NATIONAL HEALTH

PROGRAMMES FOR
CHILDREN IN INDIA
HOW TO ACHIEVE HEALTH
By improving host resistance to
environmental hazards
By improving environmental safety
By improving health systems
designed to increase the likelihood,
efficiency & effectiveness of the first
two goals
 PROGRAMMES FOR
COMMUNICABLE DISEASES

1. National Vector Borne Diseases Control

Programme (NVBDCP)
2. Revised National Tuberculosis Control
Programme
3. National Leprosy Eradication Programme
4. National AIDS Control Programme
5. Universal Immunization Programme
6. National Guinea worm Eradication
Programme
7. Yaws Control Programme
8. Integrated Disease Surveillance Programme
PROGRAMMES FOR
NON COMMUNICABLE
DISEASES
1. National Cancer Control Program
2. National Mental Health Program
3. National Diabetes Control Program
4. National Program for Control and
treatment of Occupational Diseases
5. National Program for Control of Blindness
6. National program for control of diabetes,
cardiovascular disease and stroke
7. National program for prevention and
control of deafness
NATIONAL NUTRITIONAL
PROGRAMS
Integrated Child Development Services
Scheme
Midday Meal Programme
Special Nutrition Programme (SNP)
National Nutritional Anemia
Prophylaxis Programme
National Iodine Deficiency Disorders
Control Programme
PROGRAMS RELATED TO SYSTEM
STRENGTHENING /WELFARE

1. National Rural Health Mission

2. Reproductive and Child Health
Programme
3. National Water supply & Sanitation
Programme
4. 20 Points Programme
NATIONAL HEALTH POLICIES
National Health Policy 2002
National Population Policy 2000

National AIDS control and Prevention Policy

National Blood Policy

National Policy for empowerment of Women

2001
National Charter for Children

National Youth Policy 2001998

National Nutrition Policy

Various national health programs are currently in
operation for the improvement of child health and
prevention of childhood diseases. The brief lists
of these programms are:
Reproductive and Child Health Program.
Universal Immunization Program

Integrated Child Development Services Scheme

School Health Program

Nutritional Program
 THE REPRODUCTIVE AND CHILD
HEALTH (RCH) PROGRAMME
It was launched in October 1997. The main aim of the
programme is to reduce infant, child and maternal
mortality rates.
The main objectives of the programme in its first phase
were:
To improve the implementation and management of
policy by using a participatory planning approach and
strengthening institutions to maximum utilization of the
project resources
To improve quality, coverage and effectiveness of existing

Family Welfare services

 To gradually expand the scope and coverage of the
Family Welfare services to eventually come to a
defined package of essential RCH services.
Progressively expand the scope and content of
existing FW services to include more elements of a
defined package of essential
Give importance to disadvantaged areas of
districts or cities by increasing the quality and
infrastructure of Family Welfare services
RCH-I had a number of successful and unsuccessful
outcomes. Base line statistics were recorded in 1998-99
and compared to 2002-03.
Percentage of women receiving any ANC rose by about

12 % to reach 77.2%. But use of government health

facilities has declined.
Use of contraceptives increased by 3.3 % to 52.0 %,

while family planning due to spacing method rose by

3.3% to 10.7 %. Use of permanent methods did not
change.
Infant mortality came down from 71to 63 but the aim

of universal immunization was far from reach. Polio

though reduced has not met the eradication target.
Not enough attention was paid to awareness of

diarrhoea management and Acute Respiratory

Infection danger signs hence resulting in a rise of case
incidents.
The child health programmes is now its second
phase: RCH-II.
Following are the aims of the programme:
Expand services to the entire sector of Family
Welfare beyond RCH scope
Holding States accountable by involving them in
the development of the programme
Decentralization for better services

Allowing states to adjust and improve

programmes features according to their direct
needs.
 Improving monitoring and evaluation processes at the
District, state and the Central level to ensure improved
program implementation.
Give performance based funding, by rewarding good
performers and supporting weak performers.
Pool together financial support from external sources

