National nutrition mission

NITI AYOG / MWCD launched National nutrition mission in 2018

1. Dr SEEMA VERMA
Department of Community medicine
PGIMS Rohtak
Haryana INDIA

2. POSHAN ABHIYAAN
Background
Global Overview -nutrition
Levels and trends in children undernutrition-Global and Indian
Need of NNM, its important functions
Implementation: structure,institutesand components
Convergence and Real time monitoring
Recent ongoing activity: national nutrition month
Conclusion

3. Background
•Undernutrition-Consequenceandcauseofperpetuating poverty,anderoding
humancapital.
•Nutritionalstatusof themost vulnerable age group of children is a sensitive proxy
indicator of human development and of national socio-economicdevelopment
strategies
•InvestmentinNutritionisgloballyrecognized.
•GlobalNutritionReport2015–forinvestmentinnutrition
–thebenefitcostratio–16:1for40lowandmiddle-incomecountries.
•NFHS-4–declineintheoverall levelsofundernutritioninwomenandchildren.
•High levels of maternal and child under-nutrition still persist,
–despite strong constitutional legislative policy, planandprogrammes.

11. 24-06-2018 6

12. Nutritional status of India
Every 2
nd
Woman is Anemic
Every 3rd Child is Stunted
Every 5th Child is Wasted
Moreover,
o37 out of 1000 babies do not complete
one year
o167 maternal deaths per 1,00,000 live
births
UNDP in India. (2018).Human Development Report 2016 -Human Development for Everyone.

13. Below25%
25-35%
Above35%
Underweightchildren
(% of children below 5years)
Source: NFHS-4,2015-16
Bestperformance
Bottom 3States
Mizoram 11.9
Manipur 13.8
Sikkim 14.2
MadhyaPradesh 42.8
Bihar 43.9
Jharkhand 47.8

14. Below25%
25-35%
Above35%
Source: NFHS-4,2015-16
Nutrition: High prevalence ofstunting
Stunting
(% of children below 5years) Bestperformance
Bottom 3States
Meghalaya 43.8
Jharkhand 45.3
Bihar 48.3
Kerala 19.7
Goa 20.1
Tripura 24.3

16. Districts with Highest Prevalence of ChildStunting

17. Districts with Highest Prevalence of ChildStunting

18. Source:Internationalfoodpolicyresearchinstitute,2017
24-06-
2018
1
8

20. Overall, the anemia among women and girls has stagnated from 55.3% in NFHS-3 to 53% in NFHS-4.
States which have witnessed maximum decrease in the levels of anemia are-
Sikkim (24.6), Assam (23.3), Mizoram (15.6), J&K (11.7), Tripura (10.6) and Chhattisgarh by 24.6 (10.5).
8 States/ UTs (Punjab, Himachal Pradesh, Meghalaya, Delhi, Haryana, Uttar Pradesh, Tamil Nadu and Kerala) have seen an increase

21. 24-06-2018 15
Source:Raietal.Theburdenofiron-deficiencyanaemiaamongwomeninIndia:howhaveironandfolicacid
interventionsfared?.WHOSouth-EastAsiaJournalofPublicHealth.2018;7(1):18-23.

22. Overall decreased in india.max decrease in assam,Mizoram,chhatisgarh,Manipur,Meghalaya,Arunachal
pradesh,Maharastraand
.Delhi,Goa,HaryanaIncrease

24. Need of NNM
•Acc. to Global Hunger Index(2017) India holds 100
th
rank. Even
Nepal, Myanmar, Bangladesh and Sri lankaare in better
position than India.
•As per UNDP 2016 report India ranked at 131 out of 188
countries in terms of Human Development Index(HDI)
•Internationally, we stand at Rank 114 (out of132 countries) in
Stunting, 120 (out of 130 countries) in Wasting and 170 (out of
185 countries) in Prevalence of Anaemiain Women in the
Reproductive AgeGroup

25. Total overall difference in 10 yrs
Declined (per year)
Anaemia 0.8%
Low Birth Weight 1.2%
Stunting 1%
Increased
Wasting in under-five Increased
SAM Increased

26. Introduction
•The Mission aims to reduce mal-nourishment from the Country
in a phased manner, through the life cycle concept, by
adopting a synergized and result oriented approach.
•The Mission will ensure mechanisms for timely service delivery
and a robust monitoring as well as intervention infrastructure.
•Target of Mission is to bring down stunting of the children in
the age group of 0-6 years from 38.4% to 25% by the year 2022

27. Introduction
But WCD is primarily responsible for implementation of NNM.
Draft was prepared by
NITI Aayog, WCD & MoHFW.
But officially it was launched on 8
th
March,2018
from Jhunjhunu(Rajasthan) by honorable PM Modiji.
Setting up of National Nutrition Mission (NNM)
Approved on30.11.2017 (Approval by cabinet).

