Nutritional problems and National Nutritional progams in India

This Presentation is about the nutritional Problems in India and National Nutritional Programmes

1. Nutritional Problems and Nutritional Programmes in India BY MRS.NAGAMANI.T, MSc (N)

2.   Nutritional problems in India National Nutritional Programmes National nutritional policy National Nutritional Monitoring Bureau Contents:

3. List out the causes of nutritional problems Understand the nutritional problems in India Know about the National Nutritional Programmes in India Gain knowledge about the national nutritional policy Objectives:

4. India is the second most populous country in the World next to China. Among its population majority of the people belongs to rural community and they are from low socio-economic status, illiteracy and lack of basic human needs. From the nutritional point of view majority are undernourished and only a small group are well-fed. The high income groups are suffering from the diseases of over nourishment. Introduction

5. MAJOR NUTRITIONAL PROBLEMS IN INDIA Nutritional deficiency is any deficiency of the nutrients that are required to sustain human life. - Nutritional deficiencies occur when a person's nutrient intake consistently falls below the recommended requirement.  - Children between 10–19 years of age face serious nutritional deficiencies worldwide, according to the World Health Organization.

6. Low socio economic status Illiteracy Lack of awareness regarding nutrients and their requirement Over population Decreased food production Lack of health care facilities Large families Cultural influences Infections Over nourishment among the group of high socio economic status Superstitious beliefs, misconceptions Limited availability/ inadequacy of food products Dietary practices etc. The specific causes for nutritional deficiency disorders are:

7. Protein Energy Malnutrition (PEM), Nutritional Anaemia Iodine Deficiency Disorder (IDD), Vitamin-A deficiency Low birth weight Endemic fluorosis Lathyrism Market Distortion Cardio Vascular Diseases Cancer etc. Major nutritional problems in India are

8. Malnutrition is a significant loss of lean tissue or inadequate diet for a prolonged period in the setting of severe stress. It is a significant component of many diseases. Malnutrition is more common in India. One in every three malnourished children in the world lives in India. Malnutrition limits development and the capacity to learn. It also costs lives: about 50 per cent of all childhood deaths are attributed to malnutrition. 1. Protein Energy Malnutrition  

9. In India, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished. The prevalence of malnutrition varies across states, with Madhya Pradesh recording the highest rate (55 per cent) and Kerala among the lowest (27 per cent).

10. Every age group is vulnerable to iron-deficiency anaemia . In children, anaemia can cause a 5-10 point deficiency in IQ and hamper growth and language development. In adolescents, it leads to a fall in academic performance with a dip in memory and concentration levels. It can also lead to physical exhaustion and susceptibility to infection. Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3% has hemoglobin <7 gm./dl; severe anemia) and 85% pregnant women (9.9% having severe anemia. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia. 2. Anaemia

11. One in every two Indian women (56%) suffers from some form of anaemia 4 out of every 5 children in the age of 6-35 months suffer from anaemia 20% of the maternal deaths are due to anaemia and anaemia indirectly contributes to another 40% of maternal deaths Maternal mortality staggeringly high at 454 per every 100,000 live births Results not commensurate with the 30 years of efforts by the Indian government The current situation in India is:

12. Vitamin A is necessary for good eyesight. In children, Vitamin A deficiency causes loss of eyesight. If this deficiency is very severe, it may lead to permanent blindness.   In our country every year 30, 000 children lose eye sight due to Vitamin A deficiency. Vitamin A deficiency symptoms are seen more severely in children of age group 1 to 5 years. It is estimated that there are 12.5 million economically blind persons in India. Of these over 80 per cent of blindness is due to cataract. 3. Vitamin ‘A’ deficiency

13. Iodine Deficiency Disorders (IDD) has been recognized as a public health problem in India since mid-twenties. IDD is not only a problem in sub-Himalayan region but also in riverine and coastal areas. According to Union Ministry of Health it is estimated that 71 million populations are suffering from endemic goitre and about 8.8 million people have mental/motor handicap due to iodine deficiency. Statistics furnished by the ministry of health and family welfare in its report tabulated during 2011 revealed that 1.3 crore people in UP alone were suffering from IDD. The figures of Madhya Pradesh and Bihar stood at 0.82 crore and 0.62 crore respectively. The spread of IDD is far and wide with poverty being a key driver. 4. Iodine Deficiency Disorders

