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BRIEF CONTENTS Preamble Importance of health and nutrition Definition of health and nutrition Who standards of health and nutrition Health and nutritional problems Malnutrition Health and nutritional schemes in India Health and nutritional policies and legislations Institutional mechanism for health and nutrition Financial budgets for health and nutritional programmes
³It is health that is real wealth and not pieces of gold and silver´. Mahatma Gandhi, Father of Nation (India). ³The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.´ Thomas Edison. 1. Preamble Research in Health and Nutritional services provided to human being is so important to underpin both policy making and project designing. Though there has been progress in
improving health and nutrition of people in India; some challenges remain and new ones have emerged India. The social, economic, and cultural factors influence human¶s health and
nutritional status. The major health problems of the 21st century include nutritional deficiencies and dietary changes in both rural and urban settings. The research in Health and Nutritional services can help to identify the biological and socio-cultural components of solutions to nutrition and health problems. Favorable health policies and effective and equitable health
services are critical to the broader development goal of breaking the cycle of poverty, high fertility, poor health, low productivity and slow economic growth.
1.1 The Concept of Health Health is primarily a personal responsibility and demands personal care to enjoy it. It is an essential requirement of all irrespective age, caste, creed, race, religion and economic standard. Health of an individual can be affected by general health condition of the society and vice-versa. Therefore, health of the community needs higher attention while considering the
development of a region or a country. It is a precious asset for everyone. It is the crown of all possessions and untheft treasure. It is certain that health is a basic need of all human beings from womb to tomb. Good nutrition is a firm foundation for human happiness, and sound health and skilled performance. It constitutes the most important readily improved environmental influence of health. The advances in medical sciences have the treatment of many diseases possible and simple. And yet the benefits of modern medicines have not reached the vast majority of people in poverty groups and rural areas, especially women. But it is the women who are the prime producers of the necessities of the life, women on whom the society depends so heavily for economic support and family health care. According to the census 2011 of India about 68.84 percent of Indian population is living in rural areas as against 31.16 percent in urban areas. There are nearly 6, 40, 867 villages in India which are scattered over larger areas as compared to urban areas (Census of India, 2011)1. Urban areas are not only concentrated but are also attracting centres for economic activities and for services like health, transport. As a result, large population of hospitals, dispensaries clinics and medical centers are found in urban areas than in rural areas. On the contrary, villages being smaller size, most of the health services like hospitals, dispensaries and clinics became uneconomical as their capacities remain under utilized. Moreover, health problems are rampant in rural areas, not merely because of lack of medical facilities but because of general poverty, lack of balanced and nutritious diet to large proportion of rural population, and more over lack of knowledge with regard to health and hygiene. 1.2 Importance of Health and Nutrition Health and nutrition are the most important contributory factors for human resource development in the country. Food consumption, which largely depends on production and distribution, determines health and nutrition of the population. Accessing by the poor to
services that improve health, nutrition and fertility outcomes is one of the three pillars of the World Bank's Health, Nutrition, and Population Sector Strategy (Anne Tinker, 2000, p.7)2. Health and nutrition are vital for livelihood of the human being on the earth. Especially, it requires during the childhood to sustain thereafter. A good health and nutrition can reduce the risk of chronic diseases in later life. Nourishing well balanced diets are essential for proper growth of immunity, physical, and mental development. A women¶s health and nutrition status
have important implications for her wellbeing. A Poor nutritional status of women affects not their health but also the health of their offspring. Maternal nutrition is so important determinant of pregnancy outcomes, nutrition outcomes and indicators of women¶s health. Nutrition is critical for health and well-being and is important at every stage of life. Good nutritional status is widely accepted as an important indicator of national development. Foods provide energy, nutrients and other substances needed for health. Optimal nutritional status helps ensure a healthy child hood, pregnancy and a robust newborn. Food consumption, both in terms of quantity and quality, plays a major role in determining nutritional status. Healthful nutrition reduces stress, enhances immunity, affects longevity and improves outlook and the quality of life. The prevalence of malnutrition and infectious disease among the young has important implications for the health and well-being of the population, because ill health in childhood can affect an individual¶s physical and mental development, susceptibility to disease, and capacity for work. Good health and nutrition is fundamental to live a productive life, meeting basic needs and contributing to community life. It is an enabling condition for the development of human potential. The components of health are multiple and their interactions are complex. The health of an individual is strongly influenced by genetic make-up, nutritional status, access to health care, socioeconomic status, relationships with family members, participation in community life, personal habits and lifestyle choices. A healthy population can lead the nation better in all the frontiers. Adolescence is the future generation of any country. Their nutritional needs are critical for the well being of a society. If the adolescence are well-nourished, they can make optimal use of their skills, talents and energies and would be healthy and responsible citizens. Adolescence, a second period of rapid growth cycle may serve as an opportunity for compensating faltered early childhood growth though a good health and nutritional components. Poor nutrition starts before birth and goes up to death and can spam into generation. 1.3 Definition of Health The most acceptable definition of health is given by the WHO (1978): Health is the state of complete physical, mental, social and spiritual well-being, and not merely an absence of disease or infirmity. It is a significant departure from the medical model. It is a definition of positive health and goes beyond the mere absence of a disease: the focus being on maintaining
good health, rather than on the treatment of different diseases. This comprehensive definition has made it necessary to define the health of a community in a broad perspective, and not merely in terms of the individual demographic indicators such as Infant Mortality Rate (lMR), Life Expectancy at Birth (LEB), Mortality Rate by Causes, and so on. A community could be healthy if almost every individual in it were healthy. The primary requirements for anyone to be healthy are availability of adequate food, shelter and clothing. This definition tells us that health is a positive state of human life. In other words, it is a state of complete well-being not just the absence of disease. A person may not be suffering from any disease and yet may not enjoy complete well-being. There are many times when one feel tired or exhausted and incapable of concentrating on their work. At such times they are not enjoying complete well-being, even though at other times they do. There are also times when one suffers from an infection or periods of ill health. This means no person enjoys full health all the time. However, a person can be called healthy if he or she enjoys good health most of the time. Another dimension which is also gaining prominence is spiritual health. Health relates to physical well-being, who people are as individuals, how people relate to their environment, what they know value and believe how they make decisions and behave. The dimensions of health as described in figure 1.
Fig. The dimensions of Health
1.3.1 Physical Health is easy to detect and describe. A person is physically healthy if he or she looks alert, is responsive, energetic, and vigorous. Physical health is discussed in terms of wellness of the body and absence of bodily disorders. It includes the characteristics such as one¶s weight, susceptibility to disease, nutritional status, fitness and powers of recovery from illness.
This.1. successful social relationships. family structure. in turn. especially females. 1.3 Mental or emotional health is expressed in terms of understanding one¶s emotions.3. or it may simply relate to that sense of being part of a larger environment or world. Access to Services Gender Culture Peers Education HEALTH Media Income 5 . Health status is affected by gender. The mental components of health are related to one¶s self-esteem.3. Cultural factors may influence dietary patterns. It relates to social abilities. support networks. engage in. Religious factors may determine whether immunisation occurs or a potentially lifesaving blood transfusion is allowed. and culture.4 Spiritual health may involve a religious belief. coping with everyday problems and handling stress in a non-destructive way.4 The social construct of health It recognizes that a person¶s cultural background. skills and insights. religion. self-confidence and the way you cope with problems. level of education and income all interrelate to affect their view of health status as shown in figure 2. Positive social interaction can be seen both as a means of achieving health and as a part of health itself. 1. income and social status.3. education. 1. Family and culture may determine the type and amount of physical activity which people.2 Social health is one¶s ability to get along with other people in one¶s life and have a productive role in one¶s family or community. Understanding this social view of health enables to realize that health does not mean the same to all people and as society changes. may bring into question the relevance of the standard dietary pyramid.
absorbs. development and to remain active along with the human growth cycle as shown in figure. It is a basic human need and a prerequisite to a healthy life. transports and utilizes nutrients and disposes of their end products. Nutrition can be defined as ³The science of foods. the nutrients and other substances therein. economic. interaction and balance in relationship to health and disease. nutrition must be concerned with the social. their action. Nutrition is essential from the very early stages of life for proper growth. 6 . Nutritional status is the condition of health of an individual as influenced by the utilization of nutrients. Household nutrition involves physical and economic access to balanced diets and safe drinking water for the children. the processes by which the organism ingests. In addition. cultural and psychological implications of food and eating´.5 Definition of Nutrition Nutrition refers to the availability of energy and nutrients to the body¶s cells in relation to body requirements. women and men of every family.Environment Religion Family Fig 2: Social construct of health 1. digests.
Nutrition throughout the life cycle INADEQUATE FEEDING. FREQUENT INFECTIONS INADEQUATE FOOD HEALTH & CARE MENTALLY RETARD RISK OF CHRONIC DISEASES IN ADULT HOOD GROWTH FAILURE MALNUTRITION ELDERLY REDUCED MENTAL CAPACITY BABY INADEQUATE FOOD HEALTH & CARE LBW INADEQUATE CATCHUP GROWTH CHILD STUNTED INADEQUATE FOOD HEALTH & CARE WOMEN MALNOURISHED PREGNANCY LOW WEIGHT GAIN INADEQUATE FOOD HEALTH & CARE ADOLESCENT STUNTED HIGH MMR Source: Prepared by Nina Seres for the ACC/SCN-appointed Commission on the Nutrition Challenges of the 21 Century. st 7 .