28. National Nutrition Mission (NNM) Launched
Total funding: Rs.9046.17crore
Pan India Coverage in a Phased Manner
1
st
Phase: 315 districts (including 201 districts
identified by NITI) in 2017-18
Mission as ‘Jan Andolan’

29. •The NNM would primarily be a monitoring and reviewing body
for taking stock of monitorableindicators of nutrition centric
schemes/programmesrequiring convergent actions for better
and effective delivery to the targeted beneficiaries.
•In doing so, it would not impinge on the operational authority
of any of the participating Ministry/Department or
Autonomous body.

30. NNM | Goal andObjectives
m

31. NNMGoal andObjectives
•Although target is to reduce stunting at least 2% p.a.
•Mission would strive to achieve reduction in stunting from 38.4% to 25%
by 2022.(MISSION 25 BY 22).

32. Trends in key global nutrition targets and nutrition outcomes in
Haryana, 2005-06 to 2015-16
Source: NFHS-3; NFHS-4 and RSOC for low birth weight
45.7 56.1 16.9 19.1 32.734.0 62.7 50.3
21.2
20.9
0
10
20
30
40
50
60
70
80
90
100
Stunting (among children <5 years)Anemia among women of reproductive
age
Exclusive breastfeeding Wasting (among children <5 years) Low birth weight
Percentage (%)
Haryana 2006 Haryana 2016
WHA Nutrition Target level
India 2006 India 2016
for Haryana
George et al., 2017 (IFPRI))

33. Why NNM is needed? What are wedoing?

34. 24-06-
2018
8

35. What are thegaps?
Priority If malnutrition is defined as a priority, States, Districts will devise localstrategies
Data 10 year gap between NFHS 3 and NFHS 4- we need credible year-on-yeardata
Technical
Support
for emerging issues-decision just taken to
set-up a group underMember
NITIAayog
Monitoring
systems-
Manual-
therefore Aanganwadior District level datas
neveranalyzedforreal timeinterventions.
Incentives
At this point, incentives aligned to procuring
and serving food,
notreducing malnutrition.

36. AnganwadiServices
PradhanMantriMatruVandana
Yojana, Scheme for Adolescent
Girls of MWCD
JananiSurakshaYojana
(JSY), National Health Mission
(NHM) of MoH&FW
SwachhBharat Mission of
Ministry of Drinking Water &
Sanitation (DW&S)
Public Distribution System
(PDS) of Ministry of
Consumer Affairs, Food &
Public Distribution (CAF&PD)
Mahatma Gandhi National Rural
Employment Guarantee Scheme
(MGNREGS) of Ministry of Rural
Development (MoRD)
Drinking Water & Toilets with
Ministry of PanchayatiRaj and
Urban Local Bodies through
Ministry of Urban Development.
Need of NNM
•The Mission is: convergence of all nutrition
related schemes of MWCD on the target
population.

37. Implementation strategy
•Would be based on intense monitoring and CAP right uptothe Grass root Level
•NNM will be rolled out in all states and UTs in three phases.
Year States/districts to becovered
2017-18
315commondistrictsidentifiedinthedescendingorderofprevalenceofstunting
fromamongst201districtsidentifiedbyNITIAayogonthebasisofNationalFamily
HealthSurvey-4data,162SSNIPdistrictsand106districtsofSchemefor
AdolescentGirls.
2018-19
235districtsbasedonthestatusofunder-nutritioninvariousStates/UTstobe
identified generally based on prevalence ofstunting.
2019-20
Remaining districts of all 36States/UTs.

38. Important Features of NNM
NNM will act as APEX BODY, will monitor, supervise and fix targets
and guide the nutrition related interventions across the ministeries.
Mapping of various schemes addressing malnutrition.
Introducing robust converging mechanism.
ICT based real time monitoring system.
Incentivising states/UTs meeting targets.
Incentivising AWWs using IT based tools.
Introducing height measurement by AWWs at AWCs.
Social audits.
Setting up Nutrition Resource Centres.
JAN ANDOLAN (involving masses for participation on nutrition,through various activities).

