Lok Sabha Question No. 1009 (UNSTARRED), answered on 2020-02-07
Subject: Stunting due to Malnutrition
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Pushpendra Singh Chandel, Anupriya Patel

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

## LOK SABHA UNSTARRED QUESTION NO. 1009 TO BE ANSWERED ON 7 th FEBRUARY, 2020

## STUNTING DUE TO MALN UTRITION

## 1009. SHRI KUNWAR PUSHPENDRA SINGH CHANDEL: SHRIMATI ANUPRIYA PATEL:

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

(a)  whether  the  Government  has  taken  special m asures  for  children  suffering  from malnutrition in the country, underweight and underheight including issues of ch ild wasting, child stunting and child mortality related issues;

(b) if so, the details thereof and the efforts made by the G overnment in this regard in the country, State/ UT - wise particularly in Bundelkhand;

(c)  the  schemes  being  implemented  by  the Government  to  deal  with  this  problem  in  the aftermath of India's performance in the Global Hunger Index, 2019;

(d) the details of funds allocated during the last five years to address the issue along with the achievements made so far, State/UT, scheme - wis ; and

(e) the details of targets achieved under National Nutrition Mission so far?

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

(a )to( c): Government has taken special measures for children suffering malnutrition in the country including Bundelkhand.

from

Government  of  India  has  launched  POSHAN  (Prime  Minister  Overarching  Scheme  for Holistic Nourishment) Abhiyaan, to address malnutrition cha llenges in India by engaging all the important stakeholders in a convergent approach. The goals of POSHAN Abhiyaan is to prevent and reduce stunting, underweight and low birth weight by 2% per annum and t reduction of anemia by 3% per annum.

The  Govern ment  of  India  has  also  launched several  schemes  under  the  aegis  of Ministry of Women and Child Development (MWCD) to tackle malnutrition in the country including  Anganwadi  Services,  Scheme  for  Adolescent  Girls  (SAG)  and  Pradhan  Mantri Matru Vandana Yojna ( PMMVY) to improve the nutritional and health status of children the age -group 0 - 6 years. The Anganwadi Services scheme provides a package of six services i.e.  Supplementary  Nutrition,  Pre  School  Non - formal  Education,  Nutrition  and  Health Education,  Immu nization,  Health  checkups  and  referral  services.  U nder  National  Health Mission  (NHM),  support  is  provided  to  the  States  /UTs  to  strengthen  their  health systems  including  strengthening  of  infrastructure,  and  adequate  manpower  based  on proposals rec eived from the States in their Programme Implementation Plans (PIPs). Thes PIPs are appraised in the National Programme Coordination Committee (NPCC) meetings and  approvals  are  accorded  to  States/  UTs  in  the  form  of  Record  of  Proceedings  (Ro Further, in  order  to  address  child  mortality  and  morbidity,  the  Government  of  India supporting in implementation of Reproductive, Maternal, Newborn, Child, Adolescent hea and  Nutrition  (RMNCAH+N)  strategy. The  detail  of  various health  and  nutrition intervent ions under National Health Mission (NHM) is as follows:

- Promotion  of  Institutional  deliveries  through  cash  incentive  under  Janani  Sura Yojana  (JSY)  and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  which  entitles  all pregnant  women  delivering  in  public  hea lth  institutions  to  absolutely  free  delivery including Caesarean section, post - natal care and treatment of sick infants till one yea of  age.  Pradhan  Mantri  Matru  Vandana  Yojana  (PMMVY)  is  another  maternity benefit programme under which cash incentive of R s. 5000 is provided to pregnant women and lactating mothers.
- Early initiation and exclusive breastfeeding for first six months and appropriat and Young Child Feeding (IYCF) practices are promoted under Mothers' Absolute Affection (MAA) in convergen c with Ministry of Women and Child Development.
- Home Based Care for Young Children (HBYC) has been initiated as an extension of Home  Based  Newborn  Care  (HBNC)  to  provide  community  based  care  by  ASHA workers with focus on improvement in child rearing prac t ces, nutrition counselling and breastfeeding promotion till 15th month of life.
- Treatment of sick children with Severe Acute Malnutrition (SAM) at special un called the Nutrition Rehabilitation Centres (NRCs), set up at public health facil
- Universal Immunization Programme (UIP) is being supported to provide vaccination to children against life threatening diseases such as Tuberculosis, Diphtheria, P Polio, Tetanus, Hepatitis B, Measles, Rubella, Pneumonia and Meningitis caused Haemophilus Influenzae B. The Rotavirus vaccination has also been rolled out in country for prevention of Rotaviral diarrhoea. 'Mission Indradhanush is targeted to immunize children who are either unvaccinated or partially vaccinated i.e. thos havenot been covered during the rounds of routine immunization for various reaso
- Vitamin A supplementation (VAS) for children till the age of 5 years.
- National De -worming Day as a fixed day strategy to administer Albendazole tablets t all the children in t he age group of 1 - 19  years  through the platform of AWCs and schools for good nutritional outcomes and prevention of anaemia.
- Prevention  of  childhood  illness  such  as  diarrheal  diseases  which  in  turn  pre childhood  malnutrition.  Control  of  childhood  diar rhoea  is  being  carried  out  by conducting  annual  Intensified  Diarrhoea  Control  Fortnight  (IDCF)  and  Defea Diarrhoea Initiative.
- 'Anemia  Mukt  Bharat  (AMB)' for  supplementation  and  treatment  of  anaemia  in children, adolescents, pregnant and lactating women, and women of reproductive age group in programme mode through life cycle approach. This involves, bi - weekly IFA syrup supplementation to children 6 -59 months, weekly IFA tablet supplementation to children 5 -10 years and adolescents 10 -19 years, and IFA tablets to pregnant and lactating women.
- Village Health Sanitation and Nutrition Days (VHSNDs) are observed for provisio of maternal and child health services and creating awareness on maternal and c care in convergence with Ministry of Women and Child Development. Health and nutrition  education  through  mass  and  social  media  is  also  promoted  to  impro healthy practices and to generate demand for service uptake.
- Mother and Child Protection Card is the joint initiative of the Ministry of Health Family welfare and the Ministry of Woman and Child Development which addresses the nutrition concerns in children, pregnant women and lactating mothers.
- Under 'Rastriya Bal Swasthya Karyakaram' (RBSK) children of 0 -18 years of age are screened for sele cted health conditions classified into 4Ds -Diseases, Deficiencies, Defects and Developmental delays including screening for Severe Acu Mal-nutrition and provides free referral and treatment facilities for identified children.
- The Government is also pro moting use of fortified wheat flour, fortified rice, forti oil and double fortified salt in public funded supplementary nutrition programmes

All  these  programs  address  one  or  other  aspects  related  to  nutrition  and  hav potential to improve nutri tional outcomes in the country.

(d)& (e): The funds allocated to carry out the various activities to curb the malnut under  POSHAN  Abhiyaan  (Annexure - I)  and    RCH  flexipool  of  National  Health  Mission (Annexure - II) is annexed

Government has set up POSHAN Abhiyaan on 18.12.2017 for a three year time frame commencing from 2017 - 18. The goals of POSHAN Abhiyaan are to achieve improvement in nutritional  status  of  Children  from  0 - 6  years,  Adolescent  Girls,  Pregnant  Women  and Lactating Mothers in a time bo und manner with fixed targets.

33.4%

The  results  of  the  POSHAN  Abhiyaan  can  be  known  after  the  programme  has completed  its  approved  tenure. However,  in  the  meantime,  a s  per  the  report  of Comprehensive National Nutrition Survey (CNNS) conducted by UNICEF, prevalence of stunting, wasting and underweight among children is 34.7%, 17% and respectively, which is a reduction from the levels reported by NFHS -4.

Annexure I (inlakhs)