14. More than 20 million infants are born each year weighing less than 2,500 grams (5.5 pounds), accounting for 17 per cent of all births in the developing world – a rate more than double the level in industrialized countries (7 per cent). Infants with low birth weight are at higher risk of dying during their early months and years. Those who survive are liable to have an impaired immune system and may suffer a higher incidence of such chronic illnesses as diabetes and heart disease in later life. 5. Low birth weight

15. Fluorosis is a disease caused due to excessive ingestion of fluoride. Fluorides are the compounds of fluorine. Fluorine is the 13th most abundant element available in the earth crust. As the surface water passes through the fluoride rich rocks it carries fluoride with it, hence most of the fluoride is found in ground water than surface water. Permissible limit of fluoride:WHO is only 1.0 mg/L as a safe limit for human consumption whereas several districts of Rajasthan India are consuming water with fluoride concentrations of up to 24 - 44 mg/l. 6. Flurosis

16. In India, the problem has reached alarming proportions affecting at least 17 states of India. Out of those 5 are hyper endemic, where 50-100% districts are affected viz. Andhra Pradesh, Tamil Nadu, Uttar Pradesh, Gujarat, Rajasthan. In Rajasthan the Banka Patti area has been identified in Nagaur district.

17. Lathyrism disease occurs by consuming large quantities of Lathyrus sativus ( Kesari dhal) Lathyrism in human is referred as Neurolathyrism . The disease presents as Crippling disease of nervous system characterized by gradually developing spastic paralysis of lower limbs. It contains a toxin called Beta oxalyl amino Alanine (BOAA) Lathyrus Kesari Dhal) is good source of protein. It is relatively cheaper. 7. Lathyrism

18. An economic scenario that occurs when there is an intervention in a given market by a governing body. The intervention may take the form of price ceilings, price floors or tax subsidies. Market distortions create market failures, which is not an economically ideal situation. There is a tradeoff that regulators must make when deciding to intervene in any given marketplace. Although the intervention will create market failures, it is also intended to enhance a society's welfare. 8. Market Distortion

19. For example, many governments subsidize farming activities, which makes farming economically feasible for many farmers. The subsidies paid to farmers create artificially high supply levels, which will eventually lead to price declines if the goods are not subsequently purchased by the government or sold to another nation. Although this type of intervention is not economically efficient, it does help ensure that a nation will have enough food to eat.

20. It is the most Prevalent form of malnutrition. Abnormal growth of adipose tissue due to enlargement of fat cells(Hypertrophic), Increase in no. of fat cells (hyperplasic)or Combination of both. India is now in the grip of obesity epidemic and the trend needs to be immediately arrested by taxing junk food, restricting food ads and making food labeling clearer etc. Currently, almost 1 in 5 men and over 1 in 6 women are overweight. In some urban areas, the rates are as high as 40%. 9. Obesity

21. Cardio Vascular diseases Classified as one of the Food habit related Illness. Change in food habits and lifestyle has increased the risk of CVD in Indian population mostly in Middle Class and upper middle class groups. The World Health Organisation (WHO) and reports published in medical journals like Lancet and Indian Heart Journal, suggest that by 2010 there would be close to 100 million cardiac patients in India. It is 30 million now. WHO has also estimated that by 2010, India will have 60% of world's cardiac patients, and in another five years it is likely to become the world capital for heart ailment. 10. Cardio Vascular diseases

22. On an average, about 2 million patients in India currently undergo cardio-vascular surgical procedure every year. "Unless we are able to predict and detect cardiac disease in high-risk patients, the situation will only aggravate," warns Dr Rabin Chakraborty , chief of cardiology, Apollo Gleneagles Hospital. While 4% of the Indian population suffered from heart diseases in 1980, it rose to 10% in 2003. Deaths due to heart ailments also increased from 14 deaths per one lakh people in 1985 to 260 deaths per one lakh people in 2003.

23. Recent times have seen an increase in the incidence of cancer. This is mainly attributed to urbanization, industrialization, lifestyle changes, population growth and increased life span (in turn leading to an increase in the elderly population). In India, the life expectancy at birth has steadily risen from 45 years in 1971 to 62 years in 1991, indicating a shift in the demographic profile. It is estimated that life expectancy of the Indian population will increase to 70 years by 2021–25. This has caused a paradigm shift in the disease pattern from communicable diseases to non-communicable diseases like cancer, diabetes and hypertension. 11. Cancer

24. Cancer prevalence in India is estimated to be around 2.5 million, with over 8,00,000 new cases and 5,50,000 deaths occurring each year due to this disease. More than 70% of the cases report for diagnostic and treatment services in the advanced stages of the disease, which has lead to a poor survival and high mortality rate.

