Government Initiatives in

Health and Nutrition

Vinod Paul
MD, PhD, FAMS, FNASc, FASc, FNA
Member, NITI Aayog
NATIONAL INSTITUTION FOR TRANSFORMING INDIA
2
 Key issues in childhood undernutrition

WASTED STUNTED
(Thin) (Short)
Normal height
60%
2005-05 2015-16
50%
48%

40%
38%

30%
20% 21%
20%

10%

NORMAL 0%

Stunting Wasting
Undernutrition trend by age
Childhood
6 months to 18 mo crucial
undernutrition
1. ~20% due to
small size at
Stunted birth;

2. ~25% due to
diarrhea and
Wasted
other
infections;
and

3. Rest ~55%
due to
suboptimal
feeding
 Challenge of optimum complementary feeding for children 6-24

100 40
Adequate diet 2006 Adequate diet 2016 Change
90
30
80

20
70

Percentage change
Percentage %

60
10

50
0
40

30 -10

20
-20
10

0 -30

Source: NFHS-3; NFHS-4

Adequate diet = child 6-24 fed either breastmilk/source of dairy; and age-appropriate number of food groups and age-appropriate number of meals per day
NFHS-3 indicator calculation by IFPRI; NFHS-4 indicator as reported in fact sheets.
Courtesy Avula
 Childhood
‘Biology’ of undernutrition undernutrition
1. ~20% due to
Diarrhea / pneumonia
Suboptimal BF small size at
Poor care of low Suboptimal feeding birth;
birth weight babies
2. ~25% due to
diarrhoea
maternal nutrition / health

N and other
Genetics, epigenetics,

infections;
Small
and

Undernourished 3. Rest ~55%

due to
suboptimal
Pregnancy
1 2 3 4 5 6 7 8 9 10 11 12 feeding
Age in moths
 First 2 years of life are the key
• Undernutrition occurs in
the first and the second
year
• Period of rapid brain
growth and maturation:
80% by 2 years
• Linear growth failure in
this period is associated
with adult short stature
• Less schooling
• Low productivity, income
• Lower offspring
But ICDS services in this period have low birthweight (females)
focus: a design flaw
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 Package of Interventions
WASH Safe water, hand washing, safe disposal of feces
Iron-folic acid; Vitamin A; Deworming

SWACHH* Care of the malnourished child

Supplementary nutrition Recipe reformulation

Growth monitoring Address moderate malnutrition

ICDS*

Feeding counseling Breast feeding

Complementary feeding

Management of Severe Acute Malnutrition

Beti Bachao, beti padhao;Adolescent

Immunization Strengthen, and Expand Antigens

HEALTH*

Facility Early detection and treatment of diarrhea and pneumonia

Based New Community, Integrated Management of Neonatal and Childhood Illnesses
Born Care
Pre-pregnancy care

Antenatal Care

Home Home-based Young Child Care

Birth spacing
*predominant

Based
Institutiona
l Deliveries
role

New Born
Not to
Care scale

Pre-pregnancy Pregnancy Birth 6 weeks 6 months 1 year 2 years

8
NNM | Objectives
Prevent & Reduce Stunting in Children (0-6 years) @2% per annum

Prevent & Reduce Under-Nutrition (Underweight Prevalence) in

Children (0-6 years) @2% per annum

Reduce Low Birth Weight (LBW) @2% per annum

Reduce Prevalence of Anaemia amongst Young Children (06-59

months) @3% per annum

Reduce Prevalence of Anaemia amongst Women and Adolescent Girls

(15-49 years) @3% per annum
4 Point Strategy
I. Convergence
[Inter-sectoral convergence for better service delivery]

II. Use of Technology (ICT)

[Real time growth monitoring and tracking of women and children; programme monitoring through
Dashboards]

III. Intensified Health & Nutrition Services for first 1000 days
[Immunization in High burden Districts- Rotavirus & Pneumococcal, Extended Home Based Care of
Infants from 06-24 months ; IYCF promotion]

IV. Mission as ‘Jan Andolan’

[Involving field workers, community and PRIs; strengthening VHSND]
 Poshan Abhiyan

Total funding: Rs.9046.17 crore

Pan India Coverage in a Phased Manner

1st Phase: 315 districts (including 201 districts

identified by NITI) in 2017-18

Mission as ‘Jan Andolan’

 Home based infant care
Packaging Evidence Based interventions

Growth Monitoring Platform using structured

home visits done by Outcome
Breast Feeding
ASHAs up to 1 year of
Complementary feeding age.
Prophylactic ORS Reduction Of
ECD
Diarrhoea And
Pneumonia and
IFA Supplementation Better Nutrition
Status
Immunization Home Visit
Hand Washing Schedule :
5 visits by ASHA-
Beginning of 4, 6,8,10
Care Seeking in Sickness and 12 months
Investing in Health for a New
Ayushman Bharat
India
For New India @ 2022

13
Comprehensive Primary Health Care

PHC

Prevention
Ambulatory and Health
care and
Wellness
Promotion

Primarily the responsibility of the government

Disease prevented, detected early
Care close to home, affordable, accessible
Better Health outcomes at lower costs
Masses benefitted, huge enabler of human development
Convergent Platform for Health, Nutrition, Wellness, Sanitation :
Swasth Bharat
 Ayushman Bharat

Transforming
Primary Health Care System

For a people-centric health system of India

India
‘15% of all health PHC

priorities’:
Prevention
MNCH/FP/some and
Ambulatory Health
national programs care and
Wellness
Promotion