Source: Anonymous author 1. The girls having slightly better health status2. Table1: Child Mortality Statistics Per Countries Capita GDP Eritrea Bangladesh 271 428 Under-five mortality rate MDG Average annual rate of Reduction (%) Required 2007 .6 9.6 1.8 Progress towards the MDG target on track on track India Pakistan Nigeria Philippines 976 996 1.3 4.8 1.639 115 130 230 62 76 97 191 32 38 43 77 21 2.2015 4.5).169 1.0 10.2 4. According to the NFHS-3.8 insufficient insufficient insufficient on track 8 . And that girls and boys 0-35 months were about equally likely to be underweight.1 7.6 1990 147 149 2006 74 69 target Observed 1990 2006 49 50 4.6 3. 43 percent of children under age five years are underweight for their age (WAZ<-2SD) and 48 percent of children under age five years are stunted (HAZ<-2SD).6 Current Nutritional Status The National Family Health Survey 05-06 (NFHS-3) gives statistics of the nutritional status of women and children of India.1 4. NFHS-3 shows that 36% of all women age 15-49 in India are underweight (BMI <18.A proper diet and good nutrition targeted to many solutions to the health and nutritional problems of mankind as shown in the figure.
depending on which nutrients are under or overabundant in the diet. Arthur. and had higher infant mortality rates to start with. have made commendable progress between 1990 and 20063. Bangladesh and Eritrea.6 6. Malnutrition Impaired Child Development Weak education and Health System Weak education and Health System Compromised Immunity Infection Poverty Disease Energy Loss 9 Reduced Productivity . or in the wrong proportions (Dorland's Medical Dictionary and Sullivan.2 2. Steven M. in excess (too high an intake). Malnutrition infection complex are shown in the figure. A number of different nutrition disorders may arise.2 1. which have approximately half and quarter of India¶s per capita GDP. It is the condition that results from taking an unbalanced diet in which certain nutrients are lacking. respectively.6 1.3 on track on track on track Source: Unicef Table1 demonstrates how countries with comparable per capita GDP like the Philippines. 2003). Sheffrin.676 1.Sri Lanka Egypt Indonesia 1.0 6.7 Malnutrition Malnutrition refers to any imbalance in satisfying nutrition requirements. Sri Lanka and Egypt have made better progress towards at reducing child mortality. In fact.869 32 91 91 13 35 34 11 30 30 5. 1.770 1.
An adequate intake of calories does not ensure that the need for micronutrients has been met. S. pregnant and lactating women are nutritionally the most vulnerable group. a World Health Organization Expert Committee on Nutrition in Pregnancy and Lactation wrote. beginning in childhood. Improved policy and programs are needed if India is to reach the nutrition MDG (Millennium Development Goal) target of halving the figures for malnutrition by the year 2015 (from in 1990 to in 2015). The nutritional status of young children is an important indicator of health and development²it is not only a reflection of past health insults but an important indicator of future health trajectories4.e. Being underweight due to wasting (i. Nearly one in every two of India¶s 120 million children is underweight. especially in the developing regions of the world. irondeficiency anaemia.. health and productivity ± perpetuating a vicious cycle of poverty and malnutrition. Almost 50% of pre-school children in rural India are malnourished6. Regrettably. Undernutrition directly affects many aspects of children¶s development. little has changed since then and maternal malnutrition remains a major problem in India and Pakistan. India has a serious problem of child undernutrition. and consists of a continuous cycle of pregnancy and lactation. low weight-for-height. Reduction of child undernutrition is imperative. Malnutrition plays a key role in maternal mortality. U. and yet comparatively little is known of their special nutritional needs´. May 2007. An undernourished child will fail to reach her human potential in her adult years ± in terms of educational attainment. indicating acute weight loss) or stunting (i. retarding physical and cognitive growth and increasing susceptibility to disease. In 1965. since it has enormous consequences for child and adult morbidity mortality. ³Next to young children. and deficiencies of iodine and vitamin A are among the common nutritional deficiencies that affect women in the two countries5. almost double the prevalence in Sub-Saharan Africa. then adolescence. In this two countries the majority of women are in a constant state of nutritional stress. as well as productivity. and continuing through the childbearing period which often commences before growth has ceased. low 10 .. India has one of the highest rates of malnutrition in the world.e. Chronic protein-energy malnutrition. just as in infant and child deaths. PLoS Medicine. Malnutrition and Infection: complex mechanisms and Global Impact.. Kaufmann.. all too often resulting in premature death.Fig: Malnutrition-Infection Complex Source: Schaible.
6 million deaths. are forms of malnutrition. repeated episodes of parasitic or other childhood diseases such as diarrhoea. policy inputs have been skewed towards food-based interventions. it is important to know all about the various kinds of malnutrition diseases that exist and what are the symptoms that they show. these additional health risks present a critical problem. causing nearly 3. death due to post partum haemortag and illness for herself and her baby. has a greater risk on abstracted labour. micronutrient deficiencies. pneumonia. . Approximately 852 million people around the world are unable to obtain enough food to lead healthy and productive lives. Malnutrition among children is often caused by the synergistic effects of inadequate or improper food intake. short stature. having adverse pregnancy outcomes. Thus. measles and malaria. to deal with this worldwide menace. earn an income. other micro-nutrient deficiencies. Since the common assumption is that food insecurity is the major cause of malnutrition. anemia.8 Consequences of Poor nutrition A women with poor nutritional status. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food.height-for-age. and improper care during illness (Pelletier 1994. 1. having a baby with a low birth weight. as well as being overweight. producing lower quality breast milk. So. Poor nutrition can result from either inadequate or excessive levels of nutrient intake and influences the development of chronic disease. or gain an education. as indicated by a low body mass index. 1. indicating chronic restriction of a child¶s nutrition). as it directly or indirectly leads to various deficiency disorders. Undernutrition in children is responsible for an increased risk of illness and death from many infectious diseases. almost completely ignoring the contribution of infection and inappropriate feeding practices. Malnutrition is a condition where there is insufficient or inadequate consumption of basic nutrients required by the body which leads to the manifestation of various diseases and disorders. Ruzicka and Kane 1985) 11  . According to the World Health Organization.9 Reasons for Malnutrition In communities or areas that lack access to safe drinking water. these malnutrition facts speak for themselves. including some attributed to diarrhea. malnutrition is the biggest contributor to child mortality.
Diet and nutrition are important for healthy life. Briend et al. Malnutrition during childhood can also affect growth potential and risk of morbidity and mortality in later years of life. Childhood dietary habits are important. Donohue J. 198914.25 per day. because a food culture once adopted is apparently difficult to reverse (Brunner 1997)17. Malnourished children are more likely to grow into malnourished adults who face heightened risks of disease and death. In other words. In India. immunization against major childhood diseases. and because the growth rate in this period is greater than any other age period. either directly or indirectly. a staggering about 40. undernutrition among young children captures the extent of development in a society and is thus a marker for the overall well being of a population and is well established that socioeconomic 12 . access to health care. good nutrition of the children is an indispensable component of healthy life. Furthermore. 198815). 1992a11. it increases the risk of growth retardation (Danzon M. Chen et al. and health-seeking behavior. Children¶s nutritional status affects their mortality and morbidity pattern. The most commonly cited factors are food availability and dietary intake. breastfeeding. water supply and sanitation. maternal care during pregnancy. their activity level and health status. Children (both pre-scholars and school age) being future citizens form an important segment of the Indian population.74 crore people live below the poverty line. 198010. 1992b12. socioeconomic status. Santhanakrishnan and Ramalingam 198713. It is also a determinant of healthy growth of mind and body (Balgir et al. The growing childhood years are more critical since the curse of under. excess or imbalance of nutrients. Katz et al. overnutrition. 2000)18. Vella et al. (whereas by the World Bank standard of $1. malnutrition refers to both undernutrition and Undernutrition means a deficiency or lack of one or more nutrients and overnutrition means excess of one or more nutrients.nutrition is more pronounced. Children under age three are particularly vulnerable to undernutrition. Both undernutrition and overnutrition result in ill health. 42% of Indians live in poverty) resulting in widespread prevalence of undernutrition. Vella et al. prevalence of infectious and parasitic diseases. vitamin A supplementation.Malnutrition is often cited as an important factor contributing to high morbidity and mortality among children in developing countries (Sommer and Loewenstein19759 . Malnutrition is an impairment of health resulting from a deficiency. 2002)16. A number of factors affect child nutrition.