39. National Council on Nutrition Challenges
•A National Council has been established on dated 3rd
January, 2018 and has following function:-
–Provide policy directions to address India’s nutritional challenges
through coordinated inter-sectoralaction.
–Coordinate and review convergence between Ministries.
–Review programmesfor nutrition on a quarterly basis.
•The Council shall submit its report to the Prime Minister
every 6 months

40. Structure of National Council on NutritionChallenges

41. Executive Committee
•Will report to the National Council on India’s Nutrition
Challenges
•Will be the Apex body for
–nutrition related activities (for Children below six years
age, Adolescent Girls and Pregnant Women and Lactating Mothers)
–providing direction, policy and guidance for implementation of
various programmes/schemes under the NNM.
•The Executive Committee shall meet every three months.

42. Institutional
arrangement
PMNutritionCouncil
NationalLevel
•NNMSG&EPC
•NationalNutritionMissionDirectorate
•NationalNutritionMissionResourceCentre
Direction,Polic
yandGuidance
StateLevel
•StateMissionSteeringGroup(SMSG)
•StateEmpoweredProgrammeCommittee(SEPC)
Mobilizeand
provide
addition
resources
BlockLevel&VillageLevel
UnitforState
Nutrition
Society
DistrictLevel
•DistrictNutritionMission
Nutrition
related
activities
Representation
fromStates/UTs
24-06-
2018 NNMSG–NationalNutritionSteeringGroup,EPC-EmpoweredProgrammeCommittee
53

43. InstitutionalArrangement-functions
NationalNutrition
MissionSteering
Group(NNMSG)
•Meetoncein6
months
•Functions:
•Approvalforpolicy
programme
•Ensureeffective
convergence
•AdviceEPC
Empowered
Programme
Committee(EPC)
•Meetoncein3
months
•Functions:
•Planandmonitor
•Framerulesand
procedure
•Approveannual
plans
•Trackprogress
NationalNutrition
Mission
Directorate
-Tocarryout
functionsmandated
byNNMSG/EPC
NationalNutrition
MissionResource
Centre
24-06-
2018
4
3
-Provide
Technical
Assistance
National
Level

44. InstitutionalArrangement-functions
StateLevel
-SMSGandSEPC
-Mobilizeandprovide
additionalresourcestothe
States/UT’s to enable them
tomeetdiversenutrition
needs
DistrictLevel
-Servesasadistrict
unitofstatenutrition
society
BlockLevel
-BlockMissionCommittee
VillageLevel
-VillageHealth
SanitationandNutrition
Committee(VHSNC):Co-
ordinatingnutritional
relatedactivities
24-06-
2018
4
4
-Anganwadi:
promoting
MCH,nutritionand
developmentactivities

45. Course ofAction

46. Components of NNM

47. NNM | Key Interventions

48. Convergence(ProgrammesandMinistry)
MWCD
•-ICDS
•-PMMVY
•-SABLA
MoHFW
-NationalHealthMission
-RMNCH+A
MDWS
•-SwachhBharatMission
•-Nationalruraldrinkingwater
programme
MoWCD–Ministryofwomenandchilddevelopment;MoHFW–MinistryofHealthandfamilywelfare; 3624-06-2018
MDWS–Ministryofdrinkingwaterandsanitation;

49. MCAFPD,MA,MHRD
•-Targetedpublicdistributionsystem
•-NationalfoodsecurityMission
•-Middaymeals,Agriculture
MSD,MRD
-Skilldevelopment,NRLM
-MGNREGA
MHRD,MWCD
•-SarvaShikshaAbhiyan
•-SaksharBharat
•-BetiBachaoBetiPadhao
MCAFPD–Ministryofconsumeraffairsfoodandpublicdistribution;MA-MinistryofAgriculture;MHRD–MinistryofHumanresource 3724-06-2018
development;MSD–Ministryofskilldevelopmentandentrepreneurship;MRD-Ministryofruraldevelopment
Convergence….

50. Convergence….
MI&B–Ministryofinformationandbroadcasting;MPR-MinistryofPanchayatiraj;MUD–MinistryofUrbanDevelopment;
MI&B,MPR,MUD,MYAS
•-InformationCampaigns
•-TrainingofPRIs,UrbanLocalBodies
•-YouthInitiatives
MTA,MSJE,MMA
-Focusedinterventionsforvulnerable
groups
-Multi-sectoralDevelopmentProgramme
MWCD
•-NationalNutritionMission
3824-06-2018
MTA–Ministryoftribalaffairs;MSJE-Ministryofsocialjusticeandempowerment;MMA-Ministryofminorityaffairs

53. INFORMATION COMMUNICATION TECHNOLOGY (ICT) –REAL TIME MONITORING(RTM)
Use of ICT Interventions for addressing Undernutrition
Ministry of WCD has rolled out ICT interventions to strengthen the Service Delivery System and
create mechanism for Real Time Monitoring (RTM) for nutritionaloutcomes

57. THANKYOU