Lok Sabha Question No. 1921 (UNSTARRED), answered on 2024-12-06
Subject: Maternal and Child Health
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: Smt. Harsimrat Kaur Badal

## GOVERNMENT OF INDIA MINISTRY OF WOMEN AND CHILD DEVELOPMENT

## LOK SABHA UNSTARRED QUESTION NO. 1921

TO BE ANSWERED ON 06.12.2024

## MATERNAL AND CHILD HEALTH

## 1921.  SMT. HARSIMRAT KAUR BADAL

Will the Minister of Women and Child Development be pleased to state:

- (a) whether any health initiatives have been taken for improving maternal and child health specifically among women within rural areas like Punjab, if so, the details thereof;
- (b) whether  the  Government  have  received  any  complaints  regarding  rampant corruption  being  reported  by  Anganwadi and  health  workers  in  Government schemes;
- (c) if so, the details thereof and the action taken thereon; and
- (d) whether this has affected the health of the child and lactating mothers in Punjab, if so, the details thereof?

## ANSWER

## MINISTER OF STATE IN THE MINISTRY OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SAVITRI THAKUR)

- (a) to (d) : Anganwadi services, Poshan Abhiyaan and Scheme for Adolescent girls  (14-18  years  in  Aspirational  Districts  and  North-East  region)  have  been subsumed  under  the  umbrella  Mission  Saksham  Anganwadi  and  Poshan  2.0 (Mission  Poshan  2.0)  during  the  period  of  15 th   Finance  Commission.  Mission Poshan  2.0  seeks  to  address  the  challenge  of  malnutrition  through  improved nutrition  content  and  delivery.  It  is  a  Centrally  Sponsored  Scheme,  where  the responsibility of implementation lies with the States/UTs.

Under this Mission, a new strategy has been made for reduction in malnutrition and for improved health, wellness and immunity through activities like community engagement, outreach, behavioral change, and advocacy. It focuses on Maternal Nutrition,  Infant  and  Young  Child  Feeding  Norms,  treatment  of  Severe  Acute Malnutrition  (SAM)/  Moderate Acute  Malnutrition  (MAM)  and  wellness  through AYUSH practices.

Under this Mission, Supplementary Nutrition is provided to Children (6 months to 6 years), Pregnant Women and Lactating Mothers and Adolescent Girls to beat the  intergenerational  cycle  of  malnutrition  by  adopting  a  life  cycle  approach. Supplementary  nutrition  is  provided  in  accordance  with  the  nutrition  norms contained in Schedule-II of the National Food Security Act. These norms have been revised and upgraded last year. The old norms were largely calorie-specific; however, the revised norms are more comprehensive and balanced in terms of both quantity and quality of supplementary nutrition based on the principles of diet diversity that provides quality protein, healthy fats and micronutrients.

Fortified rice is being supplied to AWCs to meet the requirement of micro-nutrients and to control anaemia among women and children. Greater emphasis is being laid on the use of millets for preparation of Hot Cooked Meal at least once a week and Take Home ration at Anganwadi centers.

Ministry of Health and Family Welfare has taken several initiatives to improve child survival in the country including in rural areas.  They are given below:

- Facility  Based New-born Care: Neonatal Intensive Care Units (NICUs)/ Special New-born Care Units (SNCUs) are established at Medical College and District Hospital, New-born Stabilization Units (NBSUs) are established at First Referral Units (FRUs)/ Community Health Centres (CHCs) for care of sick and small babies.
- Kangaroo Mother Care (KMC) is  implemented at facility and community level for low birth weight/ pre-term babies. It includes early and prolonged skin-to-skin  contact  with  the  mother  or  family  member and  exclusive  and frequent breastfeeding.
- Community Based care of New-born and Young Children: Under Home Based New-born Care (HBNC) and Home-Based Care of Young Children (HBYC) program,  home  visits  are  performed  by ASHAs  to  improve  child rearing  practices and to identify  sick  new-born  and  young  children  in  the community for referral to health facility.
- Janani Shishu Suraksha Karyakram (JSSK): Sick infants up to one year of age are entitled to free treatment in public health institutions along with the provision of free transport, diagnostics, medicines, blood and consumables.
- Universal Immunization Programme (UIP) is implemented to provide 11 vaccines to protect children against 12 preventable diseases.
- Social Awareness and Actions to Neutralize Pneumonia Successfully (SAANS) initiative  has  been  implemented  since  2019  for  reduction  of childhood morbidity and mortality due to Pneumonia.
- STOP Diarrhoea initiative  is  implemented for promoting use of ORS and Zinc and for reducing morbidity and mortality due to childhood diarrhoea.
- Rashtriya Bal Swasthya Karyakram (RBSK): Children from 0 to 18 years of  age  are  screened  for  32  health  conditions  (i.e. Diseases,  Deficiencies, Defects and Developmental delay) under Rashtriya Bal Swasthya Karyakram (RBSK) to improve child survival. District Early Intervention Centres (DEICs) at district health facility level are established for confirmation and management of children screened under RBSK.

