. Most people are dependent on ration shops to buy grains at subsidized rates. But this system holds little accountability and
transparency. Till now, the amount of food consumed has not been linked to reduction in malnutrition. So, it becomes difficult to
realize the causes of conditions such as severe malnutrition in specific family set ups.
FACTS TO KNOW:
 1 PDS shop per village.
 Roughly 30 villages under 1 PHC.
 Govt. has introduced the scheme of women and child targeting. Under this scheme, all women of the rural household are being given
mobile phones. Also the data about health of pregnant mothers and children is fed into the MCTS. This is Name Based web enabled
tracking of pregnant women and children to ensure and monitor preventive, promotive and curative health services to them.
Wide variations in the number of children enrolled per AWW
(Himachal Pradesh = 9; Uttar Pradesh = 65).
Figure2: Percentage of children 0-59 months in areas
covered by AWC by frequency of weighing
26% shortage of AWCs/ mini AWCs; 22% shortage of
Anganwadi workers (AWWs); 43% deficiency of ICDS
supervisors.

6. PROPOSED SOLUTIONS:
1. In order to improve the accountability and transparency of the existing PDS, our proposal intends to bring it under the direct
supervision of the PHCs.
2. PDS shopkeepers to maintain record of food grain collected by families of that village.
4. This data will be fed into MCTS.
3. A health worker from the concerned PHC will collect height & weight of each individual of every household quarterly.
5. THR for the special groups which was earlier supplied by AWC will now be given by PDS. This ration will be provided in the
same quantity and for the same duration of time as currently provided by AWC.
6. Thus health status can be linked to dietary intake.

7. HOW THIS PLAN WILL WORK:
Every 3 months a health worker from a PHC
will record and collect height & weight of every
individual of all households
The workers will ,add this data into the online
MCTS
Depending upon the analysis of this
report if:
FINANCES FOR RURAL
SETUP
Presently, 5665 crores are invested by government to provide SN through ICDS by AWCs out of which
approximately Rs 2,943 crore (i.e. 60% of the resource) gets wasted every year.
Cost of the additional food meant for the special groups as currently being done under the ICDS will
be bore by the state government.
However, this proposal ensures that the resources spent by the government can now be used
effectively.
• Weight for age detected below normal range.
• SMS sent to the health worker & ASHA to inform about the
deteriorating health of the concerned individual.
• SMS also sent to the individual to visit the respective PHC.
• On not turning up the health worker/ASHA visits the individual.
• On examining, if the cause is found to be any nutrient deficiency ,
then appropriate supplements will be prescribed & provided by the
PHC .

8. URBAN SETUP:
PRESENT SCENARIO
I. In urban areas most people have the capacity to buy adequate amount of food but lack the awareness to buy the right kind of
food.
II. A very large portion of the demand for food is based on the non-nutritive attributes of food, such as taste, aroma, variety, and
status which forms the major cause of malnutrition among the affluent classes.
WHAT WE PROPOSE ?
We propose to introduce diet plans for the school going children in schools that are not covered under the mid-day meal scheme.
In addition to this, we also intend to introduce a subject who will cover the important aspects of healthy living and nutrition.
Our major objective behind such proposals is to contain the prevalence of malnutrition.
PROPOSAL 1:• Every district will consult a nutritionist to design diet charts for one month.
These charts will be revised every fortnight.

9. • The diet charts will be directed to all the Public, Government aided and
Kendriya Vidyalaya schools present in the district.
•
• The diet chart will be different for different age groups, keeping in mind
their physical, mental and developmental needs.
• The charts will be different for vegetarian and non-vegetarian.
• The charts will be different for vegetarian and non-vegetarian.
•
• The intake of appropriate amount of micronutrients will also be ensured.
• The diet plan will include seasonal vegetables and fruits of that region.
BENEFICIARIES
Direct beneficiaries of the
proposed plan will be children
enrolled in
 Public schools
 Govt. aided schools
 Kendriya Vidyalaya
Indirect beneficiaries will be
families of the school going
children.

10. FINANCES:
PROPOSAL 2:
Introducing nutrition education in school curriculum:
In order to make sure that good eating habits in children are inculcated from the beginning, it is essential to introduce nutrition
education as part of the curriculum.
• Each Nutritionist will be paid an
amount of around Rs.4000 per
month.
• The respective State govt. will
bear the salary of the
Nutritionist.
• There are 640 districts in India.
Therefore the total estimated cost
on a national basis per month will
be Rs.4000*640=Rs.25, 60,000.
• Annual cost on a national basis
Rs. 25,60,000*12= Rs.3,07,20,000.
• On an average, a State will have to
bear an amount of Rs.10,24,000
per annum approximately.

11. sUnder this plan, we propose that students of standard 6th to 8th
should have nutrition education as a subject irrespective of the
board the school is affiliated to.
It will be taught in all public, government aided, central and
Municipal Corporation/ Municipality schools.
This subject should essentially be taught keeping in
mind its practical aspect.
The syllabus for this will be designed by a team of experts that
will consist of atleast 2 doctors belonging to the Department of
Preventive and Social Medicine (PSM) among others.
No examination needs to be conducted separately for
this subject; however, regular assessment during
practicals is highly recommended.
OBJECTIVES BEHIND THIS PROPOSAL:
 The subject will be based on the
concept of 'Learning by doing’.
 If the children learn about good health
and balanced diet through a series of
lectures and elaborated
practicals(innovative learning), it will
motivate them to maintain
themselves in a good state of health.
BENEFICIARIES
DIRECT: Children going to:
 Public schools
 Government aided schools
 Kendriya Vidyalaya
 Municipal Corporation/
Municipality schools
INDIRECT: Families of the school
going children.

12. Rural Urban
Total Cost of the Project
Food subsidy
through PDS
SN by AWC
through ICDS
Rs 72000 crores
as used earlier
Rs 5665 crores of
which 60% is wasted
Currently
As proposed Rs 5665 crores
used effectively
Nutrition education
in schools
Diet charts in
school
Rs 3 crores Initial finance
required to
introduce the
subject

13. REFERENCES
 Park's Textbook of Preventive & Social Medicine, K. Park, Twenty second Edition.
 Annual Report, 2012-2013, Department of Health and Family Welfare, Ministry of Health and Family Welfare, Government of
India, www.mohfw.nic.in
 Annual Report, 2011-2012, Department of Food & Public Distribution, Ministry of Consumer Affairs, Food and Public
Distribution, Government of India, http://fcamin.nic.in
 ICDS, 11th Plan- June 2007
 Nutrition in South- East Asia,2000, WHO