Lok Sabha Question No. 2257 (UNSTARRED), answered on 2021-12-10
Subject: Nutritional Rehabilitation Centres (NRCs)
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Gaurav Gogoi

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

## LOK SABHA UNSTARRED QUESTION NO. 2257 TO BE ANSWERED ON 10TH DECEMBER, 2021

## NUTRITIONAL REHABILITATION CENTRES (NRCS)

## 2257. SHRI GAURAV GOGOI:

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

- (a)  whether  the  government  has  evaluated  the  accessibility  and  effectiveness  of  Nutrition Rehabilitation Centres (NRCs)  in treating Severe Acute Malnourished (SAM)  children, especially during the COVID- 19 lockdown;
- (b) if so, details of results of such evaluation;
- (c)  the  number  of  rural  and  urban  NRCs  operational  along  with  SAM  children  treated  under NRCs between 2019 and 2021, State-wise;
- (d)  whether  the  government  plans  to  adopt  interventions  suggested  by  WHO  and  UNICEF  to treat SAM children at community level and if so, the details thereof and the time by which it will be finalized:
- (e) reasons for high prevalence of malnutrition among children under the age of five years as per NFHS-5;
- (f)  whether  the  government  has  adopted  any  other  measures  to  treat  SAM  and  if  so,  details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (c):

Nutrition Rehabilitation Centres (NRCs) are operational at public health facilities to exclusively cater  the  under-five  sick  SAM  children  who  are  admitted  for  clinical  management  of  their medical  complications  along  with  nutritional  management.  However,  SAM  children  without medical  complications  do  not  require  admission  in  NRCs  and  they  can  be  managed  in  the community setting.

MoHFW  has  issued  guidance  notes  time  to  time  to  all  the  States  and  UTs  and  organized webinars  to  understand  the  status  of  implementation  of  NRC  programme  and  to  ensure  the uninterrupted functioning of NRCs during and post COVID-19 lockdown.

The  guidance  note  on  "Enabling  Delivery  of  Essential  Health  Services  during  the  COVID  19 Outbreak"  was  issued  on  14th  April  2020  and  guidance  note  on  'Provision  of  Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition (RMNCAH+N) services during & post  COVID-19 Pandemic' was further issued on 24th May 2020, for ensuring RMNCAH+N services.

It was advised in the guidance note that NRC services in non-containment zone to be continued as per existing national guidelines, and in containment zones, medical management of sick SAM children to be ensured in the nearest NRC/health facility whereas post-discharge follow up to be conducted through tele-consultation.

During FY 2019-20, 2.25 lakh SAM children received treatment in 1072 NRCs and in FY 202021, 1.04 lakh SAM children received treatment in 1073 NRCs. State wise number of sick SAM children admitted in NRCs during FY 2019-20 & FY 2020-21 are annexed at annexures 1 & 2.

## (d) to (f):

As  per  'AN  ANALYSIS  OF  DETERMINANTS  2014'  published  by  National  Institute  of Medical  Statistics,  appropriate  feeding  of  a  young  child  and  preventing  illness  in  a  child  is critical  for  reducing  undernutrition.  These  immediate  causes  are  influenced  by  a  number  of underlying  causes  such  as  access  to  food,  maternal  status,  child  care  and  hygiene  sanitation practices.  There  is  therefore,  a  complex  interplay  of  various  factors:  food,  quality  of  food available,  feeding  practices,  mother's  education,  availability  of  maternal  and  child  health services, safe water, sanitation, status of women in the society etc. which influence nutritional status of children.

However,  as  per  NFHS-5  (2019-  21)  factsheets,  the  nutrition  indicators  for  children  under  5 years  have  improved  as  compared  to  NFHS-4  (2015-16)  wherein,  stunting  has  reduced  from 38.4% to  35.5%,  wasting  has  reduced  from  21.0%  to  19.3%  and  underweight  prevalence  has reduced from 35.8% to 32.1%.

Government has introduced Mission Poshan 2.0, an integrated nutrition support programme in budget 2021-2022 for all States/UTs. It seeks to strengthen nutritional content, delivery, outreach and outcomes with focus on developing practices that nurture health, wellness and immunity to disease and malnutrition.

Steps have been taken to improve nutritional quality and testing in accredited labs, strengthen delivery and leverage technology under Poshan Tracker to improve governance. States/UTs have been  advised  to  promote  use  of  AYUSH  systems  for  prevention  of  malnutrition  and  related diseases. A programme to support development of Poshan Vatikas at Anganwadi Centres to meet dietary diversity gap leveraging traditional knowledge in nutritional practices has also been taken up.  Guidelines  were  issued  for  transparency  and  accountability  in  delivery  of  supplementary nutrition and to track nutritional outcomes on 13.01.2021.