Encourage coordination and convergence, within and

outside the sector to maximize use resources as well as
infra structural facilities
The recommended package of services:
For the mothers:
Tetanus Toxoid Immunization

Prevention and treatment of anaemia

Antenatal care and early identification of maternal

complications
Deliveries by trained personnel

Promotion of institutional deliveries

Management of obstetric emergencies

Birth spacing
For the children:
Essential newborn care

Exclusive breast feeding and weaning

Immunization

Appropriate management of diarrhoea

Appropriate management of ARI

Vitamin A prophylaxis

Treatment of Anemia

For eligible couple:

Prevention of pregnancy

Safe abortion

Prevention and treatment of reproductive tract

infection (RTI) and sexually transmitted diseases
(STD).
Women of reproductive age must receive:
Counselling on
Importance of care of girl child

Optimal timing & spacing of birth

Small family norms

Use and choice of contraceptives

Prevention of RTI / STI

Information on Availability of
MTP Services

IUD & sterilization services

Family Planning Services

Condom distribution

Oral contraceptives

IUD
UNIVERSAL IMMUNIZATION
PROGRAMME

Sponsored by Central Government

Funding Pattern-It is a Centrally sponsored
scheme, so the total funding is managed by the
Central Government.
Ministry/Department- Department of Health &
Family Welfare Department
Description-Universal immunization programme,
UIP, was launched in 1985 in a phased manner.
Immunization is one of the most cost effective
interventions for disease prevention. Traditionally,
the major thrust of immunization services has been
the reduction of infant and child mortality.
 Immunisaton is an important vehicle for health
promotion and therefore is a true national investment.
As per NFHS 3 data, full immunization coverage in
Odisha was 52 percent and no immunization was 9
percent.
Evaluated coverage by UNICEF in the last 3 years
indicates that there is a decline in coverage of all
antigens. Proportion of districts achieving 80 percent of
DPT3 coverage has also decreased.
As per NHFS 3, full immunization has increased to 51.8
percent of children from 12 to 23 months and sustained
efforts can increase it further.
Districts will provide equitable, efficient and safe
immunization services to all infants and pregnant
women.
The aim is to achieve 100 percentages of full
immunization status by 2009 to 2010 and to
maintain it for long.

The objectives of the mission are:

I. Contribute to global eradication of Polio by 2007.
II. Elimination of Neonatal Tetanus, Diphtheria and
Pertussis by 2009.
III. Establish sufficient sustainable and accountable fund
flow at all levels.
IV. Ensure that there is sustained demand and reduced
social barriers to access immunization services.
The strategies of the programme are:
I. Reducing drop outs rate and missed opportunities.
II. Strengthen institutional training at all levels.
III. Strengthen coordination and review meeting at all
levels.
IV. Strengthening micro planning processes in all
districts and urban areas.
V. Strengthening coordination with national operational
guidelines, supervision practices and prioritizing
poorly performing districts and under served
populations.
VI. Reaching the under served by influencing behavior at
household level through BCC.
 INTEGRATED CHILD
DEVELOPMENT SERVICES
(ICDS)
ICDS being implemented by Ministry of Women and
Child Development is the worlds largest programme
aimed at enhancing the health, nutrition and learning
opportunities of infants, young children (O-6 years)
and their mothers.
It is the foremost symbol of Indias commitment to its
children Indias response to the challenge of
providing pre school education on one hand and
breaking the vicious cycle of malnutrition, mortality
and morbidity o the other.
The Scheme provides an integrated approach for
converging basic services through community based
workers and helpers.
The services are provided at a centre called the
Anganwadi, which literally means a courtyard play
centre, a childcare centre located within the village
itself.
The package of services provided are:
Supplementary nutrition,

