Lok Sabha Question No. 1059 (UNSTARRED), answered on 2020-09-18
Subject: Schemes to mitigate Anemia
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vishnu Dayal Ram

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 1059 TO BE ANSWERED ON 18 TH SEPTEMBER, 2020

## SCHEMES TO MITIGATE ANEMIA

## 1059. SHRI VISHNU DA YAL RAM:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  the  details  of  schemes/  programmes  for  mitigating  cases  of  anemia  and  malnourishm among women and children;
- (b)whethercertain shortcomings during implementation of the said schemes/ programmes have come to the notice of the Government during the COVID - 19 pandemic; and
- (c) if so, the details thereof and the reaction of the Government thereto?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a)The  Ministry  of  Health  and  Family  Welfare  has  launched  the  Anemia  Mukt  Bharat strategy for prevention and treatment of Anaemia in Pre - School Children (6 - 59 months), Children (5 - 9  years), Adolescent Girls and Boys (10 - 19 years), Pregnant and Lactating Women  and  Women  of  Reproductive  Age  group  (15 - 49  years)  in  programme  mode through life cycle approach . The six interventions under Anemia Mukt Bharat strategy are a s follows:
- Prophylactic Iron Folic Acid Supplementation
- Periodic Deworming
- Intensified Behaviour Change Communication Campaign including delayed clamping

cord

- Testing and Treatment of Anemia using digital methods and Point of Care treatment
- Mandatory prov ision of iron folic acid fortified staple foods in safety net programme
- Addressing non - nutritional causes of Anemia in endemic pockets, with special focus o malaria, hemoglobinopathies and fluorosis.

AMB strategy also has focuses on the following:

- i. Universal screening of Pregnant Women for Anaemia is a part of Ante - Natal  Care and all Severely Anaemic mothers are line listed and followed up for comprehens management at higher facilities.
- ii. In  Malaria  endemic  areas,  to  tackle  the  problem  of  Anaemia  d ue  to  Malaria particularly in Pregnant Women and Children, Long Lasting Insecticide Nets (LLIN and Insecticide Treated Bed Nets (ITBNs) are distributed.

Further to prevent anemia and malnutrition among women and children, other initiative be undertake n are as follows:

- i. Promotion  of  appropriate  Infant  and  Young  Child  Feeding  practices  that  include  e initiation of breastfeeding and exclusive breastfeeding till 6 months of age and app complementary feeding through ASHA worker at community and health care providers at health facilities.
- ii. Nutrition  Rehabilitation  Centres  (NRCs)  are  specialised  hospital  based  unit  to  p managment  and  nutritional  support  to  under - five  Severe  Acute  Malnutrition  children having medical complication.
- iii. Village Healt h Sanitation and Nutrition Days (VHSNDs) and Mother and Child Protection Card are the joint initiatives of the Ministry of Health & Family Welfare and the M of  Women  and  Child  Development  for  addressing  the  nutrition  concerns  in  Children Pregnant  w omen  and  Lactating  mothers.  Nutrition  education  during  VHSNDs  helps  to increase awareness on healthy and nutritious dietary practices (including iron ric and promotion of breastfeeding.
- iv. Mandatory promotion of intake of Double Fortified Salt (DFS) in ICDS, Mid- day meal and Public Distribution System (PDS).
- v. Janani  Surksha  Yojana  (JSY), a  national  conditional  cash  transfer  scheme  incentivises women of low socio economic status for institutional delivery at public health fa and assists her in fu lfilling nutritional needs during pregnancy. Similarly, under J nanai Shishu  Suraksha  Karyakram  (JSSK),  all  pregnant  and  lactating  mothers  and  infan seeking treatment in public health facilities are provided food, drugs and transport cost as an entitlement.
- vi. Under the Rashtriya Bal Swasthya Karyakram (RBSK) systematic efforts are undertaken to detect nutrition deficiency including Anemia among children. Similarly, the Ministry of Women  and  Child  Development  (MWCD)  has  launched  several  schemes  to  t ackle malnutrition in the country including Anganwadi Services, Scheme for Adolescent Gi (SAG) and Pradhan Mantri Matru Vandana Yojna (PMMVY) to improve the nutritional and  health  status  of  Children,  Adolescent  Girls,  Pregnant  and  Lactating  Women.  T A nganwadi Services scheme provides supplementary nutrition for children 6 months to years of age, pregnant and lactating mothers. Besides, for severely underweight chil the age group of 6 months to 6 years, additional food items as Take Home Ration are provided.

(b) and    (c)As  per  the  directions  issued  by  Ministry  of  Home  Affairs,  under  Disa Management Act, 2005; all the Anganwadi Centres across the country were closed to limit impact of COVID - 19. During the consultation held with States/UTs in the month of July 2020, most of the States had also expressed their inability to open Anganwadi Centres in the increasing  incidents  of  COVID - 19.  However,  to  ensure  continuous  nutritional  support  to Anganwadi beneficiaries, Anganwadi Workers and H elpers have been distributing supplementary Nutrition at the doorsteps of the beneficiaries. Further, Ministry of Women Development has issued necessary directions to the States/UTs to ensure distribution o items  and  nutrition  support  by  Anganw adi orkers,  once  in  15  days,  at  the  doorstep  of beneficiaries. In addition, Anganwadi Workers and Anganwadi Helpers have been assisting local administration in community surveillance, creating awareness or other works assig them from time to tim e.

Further, during the COVID - 19 pandemic, there have also been challenges in service delivery o IFA supplementation in school going children and distribution of IFA tablets to out of adolescent  girls,  pregnant  and  lactating  mothers  at  VHSNDs.  Simi larly,  service  delivery  in campaign approach for different activities such as National Deworming Day (NDD), Intensi Diarrhoea Control Fortnight (IDCF) and Vitamin A Supplementation programmes were also got affected.

In order to address these challenge s, the MoHFW  has issued guidance notes to all the States and UTs regarding ' Enabling Delivery of Essential Health Services during the COVID 19 Outbreak ' on 14 th April, 2020 and 'Provision of Reproductive, Maternal, Newborn, Child, Adolescent Health plus N utrition services during and post COVID -19 pandemic' on 24 th May, 2020 for continuation of service delivery amid COVID - 19 pandemic.

As  per  these  guidance  notes,  the  States  and  UTs  have  been  advised  to  ensure  ho distribution of Iron Folic Acid supplementa tion to the target age groups i.e. Pre - school Children 6- 59 months, Children 5 - 9 years, adolescents 10 -19 years, Pregnant and lactating Women in the containment zones.

In  non - containment  zones,  it  has  been  advised  to  undertake  distribution  of  I suppleme nts  through  the  VHSNDs  to  be  held  in  the  staggered  manner  while  ensuring  all  t personal  protective  measures  and  physical  distancing  norms  by  the  frontline  workers ASHAs/ANMs/AWWs.