25. 80 % of cancer occurs due to environmental factors Dietary fat – positive correlation with Colon cancer, breast cancer Dietary fiber – Risk of colon cancer is inversely related Micro nutrients – Lack of Vitamin C & Vitamin A arise the risk of stomach cancer and lung cancer. Food additives – Saccharin, cyclamate, Coffee, aflatoxin associated with bladder cancer Alcohol – liver cancer, Rectal Cancer etc,.

26. The government of India has launched many nation wide health programs to improve and restore the health status of the vulnerable population such as infants, preschoolers, school children, antenatal and postnatal mothers etc. Currently major nutrition supplementation programmes in India are: 1) Integrated Child Development Services Scheme (ICDS); 2) Mid-day meal Programs (MDM); 3) Special Nutrition Programs (SNP); MAJOR NUTRITIONAL PROGRAMMES IN INDIA

27. 4) Wheat Based Nutrition Programs (WNP); 5) Applied Nutrition Programs (ANP); 6) Balwadi Nutrition Programs (BNP); 7) National Nutritional Anaemia Prophylaxis Program (NNAPP); 8) National Program for Prevention of Blindness due to Vitamin A Deficiency; and 9) National Goiter Control Program (NGCP). 10) Tamil Nadu Integrated Nutrition Programme 11) Antyodaya anna yojana 12) Other Programmes

28. Integrated Child Development Service (ICDS) scheme was launched on 2nd October, 1975 (5th Five year Plan) in pursuance of the National Policy for Children in 33 experimental blocks. Success of the scheme led to its expansion to 2996 projects by the end of March 1994. Now the goal is to universalisation of ICDS throughout the country. 1. Integrated Child Development Services Scheme (ICDS)

29. The primary responsibility for the implementation of the programme is with the Department of Women and Child Development, Ministry of Human Resources Development at the Centre and the nodal departments at the state which may be Social Welfare, Rural Development, Tribal Welfare, Health & Family Welfare or Women and Child Development. Beneficiaries 1.Children below 6 years 2. Pregnant and lactating women 3. Women in the age group of 15-44 years 4. Adolescent girls in selected blocks The Ninth Five Year Plan aim to universalise the ICDS i.e. coverage to the whole country.

30. Objectives Improve the nutrition and health status of children in the age group of 0-6 years; Lay the foundation for proper psychological, physical and social development of the child; Effective coordination and implementation of policy among the various departments; and Enhance the capability of the mother to look after the normal health and nutrition needs through proper nutrition and health education.

31. The Package of services provided by ICDS are: Supplementary nutrition, Vit -A, Iron and Folic Acid, Immunisation , Health check-ups, Referral services, Treatment of minor illnesses, Nutrition and health education to women, Pre-school education of children in the age group of 3-6 years, and Convergence of other supportive services like water supply, sanitation, etc.

32. Scheme for Adolescent Girls ( Kishori Shakti Yojna ) 1991 Common Services: All adolescent girls in the age group of 11-18 years (70%) received the following common services: 1. Watch over menarche, 2. Immunisation , 3. General health check-ups once in every six-months, 4. Training for minor ailments, 5. Deworming , 6. Prophylactic measures against anemia, goiter, vitamin deficiency, etc. and 7. Referral to PHC.District hospital in case of acute need.

33. The Midday Meal Scheme is the popular name for school meal programme in India which started in the 1960s . It involves provision of lunch free of cost to school-children on all working days. Objectives Protecting children from classroom hunger, Increasing school enrolment and attendance, Strengthening child nutrition and literacy Improved socialisation among children belonging to all castes , Addressing malnutrition, and Social empowerment through provision of employment to women. 2. Mid-day meal Programs (MDM)

34. Beneficiaries Children attending the primary school. Children belonging to backward classes, scheduled caste, and scheduled tribe families are given priority. The Scheme covers students (Class I-V) in the Government Primary Schools / Primary Schools aided by Govt. and the Primary Schools run by local bodies.

35. Food grains (wheat and rice) are supplied free of cost @ 100 gram per child per school day where cooked/processed hot meal is being served with a Minimum content of 300 calories and 8-12 gms of protein each day of school for a minimum of 200 days and 3 kgs per student per month for 9-11 months in a year, where food grains are distributed in raw form.  In drought affected areas the mid day meal is distributed in summer vacations also.