Immunization,

Health check-up

Referral services,

Pre-school non-formal education and

Nutrition and health education

 It is a centrally sponsored scheme implemented
through the State Governments with 100% financial
assistance from the Central Government for all inputs
other than supplementary nutrition which the States were
to provide from their own resources.
However, from the year 2005-06, the Government
of India has decided to provide Central assistance to
States for supplementary nutrition also to the extent of
50% of the actual expenditure incurred by States or 50% of
the cost norms, whichever is less.
 SCHOOL HEALTH
PROGRAM
School Health program is a program for school health
service under National Rural Health Mission, which has
been necessitated and launched in fulfilling the vision of
NRHM to provide effective health care to population
throughout the country.
It also focuses on effective integration of health concerns
through decentralized management at district with
determinant of health like sanitation, hygiene, nutrition,
safe drinking water, gender and social concern.
The School Health Programme intends to cover 12,88,750
Government and private aided schools covering around 22
Crore students all over India
 The School health programme is the only public sector
programme specifically focused on school age children.
Its main focus is to address the health needs of children,
both physical and mental, and in addition, it provides for
nutrition interventions, yoga facilities and counseling.
It responds to an increased need, increases the efficacy of
other investments in child development, ensures good
current and future health, better educational outcomes
and improves social equity and all the services are
provided for in a cost effective manner.
 COMPONENTS OF SCHOOL HEALTH PROGRAM:

1. Screening, health care

and referral:

Screening of general health, assessment of

Anaemia/Nutritional status, visual acuity, hearing
problems, dental check up, common skin conditions,
Heart defects, physical disabilities, learning disorders,
behavior problems, etc.
Basic medicine kit will be provided to take care of

common ailments prevalent among young school going

children.
Referral Cards for priority services at District / Sub-

District hospitals.
2. Immunisation:
As per national schedule

Fixed day activity

Coupled with education about the issue

3. Micronutrient (Vitamin A & IFA) management:

Weekly supervised distribution of Iron-Folate tablets coupled
with education about the issue
Administration of Vitamin-A in needy cases.

4. De-worming:
As per national guidelines

Biannually supervised schedule

Siblings of students also to be covered

5. Health Promoting Schools:
Counseling services

Regular practice of Yoga, Physical education, health

education
Peer leaders as health educators.

Adolescent health education-existing in few places

Linkages with the out of school children

Health clubs, Health cabinets

First Aid room/corners or clinics.

6. Capacity building
7. Monitoring & Evaluation
8. Mid Day Meal
NUTRITIONA
L
PROGRAMME
S
INTRODUCTION

The various nutritional programmes are in operation

in India since 1st five year plan period.
International agencies such as WHO, UNICEF, FAO,
CARE are assisting the Govt. in these programmes of
India to improve nutrition of the people with special
emphasis on mother & children.
FUNCTIONS FALL IN 3 CATEGORIES
Toeradicate major causes of
malnutrition.
-Increase food production
-Provide safe drinking water
-improve environmental sanitation
-control of communicable diseases
-nutritional education to the masses
-promoting kitchen garden
CONT.
Aspects specially related to
women and children
-to improve the employment
opportunities for women
-provision of better health care
to parents & children
-promoting breast feeding
-weaning at right time
CONT.
Special
reference to
pregnant & lactating
mothers
-to raise nutritional status through nutritional
education
-promoting small handicrafts scheme through
self employment
 NATIONAL PROGRAMMES ON
NUTRITION
Vitamin-A Prophylaxis Program.
Prophylaxis against nutritional anemia.

Control of iodine deficiency disorders.

Applied nutritional program.

Special nutrition program.

Balwadi nutrition program.

Midday meal program.

Integrated child development services scheme.

VITAMIN-A PROPHYLAXIS
PROGRAMME
Launched by Ministry of Health and Family Welfare
in 1970.
On the basis of technology developed at NIN this
was launched.
Component- control of Blindness

Beneficiary group preschool children 200,000 IU

of oily preparation of Vitamin A (retinol palmitate
110mg) administered orally every 6 months for
every preschool child above 1 year.
CONT.
Age of the child Quantity of vitamin A
administered

