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Preventing Micronutrient
Malnutrition through ICDS
Prepared By Department of Women and Child Department, Ministry of Human Resource Development, Government of India and United Nations World Food Programme, India Introduction The
Indian Constitution recognises nutrition as a pre-requisite for the
attainment of a person's full physical and intellectual potential.
Article 47 of the Constitution of India states that "The duty of the
State is to raise the level of nutrition and the standard of living and to
improve public health. The State shall regard the raising of the level
of nutrition and the standard of living of its people and the improvement of
public health as among its primary duties....". The
Department of Women and Child Development (DWCD), Ministry of Human resource
Development, Government of India, is the lead agency to develop nutrition
policies, strategies and guidelines for implementation. It coordinates
with the other affiliated Departments to enhance the synergistic impact of
related services on the nutritional status of the Indian population. It
already ahs a comprehensive national Nutrition policy (NNP) and an Integrated
Child Development Services programme (ICDS) that have set in motion the
fundamental processes leading to a sustained improvement in the nutritional
status of children under the age of six and of adolescent girls, pregnant
women and nursing mothers. Efforts
have to be made so that the impact of these services proceeds apace. As
is evident from the present nutritional scenario, some progress has been made
in improving the nutritional status of women and children, but malnutrition
due to micronutrient deficiencies still remains a significant public health
problem. The national nutrition goals as set forth in the National Plan
of Action on Nutrition (NPAN) are still unfulfilled. To realise these
goals in the coming decade, a number of changes will be required: a high
level of political will and appropriate food technologies; adequate
resources; and community participation. Guiding
Principals In
response to these requirements, the guiding principles for improving the
nutritional status of the Indian population are enumerated below: ·
Nutrition
for the entire nation is to be promoted as a basic human right. ·
Nutritional
status, especially of children under the age of six and of adolescent girls,
pregnant women and nursing mothers, will serve as the indicator of the
country's social and economic development. ·
The
initiative of preventing micronutrient malnutrition will be needs-based and
community-driven. It will focus on the vulnerable groups, especially
women and children. ·
The
initiative will be promoted and monitored within the nationally defined goals
and through the nation's premier programme - the ICDS - using a multi-pronged
strategy for greater impact. Implementation
Strategies The
major strategies/direct nutritional interventions to deliver micronutrients
will be: ·
dietary
diversification through behaviour modification ·
fortification
of foods with nutrients (vitamins and minerals) ·
horticulture
interventions for adequate supply of nutrient-rich foods ·
supplementation
with specific micronutrients such as iron-folate and vitamin A in capsule,
tablet or liquid form ·
sensitisation
of polity on issues related to prevention of micronutrient malnutrition Food-based
interventions are most useful as they do not have any negative effects on
local food production and consumption patterns, and at the same time improve
the nutrition and quality of life of the most vulnerable people at critical
times in their lives. In this context, food-based strategies, which
include dietary diversification, food fortification and horticulture
interventions, are the most sustainable approaches to improving the
micronutrient status of populations and have a medium to long term
impact. These strategies will also promote self-reliance amongst the
poor people and communities. Each
strategy offers distinct advantages in reaching specific populations,
capitalising on particular market conditions or addressing different levels
of deficiency. They are not mutually exclusive choices but essential
components of a comprehensive, well-planned programme. Defined
populations can be targeted with specific interventions. Action Plan The
following actions are proposed in order for ICDS and NNP to honour their
mandate: Dietary
diversification through behaviour modification ·
Revitalise
nutrition and health education by building up the capacity of angadwadi workers
to become effective communicators and agents of positive change, actively
supported by the CDPOs and the Supervisors. The capacity of the
community also needs to be built to make it proactive in improving its
nutritional status. Focus will be on improving the health and nutrition
practices of the community, including the promotion of breast-feeding and the
consumption of iodised salt, and enriching their daily diets with foods that
are high in micronutrients. ·
Plan
consumer education effectively in order to instill confidence in the people that their
human rights are not being violated and that they are not being forced to act
and eat according to the regulations imposed by the government; instead, that
their right to good health is being honoured by giving them correct nutrition
information, nutrition supplements and an option to choose a food commodity
that is fortified with micronutrients. Informed action by the
population is considered the best way to promote good nutrition and health
status. ·
Use
iodised salt
for preparing ICDS supplementary food at the AWC. This should be made
compulsory. Fortification
of foods with nutrients (vitamins and minerals) ·
Fortify
/ Enrich Ready-to-Eat (RTE) / processed ICDS foods. It is recommended that the
supplementary food distribute at the angadwadi centres (AWCs) provide
a minimum of 50 percent of the daily requirements of iron and vitamin A to
the target groups. This may be achieved by adding iron and vitamin A
rich foods wherever the local food is cooked and provided to the
beneficiaries, or through fortification in cases where the food supplied is
either RTE or processed food. Horticulture
interventions for adequate supply of nutrient-rich foods ·
Develop
kitchen/backyard gardens. It is proposed that emphasis be given to the
development of horticulture to promote the production of vitamin A
(beta-carotene) and iron rich foods in the kitchen/backyard gardens wherever
possible so as to improve the consumption of micronutrient--rich foods by the
community. ·
Promote
raising of forest species that are rich in nutrients under the Social
Forestry Programme. It is proposed that committed efforts be made to popularise
raising of plants/trees that supply foods/fruits rich in beta-carotene as
well as vitamin C under the Social Forestry Programme. This would
facilitate enhanced availability and consumption of these micronutrient-rich
foods. Supplementation
with specific micronutrients such as iron-folate and vitamin A in capsule,
tablet or liquid form ·
Strengthen
iron-folate supplementation and vitamin A prophylaxis programme. It is proposed that efforts
be made to ensure universal coverage for interventions such as iron-folate
supplementation for children and pregnant women as well as vitamin A
administration to children from nine months up to six years of age. Sensitisation
of polity on issues related to prevention to micronutrient malnutrition ·
Organise
Seminars and Workshops. It is proposed that Regional / State-level meetings, seminars and
workshops be organised to sensitise the polity and develop strategies to: §
Foster
government support to the initiative to prevent micronutrient malnutrition by giving it
high priority. §
Strengthen
convergence
of services provided by related sectors (e.g. Health and Family Welfare,
Women and Child Development, Food Processing, Agriculture, Rural
Development). §
Revisit
the nutritional norms for supplementary nutrition provided under the INDS programme and include
norms for iron and vitamin A on priority basis, as these two
micronutrients critically impact quality of life. (The current norms
were established in 1970, on the basis of protein an denrgy gaps identified
among children, pregnant women and nursing mothers.)
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