## State - wise statement of funds released und r POSHAN Abhiyaan (as on 31.12.2019)

| S. No.   | State/UTs            | Released in FY 2017 - 18+ Unspent balance ISSNIP   | of Released in FY 2018- 19   | Released in FY 2019- 20   | Total Released   |
|----------|----------------------|----------------------------------------------------|------------------------------|---------------------------|------------------|
| 1        | Andhra Pradesh       | 2,572.41                                           | 8,604.68                     | 5,582.52                  | 16,759.61        |
| 2        | Bihar                | 7,063.44                                           | 15,001.67                    | 10,000.00                 | 32,065.11        |
| 3        | Chhattisgarh         | 1,668.12                                           | 9,629.51                     | 0.00                      | 11,297.63        |
| 4        | Delhi                | 945.95                                             | 2,206.88                     | 0.00                      | 3,152.83         |
| 5        | Goa                  | 238.07                                             | 197.78                       | 0.00                      | 435.85           |
| 6        | Gujarat              | 3,036.66                                           | 11,228.04                    | 7,531.00                  | 21,795.7         |
| 7        | Haryana              | 400.97                                             | 5,992.46                     | 0.00                      | 6,393.43         |
| 8        | Himachal Pradesh     | 1,557.26                                           | 4,153.15                     | 2,480.00                  | 8,190.41         |
| 9 *      | Jammu & Kashmir      | 388.59                                             | 8,343.52                     | 0.00                      | 8,732.11         |
| 10       | Jharkhand            | 2,429.59                                           | 5,110.45                     | 0.00                      | 7,540.04         |
| 11       | Karnataka            | 3,351.05                                           | 9,870.89                     | 0.00                      | 13,221.94        |
| 12       | Kerala               | 1,273.37                                           | 6,491.91                     | 0.00                      | 7,765.28         |
| 13       | Madhya Pradesh       | 4,067.20                                           | 15,894.17                    | 17,883.00                 | 37,844.37        |
| 14       | Maharashtra          | 2,572.31                                           | 20,989.28                    | 33,061.47                 | 56,623.06        |
| 15       | Odisha               | 4,600.46                                           | 10,571.65                    | 0.00                      | 15,172.11        |
| 16       | Puducherry           | 39.24                                              | 393.70                       | 497.00                    | 929.94           |
| 17       | Punjab               | 819.51                                             | 6,090.33                     | 0.00                      | 6,909.84         |
| 18       | Rajasthan            | 4,216.26                                           | 9,680.99                     | 0.00                      | 13,897.25        |
| 19       | Tamil Nadu           | 1,340.51                                           | 12,210.93                    | 0.00                      | 13,551.44        |
| 20       | Telangana            | 1,736.94                                           | 8,595.70                     | 7,003.00                  | 17,335.64        |
| 21       | Uttar Pradesh        | 8,440.60                                           | 29,582.87                    | 0.00                      | 38,023.47        |
| 22       | Uttarakhand          | 1,866.25                                           | 4,301.57                     | 3,696.00                  | 9,863.82         |
| 23       | West Bengal          | 5,545.27                                           | 19,294.11                    | 0.00                      | 24,839.38        |
| 24       | Arunachal Pradesh    | 52.93                                              | 2,663.35                     | 0.00                      | 2,716.28         |
| 25       | Assam                | 2,298.27                                           | 15,492.36                    | 14,171.00                 | 31,961.63        |
| 26       | Manipur              | 340.46                                             | 3,865.37                     | 0.00                      | 4,205.83         |
| 27       | Meghalaya            | 462.98                                             | 1,713.27                     | 1,706.80                  | 3,883.05         |
| 28       | Mizoram              | 119.38                                             | 957.65                       | 902.00                    | 1,979.03         |
| 29       | Nagaland             | 163.74                                             | 1,251.97                     | 1,445.17                  | 2,860.88         |
| 30       | Sikkim               | 98.59                                              | 328.47                       | 544.00                    | 971.06           |
| 31       | Tripura              | 277.91                                             | 3,695.72                     | 0.00                      | 3,973.63         |
| 32       | Andaman & Nicobar    | 100.22                                             | 416.89                       | 307.62                    | 824.73           |
| 33       | Chandigarh           | 158.88                                             | 306.82                       | 526.97                    | 992.67           |
| 34       | Dadra & Nagar Haveli | 108.83                                             | 129.32                       | 681.16*                   | 919.31           |
| 35       | Daman & Diu          | 42.06                                              | 197.66                       | 446.98                    | 686.70           |
| 36       | Ladakh               | -                                                  | -                            | -                         | -                |
|          | TOTAL                | 64,454.28                                          | 2,55,593.98                  | 1,08,592.44               | 4,28,640.71      |

