Nutrition constitutes the foundation for human development, by reducing susceptibility to infections, reducing the related morbidity, disability and mortality burden, enhancing cumulative life long learning capacities and adult productivity. Under-nutrition is the outcome of many factors. Insufficient dietary intake and absorption; inadequate prevention and management of disease/infections linked to the lack of access to health and child care services, lack of access to safe drinking water, environmental sanitation and hygiene, lack of access to household food security and livelihoods, and inadequate caring and feeding practices for children and women are key determinants. Basic determinants include income levels, agriculture, animal husbandry public distribution systems, water and environmental resources, education and communication, control and use of resources.
A review of monitorable targets of 11th plan shows that current data is not available with regard to prevalence of malnutrition among children 0-3 years, anaemia among women and girls vitamin A coverage of children 9 months to 5 years of age and iron folic acid supplementation for infants, children and adolescents. There has been increase in breast feeding within one hour of birth from 24.5% to 40.2% and improved source of drinking water has been accessible to 88% against the target of reaching all by 2009.
Department of Health Research (DHR) will have the overall responsibility for carrying out promoting and coordinating medical and health research.
The strategy for health research in the 12th Plan would be the following:
Address National Health Priorities: These will be based on disease profile in the country burden of disease, and the possibility of cost-effective interventions.
Build Research Coordination Framework: Besides itself carrying out medical and health research, DHR to play a lead role in bringing all the concerned departments/organisations on one platform to facilitate mutual discussion, resource pooling and prioritisation, and avoid duplication, to find innovative solutions to national priorities in a timely manner for research related to human health.
Address Ethical Issues: DHR would also put in place appropriate regulations, guidelines authorities and structures to strengthen ethics-based research governance and to protect the interests of research subjects especially, in clinical trials.
Promote Extramural Research and Development of Human Resource for Research: T will help in utilisation of available research capacity in medical colleges, tertiary care hospita, health universities and public health institutions.Provision of grants and fellowships will support development of manpower for health research.
Develop Prevention and Treatment Guidelines: DHR will develop Standard Treatment Protocols and provide guidelines for inclusion of newer vaccines and other preventive measures that are cost effective.
Convergence Across Sectors
The MOHFW would constitute a dedicated ‘Health Impact Cell’ to determine the health impact of existing and new non-health Ministries would consider its views before framing policies in sectors which have a bearing on the health of population. The or modifying policies which can impact health. The Health Impact Cell would also perform Monitoring and Surveillance functions in order to continuously gather information on health impacts of policies and programmes of key non-health departments.
Convergent Action on Nutrition
The Ministry of Health would build institutional arrangements with the Ministry of Women and Child development so that convergent delivery of services under ICDS becomes the norm. Anganwadi centre to become hub for convergence.
Strategies for Promoting Nutrition Plan
Strengthening and Restructuring of ICDS: There will be special focus on pregnant and lactating mothers and children under three years. The ICDS also needs to forge strong institutional convergence with the National Rural Health Mission and the Total Sanitation Campaign particularly at the district and village levels. It needs to provide flexibility for local action and empower mothers and the community to have a stake in the programme.
Multi-Sectoral Programme to Address Maternal and Child Malnutrition: Multi-sectoral interventions are envisaged because different sectors address different determinants of malnutrition-directly is to be carried out by increasing caring practices, or indirectly, thereby contributing to improving nutrition outcomes. This access to maternal and child care services and improving access to health care, water, sanitation and hygiene, household food security Targetted Public Distribution System, agriculture, poverty alleviation and livelihoods, education and communication, and mobilisation of community support. Towards this the Ministries that deal with Health, Drinking Water Supply and Sanitation, School Education, Agriculture and Food and Public Distribution will bring strong nutrition focus to their programmes. These will be followed up by multi-sectoral state/district Nutrition Plans of Action which will be developed, implemented and monitored by National/State/District Nutrition Councils, especially in high burden/high focus states/districts. The Centre and States will discuss and sign a Memorandum of Understanding that will be binding on all parties towards monitorable outcomes. Nutrition monitorable targets and outcomes would be reviewed regularly by National/State/ District Nutrition Councils and also by a National Development Council Sub Committee periodically.
Information Education and Communication: A nation-wide communication campaign Coordinated by the Ministry of Women and Child Development in consultation with the Planning Commission and Ministry of Health and Family Welfare, will be launched against malnutrition. This will carried out with the aim to disseminate knowledge on micro-nutrients and its prevention advocacy for food diversification to include iron, vitamin A, and carotene rich food in as well as regular dietary intake. Besides, it would also help in ensuring improved dietary intake to meet RDA, improved compliance of IFA and improved iodised salt consumption in every household. At the local level skilled counselling support will be provided by ICDS and NRHM team. Improved care and feeding practices will be demonstrated through positive role model mothers by them. Other aspects of care that would be covered are health, hygiene, care for girls and women, psychosocial care and early learning, supporting for improved parenting, with shared responsibilities of both parents and family support.
Nutrition Monitoring and Surveillance Systems: A responsive and dynamic Nutrition Surveillance System (NSS) will be put in place in order to capture nutrition related information. It would provide information on nutritional practices of vulnerable groups including SCs, STs, and Minorities being reached under ICDS, NRHM and related programmes of different sectors.