New Delhi: According to UNICEF, making the early years of a child healthy and happy is the duty of all governments, and also ensuring that every mother has a safe motherhood. The first 1,000 days – from the conception to the second birthday of the child, have been recognised as a critical window of opportunity for influencing the birth outcome and health & nutrition status of the child that forms the foundation for the future. The Government of India through its various ministries such as the Ministry of Health and Family Welfare (MoHFW), Ministry of Women and Child Development and others, has been running a number of healthcare schemes and programmes aimed at the mothers, and children and young adults.
NDTV spoke with experts to know about the major central government schemes and programmes targeting mothers, children and young adults in the country.
Integrated Child Development Service (ICDS) And POSHAN (Prime Minister’s Overarching Scheme For Holistic Nutrition) Abhiyaan & POSHAN 2.0
Launched way back in 1975, ICDS focuses on early childhood and caters to children between 0 to 6 years. It takes care of the nutritional needs of babies and children under this age group and supports pregnant and breastfeeding mothers with nutrition and child care. The ICDS Scheme offers a package of six services that can be accessed at the Anganwadi Centres:
– Supplementary nutrition to children below six years and pregnant and lactating mothers;
– Pre-school non-formal education to children in the age group 3-6 years;
– Nutrition and health education for Women (15-45 years);
– Immunization to children below six years and pregnant and lactating mothers;
– Health check-ups and, Referral services to children below six years and pregnant and lactating mothers
The State Governments/Union Territories provide 300 days of supplementary food to the beneficiaries in a year which would entail giving more than one meal to the children from 3-6 years who visit the Anganwadi Centres. This includes morning snacks in the form of milk/banana/egg/seasonal fruits/micro-nutrient fortified food followed by a hot cooked meal. For children below 3 years of age, pregnant and lactating mothers, Take Home Rations (THRs) in the form of pre-mixes/ready-to-eat food are provided. Under ICDS, apart from the above-mentioned services, for severely underweight children in the age group of 6 months to 6 years, additional food items in the form of micronutrient fortified food and/or energy-dense food as take-home ration is provided.
All children below six years of age, pregnant women and lactating mothers are eligible for availing services under the ICDS Scheme. Income is not a criterion for the registration of beneficiaries under ICDS.
The National Nutrition Mission that was launched in 2017 to tackle malnutrition set the target of reducing stunting, underweight, and low birth weight, each by 2 per cent per year; and anaemia among young children, adolescents and women each by 3 per cent per year. It also aimed to strive for reducing stunting to 25 per cent by 2022 along with a 2 per cent reduction every year. The mission was renamed POSHAN (Prime Minister’s Overarching Scheme for Holistic Nutrition) Abhiyaan in March 2018.
While the POSHAN Abhiyaan focuses on intensifying health and nutrition services for the first 1000 days of a child’s birth. It comprises a mapping of various schemes contributing towards addressing malnutrition, including Information and Communication Technology-based Real-Time Monitoring system, incentivising States/UTs for meeting the nutrition targets, incentivising Anganwadi Workers (AWWs) for using Information Technology-based tools, eliminating registers used by AWWs, introducing measurement of the height of children at the Anganwadi Centres (AWCs), Social Audits, setting-up Nutrition Resource Centres, involving masses through Jan Andolan (People’s movement) for their participation on nutrition through various activities, among others.
Restructured Saksham Anganwadi and POSHAN 2.0 is an Integrated Nutrition Support Programme to address the challenges of malnutrition in children, adolescent girls, pregnant women and lactating mothers. It brings together the Umbrella Integrated Child Development Services (ICDS) — Anganwadi Services, POSHAN Abhiyan and Scheme for Adolescent Girls.
According to Dr Dipa Sinha, Assistant Professor at the School of Liberal Studies, Ambedkar University Delhi, known for her work in the Right to Food Campaign, as a result of the pandemic-induced lockdowns and disruptions in Anganwadi services, a large number of children lost access to regular, nutritious meals. The overburdened healthcare systems in the country further impaired service delivery of critical health and nutrition interventions to children and lactating mothers.
Phase 1 of the National Family Health Survey (NFHS) – 5 data for 22 States and Union Territories (released in December 2020) also showed that child nutrition had worsened (compared to NFHS 4 levels) for indicators such as childhood stunting, wasting, and the proportion of underweight children. However, the NFHS-5 India Factsheet for Phase 2 (released in November 2021) shows improvements in the reduction of child stunting, wasting and the proportion of underweight children. At the same time, severe wasting has increased slightly and so has the proportion of overweight children. Additionally, anaemia in both children and adults is also on the rise.
According to Centre for Budget Governance and Accountability experts, while provisioning adequate levels of resource support for crucial government interventions in this domain is essential to address the challenge of malnutrition, an increase in the budget allocation alone would not necessarily result in any desirable change in the ground as far as nutrition outcome are concerned; effective implementation of schemes and proper utilisation of available funds will be imperative in this regard.