36. The programme was launched in the country in 1970-71 to improve the nutritional status of specific target groups. It provides supplementary feeding of about 300 calories and 10 grams of protein to preschool children and about 500 calories and 25 grams of protein to expect at and nursing mothers for six days a week. Objectives Improve the nutritional status of specific target groups. Provides supplementary nutrition and health care services. Supply of Vitamin ‘A’ solution, iron and folic acid tablets. Beneficiaries Children under 6 years and Pregnant and lactating mothers. 3. Special Nutrition Program (SNP)

37. The program is operated in the urban slums, tribal areas, backward rural areas. Supplementary nutrition is provided for 300 days every year. Children under 6 years – 300kcal, 10-12g protein, Pregnant and lactating women – 500kcal, 25g protein. Now the special nutrition program is integrated with the ICDS (Integrated Child Development Services)

38. Wheat based nutrition programme is a centrally sponsored programme was introduced in 1986 but now transferred to the State Sector. This programme follows the norms of SNP or of the nutrition component of the ICDS. Central Assistance for the programme consists of supply of free wheat and supportive costs for other ingredients, cooking, transport etc. This Scheme is implemented by the Ministry of Women & Child Development. 4. Wheat Based Nutrition Programs /WNP

39. Objectives Supply of free wheat and other ingredients Providing nutritious and energy food for disadvantaged sections Improving the nutritional status. Beneficiaries 1. Children below 6years of age (pre school age) 2. Expectant and lactating mothers.

40. The Applied Nutrition Programme (ANP) was introduced as a pilot scheme in Orissa in 1963 which later on extended to Tamil Nadu and Uttar Pradesh.   Objectives   1) Promoting production of protective food such as vegetables and fruits. 2) Make people conscious of their nutritional needs and 3) Provide supplementary nutrition to children aged between 3-6 years and to pregnant and lactating mothers.   Beneficiaries Children between 2-6 years and Pregnant and lactating mothers. 5. Applied Nutrition Programs (ANP)

41. During 1973, it was extended to all the state of the country. The nutritional Education was the main focus and efforts were directed to teach rural communities through demonstration how to produce food for their consumption through their own efforts. Nutrition worth of 25 paise per child per day and 50 paise per woman per day are provided for 52 days in a year. No definite nutrient content has been specified. The idea is to provide better seeds and encourage kitchen gardens, poultry farming, beehive keeping, etc., but this programme does not produced any impact. The community kitchens and school gardens could not function properly due to lack of suitable land, irrigation facilities, and low financial investment.

42. Balwadi Nutrition Program (India) was introduced in 1970 to provide nutritional support to children. It is under the control of the Department of Social Welfare. 4 National level organisations (including Indian Council of Child Welfare) are given grants as a part of this program. The voluntary organisations that receive the grants are responsible for the running of this program The program is implemented through Balwadis – they provide education and nutritional support.Food supplement provides 300kcal and 10g proteins. Balwadi nutrition program is being phased out in favour of the Integrated Child Development Services (ICDS) 6.Balwadi Nutrition Programs (BNP)

43. Objectives Supply about one-third of the calorie and half of the protein requirements of pre-school children between the age of 3-5 years Improve the nutritional status. Beneficiaries 1. Children of 3-6 years of age in rural areas

44. The programme was launched in 1970 to prevent nutritional anemia in mothers and children. This programme is being taken up by Maternal and Child Health (MCH), Division of Ministry of Health and Family Welfare. Now it is part of RCH programme . Beneficiaries Children in the age group of 1-5 years Pregnant and nursing mothers. Female acceptors of IUDs and terminal methods of family planning. 7 . National Nutritional Anaemia Prophylaxis Program (NNAPP)

45. Under this programme , the expected and nursing mothers as well as acceptors of family planning are given one tablet of iron and folic acid containing 60 mg elementary iron which was raised to 100 mg elementary iron, however folic acid content remained same (0.5 mg of folic acid) and children in the age group of 1-5 years are given one tablet of iron containing 20 mg elementary iron (60 mg of ferrous sulphate and 0.1 mg of folic acid) daily for a period of 100 days.

46. Highlights of the 11nth Five year Plan are: The infants between 6-12 months should be included in the programme as there is sufficient evidence that iron deficiency affects this age also.   Children between 6 months to 60 months should be given 20mg elemental iron and 100 mcg folic acid per day per child as this regimen is considered safe and effective.   National IMNCI guidelines for this supplementation to be followed.    

