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
• 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
Reproductive & Child
Health
(RCH) Programme
 Miles stone In MCH Care
•1880 – Establishment of Training of Dais in Amritstar
•1902 ‐ 1st Midwifery Act to Promote Safe Delivery
•1930 ‐ Setting Up Of Advisory Committee on Maternal Mortality.
•1946 ‐ Bhore Committee Recommendation on Comprehensive & Integrated
Health Care
•1952 – Primary Health Center Net Work & Family Planning Programme
•1956 – MCH Centers Become Integral Part Of PHCS
•1961 ‐ Department Of Family Planning Created
•1971 – MTP Act
•1974 – Family Planning Services Incorporated In MCH Care
•1977 – Renaming Family Planning To Family Welfare
•1978 – Expanded Programme on Immunization
•1985 – Universal Immunization Programme
•1992 – Child Survival& Safe Motherhood Programme
•1997 – RCH Programme Phase‐1 (15.10. 1997)
•2005 – RCH Programme Phase‐2 (01‐04‐2005)
 RCH Phase‐I
Aim
• To bring down the birth rate below 21 per 1000
population,
• To reduce the infant mortality rate below 60 per
1000 live birth and
• Tobring down the maternal mortality
rate
<400/1,00,000lakh.
 RCH Phase‐II
• To bring about outcomes as envisioned in the Millennium
Development Goals, the National Population Policy 2000 (NPP
2000), the Tenth Plan, the National Health Policy 2002 and
Vision 2020 India,

• Minimizing the regional variations in the areas of RCH and

population stabilization through an integrated, focused,
participatory programme meeting the unmet needs of the
target population, and provision of assured, equitable,
responsive quality services.
Vertical Programmes Integrated Service Delivery

Camp Oriented Client

Oriented
Target Oriented Goal Oriented

Quantity Oriented Quality Oriented

 OBJECTIVES OF RCH PHASE‐II
1. Reduction of Maternal Morbidity and Mortality

2. Reduction of Infant Morbidity and Mortality

3. Reduction of Under 5 Morbidity and Mortality

4. Promotion of Adolescent Health

5. Control of Reproductive Tract Infections and Sexually

Transmitted Infections.
 Components
Essential obstetrical care
Emergency obstetrical care
Strengthening referral system Strengthening
project management
Strengthening infrastructure
Capacity building
Improving referral system
Innovative schemes
 Essential obstetric care
• Promotion of institutional deliveries
– 50% of the PHCs and CHCs made operational as 24 hours
delivery centers.
• Skilled attendance at birth
• Policy descions to permit Health workers to use
drugs in emergency situations to reduce maternal
mortality
 Emergency obstetric care
• Operationalisation of FRUs to provide:
– 24 hours delivery services
– Emergency obstetric care
– New born care and emergency care of the sick child
– Full range of family planning services
– Safe abortion services
– Treatment of RTI and STI
– Blood storage facility
– Essential laboratory services
– Referral ( transport ) services
 New initiatives
• Training of PHC doctors in life saving anesthetic
skills for emergency obstetric care a FRUs
• Setting up of blood storage centers at FRUs
• Janani Suraksha Yojana (JSY)
• Vandemataram scheme
• Safe abortion services
• Integrated Management of Neonatal &
Childhood illnesses (IMNCI).
 24 hrs. Functioning of PHCs
• Availability of Services such as
 24 Hrs. Delivery services
 New Born care
 Family Planning, Counselling and services
 Availability of RTI, STI services
 Safe abortion services
 Training in Obstetric
Management
•Training of MBBS doctors in obstetric management and
skills including C.S. in RCH‐II
•Duration of training to be 16 weeks
•Expert Group is considering other details
 Janani
SurkashaYojna
•To promote Institutional Deliveries
– To reduce overall
– Maternal Mortality Ratio
– Infant Mortality Rate
•A safe motherhood intervention, replacing
the “National Maternity Benefit Scheme”, under
NRHM
•100
• % centrally sponsored
 Vandematram Scheme
• Itis a voluntary scheme wherein any obstetric
and gynaec specialist, maternity home can volunteer
• Enrolled doctors will display ‘vandemataram logo’
at their clinics.
• Iron and folic acid tablets, oral pills, TT injections, etc
will be provided for free distribution.
 Referral Transport
Key issues:
–RCH I funds poorly Utilized,
–Community participation lacking

