- POSHAN Abhiyaan was launched in India in 2018 to improve nutritional outcomes for children, adolescents, pregnant women and lactating mothers. - It aims to reduce malnutrition through a targeted life cycle approach and by leveraging technology, convergence of schemes, and community mobilization. - The key objectives are to reduce stunting across districts with highest malnutrition by improving utilization and quality of anganwadi services. - It focuses on detection of at-risk groups, improving infant feeding practices, addressing anemia and micronutrient deficiencies, strengthening health services, and promoting food security and livelihoods. - Monitoring mechanisms include tracking of antenatal checkups, immunizations, growth monitoring,

1. POSHAN Abhiyan
Dr Medha Sharma
M.B.B.S. ,M.D.(Community Medicine)
23-09-2023 1

2. Introduction
• POSHAN Abhiyaan was launched on 8th March, 2018 by the Hon’ble Prime
Minister of India at Jhunjhunu in Rajasthan.
• In Himachal it was started on 14th April 2018 at Solan by the Hon’ble Chief
Minister
23-09-2023 2

3. Journey
2015:
NITI Aayog established
Policy priorities
1. Sanitation Mission
2.Nutrition
3. Other social welfare
programe reviewed (eg.
NREGA)
2016:
Finance ministry meeting on
nutrition:
Nutrition mission received
inputs from multiple groups
2017:
Final nutrition strategy
unveiled by NITI Aayog
2018:
POSHAN Abhiyan launched
in March
2019
POSHAN Abhiyan strongly
visible and implemented
2021:
Mission POSHAN 2.0
launched in Union Budget
Combined Supplementary
nutrition program &
POSHAN Abhiyan
23-09-2023 3

4. • POSHAN Abhiyaan is the GOI flagship programme to improve nutritional outcomes
for
• Children
• Adolescents
• Pregnant women
• Lactating mothers by leveraging technology, a targeted approach and convergence.
• POSHAN (Prime Minister's Overarching Scheme for Holistic Nourishment) Abhiyaan
is not a programme but a Jan Andolan, and Bhagidaari, meaning "People's
Movement."
• This programme incorporates inclusive participation of public representatives of local
bodies, government departments of the state, social organizations and the public and
private sector at large.
• The programme, through the stated targets, will strive to reduce the level of stunting,
under-nutrition, anaemia and low birth weight babies.
23-09-2023 4

5. States/districts are covered under this scheme
Years States/Districts to be covered
2017-18 315 common districts covered on basis of prevalence
of stunting
2018-19 Further 235 districts
2019-20 Remaining districts of all States/UTs.
23-09-2023 5

6. Why We Needed POSHAN abhiyan
• "Global Nutrition Report 2016"
demonstrated India's slow progress in
addressing chronic malnutrition,
manifest in stunting , wasting,
micronutrient deficiencies and over-
weight.
• India ranked 114 out of 132
• On wasting, India ranked 120 out of
130 countries
During 2016
23-09-2023 6

7. POSHAN Abhiyan
• The Mission is: convergence of all nutrition related schemes.
Janani suraksha Yojana
NHM of MoHFW
Public Distribution System
(PDS) of Ministry of
Consumer Affairs, Food &
Public Distribution
(CAF&PD).
Mahatma Gandhi National
Rural Employment
Guarantee Scheme
(MGNREGS) of Ministry
of Rural Development
(MORD)
Pradhan Mantri Matru
Vandana Yojana, Scheme
for Adolescent Girls of
MWCD
Drinking Water & Toilets
with Ministry of
Panchayati Raj and Urban
Local Bodies through
Ministry of Urban
Development.
23-09-2023 7

8. Aims of Poshan Abhiyan
• POSHAN Abhiyaan aims to reduce malnourishment in a phased manner through life
cycle approach by adopting synergized and result oriented approach.
• The Abhiyaan will ensure mechanisms for timely service delivery and robust monitoring
as well as intervention infrastructure.
23-09-2023 8

9. Targets & Objectives
23-09-2023 9

10. Objectives Of The POSHAN Abhiyaan
Scheme
• To reduce stunting across districts with the highest malnutrition burden by improving
utilization of key anganwadi services and improving the quality of anganwadi services
delivery.
• Recognizes the need for convergence and coordination such that the benefits of
multiple government schemes and programs reach women and children in the first 1000
days of a child’s life.
23-09-2023 10