Besides  this, the Ministry of Health and  Family Welfare is  implementing Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N)  strategy  in  a  life  cycle  approach  under  National  Health  Mission (NHM),  which  includes  interventions  to  address  undernutrition  all  across  the country and activities undertaken to address undernutrition as placed below:

- Anemia  Mukt  Bharat  (AMB) strategy  is  implemented  to  reduce  anemia among six beneficiaries age group  - children (6-59 months), children (5-9 years),  adolescents  (10-19  years),  pregnant  and  lactating  women  and  in women  of  reproductive  age  group  (15-49  years)  in  life  cycle  approach through implementation of six interventions via robust institutional mechanism.
- Nutrition Rehabilitation Centers (NRCs) are set up at public health facilities to provide in-patient medical and nutritional care to children under 5 years suffering from Severe Acute Malnourishment (SAM) with medical complications.
- Mothers'  Absolute  Affection  (MAA)  Programme is  implemented  to improve breastfeeding coverage which includes early initiation of breastfeeding and exclusive breastfeeding for first six months followed by counselling  on  age-appropriate  complementary  feeding  practices  through ASHA workers during mother's meetings and health care provider at health facilities.
- Under National Deworming Day (NDD) albendazole tablets are administered  in  a  single  fixed  day  approach  via  schools  and Anganwadi centres in two rounds (February and August) to reduce the soil transmitted helminth (STH) infestation among all children and adolescents (1-19 years).
- Village Health Sanitation and Nutrition Days (VHSNDs) are observed for provision of maternal and child health services and creating awareness on maternal and child care including nutrition in convergence with Ministry of Women and Child Development.

Under  National  Health  Mission  (NHM),  Government  of  India  has  taken  various initiatives to improve maternal and child health services across all States and Union Territories including the rural areas in Punjab, which are as follows:

- Janani  Suraksha Yojana  (JSY) is  a  demand  promotion  and  conditional cash   transfer scheme for promoting institutional delivery.
- Janani Shishu Suraksha Karyakram (JSSK) entitles all pregnant women and sick infants (up to one year of age) delivering in public health institutions to  have  absolutely  free  and  no  expense  delivery,  including  caesarean section. The entitlements include free drugs, consumables, free diet during stay,  free  diagnostics,  free  transportation  and  free  blood  transfusion,  if required. Similar entitlements are also in place for sick infants up to one year of age.
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed day, free of cost, assured and quality antenatal check up by a Specialist/Medical Officer on the 9th day of every month.
- Extended PMSMA strategy ensures quality antenatal care (ANC) to pregnant  women,  especially  to  high-risk  pregnant  (HRP)  women  and individual  HRP  tracking  until  a  safe  delivery  is  achieved  by  means  of financial  incentivization  for  the  identified  high-risk  pregnant  women  and accompanying ASHA for extra 3 visits over and above the PMSMA visit.
- Village Health Sanitation and Nutrition Days (VHSNDs) are observed for provision of maternal and child health services and creating awareness on maternal and child-care including nutrition in convergence with Ministry of Women and Child Development.
- Outreach camps are  provisioned  for  improving  the  reach  of  health  care services especially in tribal and hard to reach areas. This platform is used to increase the awareness for the Maternal & Child health services, community mobilization as well as to track high-risk pregnancies.
- Mother and Child Protection (MCP) Card and Safe Motherhood Booklet are  distributed  to  the  pregnant  women  for  educating  them  on  diet,  rest, danger signs of pregnancy, benefit schemes and institutional deliveries.
- Regular  IEC/BCC is  also  a  part  of  all  the  schemes  for  greater  demand generation. Health and nutrition education through mass and social media is also promoted to improve healthy practices and to generate demand for service uptake.

Mission Saksham Anganwadi and Poshan 2.0 is a Centrally Sponsored Scheme and the  implementation  of  the  scheme  falls  under  the  ambit  of  State  Government/  UT Administration. The Scheme aims to address the challenge of child malnutrition and maternal under-nutrition  through  proper  nutrition  content  and  its  delivery.  It  further aims  to  create  conditions  and  a  convergent  eco-system  to  develop  practices  that nurture health, wellness and immunity.

This  Ministry  continuously  monitors  the  implementation  of  Mission  2.0  through sustained engagement with the States/UTs through Video Conferences, meetings and through Online Poshan Tracker System.

Since Anganwadi Services is a Centrally Sponsored Scheme and the implementation and monitoring of the Scheme including service-related matters fall under the ambit of concerned  States/  UTs,  all  grievances/complaints  are  forwarded  to  the  concerned States/UTs for taking necessary action.

Ministry has issued guidelines to all States/UTs on 13.01.2021 to streamline several aspects  such  as  quality  assurance,  roles  and  responsibilities  of  duty  holders, procedure for procurement, integrating AYUSH concepts and data management and monitoring through 'Poshan Tracker' for transparency, efficiency and accountability in the delivery of Supplementary Nutrition.

Under the guidelines, the District Magistrate (DM) has been designated as the Nodal Point  in  the  district  for  monitoring  nutritional  status  of  beneficiaries  and  quality standards. A District Nutrition Committee under the chairpersonship of DM/Collector with certified nutrition experts as members has been constituted to review the progress every month.

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