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


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.
When October W2, 2014.
Global Hunger report, India & Hidden Hunger

Global Hunger report, India & Hidden Hunger

India’s ranking
2013 63rd
  • 55th out of 76 countries
  • Ahead of Bangladesh and Pak
  • Behind Nepal and Sri Lanka


Global Hunger report uses 3 parameters (equal weight)
Parameter India
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 deficiency 25%
Anemia among pregnant women 54%
Anemia among children under 5 59%
Vit.A deficiency 62%

(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
  • 7 lakh newborn die each year in India.
  • At present, Infant mortality rate: 29 deaths per 1000
  • Target: reduce IMR to a single digit by 2030. (i.e. 9 deaths or less).
  • 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
Why To reduce malnutrition among women and children under age of 3Target: 200 high burden district
Criticism One 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

  • 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

  • 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.
  • 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.
  • 14000 newborn care centres. Roughly 3 to 4 per district.
  • For extreme medical cases- ~550 special newborn care units.
ASHA Worker makes home visit and educate new mothers on breastfeeding benefits, sanitation etc.

Expert group on PNDT

Who? Health Ministry
  • 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?

Census child sex ratio
1971 964/1000
2011 918/1000
  • 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 women Tribal children
Anemia, high level of mortality and morbidity Under 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.