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1. Global Hunger Index (GHI) Ref:Park 23/701

The Global Hunger Index (GHI) is a tool designed to comprehensively measure and track hunger globally, by region
and country. It highlights successes and failures in hunger reduction. It is calculated each year by the International
Food Policy Research Institute.
GHI combines three equally weighted indicators into one
index :
1. Undernourishment : the proportion of undernourished people as a percentage of the population (reflecting the
share of the population with insufficient calorie intake);
2. Child underweight: the proportion of children under the age of five who are underweight (that is, have low weight
for their age, reflecting wasting, stunted growth, or both), which is one indicator of child undernutrition; and
3. Child mortality : the mortality rate of children under the age of five (partially reflecting the fatal synergy of
inadequate food intake and unhealthy environments).
The global hunger index is calculated by the following formula :
GHI=Proportion of undernourished population (PNU)+Children under weight (CUW) +
Child mortality in per centage (CM)/3
For India the GHI for the year 2014 is :
17.0 + 30.7 + 5.6
--------------------------- = 17.8
3
The calculations result in a 100-point scale on which zero is the best score (no hunger) and 100 the worst, although
neither of these extremes is reached in practice. A value of 100 would be reached only if the whole population was
undernourished, all children younger than five were
underweight, and all children died before their fifth birthday.
A value of zero would mean that a country had no undernourished people in the population, no children younger than
five who were underweight, and no children who died before their fifth birthday.
Some definitions
1. Hunger : distress related to lack of food.
2. Malnutrition : an abnormal physiological condition, typically due to eating the wrong amount and/or kinds of
foods; encompasses undernutrition and overnutrition.
3. Undernutrition : deficiencies in energy, protein, and/or micronutrients.
4. Micronutrient deficiency (also known as hidden hunger) : a form of undernutrition that occurs when intake or
absorption of vitamins and minerals is too low to sustain good health and development in children and normal
physical and mental function in adults. Causes include
poor diet, disease, or increased micronutrient needs not met during pregnancy and lactation.
5. Undernourishment : chronic calorie deficiency, with consumption of less than 1,800 kilocalories a day, the
minimum most people need to live a healthy, productive life.
6. Overnutrition : excess intake of energy or micronutrients.

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Hidden hunger
Hidden hunger (micronutrient deficiency) is a form of undernutrition that occurs when intake and absorption of
vitamins and minerals (such as zinc, iodine, and iron) are too low to sustain good health and development. Factors
that contribute to micronutrient deficiencies include poor diet, increased micronutrient needs during certain life
stages, such as pregnancy and lactation, and health problems such as diseases, infections, or parasites.
While clinical signs of hidden hunger, such as night blindness due to vitamin A deficiency and goitre from
inadequate iodine intake, become visible once deficiencies become severe, the health and development of a much
larger share of the population is affected by less obvious "invisible" effects. That is why micronutrient deficiencies
are often referred to as hidden hunger.
Hidden hunger afflicts more than 2 billion individuals, or one in three people, globally (FAO 2013). Its effects can be
devastating, leading to mental impairment, poor health, low productivity, and even death. Its adverse effects on child
health and survival are particularly acute, especially within the first 1,000 days of a childs life, from conception to
the age of two, resulting in serious physical and cognitive consequences. Even mild to moderate deficiencies can
affect a person's well-being and development. In addition to socioeconomic development, particularly in low and
middle income countries. The nature of the malnutrition burden facing the world is increasingly complex.
Developing countries are moving from traditional diets based on minimally processed foods to highly processed,
energy-dense, micronutrient-poor foods
and drinks, which lead to obesity and diet-related chronic diseases. With this nutrition transition, many developing
countries face a phenomenon known as the triple burden of malnutrition-undernourishment, micronutrient
deficiencies, and obesity. In higher income, more urbanized
countries, hidden hunger can co-exist with overweight/ obesity when a person consumes too much dietary energy
from macronutrients such as fats and carbohydrates. While it may seem paradoxical, an obese child can suffer from
hidden hunger.