etc. fretful and voraciously hungry.2 Kwashiorker is one of the most acute protein malnutrition diseases in the world. it is now being said that other factors. It is also said to be protein-calorie malnutrition similar to marasmus. Thus. The person also becomes very susceptible to contracting infectious diseases. 13 . This disease is rampant in African countries and certain other third world countries. that is typically seen in the feet. Children suffering from this condition normally end up developing irritability and anorexia as well.1 Marasmus is a disease that results from severe deficiency of both proteins and calories and is one of the most common malnutrition diseases in children. a person looks emaciated and the body weight of the person maybe lower than 80% of the normal required weight of the person. for example.10.factors such as lower levels of household wealth and maternal education are important causes of childhood undernutrition (UNICEF 1998)19. 2007)20. 1. it is a major risk factor in the onset of active tuberculosis (Schaible UE. In this disease. skin depigmentation. 1. thinning hair which is normally coarse in texture. In this condition. dry and scaly skin. this condition results in overall energy deficiency. the adipose tissue reserves of the person get severely depleted. loss of teeth. The occurrence of this disease is higher in infants below the age of one. especially from the buttocks and thighs. 1.10 List of Malnutrition Diseases Malnutrition increases the risk of infection and infectious disease. like vitamin and mineral deficiency also play a very important role in causing this disease. there is extensive muscle wasting. There might also be edema. and dermatitis. as is seen in marasmus. Furthermore. but what sets it apart from marasmus is the presence of edema. an enlarged liver. The person is also seen to be very irritable. loose skin. Kaufmann SH. which further increases the mortality rate of this disease. Other signs of this disease include a distended abdomen. the person has an increased susceptibility to contracting diseases and even developing diseases after getting vaccinated for that particular disease.10. The treatment of this disease will not only consist of providing the person with all the required nutritional supplements that he is deficient of but will also entail treating dehydration and any other infections that he may be suffering from. Although it was believed for long that this disease was caused by protein deficiency. due to the severe deficiency of various essential nutrients. Once again.
If the swelling is small and is only due to slight iodine insufficiency. like diarrhea. the concentration of sodium in the plasma is less than 135mEq/L. like lethargy. This condition is often seen as a result of a complication of some other serious medical illness. headache. Anemia can be caused due to a variety of reasons. This disorder is typically seen in countries that have deficient iodine in their soil. low metabolic rate. Other symptoms present in goiter will be similar to those seen in hypothyroidism. A diet deficient in iron leads to a type of anemia known as iron deficiency anemia. Deficiency of vitamin B12 leads to a type of anemia known as megaloblastic anemia. the swelling in the neck may be so large.10. Typical symptoms include nausea. confusion. In cases of severe volume depletion.10. Serious symptoms like seizures normally require treatment using hypertonic saline. that it may lead to compression of the windpipe or the larynx. convulsions. Sometimes. increased susceptibility to cold. This kind of anemia is one of the most common malnutrition diseases in the world and is especially rampant in developing countries. there may even be mental clouding. 14 .1. excessive vomiting. then providing iodine supplements can help treat the disorder. vomiting. 1. Goiter treatment will depend on the size and cause of goiter. etc. It leads to various problems like shortness of breath.3 Anemia is one of the most common malnutrition diseases seen the world over. there may be need of intravenous administration of saline.5 Hyponatremia is a condition that is caused due to deficiency of sodium in the blood and diet. etc. depending on the case. polydipsia. etc. weakness. This leads to typical goiter symptoms like swelling of the thyroid gland which is visible as a large swelling in the neck. It is also particularly seen in pregnant women in these regions. if the swelling is large and is causing pressure on the windpipe or larynx. However. which may cause difficulty in breathing and speaking. The treatment for this disease depends on the underlying cause. In this disease. tiredness and fatigue. pallor and other symptoms that point towards a low hemoglobin count. then it is best to do an emergency partial or complete thyroidectomy. 1. This is a serious type of electrolyte disturbance that is normally seen in people who have high levels of antidiuretic hormone. If the symptoms are not treated in time and worsen further. but one of the main reasons for anemia is a diet that is deficient in iron and vitamin B12.10. or in countries where the food supplements available are not iodized. ptosis.4 Goiter is a disease that is mostly caused due to deficiency of iodine in the diet. stupor and the person may even eventually go into coma.
dry and rough skin and hair. Normally. Given below is a list of the various vitamins and what their deficiency leads to: 1. though it is rarely seen in developed countries.6 Hypokalemia is caused due to deficiency of potassium in the diet. difficulty in walking. tetany. then he will need fluid replenishment and treatment with antibiotics as well. inability to derive energy. If the person is also suffering from dehydration or diarrhea. The signs and symptoms this vitamin deficiency includes sore throat with swelling and redness of the mouth. muscle cramps.7.10. One of the most common symptoms causing due to the deficiency of this vitamin is night blindness it can even lead to complete blindness if there is severe depletion in the levels of this vitamin.7.1. The most important approach to treat this disease is to include foods high in potassium in the diet. 1. etc. which leads to symptoms like severe lethargy and fatigue. and poor wound healing.1 Vitamin A Deficiency of it is relatively common in developing countries. This Vitamin can be restored in the body with the help of including foods that are rich in vitamin A in the diet. there needs to be not only insufficient consumption of potassium but also excessive loss of potassium from the body. angular 15 . cheilosis. The treatment of this will involve administration of thiamine in the form of thiamine hydrochloride tablets or injections. The signs and symptoms of this include myalgia. nervous. lack of appetite. 1.2 Vitamin B1 or thiamine is a nutrient that is available in many sources. muscular and gastrointestinal systems. loss of muscle with muscle wasting and eventual complications of the cardiovascular.10. constipation. It is also commonly seen in alcoholics.10. One of the most common symptoms of this vitamin deficiency is the manifestation of beriberi.10. the symptoms to start showing. Thus. It is a nervous system disorder.7 Vitamin Deficiency is also commonly seen in many malnutrition diseases.7.3 Vitamin B2 or Riboflavin deficiency is normally seen in conjunction with proteinenergy malnutrition diseases and is also seen in alcoholics. which are obviously a rarity in malnourished environments. Causing blindness due to vitamin A deficiency among malnourished children can be seen all over the world. slight change in blood pressure. Other symptoms are increased susceptibility to infections. 1. like yeast and pork. it is often seen as a complication of dehydration or diarrhea and malnutrition.10. Serious effects of it include respiratory depression and cardiac arrhythmias.
Table 2: Deficiency and Excess of Nutrients Nutrients Food energy Deficiency Starvation. weakness. It is also a major contributing factor towards the development of osteoporosis in women living in developing countries. Signs of the vitamin deficiency include tingling sensation of tongue. However. 1. Cardiovascular 16 . dementia. it is important to include niacin rich foods in the diet. Cases of pellagra that are left untreated have a high mortality rate.7. The Deficiency and Excess of Nutrients narrated in the table 2. 1. The symptoms of the deficiency of it include impaired bone formation.10. To prevent this from happening. People who have a staple diet of maize also often end up suffering from pellagra. etc. seborrhic dermatitis. shortness of breath. etc. cheese. one of the most important and prominent symptoms of the vitamin is megaloblastic anemia.6 Vitamin C or ascorbic acid is a vitamin that is found in citrus fruits. headaches resembling migraine attacks. etc. mouth sores. dermatitis. yogurt. one needs to have a diet that is high in calcium and foods with vitamin D. insomnia. causing bone softening diseases like osteomalacia.10.10. eggs. alopecia. delayed wound healing. grapefruit. glossitis.stomatitis.10. hence.7.7.7 Vitamin D deficiency normally occurs due to inadequate intake of calcium coupled with inadequate sunlight exposure. lemon.4 Vitamin B3 or niacin deficiency leads to a disease called pellagra. Although an overdose of the vitamin is rare and the deficiency can be seen in developing countries habitually.5 Vitamin B12 deficiency is one of the most common deficiencies seen in the spectrum of vitamin B deficiencies. ataxia. To help prevent this from occurring. etc. white spots on skin. a deficiency of this vitamin is often seen in vegetarians. It often results from alterations of protein metabolism in the body. The deficiency symptoms can be reversed with the help of including foods rich in riboflavin. spots on skin and increased susceptibility to infections. thus. The signs and symptoms of it includes photosensitivity. lime. memory loss. Marasmus Excess Obesity. Deficiency of this vitamin leads to a condition known as scurvy and the symptoms like bleeding gums. This is the type of anemia where the red blood cells are large and immature in nature. diarrhea. etc.7. 1. This vitamin can be obtained by eating fruits like oranges. 1. like meat. as the person can die within four to five years of being diagnosed. It is found only in animal products. diabetes mellitus.
cardiac arrhythmias. Obesity none low sex hormone levels none none Malabsorption of Fat-soluble Obesity Cardiovascular disease Cardiovascular Disease Obesity Fat vitamins. hypothyroidism Xerophthalmia and Night Bleeding. Cancer Cardiovascular disease Rabbit starvation Hypernatremia.disease Simple carbohydrates Complex carbohydrates Saturated fat Trans fat Unsaturated fat none diabetes mellitus. hair loss) Vitamin B1 Vitamin B2 Vitamin B3 (Niacin) Vitamin B12 Beri-Beri Cracking of skin and Corneal Ulceration Pellagra Pernicious anemia dyspepsia. hypothyroidism) Vitamin A Blindness. low testosterone levels Hypervitaminosis A (cirrhosis. hypertension Cirrhosis. birth defects 17 . Hemorrhages Cardiovascular Disease. Rabbit Starvation (If protein intake is high) Cardiovascular Disease (claimed by some) Omega 3 Fats Omega 6 Fats Cholesterol Protein Sodium Iron Iodine Cardiovascular Disease none none kwashiorkor hyponatremia Anemia Goiter. heart disease Iodine Toxicity (goiter.