47. For children (6-60 months), ferrous sulphate and folic acid should be provided in a liquid formulation containing 20 mg elemental iron and 100mcg folic acid per ml of the liquid formulation. For safety reason, the liquid formulation should be dispensed in bottles so designed that only 1 ml cab be dispensed each time. Dispersible tablets have an advantage over liquid formulations in programmatic conditions. These have been used effectively in other parts of the world and in large scale Indian studies. The logistics of introducing dispersible formulation of Iron and Folic Acid should be expedited under the programme .  

48. The current programme recommendations for pregnant and lactating women should be continued.   School children, 6-10 year old, and adolescents, 11-18 year olds, should also be included in the National Nutritional Anaemia Prophylaxis Programme   (NNAPP).   Children 6-10 year old will be provided 30 mg elemental iron and 250 mcg folic acid per child per day for 100 days in a year.   Adolescents, 11-18 years will be supplemented at the same doses and duration as adults. The adolescent girls will be given priority.   Multiple channels and strategies are required to address the problem of iron deficiency anaemia . The newer products such as double fortified salts / sprinkles / ultra rice and other micro nutrient candidates or fortified candidates should be explored as an adjunct or alternate supplementation strategy.

49. It is estimated that there are 12.5 million economically blind persons in India. Of these over 80 per cent of blindness is due to cataract. The National Blindness Control Programme started in 1976 as 100 per cent centrally sponsored programme. The National Prophylaxis programme for prevention of blindness due to Vitamin ‘A’ deficiency is implemented through Primary Health centers and its sub centers. 8. National Program for Prevention of Blindness due to Vitamin A Deficiency

50. They are responsible for administering Vitamin ‘A’ concentrates to children less than 5 years. Every infant between 6- 11 months and children in-between 1-5 years are to be administered Vitamin ‘A’ every six months. Priority should be given to children in-between 6 months and 3 years since they have the highest prevalence of clinical sign of Vitamin ‘A’ deficiency. A child must receive a total of 9 oral doses of Vitamin ‘A’ by his fifth birthday. The targets set up under Ninth-Plan are 17.5 million cataract operations and 100,000 corneal implants in between the period 1997-2002.

51. Beneficiaries 1. Children below 5 years of age. Objectives 1. Prevention of blindness due to Vitamin ‘A’ deficiency. 2. Supplementation of Vitamin ‘A’ to all the children below 5 years of age. 3. P roviding com­prehensive eye care services at primary, secondary and tertiary health care level and 4. Achieving substantial reduc­tion in the prevalence of eye disease in general and blindness in particular.

52. Iodine is an essential micronutrient with an average daily at 100-150 micrograms for normal human growth and development. Deficiency of Iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deaf mutism , squint & various types of goitre . It is estimated that more than 71 million persons are suffering from goitre and other Iodine Deficiency Disorders. 9. National Iodine deficiency disorder control programme (NIDDCP)

53. The Government is implementing the National Iodine Deficiency Disorders Control Programme ( NIDDCP) formerly known as National Goiter Control Programme (NGCP) since 1962 a 100% centrally assisted programme with a focus on the provision of Iodated salt, IDD survey/ resurvey, laboratory monitoring of Iodated salt and Urinary Iodine excretion, health education and publicity. The programme was initially called as " Goitre Control Programme " and was renamed by Govt. of India in 1992 as NIDDCP. The programme is monitored by the Deputy Director Health Services situated in the Directorate of Health Services, Mumbai.

54. Objectives Surveillance of Goitre cases Supply of iodized salt in place of common salt. Monitoring through analysis of salt and urine samples. Assessment of impact of control measures over a period of time. To monitor regular intake of iodized salt by people in ITDP blocks, estimation of urinary iodine levels has been initiated at the State Public Health Laboratory, Pune since the year 1996-97.

55. The Tamil Nadu Integrated Nutrition Project was started in 1980 targeting at 6-36 months old children, and pregnant and lactating women. TIMP aimed for: Objectives: To reduce malnutrition upto 50% among children under 4 years of age; To reduce infant mortality by 25%; To reduce Vit -A deficiency in the under 5 year from about 27% to 5%; and To reduce ammonia in pregnant and nursing women from about 55% to about 20%. 10. Tamil Nadu Integrated Nutrition Programme

56. This project has four major components: 1. Nutrition services, 2. Health services, 3. Communication, and 4. Monitoring and evaluation. The Goals of the programme were : 1) To increase the proportion of children classified as "nutritionally normal" by 50% in new and 35% in TINP-II areas; 2) To reduce the infant mortality to 55% per 1000 live births; and 3) To 50% reduction in incidence of low birth weight. The projects are assisted by World Bank and with the goal of universalisation of ICDs all the TINP blocks will be converted to ICDS blocks.