11. Prominent features
• A high impact package of interventions with a focus on (but not limited to) the first 1000 days of
a child’s life.
• Remodelling of nutrition monitoring through the introduction of ICDS-CAS (Integrated Child
Development Services - Common Application Software)
• Improving capacities of frontline workers through the Incremental Learning Approach (ILA)
mechanism.
• Emphasizing convergent actions among the frontline workforce, including through
performance linked joint incentives for the 3As (ASHA, Anganwadi& ANM).
23-09-2023 11

12. • A focus on cross-sectoral convergence to emphasize the multi-dimensional nature of
malnutrition
• To establish convergence committees at the state, district and block levels to support
decentralized and convergent planning and implementation.
• This is supported by flexi-pool and innovation funds
• Ramping up behaviour change communication and community mobilization
through Jan Andolan.
23-09-2023 12

13. Key focus areas
Detection and registration of pregnancy
Ensuring timely antenatal care and post natal care of pregnant woman
Addressing maternal undernutrition & low birth weight
Improving infant young child nutrition and feeding practices
Ensuring proper growth monitoring of all children, addressing growth faltering at its earliest;
Addressing iron deficiency and anemia and controlling of Micronutrient Deficiency among children,
adolescent girls and mothers
Strengthening health services, drinking water and sanitation facilities and hygienic interventions and education
23-09-2023 13

14. Household food security–strengthening food supplementation programmes
Augmenting production of locally available food
Strengthening policy, coordination and convergence for improved nutrition outcomes
Monitoring nutrition interventions and strengthening nutrition surveillance
Strengthening training and capacity building of field functionaries (Health, PRIs and WCD)
Awareness generation amongst women & mothers and Strengthening livelihoods through MGNREGS, NRLM &
National Skill Development Mission etc.
23-09-2023 14

15. NITI Aayog in this scheme
• NITI Aayog has played a critical role in shaping the POSHAN Abhiyaan.
• The National Nutrition Strategy, released by NITI Aayog in September 2017
• Most of the recommendations of NNS were subsumed within the design of POSHAN
Abhiyaan.
• NITI Aayog has been entrusted with the task of:
● Bringing about convergence & Role clarity among the various ministries
● Monitoring and evaluation
● Providing technical support
● Mobilizing communities
23-09-2023 15

16. • Utilization of funds: Less than half the funds set aside for the POSHAN
Abhiyaan have been utilized by India's states.
• Mobile phones and monitoring devices: States and Union territories
(UTS) with poor distribution of mobile phones and growth monitoring
devices emerged as those with low fund utilization.
• POSHAN Abhiyaan funds: Only three states had used more than 50 per
cent of their POSHAN Abhiyaan funds between 2017-2018 and 2018-
2019.
• This improved marginally to 12 between 2017-2019 and FY 2019-2020.
• System readiness and capabilities Interventions which has
improvedcompared to the previous progress report:Human resources•
• Infrastructure•SuppliesTraining, and capacity building.Performance: On a
scale of 0-100, only Punjab scored less than 50 among thelarge states.
• • Arunachal Pradesh, Manipur, and Mizoram were the poor performers
among the small states while no UT scored less than 50.
Over scale 0-100
HP scored>50 score
Poorest scoring
states
Recent NITI Ayog Report
23-09-2023 16

17. Recent NITI Ayog Report
23-09-2023 17

18. More than half the funds(60%) remained unutilized until march 2020
50%
23-09-2023 18

19. Fund allocated under POSHAN abhiyan
• The Union Cabinet approved three year budget of Rs.9046.17 crore for 2017-18.
• In 2020-2021, POSHAN Abhiyaan encouraged States/UTs to take up replicable
nutrition centric innovations.
• States/UTs may choose any innovation pilot and scale it up as per requirement and
progress.
• To expand and replicate the proven nutrition centric innovative models
• POSHAN Abhiyaan has further provisions for Flexi-funds given to States/UTs
23-09-2023 19

20. Pillars of POSHAN abhiyaan
For implementation of POSHAN Abhiyaan, the core strategy/pillars of the mission are:
ICDS-CAS
Convergence
Behavioural change
Training and Capacity building
Innovations
Incentives
Grievance Redressal
23-09-2023 20

21. Key Programme Pillars
• Mobile-based ICDS-CAS acts as a delivery and programme monitoring device
Pillar 1:Common Application
Software
• Development and operationalisation of a Convergence Nutrition Action Plan at
various levels
• Promoting coordination and cross-sectoral convergence
Pillar 2: Convergence Action
Planning
• Incremental Learning Approach (ILA) used
• Workers are oriented on one topic every month, followed by a month of practice to
follow-up on actions.
• The system breaks down the total learning agenda into small, doable actions
Pillar 3:Capacity building
23-09-2023 21