## State wise SPIP Approval under Child Health during the period from F.Y. 2014 -15 to FY 2018 - 19

Rs. In Lakhs

| S.No.                     | State             | 2014-15        | 2015-16        | 2016-17        | 2017-18        | 2018-19        |
|---------------------------|-------------------|----------------|----------------|----------------|----------------|----------------|
|                           |                   | SPIP Approvals | SPIP Approvals | SPIP Approvals | SPIP Approvals | SPIP Approvals |
| A. High Focus States      |                   |                |                |                |                |                |
| 1                         | Bihar             | 4224.66        | 9072.44        | 11096.87       | 12136.35       | 28025.83       |
| 2                         | Chattisgarh       | 1773.40        | 1931.69        | 3878.57        | 5877.38        | 15225.33       |
| 3                         | Himachal Pradesh  | 1143.54        | 1291.28        | 827.47         | 1262.98        | 2192.53        |
| 4                         | Jammu & Kashmir   | 1350.39        | 811.84         | 1614.21        | 2306.68        | 3488.96        |
| 5                         | Jharkhand         | 3482.13        | 4732.26        | 4503.20        | 5782.74        | 8142.48        |
| 6                         | Madhya Pradesh    | 6153.71        | 6339.92        | 9288.13        | 10057.87       | 17994.68       |
| 7                         | Orissa            | 4451.94        | 4332.63        | 3918.10        | 6352.13        | 11114.13       |
| 8                         | Rajasthan         | 5617.06        | 6786.11        | 10163.06       | 8391.10        | 11915.91       |
| 9                         | Uttar Pradesh     | 13807.67       | 11597.12       | 16986.39       | 20865.73       | 31275.06       |
| 10                        | Uttarakhand       | 894.18         | 1067.62        | 522.16         | 1507.91        | 1971.47        |
|                           | Sub Total         | 42898.68       | 47962.90       | 62798.16       | 74540.87       | 131346.38      |
| B. NE States              |                   |                |                |                |                |                |
| 11                        | Arunachal Pradesh | 291.68         | 289.41         | 561.40         | 814.92         | 1253.60        |
| 12                        | Assam             | 5571.10        | 7327.69        | 6854.74        | 8473.74        | 10131.78       |
| 13                        | Manipur           | 312.85         | 262.63         | 434.40         | 357.31         | 369.25         |
| 14                        | Meghalaya         | 441.16         | 694.08         | 715.31         | 1001.53        | 1417.85        |
| 15                        | Mizoram           | 243.38         | 379.25         | 458.85         | 636.55         | 637.18         |
| 16                        | Nagaland          | 270.01         | 257.28         | 292.92         | 542.31         | 409.67         |
| 17                        | Sikkim            | 177.42         | 141.65         | 96.28          | 176.29         | 243.59         |
| 18                        | Tripura           | 411.85         | 407.31         | 469.53         | 929.88         | 1577.62        |
|                           | Sub Total         | 7719.45        | 9759.30        | 9883.43        | 12932.53       | 16040.54       |
| C. Non- High Focus States |                   |                |                |                |                |                |
| 19                        | Andhra Pradesh    | 1797.63        | 1764.19        | 3134.31        | 5759.86        | 12754.21       |
| 20                        | Goa               | 251.81         | 72.18          | 81.76          | 125.84         | 159.77         |
| 21                        | Gujarat           | 2340.87        | 4580.06        | 5891.07        | 7657.50        | 13276.33       |

| 22                   | Haryana                   | 3041.02   | 1882.78   | 1393.54   | 4108.95   | 5663.16   |
|----------------------|---------------------------|-----------|-----------|-----------|-----------|-----------|
| 23                   | Karnataka                 | 2374.11   | 2761.16   | 4345.66   | 6846.34   | 11601.24  |
| 24                   | Kerala                    | 1415.43   | 444.23    | 347.36    | 975.73    | 3101.28   |
| 25                   | Maharashtra               | 2938.58   | 3639.95   | 5867.11   | 8054.51   | 15029.71  |
| 26                   | Punjab                    | 2696.52   | 1149.76   | 1230.62   | 1477.34   | 2614.05   |
| 27                   | Tamil Nadu                | 865.41    | 1932.62   | 3244.97   | 3791.05   | 7183.55   |
| 28                   | Telangana                 | 1674.03   | 1857.46   | 3090.57   | 5206.88   | 7594.86   |
| 29                   | West Bengal               | 7747.79   | 3604.14   | 4295.81   | 8961.52   | 10242.12  |
|                      | Sub Total                 | 27143.20  | 23688.53  | 32922.79  | 52965.52  | 89220.28  |
| D. Small States/UT s |                           |           |           |           |           |           |
| 30                   | Andaman & Nicobar Islands | 80.08     | 55.53     | 77.90     | 92.82     | 268.01    |
| 31                   | Chandigarh                | 7.86      | 23.90     | 32.56     | 207.75    | 11.42     |
| 32                   | Dadra & Nagar Haveli      | 86.83     | 74.17     | 80.80     | 90.44     | 104.41    |
| 33                   | Daman & Diu               | 19.17     | 17.14     | 19.73     | 100.08    | 128.36    |
| 34                   | Delhi                     | 213.42    | 166.16    | 204.46    | 1418.41   | 2283.53   |
| 35                   | Lakshadweep               | 21.80     | 29.95     | 22.55     | 19.32     | 21.05     |
| 36                   | Puducherry                | 114.13    | 36.28     | 105.15    | 126.06    | 145.26    |
|                      | Sub Total                 | 543.29    | 403.13    | 543.15    | 2054.88   | 2962.04   |
|                      | Grand Total               | 78304.6   | 81813.8   | 106147.5  | 142493.8  | 239569.2  |

## Note:

1. The above releases relate to Central Govt. Grants & do not include State share contribution.
2. Allocation has no relevance after the closure of the Financial Year, hence only Releases are provided.