POSHAN Abhiyan, 2018

• It is a flagship programme of the Ministry of Women and Child Development launched from Jhunjhunu in Rajasthan.
• It is a multi-ministerial convergence mission initiated after NITI recommendations to reduce the problem of Malnutrition.
• Govt is implementing several schemes under ICDS as direct target intervention.
• Provisions
  • Aim is to generate Jan Andolan towards Nutrition. Use of technology, Reduce stunting, Under nutrition, Anaemia, Low birth weight, focus on Adolescent girls and P&LW.
  • It ensures convergence with various programs like Anganwadi Services, PM Matru Vandana Yojana, Scheme for Adolescent Girls, NHM, Swach Bharat Mission, PDS, MGNREGA etc.
  • Goals = It is a comprehensive approach to improve nutritional status of Children from 0-6 years, Adolescent Girls and Pregnant Women and Lactating Mothers in 3 years from 2017-18.
  • It will strive to reduce stunting, undernutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per year for 3 years.
  • Mission 25: It would strive to reduce Stunting target from 38.4% (NFHS – IV) to 25% by 2022.
  • 3 things = Technology, Behavioural Change and Targeted Approach.
  • Decentralized Governance and Good Governance.
  • 7 Components = Grievance redressal, Convergence, ICDS, Behavioural change, Incentives, Innovation, Training and capacity building.
  • Integration with Digital India = VHSN - Very high speed network.
  • Anganwadi Workers is integrated in this scheme.
  • Also include Breastfeeding.
• Funding: For 3 years from 2017-18 with a Budget outlay of 9046 crore.
  • 50% of 9046 crore is through Budgetary support with 60:40 (Center: States) for States; 90:10 Northeast and Himalayan and 100% for UTs without legislature.
  • The rest 50% will be given by World Bank or other Multilateral Development Banks.
• > 10 crore poeple will be benefited. All States and UTs covered.

National Nutrition Mission

1. It is perhaps the most ambitious Program of Central Government. Need for NNM
   1. Current efforts are fragmented. There is a need to bring together all relevant stakeholders on a single platform.
   2. The mission sets specific targets and a timeline for it.
   3. It has targeted Strategy consisting of a plan of actions and interventions.
   4. It targets behavioral change by social awareness and by creating a mass movement.
2. It has intro Central nodal agency with extensive financial resources to coordinate C-S schemes and imbue additional financial resources. Total outlay = 9000 Cr over 3 years.
3. Decentralized Governance.
4. Encourage local Solutions. Improving post harvest management.
5. Aims:
   1. Overcoming Calorie Deficiency - use NFSA.
   2. Protein Hunger - Milk, Pulses, Poultry consumption and Production.
   3. Hidden Hunger - Micronutrient deficiency by Genetic Garden of Bio-fortified plants and Farming System of nutrition Programme.
   4. Clean drinking water, Sanitation, PHC, Nutritional Literacy.
   5. Create a cadre of Community Hunger Fighters.
   6. Specific targets / Decline annually
      1. Stunting = 2%.
      2. Under nutrition = 2%.
      3. Low birthweights = 2%.
      4. Anemia = 3%.
   7. Key Implementation Strategy
      1. Outcome Orientation
      2. Incentives based on outcomes
      3. Data collection and monitoring.
      4. Coordination between different programs.
      5. Geographical convergence.
      6. Behavioral change through Jan Andolan.

National Nutrition Strategy by NITI Aayog

1. The nutrition strategy envisages a framework wherein 4 proximate determinants of nutrition – uptake of health services, food, drinking water and sanitation and income and livelihoods work together to accelerate decline of under nutritionin India.
2. Decentralized efforts: The Strategy envisages a Kuposhan Mukt Bharat – linked to Swachh Bharat and Swasth Bharat. Focus on behavioural change.
3. The aim is to ensure that States create customized State/ District Action Plans to address local needs and challenges with a greater role for panchayats and urban local bodies.