depression. confusion.1 National Diarrhoeal Diseases Control Programme was launched in 1981 to reduce the mortality in children below five years due to diarrhoeal diseases through introduction of Oral Rehyderation Therapy (ORT). Hypervitaminosis E (anticoagulant: excessive bleeding) Calcium carpopedal spasm.Vitamin C Vitamin D Scurvy Rickets diarrhea causing dehydration Hypervitaminosis D (dehydration. and hypotension Hyperkalemia. anorexia. pancreatitis. vomiting. cardiac arrhythmias Fatigue. The high priority accorded to the Programme is part of the package of services rendered under the MCH programme which was initiated during 1980-85 has now been strengthened extensively. constipation) Vitamin E Vitamin K nervous disorders Haemorrhage Osteoporosis. 18 . Government of India is administering the various programmes/schemes and enacted various legislations on health sector and some of the important are: 1. constipation.11 Health and Nutritional Programmes in India 1.1 Programmes on Health Sector Department of Health and Family Welfare. The Anganwadi Centres of the ICDS Scheme have served as nucleus for the propagation of this programme which has been found to be an effective measure to prevent dehydration. 11. palpitations Magnesium Hypertension Hypokalemia.1. nausea. increased urination Weakness. cardiac arrhythmias Potassium 1. vomiting. 11. nausea. vomiting. impaired breathing. laryngospasm. tetany.
4 Emergency Facilities of State Hospitals located on National Highways for up gradation & strengthening of Emergency Trauma Care Facility in State Government Hospitals located on National Highways under the scheme ³Assistance for Capacity Building´ with a view to provide immediate treatment to the victims of road traffic injury. Kerala. Madhya Pradesh. Cardiovascular Disease and Strokes a pilot scheme has been launched in January. Kancheepruam. Shimoga.1. their dependant family members and certain other categories like members of parliament and ex-members of parliament.2 Cancer Control Programme bridges the geographical gaps in the availability of cancer treatment facilities across the country. A well developing trained manpower at various health care set-ups in Districts/States.11. The early detection of persons with high level of risk of developing disease through opportunistic screening and capacity building of health system at all levels to tackle NCDs and improvement of quality of care. Karnataka. and Thiruvananthapuram. Jabalpur.11. Punjab.11. 1. the scheme has bee extended to cover central government pensioners.6 Central Government Health Scheme (CGHS) is a scheme for providing health care to serving Central Government employees and their dependant family members. The network of trauma care facilities along the corridors will bring down the morbidity and mortality on account of accidental trauma by observing the golden hour concept. Over the years. the programme launched in 1975-76 was revised in 198485 and subsequently in December 2004.11. 2008 with the aim of prevention and control of noncommunicable diseases (NCDs) using health promotion and health education advocacy.1. In view of the magnitude of the problem and the requirement this was initiated.1.5 Prevention and Control of Diabetes. Tamil Nadu.11.1. Under the Pilot project.3 Mental Health Programme was started in 1982 with the objectives to ensure the availability and accessibility of minimum mental health care for all. Health promotion activities were undertaken in 300 schools (30 in each district) and at 15 workplaces (1-2 workplace per district) in all the 10 States. Bhilwara. 1. Jalandhar. Rajasthan. There was a shift in approach of mental health care services from hospital based care to community based mental health care. 19 . At any point of time. Assam. The pilot scheme encompasses 10 States with one District each namely. Kamrup.1. 1.1. it is estimated that there are nearly 25 lakh cancer cases and about 4 lakh deaths occurs every year in this country. 1. to encourage mental health knowledge and skills and also to promote community participation in mental health service development and stimulate self-help in the community.
1. 1. Rashtriya Arogya Nidhi. 1. Kala-azar. Yoga Centres (4).11.11. Filaria. as per approved pattern.50. Tobacco Control Program and School Health Programs. Delhi provides technical assistance. Hospital as these patients cannot be considered for financial assistance under Rashtriya Arogya Nidhi due to income of above poverty line. beneficiaries enjoy medical facilities in around 400 private empanelled hospitals and around 170 diagnostic centres. Prevention and Control of Fluorosis. The beneficiaries are being provided health service through a huge network of: Dispensaries (247 Allopathic.9 Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was approved by Government of India in March. 1. In addition. Dental Units (21) and Gynae±maternity Hospital (1). Dengue and Chikungunya which is covered under the overall umbrella of NRHM. It has two components in its first phase .1. policies and assistance to the States in the form of cash & commodity. National Program for Prevention and Control of Deafness.35 lakhs with 32 lakh beneficiaries as on 31.1. Polyclinics (19). Laboratories (66). TB Control Programme (RNTCP).8 National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of vector borne diseases namely Malaria.per annum. Japanese Encephalitis (JE).. National Filaria Control Program.1. 2006 with the objective of correcting regional imbalance in the availability of affordable and reliable tertiary healthcare services and also to augment facilities for quality medical education in the country. Leprosy Eradication Programme (NLEP). National AIDS Control Program.2 Rural Health Services 20 .3.1.000/.11.10 Other Health Programmes are Prevention and Control of Deafness. Programme for Control of Blindness (NPCB). all over the country.11.7 Health Minister¶s Discretionary Grant is a Financial Assistance to the poor and indigent patients is given from the Health Minister¶s Discretionary Grant to defray a part the expenditure on hospitalization/treatment in Govt. but less than Rs. The membership of this scheme stood at 9.freedom fighters etc.(i) setting up of six AIIMS-like institutions and (ii) upgradation of 13 existing Government medical college institutions. Iodine Dificiency Disorders Control Programme. 82 Ayush).11. 1.2009. The States are responsible for implementation of programme whereas the Directorate of NVBDCP.
promotive and Family Welfare services. It is manned by a Medical Officer and 14 other staff. 458 PHCs functioning in the country. It acts as a referral Unit for 6 Sub-Centres and has 4-6 beds for patients. primary health care services are provided through a network of 146036 Sub-Centres.2.2 Primary Health Centre (PHC) is the first contact point between village community and the Medical Officer. family welfare. Gynecologist and Pediatrician supported by 21 paramedical and other staff. There are 23.11.11. 1. These centers facilitated with basic drugs for minor ailments needed for taking care for essential health need for women and children. 23458 Primary Health Centres and 4276 Community Health Centres as on March 2008 based on the following norms of population case load/work load and distance. At present 4276 CHCs are functioning in the country. It provides facilities for emergency obstaetrics care and specialist consultations.2. In rural areas. It performs curative. The population norms for SC/PHC/CHC are as follows: 1. These are being strengthened under NRHM to provide a package of essential public health programmes and support for outreach services to ensure regular supplies of essential drugs and equipment. It is manned by one Female (ANM) and one Male Health Worker and one LHV for six such Sub-Centres.1 Sub-Centre is the first peripheral contact point between Primary Health Care system and the community.11.4 Mobile Medical Units/Health Camps initiated with the objective to take health care to the door step of the public in the rural areas. these.The health and family welfare programme in the country is being implemented through primary health care system. especially in under-served areas.2.3 Community Health Centre (CHC) is established and maintained by the State Governments and as per standards it is supposed to be manned by four Medical specialists i.e. Surgeon. Indian Public Health Standards lays down that this CHC is to be manned by 6 Medical Specialists including Anaesthetics and an eye surgeon (for 5 CHCs) supported by 24 paramedical and other staff with inclusion of two nurse midwives in the present system of seven nurse midwives.2. diarrhea control and control of communicable diseases. 1. nutrition. and Labour room and Laboratory facilities and serves as a referral centre for 4 PHCs. provision of 3 Staff Nurses in a phased manner. These are assigned task relating to maternal health child health. X-ray. preventive. 1. have been 21 . Physician. round the clock services in all PHCs across the country. upgrading single doctor PHC to 2 doctors PHC by posting AYUSH practitioners at PHC level. immunization.11. It has 30 in-door beds with one OT.
