[Public Health] Global Hunger report, Hidden Hunger, National Nutrition Mission, Newborn action plan,

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  1. Prologue
  2. Global hunger report, Child malnutrition
  3. What is Hidden hunger?
  4. India Newborn Action Plan (INAP)
  5. National Nutrition Mission
  6. Fixing RBSK and WIFS
  7. Expert group on PNDT
  8. Tribal health problems

Prologue

Current affairs related to public health, during September Week1 to October Week3.

  • Part1: Mother, Children, Hunger, Nutrition related. You’re here
  • Part2: Policy / Mission: Mental health, Ayush.
  • Part3: “Selling” related: NPPA, Sravan, Cigar labelling.

Relevance in Mains GS2 syllabus:

  • Issues relating to poverty and hunger
  • Issues relating to development and management of Social Sector/Services relating to  Health, Education, Human Resources.

Global hunger report, Child malnutrition

What?global hunger index released
Who?by the International Food Policy Research Institute (IFPRI), the global think tank on food security.
WhenOctober W2, 2014.
Global Hunger report, India & Hidden Hunger

Global Hunger report, India & Hidden Hunger

India’s ranking
201363rd
2014
  • 55th out of 76 countries
  • Ahead of Bangladesh and Pak
  • Behind Nepal and Sri Lanka

 

Global Hunger report uses 3 parameters (equal weight)
ParameterIndia
Underweight children
  • 2005: ~45% of total children
  • 2013: ~31% (meaning reduced)
Undernourished people
  • 2004-06: ~22%
  • 2011-13: 17% (also reduced)
Child mortality under 5
  • 2005: ~8%
  • 2014: ~6% (meaning this also reduced)

India’s progress

  1. No. of underweight/ malnourished have declined. Mainly due to MNREGA, NRHM, ICDS and other schemes.
  2. This happened because fast growing economies increase investment in social sector programs. Similar phenomenon seen in Brazil and China.

Does it mean everything is hunky dory?

  1. In comparison to India, other countries on similar GDP/growth rate have pulled out more people from Hunger- example Venezuela, Mexico, Cuba, Ghana, Thailand and Vietnam – all achieving more than 55% increase in their GHI score.
  2. The report took dataset from a UNICEF report which took data from a health ministry survey.
  3. This thinktank hasn’t done separate survey of its own for crosschecking (Whether malnutrition in India is indeed reduced or not?)
  4. Other survey results conducted earlier show differing numbers. The current report numbers cannot be taken as the final number.
  5. Moreover, state-wise differences are not yet known.
  6. Highest no. of under5 underweight children live in India.
  7. 70% of Indian children are anemic.
  8. Hidden hunger still continues.

What is Hidden hunger?

  • If Government give free/ subsidized wheat and rice then hunger will be eliminated only from ‘energy / carbohydrates’ angles.
  • But Deficiency in micronutrients and vitamins will continue. This is hidden hunger. Every third person in world suffers from Hidden hunger. (total 2 billion)

Why hidden hunger?

  • During adolescence, pregnancy- higher amount of micronutrient needed but people lack the money / awareness to change died habits accordingly.
  • Solutions: iodized salt, fortified flour, bio-fortification of crops, PDS reform, Education.
Hidden Hunger in India (as per Global hunger report)
Iodine deficiency25%
Anemia among pregnant women54%
Anemia among children under 559%
Vit.A deficiency62%

(GS2) Mock Question: What is Hidden Hunger? List the initiatives taken by Government to tackle Hidden hunger and suggest further reforms, if any. 200 words.

India Newborn Action Plan (INAP)

We already saw the IMR, MMR and MDG related statistics under Ch.13 of Economic survey. So, let’s check some new initiatives in this regard:

India Newborn Action Plan (INAP)
When?2014, September W3
Who?Health ministry
Why
  • 7 lakh newborn die each year in India.
  • At present, Infant mortality rate: 29 deaths per 1000
What?
  • Target: reduce IMR to a single digit by 2030. (i.e. 9 deaths or less).
How?
  • Will implement this via existing Reproductive, Maternal Child Health and Adolescent Plus (RMCHA+) framework
  • With 6 strategies

 

6 strategies of INAP
  1. preconception and antenatal care
  2. care during labour and child birth
  3. immediate newborn care
  1. care of healthy newborns
  2. care of small and sick newborns
  3. care beyond newborn survival.

Will also take Help from ASHA workers, Indian academy of pediatricians, NGOs and philanthropists like Bill Gates.

(GS2) Mock Question: Discuss the salient features of Newborn Action Plan. 100 words.

National Nutrition Mission

When?2014, January
Who?Health ministry
WhyTo reduce malnutrition among women and children under age of 3Target: 200 high burden district
CriticismOne component not yet implemented: reducing Anaemia among adolescent girls.
How?Training Anganwadi workersNutrition councils at District level

ICT for monitoring progress: Anganwadi workers to collect child data using tablet / mobile.