22. Key Programme Pillars
• Strategy focuses on developing and operationalizing
mass media and community-based multi-sectoral campaigns to create
awareness among beneficiaries key technical areas.
Pillar 4: Jan Andolan
(Behaviour Change
Communication and
Community Mobilisation)
• A monthly performance incentive of INR 500 AWW
• AWWs on meeting the following performance criteria has been put in place:
• (i) Undertaking at least 60% of home visits to pregnant mothers and
children
• (ii) Completing at least 60% of growth monitoring of children
• A monthly incentive of INR 250 for the Anganwadi Helper if the AWC is
kept open for 21 days is also being provided.
Pillar 5: Performance Incentives
23-09-2023 22

23. • The core functions of the POSHAN Panchayats shall comprise but not be limited to the
following activities:
• Monitoring supplementary nutrition delivery
• Monitor the status of SAM/MAM children
• Monitor the number of anemic women, children and adolescent girls in the
community.
• Motivate the community to actively participate in Poshan Jan Andolan.
23-09-2023 23

24. Community based event
 To organize a Community Based Events (CBES) twice per month each AWC &
supported with an amount of INR 250 per event
 Under Community Based Events
• Annaprashan diwas
• Suposan diwas (specifically focused on orienting husbands)
• Celebrating coming of age- getting ready for pre-school at AWC
• Messages related to public health for improvement of nutrition and to reduce illness.
• Importance of hand-wash and sanitation
• Prevention of anemia, importance of nutritious food, diet diversity etc.
• Will be covered.
 Village Health Sanitation Nutrition Day (VHSND)
• Conducted regularly on 15th of the month in convergence with health department
and the Gram Panchayat.
• To bring health early childhood development nutrition services to doorstep
23-09-2023 24

25. Jan Andolan
• Every year, the month of September is celebrated
as POSHAN Maah across the country.
POSHAN Maah
• Celebrated during March
• These events have helped in reaching out to
communities through the nation's biggest nutrition-
centric annual Jan Andolans.
POSHAN
Pakhwada
23-09-2023 25

26. Sahi poshan desh roshan
1st to 30th September
Mahila swasthya & Bacha aur
Shiksha
21 March-4th April
23-09-2023 26

27. Incentives and Awards
• There is a provision of incentives @ 500/- and @ 250/- per month for AWW and AWH
respectively States/UTS
• "Kuposhan Mukt Villages @ 10 crore per annum which will be distributed to qualified
villages/panchayats @ 21 lakh each.
Incentives
• MWCD recognizes significant contributions of various stakeholders especially the Field
Functionaries.
• There has been provision for 100 awards for AWW @ 250,000/- and 50 awards for AWH
@ 240,000/-.
Awards
23-09-2023 27

28. Multi Sectoral Convergence
Promoting Safe drinking water
Promoting Sanitation
ODF
Promoting Personal hygiene Handwash
with soap
Across
• Households
• AWC
• Health Centres
• Schools
23-09-2023 28

29. Monitoring Mechanism
Antenatal check ups
Institutional deliveries
Breastfeeding
Complementary feeding
Growth monitoring & Promoting
Management of Acute Malnutrition
Anaemia
With in one hour
Continued till 6 month
Initiated at 6 month of age
SAM & MAM children
Children 0-6 yrs
Weight & height
Children
Adolescent girls
Mothers
23-09-2023 29

30. Monitoring Mechanism
Vit A supplementation
Iron & Folic acid
Calcium Supplement
Immunization
Deworming
Diarrhoea Management
Food Fortification
Pregnant women 360 tablets
Children till 1 yr of age
Oral rehydration solution
Zinc supplementation
Children 1-19 yrs
Feb & Aug every year
Action taken at state & district level
Children 6-59 month
Children 6-59 month
Adolescent girls
Women of reproductive age
Pregnant women
23-09-2023 30

31. 23-09-2023 31
38
21
7.5
35.8
58.6
22.9
53
50
35
19
7.7
32.1
67.1
18.7
57
52
Status of Malnutrition
NFHS4 NFHS5

32. 14
64.5
54.9
9.6
62
48.5
94
71.5
58.6
51.2
26.8
31
50.6
20.3
73.2
26
71.2
63.7
11.3
76
70.2
95
70
58
23.3
29.5
60.6
30.5
69
Monitoring mechanisms
NFHS 4 NFHS 5
23-09-2023 33