57. The “ Antyodaya Anna Yojana ” (AAY) was launched in December, 2000 for one crore poorest of the poor families. AAY contemplates identification of poorest of the poor families from amongst the BPL families covered under TPDS (Targeted public distribution system) within the States and providing them food grains at a highly subsidized rate of Rs.2/ per kg. for wheat and Rs. 3/ per kg for rice. The scale of issue that was initially 25 kg per family per month has been increased to 35 kg per family per month with effect from 1st April, 2002. The AAY Scheme has been expanded in 2003-2004 by adding another 50 lakh households from amongst the BPL families. 11. Antyodaya anna yojana

58. The following criteria will be adopted for identification of additional Antyodaya families: Landless agriculture labourers , marginal farmers, rural artisans/craftsmen such as potters, tanners, weavers, blacksmiths, carpenters, slum dwellers, and persons earning their livelihood on daily basis in the informal sector like porters, coolies, rickshaw pullers, hand cart pullers, fruit and flower sellers, snake charmers, rag pickers, cobblers, destitutes and other similar categories in both rural and urban areas. Households headed by widows or terminally ill persons/disabled persons/persons aged 60 years or more with no assured means of subsistence or societal support.

59. Widows or terminally ill persons or disabled persons or persons aged 60 years or more or single women or single men with no family or societal support or assured means of subsistence. All primitive tribal households. As announced in the Union Budget 2005-06, the AAY has further been expanded to cover another 50 lakh BPL households thus increasing its overage to 2.5 crore households.

60. Emergency feeding programme 2011 This was introduced in May, 2001 in selected states (Orissa) Emergency Feeding Programme , is a food-based intervention targeted for old, infirm and destitute persons belonging to BPL households to provide them food security in their distress conditions. Cooked food containing, rice- 200gms, Dal (pulse)- 40 gms , vegetables- 30 gms is provided in the diet of each EFP beneficiary daily by the Government. Other programmes include:

61. Village grain banks scheme :  Village Grain Bank Scheme implemented by the Ministry of Tribal Affairs to provide safeguard against starvation during the period of natural calamity or during lean season when the marginalized food insecure households do not have sufficient resources to purchase rations.

62. National food for work programme :  National Food for Work Programme to provide supplementary wage employment and food security Implemented in tribal belts. The scheme will provide 100 days of employment at minimum wages for at least one able-bodied person from each household in the country. Pulse mission:  Pulse Mission pulse production has been stagnant for five decades. Pulse Mission (India’s Food Security Mission) aimed at increasing pulse production. Aimed to improve pulse production by 2 million tones by2011-12

63. National water supply and sanitation programme National Water Supply and Sanitation Programme Launched in 1954 Provide safe water supply and adequate drainage facilities for the entire urban and rural population of the country. Minimum needs programme :   Minimum Needs Programme Launched on 1974 Objective To provide basic minimum needs and thereby improve the living standards of people It Includes Rural Health Rural water Supply Rural electrification Elementary education Adult education Nutrition Environmental improvement of urban slums House for landless laborers.

64. 20 Point programme 1975:  20 Point Programme 1975 Objectives: Eradication of poverty, raising productivity, reducing inequality, improving quality of life. National Children's Fund 1979 This Fund Provides support to the voluntary organizations that help the welfare of children. National Plan of Action for Children1990 United Nations Children's Fund National Rural Health Mission2005-2012

65. National Rural Health Mission2005-2012:  National Rural Health Mission2005-2012 Reduce the infant mortality rate (IMR) and the maternal mortality ratio (MMR) To have universal access to public health services Prevent and control both communicable and non-communicable diseases, including locally endemic diseases To have access to integrated comprehensive primary healthcare Create population stabilization, as well as gender and demographic balance Revitalize local health traditions and mainstream AYUSH Finally, to promote healthy life styles

66. Indirect programmes :  National Cancer Control Programme National Diabetes Control Programme Poverty alleviation Programmes Environmental Sanitation Programmes Protected water supply programme Literacy programme

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