Fixing RBSK and WIFS

RBSKWIFS
  • Rashtriya Bal Swasthya Karyakram
  • New-borns to 18-year-olds are screened for 4Ds – birth defects, diseases, deficiencies, development delays and disabilities
  • Testing done via schools and Anganwadi centres
  • Weekly Iron Folic acid Supplementation
  • To reduce anemia among girls by giving Iron folic acid (IFA) tablets on weekly basis.

So what’s the problem?

  • No. of children covered under these schemes are less than the no. of children under Mid-day meal enrollment.
  • Meaning, lot of kids yet to benefit from these two schemes.

Therefore, HRD ministry asked all States and UTs for effective convergence among RBSK and the WIFS with the three main school education programmes viz

  1. Sarva Shiksha Abhiyan (SSA)
  2. Mid Day Meal (MDM)
  3. Rashtriya Madhyamik Shiksha Abhiyan (RMSA)

Other Reforms taken to prevent Maternal and Child deaths

International
  • June 2014: WHO, UNICEF and partners joined hands to end newborn and stillbirth deaths by 2035.
  • Countries have to set newborn action plans- to provide quality care to children.
Childbirth
  • Government gives conditional cash transfer to pregnant woman, ONLY IF undergoes regular checkups, diet and medicines. Free transport to healthcare centres.
  • Promoting family planning through ASHA workers.
Building
  • 14000 newborn care centres. Roughly 3 to 4 per district.
  • For extreme medical cases- ~550 special newborn care units.
ASHAWorker makes home visit and educate new mothers on breastfeeding benefits, sanitation etc.

Expert group on PNDT

Who?Health Ministry
What?
  • Minister has setup an Expert group
  • to examine new methods used for sex determination (so that PNDT act can be amended to ban those new techniques.)
  • PNDT= Pre Conception and Pre Natal Diagnostic Techniques Act, 1994.

But why do we need to review PNDT act?

Censuschild sex ratio
1971964/1000
2011918/1000
  • PNDT was made in 1994, ~20 years have passed but child sex ratio is not improved.
  • PNDT prohibits the use of ultra-sound machines for sex-determination.
  • Nowadays, Doctors using new methods under the guise of ‘genetic disorder testing’ to bypass the law.
  • Hence the need to find out those new techniques and update PNDT act to prohibit them.

More points:

  1. SC in Sept,2014 ordered better implementation of the act.
  2. 100 district of GJ, MH, HN and PN (low sex ratio states) have been selected for “beti bachao beti padhao abhiyan”.
  3. PNDT empowers State and district committees to book the offenders. MPs should be involved in to keep check such Committees.

Tribal health problems

Generic and never ending topic. Following points/fodder based on one Hindu editorial.

Tribal lag behind in all nation averages on health, literacy, education and income.

Tribal womenTribal children
Anemia, high level of mortality and morbidityUnder 5 mortality among Tribals, is higher than other communities.
80% tribal women under-weight>50%

Other issues

  1. Starvation deaths still reported in tribal aeras
  2. The chronic diseases such as hypertension and diabetes- rising among tribal.
  3. High prevalence of malaria, TB, diarrhea

But why all these problems?

  1. Most tribals defecates in the open => lack of sanitation =>diarrhea and gastrointestinal problems.
  2. 33% of tribals don’t get clean drinking water.
  3. Illiteracy and lack of health education
  4. Government setup Primary Health Centres (PHCs) in tribal areas but staff vacant due to naxal problem.
  5. Drugs, transport, electricity, communication infrastructure is lacking.
  6. Displacement during mining projects. Most tribal groups are traditionally hunter-gatherers. They are not accustomed to agriculture. Combine this with Illiteracy =>poverty => Dependence on PDS for survival=> hidden hunger=>less immunity from diseases.

What’re the Solutions?

  1. Tribals rely on Traditional healers. So they should be trained to dispense ORS for diarrhea and anti-malarial pills and send patients to the PHC in a timely manner.
  2. Tribal youth trained as community health workers or nurses. This will create incentive for them to stay work in their own communities- rather than migrating to cities in search of petty labour work.
  3. A successful example is the Adivasi hospital in the Nilgiris, where the management and most staff (except the doctors) are tribal.
  4. Offer more diverse range of food items in PDS with macro and micronutrients to tackle the “hidden hunger”.
  5. Infrastructure for housing, clean water, toilets, electricity, road and communication.
  6. Further research on herbal medicines, promote Ayush.

Mrunal recommends

  1. (free) NCERT, NIOS, TN-Books
  2. Environment by ShankarIAS
  3. Indian Polity M.Laxmikanth (Hindi | English)
  4. Art & Culture by Nitin Singhania (Hindi | English)
  5. Spectrum: Modern History (Hindi | English)
  6. Bipin Chandra: Post Independence
  7. Fast-track to Arithmetic Rajesh Verma
  8. MK Pandey’s Analytical Reasoning
  9. Disha’s Topicwise Paperset (Hindi | English)
  10. School Atlas
  11. Mains: Language papers
  1. (free) NCERT, NIOS, TN-Books 4 History,Geo,Sci
  2. Indian Polity M.Laxmikanth (Hindi | English)
  3. Spectrum: Modern History (Hindi | English)
  4. Maths: Quantam CAT Sarvesh Kumar
  5. Objective General English SP Bakshi
  6. Word Power made Easy -Norman Lowe
  7. Topic wise Solved Paperset by Disha


So far 33 Comments posted

  1. Sachin

    Happy laxmipujan sir!!!! May god give you happiness & prosperity

  2. Jude_Prudence

    So many different figures & targets for imr,mmr,u5mr

    all are different as per mdg,npp,12 fyp are there any figures for “one fit all”.