33. Ministries under POSHAN Abhiyaan
• Under POSHAN Abhiyaan,
the high impact
interventions of 18
Ministries/Departments have
been mapped out, especially
during the first 1000 days of
child-life since conception.
• Each converging
Ministry/Department
prepares an action plan
related to nutrition and
integrates it with its ongoing
activities.
23-09-2023 34

34. Newer Initiatives
• 2 lakh AWC @ 40,000 AWCs per year strengthened & upgraded
• Internet connectivity
• LED screens
• Water purifier
• Smart learning aids
Saksham Anganwadis
• Kitchen & nutri garden near AWC & govt school
• Act as demonstration activity site for children (agriculture techniques)
• Counsel beneficiaries to sensitize them on importance of nutrition
garden, nutritional value of fruit & Vegetables
Poshan vatika
• Real time monitoring & tracking of AWC,AWW & beneficiaries on
defined indicators
• Launched on 1st March 2021
Poshan tracker
23-09-2023 35

35. POSHAN Panchayats
• The Abhiyaan is focusing on converting the agenda of improving nutrition into a Jan Andolan through
involvement of Panchayati Raj Institutions/Villages Organizations/SHGs/volunteers etc. and ensuring
wide public participation.
Poshan Panchayats shall meet and discuss reasons for malnutrition specific to their jurisdiction and
facilitate necessary community/social support mechanism, every month
The "Poshan Panchayat Committee will be led by women, who are also direct beneficiaries of the
Anganwadi services and can act as "agents of change
Which acts as a sub-committee of the Gram Panchayat
To institutionalize a "Poshan Panchayat
nominate/elect 10-15 women members
Women Led Gram Sabha Committee
23-09-2023 36

36. Situation In Himachal
Pradesh
23-09-2023 37

37. Problem Statement in Himachal
Pradesh
26.3
13.7
21.2
30.8
17.4
25.5
0
5
10
15
20
25
30
35
Stunting Wasting Underweight
Child Malnutrition – Himachal Pradesh
NFHS 4 NFHS 5
23-09-2023 38

38. MMBSY
• MMBSY(Mukhya Mantri Bal Suposhan Yojana) is based on focused
approach with seven pillars.
• Jan Andolan mode with multi stakeholder participation.
• Intensive monitoring.
• Transparent system of last mile service delivery.
23-09-2023 39

39. Seven Pillars of MMBSY- Sapt Stambh
Early
Detection and
Treatment of
Diarrhoea and
Pneumonia.
Intensified
Monitoring
and care of
Identified
High Risk
Groups.
Special SNP -
Addition of
Protein Rich
Food for High
Risk Children
and Improved
Feeding
Practices.
Interventions
for anaemia in
Children and
Adolescent
girls
Detection of
High Risk
Pregnancies
particularly
Hypertension
and Anaemia.
Treatment
and Follow Up
of
Malnourished
Children.
Social
Behaviour
Change
Strategies.
23-09-2023 40

40. 1.Early Detection and Treatment of Diarrhoea
and Pneumonia.
Dedicated Diarrhea Control Fortnight: 15th
June – 30th June
2 ORS packets and 14 Zinc tablets to Every
family with under 5 children
Demonstration of preparation and
administration of ORS and Zinc in community
Dedicated Pneumonia Control Fortnight:
November, Antibiotics at Subcentre,PHC,
Neonatal Oximeter
Combined Diarrhea & Pneumonia -March
1.Intensified Monitoring and care of Identified
High Risk Groups. (LBW,SNCU discharged)
Existing visits: Day 3, 7, 14, 21, 28 and
42
Additional visits proposed: Day 11, 18,
35, 49, 60 and 75
HBYC visits at 90 days are started.
AWW shall perform additional
congruent visits with ASHA on day 11,
35 and 60 of the HBNC
23-09-2023 41

41. 1.Intensified monitoring and care of identified
high risk groups
Special focus on Kangaroo Mother
care, breastfeeding support, and
feeding of expressed breast milk
1.Special SNP-addition of protein rich food for
high risk children and improved feeding
practices
Incentive to mother for Exclusive breast
feeding for 6 months.
Incentive to mother for Complementary
feeding after 6 months along with
continued breast feeding
Incentive to ASHA & AWW for
promoting EBF, and CBF.
23-09-2023 42

42. 1.Interventions for anaemia in Children and
Adolescent Girls
By RBSK teams and MOs at PHC
through Digital Hemoglobinometers
Advanced List preparation by Primary
Schools and AWW/ASHA
1.Detection of High Risk Pregnancies particularly
Hypertension
Short mother <145 cm, BMI < 18.5,
RTI/STI
Anemia
Hypertension
Systemic disease: Diabetes Mellitus, Heart
disease, epilepsy, TB
Incentive and travel support to expectant
mother for 5 ANC visits
23-09-2023 43