Primarily the responsibility of the government

Disease prevented, detected early

Care close to home, affordable, accessible “…… 80-90% of the federal
budget on health care
Better Health outcomes at lower costs
investment goes towards
Masses benefitted, huge enabler of human development Primary Care System in UK,
Convergent Platform for Health, Nutrition, Wellness, Sanitation : Australia, Canada,
Swasth Bharat Netherland, Sweden …….”
 The big picture

TERTIARY

SECONDARY

PRIMARY Unmet
need
Existing
services
Untrained providers, faith healers
 New Vision For Primary Health Care
• Health and Wellness
Centres: Team (1:5000)
 1 Bridge Course
Trained Mid-level
provider (Nurse
Practitioner/
Ayurveda Practitioner)
 2 Multi-purpose
workers: M/F
 5 ASHAs
• PHCs: Doctor led team
• FRU: At CHC/SDH/ DH
MPLADS/MGNREGA/Philanthropy/CSR
 Screening and early
detection of NCDs
 Package of 12 essential
services
HWC
HWC
 Integrate AYUSH, Yoga,
Diet Modification,
HWC PHC
HWC Lifestyle Change
 Monthly Dispensing of
Drugs
HWC
HWC  Point of Care Diagnostics
 IT system to enable
continuum of care
Leverage support from
Voluntarism
 People – centric
Health & Wellness
hub

HWC

India @ 75 features
Sugam access, Modular, Net-zero-energy, Solar energy powered, Rain harvesting, Low
maintenance, Local architecture , Adaptable, Inspirational Design, Disaster & earthquake proof,
Flood resistant, Swachh, Telemedicine enabled Courtesy School of Planning & Architecture, Delhi
 Robust IT
Continuum System
of Care – Expanded
Referral Service
Pathways Delivery

Drugs/
HWC Infra/ Point-Of-
Branding Care
Comprehensive Diagnostics
Primary Health
Care
(12 packages) Expanding
Financing/P HR, Multi-
rovider skilling/
Payment Capacity
Reforms Building

Partnership Community
with NGOs Mobilisation
Knowledge and Health
and private
Management Promotion
sector
/Knowledge
Translation
National Health Protection
Mission (NHPM)
Health Assurance for New India @ 2022

21
 82% persons have no health protection

RSBY
Private

State CGHS

schemes
Railways

Army

SCHIS
ESI

State Govt
employees
 Current Status – State Schemes
Approx Population
Name of the State Cover provided Type of Conditions covered
Covered
Mostly tertiary and very few
Andhra Pradesh Rs. 2.5 lakh secondary 80% of the State
Mostly tertiary and very few
Tamil Nadu Rs. 1.5 lakh secondary 60% of the State
Rs. 1.5 lakh + Rs. 2.5 lakh for Mostly tertiary and very few
Maharashtra Kidney transplant secondary 60% of the State
Secondary till 30,000 and
Rajasthan Rs. 30,000 + Rs. 3 lakh tertiary for 3 lakh 50% of the State
Secondary till 30,000 and
Himachal Pradesh Rs. 30,000 + Rs. 1.75 lakh tertiary for 1.75 lakh 50% of the State
Secondary till 30,000 and
Gujarat Rs. 30,000 + Rs. 2 lakh tertiary for 2 lakh 40% of the State

States implementing schemes with cover from Rs. 30,000 to Rs. 3 lakh
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It is time to include the Non-poor
• 6-7 crore persons fall into Well off*

poverty each year due to

medical expenses Non-poor

Poor
(and economically weak)

A Health Protection Scheme focused only on the poor

is not good enough for New India
 National Health Protection Scheme (NHPS)

Targeted to cover over 10 crore poor and vulnerable families

Provide a cover of 5 lakh per family

Service through both public and private hospitals

Cashless benefits available across India

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Primary care and financial protection –
pillars of universal health coverage

TERTIARY
National HPS
SECONDARY

Referral

• Capitation
PRIMARY
• Gate-keeping
Comprehensive Primary
Health Care System

Ensures continuum of care

Please support
National Medical Commission
Bill 2018
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 HOUSEHOLD DEPRIVATIONS (RURAL)
Standard Deprivation Parameter HHs (Lakhs)
Only one room with kucha walls and kucha roof (D1) 238
No adult member between age 16 to 59 (D2) 65.33
Female headed HHs with no adult male member between age 16 to 59 (D3) 69.43
Disabled member and no able bodied adult member (D4) 7.20
SC/ST households (D5) 387
No literate adult above 25 years (D6) 422
Landless HHs deriving major part of income from manual casual labour (D7) 540
Total deprived Households (with any one of the 7 deprivation) 873
Automatic inclusion : 15.95 Lakhs Households
Sub-classification of HHs by main source of Income (Urban):
No Worker Category Households

1 Rag picker 23,825

2 Beggar 47,371

3 Domestic worker 6,85,352

4 Street vendor/ Cobbler/hawker / Other 8,64,659

5 Construction worker/ Plumber/ Mason/ Painter/ Welder/ Other 1,02,35,435

6 Sweeper/ Sanitation worker / Mali 6,06,446

7 Home-based worker/ Artisan/ Handicrafts worker / Tailor 27,58,194

8 Transport worker/ Driver/ Conductor/ Helper / Rickshaw puller 27,73,310

9 Shop worker/ Assistant/ Peon / Attendant/ Waiter 36,93,042

10 Electrician/ Mechanic/ Assembler/ Repair worker 11,99,262