At 9th month 1,00,000 IU

15th - 16th months Mega dose of 2,00,000 IU

18 - 24 months 2,00,000 IU

24 - 30 months 2,00,000 IU
 1 IU is equivalent to 0.3 microgram of retinol.
Vitamin A deficiency increases the severity of
mortality from measles and diarrhea.
Increased infectious morbidity and mortality is
apparent even before the appearance of
xerophthalmia
Improving the vitamin A status of deficient
children aged 6 months to 6 years can
dramatically reduce their morbidity and
mortality from infection
 CONT.
Prompt administration of large doses of vitamin
A to children with moderate to severe measles,
particularly if they may be vitamin A deficient,
can reduce individual mortality by 50% and
prevent or moderate the severity of
complications.
PROPHYLAXIS AGAINST
NUTRITIONAL ANAEMIA
CONT
The programme was launched in 1970 to prevent
nutritional anemia in mothers and children.
the expected and nursing mothers as well as
acceptors of family planning are given one tablet
of iron and folic acid containing 60 mg
elementary iron which was raised to 100 mg
elementary iron, however folic acid content
remained same (0.5 mg of folic acid).
CONT...
Children in the age group of 1-5 years are given
one tablet of iron containing 20 mg elementary
iron (60 mg of ferrous sulphate and 0.1 mg of folic
acid) daily for a period of 100 days.
This programme is being taken up by Maternal
and Child Health (MCH) Division of Ministry of
Health and Family Welfare.
CONT.
Now it is part of RCH programme.
National programmes to control and prevent

anemia have not been successful.

Experiences from other countries in controlling

moderately-severe anemia guide to adopt long

term measures i.e. fortification of food items like
milk, cereal, sugar, salt with iron.
Nutrition education to improve dietary intakes in
family for receiving needed macro/micro
nutrients as protein, iron and vitamins like folic
acid, B,C, etc. for hemoglobin synthesis is
important.
CONT.
Nutritional Anemia Control Programme should be
comprehensive and incorporate nutrition education
through school health and ICDs infrastructure to
promote regular intake of iron/ folic acid-rich foods, to
promote intake of food which helps in absorption of
iron and folic acid and adequate intake of food.
The technology for the control of anemia through iron
fortification of common salt has also been developed at
the NIN, Hyderabad.
CONTROL OF IODINE DEFIECIENCY
DISORDERS
CONT.
The government of India, launched the National
Goiter control programme (NGCP) in 1962.
It aimed at replacement of ordinary salt by
iodised salt, particularly in the goiter endemic
regions.
The program of universal iodisation of edible salt
was started from first April 1986 in phases with
the aim of total salt iodisation by 1992.
CONT
IN 1992, the NGCP was renamed as national
iodine deficiency disorder control programme.
The central government provides case grants for
health education and publicity campaign for
promoting the consumption of Iodised salt.
The central government also provides cash
grants for establishing IDD control cells in the
state health directorates.
CONT
A national reference laboratory monitoring of
IDD has been set up at the bio-chemistry division
of the national institute of communicable disease,
Delhi.
It monitors the Iodine content of salt in urine
CONT.
The medical and paramedical personnel
monitoring laboratories have been established at
the district level also in many districts in
allocation of Rs.75,000/- district laboratory has
been provided for this purpose.
SPECIAL NUTRITION
PROGRAMME
SNP
The programme was launched in the country in 1970-
71 for the benefit of children below 6 years of age,
pregnant and nursing mothers.
Originally launched as a central programme and was

transferred to the state sector in fifth Five year plan as

part of the Minimum Needs Programme.
AIM-

To improve the nutritional status of the target

groups.
CONT
OBJECTIVES:
To improve the nutritional status of women, pre-

school children, pregnant women and lactating

women in urban, slums, tribal areas and drought
prove rural areas
The main activities of the program are:

-To provide supplementary nutrition

-To provide health services, including supply
of vitamin-A solution and iron and folic acid
CONT..
It provides supplementary feeding of about 300
calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of
protein to expect at and nursing mothers for six
days a week.
This programme was operated under Minimum
Need Programme.
The programme was taken up in rural areas
inhibited predominantly by lower socio-economic
groups in tribal and urban slums.
CONT..
Fund for nutrition component of ICD programme
is taken from the SNP budget.
This supplement is provided for 300 days in a
year.
BALWADI NUTRITION PROGRAMME