43. 1.Treatment and Follow Up of Malnourished
Children
Travel support to the mother for NRC
follow up Visits
Will be paid by In-Charge NRC by DBT.
Incentive to the mother for every kg
weight gain of up to 5 kg
Will be validated by ASHA and paid by
DBT.
Incentive to ASHA/AWW for follow up
of SAM/MAM Children Discharged from
NRC
Will be paid by CMO/DPO ICDS
1.Social Behaviour Change Strategies
Printing of 1000 days booklet
Strengthening of ECD Call Center
Will act as Nutrition Helpline
Installation of 100 LED Monitors
Growth Charts for AWW/ASHA/Nodal
Teachers
Activities annaparshan,poshan par
charcha,Vyanjan jhanki
.
23-09-2023 44

44. Impact Indicators (Projections by 2026)
Indicator NFHS-4 NFHS-5
Reduction by
2026 without
MMBSY
Target for
2026 with
MMBSY
Children with diarrhea in the 2 weeks
preceding the survey who received oral
rehydration salts (ORS) (%) 62.7 73.7 86.6 95.0
Children with diarrhea in the 2 weeks
preceding the survey who received zinc
(%)
15 19.5 25.4 95.0
Children with fever or symptoms of
ARI in the 2 weeks preceding the
survey taken to a health facility or
health
provider (%)
78.4 76.2 74.1 90.0
NNMR 25.5 20.5 16.5 9.0
IMR 34.3 25.6 19.1 12.0
Under 5 Mortality rate 37.6 28.9 22.2 15.0
23-09-2023 45

45. Impact Indicators (Projections by 2026)
Indicator NFHS-4 NFHS-5
Reduction by 2026
without MMBSY
Target for
2026 with
MMBSY
Children under age 6 months exclusively
breastfed (%) 67.2 69.9 72.7 80.0
Total children age 6-23 months receiving an
adequate diet (%) 10.9 19 33.1 60.0
Children under 5 years who are stunted (height-
for- age) (%) 26.3 30.8
-
20.0
Children Under 5 years who are Wasted
(weight-for- height) (%) 13.7 17.4 - 10.0
Children under Severe Wasted (weight-for-
height) (%) 3.9 6.9 - 3.0
Children under 5 years Underweight (weight-
for-age) (%) 21.2 25.5 - 20.0
Children age 6-
59 months
(<11.0 g/dl) (%)
53.7 55.4 - 30.0
Pregnant women 15 -49 years age who are
anemic (<11.0 g/dl) (%) 50.4 42.2 35.3 25.0
23-09-2023 46

46. Key Takeaways
• Helped to bring strong focus on improving nutrition outcomes during first
1000 days
Lesson 1
• Enabled a nation wide Jan Andolan catalysing nutrition related behaviour
change at scale for positive impact on feeding & health care practices
Lesson 2
• Demonstrated that the processes for inter-sectoral convergence are
effectively operationalized through in place institutional mechanisms at
multiple levels
Lesson 3
• Showed that technology can be leveraged for real time monitoring of
large scale health and nutrition programmes
Lesson 4
• Supported the resilience of health and nutrition systems during covid-19
pandemic
Lesson 5
23-09-2023 47

47. Way forward
• For increasing household demand for services.
Key focus on SBCC pillar
• Improving nutrition is challenging when families are in economic distress.
• Nutrition-sensitive social protection could play a key role in helping families
provide better nutrition for their children.
Social protection measures
strengthen
• Education is critical to prevent early marriage, which in turn is critical to
prevent early childbearing in India
Education
• Convergence of WCD and Health services
• Data sharing between ICDS-CAS/POSHAN Tracker and RCH should be
developed
Convergence
• Actions that address underlying causes of malnutrition such as poor sanitation,
gender issues, poverty, food insecurity.
Critical actions
23-09-2023 48

48. References
• Poshan_abhiyaan NITI ayog_4th_progress_report_2020
• IAPSM'S textbook of community medicine 2nd edition
• K. Park's textbook of preventive and social medicine 26th edition
• Transforming nutrition in india: poshan abhiyaan
• STATE CONVERGENCE PLAN by department of social justice & empowerment
directorate of women & child development Himachal Pradesh
• Mission POSHAN 2.0 & saksham anganwadi guidelines 2021
• Mukhya Mantri Bal Suposhan Yojana 2022 H.P.
• National Family Health Survey (NFHS-5,4)
23-09-2023 49