ECG and ultrasound are proposed to be provided in MMUs. Skilled Attendance at Birth. the Accredited Social Health Activist (ASHA) as an effective link between the Government and the poor pregnant women. 1500 per delivery to the Government 22 . It is a 100 % centrally sponsored scheme and it integrates the benefits with delivery and post delivery care. It launched on 12th April 2005. Himachal Pradesh and J&K. The other major interventions are provision of Safe Abortion Services and services for RTIs and STIs. skilled attendance at every birth. for the North. and Referral Services at both Community and Institutional level. 1. These interventions are Essential Obstetric Care.11. one per district under NRHM. Quality Ante Natal care. emergency obstetric care for those having complications and referral services. one with diagnostic facility for the States other than North-East States. up to Rs. Besides the maternal care. Post natal care for mother and newborn. 1.11. In addition. Under the NRHM and the RCH Programme.1 Schemes for Improving Obstetric Care Services initiatives are under implementation to achieve the goal of reduction in Maternal Mortality. Two kinds of MMUs are envisaged. specialized facilities and services such as X-ray. Himachal Pradesh and J&K. The Yojana subsidizes the cost of Caesarean Section or for the management of Obstetric complications.11. the Government of India is actively pursuing the goals of reduction in Maternal Mortality by focusing on the 4 major strategies of essential obstetric and new born care for all. The National Population Policy 2000 and National Health Policy 2002 have set the goal of reducing MMR to less than 100 per 100000 live births by the year 2010. is being implemented in all states and UTs. Here the main role is to facilitate pregnant women to avail Services of maternal care and arrange referral transport. This programme has identified. the scheme provides cash assistance to all eligible mothers for delivery care.3. Prophylaxis and treatment of Nutritional Anemia.provided.2 Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of promoting institutional delivery among the poor pregnant women.3 Maternal Health Programmes The promotion of maternal and child health has been one of the most important objectives of the Family Welfare Programme in India. 1.Eastern States.3. Provision of Emergency Obstetric and Neonatal Care at FRUs.
where Government specialists are not in position. In keeping with the results of this study the control programme was initiated. 23 .11. 500 per delivery. The basis of the programme was a study conducted in the mid-fifties in the Kangra Valley. 1. which is still high. Infant and young child feeding.11. preferring to deliver at home is entitled to cash assistance of Rs. supply iodized salt in place of ordinary common salt in goitre endemic areas and assess the impact of the programme over a period of time.3. and Home Based New Born Care. by the Scientists of All India Institute of Medical Sciences. focus has been on reducing the commonest cause of mortality among the under fives in the country. Some important child health programme are Navjaat Shishu Suraksha Karyakram (NSSK). This programme is now called the Iodine Prophylaxis Programme. The study showed that the prevalence of goitre comes down considerably when the common salt supply to the population is replaced by iodized salt. Sick New Born Care (SNCU). and subsequent inclusion of maternal and child health. The Infant Mortality Rate has declined from 134 per thousand live births in 1947-50 to 53 per thousand live births in 2008. Facility Based Integrated Management of Neonatal and Childhood Illness (F.11.4 1odine Prophylaxis Programme was initiated by realizing the serious health and social implications of the problem of iodine deficiency disorders Government of India launched a National Goitre Control Nutrient Deficiency Control Programmes Programme (NGCP) in 1962.3. 1. All BPL pregnant women aged 19 years and above. up to two live births. Nutrition Rehabilitation Centres (NRCs). Integrated Management of Neonatal and Childhood Illness.Institutions. 1. There is hence a firm commitment for the reduction of the MMR. 3 Village Health and Nutrition Day (VHNDs) Organizing at Anganwadi centre at least once every month to provide ante natal and post partum care for pregnant women. School Health Programme. IMR and the TFR under the National Rural Health Mission (NRHM). promote institutional delivery and health education apart from other various services. The main objectives of the control programme are to identify goitre endemic regions.4 Child Health Programmes Since the inception of the family planning Programme in 1951.IMNCI).
1. UIP become a part of Child Survival and Safe Motherhood Programme in 1992. without access to safe drinking water. Tetanus.4. of proteins to pre-school children and about 500 calories and 20 gm.1 Special Nutrition Programme was launched in the country in 1970-71.12 Nutritional Programmes 1. It provides supplementary feeding to the extent of about 300 calories and 10 gm. The nutrition component of the ICDS programme is funded by States and Union 24 .4. particularly among young children by promoting the use of oral rehydration solution (ORS) to prevent dehydration and by educating mothers in this regard. Measles and severe form of Childhood Tuberculosis. 1.11.e. This gained momentum in 1985 as Universal Immunization Programme (UIP) and implemented in phased manner to cover all districts in the country by 1989-90.2 Universal Immunization Programme was introduced in 1978 as Expanded Programme of Immunization. Diphtheria. Under the Universal Immunization Programme Government of India is providing vaccination to prevent six vaccine preventable diseases i. in particular suffer from repeated episodes of diarrhoea.3 Pulse Polio Immunization was initiated in the pursuance of the World Heath Assembly resolution of 1988.1. Diarrhoea is a serious health problem in our country. immunization activities have been an important component of National Reproductive and Child Health Programme. Pertussis. At present SNP is operated. of protein to expectant and nursing mothers for 300 days a year. 1. Children exposed to poor environmental sanitation and hygiene. Since. From 1999-2000 house to house vaccination of missed children was also introduced to vaccinate children missed during the fixed booth based vaccination of children. this Programme was started nation-wide from 1995 to eradicate polio in India covering children in the age group 0-3 years.4. afflicting millions of young children every year. 1997.12. Immunization is one of the key areas under National Rural Health Mission (NRHM) launched in 2005.11. it may even lead to the child's death. If immediate remedial measures are not taken. all children under the age of 5 years were targeted since 1996-97.1 Scheme of Oral Rehydration Therapy¶s main objectives of the scheme of oral rehydration therapy is to reduce the incidence of death due to dehydration from diarrhoea diseases. In order to accelerate the pace of polio eradication. Polio.11. as a part of the Minimum Needs Programme in the various states.
of p' Aein per child per day for 270 days a year.12.Territories from the SNP budget. from vitamin A deficiency by giving them large doses of vitamin A on periodic basis. between 6 months and 5 years of age. 1. and preschool children by giving them iron and folic acid tablets. At present about 21. particularly pregnant and lactating women. triangular spots on the white part of the eye. 2002-03 and 2003-04 in 51 identified 25 . During 1991-92. It is especially affects women in the reproductive age and young children.12. haziness and other changes such as dry.5 million beneficiaries are covered under this programme. An estimated 5 to 7 per cent children in our country suffer from eye problems resulting from vitamin A deficiency. if the condition is untreated. The Central grant is given for. Night blindness and other mild deficiency symptoms in the eye.6 Nutritional Programme for Adolescent Girls (NPGA) was launched by the Planning Commission initially for a period of two years i. This is directly or indirectly responsible for about one fifth of maternal deaths and is a major cause of premature births and low birth weight babies.2 Balwadi Nutrition Programme is being implemented since 1970-71 through five national level voluntary organisations. This programme aims at significantly decreasing the prevalence and incidence of anaemia in women in the reproductive age group. 1. about 0.12. It is estimated that more than 50 per cent of pregnant women in our country are anaemic. However. Nutritional anaemia is a widely prevalent problem in our country. for instance lack of luster. The availability and production of iodized salt and strengthening of administrative machinery controlling the entry of noniodized salt in the endemic regions have been recommended as measpres to improve the implementaion of the programme.5 National Prophylaxis Programme for Prevention of Nutritional Blindness aims at protecting children. foamy. A person suffering from anaemia feels weak and has a low capacity to work. supplemerltary feeding of children.12. 1.12. the cornea in the eye gets severely damaged and blindness results which condition cannot be reversed.23 million children in the age group 3-5 years in 5640 balwadis were covered by the scheme.4 National Nutritional Anaemia Control Programme results from deficiency of iron and folic acid in the body. 1.3 Goitre Control Programme was initiated by the GoI in 1962 to identify goiter endemic regions and to assess the impact of goitre control measures. can be cured with vitamin A therapy. It consists of 300 calories and 10 gm. 1.e.
This scheme was restarted in 2005-06. it offers non-formal pre-school education to children in the 3-6 age group. 1. immunisation.11 0.12.10 Central Rural Sanitation Programme was launched in 1986 with an objective of improving the quality of the life of rural people and provides privacy and dignity to women. and referral services to children below six years of age as well as expecting and nursing mothers.12. The major objectives of the scheme are to increase the number of institutional deliveries and to ensure the quality of services.22 0.e.00 1.41 0.62 2.48 0.08 0.63 1.21 0. 1. The components of the programme households below the poverty line conversion of the dry latrines 26 . child mortality and morbidity. The Project cost USD 2232 millions include funding from Work Bank and non-bank sources.40 2.40 0.16 0.11.29 0.03 0. in two of the backward districts in each of the major states and most populous disctrict (excluding the capital district) in remaining smaller states/UTS in the country. The Department of Food and Public Distribution provides food grains at BPL rates to the States/UT Government for implementing the programme through M/o Human Resources as shown in the table 3.07 1.12. and health and nutrition education to women in the 15-45 age groups.05 0. Additionally.disctricts i.51 0. lower fertility and the rate of population growth through expanding the use of essential RCH services.48 0.8 Integrated Child Development Services (ICDS) scheme integrates several aspects of early childhood development and provides supplementary nutrition.01 0.63 Source: 1.68 0. 1. The Ministry of Women and Child Development administers the scheme at the central level and State/UT Governments implement the scheme.9 Ayusmati Scheme the goal of this scheme is to reduce the incidence of Maternal Mortality and Morbidity.7 Reproductive and Child Health Second Phase project for India will help reduce maternal mortality. health checkups.35 0.12 0. Table3: Food Grains distributed for the programme (lakh tone) Year 2002-03 2003-04 2004-05 2005-06 2006-07 0.22 Allocation Off take Rice Wheat Total Rice Wheat Total 0.