This programme which was started in

December 1970.
It is under the overall charge of the
Department of Social Welfare.
It is being promoted with the help of four
national-level voluntary organisations,
namely, the Indian Council for Child Welfare,
Harijan Sewak Sangh, Bharatiya Adamjati
Sewak Sangh and Central Social Welfare
Board.
Beneficiary group 3 to 6 years.
CONT..
Visualizeson the provision of
supplementary nutrition to the extent of
300 calories and 15 grams of protein
during 250 days in a year for children
attending Balwadis.
ICDS PROGRAMME
Started in 1975 in pursuance of the National
Policy for children.
Strong nutritional component in this programme
is in the form of
-Supplementary nutrition
-Vitamin A prophylaxis
-Iron and folic acid distribution
CONT.
Beneficiary group:
children below 6 years

adolescent girls

elderly pregnant and lactating women

Services:
Supplementary nutrition,

immunization

Health checkups,

medical referral services,

nutrition and health education to women

non formal education.

CONT
Service Delivery :
Anganwadi Workers
Each Anganwadi unit covers a population of
about 1000.
A network of Mahila Mandals has been built up
in ICDS Project areas to help Anganwadi workers
in providing health and nutrition services.
CONT
The work of Anganwadis is supervised by
Mukhyasevikas.
Field supervision is done by the Child
Development Project Officer(CDPO).
APPLIED NUTRITION PROGRAMME
The ANP was first introduced in 1960 in Orissa
and Andhra Pradesh.
It was extended there after to Tamilnadu in
1961 and Uttar Pradesh in 1962, during 1973, it
was extended to all the states.
Specific objectives:
To make people conscious of their nutritional
needs
To increase production of nutrition foods and
their consumption
CONT.
To provide supplementary nutrition to vulnerable
groups through locally produced foods.

Components:
-Production of protective foods
-Training of functionaries involved in production of
these foods
-Nutrition education and demonstration
CONT.
Specific activities:
Supplementary feeding
Non-formal preschool education

Nutrition education

Poultry forming

Providing better seeds and seedling

Raising kitchen gardens

CONT
Beneficiaries:
Children between 2-6 years, pregnant and lactating
mothers.
The children and women are given supplementary
nutrition's worth
25paise / day / child , 50paise / women/day
respectively.
A single supplementary meals is given weekly for 25
days/year.
 APPLIED
NUTRITION
PROGRAMME
CONT..
Evaluation:
Studiesshow that ANP has not generated
and desired awareness for production and
consumption to protective food, the
community kitchens and school gardens could
not function properly. In reality the program
lacked effective supervision and has almost
become defunct.
MID-DAY MEAL
PROGRAMME
Also known as School Lunch Programme.
CONT..
1storganised in 1957 in TamilNadu.
In operation since 1961 throughout
the country.
AIM: 1/3rd of the required food per
day for the child be furnished
through this programme.
CONT.
OBJECTIVE:

- To improve the nutritional status of

children and imparting nutritional education.
- To ensure universal primary education.
- To attract more children for admission to
schools and retain them to improve literacy
rate
CONT
The feeding programme is the joint venture of
the health and educational department with
aid from UNICEF, CARE, and other agencies.
Skimmed milk, banana, rice meals etc. are
provided.
Cost is fixed as 12 paise per child.
CONT......
Princilples:
supplement, not substitute
1/3 total energy and total protein
low cost
easily prepared
locally available food
change menu frequently
Mid day meal
programme
CONT......
Itis further planned to introduce
development of vegetable gardens in schools.
Adding subject on nutrition in the
curriculum to motivate the young minds on
the concepts of nutrition for better health.
There are 70 million children who benefit
through this programme in India every year.
ROLE OF NURSE
Have to study the food habits
of people, their views etc.
Needs to impart the

knowledge of importance of
good nutrition without hurting
their cultural habits.
Needs to demonstrate

simple recipes which are

affordable and locally available.
CONT
Needs to use all media of health education.
Needs to identify the malnourished children
and refer them appropriately to the nutrition
programme.
Assists in nutrition rehabilitation programme.

Takes part in research activities.

THANK
YOU......