    1. indu

      best fit = “should keep minimum”

  3. lalu

    happy new year Mrunal sir and all of Gujarati

  4. sandeep singh sambyal

    hat’s off….hat’s off…..actually MRUNAL.ORG really awesome…..

  5. Abc

    Sare articles sivaram ke…mrunal where r u

  6. Karanth

    Happy deepavali:)

  7. vk

    Wish you happy diwali Mrunal Sir….plz dont stop this current series articles…thank you sir for an excellent article

  8. satyajit chavan

    Mere sab friend aur special to mrunal sir ko dipawali ki hardik shubhkamana
    is saal mere sare friend ko post mil jaye yahi meri prarthana rahegi

  9. deepak

    Happy deepawali sir

  10. priya singh

    who was political father of gokhle ?

    1. AK

      Great people can evaluate themselves. Conditions around him in British raj compelled him to start political movement against colonialism. He was inspired by JS Mill.

      My question-
      Under which operation 1971 war fought in western border?
      From which train gandhi came to india?
      Who was the great ruler that in her kingdom sun was never set and she ruled for years?

    2. reddy

      Mahadev Govinda Ranade

      1. priya singh

        ranade was not in option…..is it
        mazzini ?

  11. shivam

    Happy deepawali , what about agreecultre

  12. Sunil Kumar

    Thanks Mrunal Ji..

  13. VIJAY PARIT

    Happy Diwali sir!!!!

  14. praveenkumar

    Wish u hpy diwali sir…

  15. publichealthfreak

    – Its RMNCH+A (Reproductive Maternal Newborn Child Health + Adolescents.
    – WIFS is for boys too. It covers all girls, whether in school or out of school along with pregnant/lactating adolescent girls, and boys who are in school. (Class 6th to 12th, govt/govt aided/municipal schools) Also, deworming is carried out twice a year.

  16. SuccessRider

    The data is full of information. Love to read for IAS preperation ..

  17. suni

    Is this article is useful for Prelim-2015??????????????????????????????????

  18. suni

    Is this article is useful for Prelim-2015??????????????????????????????

  19. Amit

    Happy Diwali sir……………..thanks for your latest all topics…………..
    God bless you………………..

  20. Mahendra Pratap singh

    Hi mrunal sir.. Thanks for your regular and kimd help..
    one request,, if time will permit u…
    pls have an article regarding agriculture practices in India and govt policies with respect to agriculture in last few years…

  21. varun

    happy diwali sirji and thanks a lot .. you are the real mentor of the needy lots who cant afford coaching ( and also of the coaching faculty of delhi and elsewhere these days :)}

  22. x men

    Answer to moch ques(it is my 1st answer,plz guide)
    Hidden Hunger is situation in which the colorie need of a person are fulfilled but micronutrients such as iron,zinc vitamin a etc, that are required for the oveall development of a person are missing in the diet
    The problem ho Hidden Hunger is more among the women because their requirements of micronutrients are high at the time of pregnancy and because of hidden hunger india has very high burden of infant and maternal mortality.
    Government has taken steps like public distribution and different schemes which specifically focus on women like distribution of folic acid tablets,janani suraksha yojna but still there is high prevalence of hidden hunger because of structural weakness
    AS there is link between nutrition and agricultre so government can take following steps to reform the existing schemes-
    policy to diversify diet in order to improve micro nutrient
    ensuring inclusiveness in agriculture to include small and marginal farmers
    agriculture policies to.empower women
    also state should promote natural biofortification of crops
    in order to achieve target of zero hunger and to tacle hidden hunger the government must work _____________- not able to complete the conclusion
    (it is my 1st answer ever so plz guide me accordingly,that will be great help)

    1. abhishek

      also you can include,
      diversify msp grain procurement with almost equal price for every grain ( coz as of apart from wheat and paddy, in total 18 crops are present under msp but procurement cost for these two is very high as compare to others), it’ll give incentive to farmers to grow other crops like millets also. doing this will also help in sustainable development ( diverse crops, less water consuming crops –> good soil fertility–>less water use–>over all growth i.e. sustainable development.
      also tackling hidden hunger will improve immunity –> increase life expectancy

      1. x men

        Thanks Abhishek
        Will u plz help me for completing conclusion

  23. Mission 1000+

    Well tried x men!
    Afa my viewpoint is concerned, inclusion of a few of the indicators of hidden hunger in Indiashould precede the information of steps taken by GoI would improve your already well-laid out answer

    1. x men

      Thanks mission 1000

  24. Ashish Jadhav

    thank you sir

  25. Amulya

    National Nutrition Mission is by WCD ministry, not Health Min.

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