Children who have low BAZ are described as being µwasted¶. Low WAZ may reflect wasting or stunting. WORLD BANK etc. compares BMI of child with the BMI of children of the same age. It addresses the double burden of nutrition-related ill-health and building on add interconnecting on-going school-based programmes being implemented by various partner agencies like UNESCO. It signifies poor environmental conditions. and Weight-for-Age Z-scores (WAZ).11 Nutrition Friendly Schools Initiative (NFSI) the main aim is to provide a framework for designing integrated school based intervention programmes. Height-for-Age Z-scores (HAZ).¶ It is a good indicator for chronic undernutrition as it does not vary according to short term factors. y Low weight-for-age (WAZ) indicates the child is underweight. y Body Mass Index (BMI) is used to compare weight to height ratio of different individuals. This programme was funded by USAID. 27 . These indices allow comparison between children of different ages. construction of village sanitary complexes for women. WHO. safe infant feeding communities affected by HIV. and the lactation.13. BMI is calculated by dividing the weight in kilograms by the height in meters squared. 1. 1. Z scores are in reference to The WHO Child Growth Standards (2011) median values as follows BAZ <-2 SD indicates wasting. 1. such as illness. Wasting is also sometimes called global undernutrition or global acute malnutrition (GAM).12 Infant and Young Child Feeding Project (IYCF) the major objectives of the programme are to create knowledge on Breastfeeding. better maternal nutrition. y BMI±for-Age Z score (BAZ). intensive campaign for awareness creation and health education etc.13 World Health Organisation Child Growth Standards (2011) 1. y Low Height-for-Age Z score (HAZ) indicates µstunting. This general property makes WAZ a good indicator for nutritional status (Onis & Blössner.to water pour flush toilets. 2003)20.12. setting up of sanitary marts.12. Timely and appropriate complementary child feeding.1 Anthropometric Indices y For children the anthropometric indices were: Body mass index for Age Z-scores (BAZ).
HAZ <-2 SD indicates stunting HAZ <-3 SD indicates severe stunting WAZ <-2 SD indicates undernutrition. However different populations have different body proportion which means the same BMI of people in different nations may have different nutritional status (WHO Global Database). BMI indicates an adult¶s health status. be required to set up a Rogi Kalyan Samittee (RKS)/Hospital Management Committee) which will bring in community control into the management of public hospitals.16. CHCs.. Subdivisional/ Sub-district Hospitals and District Hospitals not only for personal and physical infrastructure.. PHCs. Each Hospital would. For women body mass index (BMI) was used.5-22. but also for delivery of services and management. BMI<16.14 Indian Public Health Standards (IPHS): Indian Public Health Standards (IPHS).00 (kg/m2) Moderate thinness. BMI was calculated by dividing the weight in kilograms by the height in meters squared.9 (kg/m2) Overweight.1995). These standards are lain down in sub-centers.18.BAZ <-3 SD indicates severe wasting. BMI>23 (kg/m2) The WHO international cut-offs are the same with the exception of the cut-off for overweight being >25 (kg/m2) 1.00 . as all children grow similarly when their health needs are met. 28 . WAZ <-3 SD indicates severe undernutrition.49 (kg/m2) Healthy weight. Also any difference in growth between ethnicities is minor compared to the effect of environment. The WHO growth reference is based on an international group of children. For adults BMI values are age-independent and the same for both sexes.. BMI = 18. BMI = 17.99 (kg/m2) Mild thinness. which detail the specifications of standards so that the citizen is confident of getting public health services in the hospital.00 . BMI classifications for Asian adults are as follows: Severe thinness. (Physical Status. BMI = 16. This is appropriate as a comparison group. as part of IPHS.
2 Reducing Infant Morbidity & Mortality y 1. Expansion in emergency delivery services. y y Strengthening Integrated Management Child hood Illness (IMCI) system. Efforts will be made to provide atleast one medical facility available for 24 hours within 15-20 km radius.15.3 Reducing Maternal Mortality Ratio y MMR to be brought down to atleast 148 per one lac of live births by the end of the XIth five year plan.15. Reduction in Infant Mortality Rate atleast to 32/1000 by the end of XIth five year plan.15 Goals and Strategies for Eleventh Five Year Plan 1. Mission mode approach to combat malnutrition among children under 3 years in tribal areas to be introduced. y Expansion of Management of Child Malnutrition Scheme throughout the State including establishment of Malnutrition Treatment Centres (MTCs) in district hospitals. Improvement in antenatal services to cover all pregnant women.15. Complete immunization coverage to be increased to 90% of children. Anemia in women to be reduced to 24. y Training component for management malnutrition to be strengthened.1 Reducing Malnutrition y Virtual elimination of acute severe malnutrition and reduction in malnutrition among children under 3 years of age up to at least 25. Complete feeding of infants aged 6-9 months to be increased to at least 80%. Iron and Folic Acid supplementation to pregnant women. 29 .1. y y y y y y Promotion of institutional deliveries. Malnutrition in children upto 5 years is to be brought down to atleast 30% by 2011. Empowering families for child care and development.3% by the end of XIth five year plan. y Exclusive breast-feeding to be increased to 75%.3% by the end of the XIth five year plan. 1. y y IYCF practices to be given priority for promotion of feeding best practices.
y The services of graduate/post-graduates of home science colleges to be utilized in creating awareness regarding food security and nutrition.g. y Regular inspections and quality checks to ensure clean and healthy foods for the customers at each and every eating place. y y Kishori Shakti Yojana to be strengthened. y Programme on the lines of National Nutrition Mission for providing food grain to adolescent girls upto 18 years weighing less then 35 k. Participation of NGOs could be promoted. y Civil Supplies Corporation recommended to be set up. y y y Mid-Day-Meal programme for girls to be extended upto 10th class. Specific scheme for non-school going girls in 6 to 11 years of age to be formulated and implemented. School health check up programme to be initiated and expanded to all the schools including educational institutions for girls. A system of demonstration in proper cooking methods including counseling on nutritional requirements to be developed for creating awareness. y y y Food and nutrition security and safety policy be developed and implemented. Adolescent girls clubs to be formed and supported. y y Supply chain under TPDS to be improved to ensure availability of food stock at FPSs. Special food and nutrition cell on the lines of Food & Nutrition Board to be setup. y Food and Nutrition visitors proposed to be appointed. 30 . 1.15. Department of Food & Civil Supplies to be strengthened in terms of manpower and mobility.15. needs to be promoted throughout the state.4 Goals and Strategies for Adolescent Girls in Eleventh Five Year Plan y Issues concerning adolescent girls will be addressed keeping in mind the life cycle approach.1.5 Goals and Strategies for Nutrition in Eleventh Five Year Plan y Separate department for food security and nutrition to focus on food security in an integrated manner is recommended.
2000 presented to the former Prime Minister of Inida.y y Strict enforcement of Food Adulteration Act is to be ensured. 1. Justice CR Krishna Iyer. The day was observed as the millennium's first children's day. it emphasized safe motherhood and child survival as well as the need for the provision of health care for school-going children through the school health program. development and protection of all children.1 Constitutional provisions Various ministries of the government of India have developed policies related to Health and Nutrition.4 Decade of the Girl Child. The plan of Action is to ensure survival.3 National Plan of Action for Children (Planning Commission of India).16.).1. protection and development of the girl child with the ultimate objective of building up a better future for the girl child. so that each child can realize his or her inherent potential and grow up to be a healthy and productive citizen. 1992 commits itself to ensure all rights to all children upto the age of 18 years. 1. 1991±2000 Department of Women and Child Development has formulated a National Plan of Action for the SAARC Decade of the Girl Child (1991-2000 A. While the policy did not mention adolescence specifically.16.1 The Children¶s Code Bill.1.16. Assessment of poverty levels need to be assessed regularly for appropriate management of supplies. 1983 (the draft National Health Policy 2000 is in the process of finalization) aimed at attaining health for all through primary health care. whereas others have done so implicitly. growth.16.16.1. Sufficient stock of food grain and other essential commodities to be maintained at strategic points particularly in areas frequently facing drought situation.1.16 Health and Nutritional Policies and Legislations 1. Important relevant policies and plans that have been developed in India include: 1. 1. y y Grain Banks could be set up through women SHGs. Chairperson of the National Expert Group on Child Rights. 1. 31 . Some of the policies deal explicitly with adolescent health and development issues.2 National Health Policy.D. The Government shall ensure all measures and an enabling environment for survival. Shri Atal Behari Vajpayee at a high level meeting attended by Union Ministers and Child Rights experts on November 14 by Mr.
