Report No. 259

C. National Schemes relating to Health and Nutrition

5.4.1 As has been discussed earlier in this work the importance of children's health and nutrition has indeed been recognised by the Central Government at the policy level. The National Policy for Children, 1974 recognised that programmes for children should find prominent place in national plans for the development of human resources. It laid down that the State shall provide adequate services towards children, both before and after birth and during the growing stages for their full physical, mental and social development.

The measures suggested include a comprehensive health programme and supplementary nutrition for mothers and children, free and compulsory education for all children up to the age of 14 years, promotion of physical education and recreational activities protection of children from neglect, cruelty and exploitation, etc. The Integrated Child Development Services (ICDS) scheme, launched under the 1974 Policy, is a comprehensive scheme showing India's realisation of the importance of ECD.

It adopted a holistic approach converging several aspects of early childhood development by including supplementary nutrition, immunization, health check-ups, pre-school education, health and nutrition education to women, referred services to children below six years of age as well as expecting and nursing mothers.

The National Policy for Children, 2013 was adopted to affirm the Government's commitment to the rights based approach in addressing the continuing and emerging challenges in the situation of children. The key priorities and undeniable rights of every child under the policy of 2013 are survival, health, nutrition, development, education, protection and participation.

5.4.2 The Draft National Health Policy, 201550 in Section 3.3.3, mentions among its objectives the provision of access to primary healthcare services as an "entitlement": "Assure universal availability of free, comprehensive primary health care services, as an entitlement, for all aspects of reproductive, maternal, child and adolescent health." considering nutrition as one of the priorities the government has launched various initiatives relating to nutrition, such as the Applied Nutrition Programme, 1963-64 that was initiated to arrange nutritious food for pre-school children, expectant and nursing mothers, and the Special Nutrition Programme, 1970 which provided for a high protein and nutritious diet to children below six years and pregnant and nursing mothers.

50 http://www.mohfw.nic.in/showfile.php?lid=3014

5.4.3 The National Nutrition Policy, 1993 advocated a multi-sectoral strategy for eradicating malnutrition and achieving optimum nutrition for all. It affirmed that "nutrition affects development as much as development affects nutrition". It recognized children below 6 years as nutritionally vulnerable and one of the "high risk" groups and accorded highest priority to them through policy articulations and programmatic interventions. The problem of malnutrition was envisaged to be tackled through direct nutrition intervention and also through conditions created for improved nutritional status51.

The Nutritional Programme of Nutritional Support to Primary Education, 1995 was initiated with the objective to promote universalization of primary education and also to improve the nutrition of children in primary classes where food grains (rice/wheat) at the rate of three kg per student per month was distributed subject to a minimum of 80 percent attendance in primary class. The National Population Policy, 2000 acknowledged the health of children as a dynamic medium for population stabilization.

Thereafter, the National Health Policy, 2002 noted that: "Another area of grave concern in the public health domain is the persistent incidence of macro and micro nutrient deficiencies, especially among women and children. In the vulnerable sub-category of women and the girl child, this has the multiplier effect through the birth of low birth weight babies and serious ramifications of the consequential mental and physical retarded growth."52

The National Charter for Children, 2003, adopted on 9th February 2004, was to reiterate the commitment to the cause of the children in order to see that no child remains hungry, illiterate or sick. It underlined the intent to secure for every child its inherent right to be a child and enjoy a healthy and happy childhood, to address the root causes that negate the healthy growth and development of children, and to awaken the conscience of the community in the wider societal context to protect children from all forms of abuse, while strengthening the family, society and the nation.

The Wheat Based Nutrition Programme, tied to ICDS, provides food grains for preparation of supplementary nutrition to be distributed among the beneficiaries of the ICDS. The National Food Security Mission has been launched in 2007 with the objectives of :1) to increase production of rice and pulses through area expansion and productivity enhancement in a sustainable manner; 2) to restore soil fertility and productivity at the individual farm level; 3) to create employment opportunities and; 4) to enhance farm level economy.

51 http://portal.unesco.org/education/en/file_download.php/20bd37d284a34d514aef4611b6b88ad8India.pdf

52 Section 1.7, National Health Policy, 2002.
http://www.nhp.gov.in/sites/default/files/pdf/NationaL_Health_Pollicy.pdf

5.4.4 Several States have initiated their own schemes to deal with health and nutrition of young children. Maharashtra was the first state in the country to take a decision to tackle malnutrition in 'Mission - mode' under the Rajmata Jijau Mother-Child Health & Nutrition Mission in 2005, which aims at reduction of child malnutrition by focusing on the first 1000 days from conception, i.e. the period of 9 to 24 months.53

In 2012, the Government of Maharashtra commissioned the first-ever state-wide nutrition survey, Comprehensive Nutrition Survey, to assess progress of the mission.54 Results indicated that there was a remarkable decrease in the percentage of stunting in children under the age of 2. Improvement was associated with changes in how children were taken care of and fed, the attention their mothers received and the surroundings in which they lived.

However, the provisional results of the survey revealed that in spite of more frequent meals, very few received a minimal acceptable diet and few were fed an adequately diverse diet rich in essential nutrients to ensure their optimal physical growth and cognitive development.55

53 http://nutritionmissionmah.gov.in/Site/Home/Index.aspx

54 Improving Child Nutrition - The Achievable Imperative For Global Progress, United Nations Children's Fund (UNICEF) 2013, available at
http://www.unicef.org/gambia/Improving_Child_Nutrition_-the_achievable_imperative_for_global_progress.pdf

55 Ibid.

5.4.5 It emerges from the above that the Central and State governments have been aware of the significance of health and nutrition for young children, but that this has only been recognised at the executive level through various schemes and in general policy objectives. Being so the approach towards ensuring needs relating to health and nutrition to young children as has been seen earlier in the Chapter dealing with National Policies and Schemes remain vague, weak and uncertain. However, both the constitutional mandate and the international legal framework require legislative action that will create proper entitlements for the 0-6 age group. It is unfortunate that no concrete legislative provisions have been enacted so far.