Looking at resource allocations towards nutrition schemes Saksham Anaganwadi and POSHAN 2.0 provided in Union Budget 2022-23 which was Rs. 20,263.07 crore. It is an increase of a meagre 1.31 per cent from the revised estimate of Rs. 19,999.55 crore for the year 2021-22.
Talking about the significance of the ICDS and POSHAN, Basanta Kumar Kar, Chief Advisor Cum Mentor, The Coalition For Food and Nutrition Security said,
India’s ICDS program boasts of high public investment in universal food and nutrition programs for pregnant and lactating mothers and children under six years of age. Food has been recognised as part of entitlement and reinforces food and nutrition in the life cycle approach.
However, Mr Kar highlighted that transparency, public accountability and good governance practices remain a great challenge thus resulting in wide-scale disruptions and poor access. The supplementary nutrition provided under ICDS program is supplemental in nature and is limited to addressing only calorie hunger while protein and nutrition hunger still remain a challenge, he said.
Mr Kar said that India needs a new national Food and Nutrition Legislation with strong regulatory enforcement measures that address calorie, protein and hidden hunger popularly known as micronutrient malnutrition and food-related non-communicable diseases, obesity and overweight specifically for women and children.
Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Programme
The Reproductive and Child Health (RCH) Programme was launched throughout the country on October 15, 1997. In 2013, this programme expanded to include maternal, newborn and adolescent health as well. It aims to reduce the rates of maternal, newborn and child mortality. The main features include improvement of reproductive and newborn health, promotion of family planning, adolescent health, HIV, gender, and preconception and prenatal diagnostic techniques.
Programmes undertaken under the scheme include health tracker Scorecard, Janani Shishu Suraksha Karyakaram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), The Rashtriya Kishor Swasthya Karyakram, Mission Indradhanush & Intensified Mission Indradhanush (IMI), National Iron Plus Initiative (NIPI – to combat the wide-scale occurrence of anaemia), prenatal screening for birth defects and early interventions, as well as combating nutritional deficiencies among children and adolescents.
Janani Shishu Suraksha Karyakaram (JSSK)
The JSSK scheme motivates expecting mothers to opt for institutional delivery, through which they can avail several protective facilities before and after the birth of the baby. It is completely free and is for all pregnant women. It eliminated the out-of-pocket expenses being incurred by pregnant women and their families in the case of institutional deliveries in the form of drugs, user charges, diagnostic tests, for C –sections, diet up to 3 days during normal delivery and up to 7 days for C-section, transport from home to institution, and care of sick newborn (up to 30 days after birth) in Government health institutions in both rural and urban areas.
According to Sunish Jauhari, President, Vitamin Angels India, an international NGO that works on eradicating malnutrition and tackling deficiencies like Vitamin A and anaemia said that because of the JSSK programme, there has been a consistent growth in the share of institutional deliveries in India, from 40.8 per cent in 2005-06 to 88.6 per cent in 2019-2021 as per National Family Health Survey 5. He said,
The remarkable rise in the institutional deliveries can be attributed to the Janani Shishu Suraksha Karyakram (JSSK) which provides a range of direct benefits to incentivise institutional deliveries, leading to an improvement in maternal health outcomes.
He added that while there were setbacks due to the pandemic, going forward, there is a need to ensure that the programme is reaching the most vulnerable women and effective monitoring and evaluation measures are put in place to assess the gaps and address those efficiently.
Rashtriya Bal Swasthya Karyakram (RBSK)
The RBSK scheme is meant to specifically address nutritional deficiency and disabilities related issues in newborn babies and young children through early detection and management. Rashtriya Bal Swasthya Karyakram provides care and treatment to children below 18 years through screening and early detection of 4 D’s (Defects, Diseases, Deficiency, and Developmental Delays including disabilities). RBSK is led by AYUSH practitioners.
While talking about the significance of this scheme, Mr Jauhari said that with a focus on screening, early detection and treatment of health conditions among children, the programme has transformative potential in ensuring better health outcomes, particularly for socio-economically marginalized families.
However, he added that there continues to be a lack of proper understanding of the scheme among the target groups. In addition, the over-burdened community-level health workers have led to continuous shortfalls in annual screening targets, he said. Mr Jahauri asserted,
Recent pandemic has proven that NGOs play a critical role whether it’s capacity building of frontline workers or building deeper awareness among communities. There’s potential to do more of this in Programs like Rashtriya Bal Swasthya Karyakram.
According to Mr Kar, while the programme is an important step toward ‘health for all’, there is a need for strong rapport-building activities with community stakeholders prior to the scheduled visit of the RBSK team to screen the children which will reduce the community resistance experienced by the RBSK doctors, paramedics and health care workers. He added that there is a need to strengthen District Early Intervention Centers (DEICs) and establishment of regional centres for defect correction.