1974 initiative was identified in this Policy. 1997 & 2000 have developed by Indian states for themselves. 1987 scheme was started in 1988 to rehabilitate child labour. including adolescent boys and girls. Where applicable. food supplements and nutrition services are available.16. In many states. Under the Scheme. which recognized the right to education for all segments of the population and made elementary education for all children compulsory.16. It also emphasized that reproductive health services for adolescent girls and boys are especially needed in rural areas.8 National Youth Policy.1. where adolescent marriage and pregnancy are most prevalent.1. counseling.16. 1. however. several legislative provisions have also been introduced that directly or indirectly protect the rights of adolescents. particularly girl children.1. population education. It aims at ensuring that adolescents¶ need for information. The Scheme seeks to adopt a sequential approach with focus on rehabilitation of children working in hazardous occupations & processes in the first instance. including the need for protection from unwanted pregnancies and STIs. after a survey of child labour engaged in hazardous occupations & processes has been conducted. especially among adolescent girls. 1. 1. Recognizing that the needs of adolescents.5 National Policy on Child Labor.1. Apart from various policies. have not been specifically addressed in the past. 1986 and Draft New National Youth Policy.1. these have included concerns about adolescent health and development. the education of girls is free until the graduate and postgraduate levels.16. The Ministry is significantly involved with the issues of nutrition and development of children. The major thrust to adolescent health. The programs have been developed and implemented to universalize education and reduce school dropouts. and contraceptive services are accessible and affordable. children are to be withdrawn from these occupations & processes and then put into special schools in order to enable them to be mainstreamed into formal schooling system. and the legislation on restraint of child marriage is enforced.7 National Education Policy. was given in the Policy. 2000 placed adolescent health as a subsection under the health sector. This Policy underscored adolescent health as a strategic focus in achieving socio-demographic goals. Adolescent health is the domain of the Ministry of Health and Family Welfare and the Departments of Health and Family Welfare of the states. 32 .6 National Population Policy. Youth empowerment and gender justice were recognized as the major thrust areas of the policy.
and the Shrivastav Committee of 1975 (Government of India. MMR of 200 by 2000 etc. It focuses on the need for enhanced funding and organizational restructuring of the public health initiatives at national level in order to facilitate more equitable access to the health facilities.1.11 National Health Policy 2002 and NRHM 2005 The second major policy endeavor is National Health Policy 2002 (NHP 2002) and it closely followed on the heels of the National Population Policy 2000 ( NPP 2000). Emphasis has been given to increase the aggregate public health investment through a substantially increased contribution by the Central Government. 1983.16. was the first attempt to synthesise recommendations of three important earlier committees. as was in Alma Ata declaration. µThe enjoyment of the highest attainable standard of health is one of the fundamental Rights of every human being without distinction of race. All targets were set to be achieved by 2000. 1. political belief.16. and by upgrading the infrastructure in the existing institutions. 1976) and the Alma Ata declaration of global demand of Health for All by 2000. 1. 1962).1. An acceptable standard of good health amongst the general population of the country is sought to be achieved by increasing access to the decentralized public health system by establishing new infrastructure in deficient areas. IMR of 60 by 2000. the Bhore Committee of 1946 (Government of India. economic or social condition¶ None of the health impact goals set in NHP 1983 were achieved by 2000. Both policies grew in the context of liberalization and globalization.9 National Health Policy-2002 (NHP-2002) The National Health Policy-2002 (NHP-2002) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. the Mudaliar Committee of 1962 (Government of India. It also reiterated the resolution of taking health services to the doorstep of the people and ensuring fuller cooperation of the community.10 National Health Policy -1983 The NHP. The concept of Health for All and Health is a Fundamental Human Right that was the corner stone of the Soviet Health Policy was given a go 33 .16. religion. The policy outlines the need for improvement in the health status of the people as one of the major thrust areas in the social sector. It was largely dictated by global slogans and the field realities in India. 1975. it failed to even declare health care as a fundamental right of the people and quieted the WHO preamble of 1948 that states.1. Priority would be given to preventive and curative initiatives at the primary health level through increased sectoral share of allocation.1. 1946).
This is done through the Prevention of Food Adulteration (PFA) Act 1954 and the PFA Rules 1955 made there under. a new law encompassing the domains of various food related laws in the country has been enacted to revamp the food safety requirements in keeping with modern day needs as well as the international trend towards modernization. After the collapse of the Soviet Union the health programs were also gradually privatized. and by upgrading the infrastructure in the existing institutions. The new law aims to ensure safe. to manufacture and supply safe. The Food Safety and Standards Authority of India has been established to implement the provisions / mandate of this new law.16. However ambitious health goals were set in NHP 2002.1. The Act also provides for compensation to the victim or the legal representative to be paid by vendor /manufacturer. storage. The implementation strategy involves setting up Inter Sectoral Coordination mechanism at Centre.bye. advocated a mult i-sectoral strategy for eradicating malnutrition and achieving optimum nutrition for all. 2006. It bestows responsibility on the Food manufacturers. The National Health Policy-2002 (NHP-2002) gives prime importance to ensure a more equitable access to health services across the social and geographical expanse of the country. Ministry of Health and Family Welfare is responsible for ensuring safe food to the consumers. An acceptable standard of good health amongst the general population of the country is sought to be achieved by increasing access to the decentralized public health system by establishing new infrastructure in deficient areas. distribution.12 The National Nutrition Policy The National Nutrition Policy adopted by the Government of India in 1993 under the aegis of the Depart ment of Women and Child Development. State and District levels. traders etc. 1. hygienic and wholesome food for the citizens of the country. The policy outlines the need for improvement in the health status of the people as one of the major thrust areas in the social sector. in case of injury or death of consumer by adulterated / injurious food article. Emphasis has been given to increase the aggregate public health investment through a substantially increased contribution by the Central Government. sale and import to ensure the availability of safe and wholesome food for human consumption. hygienic and wholesome food. The Food Safety & Standards Act. NHP 2002 was followed by a massive National Rural Health Mission launched by the Prime Minister in 2005. Advocacy and sensitisation of policy makers and programme 34 . for laying down science based standards for articles of foods and to regulate their manufacture.
to ensure simultaneous action on a wide range of determinants of health like water. intensifying micronutrient malnutrition control activities. To expand the Nutrition intervention net through ICDS so as to cover all vulnerable children in the age group 0 to 6 years. reaching nutrition information to people.16. the difficult areas with unsatisfactory health indicators were classified as special focus States to ensure greatest attention where needed. (2) Improved Management Capacity (3) Flexible Financing (4) Innovations in human resources development for the health sector. nutrition.13 National Rural Health Mission (NRHM) launched in 2005. 1. education.D. and (5) Setting of standards and norms with monitoring. y At least 100 days of employment created for each rural landless family. for that. and developing district-wise disaggregated data on nutrit ion. The Objectives of the Policy are: y To reduce the incidence of severe (8. sanitation. community owned. y y y Distribution of iodized salt to cover all endemic areas. Nutritional blindness to be completely eradicated by 2000 A. The mission is shifting the focus to a functional health system at all levels. to achieve production targets of 230 MT by 2000. The architectural correction envisaged under NRHM is organized around five pillars. Development of State Plans of Acton on Nutrition by respective States was also an important mandate. y To increase per capita availability of 215Kg. from the village to the district. employment opportunities in urban slum dwellers and urban poor. These five fillers are: (1) Increasing Participation and Ownership by the Community.D.8 per cent) malnutrition by half by the year 2000 A. each of which is made up of a number of overlapping core strategies. social and gender equality. District and Communit y level. 1.D. decentralized health delivery system with inter-sectoral convergence at all levels. establishing nutrit ion monitoring and mapping at State.7 per cent) and moderate (43. in all CD blocks of the country and 50% of urban slums.17 National Health Legislative Acts 35 . y All adolescent girls from poor families to be covered through the ICDS by 2000 A.managers. The thrust of the Mission is on establishing a fully functional.1.