The Integrated Child Development Service (ICDS) Scheme, 1975 (Flagship)

• The Scheme has been renamed as Anganwadi Services. It is 1 of the World's largest programmes providing for an integrated package of services for the holistic development of the child.
• Funding: Centrally Sponsored Scheme. All components of ICDS except Supplementary Nutrition Programme (SNP) are financed through a 60:40 ratio. For SNP = 50:50. The North East states have a 90:10 ratio.
• Coverage: The scheme is universal covering all the districts of the country. Both Urban and Rural India.
• Objectives
  1. To improve the nutritional and health status of children in the age-group 0-6 years;
  2. To lay the foundation for proper psychological, physical and social development of the child;
  3. To reduce the incidence of mortality, morbidity, malnutrition and school dropout;
  4. To achieve effective co-ordination, implementation and enhance the capability of the mother.
• Components:
  1. Beneficiaries: Children of 0 - 6 years; Pregnant women and Lactating Mothers (PW&LM)
  2. 6 Services under ICDS: Provided at Anganwadi centers through Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs) at grassroots level.
     1. Supplementary Nutrition, Pre-school non-formal education, Nutrition & health education
     2. Immunization, Health check-up and Referral services. They are provided through NHM. Auxiliary Nurse Midwife.
  3. There will be 1 Anganwadi centre (AWC) for population of 400-800; 2 AWCs for 800-1600; and thereafter in multiples of 800 -1 AWC.
  4. The AWWs and AWHs are paid fixed salary of Rs.4,500/- and Rs.2250/- per month respectively. Workers of Mini-Anganwadi Centres are being paid honoraria of Rs.3500/-. In addition, monthly performance linked incentive of Rs.250/- is also being paid to AWH.
  5. Anganwadi Workers work in ARSH, SABLA and ICDS.
• Wheat Based Nutrition Program (WBNP)
  1. It is implemented by Ministry of Women and Child Development.
  2. Foodgrains are given to ICDS for providing food to children from 2 to 6 years and pregnant/ lactating women.
• ICDS Systems Strengthening and Nutrition Improvement Project (ISSNIP): To improve nutritional and early childhood development outcomes of children in India. To strengthen ICDS policy framework.
• ANGANWADI:
  1. Anganwadi is a type of rural mother and child care centre in India.
  2. It was started in 1975 as a part of ICDS to combat child hunger and malnutrition.
  3. It provides basic healthcare include contraceptive counseling and supply, nutrition education and supplementation, as well as preschool activities.
  4. It may be used as depots for oral rehydration salts, basic medicines and contraceptives.
• Anganwadi Worker responsibilities according to MoWCD rules:
  1. Community support, conduct regular quick surveys, pre-school activities.
  2. Provide health and nutrition education to families especially pregnant women on how to breastfeed, etc.
  3. Motivating families to adopt family planning.
  4. Educating parents about child growth and development.
  5. Assist in the implementation of Kishori Shakti Yojana (KSY) to educate teenage girls and parents. Identify disabilities in children, and so on.
• Anganwadi Worker (AWW) guides ASHA in performing activities such as importance of nutritious food, personal hygiene, care during pregnancy, importance of immunisation etc. Anganwadi worker is a depot holder for drug kits and will be issuing it to ASHA.
• ICDS Scheme Analysis:
  1. There are 13.79 lakh Anganwadis in the country out of which 9.31 lakh centers are linked to Government's web enabled data entry system called Rapid Reporting system. Out of them, only 1.09 lakh centers are in urban areas.
  2. For every 100 Anganwadi beneficiaries, only 7 are in urban areas. Because of lack of Anganwadis in cities, leading to poor coverage.
  3. World Urban Prospects 2018 given by UN DESA (Dept of Economic and Social Affairs) estimate urban population in India which, at present is 34%, will be 40% by 2030 and 50% by 2050. The need for Anganwadis in urban India is high.
• Center seeks to revamp child care scheme in urban areas
  1. NITI Aayog will develop draft policy. Urban areas are likely to receive a renewed focus under the govt’s ICDS programme, which provides for anganwadis or day-care centres for delivery of nutrition and pre-school education. Health and ICDS models that work in rural areas may not work in urban areas because of higher population density, transportation challenges and migration.
  2. 2018 Govt data says, of the 14 lakh anganwadis in India there are only 1.38 lakh anganwadis in urban areas.
  3. The CNNS Survey highlighted that malnutrition among children in urban India is characterised by relatively poor levels of breastfeeding as mothers have to travel long distances for work. It also found a higher prevalence of obesity because of relative prosperity and lifestyle patterns, along with iron and Vitamin D deficiency.