Under Consideration:
–Place funds with AWW /ANM, JSY
–Develop community mechanisms
–Provide out source ambulances at PHCs, CHCs, and FRUs
 Role of ASHA
•A village level link worker attached to AWW/ANM
•Motivator for ANC, PNC, Institutional Delivery,
Immunization and Family Planning Services
• Provide Escort to beneficiary for above services.
• Adolescents Health Counsellor.
• Janani‐Shishu Suraksha Karyakram (JSSK)
• Village Health & Nutrition Day (VHND)
• Pregnancy Tracking
• Maternal Death Review (MDR)
 Integrated Management of Neonatal
& Childhood Illnesses (IMNCI)

• Inclusion of 0‐7 days age in the programme

• Training of health personnel begins with sick
young infants up to 2 months
• Proportion of trainingtime devotedto sick
young infant and sick child is almost equal
• Skill based
IMNCI
 Adolescent Reproductive and Sexual Health
(ARSH)
A two‐pronged strategy will be supported:
– Incorporation of adolescent issues in all the
training programs and all RCH materials
RCH
developed for and behaviour
communication
change.
– Dedicated days and dedicated timings for
adolescents at PHC’s.
 Safe Abortion Practices
• MEDICAL METHOD
– Termination of early pregnancy (49days)
– Mifepristone followed by Misoprostol

• MANUAL VACCUM ASPIRATION

– Safe and simple technique for termination of pregnancy.
– Can be used at PHC or comparable facility
 RMNCH + A
• Reproductive, Maternal, Newborn, Child and
Adolescent Health
• The 12th Five year plan (2012‐2017)
Health Outcome Goals established in
the 12th Fiver Year Plan
• Reduction
Infant Mortality Rate (IMR) to
25 per 1,000 live births by 2017
Maternal Mortality Ratio (MMR) to
100 per 100,000 live births by 2017
Total Fertility Rate(TFR) to 2.1 by 2017
 Quality Indicators
Following are the quality indicators used to monitor and evaluate
RCH programme through monthly reports:
1. Number of antenatal cases registered
2. Number of pregnant women who had 3 antenatal checkups
3. Number of high risk pregnant women referred
4. Number of pregnant women who had 2 doses of TT
5. Number of pregnant women under prophylaxis and treatment of
anaemia
6. Number of deliveries by trained and untrained attendants
7. Number of cases with complications referred to PHC/FRU
8. Number of newborn with birth weight recorded
 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
• 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 world’s 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 India’s commitment
to its children – India’s 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
 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 • It responds to an
public sector programme increased need, increases
specifically focused on the efficacy of other
school age children. investments in child
development, ensures
• Its main focus is to address good current and future
the health needs of health, better educational
children, both physical and outcomes and improves
mental, and in addition, it social equity and all the
provides for nutrition services are provided for
interventions, yoga in a cost effective manner
facilities and counseling.
 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
NUTRITIONAL
PROGRAMMES
 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
• To eradicate 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
• 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
• 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.
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

30 - 36 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
• 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
• 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).
• 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.
• 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.
• 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
• 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.
• 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.
• 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
• 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.
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
• 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.
• 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.
• Visualizes on 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
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.
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.
• 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
• 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
Specific activities:
• Supplementary feeding
• Non-formal preschool education
• Nutrition education
• Poultry forming
• Providing better seeds and seedling
• Raising kitchen gardens
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.
MID-DAY MEAL PROGRAMME
• Also known as School Lunch Programme.
• 1st organised 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.
• 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
• 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.
Princilples:
• supplement, not substitute
• 1/3 total energy and ½ total protein
• low cost
• easily prepared
• locally available food
• change menu frequently
Mid day meal
programme
• It is 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.
• 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.
*******************