Rashtriya Kishor Swasthya Karyakram (RKSK)
The RKSK aims to enable all adolescents in the country to realize their full potential by making informed and responsible decisions related to their health and well-being and by accessing the services and support they need to do so. The programme has the following components:
-The Adolescent Friendly Health Clinics (AFHCs) are established across various levels of public health institutions in all the States.
– Weekly Iron Folic Acid Supplementation (WIFS) Programme is being implemented for school going adolescent boys and girls and out of school adolescent girls across the country to address iron deficiency among them.
– Peer Education programmes are being implemented for awareness building on nutrition, sexual and reproductive health, non-communicable diseases, substance misuse, injuries and violence and mental health to improve life skills, knowledge and aptitude of both school and non-school going, adolescents.
-Under the Menstrual Hygiene Scheme, funds are provided to the States/UTs for procurement of sanitary napkins for Adolescent Girls (aged 10-19 years) as per proposals received from them in their Annual Programme Implementation Plans.
According to Mr Jahauri, Rashtriya Kishor Swasthya Karyakram’s holistic approach to adolescent health seeks to address some of the most pertinent issues such as nutrition, mental health, sexual and reproductive health, and prevention of substance abuse. He said,
The programme is particularly well-positioned to increase access to reproductive health services, including access to family planning services, among vulnerable populations. NFHS 5 data also corroborates some of these gaps. In principle, working with adolescents is critical since pro-health behaviour and practices are likely to stick with them throughout their lives as parents and caregivers. This programme can make the most impact going forward and ensure better health outcomes.
Universal Immunisation Programme
The immunization Programme in India was introduced in 1978 as the ‘Expanded Programme of Immunization’ (EPI) by the Ministry of Health and Family Welfare (MoHFW). In 1985, the programme was modified as the ‘Universal Immunization Programme’ (UIP) and the target was 100 per cent coverage of pregnant women and 85 per cent of all infants by 1990. For ensuring full immunisation with all standard vaccines for children up to two years of age and pregnant women, the Mission Indradhanush was launched in 2014 under the UIP and later in 2017 it was further expanded to reach more children and was launched as the Intensified Mission Indradhanush (2017).
Through the UIP, the Government of India is providing vaccination free of cost against vaccine-preventable diseases that include diphtheria, pertussis, tetanus, polio, measles, a severe form of childhood tuberculosis, hepatitis B, meningitis and pneumonia (Hemophilus influenza type B infections), Japanese encephalitis (JE) in JE endemic districts with the introduction of newer vaccines such as rotavirus vaccine, IPV, adult JE vaccine, pneumococcal conjugate vaccine (PCV) and measles-rubella (MR) vaccine in UIP/national immunization programme.
According to experts, the advancement in vaccination efforts in India is incredible. Mr Jahauri said,
India’s rapid scale up of the COVID-19 vaccination drive was made possible due to the robust vaccine logistics management and delivery infrastructure of the Universal Immunization Programme. UIP has been one of the most successful public health interventions in India and with the nationwide rollout of PCV vaccines with an aim to reduce child mortality by 60 per cent, the programme has received another boost. In the last two years, we have seen some setbacks in routine immunization and our focus now should be on addressing these gaps to meet the SDG goals.
Experts said that in order to give more strength to the immunization capacity of the country, there is a need for a better convergence with departments other than health like women and child development, labour, Panchayati Raj Institutions, Housing and urban, Culture, among others to get their support.
In the Union Budget 2022-23, several components under the National Health Mission have been merged together into a single head titled, ‘Flexible Pool for RCH & Health System Strengthening, National Health Programme and National Urban Health Mission’, with a combined net allocation of Rs. 22,317 crore. Allocation for the NRHM-RCH (National Rural Health Mission-Reproductive and Child Health) Flexi pool, which constitutes the bulk of health-related expenditure on children and includes immunisation, has dropped from Rs. 3,459 crore in 2021-22 to Rs 3,174.6 crore for 2022-23.
According to the Reproductive and Child Health portal of the government, the scheme has so far reached to 21.12 crore pregnant women and 18.25 crore children.
RMNCH+A is an innovative programme that caters to some of the most crucial segments of the population. This strategy has helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the various stakeholders. However, the lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements, said Basanta Kumar Kar, Chief Advisor Cum Mentor, The Coalition For Food and Nutrition Security.
Experts said that the programmes targeting mothers, children and young adults have huge potential to bring a change in the health and nutrition outcomes but transparency, public accountability and good governance practices remain a great challenge thus resulting in wide-scale disruptions and poor access. Mr Kar recommended that the programme delivery and effectiveness of these schemes can be improved by the use of technology. He asserted that the use of Artificial Intelligence (AI) can be explored for growth monitoring, tracking and improving data transparency can be explored for a new generation solution.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.