1964. 1993 and 2001) The Children Act 1960 The Maternity Benefit Act 1961 The Atomic Energy Act 1962 The Registration of Birth and Death Act 1969 The Medical Termination of Pregnancy (MTP) Act 1971 (Rules 1975) The Water (Prevention and Control Pollution) Act 1974 The Air (Prevention and Control Pollution ) Act 1981 The Dangerous Machines (Regulation) Act 1983 The Narcotic Drugs and Psychotropic Substance Act 1983 Juvenile Justice Act 1986 The Child Labor (Prohibition and Regulation) Act 1986 36 . 1976.Besides constitutional provisions. some other legislative acts have been promulgated to safeguard the health and some of the National Health Legislative Acts are: y y y y y y y y y y y y y y Workmen¶s Compensation Act 1912 The Child Marriage Restraint Act 1929 The Red Cross Society Act (Allocation of Property) 1936 The Drugs and Cosmetic Acts 1940 The Indian Nursing Council Act 1947 The Dentist Act 1948 The Pharmacy Act 1948 The Drugs (Control) Act 1948 The Minimum Wages Act 1948 The Factors Act 1948 The Employees State Insurance (ESI) Act 1948 The Plantation Labor Act 1951 The Mines Act 1952 The Prevention of Food Adulteration Act 1954 (Amended 1956. 1971. 1986) y y y y y y y y y y y y y The Indian Air Craft (Public Health) Rules 1954 The Indian Medical Council Act 1956 (Amended 1964.
school teachers. promote health and provide basic health care. etc. 1. 1956 The Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act of 1994.y y y y y y y y The Environment (Protection) Act 1986 The Consumer Protection Act (CPA) 1986 The Epidemic Diseases Act 1987 The Mental Heath Act 1987 The Rehabilitation Council of India Act 1992 The Transplantation of Human Organs Act 1994 The Pre-natal Diagnostic Techniques (Regulation and prevention of misuse) Act 1994 The Persons with Disabilities (Equal Opportunity. a primary health center ( PHC-one for one lakh population) and a secondary center .18.1 Sir John Bhorewas Committee ± 1943 for the first time a committee headed by Sir John Bhorewas appointed to study the existing health conditions and make recommendations to prevent communicable diseases. It gave some pragmatic directions recommending population based national net work of maternity sub-centers (SC-one for 20. Protection of Rights and Full Participation) Act 1995 y y y y The National Environmental Tribunal Act 1995 The Biomedical Waste (Management and Handling) Rules 1998 Immoral Traffic (Prevention) Act.18.2 The Mudaliar Committee ± 1962 gave its report in 1962 concentrated on medical education and development of training infrastructure for static medical units. The committee concentrated on preventive medicine and tried to link health with social justice.000 population). the major recommendations therein still form the basis of the Indian public health system. also called the referral center ( SHC-one for each taluka or teshil) and a specialized hospital with teaching facilities at the district level.3 The Shrivastav Committee ± 1975 gave its report in 1975 urged the training of a cadre of health assistants to serve as links between qualified medical practitioners and multipurpose workers (e.19 Institutional mechanism for Health and Nutrition 37 . 1. post masters.g. gram-sevaks.18.18 Committees on Health and Nutrition 1. 1.). It submitted its report in 1946. 1.
1. and To periodically evaluate the ongoing national nutrition programmes to identify their strengths and weaknesses and to recommend appropriate corrective measures.2 Food and Nutrition Board as reconstituted on 26 July 1990. the survey is done only once in 5 years. advises Government. with the Central Reference Laboratory at the National Institute of Nutrition (NIN). coordinates and reviews the activities in regard to food and nutrition extension/education. the data may provide excellent insights into changing dietary patterns in India. if coupled with the NNMB survey. 1. development. This information is used to calculate poverty levels based on expenditure on calories. 1992-93. measures required to combat deficiency diseases.19.19. II &III) provides valid state level estimates of under nutrition and comparable state level estimates at two time points i. 1. production & popularization of nutritious Foods and Beverages. It carries out surveys under the guidance of a Steering Committee and has been generating dynamic database on diet and nutritional status of the communities regularly. on a continuous basis. data on dietary pattern and nutritional status adopting standardized and uniform procedures and techniques. The disadvantages are that this does not provide information on dietary consumption at the family and individual level and does not assess nutritional status.4 National Sample Survey Organization (NSSO) Conducts every five years the information on expenditure on food at family level is collected on a statistically adequate and representative sample all over the country.1 National Nutrition Monitoring Bureau (NNMB) was established under the aegis of Indian Council of Medical Research in the year 1972. on representative segments of population in each of the States. 1998. NFHS (I.e. It is dedicated to disseminate the results of the latest research in nutrition ± basic and applied aspects.19. and 'Conservation and efficient utilization as well as augmentation of food resources by way of food preservation . Hyderabad established in 1967 is an association of nutrition professionals.19. programmers and policy makers from India and abroad. The NSI. However.and processing.3 National Family Health Survey (NFHS) has undertaken height and weight measurement in a representative sample of children and women at state level. 1.19. Hyderabad. through its annual meetings provides a 38 .5 The Nutrition Society of India (NSI). since inception and it has the following objectives: To collect.99 and 2005-06. 1. analyse the current status of nutrition programmes in the country and recommend appropriate strategies to promote nutrition of the community at large.
v.20 Trends in Policy Development Although the National Health Policy (NHP) in India was not framed until 1983. Home Based Care of Newborns Universal Immunization Early detection and appropriate management of Acute Respiratory Infections. and Consultative Committees attached to the Ministry of Health and Family Welfare. Mudaliar. and y Federation of Asian Societies of Nutrition 1. i. 73 rdand 74th Constitutional Amendments in 1992. affordable and accountable quality health services to the poorest households in the remotest rural regions.forum for young scientists to present their research findings. viii. iii.6 National Rural Health Mission (NRHM) was launched on 12th April 2005. to provide accessible. National Nutrition Policy in 1993. It is the recognized Indian representative of y International Union Nutritional Sciences (IUNS). ix. the Central Council of Health and Family Welfare. Navjaat Shishu Suraksha Karyakram Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and Pre-Service IMNCI iv. Infant and young child feeding including promotion of breast feeding Management of children with malnutrition Vitamin A supplementation and Iron and Folic Acid supplementation School Health Programme. vi. India has built up a vast health infrastructure and initiated several national health programmes over last five decades in government.19. The period after 1983 witnessed several major developments in the polices impacting the health sector . through the adhering body. Kartar Singh. 39 . Diarrhoea and other infections vii. 1. Indian National Science Academy (INSA). Srivastava). Establishment of New Born Care facilities and Facility Based Integrated Management of Neonatal and Childhood Illnesses (F-IMNCI) ii. the Planning Commission. the Constitution. voluntary and private sectors under the guidance and direction of various committees (Bore.adoption of National Health Policy in 1983.
the provision of essential drugs and vaccines. except the ones (such as TB. Decentralising the implementation of health programmes to local self governing bodies by 2005. y y Promoting public health discipline. Increase allocation of public health investment in the order of 55 percent for the primary health sector. y Setting up of Medical Grants Commission for funding new Government Medical and Dental colleges. the active involvement and participation of voluntary organisations. It stressed the creation of an infrastructure for primary healthcare. y Increase in Government funded health research to a level of 2 percent of the total health spending by 2010. The major policy prescriptions are as follows: y y Increase public expenditure from 0. Drug Policy in 2002. introduction of Universal Health Insurance schemes for the poor in 2003.Primary Health Centre for a population of one lakh and Government General Hospital. qualitative improvement in health and family planning services.9 percent to 2 percent by 2010. 35 percent and 10 percent to secondary and tertiary sectors respectively. y Gradual convergence of all health programmes. and medical research aimed at the common health problems of the people.National Health Policy in 2002. drinking water supply and sanitation). 40 . which need to be continued till moderate levels of prevalence are reached. y Need to levy user charges for certain secondary and tertiary public health services. Malaria. for those who can afford to pay. HIV/AIDS. and inclusion of health in Common Minimum Programme of the UPA Government in 2004. 2002 is to achieve an acceptable standard of good health among the general population of the country and has set goals to be achieved by the year 2015. RCH). The first National Health Policy in 1983 aimed to achieve the goal of `Health for All' by 2000 AD.National Policy on Indian System of Medicine and Homeopathy in 2002. through the provision of comprehensive primary healthcare services. close co-ordination with health-related services and activities (like nutrition. The main objective of the revised National Health Policy. Establishing two-tier urban healthcare system . y y Mandatory two year rural posting before awarding the graduate medical degree. the provision of adequate training.
the local bodies (Municipalities and Panchayat) have been assigned 29 development activities. The Common Minimum Programme announced by the UPA government in 2004 has proposed to raise public spending on health to at least 2-3 percent of the Gross Domestic Product (GDP) over the next five years.y Appreciation of the role of private sector in health. family welfare. 41 . PHCs and dispensaries). The present Government has proposed to take all steps to ensure availability of life saving drugs at reasonable prices through revival of Public Sector Units in the manufacture of critical bulk drugs. These include health and sanitation (covering hospitals. drinking water. Promotion of tele medicine in tertiary healthcare sector. Through the 73 rdand 74th Constitutional Amendment Acts (1992). women and child development. Encouragement and promotion of Indian System of Medicine. Encouraging setting up of private insurance instruments to bring secondary and tertiary sectors into its purview. which have a direct and indirect bearing on health.21 Health Expenditure The amount allocated during five year plans in India for health and family welfare and total investment can be seen in the table 4. and enactment of legislation by 2003 for regulating private clinical establishments. the public distribution system and poverty alleviation programmes. Co-option of NGOs in national disease control programmes. The budget 2004-05 has proposed three major initiatives in the health sector. They are: (i) redesigning the Universal Health Insurance scheme introduced in 2003 to make it exclusive for below poverty level people with a reduced premium (ii) introduction of Group Health Insurance scheme for members of Self Help Groups and Credit Link Groups at a premium of Rs 120 per person for an insurance cover of Rs 10000. Full operationalisation of National Disease Surveillance Network by 2005. y y y y y y Formulation of procedures for accreditation of public and private health facilities. and (iii) exemption of income tax for the hospitals working in rural areas. Notification of contemporary code of medical ethics by Medical Council of India. with focus on primary healthcare. y y Promotion of medical services for overseas users. 1.
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