Further, under the Anganwadi Services of the Umbrella Integrated Child Development Services (ICDS) Scheme, severely malnourished children are provided additional nutrition in the form of food supplement providing 800 Kcal of energy and 20-25 g of protein.

## State wise NRC progress data for FY 2019-20

| S. No   | State             |   No. of Functional NRCs |   Total Admissions (N) |
|---------|-------------------|--------------------------|------------------------|
| INDIA   | INDIA             |                     1072 |                 225073 |
| 1       | Arunachal Pradesh |                        1 |                     10 |
| 2       | Andhra Pradesh    |                       18 |                   4320 |
| 3       | Assam             |                       24 |                   1706 |
| 4       | Bihar             |                       40 |                  10297 |
| 5       | Chandigarh        |                        1 |                    143 |
| 6       | Chhattisgarh      |                       79 |                  15802 |
| 7       | Dadra&NH          |                        1 |                     47 |
| 8       | Delhi             |                        2 |                    486 |
| 9       | Gujarat           |                      135 |                  25902 |
| 10      | Haryana           |                       11 |                   2451 |
| 11      | Himachal Pradesh  |                        5 |                   1182 |
| 12      | Jammu &Kashmir    |                        5 |                   1469 |
| 13      | Jharkhand         |                       94 |                  11329 |
| 14      | Karnataka         |                       32 |                   8091 |
| 15      | Kerala            |                        4 |                    156 |
| 16      | Madhya Pradesh    |                      315 |                  87792 |
| 17      | Maharashtra       |                       43 |                   7078 |
| 18      | Manipur           |                        1 |                    135 |
| 19      | Meghalaya         |                        7 |                    433 |
| 20      | Nagaland          |                        1 |                     38 |
| 21      | Odisha            |                       65 |                  11207 |
| 22      | Rajasthan         |                       39 |                   7069 |
| 23      | Tamil Nadu        |                        6 |                   3366 |
| 24      | Telengana         |                       12 |                   3469 |
| 25      | Tripura           |                        1 |                     31 |
| 26      | Uttar Pradesh     |                       77 |                  15013 |
| 27      | Uttarakhand       |                        2 |                    178 |
| 28      | West Bengal       |                       51 |                   5873 |

## Annexure 1

## State wise NRC progress data for FY 2020-21

| S. No.   | State/ UT         |   Total No. of Functional NRCs |   Admission (No.) |
|----------|-------------------|--------------------------------|-------------------|
|          | INDIA             |                           1073 |            104405 |
| 1        | Arunachal Pradesh |                              1 |                 1 |
| 2        | Andhra Pradesh    |                             18 |              1415 |
| 3        | Assam             |                             24 |              1032 |
| 4        | Bihar             |                             41 |              3543 |
| 5        | Chandigarh        |                              1 |                68 |
| 6        | Chhatishgarh      |                             79 |              6845 |
| 7        | Dadra&NH          |                              1 |                12 |
| 8        | Delhi             |                              2 |               169 |
| 9        | Gujarat           |                            135 |              9606 |
| 10       | Haryana           |                             11 |              1298 |
| 11       | Himachal Pradesh  |                              3 |               187 |
| 12       | Jammu &Kashmir    |                              6 |               680 |
| 13       | Ladakh            |                              2 |                67 |
| 14       | Jharkhand         |                             95 |              7112 |
| 15       | Karnataka         |                             30 |              3930 |
| 16       | Kerala            |                              4 |                87 |
| 17       | Madhya Pradesh    |                            318 |             41629 |
| 18       | Maharashtra       |                             38 |              2405 |
| 19       | Manipur           |                              1 |                76 |
| 20       | Meghalaya         |                              7 |               222 |
| 21       | Nagaland          |                              1 |                 0 |
| 22       | Odisha            |                             66 |             10150 |
| 23       | Rajasthan         |                             40 |              3448 |
| 24       | Tamil Nadu        |                              6 |              1045 |
| 25       | Telengana         |                             12 |              1278 |
| 26       | Tripura           |                              1 |                 6 |
| 27       | Uttar Pradesh     |                             77 |              5819 |
| 28       | Uttarakhand       |                              2 |                26 |
| 29       | West Bengal       |                             51 |              2249 |