2. Interventions under National Health Mission

focussing on newborns Ref:Park 23/468

INDIA NEWBORN ACTION PLAN (INAP)

In the past two decades, there has been remarkable progress in the survival of mother and children beyond the newborn p
Presently, the newborn health has captured the attention of the policy makers and two important milestones in this directi
been the National Rural Health Mission and the Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy
(RMNCH + A Strategy), NRHM has provided unprecedented attention and resources for newborn health. By adopting
RMNCH+A strategy in 2013, the country observed a paradigm shift in its approach towards health care. Newborn health
occupies centre stage in the overall
strategy as all the inter-linkages between various components have the greatest impact on the mortality and morbidity rat
newborn. In India, Newborn Action Plan (INAP) developed in response to the global Every Newborn Action Plan (ENAP)
launched in June 2014. The plan outlines a targetted strategy for accelerating the reduction of preventable newborn death
stillbirths in the country. INAP defines the latest evidence on effective interventions which will not only help in reducing th
burden of stillbirths and neonatal mortality, but also maternal deaths. The goal is to attain Single Digit Neonatal Mortal
by 2030 and Single
Digit Stillbirth rate by 2030. The INAP will be implemented within the existing RMNCH + A framework, and guided by th
principles of integration, equity, gender, quality of care, convergence, accountability and partnerships. Its strength is buil
six pillars of intervention packages impacting stillbirths and newborn health, which includes :
(a) Pre-conception and antenatal care;
(b) Care during labour and childbirth;

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(c) Immediate newborn care;

(d) Care of the healthy newborn;
(e) Care of small and sick newborn;and
(f) Care beyond newborn survival.
For effective implementation, a systematic plan of monitoring and evaluation has been eveloped with a list of dashboard
indicators .
The interventions under the National Health Mission focussing on newborns are shown in Table
Programme (Year)
Janani Suraksha Yojana
(JSY) (2005)

Integrated Management of
Neonatal and Childhood
Illnesses (IMNCI) at the
community level and F-IMNCI
at health facilities (2007)

Navjat Shishu Suraksha

Karyakram (NSSK) (2009)
Janani Shishu Suraksha
Karyakram (JSSK) (2011)

Facility Based Newborn

Care (FBNC) (2011)

Home Based Newborn

Care (HBNC) (2011)

Objectives
Safe moherhood intervention to
increase
institutional delivery through demandside financing and conditional cash
transfer
Standard case management of major
causes of neonatal and childhood
morbidity and mortality

Basic newborn care and resuscitation

training programme
Zero out-of-pocket expenditure for
maternal
and infant health services through free
healthcare and referral transport
entitlements
Newborn care facilities at various
levels of public health services that
includes Newborn Care Corners
(NBCCs) at all points of childbirth to
provide immediate care; Newborn
Stabilization Units (NBSUs) at
CHC/FRUs for management of
selected conditions and to stablize sick
newborns before referral to higher
centres; and Special Newborn Care
Unit (SNCUs) at district/ sub-district
hospitals to care for sick newborns
(all types of care except assisted
ventilation and major surgeries)
Provision of essential newborn care to
all newborns, special care of preterm
and low-birth-weight newborns; early

Status
- Implemented in all states and union
territories (UTs)
- Special focus on low-performing states

- Operationalised in more than 500

districts
- 5.9 lakhs health and other functionaries,
including physicians, nurses, AWWs,
and ASHAs trained under IMNCI
- 26,800 medical officers and specialists
placed at the CHCs/FRUs trained under
F-IMNCI
- 1.3 lakh health providers trained to-date
- Implemented in all states and UTs
- Assured service package benefits
extended to sick children upto age one

- 14,135 NBCCs established at delivery

points to provide essential newborn care
- 1,810 NBSUs established at
CHCs/FRUs
- 548 SNCUs established at district/subdistrict hospitals or medical colleges
- More than 6,300 personnel provided
FBNC training
- Online reporting system adapted and
scaled up in seven states with 245
SNCUs made online and more than 2.5
lakhs newborns registered in the data
base
- Implemented in all states and UTs
- Most of the ASHAs trained in newborn
care

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Rashtriya Bal Swasthya

Karyakram (RBSK)
(2013)

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detection of illness followed by

referral; and support to
family for adoption of healthy
practices, by ASHA worker
Screening of children with birth
defects, diseases, deficiencies, and
developmental delays (including
disabilities

- ASHAs visited more than 12 lakhs

newborns in 2013

- All children, ages 0 to 18 years targeted

- More than 8 crore children screened
and more than
10 lakhs children identified for tertiary
care ir 2013

Dashboard indicators for INAP

Impact level indicators

Pre-conception &
antenatal care
Care during labour and
child birth
Immediate newborn care
Care of healthy newborn
Care of small and sick
newborn
Care beyond survival

- Birth registration
- Stillbirth rate
- Early neonatal mortality rate
- Neonatal mortality rate
- Percentage of neonatal deaths to under-5 deaths
- Survival rate of newborns discharged from SNCU/NICU at one year of age
- Cause-specific neonatal mortality
- Births to women aged 15-19 years out of total births (teenage pregnancy)
- Percentage of pregnant women who received full ANC
- Percentage of pregnant women detected and treated with severe anaemia
- Percentage of pregnant women detected and treated with PIH
- Percentage of safe deliveries (institutional + home deliveries by SBA)
- Percentage of preterm births
- Caesarean section rate
- Percentage of women with preterm labour (< 34 weeks) receiving at least one dose of
antenatal corticosteroid
- Intra-partum stillbirth rate
Percentage of newborns breast-fed within one hour of birth
- Percentage of newborns delivered at health facility receiving vitamin K at birth
- Percentage of labour room staff trained in Navjat Shishu Suraksha Karyakram
- Percentage of newborns weighed at birth
- Percentage of low birth weight babies
Percentage of newborns received complete schedule of home visits under HBNC by ASHAs
- Percentage of sick newborns identified during home visits by ASHAs
- Exclusive breast-feeding rate
- Percentage of mothers stayed for 48 hrs in the facility
- Percentage of newborn received birth dose of Hepatitis B, OPV and BCG
- Percentage of district hospitals with functional SNCU
- Percentage of facilities with SNCUs having functional KMC units
- Percentage of female admissions is SNCU
- Mortality rate in newborns with admission weight <1800 gm
- Percentage of newborn deaths due to birth asphyxia
- Percentage of newborns with suspected sepsis receiving pre-referral dose of gentamicin by
ANM
- Percentage of newborns screened for birth defects (facility + community)
- Percentage of newborns with any defect seen as birth
- Percentage of newborns discharged from SNCU followed up till one year of age
- Percentage of districts with functional District Early Intervention Centre (DE1C)

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3. Universal eye health:

a global action plan 2014-2019 Ref:Park 23/440

WHO estimates that in 2010 there were 285 million people visually impaired, of which 39 million were blind.
If just the two major causes of visual impairment were considered priorities and control measures were
implemented consistently by providing refractive services and offering cataract surgery to the people in need,
two-thirds of the visually impaired people could recover good eye sight.
Provision of effective and accessible eye care services is the key to control measures.
The preference should be given to strengthening eye care services through their integration into the primary
health care and health system development, as almost all causes of visual impairment are avoidable, e.g .
diabetes mellitus, smoking, premature birth, rubella, vitamin A deficiency etc., and visual impairment is
frequent among older age groups. Improvements in the areas of maternal, child and reproductive health and
the provision of safe drinking water and basic sanitation are important.
Eye health should be included in the broader non-communicable and communicable disease frameworks, as
well as those addressing ageing populations.
There are three indicators to measure progress at the national level.
They are:
1. The prevalence and causes of visual impairment. As a global target, reduction in prevalence of avoidable
visual impairment by 25 per cent by 2019 from the baseline of 2010 has been selected for this action plan;
2. The number of eye care personnel; and
3. Cataract surgical service delivery.
The cataract surgical rate (number of surgeries performed per year, per million population) and cataract
surgical coverage (number of individuals with bilateral cataract causing visual
impairment, who have received cataract surgery on one or both eyes).

In June 2012, the Government of India, Ethiopia, USA and the UNICEF convened the "Global Child Survival Call to Action : A Promise to
Keep" summit in Washington, DC to energize the global fight to end preventable child deaths through targeted interventions in effective,
life-saving interventions for children. More than 80 countries gathered at the Call to Action to pledge to reduce child mortality to < 20
child deaths per 1000 live births in every country by 2035 (48).
Eight months after the event, in February 2013, the Government of India held its own historic Summit on the Call to Action for Child
Survival, where it launched A Strategic Approach to Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) in
India. Since that time, RMNCH+A has become the heart of the Government of India's flagship public health programme, the National
Health Mission (48).
With support from USAID and its Maternal Child Health Integrated Programme (MCHIP), as well as from UNICEF, UNFPA, NIPI and
other development partners, the Government of India has taken important steps to introduce and support RMNCH + A implementation.
This approach is likely to succeed given that India already has a community based programme with presence of 8.7 lakh ASHA workers,
as well as the three tiered health system in place. These provide a strong platform for delivery of services. This integrated strategy can
potentially promote greater effeciency while reducing duplication of resources and efforts in the ongoing programme.
4 6 2 HEALTH PROGRAMMES IN INDIA The RMNCH+A strategy is based on provision of comprehensive care through the five pillars, or
thematic areas, of reproductive, maternal, neonatal, child, and adolescent health, and is guided by central tenets of equity, universal
care, entitlement, and accountability. The plus
within the strategy focusses on :
- Including adolescence for the first time as a distinct life stage;
- Linking maternal and child health to reproductive health, family planning, adolescent health, HIV, gender,
preconception and prenatal diagnostic techniques;
- Linking home and community-based services to facilitybased care; and
- Ensuring linkages, referrals, and counter-referrals between and among health facilities at primary (primary
health centre), secondary (community health centre), and tertiary levels (district hospital). In developing the RMNCH+A strategy, the aim
is to reach the

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4. Ebola virus disease: Ref:Park 23/440

A new breed of deadly haemorrhagic fevers, of which Ebola virus disease (previously known as Ebola
haemorrhagic fever) is the most notorious, has struck in Africa.
Ebola appeared for the first time in Zaire and Sudan in 1976. Since then it has appeared periodically.
Ebola virus is a member of Filoviridae family and comprises of 5 distinct species - Zaire ebolavirus; Reston
ebolavirus; Sudan ebolavirus; Tai ebolavirus; and Bundibugyo ebolavirus.
The recent epidemic started in December 2013 in Guinea and spread to South Africa. By 28th Sept. 2014, a
total of 7,192 cases have been reported with 3,286 deaths.
Case fatality rate may be as high as 70 per cent.
Ebola has incubation period of 2-21 days, and is not infective during this period. Asymptomatic cases are also
not infective.
The virus is transmitted through direct contact with the blood, organs, body secretions or other body fluids of
infected animals like chimpanzees, gorillas, monkeys, fruit bats etc.
Human to human transmission is through blood or body fluids of an infected symptomatic person or through
exposure to objects (such as needles) that have been contaminated with infected
secretions.
It is not transmitted through air, water or food.
The illness is characterized by sudden onset of fever, intense weakness, muscle pain, headache, sore throat,
vomiting, diarrhoea, rash, impaired kidney and liver functions and in some cases both internal and external
bleeding.
Currently there is no specific treatment for this disease. However, by intensive supportive care, the mortality
can be reduced and spread of the disease can be prevented by instituting specific infection control measures.
There is no vaccine against ebola

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